Referral Criteria – Learning Disability Nursing

Our service uses behavioural, sleep and toileting assessments; working with children or young people who have profound and severe levels of learning disability (including those who additionally have autism) and supporting the development of community and school based programmes of support. As such this service offers both indirect and direct support to children and young people with learning disabilities and facilitates their access to mainstream services.

Conditions in scope

The Children’s Community Learning Disabilities Team will accept requests for service for:

• Children/young people up to 18 years of age, registered with a Devon GP, who have a diagnosis of profound, severe (or moderate, where there are safeguarding concerns) learning disabilities, including those children/young people who have acquired this status

Requests will be considered for:

• Children or young people who have been identified as having a cognitive impairment which is severe or profound and which limits educational and practical development
• Children or young people attending other special schools or attending mainstream provision (or attached units) with a Statement of Special Educational Needs (or Education, Health Care plan equivalent), dependent upon the child or young person’s level of learning disability, the level of functional impairment and the nature and severity of the presenting problem

Exclusion Criteria

Requests for service will not be accepted for children and young people with:

• Mild learning disability
• Higher functioning Autism Spectrum Conditions (i.e. average or above average intelligence),
• Acquired head or brain injury
• Issues that are school based only, where the family does not require support – these should be supported by educational services such as Educational Psychology and Behaviour Support services

Consideration will be given on a case by case basis in regard to specific syndromes that do not necessarily mean there is a learning disability as a consequence, as to whether the child/young person meets the criteria for the service. The requester should first consider appropriate mainstream services that would better meet the child/young person’s needs or provide the evidence that the child/young person’s disorder meets the criteria. For example, if a child or young person with a learning disability presents with possible mental health problems, then a referral should be made via the Single Point of Access (SPA) to Child and Adolescent Mental Health Services (CAMHS).

There are times when it might be more appropriate for a child/young person to access mainstream services, such as school and public health nursing, in line with the guidance around inclusive practices.

Pre-request requirements

A request for service is appropriate if there are significant concerns about the child’s development, health, well-being or behaviour and these are having a significant impact on the child or young person’s functioning at home.

Before making the request it is important that:

• The child or young person has been seen in person and assessed by the person making the request
• Prior attempts have already been made by frontline staff to resolve the child or young person’s difficulties with mainstream support
• Formal consent has been obtained from someone with legal parental responsibility for the child. Young people aged 16 and above are able to give consent to the request in their own right. Some young people under the age of 16 who are deemed competent to consent can also do so. Although it is always usual to obtain parental consent for a request, the service will see young people alone, as appropriate. In such cases, the person making the request should give careful consideration to any risks involved to the young person and assess the capacity of the young person to consent to the request
• The request includes all the necessary information regarding what is needed to support the child, young person and/or family to engage with the service

Please note that any safeguarding concerns should already have been reported to the statutory agencies prior to the request for service.