A mapping review of sustainable transformations to reduce waiting time for speech and language therapy (SALT) or neurodevelopmental assessment within a community paediatrics service [version 1; peer review: awaiting peer review]

Background

This mapping review aimed to identify approaches to reduce waiting times for assessment, support children/young people and their families during waiting periods, and improve early identification of Speech and Language Therapy (SALT) services and neurodevelopmental assessment in community paediatric settings.

Methods

Methods included a systematic search of literature published between 2020 and February 2025, supplemented by grey literature searches and consultation with stakeholders, for UK studies and studies from similar healthcare systems (e.g., Australia and Canada).

Results

Nineteen studies comprising randomised controlled trials, implementation studies, case studies, and service evaluations were included. To reduce waiting times within paediatric community health services, the Specific Timely Appointments for Triage (STAT) model and the “balanced system” approach demonstrated reductions in waiting times. For Attention Deficit Hyperactivity Disorder (ADHD) assessment incorporating the QbTest accelerated diagnosis. Autism services saw reduced waiting times through service redesign. The establishment of a single neurodevelopmental pathway also showed promise for reducing waiting times. Complex cases took longer, suggesting the potential for initial triage to identify these children or young people. Support during waiting periods showed mixed results, with limited evidence for information provision alone and the potential tension of increased requests for help, which could increase waiting time. Key facilitators included multidisciplinary teams and streamlined processes, whereas finances and staffing were common barriers. The limitations of the included evidence were small sample sizes, limited demographic diversity, lack of cost information, and minimal long-term outcome data.

Conclusions

Multi-faceted approaches combining service redesign, improved initial triage/screening, and targeted support during waiting periods may be the most effective in addressing the challenges of long waiting lists for SALT and neurodevelopmental assessment service provision. Implementation of promising models should continue alongside robust evaluation to build the evidence base for addressing waiting list challenges in paediatric community services.