Positive behaviour, autism, learning disability and mental health service (PALMS)

  • PALMS has a duty team in place between 9am and 5pm, Monday to Friday who can respond to calls from families who are open to PALMS and may be experiencing escalation. PALMS carries out priority assessments within 5 days. PALMS duty team will liaise with the children crisis assessment and treatment team (CCATT) if a more urgent response is required.

    A QR code
    Scan the above QR code for the PALMS information leaflet.

    PALMS can be contacted on 01727 582122 or alternatively professionals and families are encouraged to contact the service by email: hct.palms@nhs.net

    About the service

    PALMS (positive behaviour, autism, learning disability and mental health service) works across Hertfordshire providing a specialist multidisciplinary approach to children and young people aged 0-18 who have a global learning disability and/or autistic spectrum disorder and their families. PALMS clinicians comprise a ‘virtual team’ delivering a consistent service in a variety of community settings.

    PALMS is a multi-disciplinary team who provide individually tailored support to help manage a number of concerns experienced at home. The service is available for children and young people up to the age of 18.

    PALMS aims to keep children and young people with their families within Hertfordshire thereby improving outcomes for all family members.

    We are a family-led service working to understand and support the significant impact of challenges experienced by families of children and young people with learning disabilities and/or autism spectrum disorder (ASD). To achieve this we work closely with children and young people, their families, colleagues and commissioners and view working closely as a key approach that underpins PALMS.

    We strive to focus on both prevention and intervention. We endeavour to help children and young people move towards attaining their ambitions and leading happy, healthy and fulfilled lives. We aim to promote the involvement of children, young people and their families and carers in the evolution of PALMS in a meaningful and helpful way for the local communities across Hertfordshire

    We are a cohesive team who support one another to work in dynamic and innovate ways to provide the best possible service.

    Contact the service

    PALMS: Temporary Phone Number

    Please note if you need to contact the PALMS Service, their new temporary phone number in use: 01727 582122. Alternatively professionals and families are encouraged to contact the service by email: hct.palms@nhs.net 

    Parking at our clinics

    The team

    The PALMS team at HCT PALMS are a multi-disciplinary team, with training and experience in working with children and young people with ASD and learning disabilities.

    Through your journey of care with PALMS, you may meet some of the professionals detailed below.

    • Administrative team
    • Assistant PALMS practitioners
    • Assistant psychologists
    • Clinical lead
    • Clinical psychologists
    • Development lead
    • Duty triage worker
    • Learning disability nurses
    • Outreach workers
    • Positive behaviour analysts
    • Psychiatrists
    • Senior positive behaviour analysts
    • Service lead
    • Speech and language therapists
    • Systemic therapists

How the service is provided

PALMS is a multi-disciplinary team who provide individually tailored support to help manage a number of concerns experienced at home. The service is available for children and young people up to their 18th birthday.

PALMS provides intervention and where necessary, intensive support to families reaching crisis with a step up and step down approach throughout their care journey.

PALMS offer bespoke packages of assessment and intervention to children young people and their families. The range of interventions PALMS will offer is detailed below.

Intervention Workshops

Our workshop draws on your current understanding about autism and learning disabilities and provides a space where these ideas can be shared and developed. Considering the voices of young people with autism and learning disabilities, the literature about both and our professional experience allows us to build on these existing understandings collaboratively.

The workshop enables you and other parents to develop broader understandings about autism and learning disabilities. These can then be related to your own individual circumstances.

The positive feedback that we have received from families has focused on how interactive and supportive our workshops have been. We aim to create a friendly and non-judgemental setting so that all experiences can be shared. However, there is no pressure to share your stories within the workshop environment.

We appreciate that many parents have attended other workshops in the past; however, we do find that attending our workshop better prepares parents/carers for their work with PALMS. Following the workshop a PALMS clinician will be in contact with you to arrange the next part of your intervention.

Intervention Groups

PALMS provides a positive behaviour support (PBS) group for parents/carers to attend for eight sessions. This is an intervention within PALMS which aims to familiarise parents and carers with the basic principles of PBS and develop their own set of behavioural strategies to implement at home.

PALMS provides a sleep group for parents/carers to attend for five sessions in the group (plus one review session) and four individual sessions (two before the group starts and up to two after the group content). This is an intervention within PALMS which aims to familiarise parents and carers with the underlying principles and research behind good sleep habits and routines. Each family will develop their own sleep plan to implement at home.

PALMS provides a feeding group for parents/carers to attend for seven sessions. This is an intervention within PALMS which allows families to take an interactive approach to developing understandings and strategies to manage feeding difficulties they may experience.

All our groups are currently run via MS Teams with sessions available in the day time and evening.

Therapeutic work

Following your workshop it may be appropriate next step to work with our team in the community. This intervention offers individualised appointments, currently being undertaken via video conferencing but where appropriate could be in the community, school or at home.

Our approach is very much centred on parents as experts and allowing you the space to walk in your child’s shoes. We help to support alternative understandings and use these throughout our work together. These sessions will focus on parent / carer’s goals and your family’s needs. Clinicians will help to agree a plan of support for the sessions.

We are able to offer sessions with parents / carers, individual work with the young person to get to know them which may include individual therapy, sibling sessions and modelling sessions in the home based on your family’s needs.

Positive Behaviour Support (PBS)

Positive Behaviour Support (PBS) is a framework developed from behaviour analysis that centres around supporting people to have a better quality of life. This is done by making sure a person is fully understood and supported, as well as helping them develop new skills so they can thrive.

Behaviour Analysis is the science of why we behave in the ways we do.   Applied Behaviour Analysis (ABA) uses strategies based on this science. There are a lot of approaches that have come from behaviour analysis, such as PBS.

 In PALMS, we use PBS to:

  • Understand why behaviours happen.
  • Put strategies in place that:
    • Increase quality of life
    • Teach alternative skills/behaviours to communicate their needs safely
    • Reduce challenges
  • Help people work towards personalised goals within the PALMS commissioned remit for intervention around behaviour, feeding, mental health, sleeping and toileting

The British Institute of Learning Disabilities (BILD) has created a video on PBS. Click here if you would like to watch it.

Intensive Support

The intensive support pathway provides a small number of families with an intensive piece of work with PALMS when the following factors are present:

  • Behaviour with high intensity and frequency that could be putting other family members at significant risk of physical and / or emotional harm.
  • Family are seeking alternative accommodation or residential school
  • Family continue to feel that they are unable to cope
  • Information from assessments and professionals showing evidence that the family is at immediate risk of breakdown
  • School placement is at risk of breakdown
  • There is a risk of the child being placed out of county

The intensive support pathway is a short intervention which may proceed or follow another PALMS intervention. The PALMS journey is step up and step down approach and the intensive support pathway enables this journey to take place. It may include:

  • Frequent observations in the community and at home
  • Modelling sessions in the home
  • Increased Parent As Therapist sessions with allocated clinician

Following the recently commissioned PALMS review PALMS are no longer commissioned to provide ASD 2nd opinions.

Mental Health Support Team (MHST) in SEN Schools in Hertfordshire and West Essex

The MHST is an early intervention service, working with mild to moderate mental health difficulties and challenging behaviours. This is part of a national programme to offer early interventions in school settings. PALMS is hosting the MHST for Hertfordshire and West Essex (HWE).

The MHST supports mental wellbeing in the following SEN schools in HWE:

  • The Collett
  • Colnbrook
  • Garston Manor
  • Middleton
  • Southfield
  • The Valley
  • Woolgrove
  • Oakview
  • Wells Park

We are only able to offer support to parents/ carers of children who attend schools that have signed up to support from the MHST for SEN schools.

This support will be delivered by an educational mental health practitioner (EMHP). The MHST is currently offering virtual support due to COVID-19, therefore you will need access to a computer or smartphone.

MHST support in schools

The MHST helps to support mental health in schools in several ways:

  • Workshops with young people or parent/carers
  • Group based work with young people or parent/carers
  • Guided 1:1 self-help sessions with young people, parent/carers around proactive prevention and support for mild to moderate mental health difficulties and challenging behaviour
  • A ‘whole school approach’ to understanding and improving mental health, which may include supporting the school’s mental health lead, supporting with the wellbeing curriculum, identifying mental health resources, creating posters and displays etc

Referring to MHST

School staff are able to refer your child to the MHST for 1:1 support. The following members of staff at your child’s school can make a referral

  • Mental health lead (MHL)
  • SENCo
  • Family support officer (FSO)
  • Pastoral support
  • Teaching staff (including head of year / head of department / key workers and teaching assistants)

The referral will be considered by the team. If the MHST is not the most suitable team to support your needs, we will signpost to the most appropriate resources.

Please note that the MHST can only work with a limited number of children at a given time therefore referrals may be added to a waitlist.

Information regarding parent groups and workshops will be shared with you via school.

A young person would need to meet the following criteria:

  • Attend a Hertfordshire or West Essex SEN school which is part of the MHST
  • Young person (if appropriate) and parent consent to the intervention
  • Difficulty is mild-moderate
  • For 1:1 work with a young person there needs to be some ability to identify and communicate their thoughts and feelings

Contact us:
Email: hct.mhst@nhs.net
Phone: 01727 582122

Outcome measures

These questionnaires are used at the beginning and end of the PALMS intervention. They show us if PALMS intervention has made any positive changes to you, your child and your family. We measure this through the scores that are generated, and also through the written comments. We might ask families to complete the questionnaires during the intervention, in order to measures progress.

These questionnaires are standardised, so it might be that some questions are not relevant to your child. We also use this information to show how PALMS is an effective service to support our continued funding.

Who is eligible for the service

Referrals to PALMS will be accepted from any professional working with a child/young person (CYP) and their family who meet the following criteria:

  • CYP is registered with a Hertfordshire GP
  • CYP is age 0-18
  • CYP has a diagnosis of Autism* and/or Global Learning Disability.
    *Eligibility criteria is also met where a CYP is awaiting an assessment for ASD and it is deemed by professionals that the CYP is highly likely to receive a diagnosis.

Also where the CYP has one (or more) of the following emotional, behavioural, or mental health needs:

  • A. Challenging behaviour
  • B. Sleep difficulties
  • C. Feeding difficulties
  • D. Toileting difficulties
  • E. Mental health difficulties

Please note: examples of the type of difficulties PALMS supports have been provided in this document Criteria to access PALMS for each area of need. This is not an exhaustive list and professionals should discuss with the service prior to a referral being made if it is unclear if the area of need is within the remit of support PALMS provides.

Also where:

  • Community intervention has been accessed for the presenting concerns and difficulties persist.
  • The presenting concerns are as such that mainstream mental health services, with reasonable adjustments, are unable to meet the CYP’s needs.

What will happen at your appointment

Once accepted, PALMS will offer the family an initial assessment appointment (IAA). PALMS will explore the family’s expectations of PALMS and consider the goals that the family would like to work towards when they start their work with PALMS.

If English is not your first language we can provide an interpreter, but we need to know in advance if you are likely to need one. When your appointment is made please request this service, which is free of charge.

Initial assessment appointments

The initial assessment appointment can last up to one hour. Parents or carers need to attend but we also encourage you to invite other people who you deem to be important to your child’s care. This may include family members, carers, professionals such as a social worker and/or teacher and voluntary support agencies. This would help us decide the most appropriate PALMS professionals to support your family and begin integrated work.

We appreciate that it can be hard for children and young people to feel comfortable for a long period of time in a ‘formal meeting setting’. We realise it can also be difficult and is often not be appropriate to discuss all the issues you feel are important. If the young person does attend this appointment, it is important that we focus on the positives however we recognise there may be some more difficult discussions you may wish to have.

In this instance it may be helpful if you could bring another family member or friend to the appointment to enable the young person to leave for the second part of the appointment giving you the opportunity to discuss some of the difficulties.

In most circumstances the appointment will be with one member of the team, although at times the appointment may be undertaken by two members of the team.

Social stories

If the young person will be attending the appointment, we will also send you a social story which can be used to help prepare them for the appointment.

 

The assessment process will involve:

  • Getting to know you and your family.
  • Discussing your and your child’s concerns.
  • Gaining an initial understanding of your current needs.
  • Gaining relevant background information including a developmental history where appropriate.
  • Finding out what you have already tried to improve the situation.
  • Identifying your goals.
  • Gaining information about which professionals are involved in your child’s life, and requesting your consent to contact them for further information, if required.

Following on from the initial assessment

If PALMS is the most appropriate service to meet your child’s needs, we will agree a care package and write to you with a summary of our session and agreed next steps. The way forward and additional appointments will be agreed together with your clinician.

Discharge

Sometimes following assessment it may be decided that further input from PALMS is not required and your child will therefore be discharged and if appropriate referred to another service.

Useful information

You may find the following information helpful; this information will support you in accessing other services to support with any concerns and also suggest resources for parents, carers and young people to access on a variety of topics.

 qr code Scan this QR code for the list of services in Hertfordshire

Making a referral

Please be aware that we cannot accept self-referrals from parents/carers. Only a professional can refer into the service.

A referral can be made via a number of options, including:

  • Via Electronic SystemOne referral within Hertfordshire Community NHS Trust
  • Via Hertfordshire Partnership NHS Trust's Single Point of Access Service
  • By completing a PALMS Referral Form or detailed letter sent to:

PALMS Admin Team
Sandridge Gate Business Centre
Ronsons Way
St Albans
AL4 9XR

Please note if you need to contact the PALMS Service, the new temporary phone number to call is 01727 582122.

• By completing a PALMS Referral Form and emailing it to hct.palms@nhs.net

Useful documents

Professionals

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 duty worker to triage effectively.

Patient experience

If you would like to share your story, please contact the Patient Experience team on 01707 388036 or email pals.hchs@nhs.net.

We would also love to hear about your experience on our service, please complete a survey by clicking here.

Messages of Hope are used in PALMS to support families who are starting their journey with the service. We collect messages of hope from families who have finished their work with the team to offer words of encouragement, support and empowerment to families starting their work. We also capture messages from young people who we have worked directly with and share these with other young people and their families.

We have compiled these messages into a book that we share with families when they come along to their initial assessment appointment. These messages are so powerful and as well as offering words of encouragement to new families they support the team in understanding what is helpful to families so we can continually evolve as a service to meet their needs. Please take some time to have a read through some of the messages below.

Messages of hope from families and young people

What we've done thanks to your feedback

An infographic with the title "You said, We did". Parent says: "We would like the family to be more involved in sessions." Clinician replies: "We have created a Family Clinic for this purpose." Parent says: "The videos used in the PBS Intervention Group weren't recent." Clinician replies: "We developed our own fit-for-purpose animations specifically for the PBS Intervention Group." Parent says: "Some of the sessions of the PBS Intervention group were confusing." Clinician replies: "We reviewed the entire PBS Intervention Group and changed parts according to feedback." Parent says: "We'd like clearer information about IAAs and PALMS pathways." Clinician replies: "We created an information leaflet, available on our website and via QR code, sent with all IAA packs to families." Parent says: "There isn't enough time to implement change between sessions of our Sleep Intervention Group." Clinican replies: "We changed the length of time between sessions 6 and 7 to enable you to implement changes before the group finished." Infographic finishes with HCT and PALMS logos.

FAQs

Click one of the sections below:

 

Triage and Assessment

“Is there a waiting list to be seen by PALMS?”

Unfortunately, there is a wait to receive assessment and intervention from PALMS.

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.

Following the IAA, a pathway is agreed with the family and if PALMS is an appropriate service the intervention(s) will be explained. 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.

“Do children need to have a diagnosis before they can be referred to PALMS?”

PALMS offers intervention to children who have a diagnosis of moderate to severe learning disability and / or autism which has a moderate to severe impact on cognitive functioning who meet the criteria for the remit of the service, 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 the criteria for the remit of PALMS.

“Will PALMS meet my child at the Initial Assessment Appointment (IAA)?”

The first appointment is called 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 at home.  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. 

“Do PALMS contact the family when their referral has been accepted?”

Once a referral is accepted by PALMS, the family, referrer and GP (if not the referrer) will receive a letter advising of the next steps.    

If the referral is not accepted, a letter will be sent to the referrer to explain why this referral was not accepted. The family are always sent a copy of this letter. Signposting to alternative services and support are included in this letter so that more appropriate services can be accessed without delay.

If the referral is not accepted and the family have additional information that they understand would indicate that PALMS is an appropriate service, they are very welcome to contact us directly to provide this information.

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.

“What happens at the IAA?”

During this assessment, the clinician(s) will aim to gather an in depth understanding of what would be most beneficial to support your child and your input will be invaluable to this process. This includes: identifying the goals from accessing PALMS; ensuring PALMS is the most appropriate service to support these goals; discussing what intervention looks like and will require from the family; and, identifying any alternative signposting. 

Following the IAA you will receive a summary letter that will set out the care plan and explain what the suggested pathway is for your child.  This intervention plan will be continually reviewed with you by your allocated PALMS’ clinician.

“Do PALMS prescribe medication?”

As a service, PALMS are committed to reducing the usage of medication prescribed to children and young people with a learning disability, autism, or both. This commitment is in line with the STOMP and STAMP initiatives which have been developed by NHS England.

Whilst there may be times when medication is a useful intervention to support a child, in line with best practice guidelines other therapeutic interventions are always provided first with the aim that medication is not needed. If medication is required, the prescriber will work hard to ensure that this is prescribed for the minimum duration necessary.

PALMS do not provide medication as a sole intervention.

“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.

“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.

“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 by dialling 0300 123 4043 24/7.

“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 your query within 5 working days.

 

Intervention

“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. 

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. Intervention groups are stand alone and evidence based and it is anticipated that no further interventions are required following attendance at an intervention group.

“Are the intervention groups offered by PALMS parenting courses?”

The intervention groups offered by PALMS are direct interventions and not parenting courses though most often, our intervention groups are attended by parents. PALMS’ intervention groups do not focus on ‘parenting’ though parents/carers do learn strategies that will enable the intervention and support the whole family. 

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?”

Through the group intervention process families will be allocated two clinicians who will develop an individualised bespoke intervention plan in collaboration with families for each child. This plan is implemented at home; supported by the clinicians who will provide both follow up telephone calls and outreach sessions.

PALMS always view families as the experts on their child. By meeting in a small group forum (no more than 8 families), families have the opportunity to share and hear from others who are facing similar challenges alongside working collaboratively with PALMS’ clinicians.

“Will PALMS work with my child’s school?”

PALMS recognises the importance of a whole system approach when supporting a child.  Whilst it is recognised that Education is an important part of every child’s life that 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.

“Is PALMS a ‘behaviour’ service?”

PALMS provide intervention for children who have a diagnosis of moderate to severe learning disability and/or autism which has a of moderate to severe impact on cognitive functioning. PALMS is one of the CYP Mental Health services in Hertfordshire who provide intervention at the getting more help level for a variety of emotional, behavioural, and mental health difficulties.

Scan for PALMS Criteria:

An QR code that links to the PALMS criteria document.

“Will PALMS work with other services who are supporting my child?”

PALMS provides evidence based practice and therefore joint and collaborative working with children, their families, other professionals, agencies, and organisations is essential. Working collaboratively with the network surrounding a child provides opportunities for sharing knowledge, experiences, and expertise to achieve the best outcomes for the child.

 

Intervention: Groups and Pathways

“Do PALMS offer individual work to children/young people?”

PALMS offer individual work with children/young people based on their clinical needs. PALMS also work with parents/carers, the wider family and supporting professionals.

“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. The evidence for this approach highlights the importance of primarily working with systems supporting children who have Autism Spectrum Disorder and/or a Learning Disability rather than solely provide individual intervention with the child. This approach recognises the huge amount of knowledge that parents/ carers hold about their children, the knowledge and skills professionals hold, and how both contributions play 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.

Does PALMS offer virtual appointments?

Yes, PALMS provide virtual video appointments when this is clinically appropriate. As part of the intervention the clinician and family develop a contract to understand what the intervention will look like going forward, a discussion regarding the remit and appropriateness of virtual appointments is had as part of this.

PALMS provide face to face sessions in a variety of community environments, such as clinic, home or school.

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.

As a service, PALMS are committed to reducing the usage of medication prescribed to children and young people with a learning disability, autism, 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, in line with best practice guidelines other therapeutic interventions are always provided first with the aim that medication is not needed. 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.

 

Discharge, Transitions and Signposting

“Is PALMS the only service who support children with Autism/Learning Disability?”

PALMS is one of the many services in Hertfordshire that support children with Autism/ Learning Disabilities.  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.

For most up to date information on where you can access other local services, please scan QR code:

A QR code.

Website (Local offer): https://www.hertfordshire.gov.uk/microsites/Local-Offer/The-Hertfordshire-Local-Offer.aspx

Hertfordshire County Council:  0300 123 4043 or  https://www.hertfordshire.gov.uk

“Can my child be re-referred to PALMS if we’ve been discharged?”

We know that it is possible that needs change as children develop, and therefore PALMS do 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.

A typical journey through PALMS can look like this:

  • Families are offered an initial assessment where goals are discussed and agreed, an outline of what is required of families to access PALMS is provided and to ensure PALMS is the most appropriate service.
  • 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.

Discharge can be agreed for a number of reasons, including:

  • Progress on goals
  • Agreement that this is not the right time for intervention
  • A number of sessions have been missed by the child or family in accordance with the Do Not Attend (DNA) and cancellation policy.
  • Another service has been identified as being more appropriate to offer the required intervention.
  • Transition to adult services.

Positive behaviour, autism, learning disability and mental health service (PALMS)

  • PALMS has a duty team in place between 9am and 5pm, Monday to Friday who can respond to calls from families who are open to PALMS and may be experiencing escalation. PALMS carries out priority assessments within 5 days. PALMS duty team will liaise with the children crisis assessment and treatment team (CCATT) if a more urgent response is required.

    A QR code
    Scan the above QR code for the PALMS information leaflet.

    PALMS can be contacted on 01727 582122 or alternatively professionals and families are encouraged to contact the service by email: hct.palms@nhs.net

    About the service

    PALMS (positive behaviour, autism, learning disability and mental health service) works across Hertfordshire providing a specialist multidisciplinary approach to children and young people aged 0-18 who have a global learning disability and/or autistic spectrum disorder and their families. PALMS clinicians comprise a ‘virtual team’ delivering a consistent service in a variety of community settings.

    PALMS is a multi-disciplinary team who provide individually tailored support to help manage a number of concerns experienced at home. The service is available for children and young people up to the age of 18.

    PALMS aims to keep children and young people with their families within Hertfordshire thereby improving outcomes for all family members.

    We are a family-led service working to understand and support the significant impact of challenges experienced by families of children and young people with learning disabilities and/or autism spectrum disorder (ASD). To achieve this we work closely with children and young people, their families, colleagues and commissioners and view working closely as a key approach that underpins PALMS.

    We strive to focus on both prevention and intervention. We endeavour to help children and young people move towards attaining their ambitions and leading happy, healthy and fulfilled lives. We aim to promote the involvement of children, young people and their families and carers in the evolution of PALMS in a meaningful and helpful way for the local communities across Hertfordshire

    We are a cohesive team who support one another to work in dynamic and innovate ways to provide the best possible service.

    Contact the service

    PALMS: Temporary Phone Number

    Please note if you need to contact the PALMS Service, their new temporary phone number in use: 01727 582122. Alternatively professionals and families are encouraged to contact the service by email: hct.palms@nhs.net 

    Parking at our clinics

    The team

    The PALMS team at HCT PALMS are a multi-disciplinary team, with training and experience in working with children and young people with ASD and learning disabilities.

    Through your journey of care with PALMS, you may meet some of the professionals detailed below.

    • Administrative team
    • Assistant PALMS practitioners
    • Assistant psychologists
    • Clinical lead
    • Clinical psychologists
    • Development lead
    • Duty triage worker
    • Learning disability nurses
    • Outreach workers
    • Positive behaviour analysts
    • Psychiatrists
    • Senior positive behaviour analysts
    • Service lead
    • Speech and language therapists
    • Systemic therapists

How the service is provided

PALMS is a multi-disciplinary team who provide individually tailored support to help manage a number of concerns experienced at home. The service is available for children and young people up to their 18th birthday.

PALMS provides intervention and where necessary, intensive support to families reaching crisis with a step up and step down approach throughout their care journey.

PALMS offer bespoke packages of assessment and intervention to children young people and their families. The range of interventions PALMS will offer is detailed below.

Intervention Workshops

Our workshop draws on your current understanding about autism and learning disabilities and provides a space where these ideas can be shared and developed. Considering the voices of young people with autism and learning disabilities, the literature about both and our professional experience allows us to build on these existing understandings collaboratively.

The workshop enables you and other parents to develop broader understandings about autism and learning disabilities. These can then be related to your own individual circumstances.

The positive feedback that we have received from families has focused on how interactive and supportive our workshops have been. We aim to create a friendly and non-judgemental setting so that all experiences can be shared. However, there is no pressure to share your stories within the workshop environment.

We appreciate that many parents have attended other workshops in the past; however, we do find that attending our workshop better prepares parents/carers for their work with PALMS. Following the workshop a PALMS clinician will be in contact with you to arrange the next part of your intervention.

Intervention Groups

PALMS provides a positive behaviour support (PBS) group for parents/carers to attend for eight sessions. This is an intervention within PALMS which aims to familiarise parents and carers with the basic principles of PBS and develop their own set of behavioural strategies to implement at home.

PALMS provides a sleep group for parents/carers to attend for five sessions in the group (plus one review session) and four individual sessions (two before the group starts and up to two after the group content). This is an intervention within PALMS which aims to familiarise parents and carers with the underlying principles and research behind good sleep habits and routines. Each family will develop their own sleep plan to implement at home.

PALMS provides a feeding group for parents/carers to attend for seven sessions. This is an intervention within PALMS which allows families to take an interactive approach to developing understandings and strategies to manage feeding difficulties they may experience.

All our groups are currently run via MS Teams with sessions available in the day time and evening.

Therapeutic work

Following your workshop it may be appropriate next step to work with our team in the community. This intervention offers individualised appointments, currently being undertaken via video conferencing but where appropriate could be in the community, school or at home.

Our approach is very much centred on parents as experts and allowing you the space to walk in your child’s shoes. We help to support alternative understandings and use these throughout our work together. These sessions will focus on parent / carer’s goals and your family’s needs. Clinicians will help to agree a plan of support for the sessions.

We are able to offer sessions with parents / carers, individual work with the young person to get to know them which may include individual therapy, sibling sessions and modelling sessions in the home based on your family’s needs.

Positive Behaviour Support (PBS)

Positive Behaviour Support (PBS) is a framework developed from behaviour analysis that centres around supporting people to have a better quality of life. This is done by making sure a person is fully understood and supported, as well as helping them develop new skills so they can thrive.

Behaviour Analysis is the science of why we behave in the ways we do.   Applied Behaviour Analysis (ABA) uses strategies based on this science. There are a lot of approaches that have come from behaviour analysis, such as PBS.

 In PALMS, we use PBS to:

  • Understand why behaviours happen.
  • Put strategies in place that:
    • Increase quality of life
    • Teach alternative skills/behaviours to communicate their needs safely
    • Reduce challenges
  • Help people work towards personalised goals within the PALMS commissioned remit for intervention around behaviour, feeding, mental health, sleeping and toileting

The British Institute of Learning Disabilities (BILD) has created a video on PBS. Click here if you would like to watch it.

Intensive Support

The intensive support pathway provides a small number of families with an intensive piece of work with PALMS when the following factors are present:

  • Behaviour with high intensity and frequency that could be putting other family members at significant risk of physical and / or emotional harm.
  • Family are seeking alternative accommodation or residential school
  • Family continue to feel that they are unable to cope
  • Information from assessments and professionals showing evidence that the family is at immediate risk of breakdown
  • School placement is at risk of breakdown
  • There is a risk of the child being placed out of county

The intensive support pathway is a short intervention which may proceed or follow another PALMS intervention. The PALMS journey is step up and step down approach and the intensive support pathway enables this journey to take place. It may include:

  • Frequent observations in the community and at home
  • Modelling sessions in the home
  • Increased Parent As Therapist sessions with allocated clinician

Following the recently commissioned PALMS review PALMS are no longer commissioned to provide ASD 2nd opinions.

Mental Health Support Team (MHST) in SEN Schools in Hertfordshire and West Essex

The MHST is an early intervention service, working with mild to moderate mental health difficulties and challenging behaviours. This is part of a national programme to offer early interventions in school settings. PALMS is hosting the MHST for Hertfordshire and West Essex (HWE).

The MHST supports mental wellbeing in the following SEN schools in HWE:

  • The Collett
  • Colnbrook
  • Garston Manor
  • Middleton
  • Southfield
  • The Valley
  • Woolgrove
  • Oakview
  • Wells Park

We are only able to offer support to parents/ carers of children who attend schools that have signed up to support from the MHST for SEN schools.

This support will be delivered by an educational mental health practitioner (EMHP). The MHST is currently offering virtual support due to COVID-19, therefore you will need access to a computer or smartphone.

MHST support in schools

The MHST helps to support mental health in schools in several ways:

  • Workshops with young people or parent/carers
  • Group based work with young people or parent/carers
  • Guided 1:1 self-help sessions with young people, parent/carers around proactive prevention and support for mild to moderate mental health difficulties and challenging behaviour
  • A ‘whole school approach’ to understanding and improving mental health, which may include supporting the school’s mental health lead, supporting with the wellbeing curriculum, identifying mental health resources, creating posters and displays etc

Referring to MHST

School staff are able to refer your child to the MHST for 1:1 support. The following members of staff at your child’s school can make a referral

  • Mental health lead (MHL)
  • SENCo
  • Family support officer (FSO)
  • Pastoral support
  • Teaching staff (including head of year / head of department / key workers and teaching assistants)

The referral will be considered by the team. If the MHST is not the most suitable team to support your needs, we will signpost to the most appropriate resources.

Please note that the MHST can only work with a limited number of children at a given time therefore referrals may be added to a waitlist.

Information regarding parent groups and workshops will be shared with you via school.

A young person would need to meet the following criteria:

  • Attend a Hertfordshire or West Essex SEN school which is part of the MHST
  • Young person (if appropriate) and parent consent to the intervention
  • Difficulty is mild-moderate
  • For 1:1 work with a young person there needs to be some ability to identify and communicate their thoughts and feelings

Contact us:
Email: hct.mhst@nhs.net
Phone: 01727 582122

Outcome measures

These questionnaires are used at the beginning and end of the PALMS intervention. They show us if PALMS intervention has made any positive changes to you, your child and your family. We measure this through the scores that are generated, and also through the written comments. We might ask families to complete the questionnaires during the intervention, in order to measures progress.

These questionnaires are standardised, so it might be that some questions are not relevant to your child. We also use this information to show how PALMS is an effective service to support our continued funding.

Who is eligible for the service

Referrals to PALMS will be accepted from any professional working with a child/young person (CYP) and their family who meet the following criteria:

  • CYP is registered with a Hertfordshire GP
  • CYP is age 0-18
  • CYP has a diagnosis of Autism* and/or Global Learning Disability.
    *Eligibility criteria is also met where a CYP is awaiting an assessment for ASD and it is deemed by professionals that the CYP is highly likely to receive a diagnosis.

Also where the CYP has one (or more) of the following emotional, behavioural, or mental health needs:

  • A. Challenging behaviour
  • B. Sleep difficulties
  • C. Feeding difficulties
  • D. Toileting difficulties
  • E. Mental health difficulties

Please note: examples of the type of difficulties PALMS supports have been provided in this document Criteria to access PALMS for each area of need. This is not an exhaustive list and professionals should discuss with the service prior to a referral being made if it is unclear if the area of need is within the remit of support PALMS provides.

Also where:

  • Community intervention has been accessed for the presenting concerns and difficulties persist.
  • The presenting concerns are as such that mainstream mental health services, with reasonable adjustments, are unable to meet the CYP’s needs.

What will happen at your appointment

Once accepted, PALMS will offer the family an initial assessment appointment (IAA). PALMS will explore the family’s expectations of PALMS and consider the goals that the family would like to work towards when they start their work with PALMS.

If English is not your first language we can provide an interpreter, but we need to know in advance if you are likely to need one. When your appointment is made please request this service, which is free of charge.

Initial assessment appointments

The initial assessment appointment can last up to one hour. Parents or carers need to attend but we also encourage you to invite other people who you deem to be important to your child’s care. This may include family members, carers, professionals such as a social worker and/or teacher and voluntary support agencies. This would help us decide the most appropriate PALMS professionals to support your family and begin integrated work.

We appreciate that it can be hard for children and young people to feel comfortable for a long period of time in a ‘formal meeting setting’. We realise it can also be difficult and is often not be appropriate to discuss all the issues you feel are important. If the young person does attend this appointment, it is important that we focus on the positives however we recognise there may be some more difficult discussions you may wish to have.

In this instance it may be helpful if you could bring another family member or friend to the appointment to enable the young person to leave for the second part of the appointment giving you the opportunity to discuss some of the difficulties.

In most circumstances the appointment will be with one member of the team, although at times the appointment may be undertaken by two members of the team.

Social stories

If the young person will be attending the appointment, we will also send you a social story which can be used to help prepare them for the appointment.

 

The assessment process will involve:

  • Getting to know you and your family.
  • Discussing your and your child’s concerns.
  • Gaining an initial understanding of your current needs.
  • Gaining relevant background information including a developmental history where appropriate.
  • Finding out what you have already tried to improve the situation.
  • Identifying your goals.
  • Gaining information about which professionals are involved in your child’s life, and requesting your consent to contact them for further information, if required.

Following on from the initial assessment

If PALMS is the most appropriate service to meet your child’s needs, we will agree a care package and write to you with a summary of our session and agreed next steps. The way forward and additional appointments will be agreed together with your clinician.

Discharge

Sometimes following assessment it may be decided that further input from PALMS is not required and your child will therefore be discharged and if appropriate referred to another service.

Useful information

You may find the following information helpful; this information will support you in accessing other services to support with any concerns and also suggest resources for parents, carers and young people to access on a variety of topics.

 qr code Scan this QR code for the list of services in Hertfordshire

Making a referral

Please be aware that we cannot accept self-referrals from parents/carers. Only a professional can refer into the service.

A referral can be made via a number of options, including:

  • Via Electronic SystemOne referral within Hertfordshire Community NHS Trust
  • Via Hertfordshire Partnership NHS Trust's Single Point of Access Service
  • By completing a PALMS Referral Form or detailed letter sent to:

PALMS Admin Team
Sandridge Gate Business Centre
Ronsons Way
St Albans
AL4 9XR

Please note if you need to contact the PALMS Service, the new temporary phone number to call is 01727 582122.

• By completing a PALMS Referral Form and emailing it to hct.palms@nhs.net

Useful documents

Professionals

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 duty worker to triage effectively.

Patient experience

If you would like to share your story, please contact the Patient Experience team on 01707 388036 or email pals.hchs@nhs.net.

We would also love to hear about your experience on our service, please complete a survey by clicking here.

Messages of Hope are used in PALMS to support families who are starting their journey with the service. We collect messages of hope from families who have finished their work with the team to offer words of encouragement, support and empowerment to families starting their work. We also capture messages from young people who we have worked directly with and share these with other young people and their families.

We have compiled these messages into a book that we share with families when they come along to their initial assessment appointment. These messages are so powerful and as well as offering words of encouragement to new families they support the team in understanding what is helpful to families so we can continually evolve as a service to meet their needs. Please take some time to have a read through some of the messages below.

Messages of hope from families and young people

What we've done thanks to your feedback

An infographic with the title "You said, We did". Parent says: "We would like the family to be more involved in sessions." Clinician replies: "We have created a Family Clinic for this purpose." Parent says: "The videos used in the PBS Intervention Group weren't recent." Clinician replies: "We developed our own fit-for-purpose animations specifically for the PBS Intervention Group." Parent says: "Some of the sessions of the PBS Intervention group were confusing." Clinician replies: "We reviewed the entire PBS Intervention Group and changed parts according to feedback." Parent says: "We'd like clearer information about IAAs and PALMS pathways." Clinician replies: "We created an information leaflet, available on our website and via QR code, sent with all IAA packs to families." Parent says: "There isn't enough time to implement change between sessions of our Sleep Intervention Group." Clinican replies: "We changed the length of time between sessions 6 and 7 to enable you to implement changes before the group finished." Infographic finishes with HCT and PALMS logos.

FAQs

Click one of the sections below:

 

Triage and Assessment

“Is there a waiting list to be seen by PALMS?”

Unfortunately, there is a wait to receive assessment and intervention from PALMS.

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.

Following the IAA, a pathway is agreed with the family and if PALMS is an appropriate service the intervention(s) will be explained. 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.

“Do children need to have a diagnosis before they can be referred to PALMS?”

PALMS offers intervention to children who have a diagnosis of moderate to severe learning disability and / or autism which has a moderate to severe impact on cognitive functioning who meet the criteria for the remit of the service, 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 the criteria for the remit of PALMS.

“Will PALMS meet my child at the Initial Assessment Appointment (IAA)?”

The first appointment is called 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 at home.  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. 

“Do PALMS contact the family when their referral has been accepted?”

Once a referral is accepted by PALMS, the family, referrer and GP (if not the referrer) will receive a letter advising of the next steps.    

If the referral is not accepted, a letter will be sent to the referrer to explain why this referral was not accepted. The family are always sent a copy of this letter. Signposting to alternative services and support are included in this letter so that more appropriate services can be accessed without delay.

If the referral is not accepted and the family have additional information that they understand would indicate that PALMS is an appropriate service, they are very welcome to contact us directly to provide this information.

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.

“What happens at the IAA?”

During this assessment, the clinician(s) will aim to gather an in depth understanding of what would be most beneficial to support your child and your input will be invaluable to this process. This includes: identifying the goals from accessing PALMS; ensuring PALMS is the most appropriate service to support these goals; discussing what intervention looks like and will require from the family; and, identifying any alternative signposting. 

Following the IAA you will receive a summary letter that will set out the care plan and explain what the suggested pathway is for your child.  This intervention plan will be continually reviewed with you by your allocated PALMS’ clinician.

“Do PALMS prescribe medication?”

As a service, PALMS are committed to reducing the usage of medication prescribed to children and young people with a learning disability, autism, or both. This commitment is in line with the STOMP and STAMP initiatives which have been developed by NHS England.

Whilst there may be times when medication is a useful intervention to support a child, in line with best practice guidelines other therapeutic interventions are always provided first with the aim that medication is not needed. If medication is required, the prescriber will work hard to ensure that this is prescribed for the minimum duration necessary.

PALMS do not provide medication as a sole intervention.

“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.

“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.

“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 by dialling 0300 123 4043 24/7.

“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 your query within 5 working days.

 

Intervention

“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. 

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. Intervention groups are stand alone and evidence based and it is anticipated that no further interventions are required following attendance at an intervention group.

“Are the intervention groups offered by PALMS parenting courses?”

The intervention groups offered by PALMS are direct interventions and not parenting courses though most often, our intervention groups are attended by parents. PALMS’ intervention groups do not focus on ‘parenting’ though parents/carers do learn strategies that will enable the intervention and support the whole family. 

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?”

Through the group intervention process families will be allocated two clinicians who will develop an individualised bespoke intervention plan in collaboration with families for each child. This plan is implemented at home; supported by the clinicians who will provide both follow up telephone calls and outreach sessions.

PALMS always view families as the experts on their child. By meeting in a small group forum (no more than 8 families), families have the opportunity to share and hear from others who are facing similar challenges alongside working collaboratively with PALMS’ clinicians.

“Will PALMS work with my child’s school?”

PALMS recognises the importance of a whole system approach when supporting a child.  Whilst it is recognised that Education is an important part of every child’s life that 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.

“Is PALMS a ‘behaviour’ service?”

PALMS provide intervention for children who have a diagnosis of moderate to severe learning disability and/or autism which has a of moderate to severe impact on cognitive functioning. PALMS is one of the CYP Mental Health services in Hertfordshire who provide intervention at the getting more help level for a variety of emotional, behavioural, and mental health difficulties.

Scan for PALMS Criteria:

An QR code that links to the PALMS criteria document.

“Will PALMS work with other services who are supporting my child?”

PALMS provides evidence based practice and therefore joint and collaborative working with children, their families, other professionals, agencies, and organisations is essential. Working collaboratively with the network surrounding a child provides opportunities for sharing knowledge, experiences, and expertise to achieve the best outcomes for the child.

 

Intervention: Groups and Pathways

“Do PALMS offer individual work to children/young people?”

PALMS offer individual work with children/young people based on their clinical needs. PALMS also work with parents/carers, the wider family and supporting professionals.

“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. The evidence for this approach highlights the importance of primarily working with systems supporting children who have Autism Spectrum Disorder and/or a Learning Disability rather than solely provide individual intervention with the child. This approach recognises the huge amount of knowledge that parents/ carers hold about their children, the knowledge and skills professionals hold, and how both contributions play 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.

Does PALMS offer virtual appointments?

Yes, PALMS provide virtual video appointments when this is clinically appropriate. As part of the intervention the clinician and family develop a contract to understand what the intervention will look like going forward, a discussion regarding the remit and appropriateness of virtual appointments is had as part of this.

PALMS provide face to face sessions in a variety of community environments, such as clinic, home or school.

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.

As a service, PALMS are committed to reducing the usage of medication prescribed to children and young people with a learning disability, autism, 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, in line with best practice guidelines other therapeutic interventions are always provided first with the aim that medication is not needed. 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.

 

Discharge, Transitions and Signposting

“Is PALMS the only service who support children with Autism/Learning Disability?”

PALMS is one of the many services in Hertfordshire that support children with Autism/ Learning Disabilities.  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.

For most up to date information on where you can access other local services, please scan QR code:

A QR code.

Website (Local offer): https://www.hertfordshire.gov.uk/microsites/Local-Offer/The-Hertfordshire-Local-Offer.aspx

Hertfordshire County Council:  0300 123 4043 or  https://www.hertfordshire.gov.uk

“Can my child be re-referred to PALMS if we’ve been discharged?”

We know that it is possible that needs change as children develop, and therefore PALMS do 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.

A typical journey through PALMS can look like this:

  • Families are offered an initial assessment where goals are discussed and agreed, an outline of what is required of families to access PALMS is provided and to ensure PALMS is the most appropriate service.
  • 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.

Discharge can be agreed for a number of reasons, including:

  • Progress on goals
  • Agreement that this is not the right time for intervention
  • A number of sessions have been missed by the child or family in accordance with the Do Not Attend (DNA) and cancellation policy.
  • Another service has been identified as being more appropriate to offer the required intervention.
  • Transition to adult services.