Health Information and Advice to Support An

CONFIDENTIAL Page 1 of 13

EHCP APPENDIX C
(2014) / /

HEALTH INFORMATION AND ADVICE TO SUPPORT AN

EDUCATION, HEALTH AND CARE NEEDS ASSESSMENT

Please use typescript or BLACK ink

This information is sought in accordance with the Children and Families Act 2014. The Local Authority is seeking advice as part of an Education, Health and Care needs assessment. In providing information the designated medical officer has a duty to co-ordinate the health response to provide an overarching report, or make sure that where there are reports from other health professionals, these are appended to thishealth advice.

Personal Details of Young Person

Full Name / Date of Birth
Address and
Post Code / LAC Status
Gender
Tel / Mobile
Parent / Guardian / Relationship
Parent Name and
Address
(if different from
above)
GP / NHS Number
School/Provider

Details of Person Providing this Information and Advice

Service
Organisation
Name of Practitioner / Designation / Grade
Email address / Tel No.
Date report requested / Date report submitted

Report Review

Report Author / Signature / Parents / Signature
Name / Name
Date / Date
Section A
Co-signed / Signature / Section B
Authorised / Signature
Name / Name
Designation / Designation
Date / Date

Report Guidance

ThisReport must be completed by all health professionals, who are requested to provide information and advice for the named child / young person’s Education, Health and Care Needs Assessment.

It is acknowledged that some professional groups may not have completed all the necessary assessments to make an informed recommendation on each area of need. In such circumstances please make a note on this Report that the section is not applicable or beyond the scope of the service.

Please ensure that all informationcontained within this Report can be supported with the appropriate assessments or evidence – any supporting evidence must be clearly indicated and attached to the Report.

Should it be necessary for the Local Authority to issue an Education, Health and Care Plan, all information submitted may be used in the content of the Final Plan and be subject to review and scrutiny by North Lincolnshire Clinical Commissioning Group (CCG). Please note that a member of the CCG may be required to contact you directly to explore further any information provided.

Section A must be completed for all requests.

Section B must only be completed when any identified objectives cannot be met from within the core service offer. If you intend to submit a request under Section B, please contact the Children’s Complex and Continuing Care Team on 01652 251028 or , prior to the submission date. The team will be able to offer further support and guidance and ensure that the correct information is submitted so a decision can be made within statutory time limits.

Please note that Section A must be countersigned by a senior member of staff. Section B (if applicable) must be countersigned by the Service Lead Practitioner or Service Manager.

Section A

1Details of Contact with Service

Referred By / Date
Reason for Referral
Date of Initial Assessment / Date of Last Contact(s)
Service and Frequency of Routine Contact

2Clinical Diagnosis/es

Clinical diagnosis related to your service area – please include date clinical diagnosis received, designation and organisation of assessor – please attach any supporting reports
Please describe any associated medical difficulties / diagnoses e.g. Down’s Syndrome etc.

3Health Needs

Please provide a brief summary of the child / young person’s health history and current needs – please attach relevant evidence / assessments

4Health Outcomes

Please identify what you consider to be the child or young person’s health outcomes and how they impact on the child / young person. Please note that you may not be able to comment on all areas and/or have several needs identified in one particular section – additional rows may be inserted to each table if necessary.

(a)Communication and Interaction

Summary of Need / Desired Outcome
(Please identify whether outcome is short term,
ie. within a year,
or long term,
ie.more than a year) / What support is required to achieve the
Outcome? / How often is the support to be provided and by whom? / When will it be reviewed and who will review it? / Can the outcome be supported within core offer?
Yes/No
(if No, please complete section B)

(b)Cognition and Learning

Summary of Need / Desired Outcome
(Please identify whether outcome is short term,
ie. within a year,
or long term,
ie.more than a year) / What support is required to achieve the
Outcome? / How often is the support to be provided and by whom? / When will it be reviewed and who will review it? / Can the outcome be supported within core offer?
Yes/No
(if No, please complete section B)

(c)Social, Emotional and Mental Health

Summary of Need / Desired Outcome
(Please identify whether outcome is short term,
ie. within a year,
or long term,
ie.more than a year) / What support is required to achieve the
Outcome? / How often is the support to be provided and by whom? / When will it be reviewed and who will review it? / Can the outcome be supported within core offer?
Yes/No
(if No, please complete section B)

(d)Physical and/or Sensory

Summary of Need / Desired Outcome
(Please identify whether outcome is short term,
ie. within a year,
or long term,
ie.more than a year) / What support is required to achieve the
Outcome? / How often is the support to be provided and by whom? / When will it be reviewed and who will review it? / Can the outcome be supported within core offer?
Yes/No
(if No, please complete section B)

5Social Needs

From your perspective, what are the child / young person’s social needs which impact onhis/her health – if you are unable to comment please indicate so.

Social Need – please describe how the child / young person’s health impacts on the child / young person’s health and social needs / access to activities / Desired outcome / What support do you recommend to meet the identified outcome

6Views on Health Provision in Your Clinical Area

Child / Young Person
Parents / Carers
Education Provider
(if appropriate)

7Required – please indicate as appropriate

Section B not applicable – outcomes met within core offer
Section B applicable as it is felt that provision outside the core offer is required in order to meet outcomes for the child / young person
End of Section A
Section B

For each of the outcomes identified in Section A 4 (a)-(d), which require provision outside core offer, the following information is provided – please complete an additional table row for each identified need and associated outcome.

Assessed need / Outcome required / Rationale as to why outcome need cannot be met within the core service offer / Implications of outcome not being met / additional input not being commissioned / Recommended service / therapy to meet desired outcome – include frequency / Evidence base of recommended intervention (please include any research papers / references) / Identified providers of intervention and associated cost

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DECLARATION

All required supporting documentation, including professionals’ reports, minutes of relevant meetings and any other evidence in support of this report, are attached.

Name
Signature
Date

Please return the completed Report with all supporting documentation and duly signed to:

The SEN Team, SEND/LACES, PO Box 35, Hewson House, Station Road, Brigg. DN20 8XJ

or e-mail in pdf format to