Early Years Request for Additional Information to support a request for Statutory Assessment for an EHCP.

Shropshire Local Authority have received a request to undertake a joint assessment for an Education Health Care Plan (EHCP). Please complete this form within one week of the date of receipt and return to: SEN Team, Shirehall, Shropshire Council, Abbey Foregate, Shrewsbury, SY26ND. Tel: 01743254366

Thank you for your co-operation with this.

Part 1 Personal Details

Child's Name ...... Date of Birth ......
Address ...... Sex ......
...... Home Language ......
...... Telephone No ......
Current Setting ...... Date of admission ......
Any previous setting ………………………………………………….
Name of parent(s)*/carer/those with parental responsibility ......
If fostered, include name of foster parent(s)
Address ...... Telephone No ......
(if different from above)
......

Part 2 Summary of Needs

Child's main areas of SEN which are significant barriers to participation and learning:
Number of sessions attended: ……………………….
Has the Early Help process (EHAF) been initiated YES  NO  Don’t know 

Part 3A: Evidence of Attainment (where are they now?)

Educational Progress
Communication and Language:
Personal, Social and Emotional Development:
Physical Development::
Please circle the appropriate months below for each prime area:
Personal, Social and Emotional
Making relationships:
0-11 / 8-20 / 16-26 / 22-36 / 30-50 / 40-60+
Self-confidence and self-awareness:
0-11 / 8-20 / 16-26 / 22-36 / 30-50 / 40-60+
Managing feelings and behaviour:
0-11 / 8-20 / 16-26 / 22-36 / 30-50 / 40-60+
Physical Development
Moving and handling:
0-11 / 8-20 / 16-26 / 22-36 / 30-50 / 40-60+
Health and self-care:
0-11 / 8-20 / 16-26 / 22-36 / 30-50 / 40-60+
Language and Communication
Listening and attention:
0-11 / 8-20 / 16-26 / 22-36 / 30-50 / 40-60+
Understanding:
0-11 / 8-20 / 16-26 / 22-36 / 30-50 / 40-60+
Speaking:
0-11 / 8-20 / 16-26 / 22-36 / 30-50 / 40-60+
Please comment on Characteristics of Effective Learning:
Play and exploring: / Active Learning:
Creativity and thinking critically:

Part 3B: Presenting Difficulties

Language Development:
Attention and Listening
Understanding of Language (Receptive Language)
Speech Sounds and Talk (Expressive Language)
Interaction Skills (Use of Language
Personal Social and Emotional:
Self – confidence and self-awareness
Managing feelings and behaviour
Making relationships
Physical Development:
Moving and Handling
Health and Self – care

Part 4 Summary Evidence of Setting-based Intervention

SEN Support
Date recorded at SEN Support ……………………Date parents consulted …………………………..
Current provision for child (including group size, additional support)
Reviews at SEN Support
Please provide dates and a brief description of action taken
Name and position of professionals involved:

Part 5 Any other agencies involved

Early Years Transition Officer
or Early Years adviser Child and Family Service
Learning Support Advisory TeacherPhysiotherapist
Educational PsychologistOccupational Therapist
Sensory Inclusion Service (HI)Speech and Language Therapist
Sensory Inclusion Service (VI)Social Services
Behavioural Support ServiceOther, please specify
Date of external agency reports/adviceAgency producing advice
Please detail what you feel are the child’s main areas of difficulty. This information will be used to inform Section E (outcomes) of an EHCP. Information for this section is requested from a range of sources
Please note this is the next steps which you have identified for child using your knowledge
Main area of difficulty / What should the child be able to do by the next review?
(6 months) / What should the child be able to do by the end of the Foundation Stage? / What strategies will help them achieve this?

Signatures:

Signature of Headteacher

or Setting Manager …………………………………………………Date ……………………….

Early Years request for additional information (05/15)1