Child/Young Person’s Name: / DOB:
Lead Professional (LP): / Agency:
LP contact details: / Date of Plan:
People Present
Name / Relationship to Child/Young Person/Agency / Contact Details
Following on from the Assessment and Analysis of the situation, in Part B: what is the future that you would like to see?
Please write here yourGoal Statement(s)and a scale of where you think you are at this moment in time.
Please use child/young person friendly language to write the goal statements.
I would like to be able to communicate my needs to other people and understand what they would like me to do.
0
Worst / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10: GOAL!
In relation to the Goal Statement, on a scale of 0 to 10 where is your score?
√
Building on your assessment, discuss with the child, young person and parent/carer(s) the things they would like to change or work towards in order to progress with their goal statement(s).
Goal statement: / What needs to happen now?(Small step actions) / Who needs to be involved and for how long? / How will we know if things are working? What shall we use as evidence of success? / Review date
1. I need to have my hearing looked at as I failed my last hearing test / A referral is being made for me to attend GWH clinic
People will need to make sure they have eye to eye contact with me to make sure I have heard them
I may need to be in a quiet place if you want me to listen to you and stay focussed / Clinic to refer me for an ENT apt
All people working with me and all people I see outside setting / I will have an appointment and my hearing will improve / July 2015
2. I will take part in 2 adult-led activities when I attend each session / Sometimes I find it hard to settle to an activity chosen by an adult before I have had time for physical activity. To help me with this I will take part in 2 adult-led activities each session after I have had some physical play either inside or outside. I will be shown 2 pictures and I will choose which one I will put first on my ‘first and then’ board. The adult will decide when I have finished the activity ready to move onto my second choice / All settings to use ‘first and then’ board after I have had some physical play / I will happily and willingly take part in adult-led sessions when shown my ‘first and then’ board / July 2015
3. I would love all staff at my settings to attend signalong training and use signing with other children so they can understand my communication with them / Setting manager to arrange training for all staff as soon as possible
All staff use signalong consistently throughout all sessions to get all children confident in using and interpreting the signs / I am able to communicate effectively with staff and children using signalong / July 2015
4.
Notes:
Child/young person’s views. Do you know what is going to happen now? Do you know what is expected of you and others?
Signed: / Date:
Parent/Carer’s views. Do you know what is going to happen now? Do you know what is expected of you and others?
Signed: / Date:
Lead Professional
Signed: / Date:
Record if TAC/F Open or Closed: / Choose an item. / Date of review: / Click here to enter a date. /
Change of Lead Professional
Name: / Agency: / . / Contact Details:
Date: / Click here to enter a date. /
Please send a copy of the Plan to:
Family Contact Point (FCP)
01793 466903
Please remember to use secure e-mail or WinZip and Password Protect
1 / Children, Families and Community Health. EHR Part C Version 2:29/08/14