Education, Health and Care Needs Assessment

Application Form:

Education, Health and Care Needs Assessment

Application for
Date of birth / Year group
Completed by
Designation/role
Setting/School /College
Date of application
Date application received by SEN team

Contents

Part1:Personal Details

Personal information relating to the child or young person and their family members and carers which will be included within the draft EHCP.

Part2:‘All About Me’

A holistic view of the child or young person, from the perspective of the child or young person and those closest to them. There is guidance on how this can be achieved in the Local Offer. This information will be included within the draft EHCP.

Part3: Education, Health and/or Carestrengths, needs and support

Evidence of the child or young person’s strengths, needs, what has been done to address needs and the impact of the support provided

Part4: Reports and assessments

Reports and assessments submitted with this application that provide the evidence of the child or young person’s needs and the support received

Part 5: Desired outcomes

Description of the desired outcomes and benefits for the child/young person to be supported through an EHC Plan.

Part 6: Additional considerations

Description ofother factors relevant to the application.

The special educational needs case work team is available to support you in preparing your application. Please email or contact your SEN Officer.

Application for EHC needs assessmentv.8June2018

Settings, Schools & Colleges

Information storage and sharing

Please read this section before filling out the rest of the form.

The information in this form will enable professionals to understand what help your child or young person may need. It will be necessary to share this information with appropriate professionals as part of the assessment, should one be made. This could include (but is not necessarily limited to) the Educational Psychology Service, health services including Child & Adolescent Mental Health Services (CAMHS), and Community Paediatricians and social care services. The local authority may also engage the services of practitioners in the private sector to assist with the assessment and or drafting of the plan. In all cases these providers will have been subject to a confidentiality risk assessment undertaken by the local authority’s Information Management team. We will not share the information with any other organisation for any other purpose, unless required to by law.

If you would like any further information, please contact SENDIASS to discuss your application and any queries you may have.

Your rights

Oxfordshire County Councilis a data controller under the EU General Data Protection Regulation (GDPR) and under the Act you have a right of access to the information we hold about you. Our Privacy Notice is designed to explain how and why information about you will be used and stored by us.

If you would like to obtain a copy of your personal information you can make a subject access requestor ring 08452 262636.

Preferred method of communication

During the application process Oxfordshire County Council will need to contact you.

Please specify your preferred method of receiving communicationfrom the council.

☐email ☐hard copy (paper letters)☐both email and hard copy

If you are 16 or 17 years old correspondence will be addressed to both you and your parent(s)/carer(s).

Oxfordshire County Council uses a secure system called Egress Switch for sending information. It's free to sign up and simple to use when you send messages to us. Please be aware that if you choose to communicate with us by email without signing up your information may not be sent securely.

Note for professionals: If it is not possible to get a parent/carer or the young person to complete this page please make this clear when submitting the application

Application for EHC needs assessmentv.8June2018

Settings, Schools & Colleges

Part1: Personal Details

The child or young person

Full Name
Date of birth / Male / Female
Address
NHS Number / Unique Pupil Number
Nationality / Looked After Child
Languages
or preferred method of communication / Interpretation needed / Yes / No
Mobile number
(optional) / Email Address
(optional)
Primary area of need / Secondary area(s) of need
Name of current setting/school /college

The parents or carers

Parent/Carer One / Parent/Carer Two
Names
Address
Telephone
Mobile
Email address
Languages
or preferred method of communication
Interpretation needed / Yes / No / Yes / No

Application for EHC needs assessmentv.8June2018

Settings, Schools & Colleges

Part 2: ‘All About Me’

This section is to record the views, interests and ideas of the child or young person and his or her family. Click here to see ways this information can be gathered and recorded or visit:

Add additional pages if necessary.

Who completed this section:
Relationship to the child or young person:

‘All About Me’: My family's views

Add additional pages if necessary

This section is to record the views, interests and aspirations, in relation to the child or young person, of the people important to them, such as parents/carers and other family members.
Who completed this section:
Relationship to the child or young person:

Application for EHC needs assessmentv.8June2018

Settings, Schools & Colleges

Part 3: Education, Health, Care strengths, needs &support
This section provides the evidence that will be used to make a decision about whether to proceed with an EHC needs assessment. Information should be succinct but specific. All the reports referred to should be listed in the next section.
1. The child or young person’s strengths
Describe the child or young person’s strengths
2. The child or young person’s needs
Provide evidence that the child or young person haslong term complex needsrequiring co-ordinated provision. Include information about the nature, extent and context of the child or young person’s SEN.
Evidence / Tick if included / Summarise, andnote where to be found in attached reports
Current academic attainment or developmental levels
Other evidence of educational needs
Evidence of health needs including diagnosis/es, physical needs and emotional and social development
Evidence of social care needs
Multi-agency chronology of involvement
2. Action to meet needs by the setting, school or college
Provide evidence of purposeful actionby the setting, school or college to meet the child or young person’s needs and evidence that where progress has been made it has only been the result of much additional intervention.
Describe how element 2 funding (£6,000),or targeted funding in Early Years settings, plus any additional funding that was agreed by the local authority, the Local Offer and other agency support has been used to achieve the child/young person’s outcomes over the last 12 months.
List the interventions, support, services, activities etc. and costs for each. / Cost / Please describe the impact of this intervention/activity and why it has not been effective in improving the child or young person’s outcomes or is no longer sufficient
Attach an individual provision tracker showing longer term intervention and impact, a timetable showing current support, the last 3 support and outcomes plans and copies of professional reports with relevant sections highlighted.
3. Action to meet needs by other agencies
Health Support
Give details of the support provided by health services. / Please describe the impact of this intervention/activity and why this has not been effective in improving the child or young person’s outcomes or is no longer sufficient.
Social Care Support
Give details of the support provided by Children’s or Adult’s Social Care. / Please describe the impact of this intervention/activity and why this has not been effective in improving the child or young person’s outcomes or is no longer sufficient.
4. Applications for over 18 year olds
Provide evidence that the young person requires additional time to complete their formal education or training to enable them to achieve education and training outcomes to be prepared for adult life.
5. Why is an EHC plan being requested at this stage?

Application for EHC needs assessmentv.8June2018

Settings, Schools & Colleges

Part 4: Reports and assessments
Existing reports and assessments including those produced by external services that support/provide the evidence in Part 3.
Essential reports and assessments[1]:
Name of report or assessment / Report/ assessment attached / Name of the lead professional/author of the report
Last three SEN Support and Outcomes Plans, or equivalent
(fewer required for Early Years children)
Individual Provision Tracker showing longer term intervention and impact, including where professional advice has been received and its impact.
(OCC template available)
Current individual timetableshowing support (including adult-child ratio) and interventions at the time of application
Attendance (percentage attendance, authorised and unauthorised absence over the last 12 months for school aged children)
Number of fixed term exclusions over the last 12 months (school aged children only) and any permanent exclusions or managed moves.
Most recent Learning Difficulty Assessment (post 16 non-school applications only)
Other reports and assessments: education, health and/or care:
Where these exist: Evidence of diagnosis, latest SENSS and other education reports, latest CAMHS and other health reports, current risk assessment, provision map, evaluated PSP, other relevant reports. Highlight relevant sections on allreports to show link to part 3 above.
Name of report or assessment (relevant specialist SEN, care and/or health reports) / Report/ assessment attached / Name of the lead professional/author of the report

Application for EHC needs assessmentv.8June2018

Settings, Schools & Colleges

Part 5: Desired outcomes
What outcomes are hoped to be achieved through an EHC Plan?
Need/Barrier to learning / Outcome / What will be done to achieve this
Part 6: Additional Considerations
Detail any additional circumstances that you feel should be considered with the application.These can include specific events or situations that may have caused a recent change in the emotional or physical wellbeing of the child or young person.
Include here evidence of a compelling need for assessment if evidence is not available as requested in part 3.

Application for EHC needs assessmentv.8June2018

Settings, Schools & Colleges

[1] Schools see here for Oxon templates where available