Education, Health and Care Needs Assessment Request Form For Education Settings: Post 16 Education

Guidance

This information is sought in accordance with the Children and Families Act 2014. In the first instance all educational settings are required to use their best endeavours to meet the needs of children and young people identified with Special Educational Needs. In providing information, the educational setting must evidence the following:

A copy of the young person’s additional support plan provided for them under the SEND Support Stage of the Code of Practice 2014;

The educational establishment's assessment of the young person’s difficulties;

The outcomes sought by the educational establishment for the young person;

The external professional advice that has been sought, which is pertinent to the request for an assessment. Where possible external agencies should be contacted to

provide up to date and accurate reports before you submit the request.;

Details of the support and interventions that have been provided for the young person;

An assessment by the educational establishment of the progress made or lack of progress;

What additional support the educational establishment feels is required which cannot be provided through its ordinary resources.

This form is intended to be filled out electronically, if you require a hard copy request form please contact the relevant locality casework team using the details

found at the end of this request pack.

Wherever possible attainment and attendance information should be provided over recent years for the panel to be able to form a view about the rate of progress that the young person has made; it may therefore be necessary to contact the young person's previous educational setting.

Education, Health and Care Plans and Lincolnshire’s Transition Pathway have an outcome based approach which is focussed on the four Preparing for Adulthood pathways. An assessment for an Education Health and Care Plan will be considered in accordance with the Code of Practice and Colleges should include details of planned, robust and realistic educational outcomes for a young person.

Where a young person is over 16 years then the Local Authority will need to gain consent from them directly in order to proceed an EHC needs assessment in line

with the Mental Capacity Act 2005, rather than from their parent / legal guardian.

Personal Details

Full Name: Educational Setting:

Date of Birth: Age Gender Last Educational Setting:

Young person's Address:

Ethnicity Please Select…

First Language

Previously had SEND Statement? Please Select… Is the Young Person

living independently? Please Select…

Do any of the following Apply?(select from the drop down boxes)

Looked After TAC Child Protection Families Working Together ESCO Child in Need EFA Bursery

Please Select… Please Select… Please Select… Please Select… Please Select… Please Select… Please Select…

Parent/Carer Name:

2nd Parent/Carer Name:

Relationship: Relationship:

Parents Address (if different and / or relevant)

Parents Address (if different and / or relevant)

Who has Parental Responsibility?

Phone Numbers Phone Numbers

Email Address Email AddressPreferred Method of Contact

Preferred Method of Contact

Who is making the request? Name Position / Title

SECTION A: Pen Picture

In no more than 250 words please briefly describe the young person's life so far. You may wish to complete this box after you have filled out the rest of the form

Please Note: The text box is a fixed size due to the word limit, entering anymore text than can fit in the frame above will result in the text being hidden from view.

SECTION B: Attendance

Current Attendance Record - please provide as much information as possible

Name of Educational Setting Period (Dates) Actual Attendance(No. of Sessions)

Possible Attendance (No. of Sessions per week)

Percentage Attended

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SECTION C.1: Young Persons Views

You may wish to include alternative evidence of the young person's views if they are unable to verbally communicate their opinion. Such evidence could include: drawings, photographs, comments from parents, observations etc

What is important to me?

What I like to do / What am I good at.

How do I communicate?

What do I need help with?

These views were gathered / recorded by:

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SECTION C.2: Parents / Legal Guardians Views

Where appropriate and with consent from the young person, please ensure that the parents and / or legal guardian's views are sought and recorded in the table below.

You may wish to seek views and then fill out table below electronically, if you do so please ensure that parents / legal guardians have had the opportunity to confirm that what has been written is a true and accurate picture.

Where relevant Parents / Legal Guardians will be given the opportunity to submit additional information once a request has been submitted.

What's working well? What's not working well?(Eg, Either in school or out)

What would you like to happen?(Eg. The support you believe is required and the educational outcomes that you believe are not

currently being met)

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SECTION D.1: Identified Needs

The identified Special Educational Needs – What do you consider the young person's difficulties to be which are acting as barriers to curriculum access and progress. You may wish to complete more than one section.

Please include any details of young person's needs and/or any diagnoses made.

Please note: There is a section (Section I) later on in the form which you may wish to fill in when a request is made due to exceptional circumstances as outlined in Paragraph 9.3 of the SEND Code of Practice 2014. Section I should be used in conjunction with this section to provide context to the current support arrangements where there are exceptional circumstances

Barriers to Learning What does this look like in the Post 16 provision? / What is the impact on learning?

Communication and Interaction

Cognition and Learning

Social Emotional and Mental Health

Sensory and/or Physical Needs (including health needs that impact on access to learning)

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SECTION D.2: Additional Significant Factors

If the answer is yes please attach copies of relevant information/advice Include where relevant both past and present circumstances that are relevant to the request.

Health(Anything else that has not

already been described above in Section D.1)

YES/NO

Attendance(Eg: concerns about attendance,

erratic attendance , hospital appointments)

YES/NO

Home Circumstances(Eg. Where relevant, reference to the fact that the request is for: a

young person of service personnel; a young carer; a traveller or is

adopted.)

YES/NO

Social Care / Family Support(Eg. Tac, ESCO, CiN, CP, LAC) YES/NO

Other:(such as independent living

arrangements, home circumstances)

YES/NO

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SECTION E.1: Attainment

Attainment/Ability Assessments/Milestones met. – include end of School acheivements

Date Assessed Year Group Key Stage English Maths

AssessmentsDate Age Name of Assessment Carried Out By

Current AttainmentDate Name of Course Course Level Current Grade Predicted Grade

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Outcome Date

Educational Outcomes Sought – Outcomes should be focussed on the Preparation For Adulthood pathways. For further information refer to the SEND Code of Practice 2014 Chapter 8.

Description and commentary of attainment data.

Please provide a commentary for the attainment data explaining methodology

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SECTION F: Observation of Progress

Any progress which cannot be quantified or formally assessed

Please include such information as improvements in behaviour, confidence, self help / care etc..

Date Assessed Observation / Progress

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SECTION G.1: Support Provided and Funding / Current Support Arrangements

All Post 16 educational settings are provided with resources to support those with additional needs, including students with SEN and disabilities. Please therefore identify the provision made from the Element 2 budget to address the young person’s needs:

Give details of the targeted support received for the young person that was additional to and different from normal differentiated group arrangements

Type of provision: (and whether in

large/small group)

Objective of Provision Frequency & Duration

Delivered by StartDate

ReviewDate

Outcomes: (Achieved, Partially Met, Not Met)

SECTION G.2: Additional Support

Please list any additional support required above and beyond what is already being provided.

Outcomes Sought Type of Provision Objective of Provision Frequency & Duration Delivered By Start Date Review Date

What are the financial implications for providing the additional support identified?

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Total Cost: £

Total Cost: £

SECTION H Documentation to support request

Please list details of attached reports/evidence from appropriate Services. Include only reports which are relevant to the current request and the young persons identified needs. You are only required to submit evidence where evidence has already been sought and/or given

Please note the involvement of specialists is essential to help evidence that an informed assess, plan, do, review approach has taken place. Please see Paragraphs 6.58-6.62 of the SEND Code of Practice 2015.

EDUCATIONService Provided By: (Name & Role) Date of report/

Consultation record/ document relevant to

need.

Name of professional (where relevant)

Brief Description of Involvement(including a brief description of any evidence attached to the request)

1. Educational Psychology consultation records or reports (where available). This is important to show that the assessment of need, provision to meet need and review of the same has been informed by an Educational Psychologist.

2. Specialist TeachersSuch as the Specialist Teaching Team or other independent provider

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EDUCATIONService Provided By: (Name & Role) Date of report/

Consultation record/ document relevant to

need.

Name of professional (where relevant)

Brief Description of Involvement(including a brief description of any evidence attached to the request)

3. Sensory professional report or documentation ( eg. Sensory Education & Support Team) for pupils whose HI/VI/MSI is affecting access to the curriculum.

4. Behavioural professional report where the pupil’s behaviours are a primary need e.g. TLC Pathways / independent provider together with a risk assessment where appropriate is included

5. Working Together Team Discussion Record, (previously known as Social Communication Outreach Service) where relevant, to show that the assessment of need, provision to meet need and review of the same has been informed by the Working Together Team

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EDUCATIONService Provided By: (Name & Role) Date of report/

Consultation record/ document relevant to

need.

Name of professional (where relevant)

Brief Description of Involvement(including a brief description of any evidence attached to the request)

7. Youth Offending Service

8. Careers Guidance Service

9. Dated Post 16 provider documents or individual planning sheets over three terms have been included which demonstrate SMART outcomes reflective of the pupils needs with details of the provision informed by the specialist’s recommendations. The targets will have been reviewed at least three times and clearly state impact/outcome10. Other Specialist Services

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HEALTHService Provided By: (Name & Role) Date of report/

Consultation record/ document relevant to

need.

Name of professional (where relevant)

Brief Description of Involvement(including a brief description of any evidence attached to the request)

1. Speech and Language Therapist report or other evidenced language input (Elklan) where language is regarded to be a significant concern/need. This is important to show that the assessment of need, provision to meet need and review of the same has been informed by the Speech and Language Therapy Service or other relevant language specialist.

2. Occupational Therapist Documentation where motor/physical difficulties are regarded to be a significant concern/need. This will show that the assessment of need, provision to meet need and review of the same has been informed by an Occupational Therapist

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HEALTHService Provided By: (Name & Role) Date of report/

Consultation record/ document relevant to

need.

Name of professional (where relevant)

Brief Description of Involvement(including a brief description of any evidence attached to the request)

3. Physiotherapist documentation where motor/physical difficulties are regarded to be a significant concern/need. This will show that the assessment of need, provision to meet need and review of the same has been informed by a Physiotherapist.

4. Paediatrician or other expert health practitioner documentation where general health/ medical issues are a significant concern/need and, where relevant a Health Care Plan.

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HEALTHService Provided By: (Name & Role) Date of report/

Consultation record/ document relevant to

need.

Name of professional (where relevant)

Brief Description of Involvement(including a brief description of any evidence attached to the request)

5. CAMHS (Child and Adolescent Mental Health Service)

6. 0 – 19 Team (Previously known as Health Visitors)

7. Other Specialist Services (Eg, Add-Action, School Nurse)

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SOCIAL CAREService Provided By: (Name & Role) Date of report/

Consultation record/ document relevant to

need.

Name of professional (where relevant)

Brief Description of Involvement(including a brief description of any evidence attached to the request)

1. Where appropriate and relevant, a summary of social care needs, interventions and recommendations provided by Social Care professionals, including those provided in the home and community. This could be a record of involvement by, for example, an ESCO worker or TAC or Social Worker.

2.Multi agency meeting minutesPlease include minutes from multi agency meetings such as Team Around the Child, Looked After Child, Child in Need, Child Protection meetings.

Please ensure that you have obtained consent from the person holding parental responsibility or the young person if over 16 before sharing sensitive information

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SOCIAL CAREService Provided By: (Name & Role) Date of report/

Consultation record/ document relevant to

need.

Name of professional (where relevant)

Brief Description of Involvement(including a brief description of any evidence attached to the request)

3.Prevent Strategy

4. Housing

(Include relevant information from District Local Authorities in relation to housing matters and independent living)

5.Additional Assistive Technology (such as telecare)

6. Other Specialist Services

(such as those relating to counselling / gender issues and identity)

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SECTION I: Exceptional Circumstances

If there are any exceptional circumstances as defined in the Code of Practice Paragraph 9.3:

"In a very small minority of cases children or young people may demonstrate such significant difficulties that a school or other provider may consider it impossible or inappropriate to carry out its full chosen assessment procedure. For example, where its concerns may have led to a further diagnostic assessment or examination which shows the child or young person to have severe sensory impairment or other impairment which without immediate specialist intervention beyond the capacity of the school or other provider would lead to increased learning difficulties."

Please describe them below:

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SECTION J: Consent to Proceed

Please Note: You may wish to print this page separately in order to get a signature. If you are sending the request in electronically please scan in the signed consent form and send along with the request. This will speed up the processing of the request.

Name of Young Person:

Date of Birth:As part of the EHC needs assessment the Local Authority will need to request information relevant to the assessment from our partner agencies. Could you please ensure young person / parents / legal guardians are aware of this requirement and have read the LCC SEND Data Sharing Agreement before submitting the request. Please indicate using the statements below if young person / parents / legal guardians are happy for the Local Authority to request and share information relevant to the EHC needs assessment.

NOTE: If a young person is over 16 years then the Local Authority must have consent from the young person in line with the Mental Capacity Act 2005, rather than from their parent / legal guardian.

N.B. Without young person / or authorised signatory consent, the assessment process cannot proceed

Please indicate in the boxes below whether you do or do not agree with each statement

I agree for the Local Authority to request and share information with other agencies with regards to the EHC assessment process under the Children & Families Act 2014.I do not agree for information to be shared with the Local Authority as part of the EHC needs assessment process under the Children & Families Act 2014

If an assessment is agreed and an EHC Plan is issued the Local Authority requires your permission to enable the plan to be shared with relevant professionals

I DO agree for the Local Authority to share any EHC Plan or feedback produced as part of the EHC needs assessment to partner agencies who have been involved with the assessment.I DO NOT agree for the Local Authority to share any EHC Plan or feedback produced as part of the EHC needs assessment to partner agencies who have been involved with the assessment.

Signed ___________________________________ Date _______________

* Young Person / Authorised Signatory (*Please delete as appropriate)

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To Be Completed by the person submitting the request:

Signature: Name:

Title: Date:

Contact Tel Number: Contact Email Address:

Please return this form, together with any reports to the relevant locality team responsible for your area based on young person's home address not the educational setting:

East Lindsey: EAL_SendLocality@lincolnshire.gov.ukLincoln & West Lindsey: LWL_SendLocality@lincolnshire.gov.ukNorth Kesteven & South Kesteven: NKSK_SendLocality@lincolnshire.gov.ukBoston & South Holland: BSH_SendLocality@lincolnshire.gov.uk

or by post to: SEND Team, Lincolnshire County Council, 9/11 The Avenue, Lincoln, LN1 1PA

Office Use

Date Received: Response due by:

Officer: Panel Date:

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