Information from Education/Training Providers to support parent/carer Education, Health and Care (EHC) Needs Assessment Request
CHILD/YOUNG PERSON DETAILS
Child/Young Person’s name / UPNGender / Choose gender. / Date of birth / Click here to enter a date. /
Child’s first language / Year group
Ethnicity / Religion
Current Course Name (if in post 16 provision) / Course Level & Year (if in post 16 provision)
Who has parental responsibility?
What is their relationship to child/young person?
Is the child looked after/in care to/accommodated by a Local Authority? / Yes/No
If so which authority
Is the child a ward of court? / Yes/No
Does this child have a Common Assessment Framework (CAF)? / Yes/No
Has consideration been given to completing a CAF? (applicable to under 19’s) / Yes/No
Is the child the subject of a Child Protection Plan? / Yes/No
Is the child the subject of a Child in Need Plan? / Yes/No
Is the child the subject of a Health Care Plan? / Yes/No
Has the signed consent form been sent together with this form? (An assessment request will be refused by default without parent/carer/young person consent evidenced) / Yes/No
If you have answered ‘Yes’ to any of the above, you must provide details/documents with this referral
FAMILY DETAILS(please include sheet with parent’s signature)
Address where child livesTel: Home / Tel: Mobile
Parent/Carer 1‘s name
/ Parent/Carer 2’s nameAddress (if different from child/young person’s above) / Address (if different from child/young person’s above)
Names of other carers (that the child/young person lives with) and their relationship to child/young person e.g. brothers/sisters
If the child is looked after by a local authority:
Name of social workerAddress
Tel no
Name(s) of foster parent(s)
Family home languagespoken
written
Does the education/training provider use an interpreter when meeting with parents? / Yes/No
Does the education/training provider use a translator when writing to parents? / Yes/No
Will there be other communication difficulties, e.g. visual/hearing difficulties, literacy etc. / Yes/No
(if yes, please give details):
EDUCATION/TRAINING PROVIDER DETAILS
Name of Education/Training ProviderAddress
Tel
SENCO (or N/A)
Tel
Form completed by
Position in school
Signed
Date / Click here to enter a date. /
This referral has been discussed withDate of discussion
Parent(s) / Click here to enter a date. /Educational Psychologist / Click here to enter a date. /
External specialist, e.g. Outreach teacher, therapists (give details) / Click here to enter a date. /
Headteacher / Click here to enter a date. /
Other / Click here to enter a date. /
The support services involved are:
Please indicate all support services with the name of the professional involved
Education psychologist / ☐ /Education Welfare Officer / ☐ /
Occupational Therapist / ☐ /
Physiotherapist / ☐ /
Psychiatric social worker / ☐ /
Psychiatrist / ☐ /
School medical officer / ☐ /
School nurse / ☐ /
Specialist (Outreach) teacher / ☐ /
Speech and Language Therapist / ☐ /
Social worker / ☐ /
Other
Checklist of evidence required to accompany education/training provider’s referral for statutory EHC Needs Assessment
Evidence needs to be included (attached) with the referral. If evidence is missing please explain why, e.g. very young child, immediate significant concern
Evidence of nature and severity of child/young person’s special educational needs. Evidence must include (please tick)
School’s chronological list demonstrating history of SEN Support model of “Assess, Plan, Do, Review”. / ☐ /Minutes/notes of SEN Support review meeting where decision was made to request an EHC Needs Assessment. / ☐ /
Additional evidence should be included where available (please note Y or N)
Records of Involvement by Educational Psychologist / Yes/No /Assessments by and advice from specialist teachers / Yes/No /
Checklists to identify particular difficulties in e.g. social communication or behaviour, such as those advised by educational psychologist or specialist teacher / Yes/No /
Pastoral Support Plan / Yes/No /
Speech and Language assessments and advice / Yes/No /
Advice from other health professionals / Yes/No /
First language assessment / Yes/No /
Details of the education/training provider’s special educational provision
Individual Education Program’s (IEP’s)The nature of special educational needs addressed in the IEPs should mirror the concerns described in the referral. The special educational provision identified in the IEPs should reflect good practice, for example that described in the Redbridge Guidance, and advice from external specialists.
If schools use a different method for recording short term targets, please include instead of IEPs. / Yes/No /
Evidence of progress
Examples of child/young person’s work / Aided, with explanation of support (+ date, explanation of task set, time taken to complete task) / Yes/No /Unaided written work
(+ date, explanation of task set, time taken to complete task)
Figure drawing / Yes/No /
Attainment levels, including P levels / Key Stage or other whole school measures of attainment used (with explanation) / Yes/No /
Any standardised assessments for literacy etc. / Yes/No /
Additional information
Child/Young person’s views / ☐ /Parent’(s)/Carer’(s) views / ☐ /
Recent attendance record (if a concern) / ☐ /
Involvement of social care / ☐ /
Other
Against the main headings, please indicate whether this area is a concern
Please indicate in which SENcategory you have recorded the pupil.
Type of Need / Tick if a concernCommunication and Interaction Needs:
Speech, Language and Communication Needs / ☐ /
Autistic Spectrum Disorder / ☐ /
Social, Emotional and Mental Health Needs:
Social, Emotional and Mental Health Needs / ☐ /
Cognition and Learning Needs:
Specific Learning Difficulty / ☐ /
Moderate Learning Difficulty / ☐ /
Severe Learning Difficulty / ☐ /
Profound and Multiple Learning Difficulty / ☐ /
Sensory and/or Physical Needs:
Visual Impairment / ☐ /
Hearing Impairment / ☐ /
Multi-Sensory Impairment / ☐ /
Physical Disability / ☐ /
Reasons for requesting statutory EHC NeedsAssessment
The blue text (in italics) provides guidance for completing the referral form and may be deleted before sending it to the LA. Please also refer to guidance on completing the form which explains what the Special Educational Needs Panel will be looking for.
Background
Brief relevant summary of education/training provider/family history/attendance
1Special Educational Needs (and strengths to build on).
This section is divided into areas of need
In each area please describe the nature and extent of the child/young person’s difficulties, and the impact on their access to learning. Also describe any strengths the child/young person has in these areas.
Please see guidance notes for more information.
Communication & Interaction
What are their communication & interaction needs (what can they do now and what do they find difficult)?
This area covers speaking and listening skills; receptive and expressive language; social use of language; non-verbal communication skills; use of signing
Social,emotional & mental health
What are their social, emotional & mental health needs (what can they do now and what do they find difficult)?
This area covers relationships with peers; relationships with adults; play skills; social skills; behaviour, within and outside the classroom, and impact of behaviour on others; self esteem; level of independence; ability to respond in an age appropriate manner.
Cognition & Learning
What are theircognition and learning needs (what can they do now and what do they find difficult)?
This area covers cognitive functioning; acquisition of concepts; Literacy and numeracy skills; educational attainment in other areas of the curriculum. It also covers learning style; ability to concentrate; memory; motivation; organisation and independence skills.
Physical and sensory
What are theirphysical and sensoryneeds (what can they do now and what do they find difficult)?
This area covers gross and fine motor skills; vision; hearing; mobility issues that affect access
Health Needs
What are their Health needs in relation to their SEN?
Education/training providers should seek information from parent(s)/carer(s)/young person regarding this section
Social Care Needs
What are their social care needs in relation to their SEN, including family friends and community?
Education/Training providers should seek information from parent(s)/carer(s)/young person regarding this section
2 Parent/Carer involvement
What do parent(s)/carer(s) think about their child/young person’s needs?
How have the parent(s)/carer(s) been involved in designing, implementing and reviewing the child/young person’s special educational provision?
3 Child/young person’s views
What does the child/young person think about their difficulties?
How has the child/young person been involved in designing, implementing and reviewing their special educational provision?
4The education/training provider’s special educational provision
Please explain the success or otherwise of the education/training provider’s special educational provision, including the input from other agencies. Please refer to the SEND Code of Practice
Questions relating to provision may not be wholly relevant for all children/young people, for example very young children or those who have moved into a school and are causing immediate and significant concern. Please adapt your report accordingly.
How do you meet the needs of the child/young person?
- Inclusion strategies
- Adaptations to curriculum
- Adaptations to environment
- Specific resources
- Intervention programmes
Does the child/young person need additional support or strategies at playtimes, lunchtimes, or for extra-curricular activities?
If the child/young person has a disability what steps have been taken to avoid them being placed at a substantial (more than trivial) disadvantage? (Disability Rights Commission, Code of Practice)
What specific programmes and teaching methods have been successful, and why?
What specific programmes and teaching methods have been unsuccessful, and why?
What additional support (LSA/teacher time) has been put in place and for how long?
What use has education/training provider made of ICT to address the child/young person's particular SEN?
(This question relates to specific ICT to support a child/young person’s SEN and not to the school’s ICT curriculum)
What involvement has there been from external agencies?
Please include explanation of each agency’s involvement. Please include any reports with referral.
Educational Psychologist
- Advice received
- How it has been implemented?
- How successful it has been?
Health professionals
- Advice received
- How it has been implemented
- How successful it has been
Social care professionals
- Advice received
- How it has been implemented
- How successful it has been
Other agency
- Advice received
- How it has been implemented
- How successful it has been
Other agency
- Advice received
- How it has been implemented
- How successful it has been
Ensure there is supporting evidence to accompany your referral
5Evidence of child/young person’s progress
Please describe the child/young person’s progress over time and include evidence on the Attainment Form and examples of their work
Explain how the child/young person’s progress is being monitored.
Describe areas of the curriculum where you believe the child/young person has not made adequate progress.
Refer to all the core areas of the curriculum and other areas where there are particular problems, e.g. PE if there are motor difficulties. It may be helpful to specify the child/young person’s programme of study are being taken from e.g. a different key stage, an individual programme of study, P levels if appropriate.
Explain whether the child's performance is different in different environments
E.g. with different teachers, peer groupings or in structured/unstructured times.
Questions relating to progress may not be wholly relevant for all children/young people, for example very young children or those who have moved into a school and are causing immediate and significant concern. Please adapt your report accordingly.
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