Parent/carer guide to the ND triage tool (formerly known as stratification)
What is the ND triage tool?
When a child or young person is referred for a neurodevelopmental (ND) assessment, ND triage is a tool the provider uses to understand their level of need. It used to be called stratification, but this was changed based on co-production feedback from families and clinicians.
Until recently, all children and young people in Cheshire and Merseyside were seen on a first-come, first-served basis. In some places, this would be from the date they were referred. In others, it would be from the date they were accepted onto the waiting list.
Now that providers use ND triage, they can look at each referral and see if a child or young person needs to be seen more urgently.
How does ND triage work?
Providers, professionals and parent-carer representatives agreed on a set of standardised factors for triage.
‘Factors’ are things that could put the child or young person at higher risk of harm while they wait for an assessment. ‘Standardised’ means that the same factors are used by all providers across Cheshire and Merseyside.
This approach helps to avoid a ‘postcode lottery’ where some children and young people have to wait longer just because of where they live.
The factors are used to place a referral into one of three groups based on level of need:
- Urgent: Factors include serious mental health concerns, risk of harm, or other critical needs.
- Accelerated: Factors include moderate concerns or complex needs. These cases need to be seen sooner but are not emergencies.
- Standard: For children and young people without urgent or complex needs.
Children and young people in all groups will be seen by a specialist ND assessment team.
Note that a child or young person does not need to have any factors to be referred for an assessment. These factors are only used to find out who needs a more urgent assessment.
How do providers decide which group to put a referral into?
When a provider receives a referral, they will check to see if the child or young person has any of the accelerated or urgent factors. Because every child and young person is unique, they will look at their individual needs, circumstances, and any other clinical issues. If a longer wait would have a more severe impact, the provider then puts them in the appropriate group.
Does a ‘standard’ referral mean a child or young person goes to the back of the waiting list?
No, every assessment provider divides their clinic time into three blocks – one for each group. Each provider divides it in their own way, depending on how many children and young people are in each group in their area.
As an example, a clinic session might look like this:
- Around 20% of appointments go to urgent referrals.
- Around 30% of appointments go to accelerated referrals.
- Around 50% of appointments go to standard referrals.
In each of these blocks, the child or young person is seen in the order they were referred. This lets providers see the most urgent referrals quickly, without standard referrals being put to the end of the line.
What if my child’s situation changes?
If your child’s situation changes, you can ask for the referral to be reviewed. Speak to the professional who made the referral first. They can help decide if your child now meets the criteria to be seen sooner.
Children and young people in all three groups should be able to get needs-based support while they wait for an assessment (Children & Families Act 2014). If the Knowing Me profiling tool is available in your area, ask the professional who referred you to complete a profile with you and your child. The tool can help your child to access early, needs-based support, no matter where they are on the pathway. If you’re already getting early help through the profiling tool but you need more support, ask the professional to review your support plan with you.
Our commitments to you
You can expect clear, open and honest communication about:
- How referrals are prioritised.
- Estimated current waiting times for each group (from referral date).
- Where to get support while you wait.
We are working towards reducing waiting times for children and young people in Cheshire and Merseyside. As part of this commitment, we will continue to monitor waiting times for each referral group and listen to feedback from families through our evaluation and co-production work. This information is important as it helps services improve the assessment pathway and long-term health outcomes for all children and young people into adulthood.