Request for EHC needs assessment for schools Web viewChildren & Young People’s Services. Vulnerable Learners including SEN. November 2014 . Education Directorate. EDUCATION, HEALTH

Children & Young People’s ServicesVulnerable Learners including SEN

November 2014 EDUCATION, HEALTH & CARE NEEDS ASSESSMENT

Request must be typed/word processed. Please ensure that you have read the guidance provided before completion.

Please tick whether this form is:

A Request for an EHC Needs Assessment:

OR this is New or Updated Submission of Statutory Advice:

New Updated

Date of Request: Date of updated submission:

SECTION 1 – CHILD’S/YOUNG PERSON’S PERSONAL DETAILS 1.A. Child’s/Young Person’s names/personal details

Child’s/Young Person’s Legal Surname: Forename(s):

Surname also known as (if applicable):

Prefers to be known as:

Date of Birth: Gender: Male Female

Address of Child/Young Person(including Postcode):

If Young Person has reached the end of Y11 or is older, do they want to be involved and contacted directly (also see Section 1E)? Yes* No

If YES, add tel no/mob no, email & address (if different from above):

1.B. Child’s/Young Person’s Current Educational Setting & Care Status

Setting Name:

Setting Address (& Postal Address if different)(including Postcode):

Setting Tel No:

Date of Admission to current Setting: NCY:

Has the child/young person been placed out of their chronological year? No Yes* * If yes, in

which year?

Child in Care? Is the child subject to a care order or any other court order? Yes* No

* If Yes, Please give details of the nature of the order and the name/contact address/telephone of the allocated Social Worker:

1.C. Parent/Carer/Other details (names and addresses of ALL persons who hold parental

EHC Needs Assessment – Request Form or Submission of Statutory AdvicePage 1

responsibility under Children & Families Act 2014). Append a separate sheet if necessary

PARENT/CARER DETAILS 1 PARENT/CARER DETAILS 2Title: Title:

Family Name: Family Name:

Forename(s): Forename(s):

Address (including Postcode):

Address(including Postcode):

Telephone(Home):

Telephone(Home):

Telephone(Mob or Work):

Telephone(Mob or Work):

Email address: Email address:

Relationship Relationship

Any Communication Difficulties?

Any Communication Difficulties?

1.D. Language & Religion of child/young person: Home Language(s):

Preferred Language:

Religion: Interpreter needed? Yes No

1.E. Other information relevant to child’s/young person’s needs:Has a Common Assessment Framework (CAF)/Early Support Plan been completed on this child/young person? Yes* No

* If Yes, please name the keyworker and attach a copy of the CAF/Early Support Plan (having obtained parental agreement to forward the form):

CAF Attached?

Yes NoHas the child/yp had any support from Children’s Social Care in the past year? Yes* No* If Yes, IMPORTANT please name the social worker involved below and PLEASE OBTAIN PARENTAL AGREEMENT for Children’s Social Care to share information with us by asking the parent/carer to sign section 6.C. at the end of this form:

Name/tel no of Social Worker:

Has the child/young person received short breaks during the past year? Yes No

Is the child/young person from a Services (Armed Forces) family? Yes No

Is the child/young person from a Traveller family? Yes No

From the end of Y11 onwards, a young person may wish to be fully involved in the process and be supported by a family member or friend who will, for example, receive correspondence on their behalf, fill in forms, attend meetings, make telephone calls and help make decisions.If this is the case, is this person the Parent/Carers in Section 1c? Yes No*

* If NO, please provide details (name/address/tel no/ email/relationship) of ‘support person’ & attach this as an appended sheet –

Support Person Appended sheet?

Yes NoDoes the young person want the ‘support person’ to receive correspondence on their behalf? Yes No

1.F. Views, Interests, Background and Communication

Details of child’s/young person’s views, interests, skills and hobbies:


Details of child’s/young person’s background/history including factual information about the family context if considered relevant:

How to communicate with and engage the child/young person:


SECTION 2 – DESCRIPTION OF SPECIAL EDUCATIONAL NEEDS, DEVELOPMENT, LEARNING, PROGRESS AND ATTAINMENT2.A. ATTAINMENT AND PROGRESS IN MAIN CURRICULUM AREAS Please complete table to record long-term attainment/progress using EYFS / P Scales / NC / GCSE unsupported levels and indicating end of KS/teacher assessment. Please provide age equivalent or standardised scores if you prefer. Indicate TA, if Teacher Assessment.

Please attach more detailed information if required regarding tracking, e.g. use of CASPA in special schools

Equivalent format can be provided as long as it shows the child’s attainment and progress over time

Subject Area (or EYFS area)

(Include subjects below as appropriate)

Previous year Last year Current year Comment on progress Indicate the next steps (include EYFS/NC target level for end of year)

Date: Date: Date:


2.B. FOUR BROAD AREAS OF NEED & SUPPORT MEETING THE BOURNEMOUTH CRITERIA OF EHC NEEDS ASSESSMENT

Explain how the child/young person meets the Bournemouth criteria for EHC needs assessment with reference to the four broad areas of need and support (include strengths and needs).

COMMUNICATION AND INTERACTION:

COGNITION AND LEARNING (add here any general information in addition to Section 2A Attainment & Progress table above)

SOCIAL, EMOTIONAL AND MENTAL HEALTH:

SENSORYAND/OR PHYSICAL NEEDS:


2.C. DEVELOPMENT AND LEARNING, PROGRESS AND ATTAINMENT - Areas of strength:

(For Early Years & Reception Children, please refer to the EYFS Curriculum)

Reading:

Writing:

Maths:

DEVELOPMENT AND LEARNING, PROGRESS AND ATTAINMENT - Areas of need:

(For Early Years & Reception Children, please refer to the EYFS Curriculum)

Reading:

Writing:

Maths:

How child/young person communicates and interacts – Areas of strength:

How child/young person communicates and interacts – Areas of need:

How child/young person feels and gets on with others – Areas of strength:

How child/young person feels and gets on with others – Areas of need:


2.D. LONG TERM ATTAINMENT RECORD USING AGE EQUIVALENT SCORES (last three years)

PREVIOUS YEAR LAST YEAR CURRENT YEAR

Subject Area Test Used Date Used Age at

Test

Age Equivalent

ScoreTest Used Date Used Age at

Test

Age Equivalent

ScoreTest Used Date Used Age at

Test

Age Equivalent

Score

Reading

Spelling

2.E. LONG TERM ATTAINMENT RECORD USING STANDARDISED SCORES (last three years)

PREVIOUS YEAR LAST YEAR CURRENT YEAR

Subject Area Test Used Date Used Standardised Score Test Used Date Used Standardised Score Test Used Date Used Standardised Score

Reading

Spelling


2.F. SCHOOL ATTENDANCE DETAILSPlease list the name and dates of all schools attended in the last 18 months along with percentage attendance levels for the last 12 months:

School Name(start with current school then list previous schools in last 18

months)

Attendance From Date:

Attendance to Date:

For the past 12 months only, please give actual attendance figures over the last three terms

(including the present term). PLEASE ATTACH ATTENDANCE PRINTOUT.

Term/Year Term/Year Term/Year

Has the child/young person had any fixed term exclusions during the past year?

* If Yes, please list dates and reasons below:

YES* NO


SECTION 3 – HEALTH & SOCIAL CARE NEEDS

3.A. Health Needs

Health (including mental health), physical development and sensory needs (related to SEN)

Areas of strength:

Areas of needs:

Other health needs

Areas of strength:

Areas of needs:

Self help and skills for independence (related to health needs):

Areas of strength:

Areas of needs:

3.B. Social Care or Early Help Needs

Social Care needs (relating to SEN) - Please complete this section if Social Care or Early Help Services are involved with the child/young person

Areas of strength:

Areas of needs:


SECTION 4 – DESIRED OUTCOMES

4.A. Briefly state the desired outcomes for the child/young person.

The following outcomes have been discussed with the parent/carer and, where appropriate, with the child/young person:

The following shorter term targets have been discussed with the parent/carer and, where appropriate, the child/young person.

Briefly state (for young people in Year 9 and above only) how the young person is being prepared for post 16 education and/or training opportunities.


SECTION 5 – CURRENT PROVISION MADE (SPECIFIC/QUANTIFIED/COSTED) AND RESULTANT PROGRESS TO MEET SEN

5.A. SCHOOL SEN SUPPORT Attach the SEN SUPPORT PLANS (SSP)SSP Start Dates SSP Review Dates

Provide dates for the two most recent SEN Support Plan (SSP) or equivalent documents and reviews. Attach copies of these. Ensure they are signed, dated and reviewed. They should show evidence of current provision which is regularly reviewed to reflect the child’s/young person’s needs.

5.B. COSTED PROVISION

Details of existing provision (including specialist programmes) including from setting or Local Authority, e.g. Outreach Service, Inclusion Services and Health provision. Complete table below and indicate costs:

Level What is provided? Frequency Provided by Whom? Evidence (e.g. Timetable/Costed Provision Map)

COSTINGS

(This information is ESSENTIAL)

Whole Class

Small Group

Individual

Please provide details below of any training courses relevant to the needs of this child/young person that teachers/TAs/other staff have attended and/or training resources that have been used, e.g. Inclusion Development Programme (IDP), within the last 18 months:


5.C. Child’s/Young Person’s progress in response to provision

Why is an Education, Health & Care (EHC) Needs Assessment being requested now?

What effect has SEN Support had on the child’s/young person’s progress?


5.D. How have Specialist Support Services or outside agency input been used to develop provision – graduated response?

Examples of services/agencies are Educational Psychology Service, Learning Support Service, Behaviour Support Service, Hearing & Vision Support Service, Educational Welfare Service, Children’s Social Care, Therapists, Tuition Service, EMTAS, CAMHS, Other.

Involved since (date)

Name of each professional involved/contact details

Service / Agency

Recommendations Action by school – targeted intervention

Outcome achieved for child/young person


SECTION 6 – COMPARISON WITH CODE OF PRACTICE CRITERIA FOR EHC NEEDS ASSESSMENT & IDENTIFICATION OF PRIMARY NEED & OTHER NEEDS RANKINGSee Code of Practice 2014, along with the Bournemouth Special Educational Needs Criteria

6.A. Please indicate the PRIMARY NEED with a 1 and, if more than one need, please rank the others in terms of significance (you should discuss this with your Educational Psychologist):

Need Ranking Please indicate below any diagnosed medical conditions (these are not primary needs): for example ADD, ADHD, Cystic Fibrosis, Downs, MS, MD, Epilepsy, etc)

Social, Emotional & Mental Health Difficulties (SEMHD)Cognition and Learning: Moderate Learning Difficulties (MLD)Cognition and Learning: Severe Learning Difficulties (SLD)Cognition and Learning: Specific Learning Difficulties (SpLD)Cognition and Learning: Profound and Multiple Learning Difficulties (PMLD)Communication & Interaction: Autism (including Asperger’s syndrome) (ASD)Communication & Interaction: Speech, Language & Communication Difficulties (SLCN)Sensory or Physical Needs: Physical Difficulty (PD)Sensory or Physical Needs: Hearing Impairment (HI)Sensory or Physical Needs: Visual Impairment (VI)Sensory or Physical Needs: Multi-Sensory Impairment (VI)


SECTION 7 – CHECKLIST OF ESSENTIAL ATTACHMENTS FOR REQUEST FOR EHC NEEDS ASSESSMENT

Document RequiredDocument Attached?

YES

Document Attached?NO

please indicate why document is missing

7.A.2 most recent SEN Support plans and Reviews at SEN Support (or the provision map with evidence of impact)

7.B. Copies of assessment information, e.g. reports or letters from SENCOs, test results

7.C.Evidence that the Educational Psychologist has been involved in planning the interventions and reviewing progress (must be within the last six months), i.e. (Joint Action Plan and Joint Review forms)

7.D.

Reports or Records of Involvement from other Local Authority Inclusion Services, Children’s Social Care, Outreach and from Health (e.g. Speech & Language Therapist (SaLT); Physiotherapist, Occupational Therapist, Paediatrician, Psychiatrist)

7.E. Pastoral support plans, where appropriate

7.F. Behaviour Management Plan/Positive Handling Plan, where appropriate

7.G. Risk Assessment, where applicable

7.H.

The Child’s/Young Person’s One Page Profile or similar document

Child’s/Young Person’s View – the child/young person should be encouraged to contribute. This may be done either through the school or via the parent in a format appropriate to the child’s/young person’s needs – either a One Page Profile or similar document:

7.I.

The Parent/Carer’s ‘My Child, My Story’ or similar document

the parent(s)/carers should be encouraged to submit a written contribution detailing their perception of their child’s difficulties and needs. Copies of a leaflet ‘My Child, My Story’ can be obtained from the SEN Team to help them do this. The Parent Partnership Service will also help parents to write their contribution.


SECTION 8 – AUTHORISATIONS

8.A. Headteacher/Manager/Principal

I confirm that, having followed the procedures outlined in the Code of Practice, the setting is making this request for EHC Needs Assessment.

I confirm that the Educational Psychologist is aware of this request and has been involved in supporting the setting to meet this child’s/young person’s needs. Evidence of Consultations, Records of Involvement, etc are enclosed, along with evidence of graduated response.

Headteacher/ Manager / Principal:

Name (BLOCK CAPITALS): Signature: Date:

8.B. Parent/Carer

I support this request for EHC Needs Assessment. I agree that my child can be discussed and relevant information shared by all agencies involved in the EHC Needs Assessment process, if the process goes ahead, including the Education Services, the Health Service and Social Care.

I confirm that I consent to psychological and medical reports being obtained for my child if the process goes ahead.

Parent(s)/Carer(s)

Name(s) (BLOCK CAPITALS) and Relationship to child/young person:

Signature: Date:

8.C. OR Young Person (FROM END OF Y11)

I support this request for EHC Needs Assessment. I agree that information about me can be discussed and relevant information shared by all agencies involved in the EHC Needs Assessment process, if the process goes ahead, including the Education Services, the Health Service and Social Care.

I confirm that I consent to psychological and medical reports being obtained for me if the process goes ahead.

Young Person:

Name (BLOCK CAPITALS): Signature: Date:

This form was developed using a Pan Dorset approach. Information provided may be processed electronically and used for administrative, audit and quality

assurance purposes.


SECTION 9 – HOW AND WHERE TO SEND THIS FORM

Please send your fully completed form and attachments as follows:

1. HARD COPY VIA POST/ INTERNAL COURIER:to The SEN Team, Floor E3, Town Hall, Bourne Avenue, Bournemouth, BH2 6DY

2. VIA SECURE EMAIL:You may send this form electronically, by attaching to email and also scanning the Authorisation Pages and Attachments. Please put in the Subject Line either: Request for an EHC Needs Assessment OR Submission of Statutory Advice

BUT YOU MUST USE SECURE EMAIL

HOW? a) Email is secure if you have a bournemouth.gov.uk email address. Simply send to:

[email protected]

OR

b) Email is secure if you send via a Clearswift account – a secure website portal where you set up an account with your email address and password. If you don’t have a Clearswift account set up with us, please call the SEN Team on 01202 456168.


mailto:[email protected]

Request for EHC needs assessment for schools Web viewChildren & Young People’s Services. Vulnerable Learners including SEN. November 2014 . Education Directorate. EDUCATION, HEALTH

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