Parental Contribution

For transfer from Statement of Special Education Needs (SSEN) to an Education, Health and Care Plan

The Education, Health & Care Plan (EHC Plan) for 0-25 year olds needs to keep your child or young person right at the centre of the Plan.

This form is for you, as a family, to share your experience, thoughts and ideas on what needs to be included within your child’s EHC Plan. There are 4 sections to complete with an additional section at the end for anything else you may wish to add which hasn’t been covered in the other sections.

Each section of this form is numbered and guidance given on what to include within each one.

Your child’s EHC Plan will be drafted during a Transition Review Meeting so if there are any sections that you have not completed before the return date, you will have another chance to do so during this meeting.

You will also be contacted by practitioners from the Advisory Teaching Service and Educational Psychology Servicewho will seek your views regarding your child’s needs. This is done to help these practitioners complete their reports to contribute to the transformation process.

If you need any information, advice or support with this form please contact:

Gloucestershire Parent Partnership Service - Britt Fox & Karin Young

Freephone: 0800 158 3603

Email: website:

Carers Gloucestershire - Independent Support Coordinator Lisa Davenport

Freephone: 0300 111 9000

Email:

SEND Independent Support is funded by the Department for Education and is being delivered in Gloucestershire by Carers Gloucestershire alongside the Parent Partnership Service. It is independent, impartial, free and confidential.

My Story

Section 1a:

This section provides details about your child or young person

Family name/Surname: / First name:
DoB / Gender:
Address:
Contact phone number(s): / Ethnicity:
Child/Young Person’s First Language / Parent/Carer’s First language
Is the Child /Young Person a Child in Care / If yes, name of Social Worker

Section 1b:

Family structure & significant others

This section provides information on your child or young person’s family and other people who are important in his/her life

Name: / DOB(if under 16 years): / Gender
(M/F) / Relationship to young person / Address if different to child/young person / Contributed to assessment(Y/N) / Parental Responsibility?(Y/N)

Section 1c:

People and Services working with xx and family

This section provides information on the professionals and practitioners involved with your child or young person

Name / Role / Agency / Address / Contact Details (phone no./e-mail)

Section 2:

About your child or young person.

‘About Me’ should give a clear picture of what is important to your child, from your child’s point of view. As far as possible this information should be given directly by your child. Where this is not possible, please say how your child’s views are understood e.g. by choosing pictures; by how they react to certain situations, people etc. or other ways your child communicates how they feel and their likes/dislikes.

Suggestion: your child’s school or education setting may have gathered this information within a ‘My Profile’ document so it may be helpful to ask themto share this with you.

About Me
What is important to me..and why:(for example, people; places; what I like to dowhat I enjoy doing, favourite toy, things I like to have with me; equipment I use, communication aids,routines; etc.)
My aspirations and goals – My hopes and dreams:(what I want to be able to do; activities I want to do; making friends; being more independent; training; jobs; where I want to live. As EHC Plans are for young people up to 25 years old, hopes and dreams are likely to change over time.)
What people like about me:(what other people appreciate about me; giving other people’s feedback on what they like about me, what I do well, my strengths etc.)
What helps me:(people, places, things that help meand make it easier for me to do the things I want to do; routines; equipment, medication, etc.)
What doesn’t help me:(Things that make life difficult or upset me;noisy/busy environments, eye contact, tone of voice, unexpected changes, etc.)

Section 3:

This section is about your views as a parentcarer

You may wish to include any views from close friends or family members who have a significant role in your child’s life.

Sometimes thinking about the future can be difficult so don’t worry, your hopes and aspirations may be short term.

Our Hopes and Aspirations for xx
Our hopes for xx now and for the future:(this may include how you would like to see your child be part of his/her community, going to activities and clubs, making friends, being happy and successful at school, becoming more independent, progressing into training or employment etc.)
How we support xx:(this may include the routines you have in place, providing consistency, equipment you use, daily living tasks, medication, attending medical appointments,etc.)
What helps us as a family:(this may include attending support groups, communication and support from your child’s nursery, school or college, support from other practitioners, having access to courses to learn new skills and ways of supporting your child; going out as a family; short breaks etc.)

Section 4:

This section gives your views as a family on what’s going well and not so well in the following areas. This information may be drawn from your child’s Statement/LDA/Social Care Plan

About xx’s communication and interaction
(how your child communicates with others e.g. uses single words, sentences, uses communication aids, joins in conversation, other languages within the family)
About xx’s education, learning, skills and training
(about your child’s education placement, communication with teachers, learning and progress; what’s going well and what can be improved)
About xx’s social, emotional & mental health
(co-operates, sharing toys, taking turns, interactions with peers/ adults; opportunities for socialising outside of home, behaviourtriggers, self esteem, identify, anxieties, disorders)
About xx’shealth and physical development
(e.g. general health, physical activity/sport, sleeping, eating, , medication, all aspects of personal care,sexual health fine/gross motor skills such as using zips, buttons)
About xx’s family and community
(e.g. activities, clubs, friends and family, opportunities to take part and feel part of own community)
About preparation for adulthood
(only complete if your child is 14 years or in Year 9 or above)
(e.g. independence skills, training, employment and housing, opportunities for work experience, transport, managing finances, making decisions, access to health/social care services, personal safety, etc.)

Section 5:

This section is for you to tell us anything else about your child that you haven’t told us in any of the other sections in the form.

You may wish to leave this box blank.

Additional Information for xx

**Please enclose any reports you have that will help to inform the Local Authority about xx, and return in the pre-paid addressed envelope

Thank you for completing this contribution form

Parent/carer signature: ………………………………………………………..

Parent/ carer print name: …………………………………………………….

Date: …………………………………………………………

Parental Contribution form for Transformations Dec 2014