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Sussex CAMHS Neurodevelopmental Screening Form - Young Person

The Sussex CAMHS Neurodevelopmental Pathway is a neurodivergent positive CAMHS specialist service offering assessment for Autistic Spectrum Condition (ASC) for young people aged 11+ and Attention Deficit Hyperactivity Disorder (ADHD) for young people aged 6 up to 18 years. We also provide medication treatment for young people diagnosed with ADHD. If your are outside of these age ranges, please ask to be referred to your local child development centre or adult health service. 

Please note these are not referral forms. Only screening forms which are linked to an accepted referral will be reviewed. Please do not complete and submit the screening forms unless your referral has been accepted by the local Neurodevelopmental team.

Due to the high demand for our neurodevelopmental assessments, unfortunately, we have long waiting lists.  Consequently, if you are referred to us at the age of 17 years, it is unlikely you will be seen by children's services. However, we will ensure that your details are passed on to the local adult teams when you turn 18 years. We sincerely apologise for the extended waiting times for assessments and understand the frustration this may cause. We would like to reassure you that we are working hard to address the increased demand on the neurodevelopmental service.

  • Make sure you have enough time, around 20 minutes to 2 hours. If you are logged in, you can save your progress and are not required to complete the form in a single session. However, if you do not have an account or are not logged in, you must complete the form in one go. 
  • Have your address and other personal details
  • Have information about your school or education status
  • Get your GP details and NHS No. if possible
  • Have to hand any medical information
  • Get digital copies of any reports you may already have, such as an EHCP or Speech and Language reports and email them to"

If you would like to download a blank preview version of this form to your desktop please click here

If further assessment is indicated, you will be added to our waiting list by our Neurodevelopmental Specialist Practitioners and you will receive a confirmation letter with further details. If further assessment is not indicated we will send a letter to that effect.

We are experiencing a high demand for this service which is resulting in growing waiting lists. Please be assured that we are working hard to address this. All our local commissioners (the funders of our service) have recognised that the group of young people with neurodevelopmental conditions (including ADHD) is growing.

Neurodivergent positive means acknowledging that:

  • Neurodivergent young people have a different neurology or neurotype that is part of natural human variation, like sexuality, gender or race.
  • Neurodivergent young people are often disabled by barriers put in place by society, not as a consequence of their impairments or differences.
  • Diagnosis can be a gift to the young person, through which many can acknowledge their strengths as well as their differences and vulnerabilities
  • Diagnosis can help a young person find belonging and identity in membership of a worldwide community of neurodivergent people
  • Diagnosis can provide the language for young people to self-advocate
  • Diagnosis can provide the legal foundations for equality of access to education and future work through the Equalities Act (2010) and making reasonable adjustments
  • Diagnosis can validate educators and parents in growing a more effective and compassionate understanding of young people

Sussex CAMHS Neurodevelopmental Screening Form - Young Person

CAMHS Neurodivergent Pathway Logo

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Referral confirmation

Please confirm that you have had your initial referral accepted for the next stage in the Autism or ADHD assessment process and this screening has been requested by the team?*

Young Person's Details

This service is for patients who are aged over 6 and under 19

In the interests of the environment and costs to the service, we would like to email correspondence and appropriate documentation to you. Do you consent to us using your email address for these purposes?*
Are you (please select all that apply):
Do you have a disability?*
Are you a Young Carer?*
Do you require an interpreter? e.g. British Sign Language (BSL) or foreign languages*

Parent/Carer Details

Please enter the details of at least one parent/carer.

Do you consent for email correspondence to also be sent to the above email address?*
Do you wish to submit a second set of parent/ carer details?

Young Person's Consent

Do you consent to be contacted about the screening?*
Do you give consent for CAMHS to liaise with external agencies e.g. Children's Services, Education, Voluntary sector? *
Are the above parents/carers aware of your referral to the CAMHS service? *
Do you consent for us to contact the above parents/carers? *
Do we have your permission to share information with any other family member not already listed above?*
During the review of the screening forms, the information may indicate either an Autism only, ADHD only or joint Autism and ADHD assessment is needed. Please select an option below to confirm which assessments you consent to:*

GP Details

How to find your NHS number

Your NHS number is a 10 digit number, like 485 777 3456.

You can use the NHS website to find your NHS number. Vist https://www.nhs.uk/find-nhs-number/what-is-your-name.

Education Details

Are you in education e.g full time education, part time education, home schooled, apprenticeship, other education types?*

School Services

Please list below any school services that you are involved with.

Other Services

Please list below any other services that you are involved with

Young person's views

Why are you making this referral? What is it about you that makes you think you are neurodivergent, autistic or ADHD? You can write in the box below and email drawings, writing or anything else to NDP.Screening.WestSussex@spft.nhs.uk. We want to understand what has brought you here

Current Concerns

Do you self-harm, or tell people that you would like to seriously harm yourself?*
Why are we asking this?

We ask this so our Neurodevelopmental Specialist Practitioners understand more about the risk that you present to yourself before they ring you for the first time. In particular, we want to try to understand if there are any risks that you not telling anyone about, and to understand exactly what you have done to yourself in the past (if anything).

Reminder:

We are not a 24 hour emergency service, and our Neurodevelopmental Specialist Practitioners meet to screen referrals at various different times. If you need immediate support and are a danger to yourself, please speak to a responsible adult like your parent, carer, teacher, school nurse or GP about how you feel. Below is information for further support:

Look at www.sussexcamhs.nhs.uk

Contact the Sussex Mental Health line 0800 0309 500 (which is open 24/7) or NHS 111.

Attend A&E for emergencies and medical treatment.

If you abscond, someone may contact the police to let them know you have gone. Please get in touch with a responsible adult to let them know you are OK as someone will be very worried about you.

Academic Profile

Relationships

Language and Communication

Sensory

Personal Information

Additional Information

Please also send copies of any reports you may already have, such as an EHCP or Speech and Language reports to NDP.Screening.WestSussex@spft.nhs.uk

Terms and Conditions

On receipt of the screening form, we will consider whether or not the neurodevelopmental pathway is the most, or only, appropriate CAMHS service for you. Our service is not 24 hours and it may take several weeks for the information to be screened. The information you have provided will be used primarily for the purpose of undertaking a neurodevelopmental assessment, and contacting you, your parents/carers or your school should we require more information, but there may be instances (particularly around risk) where contacting other Sussex Partnership NHS Foundation Trust services using your information is deemed appropriate. This information will not be shared with anyone else without your consent. Information will be held as a part of the service user's record in line with the NHS Records Management Code of Practice. For more information on how we use your information, please see our privacy policy.