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ALTERNATIVE AND COMPLEMENTARY EDUCATION AND RESIDENTIAL SERVICE
MAINSTREAM SCHOOLS' REQUEST FOR ACERS PRIMARY EARLY INTERVENTION SUPPORT
JULY 2011
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FLOWCHART: ACCESSING ACERS PRIMARY EARLY INTERVENTION SUPPORT
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ALTERNATIVE AND COMPLEMENTARY EDUCATION AND RESIDENTIAL SERVICE
REQUEST FOR EARLY INTERVENTION SUPPORT –
ESSENTIAL INFORMATION TO BE ATTACHED TO THE FORM BELOW
The mainstream school MUST attach the information listed below to the Request for Early Intervention Support Form prior to submission to short stay school / PleaseTick
1. / Common Assessment Form (CAF) plus CAF Reference Number All TAC meeting minutes /outcomes
2. / Chronology of action
Summary of incidents or observation reports
3. / Classteacher / SENCO / Headteacher view
(Page)
4. / Pupil Assessment information:
- PIVATS (current levels of achievement in Literacy. Maths and PSD)
- SATS /Teacher Assessments
- Other normative/summative assessments
5 / Evaluated Individual Educational Plans (IEPs) or Pastoral Support Plans
6. / Fixed term / permanent exclusion information
7. / SEN review documents / TAC meetings
8. / Attendance (print out from SIMS)
9. / Child's view (Page)
10. / Parents View (Page)
11. / Reports from other services and agencies involved:
LEIS
CAMHS / Medical Reports
Children's Social Care
Voluntary agencies
Other
REQUEST FOR ACERS PRIMARY EARLY INTERVENTION SUPPORT
MAINSTREAM SCHOOL DETAILS
School DetailsSchool Name / LCC School No
School Address / Tel / Fax number
School: Email Address / School Website:
Head teacher: Name /Email Address / Classteacher:
Name /Email Address
SENCO:
Name /Email Address / L.A. Adviser
Name/EmailAddress
Pupil Details
Forenames
Family Name
Gender / Male / Female / Date of Birth
UPN / Year Group
PUPIL'S PERSONALDETAILS
Home address
Postcode
Telephone number / Ethnicity
FAMILY DETAILS
Parent/Carer / Parent/Carer
Name / Name
Relationship / Relationship
Address / Address
Postcode / Postcode
Tel No / Tel No
Email: / Email:
Siblings (if known)
NameDate of BirthAge
1.
2.
3.
Are there any access rights issues? Yes No (if yes please give details)
PUPIL'S HEALTH DETAILS
Any medical conditions: ADHD/ASD /Dyspraxia/Epilepsy/other
Is the pupil taking any type of medication? Yes No (if Yes please give details)
Condition:
Medication:
Has the child experienced any significant changes, bereavement or loss during last 24 months? (if yes please give details)
PUPIL'S SEN INFORMATION
Stage on SEN code of practice (please tick and give dates )
School action / Date placed at School Action / School action plus / Date placed at School Action Plus
Undergoing Statutory Assessment / Date RSA1 submitted / Final statement / Date of Final Statement
Please indicate category of statement
BESD, ASD, SpLD, MLD etc
Category: / Date of last Statement Review:
PUPIL'S ATTENDANCE INFORMATION
Last Academic year: / Current Academic year:
Attendance / % / Maximum number of days possible attendance:
Authorised absences / % / Actual number of days attended:
Unauthorised absences / %
INVOLVEMENT OF OTHER PROFESSIONALS
Please complete the table below as fully as possible.
Title or service / Name/Address / Telephone / Report enclosed (please tick)
Local Authority Educational Psychology
Local Authority LEIS
Child and Adolescent Mental HealthService
Medical Officer/
YOT
Police
Children’s Social Care
(please see below)
Is the pupil accommodated by the Social Services Directorate? / Yes / No
Is the pupil in care of the Social Services Directorate? / Yes / No
Child Protection - Is there any information which needs to be shared? / Yes / No
MAINSTREAM SCHOOL EDUCATIONAL REPORT IN SUPPORT OF A REQUEST FOR EARLY INTERVENTION SUPPORT
To be completed by Classteacher / SENCO / Headteacher
Name of pupil / D.o.B & Year GroupSchool
Date / Teacher
Nature of school:
Size :
Type :
Catchment area:
Previous ACERS involvement:
Class size:
Number of pupils with SEN etc:
In class support:
Pupil's difficulties:
Emotional:
Social:
Behavioural:
Within pupil factors:
Medical factors:
Learning difficulties:
Personality:
Other:
Family or environmental factors:
Size, siblings,parents, carers:
Family relationships:
Culture:
Housing:
LAC:
Action taken by the school to assess the pupil's SEN needs : (e.g. emotional, social, behavioural and academic)
PIVATS:
Boxall Profile plus analysis:
IEP / Pastoral Support Plans plus evaluation:
EP Report plus evaluations:
Behaviour logs plus evaluation:
AfL:
Evaluative analysis of the above:
Actions taken to address the SEN of the pupil:
How have you involved the family? How? What support is in place for the family?
Has the pupil received Mentoring / Counselling? Who? When?
Which Teaching and Learning Strategies have you used? Examples?
Have you received EP advice?
Have you involved other services? How?
Any other information that may be relevant?
ESSENTIAL ASSESSMENT INFORMATION
PIVATS Score / NCpoints / NC level / Comment
PIVAT / Speaking & Listening: Listening
Speaking & Listening: Speaking
Reading
Writing
Using & Applying
Number
Shape, Space & Measures
Interacting & Working with Others
Independent & Organisation Skills
Attention
Other Tests:
Name of Test / Scores / CommentSigned Class teacher /SENCO / Headteacher
PUPIL’S VIEWS (Essential – to be completed with support from school or family)
What problems are you experiencing at school? (Discuss whether or not you are happy, sad, fed up, etc. Why?What has school and teachers done to help you?
How do you think school could help you more?
Who else could help you? Is there anyone you would like to talk to?
Date pupil’s views sought:
Name and position of adult providing support when seeking pupil’s views:
PARENT /CARERS VIEWS (ESSENTIAL)
What problems is your child experiencing at school?How has the school supported your child with these difficulties?
How do you think school could help you, your family and your child more?
Who else could help your child and your family? Are you receiving support from parent partnership, social care, CAMHS, or any other
PARENTAL/CARER PERMISSION
-I have discussed my child's difficulties with the school and agree to the Request for Early Intervention Support from ACERS Primary Service
- I give my/our permission for the enclosed evidence to be shared with other professionals.
Parent(s)/Carers Name (print please)
Parent(s)/CarersSignature: Date
SCHOOL EXPECTATIONS / OUTCOMEWhat are your expectations of ACERS Primary Early Intervention Support?
What outcome do you expect?
SCHOOL PERMISSION
I have discussed this Request for Early Intervention Support with parents of and submit our documentation with this form:
Name of member of staff requesting support:
Signature: Date:
Please send this completed form with attached essential information to your area primary short stay school (See addresses and contacts below)
ACERS KEY CONTACTS
AREA NORTH
Districts 1, 2 & 4
STEPPING STONES (SHORT STAY) SCHOOL
BOWERHAM ROAD
LANCASTER
LA1
TEL: 01524 67164
FAX: 01524 841239
Headteacher: Alison Cannell
EIS Manager /Lead: Jane Meacham
Mobile: 07717 423 891
AREA SOUTH
Districts 6,7,8 &9
GOLDEN HILL (SHORT STAY) SCHOOL
EARNSHAW DRIVE
LEYLAND
PR25 1QS
TEL:01772 904780
FAX: 01772 904781
Headteacher: Allison Collinge
Mobile: 07766 785350
EIS Manager/Lead: Sue Payne
Mobile:
AREA EAST
Districts 12 and 13
HENDON BROOK (SHORT STAY) SCHOOL
TOWNHOUSE ROAD
NELSON
BB9 8BP
Tel:01282 693432
Headteacher: Janette Wallis
EIS Lead: Linda Copeman
Mobile:07766 803699
AREA EAST (Intervention ONLY)
Districts 11 and 14ROSSENDALE & HYNDBURN INTERVENTION PATHWAY PROVISION
RYEFIELD AVENUE
HASLINGDEN
ROSSENDALE
BB4 4BJ
Julie Burnside (Headteacher)
Tel: 01706 215947
OTHER ACERS KEY CONTACTS
ACERS SENIOR MANAGER PRIMARY
Sue Parr
Room B30
County Hall
Preston
Lancashire
PR1 8RJ
Tel: 01772 532290
Mobile: 07766 785410
HEAD OF ALTERNATIVE & COMPLEMENTARY EDUCATION AND RESIDENTIAL SERVICE (ACERS)
Laura Hurley
Room 4
County Hall
Preston
Lancashire
PR1 8RJ
Tel: 01772 531730