About the CWPT Community Learning Disability Team Dietetic Service

Coventry & Warwickshire Service Pathway Referral Criteria: 

The Specialist Dietetic service within our CLDTs is a Tier 3 intervention

It is reserved for individuals whose nutritional needs cannot be met by mainstream primary or secondary care services, even when reasonable adjustments are attempted

This level of support is necessary when the person’s learning disability creates significant barriers to standard treatment, requiring significant “reasonable adjustments” or a multidisciplinary approach

We are a small team of specialist dietitians who support the delivery of dietetic intervention alongside other Learning Disability specialist clinicians in our community learning disability teams across Coventry and Warwickshire

1. Core Eligibility

Before clinical triggers are assessed, the individual must meet the service baseline criteria:

• Age: ≥18
• Diagnosis: Evidence of a moderate to profound learning disability (as defined by significant global cognitive impairment and deficits in adaptive functioning). An IQ typically below 70
• Mainstream Exhaustion: Evidence that Tier 1 (GP) or Tier 2 (General Community Dietetics) has been unable to meet the need

2. Reason for LD specialist dietitian intervention

To ensure the capacity of our specialist team is directed to those most in need, referrals must meet at least two of the following complexity markers:

 

3. Clinical Priority Triggers

A referral is indicated when the individual’s nutritional health is at risk due to their learning disability

We prioritise referrals for the following specialist clinical needs:

• Nutritional Failure: Individuals with high MUST (Malnutritional Universal Screening Tool) scores or rapid unintentional weight loss who require specialist LD-specific intervention to reduce the risks of malnutrition
• Health Inequalities: Managing complex comorbidities (e.g. Diabetes, Coeliac disease or obesity) where cognition or behavioural barriers due to the learning disability are a primary barrier to standard dietary advice and treatment
• Complex Dysphagia: Nutritional management for those on IDDSI-modified diets (textures 3-7) to prevent aspiration or malnutrition (often in partnership with SLT)
• Complex Enteral Nutrition: Provide in reach support to Community Physical Health Services where cognitive or behavioural factors due to the learning disability impact tube safety and tolerance

Clinical Referral Criteria

Referrals are typically accepted for the following nutritional and health concerns:

Underweight & Malnutrition

• High Risk (MUST score ≥ 2): Identified via the Malnutrition Universal Screening Tool
• Unintentional Weight Loss: Loss of >5-10% of body weight within 3–6 months
• Low BMI: Typically a BMI < 18.5 or BMI < 20 with other health concerns.
• Poor Intake: Significant concerns regarding appetite or volume of food consumed

Overweight & Obesity

• High BMI: Often a BMI > 35 (or BMI > 30 with comorbidities like Type 2 diabetes, hypertension, or sleep apnoea)
• Syndrome-Specific Management: Support for specific conditions like Prader-Willi Syndrome or Down’s Syndrome, where weight management is a primary health risk
• Antipsychotic Weight Gain: Rapid weight gain linked to medications commonly used in LD services

Eating, Drinking, and Swallowing (Dysphagia)

• Modified Diets: Referrals are often made in conjunction with Speech and Language Therapy (SLT) for patients requiring IDDSI-level modified textures 3-7
• Enteral Feeding: In reach MDT working is required to support Community Physical Health Services for patients who are tube-fed (PEG, JEJ) and due to the learning disability cognitive or behavioural factors are impacting tube safety and tolerance

Long-Term Conditions

• Diabetes: Poorly controlled Type 2 diabetes where mainstream education (e.g., DESMOND) is not accessible
• Gastrointestinal Issues: Chronic constipation (very common in LD), IBS, Coeliac disease, or GORD (reflux)
• Nutrient Deficiencies: Confirmed deficiencies (e.g., iron, calcium, vitamin D) that require specialist dietary planning

Guidance for Referrers

When submitting a referral, please state:

1. How the learning disability impacts the person and what are the specific barriers prevent them from using a mainstream GP or community dietitian? (e.g., severe anxiety in clinics, inability to follow verbal instructions, or need for 1:1 behavioural support)

2. Has a referral to mainstream dietetics already been attempted? If so, what was the outcome or why did it fail?

3. Which other CLDT professionals are currently involved in the person’s care

4. The specific nutritional risk (e.g., weight loss, choking risk, or tube complications).

Accompanying Information for Referral

As well as the above please include:

Observations Current weight, height, BMI, and weight history (recent losses/gains).

Social Context Who supports the person with shopping and cooking? (e.g., 24-hour care, living with parents).

Communication How does the person communicate? Do they use PECS, Makaton, or easy- read materials?

Clinical Data  Any recent blood results (HbA1c, lipids, U&Es) and a full medication list

Reasonable Adjustments Does the patient need a home visit, a quiet clinic, or a double appointment slot?