With NHS Trusts and local authorities continuing to think creatively about their service design, Triple P is always thrilled to see a delivery model that is addressing the needs of children and young people and their families effectively and efficiently.

Cambridgeshire and Peterborough NHS Foundation Trust and Peterborough City Council have a unique approach to the Neurodevelopmental Pathway (NDP) which is addressing need rapidly and successfully, to ensure children presenting with suspected Autism, ADHD and Learning Difficulties are getting support within a matter of weeks. This support meant some families felt they didn’t need to continue on the pathway, therein freeing up resources and reducing wait times for those that did.

Speaking with Dr Venkat Reddy, Consultant Neurodevelopmental Paediatrician and Lead Clinician at the Child Development Centre in Cambridgeshire and Peterborough NHS Foundation Trust, he shared why embedding an evidence-based parenting programme into their NDP as a mandatory first step in the model was essential. As the architect of the streamlined pathway, he suggests that parenting support, along with changes to the wider pathway, ensure better use of limited staffing resources, significantly reduces costs of assessment and improves the child and family’s journey through the diagnostic process.

Before implementing the universal system, the waiting lists for the NDP were very high and local services were overwhelmed with ADHD, Autism and Learning Difficulties referrals. Collectively the services needed to come up with a multiagency model where child health, mental health and local authority services join up delivery and tackle the backlog together.

Cambridgeshire and Peterborough NHS Foundation Trust and Peterborough City Council started to offer a robust, universal pathway to support the demand. Funding was given to the local authority every year to facilitate the pathway through a joint commissioning arrangement, and the Foundation Trust changed their offer from a more scattered referral system to single referral pathway.

The process to access the pathway is as follows:

• Parents wanting to refer their child to be assess for ADHD, Autism, conduct disorders, learning disabilities and other neurodevelopmental conditions can sign up via a QR code or a Register Now button on the website.
• They can be referred there by a number of agencies, including schools, GPs, social workers, or crucially, through just their own research about support for their children provided by the local authority.
• Parents fill in a short form which then goes to the Business Support Team at the local authority, who set up an account on their system for each parent.
• Once the parents have completed this, the local authority send a letter to parents, saying they should expect to be contacted within 5-10 days.
• The charity Barnardo’s, a delivery partner for the Council, then send out a pre-evaluation form and parents are encouraged to complete an evidence-based parenting programme, in this case Triple P Online, before a referral is progressed to a Paediatrician.
• Once this form is completed, they are sent a code to access Triple P Online or Teen Triple P Online, depending on the age of their child.
• Families don’t have to access an early help assessment, which they needed to do within the previous system, which has been crucial for reducing waiting times.
• Once families are referred into the service, parents then complete the self-directed programme in their own time, and have a check in call with a practitioner half way through, to discuss how they are getting on.
• Families also then have a post-evaluation, which is conducted by a practitioner, so the local authority is also successfully tracking the progress and outcomes for families.

The local authority reported that since launching, 417 parents took part in the parenting programme over a 9-month period, and a quarter of these families didn’t go on to want a paediatric appointment.

The great benefit of the model this is manifold; parents were offered support within a few weeks, giving them evidence-based practices to implement immediately. Building on that, twenty-five percent of families were then satisfied with the impact of the programme and felt it wasn’t necessary to see a Paediatrician for a diagnosis, alleviating pressure on the waiting lists. Those families which didn't seek further support reported improvements in the areas where they originally had concerns as a result of the support they had been given.

For families who feel further support is required, they are then progressed through the system, to have a paediatric appointment, and to start the process of getting a formal diagnosis.

Since implementing this system, the waiting list for the Neuro-Developmental Pathway has reduced by 70% over a nine month period across 2022 and 2023, meaning families are getting interim support immediately, with many finding that sufficient, and overall, families being seen by a paediatrician significantly quicker than in previous years.

Beyond the highly successful results of this element of the pathway, wider changes were also made to reduce complexity and costs, these were published in the Integrated Healthcare Journal ¹

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_{1. Male I, Farr W, Reddy V. Should clinical services for children with possible ADHD, autism or related conditions be delivered in an integrated neurodevelopmental pathway? Integr Healthc J. 2020 Apr 26;2(1):e000037. doi: 10.1136/ihj-2019-000037.}