Referral from Schools for statutory Education Health and Care plan (EHC) assessment

CHILD DETAILS

Child’s name / UPN
Gender / Date of birth
Child’s first language / Year group
Ethnicity / Religion
Who has parental responsibility?
What is their relationship to child?
Is the child looked after /in care to/accommodated by a Local Authority? / Yes / No
If so which authority
Is the child a ward of court? / Yes / No
Does this child have a CAF? / Yes / No
Has consideration been given to completing a CAF? / Yes / No
Is the child the subject of a Child Protection Plan? / Yes / No
Is the child the subject of a Child in Need Plan? / Yes / No
Is the child the subject of a Health Care Plan? / Yes / No
Is parental consent included? / Yes / No

If you have answered ‘Yes’ to any of the above, you must provide details/documents with this referral

FAMILY DETAILS (please include sheet with parent’s signature)

Address where child lives
Tel: Home
Tel: Daytime

Mother‘s name

/ Father’s name
Address (if different from above) / Address (if different from above)
Names of other carers (that the child lives with) and their relationship to child

If the child is looked after by a local authority:

Name of social worker
Address
Tel no
Names of foster parents
Family home language spoken
written
Does the school use an interpreter when meeting with parents? / Yes / No
Does the school use a translator when writing to parents? / Yes / No
Will there be other communication difficulties, eg visual/hearing difficulties, literacy etc. / Yes / No (if yes, please give details)
SCHOOL DETAILS
Name of School
Address
Tel
SENCO
Tel
Email
Form completed by
Position in school
Signed
Date

This referral has been discussed with Date

Parents
Educational Psychologist
External specialist, eg Outreach teacher, therapists (give details)
Headteacher
Other

The support services involved are:

Please indicate all support services with the name of the professional involved

Education psychologist
Education Welfare Officer
Occupational Therapist
Physiotherapist
Psychiatric social worker
Psychiatrist
School medical officer
School nurse
Specialist (Outreach) teacher
Speech and Language Therapist
Social worker
Other

Checklist of evidence required to accompany school’s referral for statutory EHC assessment

Evidence needs to be included with the referral . If evidence is missing please explain, e.g. very young child, immediate significant concern

Evidence of nature and severity of child’s special educational needs. Evidence must include (please tick)

School’s chronological list demonstrating history of SEN assessment, provision and review
Minutes/notes of SEN support review where decision was agreed to request EHC assessment .

Additional evidence should be included where available (please note Y or N)

Records of Involvement by Educational Psychologist
Assessments by and advice from specialist teachers
Check lists to identify particular difficulties in e.g. social communication or behaviour, such as those advised by educational psychologist or specialist teacher or published with Redbridge Guidance to support the SEN Code of Practice 2001
Pastoral Support Plan
Speech and Language assessments and advice
Advice from other health professionals
First language assessment

Details of the school’s special educational provision

Evidence of differentiation currently in place
For example, 2 lesson plans demonstrating planning such as described in DFES guidance ‘Including all children in the literacy hour and daily mathematics lesson’. It would be helpful if samples covered more than one area of the curriculum.
IEPs
The nature of special educational needs addressed in the IEPs should mirror the concerns described in the referral. The special educational provision identified in the IEPs should reflect good practice, for example that described in the Redbridge Guidance, and advice from external specialists.
If schools use a different method for recording short term targets, please include instead of IEPs.

Evidence of progress

Examples of child’s work / Aided, with explanation of support (+ date, explanation of task set, time taken to complete task)
Unaided written work
(+ date, explanation of task set, time taken to complete task)
Figure drawing
Attainment levels, including P levels / National Curriculum or other whole school measures of attainment used ( with explanation )
Any standardised assessments for literacy etc.

Additional information

Child’s views
Parents’ views
Recent attendance record, if a concern
Involvement of social services
Other

Against the main headings, please indicate whether this area is a concern

Please indicate in which CENSUS SEN category you have placed the pupil.

Type of Need / Yes/no
Communication and Interaction Needs:
Speech, Language and Communication Needs
Autistic Spectrum Disorder
Social, Emotional and Mental Health Needs:
Social, Emotional and Mental Health Needs
Cognition and Learning Needs:
Specific Learning Difficulty
Moderate Learning Difficulty
Severe Learning Difficulty
Profound and Multiple Learning Difficulty
Sensory and/or Physical Needs:
Visual Impairment
Hearing Impairment
Multi-Sensory Impairment
Physical Disability

Important Note: The information submitted in this referral is not used as part of the advice in a statement. If you wish the information you have provided on this form to be included as part of any subsequent professional advice, you will need to copy the information that you provide under the areas of need shown under 1 below, and paste this on to the advice form.

Reasons for requesting statutory EHC assessment

The blue text (in italics) provides guidance for completing the referral form and may be deleted before sending it to the LA. Please also refer to guidance on completing the form which explains what the Special Educational Needs Panel will be looking for.

Background

Brief relevant summary of school / family history / attendance

1 Special Educational Needs (and strengths to build on).

This section is divided into areas of need

In each area please describe the nature and extent of the child’s difficulties, and the impact on their access to learning. Also describe any strengths the child has in these areas.

.

Please see guidance notes for more information.

Communication

What are his/her communication needs (what can he/she do now and what does he/she find difficult)?

This area covers speaking and listening skills; receptive and expressive language; social use of language; non-verbal communication skills; use of signing

Social and emotional

What are his/her social and emotional needs (what can he/she do now and what does he/she find difficult)?

This area covers relationships with peers; relationships with adults; play skills; social skills; behaviour, within and outside the classroom, and impact of behaviour on others; self esteem; level of independence; ability to respond in an age appropriate manner.

Approaches to Learning/Learning Skills

What are his/her education and learning needs (what can he/she do now and what does he/she find difficult)?

This area covers cognitive functioning; acquisition of concepts; Literacy and numeracy skills; educational attainment in other areas of the curriculum. It also covers learning style; ability to concentrate; memory; motivation; organisation and independence skills.

Physical and sensory

What are his/her physical and sensory needs (what can he/she do now and what does he/she find difficult)?

This area covers gross and fine motor skills; vision; hearing; mobility issues that affect access

Health Needs

What are his/her Health needs in relation to his/her SEN?

Schools should seek information from parents regarding this section

Social Care Needs

What are his/her social care needs in relation to his/her SEN, including family friends and community?

Schools should seek information from parents regarding this section

2 Parental involvement

What do parents think about their child’s needs?

How have the parents been involved in designing, implementing and reviewing the child’s special educational provision?

3 Child’s views

What does the child think about their difficulties?

How has the child been involved in designing, implementing and reviewing their special educational provision?

4 The school’s special educational provision

Does the child require provision over and above normal school resources?

Please explain the success or otherwise of the school’s special educational provision, including the input from other agencies. Please refer to the ‘Guidance to completing the referral form’ for help in filling out this section.

Questions relating to provision may not be wholly relevant for all children, for example very young children or those who have moved into a school and are causing immediate and significant concern. Please adapt your report accordingly.

How do you meet the needs of the child

·  Inclusion strategies

·  Adaptations to curriculum

·  Adaptations to environment

·  Specific resources

·  Intervention programmes

Does the child need additional support or strategies at playtimes, lunchtimes, or for out of school activities?

If the child has a disability what steps have been taken to avoid the child being placed at a substantial (more than trivial) disadvantage? (Disability Rights Commission, Code of Practice for Schools)

What specific programmes and teaching methods have been successful, and why?

What specific programmes and teaching methods have been unsuccessful, and why?

What additional support (LSA/teacher time) has been put in place?

What use has school made of ICT to address the child's particular SEN?

(This question relates to specific ICT to support a child’s SEN and not to the school’s ICT curriculum)

What involvement has there been from outside agencies?

Please include explanation of each agency’s involvement. Please include any reports with referral.

Educational Psychologist

·  Advice received

·  How it has been implemented?

·  How successful it has been?

Health professionals

·  Advice received

·  How it has been implemented

·  How successful it has been

Social care professionals

·  Advice received

·  How it has been implemented

·  How successful it has been

Other agency

·  Advice received

·  How it has been implemented

·  How successful it has been

Other agency

·  Advice received

·  How it has been implemented

·  How successful it has been

Ensure there is supporting evidence to accompany your referral

5 Evidence of child’s progress

Please describe the child’s progress over time and include evidence on the Attainment Form and examples of the child's work

Explain how the child’s progress is being monitored.

Describe areas of the curriculum where you believe the child has not made adequate progress.

Refer to all the core areas of the curriculum and other areas where there are particular problems, e.g. PE if there are motor difficulties. It may be helpful to specify the child’s programme of study are being taken from e.g. a different key stage, an individual programme of study, P levels if appropriate.

Explain whether the child's performance is different in different environments

e.g. with different teachers, peer groupings or in structured/unstructured times.

Questions relating to progress may not be wholly relevant for all children, for example very young children or those who have moved into a school and are causing immediate and significant concern. Please adapt your report accordingly.

Referral Form V2 Page 8 of 8