CONSENT STATEMENT -

Consent is when one person agrees to or gives permission to another person to do something. Consent means agreeing to an action based on your knowledge of what that action involves, its likely consequences and having the option of saying no. The absence of no does not mean yes.

(Click the link to : Learn more about consent )

I understand that my child/young person has been referred to Alder Hey’s Developmental Paediatric Services which includes: The Neurodevelopmental Service & Developmental Paediatrics. This referral has been fully explained to me/us. I/We understand that following the assessment outcome, my Child/Young Person may be given a diagnosis of Autism spectrum disorder and/or ADHD. I agree that I fully understand this and consent for the assessment to take place. 

I/We give permission for the Alder Hey’s Developmental Paediatric and Neurodevelopmental Services to undertake assessments as appropriate.  Permission is also given to gather, discuss & share applicable information in respect to my/our child’s assessment within the team & appropriate outside agencies.  Where applicable, this may include:

School and SENCO; including School observations
Clinical Psychology
Paediatrician
Educational Psychology Service
GP
Alder Hey/Hospital Contact
Occupational Therapy Service 
ADDvanced Solutions Community Network
Speech and Language Therapy Service
Health Visitor
Social Worker, Social Services
Child and Adolescent Mental Health Services 
Learning Disability Team
ASD Training Team
Other e.g.  Children’s Centre, Prevent Services,
Youth Justice Team

I/We understand that parents/carers/guardians who have parental responsibility are required to give consent for an assessment to be completed.  If parents have joint parental responsibility, we understand that both parents are required to agree to assessment. However, we understand that an assessment can be progressed with informed consent from one legal guardian.

I/We understand that if my Child/Young Person person is cared for fully or partially by the local authority that the supervising social worker will need to counter sign the referral form.

Once all assessments are completed I/ We may be invited to opt in for a feedback session. I/We understand attending the feedback session, if invited, is strongly advised as the outcome of the assessment will be discussed.  I/We agree it is in the child’s best interest that the feedback session is attended, if invited.

If I/We do not attend the feedback session as advised or make any contact with the Team to discuss this matter a copy of the report containing the outcome of the assessment will be sent to my/our address & GP.

I/We understand that demographic data in relation to my child will be shared with ADDvanced solutions community network, so they are able to communicate we us in regard to training / events that are taking place.

I/We understand that information concerning risk of harm to a Child/Young Person must always be shared for safeguarding reasons.  

This form has been fully explained to me.

I can confirm I have read the above and give my consent as legal guardian.