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PALMS is a mental health service who provide support to children or young people aged 0-18, who have an intellectual disability and/or are autistic and their families.
PALMS supports with the following concerns that present at a getting more help / getting risk support level of need:- behaviours of concern
- feeding
- mental health
- problematic sexualised behaviour
- sleep
- toileting
Our ethos has always aligned with being neuro-affirmative. We recognise that neurodivergent children and young people all have unique skills and strengths.
We incorporate a strengths-based model and work in a way that looks at the environment first when thinking of ways to support mental health.
Clinicians in PALMS aim to work as neuroaffirmative practitioners and promote a positive autistic identity.Contact the service
If you need to contact the PALMS team please call 01727 582122.
Alternatively professionals and families can contact the service by email: hct.palms@nhs.net
Experiencing a crisis
We encourage families to use the emergency services, if you do not feel that you are able to keep your family safe; they can be contacted via 999 or via A&E.
Whilst PALMS is unable to provide emergency support, you can contact the following:
- GP
- ChildLine – 0800 1111
- Samaritans – 116 123
- Hertfordshire Children’s Social Services – 0300 123 4043
- Hertfordshire Mental Health Helpline – 01438 843322
There are several options available to families to help you to remain safe. We have details of services available here.
- Address: Sandridge Gate Business Centre | Ronsons Way | St Albans | Herts AL4 9XR, St Albans, AL4 9XR
- Reception phone number: Contact Number: 01727 582122
- How the service is provided
- Who is eligible for the service
- What will happen at your appointment
- Useful information
- Making a referral
- Patient experience
- FAQs
How the service is provided
We recognise that the lived experience for every child and their family will be unique. The approaches and interventions we deliver are individually tailored based on the specific needs of the child/young person and the presenting need.
Our interventions are time-bound and goal focused. We offer sessions with parents and carers, individual work with the young person, sibling sessions and modelling sessions based on your family’s needs.
Who is eligible for the service
Before accessing PALMS, families would have had support from community interventions for the presenting need.
Referrals to PALMS will be accepted from any professional working with a child/young person (CYP) and their family who meet the following eligibility criteria.
A child or young person is/has:
- registered with a Hertfordshire GP
- aged 0 to 18
- a diagnosis of autism or is on an NHS waiting list for an assessment and/or an intellectual disability
- unable to access assessments and interventions used in mainstream mental health services with reasonable adjustments
- one (or more) of the following emotional, behavioural, or mental health needs at a getting more help / risk support level (consideration of frequency, intensity, severity, and complexity):
- behaviours of concern
- feeding
- mental health
- problematic sexualised behaviour
- sleep
- toileting
AND - accessed Community intervention for the presenting need
View our full referral criteria and descriptions.
Exclusion criteria
PALMS are unable to work with children or young people where:
- organic / medical explanations are causing the presenting need
- learning difficulties are present but the child or young person does not have an intellectual disability or Autism Spectrum Disorder (ASD)
- concerns are solely education based
- the purpose of the referral is for an ASD and/or an intellectual disability assessment
- the referral requests for medication monitoring and prescribing as a sole intervention
Indicators
Indicators that PALMS is an appropriate service for a child or young person who is autistic and/or has an intellectual disability:
- they have a moderate to severe intellectual disability and or autism that has a moderate – severe impact on cognitive functioning
- they attend a SEND school, especially a SEND school for young people who have moderate to severe intellectual disabilities
- they struggle to identify and express their thoughts and feelings and relate these to the current situation through a range of verbal and non verbal methods of communication.
In comparison, indicators that PALMS is not the most appropriate service to meet the needs of a child or young person when:
- a young person has a mild intellectual disability or no intellectual disability
- attends a mainstream school or an SEMH school and can access therapeutic intervention with reasonable adjustments
- uses complex and or full sentences within communication and can identify and express their thoughts and feelings
- can take what is discussed within the intervention and apply them outside of the clinical setting.
What will happen at your appointment
Once accepted, PALMS will offer the family an initial assessment appointment (IAA). PALMS will assess the CYP’s needs and referral reason to PALMS and consider the goals that the family would like to work towards.
If English is not the families’ first language we can provide an interpreter.
Useful information
To support you to access other services and with any concerns you may have, here are suggested resources for parents, carers and young people to access, on a variety of topics:
Making a referral
A referral can be made via:
- PALMS Service Referral Form
- electronic SystmOne referral within Hertfordshire Community NHS Trust
- Hertfordshire Partnership NHS Foundation Trust's Single Point of Access Service
Useful documents:
- More information about interventions in PALMS
- PALMS criteria
- If you are a professional and thinking of making a referral to PALMS, we have put together some examples of good referrals to support you when completing your letter or our form. These show the level of detail required for our team to triage effectively.
Patient experience
Your experience
We would love to hear about your experience of our service, please complete a Patient Experience survey.
If you would like to share your story, please contact the Patient Experience team on 01707 388036 or email hct.patientexperienceteam@nhs.net
Messages of Hope
Sometimes the families we meet with could use your support in their journey. Our Messages of Hope allow you to share any messages, words of encouragement, or advice that may be helpful for other families to hear during their time with PALMS. We have heard how families appreciate messages from others, like you, who share some of their lived experiences.
Some examples of the messages:
Messages of hope from families and young people
What we've done thanks to your feedback
Please take a look at some of the things we have done in response to feedback we have received from families we are working with.
You said: More joint sessions or family-based activities to strengthen the entire family's involvement.
We did: We have a systemic family clinic within PALMS that can be offered when clinically appropriate. Needs of this clinic are discussed as part of the package.
You said: Parents within the group had received very different levels of previous support resulting in some parents having elss understanding of autism than others, which impacted the efficiency of the sessions.
We did: All families accepted are booked on to an intervention workshop whilst waiting for intervention to support understanding of autism diagnosis amongst other things.
You said: Request for a three-month check in following groups to encourage and reinforce strategies.
We did: We have a patient-initiated follow-up pathway that works in line with NHS England guidance. This allows families flexibility to arrange any follow-up appointments if necessary. Not all families will go on to this pathway and is discussed on a case-by-case basis with your clinician.
FAQs
Referral to PALMS and signposting
Working with the child or young person's network
Referral to PALMS and signposting
Is PALMS the only service who support children with autism or a learning disability?
PALMS is one of the many services in Hertfordshire that support children who are Autistic and/or have an Intellectual Disability. PALMS works collaboratively with these services to ensure that the most appropriate service(s) are accessible when it is needed.
If you need to discuss PALMS’ criteria before making a referral, please contact PALMS directly on: 01727 582122.
Find information on where you can access other services in Hertfordshire, the Hertfordshire Local Offer or Hertfordshire County Council.
How can I contact PALMS?
PALMS principally operates between 07.00-19.00 Monday to Friday.
Our administration team are available 08.30-17.30 Monday to Friday
Please contact us on: 01727 582122 or via email: hct.palms@nhs.net
We will respond to you within 5 working days.
Do children need to have a diagnosis before they can be referred to PALMS?
PALMS offers intervention to children with an intellectual disability and/or who are Autistic and are unable to access mainstream mental health services with reasonable adjustments. PALMS also accept referrals for children who are waiting for an autism assessment where it is highly likely that the diagnosis of autism will be confirmed, and they meet other eligibility criteria for PALMS.
How do I know if my child can access mainstream mental health services with reasonable adjustments?
PALMS supports young people with a diagnosis of autism and/or intellectual disability, whose mental health needs cannot be met by mainstream mental health services with reasonable adjustments. Examples of reasonable adjustments include shorter sessions, more sessions to allow engagement and offering appointments in familiar settings.
Indicators that a young person’s needs could be met by mainstream mental health services include; being able to talk about their thoughts and feelings, socialising independently with their peers, working towards age related targets in education, and/or holding a conversation with professionals that is more than about their interests.
Do PALMS contact the family when their referral has been accepted?
Once a referral is triaged by PALMS, the family, referrer and GP (if not the referrer) will receive a letter advising of the outcome.
If the referral is not accepted, the letter will explain why this referral was not accepted and signposting to alternative services and support are included. The family can contact PALMS to provide any additional information they understand would indicate that PALMS is an appropriate service.
If the referral is accepted, the letter will include information about the next steps and information required to book your initial assessment.
If you believe that you have been referred to PALMS but have not received any correspondence from us, please talk to the referrer initially to ensure that this referral has been made. If they confirm it has, then please contact PALMS.
Assessment
Is there a waiting list to be seen by PALMS?
Unfortunately, there is a wait to receive assessment and intervention from PALMS. The waiting times vary based on how many referrals are received.
What happens if the referral is accepted?
When the referral has been accepted by PALMS, the family will be offered an Initial Assessment Appointment (IAA). The purpose of the IAA is to consider the needs of the child and family, the related goals and to ensure PALMS is an appropriate service to support the current needs. In addition, other services are identified when some of the needs cannot be met within the remit of PALMS.
What happens at the initial assessment appointment (IAA)?
During the assessment, the clinician(s) will aim to gather an in depth understanding of your concerns and what would be most beneficial to support your child. This includes: identifying goals ensuring PALMS is the most appropriate service to support these goals; discussing what intervention looks like and what will be required from the family; and, identifying any alternative signposting.
If PALMS is an appropriate service, following the IAA, an intervention pathway is agreed with the family and detailed in a letter. Family and professionals can contact PALMS directly if there are any concerns and/or changes in need that they would like to discuss prior to the intervention beginning.
Will PALMS meet my child at the initial assessment appointment (IAA)?
We appreciate that some appointments can be difficult for children and young people and that you may wish to have sensitive conversations about the concerns. We would like to meet both yourself and your child at the initial assessment and will work with you to ensure that this experience is as positive as possible. If you anticipate that attending the initial assessment will cause significant stress or upset for your child/young person, please contact our team to discuss the options. You can also contact us to let us know in advance if there are any adjustments that may be helpful.
Interventions in PALMS
What does a typical journey look like in PALMS?
A typical journey through PALMS can look like this:
- Families are offered an initial assessment where needs are reviewed. If PALMS is identified as an appropriate service goals are discussed and agreed.
- Families are offered an intervention in line with the goals that are within the service remit.
- Goals will be reviewed throughout the intervention to work toward discharge.
Will I have to attend a PALMS' intervention group before receiving an intervention?
PALMS provides different intervention pathways to support the child and their families. This includes intervention groups which are an effective and evidence based intervention and it is anticipated that no further interventions are required following attendance at an intervention group. These are not parenting groups however, parents/carers do learn strategies that will enable the intervention and support the whole family.
Each pathway aims to offer an individualised plan that is suitable to the needs of the child. Parents/carers do not have to attend an intervention group unless it is assessed as being an appropriate intervention.
Currently, three intervention groups are provided. These are: Feeding Intervention Group, Positive Behaviour Support (PBS) Intervention Group, and Sleep Intervention Group.
What can I expect from the intervention group that PALMS has offered me?
PALMS always view families as the experts on their child. By meeting in a small group forum (no more than 8 families), families can share and hear from others who are facing similar challenges alongside working collaboratively with PALMS’ clinicians.
Through the group intervention families will be allocated two clinicians who will develop an individualised and bespoke intervention plan in collaboration with families for each child. This plan is implemented at home and supported by the clinicians who will provide both follow up telephone calls and outreach sessions.
Do PALMS offer a 'parent as therapist' model of intervention?
The ‘Parent as Therapist’ model is one of the evidence based approaches implemented by PALMS. Mental health support for children/young people who are Autistic or those with an Intellectual Disability often involves working with the environment and systems around a child/young person, rather than solely providing direct intervention to the child.
This approach recognises the huge amount of knowledge that parents or carers hold about their children and places families as experts in their own lives. This, alongside the knowledge and skills professionals bring plays a key role in the success and sustainability of all interventions we provide.
To support any intervention, even when working directly with a child, PALMS requires parents/carers and families to develop understanding, skills and strategies, to ensure the success and sustainability of the intervention.
Do PALMS offer individual work to children/young people?
PALMS work with parents/carers, the wider family, and supporting professionals. PALMS offer individual work with children/young people if this is determined to be an appropriate way to support the presenting needs.
Do PALMS offer virtual appointments?
Yes, PALMS can provide virtual video appointments when this is clinically appropriate. There will be some situations where face to face appointments are required and these can be undertaken in a variety of environments such as our clinics, home, and school. As part of the intervention the clinician and family develop a contract to understand what the intervention will include, and a discussion regarding the appropriateness of virtual appointments is had as part of this.
Do PALMS only see children who are in crisis?
PALMS is not a crisis service. However, PALMS have an Intensive Intervention Team who provide Intensive Intervention and Priority Assessments (within 5 working days) as part of the Hertfordshire joint crisis offer.
Please do not contact us in an emergency. This may delay you receiving the help that is needed.
Please contact 999 or take your child/ young person to A&E if you do not believe that the situation can be safely managed.
The Hertfordshire Mental Health Helpline is also available 24/7 on 0800 6444 101 or by contacting 111 and selecting option 2.
Hertfordshire Social Care can be contacted 24/7 by dialling 0300 123 4043 .
Is PALMS a ‘behaviour’ service?
PALMS is a mental health service for children/young people with an intellectual disability and/or who are Autistic and their needs cannot be supported by mainstream services with reasonable adjustments. PALMS is one of the CYP Mental Health services in Hertfordshire who provide intervention for a variety of emotional, behavioural, and mental health difficulties.
My allocated clinician from another service referred me for a specific intervention e.g. Psychiatry, why am I not receiving this intervention?
Professional input and intervention pathways are agreed according to the clinical needs of the child following assessment by the PALMS multi-disciplinary team. PALMS provides different intervention pathways and any agreed interventions and care plans will be continually reviewed with you by your allocated PALMS’ clinician.
Will I see a psychiatrist in PALMS?
As with all professionals within PALMS, Psychiatry input is allocated according to the clinical needs of the child following assessment by the multi-disciplinary team. If you think that psychiatry support would be beneficial to your child this should be discussed with your PALMS’ clinician in the first instance.
Whilst there may be times when medication is a useful intervention to support a child, other therapeutic interventions are always provided first with the aim that medication is not needed. This is in line with best practice guidelines. If medication is required, the prescriber will work hard to ensure that this is prescribed for the minimum duration necessary.
PALMS does not provide medication/psychiatry as a sole intervention.
Do PALMS prescribe medication?
As a service, PALMS are committed to reducing the usage of medication prescribed to children and young people with an intellectual disability, who are Autistic, or both. This commitment is in line with the STOMP and STAMP initiatives which have been developed by NHS England (NHSE).
Whilst there may be times when medication is a useful intervention to support a child, other therapeutic interventions are always provided first with the aim that medication is not needed. This is in line with best practice guidelines. If medication is required, the prescriber will work hard to ensure that this is prescribed for the minimum duration necessary.
PALMS does not provide medication/psychiatry as a sole intervention.
Do PALMS assess and prescribe medication for ADHD?
PALMS do not assess for or provide medication for ADHD.
If your child requires an assessment for ADHD, you should speak to your child’s paediatrician or see your GP in the first instance. They will be able to refer you to the correct service within Hertfordshire.
Working with the child or young persons network
Will PALMS work with other services who are supporting my child?
Collaborative and joint working with children, their families, other professionals, agencies, and organisations is often essential to the interventions and support PALMS provides. This provides opportunities for sharing knowledge, experiences, and expertise to achieve the best outcomes for the whole family.
Do I need to access PALMS before I can have input from social care?
No. A referral can be made to social care at any time, without having input from PALMS.
Will PALMS work with my child’s school?
PALMS recognises the importance of a whole system approach when supporting a child and their family. Whilst it is recognised that Education is an important part of every child’s life and can significantly impact on well-being, PALMS are not commissioned to work in or for schools. However, we believe it is essential to work collaboratively with schools, teachers and SEND professionals to share ideas, understanding and strategies to support the child successfully in this environment. We are also required to contribute to SEND processes such as Education, Health Care Plans (EHCP’s) if this is relevant to your child.
Discharges and transitions
Can my child be re-referred to PALMS if we’ve been discharged?
We know that as children develop, their needs may change. PALMS accept re-referrals for those concerns that are within the remit of PALMS.
Is PALMS a long-term service who will be involved until my child turns 18?
PALMS is not a long-term service. We understand that our CYP have lifelong needs, however we offer targeted interventions based on a child’s specific needs and goals at the time of assessment. From the point of being accepted into PALMS, we will be working towards discharge. PALMS interventions are evidence based, goal focussed and time-bound. Our aim is to empower families to continue independently with the sustainable ideas and interventions developed during your time with PALMS.
Discharge can be agreed for a number of reasons, including:
- Progress on goals
- Agreement that this is not the right time for intervention
- Another service has been identified as being more appropriate to offer the required intervention.
- Transition to adult services.
- Several sessions have been missed by the child or family in accordance with the Do Not Attend (DNA) and cancellation policy.
