How should I approach a multidisciplinary referral for a patient with complex communication needs?

When approaching a multidisciplinary referral for a patient with complex communication needs, it is crucial to ensure early and comprehensive assessment, involving the patient and their family or carers ¹,⁴.

• For disabled children and young people with severe complex needs, refer to specialised augmentative and alternative communication (AAC) services if they meet the eligibility criteria ¹.
• Follow the specific referral process and eligibility criteria outlined in NHS England guidance for commissioning AAC services and equipment ¹.
• It is important not to add requirements for referrals to be made by specific practitioners (such as occupational therapists), as this can cause delays ¹.
• For children and young people with cerebral palsy, regularly assess for concerns about speech, language, and communication, and refer for specialist assessment if concerns are identified ⁴. If there are ongoing problems with using AAC systems, refer to a specialist service to tailor interventions to their individual needs ⁴.
• For adults after a stroke, speech and language therapists should assess if they could benefit from a communication aid ³. If persisting communication difficulties are identified at 6-month or annual reviews, refer them back to a speech and language therapist for detailed assessment and treatment ³.

• A multidisciplinary team for patients with complex needs can include a doctor, nurse, therapists, mental health practitioner, pharmacist, dietitian, specialists in the person's conditions, social worker, housing specialist, and voluntary sector practitioners ².
• For children and young people with cerebral palsy, specialist assessment of communication skills should be conducted by a multidisciplinary team that includes a speech and language therapist ⁴.
• The multidisciplinary team should receive appropriate information, education, and training to enable them to support and communicate effectively with people who have communication difficulties and their families and carers ³.
• Speech and language therapy, a key component, should be led and supervised by a specialist speech and language therapist working collaboratively with other trained individuals ³.

• When assessing for communication aids, consider how they will function across multiple settings (e.g., school and home) ¹.
• If possible, provide equipment directly to the individual rather than to a service they use, allowing them to use it wherever they go ¹.
• Ensure staff are provided with information and training to support the individual and make best use of the communication aid, with local AAC services able to provide this training ¹.
• Agree on who is responsible for maintaining, servicing, and insuring the communication aid ¹.
• Provide support during transitions (e.g., finishing education) to ensure continued use of the communication aid in new environments ¹.
• Provide a paper-based backup for children and young people using powered systems ¹.
• Arrange regular reviews for communication aids to ensure they continue to meet the individual's needs ¹.
• Inform individuals and their families or carers about any support and mentoring groups that can help with communication and social interaction ¹,³.