A Prudent Social Communication Pathway (in Speech and Language Therapy)

Cwm Taf Morgannwg University Health Board

Natasha Bold, Highly Specialist Speech and Language Therapist


Speech and Language Therapy (SLT) is one of the first services children are referred to when they are presenting with social communication difficulties or early signs of Autism Spectrum Disorder (ASD). The prevalence of ASD is significantly higher than previously reported with around one in 57 (1.76%) children in the UK with a diagnosis (Roman-Urrestarazu, R et al. 2021). Prior to the covid-19 disruptions to services the pressure on the SALT service due to referrals for children with social communication difficulties and/or emerging ASD were high. Adding in the aftermath of covid-19 which delayed feeder services to provide early input and referrals to our service the demand has now reached a peak resulting in our current model of working as insufficient.


To develop and pilot a new social communication pathway in speech and language therapy which encompasses the prudent healthcare principles with particular focus on caring for those with the greatest health need first, making most effective use of all skills and resources.

How it will be achieved

  • Providing a robust universal (pre-referral) provision for parents, pre-school setting and key professionals working with families. This will include training, resources and signposting.


  • Adapted triage criteria which will identify the children at a developmental level to most benefit from direct assessment and input from the SLT service.


  • Effectively communicating the change of pathway and rationale to referral agents and families.

Expected benefits

  • For parents and pre-school settings to have developed self-management skills with a fuller understanding of their/a child’s communication level and appropriate ways to support them.


  • Therapists wellbeing and job satisfaction to be increased.


  • Referrals to be more appropriate as the universal provision is increased.


  • Smaller caseloads and shorter episode of care timeframes.


  • Increase in discharge rates due to better treatment outcomes following timely episodes of care.