REFERRALS

Refer a child who has an independent (private) SLT

Your independent SLT may decide with you that a specialist assessment at the MPC might be helpful. They can make a referral for you, or you can make it yourself. We will invite your independent SLT to an assessment with you where we will agree recommendations together that they can deliver. We are not able to apply for funding for therapy to take place at the MPC via your independent SLT.

If your child is seeing an independent SLT, we will be able to invite your them to be part of your child’s assessment. Involving everyone in the assessment means that we can all think about what your child needs and what therapy is required.  

Independent SLTs can refer a child or young person up to 18;11 years old when they wish to confer about the work they are doing with a family and get advice and support from our specialist team. If you are working as an independent SLT we can make recommendations for you to deliver. However, we will not be able to apply for funding for therapy, so if you think your client may need to be transferred to the MPC please refer them to your local NHS team.

When it is time for the child’s assessment, we aim to give SLTs and families two months’ notice of an appointment. The child assessment lasts about two hours. If the child has completed recent language assessment, please share that information with the MPC. SLTs will be invited to meet with the MPC SLTs for 15 minutes at the start of the assessment and will then observe the parent session which lasts approximately three and a half to four hours and discuss recommendations with the MPC team before feedback is given to parents.

SLTs and families can choose to attend in person or via telehealth.

    REFERRAL TYPE (required)

    CHILD OR YOUNG PERSON

    PARENT 1

    Title [e.g. Mr., Ms., Mrs., Dr., etc.]:

    PARENT 2

    Title [e.g. Mr., Ms., Mrs., Dr., etc.]:

    PARENT 3

    Title [e.g. Mr., Ms., Mrs., Dr., etc.]:

    PARENT 4

    Title [e.g. Mr., Ms., Mrs., Dr., etc.]:

    PARENTAL INVOLVEMENT

    Both parents are required to attend the consultation for children up to 16 years old.

    If your child is over 16 please tell us if you would like to have a parent session.

    I would like a parent session

    Who has parental responsibility?

    Parents' status
    TogetherSeparatedDivorced

    Would you like to attend together or separately?
    TogetherSeparately

    Please provide name(s) of other partners to be invited and enter their details in PARENT 2, 3 and/or 4 section

    SIBLINGS (names and ages). Siblings are not invited to the assessment.

    SCHOOL/NURSERY

    School name

    School address

    School post code

    School headteacher

    School telephone

    School email

    FAMILY DOCTOR

    GP name

    GP address

    GP telephone number

    GP email

    YOUR LOCAL NHS TRUST

    Name

    EMERGENCY CONTACT

    Name and number of the person we would contact if there were an emergency while you were at the Centre.

    Name

    Telephone number

    NHS SPEECH AND LANGUAGE THERAPIST

    Name

    Address

    Post code

    Telephone number

    NHS Trust

    Email address

    When seen (currently or past)

    NHS SLT Manager (to be completed by SLT)

    INDEPENDENT SPEECH AND LANGUAGE THERAPIST

    Name

    Address

    Post code

    Telephone number

    Email address

    When seen (currently or past)

    ETHNICITY

    Child (required)

    If you / your child has identified as "other" in any way, please enter further details below

    Parent 1 (required)

    Parent 2

    Parent 3

    Parent 4

    LANGUAGES SPOKEN

    Child

    Parent(s)

    Does your child need an interpreter? (required)
    YesNo

    Does the parent / do the parents need an interpreter? (required)
    YesNo

    STAMMERING

    Onset of stammer

    Has it changed since then?

    When do they stammer more?

    When does it happen less?

    Do you have any idea(s) about why your child started to stammer?

    Any other members of the extended family who stammer now or used to stammer?

    What does your child do when they stammer?

    How do you refer to the problem when talking to your child?

    REASON FOR REFERRAL

    Advice and guidance to support local therapyIndividual therapy at the Michael Palin CentreGroup therapy at the Michael Palin Centre (ages 10 to 18 years)

    ADDITIONAL INFORMATION

    SPEECH AND LANGUAGE ASSESSMENTS

    Please send copies of reports to:

    Administrator
    The Michael Palin Centre
    13-15 Pine Street
    London EC1R 0JG

    Previous therapy and progress

    Up-to-date language assessment (for SLT referrals)

    Additional needs (e.g. medical, social, educational, emotional)

    Other professionals involved (e.g. CAMHS, Occupational Therapy, Social Services)

    Any other information

    RESEARCH (for parents)

    Occasionally at the Michael Palin Centre we conduct research studies to investigate stammering. If you would like to receive information about research studies in which you and/or your child can participate then please indicate below. You do not have to commit or participate in any of the studies. You can withdraw from receiving this information at any time without giving any reason.

    Would you like to receive information?

    YesNo

    NAME OF REFERRER

    Contact details if different from above (name is required)

    If you would like a printed copy of your completed referral form, please hit ctrl + ‘p’ (on a PC) or cmd + ‘p’ (on a Mac) before you click submit/send.

    You will receive an automated email to confirm that your referral has been received.

    MPC on Twitter

    Happy 4th of July to our many friends and colleagues in the US, with whom we love to collaborate @stutteringfdn Enjoy your celebrations !!#Happy4thofJuly

    A wonderful evening with @GeorgeFreemanMP and friends from @ascstammering and many grown up children from @thepalincentre celebrating @JoannaHunter5 & @StevenGauge & the fantastic achievements of the Stambition programme. Thank you!

    Speech-Language Pathologists from Around the World Attend Intensive Workshop on Stuttering. READ MORE: https://www.stutteringhelp.org/content/speech-language-pathologists-around-world-attend-intensive-workshop-stuttering-0 #Stuttering #StutteringHelp #Stammering #SLPeeps @thepalincentre

    📊Help us shape the future of #stammer research!

    We're working with @LindAlliance and organisations in the stammering community to determine the most important areas of research into developmental #stammering.

    🔗Get involved: https://bit.ly/ChildhoodStammeringPSP
    ⏰Survey closes August 26th

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