Integrated Health and Education Review at Age 2

Child and Family Information

Name of Child
Gender
Date of Birth
Gestational age at birth
Home language
Ethnicity code
NHS number
Postcode
Parent(s) Name(s)
Mother’s date of birth

Early Education Information

Early years setting name
Name of key person/childminder
Setting manager
No. of months at setting
Local Children’s Centre
Registered at the children’s centre?

Health Information

Health Visiting Team
Health Visitor / Family Health Advisor name
GP practice
Dental practice
Immunisations outstanding

Review Information

Date and time of integrated review
ASQ Questionnaire used (tick one) / 24 months / 27 months / 30 months
Date ASQ completed (if different from review date)
How the child demonstrates the characteristics of effective learning (to be completed by key person)
Personal, Social and Emotional Development
Parent(s) comments
Education – current progress
Health comments includes behaviour management, sleep routine
Areas for development
What parents/carers can do at home:
How the child will be supported at the education setting:
Actions for Health Visiting (if applicable):
Making Relationships / Self-confidence and self-awareness / Managing Feelings and Behaviour
Communication and Language Development
Parent(s) comments
Education – current progress
Health comments (including hearing)
Areas for development
What parents/carers can do at home:
How the child will be supported at the education setting:
Actions for Health Visiting (if applicable):
Listening and Attention / Understanding / Speaking
Physical Development
Parent(s) comments
Education – current progress
Health comments (to include vision, height and weight, toilet training, immunisations, oralhealth, vitamins,vitamin D, diet and nutrition, sleep routine,hospital and A&Eadmissions)
Child’s height: / Child’s weight:
Areas for development
What parents/carers can do at home:
How the child will be supported at the education setting:
Actions for Health Visiting (if applicable):
Moving and Handling / Health and Self-Care
Family and Environmental Context
(this section to be led by Health Visiting)
Parent(s) comments
Health comments – household members, relationships and changes in the family
Education comments (if applicable)
Health Promotion
This section to be led by Health Visiting(can include home safety, road safety, immunisations at three plus, dental care, accident prevention, management of minor ailments, attending children’s centres, outdoor activities, library - reading, passive smoking, safety around pets)
Parent(s) comments
Health comments
Education comments (if applicable)

Summary Information

ASQ Summary
Area / Cutoff / Total score / Summary (delete as appropriate)
Communication / On schedule / Monitor & review / Assess further
Gross Motor / On schedule / Monitor & review / Assess further
Fine Motor / On schedule / Monitor & review / Assess further
Problem Solving / On schedule / Monitor & review / Assess further
Personal-social / On schedule / Monitor & review / Assess further
Summary of the child’s development (tick one box)
Significantly below typical development / ☐ / Below typical development / ☐ / In line with/ exceeding typical development / ☐
Summary of Family and/or Environmental context (tick one box)
High level concerns / ☐ / Low level concerns / ☐ / No concerns / ☐
Level of intervention required or already in place(tick one box)
High (universal partnership plus) / ☐ / Low (universal partnership) / ☐ / None / ☐
Support already in place, if applicable
Targeted support now in place:
Specialist support now in place:
Future plans for support
Referral needed? / ☐
Any actions to be taken by professionals, if applicable (e.g. referrals to other agencies):
Action (Referral or service needed) / Who will be responsible / When will this be done
Names of professionals with input into this assessment:
Name / Job Title
London Borough of Islington and Whittington Health will handle the information you have provided in line with the provisions of the Data Protection Act. Any personal information will be held in confidence with only the necessary people able to see or use it. Under the Data Protection Act you have the right to make a formal request in writing for access to personal data held about you or your child.
We have a duty under the Children’s Act 2004 to work with partners to provide and improve services to children and young people in the area. Therefore we may also use this information for other legitimate purposes and may share this information where necessary with other bodies responsible for administering services to children and young people.
Parent(s’) Signature(s)
Review date, if applicable:
Review organiser: