Education and Children’s Services

LEARNING COMMUNICATION AND INTERACTION SUPPORT TEAM (LCI)

REFERRAL FOR PUPIL FOCUSED SUPPORT

The referral route to the Link Teachers of LCI is negotiated with schools at a Joint Planning Meeting, which takes place twice a year (September and February).

When considering possible support for whole school SEN issues or to meet the needs of identified pupils and the ways LCI can most effectively provide support, schools could consider the following possible approaches. Many of these approaches would evidence the involvement of LCI as an external agency, in addition to the more formal assessments with follow-up reports.

Please tick the box for the type of support being requested: For this work to be carried out, the Parent Consent Form will must be signed and Referral Form completed.

Baseline Assessment – This is where the Link Teacher completes an assessment to gain accurate information on a pupil with an EHC / Statement who is new to caseload.

Shared Assessment – This is where the school provides some school based assessment information which contributes to the report along with additional assessment results and insights provided by the Link Teacher.

Full Assessment – This is an assessment completed by the Link Teacher when earlier advice and appropriate school based support has not overcome a pupil’s persistent difficulties

Please note:

·  Where ever possible, please ensure the LCI member has this completed form 2 weeks prior to the assessment.

If there are any difficulties please speak to the Link Teacher.

·  Please prepare a suitable room (e.g. distraction-free and with an appropriate sized table for any 1:1 work

PUPIL DETAILS

Pupil Name / School
Address
Date of referral / DOB
Class/ Form Teacher / SENCo
Child’s first language / NC Year / % attendance
Date of entry to this country
[If appropriate] / Male / SEN Support
Female / EHC/ Statement

Other agencies involved: (please tick and attach copies of relevant reports)

EPS / Social Services / EWO / VS / HS / Speech & Language Service
School nurse / GP / Health involvement / PSEMH / EYST / Virtual School involvement / Other

BACKGROUND INFORMATION –eg social concerns, time in school, frequent changes of school, medical issues

TEACHER/ TA’S VIEWS OF NEEDS AND PROGRESS

PLEASE INCLUDE INFORMATION ABOUT CURRENT PUPIL VIEWS OF THEIR NEEDS AND PROGRESS

PARENT/CARER VIEWS OF CHILD’S NEEDS

Had Eye Check / Yes / No Approximate date of last check
Had Hearing Check / Yes / No
Approximate date of last check

Wears Glasses Yes / No

Wears Grommets/ Hearing aids Yes / No

Further medical information available from: ______

If there are any medical diagnosis’s (e.g. asd, DCD) Please include conformation/evidence

PROVISION AND ATTAINMENT INFORMATION PART B

Areas of strength: please tick as appropriate

Willingness to learn / Focus on task / Social interaction with peers / Co-operation
Language/ vocabulary / Creative
Eg Art / Design/ Construction / Science / Maths
Good general knowledge / Interest and / or ability in
/ Other:

The pupil has difficulties in the following area[s]: please tick as appropriate

Reading / Writing / Spelling / Speech and Language / Numeracy / Listening/ Attention
Fine Motor Skills / Gross Motor Skills / Interaction / Communication Skills / Short term / Working Memory / Behaviour
[acting out/ acting in] / Other

Details of targeted interventions/additional provision given over the last 12 months to address needs: [Alternatively please attach your highlighted Provision Map]

Additional provision including Intervention / Date started / Date ended / Impact of Support
Eg nature of progress
Number of in- class TA support hours this year

Summary of Assessment Information: or attach school tracking data

End of previous KS Results / End of Last Year’s results / Current Level
______Term
Reading/ English
Writing
[for KS1 and 2]
Maths
Other (specify)

PARENT/CARER CONSENT TO REFERRAL

I give permission for members of the Learning, Communication and Interaction Support Team, SEND Support Service, to:

§  offer advice and support to the school about my child’s needs

§  observe my child in classroom or in a small group

§  carry out an assessment of my child in a 1:1 situation

§  access and share reports by and with other professionals

§  store information electronically, in line with the Data Protection Act

signed:
date:

J:\CLCI\4. TEAM DOCUMENTS\3. Templates\11) Referral form.doc