Education, Health & Care Assessment Request for

Name

DoB: ../../….

Insert image - photograph or drawing of child or young person

SettingCompiled byRoleTelephoneE mailDate of submission ../../….

Schools and settings

All requests should be completed with regard and reference to the North Yorkshire banding criteria.

In the vast majority of situations, we would expect evidence of 2 cycles of the graduated response. Information from a previous school / setting or outside professionals may be used but is not essential if you have sufficient evidence without it. If you cannot complete 2 cycles, please state the reasons why

in your request – this will be a rare number of urgent cases such as moved-in from abroad and requiring highly specialist support.

EHCAR Sep 19

plan

do

review

The Child or Young Person’s Personal DetailsPersonal DetailsFull nameKnown asDate of BirthYear GroupUPN or NHS numberAddress Main contact phone number TextParent/carer’s details Parent/carer 1

Parental responsibility: Y/N Name:Address:

Telephone:Email:

Parent/carer 2Parental responsibility: Y/N Name:Address:

Telephone:Email:

Preferred method of contact Telephone/email/letterCorrespondence copied toPreferred time for calls/meetingsLanguageGP name and address

Child Looked After by the Local Authority (CLA) yes/noSocial Worker NameSocial Worker Contact NumberSocial Worker AddressLocal Authority & TeamWho has parental responsibility?

Forces Family yes/noDetails

P a g e | 2 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

P a g e | 3 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

Section A - All About Methe views, interests and aspirations of the child and his or her parents or of the young person

A1 What I’m good at, what people like about me…

What others say:

A2 What’s going well for me is…

What others say:

A3 What’s not going so well for me now is…

What others say:

P a g e | 4 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

My views

My views

My views

A4 What’s important to me now is…

What others say:

A5 What’s important to me in the future is…

What others say:

A6 How you can help me to make choices and to let you know what I want to happen…

What others say:

P a g e | 5 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

My views

My views

My views

Parent or Carer Views

Completed by:

Date

Our child’s story so far…

My child’s strengths are…

What’s going well is…

What’s not going so well is…

P a g e | 6 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

What’s important for my child now is…

What’s important for my child in the future is…

Any other comments?

Background Information

Educational history

P a g e | 7 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

Strengths and achievements

Current educational attainment/developmental milestones

NB: Please include context for individual school tracking information. Also include a SENCo/class teacher opinion on the National Curriculum year group that the child/young person’s learning currently best aligns with.

Previous educational attainment/ developmental milestones(summary at end of each key stage so far)

Please include previous summative information as available/appropriate to show progress over time

Attendance (% - last academic year & current academic year so far)

? % (yy/yy) ? % (yy/yy)

Have there been significant periods or patterns of absence?

yes/no

If yes, please explain:

Exclusion (Sessions - last academic year & current academic ? (yy/yy) ? (yy/yy)

P a g e | 8 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

year so far) Have there been any significant patterns of exclusion? yes/no

If yes, please explain:

Educational offer

Does the child or young person have a full-time offer of education?

yes/no

If no, please describe what the offer of educational provision is and explain the reasoning for this, including planned steps back to full entitlement

Why is an EHCP required?What needs cannot be met without an EHCP? What difference would this make?

P a g e | 9 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

Description of Special Educational Needs

NYCC banding referencePrimary Need identified on School Census under School Support

Banding that best fits the Needs Identified

The following sections should be used to collate the opinions of parents and carers, the school, college or setting along with the advice of other professionals about the precise nature of the child or young person’s needs. Please

ensure that the evidence submitted to support this request for statutory assessment is referenced within the corresponding descriptions of special educational need.

Cognition and Learning (C&L)

Communication and Interaction (C&I)

Social, Emotional and Mental Health (SEMH)

P a g e | 10 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

Sensory, Physical and/or Medical (SPM)

Developing independence, self-care and/or Preparation for Adulthood*

* PFA consideration is statutory from Year 9.

Description of any Health Needs related to the child/young person’s special educational needs

Provide extracts from reports in inverted commas with the author’s consent regarding the appropriateness of this content to this EHCAR process.

Description of any Social Care Needs related to the child/young person’s special educational needs

Provide extracts from reports in inverted commas with the author’s consent regarding the appropriateness of this content to this EHCAR process.

P a g e | 11 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

P a g e | 12 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

Graduated Approach: additional and different provision by education providers in line with NYCC Banding Documents

Graduated approach at SEN support Approximately how long has the graduated approach of assess, plan, do, review been in place/or for how many cycles of this? Please detail below and include evidence to support this.(the usual expectation would be for the education provider to have implemented at least two cycles of the graduated approach prior to discussing an EHCAR with parents/carers)

History of previous targeted and specialist interventions/provision(at least two cycles of assess, plan, do, review wherever possible)

NC Year Provision

Details frequency, duration,

group size etc.

Impact(with ratio gains if possible)

Interventions/provision currently in place to meet needs(Please submit relevant school-based summaries, e.g. timetable, individual provision map, IEP etc)

Provision Recommended by

Details frequency, duration

group size etc.

Cost(approx. per

academic year)

Impact(with ratio gains if

possible)

P a g e | 13 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

£

£

£

£

£

£

Total(show evidence of how additional EYFS E2

or Element 2 funding has been allocated to meet SEN needs)

£

P a g e | 14 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

External Agency/Professional InvolvementRole Name Involvement dates Contact Details

(address, email and telephone)Report

from to requested included

../../.. ../../.. yes/no yes/no

../../.. ../../.. yes/no yes/no

../../.. ../../.. yes/no yes/no

../../.. ../../.. yes/no yes/no

../../.. ../../.. yes/no yes/no

Evidence informing this EHCAR

Author Detail (e.g. SENCo assessment, IF2 funding application etc.) date submitted

1 ../../.. yes/no

2 ../../.. yes/no

3 ../../.. yes/no

4 ../../.. yes/no

5 ../../.. yes/no

6 ../../.. yes/no

EHCAR Submission Summary

P a g e | 15 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

Is this a first submission? yes/noIf a resubmission, please provide date(s) of previous submission(s)If a resubmission, please outline major changes/evidence additions within this EHCARAll EHCAR sections completed? yes/no

Child/young person voice? yes/no

Parent or parent voice? yes/no

Signed parent/carer consent? yes/no

Please return to the Local Authority, as a Word file. Email to sen@northyorks.gov.uk (via Egress ) or post to SEN Business Support, Room SB008, County Hall, Northallerton, DL7 8AE

Appendix 1: Authorisations and consents related to the EHCAR

Please ensure that this appendix is scanned and submitted as a separate PDF or image along with the main EHCAR submission. Please note that the Local Authority cannot progress the EHCAR without receipt of this signed consent.

EHCAR submitted by: SENCo (or other) Signed ../../….

Submission authorised by: Headteacher Signed ../../….

As required, is there consent from the author(s) of professional reports that this information can be shared either within the EHCAR or as separate evidence?

Yes/no

Parent(s) or carer(s): information sharing and consent

P a g e | 16 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

Consent to seek and share information about children and young people undergoing an Education, Health and Care assessment or who have an EHC Plan or Statement: North Yorkshire County Council has a responsibility to you and your family to ensure that we manage your personal information sensitively. This includes sharing your information appropriately with other services and storing your data securely.

We are required to adhere to the requirements of the Data Protection Act 2018 and other relevant legislation including the General Data Protection Regulation, to maintain confidentiality and to obtain your consent when sharing your information with other professionals and organisations.

All information relating to your Education, Health and Care Assessment/Plan/Statement will be securely stored, and will only be accessed by professionals involved in the assessment and the provision of services to your child.

According to the law (Reg. 6(1) SEND Regs. 2014) the LA must seek information and advice on SEN / provision / outcomes from a range of agencies and people. These are:

a) The child or YP or parentsb) Head of school or post 16 settingc) Health Care professionalsd) Educational Psychologiste) Social Care f) Any other person the LA thinks appropriate (including specialist teachers/practitioners and NHS

practitioners)g) A professional in relation to preparing for adulthood, e.g. Careers Advisor (for pupils in or

beyond year 9)h) Any person you would like us to seek advice from

As soon as you request an assessment, the LA has a statutory duty to seek information and advice from the agencies listed above and your consent is not required. The information collected regarding the child or young person’s Statutory Assessment process may also be used for the planning / evaluation of provision for children and young people with SEN or disabilities.

In some exceptional circumstances, for example, where there is a significant risk to a child or young person’s safety, we may need to share information without consent.

We must also share the assessment advice and Education, Health and Care Plan with current and/or future potential nursery, school or college settings to ensure they have the full information to allow them to meet your child’s needs. This will happen following the completion of the statutory assessment or subsequent review of the Education Health and Care Plan.

P a g e | 17 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)

If you would like further information about how NYCC processes your personal data please refer to https://www.northyorks.gov.uk/privacy-notices

Should the Local Authority agree to assessment, I agree to this assessment and understand that the Local Authority will have a duty to seek advice and share this information with other relevant agencies and professionals as specified in Sec 6(1) of the SEND Regulations 2014. Those agencies and professionals have a statutory duty to supply that advice to the Local Authority when requested.

This must be signed and returned with the ECHAR submission.

Child/young person’s name______________________________________________________________

Signature (if over 16) ______________________________________________________________

Parent/carers name______________________________________________________________

Signature______________________________________________________________

P a g e | 18 NYCC ▌ Education, Health and Care Assessment Request (EHCAR)