Specialist Advice and Resources Service (SARS)
REFERRAL TO SARS WITH REQUEST FOR ADVICE
Child or Young Person’s (CYP) Details
Name: / NC YearPreferred Name:
Date of Birth:
Male/Female:
Religion:
Preferred Method of Communication:
Parent(s) Name: / Parent Name (if different address):
Address: / Address:
Telephone Number: / Telephone Number:
E-mail: / E-mail:
Preferred method of Communication: / Preferred method of Communication:
Parental Responsibility:
Address:
Telephone Number:
E-mail:
Preferred Method of Communication:
Provision/School/Nursery: / Tel:
SENCO: / Class Teacher/Key worker: / Head Teacher:
Referral made by: / Date:
Referral Reason (highlight as appropriate):
Annual Review / Medical / EPS / Other Reasons
New to Area / Access / CAF/GIR
Equipment / SARP Panel / Pre-School Referral
Emergency Action / CWAN
Request for advice from (highlight as appropriate):
Physical and Sensory Team / Communication Learning and Autism - CLAS / Early Years
Hearing / ASD / Portage
Visual / SLD / EYIP
Physical / L&C
Medical / SLCN
Is the CYP at School Action Plus/School SEN
Has the CYP got a Statement/EHCP? / Date:
Have you received permission from parents for this referral and do they understand that this information may be shared with other professionals? / Date permission received:
How the permission was obtained:
Who obtained the permission?
Has the pupil got a Tell Me Once Document – please attach
Has the pupil got a One Page Profile – please attach
Other Professionals involved with this CYP please complete as much as possible:
GP Name:Address:
Telephone Number:
Consultant Name:
Address:
Telephone Number:
Consultant Name:
Address:
Telephone Number:
Educational Psychologist Name:
Address:
Telephone Number:
Social worker Name:
Address:
Telephone Number:
E-mail:
Speech and Language Therapist:
Address:
Telephone Number:
Physiotherapist:
Address:
Telephone Number:
Occupational therapist
Address:
Telephone Number:
E-mail:
Other:
Address:
Telephone Number:
Other
Address:
Telephone Number:
What is the reason for this referral?
What are the anticipated outcomesfor the CYP from this referral?
What other advice has been sought?
What additional support has the school put in place already? Please provide evidence of support.
‘Teacher’s are responsible and accountable for the progress and development of the pupils in their class.’ (SEN CoP 2014).
In deciding whether to make special educational provision the Teacher and SENCO should consider all the information gathered from within the school about the CYP’s progress this may include drawing on more specialised assessments. Parents and CYP should be involved in this process and records kept of all meetings held.
If a decision is made that SEN provision is required the desired outcomes should be identified and agreed with CYP and parents. This will help determine the support required. Once this support is agreed clear dates for reviewing progress should be agreed by parents CYP and teaching staff. (Summarised from SEN CoP 2014).
Who / Assessment / Plan / Do / Review
Class subject teacher / Observes a difficulty / Discusses with other class staff and CYP and agree how to make adjustments to address difficulty / Makes adjustment to class routine/environment to address difficulty.
Move CYP to different group / Difficulty addressed no further action
Difficulty not addressed go to cycle 2.
Class
subject
teacher and SENCO / Established clear analysis of pupil needs
The SENCO supports the class teacher to establish a clear analysis of the pupils needs / Parents notified
Agree adjustments, interventions support , (e.g. small group work, additional SSA support, environmental changes etc). and expected impact on progress development and behaviour
Inform all teachers and support staff
Support and intervention should be based on reliable evidence of effectiveness and provided by staff with sufficient skills and knowledge.
Parents made aware of the planned support and parental involvement if necessary
Agree date for review / The class teacher takes responsibility for managing and liaise with any other teachers, support staff or specialist staff involved to plan and assess the impact of the support and interventions
SENCO – supports the class teacher in further assessment, problem solving and advising on the effective implementation of support / The class teacher working with the SENCO will assess the impact of the support provided.
Revisions can be made in light of the pupil’s progress and development in consultation with the parent and CYP
NC levels for last 2 years / NC Year / NC Year
English
Reading
Writing
Maths
Is the CYP working within: please tick / The top group / The middle group / The bottom group
Do you feel the CYP is making appropriate progress
Please include any additional information you may feel to be relevant
How would you describe the CYP behaviour: please tick / Quiet / Quiet but contributes to class discussion / Confidently contributes in class / Over confident
Please include any additional information you may feel to be relevant
For completion by SARS team:
Service Coordinator – please highlightPaul Boldy / Angela Crawforth / Carly Fitzpatrick / Janette Weafer
Outcome of Referral / Accepted/Declined
Reason why?
Next step
Allocated Key Worker
FOR ADMIN USE ONLY
Date admin informed: ……………………………………………………………………………………………………………….
Admin informed by: ………………………………………………………………………………………………………………….
Date inputted on EMS: ………………………………………………………………………………………………………………
Date inputted on database: ………………………………………………………………………………………………………...
Admin