Version 16 INTERIM
0 – 25 EDUCATION, HEALTH & CARE DRAFT NEEDS ASSESSMENT
0 – 25 EDUCATION, HEALTH & CARE FINAL NEEDS ASSESSMENT
0 – 25 EDUCATION, HEALTH & CARE DRAFT PLAN
0 – 25 STATUTORY EDUCATION, HEALTH & CARE PLAN
0 – 25 TRANSFER REVIEW, EDUCATION, HEALTH & CARE PLAN
* Please put an X in appropriate box above
Child / young person’s details
First NameName young person prefers
Surname
Male/Female
Address
Contact telephone numbers
Contact emails
Date of Birth
Name of Parents or Carers who have parental responsibility / If appropriate
Address
Contact Tel. Numbers and emails
Other family members living at home
Language used at home [if interpreter required, give details]
Dates stages completed / Draft EHC plan: / Final EHC plan:
Section A
1. Profile from the Child / Young person’s perspective
What people like and admire about me:What has happened to me in my life so far:
My hopes and dreams:
Getting to know you
This is taken from conversations with the Child or Young Person and where possible they are written in the First Person. This should be about the views of the child or young person, from their perspective.
What is important to you? (This could include People, Events, activities, Interests )What do you like and enjoy doing? (this could be activities, lessons .work, family /social outings)
What are you good at?
Can you tell us about things that are not working well or you find difficult?
Are there things you need help with from other people?
What is important to you for your future?
Do you have any worries about your future?
Is there anything else you would like us to know about?
Parents or Carers views: Getting to know my son, daughter.
Please share with us the best things about your child and their strengths.Describe things that are working well.
What do you think is important for your child?
What are your concerns or worries for your child?
Do you have any thoughts on your child’s future?
What things do you think will help your child?
Other things you may want us to know about your family circumstances?
Anything you would like to let us know about your other children, if applicable?
What things do you think will help you?
Is there anything else you would like to share with us?
Details of current setting
Name and address of current education setting / paid / voluntary workDetails about previous settings as appropriate
Plans and aspirations for independent living to include Employment, Training, Housing and Social Care Needs
Current support in place
Section B – Education -Summary of Special Educational Needs
Communication, and interaction
Cognition and learning
Emotional social and mental health
Physical and sensory
Section C – Health - summary of related health needs
Please describe the needs that have been identified throughout the Assessment in the following areas:Communication and interaction
Cognition and learning
Emotional social and mental health
Physical and sensory
Section: D – Social Care - summary of related social care needs
(Please indicate any other statutory requirements included in this plan – the information within can only be included with consent)
Please describe the needs that have been identified through the Assessment (in priority order, where possible) in the following areas:Emotional, social and mental health
Family and social environment (including Play and Leisure)
Physical and sensory
Assessed needs under s2 Chronically Sick and Disabled Persons Act 1970
Social Care needs not linked to the SEN ie Child in need, Parenting Assessment, Child Protection Plan and Community Care needs for those over 18. Provided the With consent of parents/young person is given.
Section E - Action and Support Plan - Summary of desired education, health and care outcomes to be achieved
From the needs identified please agree the required outcomes that will go into this plan
Outcome 1Outcome 2
Outcome 3
add additional rows as required
Action plan for outcome 1
Actions over the next 6-12 months[short term and long term] / By whom / By when / How will we know we have achieved the outcome?
Risks of not achieving these outcomes
Action plan for outcome 2
Actions over the next 6-12 months[short term and long term] / By whom / By when / How will we know we have achieved the outcome?
Risks of not achieving these outcomes
Action plan for outcome 3
Actions over the next 6-12 months[short term and long term] / By whom / By when / How will we know we have achieved the outcome?
Risks of not achieving these outcomes
Arrangements for Review: Add monitoring of outcomes to meet goals.
Date of Review (within 12 months)How will this plan be reviewed?
What monitoring will be required?
Identified Lead responsible for reviewing this plan / Name:
Role:
Contact details:
section F – Details of Special Educational provision required
Provision required by child or young person specified for every need as noted in Section B
EducationOutcome to be met through Local Offer or an additional resource / Quantified Educational Provision / Funding Source / Proposed
allocation / Date of agreement
Transport Assessment Summary / Costs / Please include;
· transport details costs.
· Where the local authority has named a residential provision, please also note if it is reimbursement of public transport costs, petrol costs or provision of a travel pass
£
Total / £
Section G – Details of Health Provision
Provision required by child/young person specified for every need as noted in Section C
HealthOutcome to be met through Local Offer or an additional resource / Quantified Health Provision / Funding Source / Proposed allocation / Date of agreement
Total / £
Section HI – Details Social Care Provision resulting from Section 2 of the Chronically Sick and Disabled Person Act 1970
Social CareOutcome to be met through Local Offer or an additional resource / Quantified Care Provision / Funding Source / Proposed allocation / Date of agreement
Total
Please specify the services to parent carers
Section H2 – Details of other Social Care Provision –
Please state if s17/Transition assessment is combined. If young person is over 18 years this will be the support under the statutory Care and Support Plan
Social Care6-12 month outcome needing additional resource / Quantified Care Provision / Funding Source / Proposed allocation / Date of agreement
Total / £
Section I - Details of School /Education Setting (Only to be included in the final EHC Plan)
The Name and type of School/education settingSection J - Details of Personal Budget (including arrangements for Direct Payments)
Total Personal Budget / Personal Budget Arrangements / List requirements of formal agreements for the EHC types of fundingSection K – Advice and Information gathered during the EHC integrated assessment and single plan
Please name everyone who has contributed to this Education Health and Care Needs Assessment and EHC Plan through the identification of specific needs and outcomes to meet these needs.Name / Title and Contact Details / How did they contribute? / Report Attached (and date of report)
Where there are any disagreements about either the assessment of needs or the action plan being proposed to meet outcomes they MUST be recorded fully here as part of the Transition Review Meeting.
Who is disagreeing?Name , role and contact details / What part of the plan is not agreed? / What is the issue?
Once the draft transition plan is finalised, it is signed off below
Child/young person –If not signed why not? / Date
Parents / carers / Date
Duly authorised officer – on behalf of South Gloucestershire Council / Date
Duly authorised officer – on behalf of Health Commissioners / Date
Duly authorised officer – on behalf of Health Providers / Date
Office Use Only
Male/ FemaleLanguage at home
Main communication method
Language Interpreter needed
Who is interpretation needed for Child/young person/family
NHS/NI Number
Unique Personal Number
Ethnicity and nationality
Consent agreed to the inclusion of Social Care issues e.g. CP plan
Consent agreed for young people Post 16 for health and social issues.
Under the Mental Capacity Act does the young person (if over the age of 16 yrs) have the capacity to make decisions regarding their education, health or social care and treatment needs and outcomes identified in this plan? If not any best interest decision made needs to be fully recorded as set out in the Department’s Mental Capacity Act Practice Guidance.
Is the care or treatment in this plan likely to amount to a Deprivation of Liberty under Deprivation of Liberty Safeguards? If yes, the care setting must request authorisation prior to placement.
Any other Equal Opportunity issues
1