Which Children do you see on the Violet Pathway?

Children who have long term conditions, who may need regular review and may need advice from a Paediatrician. Children with cerebral palsy, Downs syndrome, genetic disorders, global developmental delay and children who are being investigated who are presenting with developmental delay or difficulties.

I have a child in my school who is very behind with their learning but doesn’t appear to have ASD or ADHD. Can I refer in to the Violet pathway?

If the child is under 6 years of age and is presenting two years behind in learning ability then we will accept the child into Violet pathway to have a full medical to check there is no underlying medical conditions. If the child is established in school and is over 6 years we suggest that the Educational Psychologist is invited to give advice. If the team consider there is a need to refer in for medical help we will accept a joint referral from the school and Educational Psychologist.

If a child is generally delayed in aspects of their development for example speech and movement who will see this child?

If the child is under 6 years of age then a referral into the violet pathway with be reviewed by the team and the most appropriate professional will see the child first. The team will assess the child and ensure all their medical needs are assessed. If the child is over 6 years and has never seen a health professional then we will assess if the child meets our criteria.

Do the Paediatricians review non ADHD medication on the Violet pathway?

Medications for ADHD are seen on the Indigo pathway. Children that are on medications for managing spasticity, epilepsy and sleep will be regularly reviewed by the Paediatrician if they are the primary prescriber. Children on medications for cancer, diabetes, respiratory disorders, heart conditions urinary disorders cystic fibrosis will be seen by the acute paediatricians at the hospital.

I think the child I want to refer has ASD but I’m not sure and I’m worried they will be put down the wrong pathway.

It is really important that school include all possible information on the child. Little details on how they behave, communicate and play will help us clinically triage onto the right pathway. If we don’t think the ASD pathway is right we will automatically move them to the right pathway.

We find it difficult to talk to parents about whether the child has ASD or ADHD

We are changing the wording on the referral form to state, social communication difficulties or attention and listening difficulties. This will help school discuss issues without having to label children

As a school we are sometimes unsure why some children are rejected from the service

This can be for many reasons. Often the screening forms ie ASD profile and The Cambridge questionnaire have not been sent with the referral. When triaging we may note that the child appears not to meet the criteria from the questionnaires

Having made this referral I would like to support parents and attend the appointment.

We encourage school to attend but you would need to gain consent for this to happen from parents. One member of staff can come along with parents.

How can we get our pupil seen by a paediatrician?

Our services have now changed and we try and get the most appropriate person to see the child this may not be a paediatrician at any point in the referral process. For example if a school suspects a child has ADHD then we will ensure the child receives a full assessment lead by our specialist nurses who are able to prescribe any ADHD medications.

For children who have developmental delay our therapists may be the first port of call with a Doctors working alongside at the point that we are ready to make a potential diagnosis.

Children with long term conditions such as cerebral palsy or Downs syndrome will see a paediatrician with the MDT at least once per year.

After we have made a diagnosis of ASD the child will not continue to see a Doctors unless the child is on medication or we are considering further test to look at other diagnosis.

What I do if I or a parent am concerned about a child’s behaviour?

Schools can access the ASD and ADHD diagnostic pathways if children meet the criteria. If children do not meet the criteria for these two pathways then parents should be encouraged to visit their child’s GP who will be able to undertake a full medical to rule out any other concerns. GP’s can access the ASD and ADHD diagnostic pathway but we have asked them to refer through the school so that we get all the information we need. This will mean that we will still apply our referral criteria If a GP has any concerns not linked to the ADHD and ASD pathways they have direct access into our community paediatricians. 

Where can I access behaviour support?

There are universal services like school nurses and health visitors who can give support about behaviour. Also Early Help services in Medway can offer behaviour support for schools.

What can I refer parents who require support for their child’s behaviour?

Early help services offer parenting support for under 5’s and parents with children who are undergoing ADHD assessment via the Triple P programme. Incredible years programmes are also available through Early help services if parents are eligible for Early help. Voluntary agencies like Family Action and The Salvation Army also have parenting support programmes available. 

If a parent/carer has a child that is known to MCH they will be eligible to access parent group sessions that will be delivered at MCH and behaviour clinics for some who may require a higher level of support. 

Why do we have to fill out such long referral forms for potential ADHD and ASD?

We really value the input schools give us in relation to how the child performs at school in terms of their learning ability, social skills and any sensory difficulties. Without this information we cannot make an accurate diagnosis and forward plan as the criteria for diagnosis says for ADHD and ASD states the child should present with difficulties in all areas of their life School is clearly a big area. The questionnaires  that schools and parents complete are scored and form part of the diagnostic information

I have been told that MCH staff cannot discuss details about a child due to confidentiality

MCH can talk to school about aspects of the child’s care if parents have consented for this information to be shared.

What’s the role of the school nurse.

At MCH we have several different school nurses who can help pupils. For the majority of children our Public Health school nursing team will be your first point of contact from 7 y – 18 years. Schools nurses work alongside the health visiting service for children transitioning into school up to the age of 7.

For children with learning disabilities are learning disability nurses are available to help families with specific concerns especially around sleep management continence and behaviours. For children that have on-going health needs our specialist schools nurses are available to help children in school and at home and will also train schools staff in medical procedures that have to be undertaken in school time.

We also have a team of nurses who are responsible for delivering the school health checks such as vision, hearing, and weight management.

Why can’t we refer a child for the ADHD diagnostic pathway if parents have not been on a parenting course?

MCH follow NICE guidance and it is recommended that parents and schools offer a graduated response to helping the child before medical intervention is considered. This includes strategies within school and at home. Research has shown us that parents that have a better understanding of how to help their children with behavioural difficulties after attending a  parenting programme. Without behavioural management strategies in place at home and at school then the child will continue to struggle to learn regardless of any diagnosis.

What should the school do if the child is on ADHD medication and they are showing side effects such as sleepiness, gaining or losing weight? Maybe they suddenly and consistently become withdrawn or over anxious?

In the first instance contact the childs parents and ask if they have noticed a difference. It is important to compare notes as often the timing of when medications are given can alter performance at different times of the day. Parents and schools can ring the central number to get a message to the clinical team. Please ensure contact details are left and times the clinicians can call or if it is easier an email address. At all times we will seek permission from parents  to discuss the childs case with schools. We try and get this permission at the time of diagnosis for on going dialogue between parents, school and ourselves but this may not always be given and we will always respect parents choice. However any concern a school raises with us will be investigated and appropriate actions taken.

If schools have serious concerns regarding medications that they feel parents are not addressing then schools should alert us so we can discuss with parents and If necessary the school should raise this through their normal safeguarding routes.

The report we have received refers to Medway Core Standards what is this?

Medway core standard has been written by MCH in partnership with n interested group of Medway Head teachers and SENCo s to help school offer a graduated response to helping children with emerging needs. The resource manual is available when schools book onto the one day free training. We have included lots of activities you can use in the classroom incorporating movement, sensory and communication into one programme of care underpinned by sound behavioural management techniques. Completion of the course and school self audit will enable you to become a Bronze partner with us so that we can work with you throughout the year to build on your skills and help you develop a fully inclusive school.

To become a silver and gold partner please have a look on our web site at the schools training manual where you will see a large variety of course for school staff.