Barnsley Education Specialist Support Team

BMBC

PO Box 634

Barnsley

S70 9GG

REFERRAL FOR PORTAGE INVOLVEMENT

The following criteria shouldbe met:

  • The child is aged 0-4yrs and is not accessing a fundedplace in a setting for 15 hours or more.
  • The child’s development is delayed approximately one third of its age in three different skills areas, such as physical development, cognitive development, social communication and sensory development.
  • The child has a recognised syndrome or condition that is likely to lead to a delay in their development and learning.
  • The child’s parent/primary carer will be available to meet with the home visitor on a regular basis.
  • The referral has been discussed with parents/carers by the referring professional/ service.

(Please complete this form fully and return to the above address)

Name of Child: / Date of Birth:
Names of Parents/Carers:
Address:
Telephone Number:
Names of other children in the family:
Parents/carers agreed to a referral The SEND Early Years Team: Y/N
An Early Help Assessment been completed for the child: Y/N
Physical Development
Y / N / Cognitive Development
Y / N / Social / Communication
Y / N / Sensory Impairment
Y / N

Other agencies involved with the family (reports from involved professionals must be included in the referral)

SERVICE / NAME AND TELEPHONE (IF KNOWN)
Health Visitor
Associate Specialist in Community Paediatrics
Paediatrician
Other Consultants
General Practitioner
Occupational Therapist
Physiotherapist
Speech Therapist
Community Nurse
Social Worker
Teacher for Visually Impaired
Teacher of Hearing Impaired
Pre-School Setting
Voluntary Organisations
Other
Summary of child’s needs and other relevant information:
How do you think the SEND Early Years Team can help?
Do you know about any safeguarding concerns?
If yes who can provide further information?
Do you know any safety risks to others e.g. communicable, infection, risk of violence and aggression?
If yes who canprovide further information?

Details of Referrer:

Name: Job Title:
Address:
Telephone Number:
I confirm that I have discussed this referral with the child’s parents/carers:
Signature: Date: