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SPLD Learning Disability Referral Form

SPLD Learning Disability Referral Form

Referral form to services for people who have a learning disability (SPLD) via the ELFT Specialist Healthcare Team.

Referral to services for people who have a learning disability (SPLD) - Specialist Healthcare Team

Eligibility criteria to access our service:
- Must be registered with a GP in Bedfordshire & Luton - Must be aged 18 years or over to receive direct clinical support (Referrals/ information for young people approaching 18 will be considered to support transition, from age 17) - Must have a learning disability, which prevents access to mainstream services - Must consent to this referral (please ensure that section on consent/ capacity/ best interests is fully completed) - Must agree to have their information shared where appropriate

Personal Details

You can add your own date of birth.
Interpreter required?
Please tick the best way to contact the service user

Details of next of kin, or carer

GP Details

Is this person on the GP Learning Disability register?
Do they receive an Annual Health Check?
Is there a documented diagnosis of learning disability? (If unsure please complete screening tool towards the end of referral)
Diagnosis:
Do they have an Educational Health Care Plan (ECHP) in place?

Reason for referral

What is the clinical need? (What’s happening that the service user needs help with? Is it around activities of daily living / sensory needs / communication / eating and drinking / eyes and ears / accessing Primary Care / Annual Health Checks / health prevention and health promotion / medication review / mobility / bereavement / behaviours / emotions / or support around mental health)
If you think you know which team/s you need support from, please tick appropriate boxes below:

Risk

Please provide details of any immediate risk
Are you aware of any safeguarding issues?

About You

Details about you, the referrer (Please give all details)
Please provide details of current professionals involved. E.g. Community Mental Health, Wellbeing Hub, Social worker, Day Services
Each referral may be allocated to a team or teams at the service’s weekly Referral Allocation Meeting based on needs and resources, not necessarily to the team/s suggested by you. Please note that some information in this form will be entered on the computer in accordance with the Data Protection Act. Some information may be shared with service colleagues on a need to know basis only.

Learning Disability Screening Tool

Use of the LD Screening Tool to support identification Screening Tool: - This can help as a checklist for GPs and other professionals to assist them in identifying learning disability - This is not intended as a diagnostic tool so apply sound clinical judgement

Questions to consider

Has anyone ever told the person that they have a learning disability?
Is there a diagnosis of a learning disability/mental handicap in any notes? IQ under 70
Did person attend any special schools (SILC) or were they statemented in mainstream school?
Did the person achieve qualifications at school? (GCSE at low grades could indicate LD but high grade GCSE, A Levels or university education LD is not likely)
Is the person known to the Community Learning Disability Team?
Does person have a consultant psychiatrist for learning disabilities?
Does person need assistance with transport? (Unable to get around independently?)
Does person have problems with simple numerical calculations? (i.e. ‘If I gave you £5 to buy milk. Milk costs £1.50 – how much is left?)
Does person have problems reading? (Reading a novel or newspaper usually rules out a learning disability.)
How does the person function in society? Does the person need support with activities of daily living?

Does the person have difficulty with:

Communicating
Writing
Self-Care
Living independently
Interpreting social cues
Controlling behaviour
Co-ordinating movement
Learning new skills
Understanding new complex information

Factors which MAY NOT indicate a learning disability

- Normal development until other factors impact (before 18). - Diagnosis of ADHD, dyslexia, dyspraxia or Asperger’s - Successfully attend mainstream education without support. - Gained qualifications (GCSE and/or A Levels) - Able to function socially without support - Able to complete complex purchases e. g. buying a house - Able to drive a car - Contact with mental health services - Recorded IQ above 70.

Factors which MAY indicate a indicate a learning disability

- Record of delayed development / difficulties with social functioning daily living before 18. - Requires significant assistance to provide for own survival (eating and drinking, keeping self-clean, warm and clothed) and/or with social / community adaptation (e.g. Social problem solving/reasoning). - NB need for assistance may be subtle. - Presence of all three criteria for LD i.e. Impairment of intellectual functioning/social adaptive functioning and age of onset. - Range of information presenting a picture of difficulties in a number of areas of function, not explainable by another ‘label’. - Contact with specialist Learning Disability consultant.
One file only.
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