OUR STORY

(Appendix A First Version)

Child or Young Person’s Details

Surname / DOB
First Names / Gender
Home Language
Name of Parents/Carers
Home
Address
Telephone Number
Email Address
Name and Address of GP
NHS Number
Present Setting, School or College.
Other early years setting, school, college attended.

We would like to hear your views about your child to help decide whether a statutory assessment for an Education, Health and Care is needed. A copy of this will be sent to professionals who may contactyou should we decide to go ahead with a statutory assessment. If there are particular professionals whom you would like us to contact please let us know. If an EHC plan is agreed the advice, information and views in this document will inform the writing of the plan.

Our Story Guidance
This form is the place for parents and carers to explain the family ‘story’ which includes background information as well as abilities and needs. As appropriate, the child or young person’s views will be gathered separately. It is important that parent/carer views are heard and understood. Please refer to the guidance notes below when completing each section of the form. The form should highlight relationships, describe the young person’s strengths and needs, what is working well and what is not working well, what is important to them and for them and parent/carers hopes for the future.
SECTION A: Your Child’s History / In this section, it would be helpful to describe your child’s family background. You may wish to include information about the following:
  • Pregnancy/birth history and any complications.
  • Family situation – Who does your child live with now? Has your child lived with anybody else previously? Does your child have siblings in/outside of the home? Is your child adopted or are fostering him or her? Are there any other significant family members or friends?
  • Relevant experiences which may be useful for professionals to be aware of – e.g. bereavement, trauma etc.
  • Your child’s previous strengths and achievements

SECTION B: Your Child at the present Time
General health. / Describe any medical diagnoses or conditions; regular medication; hospital appointments attended in the last year ;assessment or interventions from any health professional in the last year. (E.g. Speech and Language Therapist, Occupational Therapist, Physiotherapist, Community Paediatrician, CAMHS)
Physical skills / Describe any difficulties your child has with movement. (e.g. walking, balance, coordination); visual, hearing or sensory impairment; any aids to help with physical skills e.g. splints, walking frame, wheelchair, cochlear implant, guide dog, long cane etc and adaptations to the home to help support your child’s physical needs.
Self Help Skills / Describe your child’s level of independence when feeding, washing or dressing. Do they need any help needed with personal care and/or toileting.
Communication
Skills / Describe how your child communicates their wants and needs? (e.g. using words, sounds, sign language, Makaton, gestures, eye pointing, PECS, assistive technology)
Play, Learning, Hobbies and Interests at home / Describe what your child likes to do at home; how and what they like to play and any preferred sensory experiences.
Activities and Leisure outside of the home / Describe any clubs/groups your child attends and their level of independence in activities outside the home
Relationships / Describe who is important to your child and any special relationships.
Behaviour / Describe how your child responds to other children and adults; how your child responds to different environments; how your child displays anxiety and what makes your child happy?
Learning / Describe your child’s current learning or development progress and any concerns you have about their learning progress.
General Views / Use this section to describe anything about your child and their needs which has not already been mentioned elsewhere on the form.
Next Year / Describe: what you would like your child to achieve in the next twelve months. Whatdo you think needs to happen to make this possible?
Long Term / What you would like your child to achieve in the next few years e.g. By the time they leave nursery/primary school/secondary school, college?
Key people involved with my child. / List all key people involved with your child.Include family members, friends and professionals.

Professionals involved with my child

Name / Job Title / Contact Details

Family and Friends important to my child

Name / Relationship

I consent to this information being shared with other professionals in order to consider whether and EHC statutory assessment is needed.

Name: ______

Relationship to child: ______

Signature: ______

Date: ______

Cheshire West and Chester Council

SEN Assessment, Monitoring and Support Team

Council Offices

2nd Floor

Civic Way

Ellesmere Port

CH65 0BE

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