SEND Early Help Assessment

A copy of this assessment form must be sent to your local SEND Team. Please register this assessment using the registration form and email to early.help@cumbria.gov.uk. The completed assessment should not be sent to this mail box.

Date assessment started       Child's name      

Request for specialist support Date of birth      

Notes for use: If you are completing this form electronically, text boxes will expand to fit your text. Where there are tick boxes, please insert a where applicable.

Identifying detailsRecord details of unborn baby, infant/s, child/ren or young person/s being assessed. If unborn, state name as ‘unborn baby’ and mother’s name, e.g. unborn baby of Ann Smith.

Family details - include all those living in the family home

Family name:       AKA1/Previous names:      

Family address (inc postcode):      

Telephone:      

Details of other significant family members, siblings, grandparents etc.(inc DOB, relationship, and address if different):

Full name DOBEDD2

Sex Family member?

e.g. mother, father, child

Ethnic origin Nursery/School/College

(if applicable)

Address(if different)

                        Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose                                    Please choose            1 - 'Also known as' 2 - Expected date of delivery

1

Immigration status      

Child’s first language      

Parent’s first language      

Is the child/ren or young person/s disabled? Yes No

If ‘yes’ give details      

Details of any special requirements (for child and/or their parent) e.g. signing, interpretation or access needs

     

Assessment information

People who have contributed to the assessment     

What area of need has led to this assessment being undertaken?

Communication and interactionCognition and learningSocial, emotional or mental healthSensory - deaf Sensory - visualPhysical disability Medical condition (please specify)

     

Other (please specify in box below)

     

2

Additional Information

Details of parents/carers

Name:       Contact tel. no:      

Relationship to unborn baby, infant, child or young person      

Address:      

     

Postcode:       Parental responsibility? Yes No

Name:       Contact tel. no:      

Relationship to unborn baby, infant, child or young person      

Address:      

     

Postcode:       Parental responsibility? Yes No

Current family and home situation(e.g. family structure including siblings, other significant adults etc; who live with the child or who do not live with the child)

     

3

Details of person(s) undertaking assessment

Name:       Contact tel. no:      

Address:      

     

Postcode:      

Role:       Organisation:      

Name of coordinator (where applicable):      

Coordinator’s contact number:      

Coordinator’s email address:      

Services working with this infant, child or young person

Key agencies involved: (GP, midwife, nursery, school, attendance officer, youth provision, other)

Name Agency Role Contact Details   Took part in assessment

(y/n)                             

                             

                             

                             

                             

                             

                             

Does the child have an identified Special Educational Need?  Yes No

4

Child/Young Person Profile (Child/Young persons name)

Assessment summary of strengths and needsPlease consider each of the elements and comment on the young person's needs as identified by any previous assessment. You do not need to comment on every element. Wherever possible, base comments on evidence, not just opinion, and indicate what your evidence is. However, if there are any major differences of view, these should be recorded too.

HealthGeneral health Conditions and impairments; registered with and use of dentist, GP, optician; immunisations, developmental checks, hospital admissions, accidents, allergies, health advice and information

Strengths

Needs

Physical development Nourishment; activity; relaxation; vision and hearing; fine motor skills (mark making/writing); gross motor skills (mobility, playing games and sport etc.)

Strengths

Needs

Speech, language, communication and interactionPreferred communication, language, conversation, expression, questioning; games; stories and songs; receptive and expressive languages; social communication; understanding

Strengths

Needs

Emotional Well Being and social development Feeling special; early attachments; risking/actual self-harm; phobias; psychological difficulties; coping with stress; motivation, positive attitudes; confidence; relationships with peers; feeling isolated and solitary; fears;often unhappy

Strengths

Needs

5

SensoryCurrent sensory needs, history and support including equipment/ adaptation

Strengths

Needs

Mental/Physical Health Current mental health, previous mental health history, diagnosis, medication and compliance

Strengths

Needs

Behavioural development Lifestyle, self-control, reckless or impulsive activity; behaviour with peers; substance misuse; anti-social behaviour; sexual behaviour; offending; violence and aggression; restless and overactive; easily distracted, attention span/concentration

Strengths

Needs

Cognition and learningUnderstanding, reasoning and problem solving Organising, making connections; being creative, exploring, experimenting; imaginative play and interaction

Strengths

Needs

Identity, self-esteem, self-image and social presentationPerceptions of self; knowledge of personal/family history; sense of belonging; experiences of discrimination due to race, religion, age, gender, sexuality and disability

Strengths

Needs

6

Family and social relationships Building stable relationships with family, peers and wider community; helping others; friendships; levels of association for negative relationships

Strengths

Needs

Self-care skills and independenceBecoming independent; boundaries, rules, asking for help, decision-making; changes to body; washing, dressing, sleep patterns, feeding; positive separation from family

Strengths

Needs

Participation in learning, education and employment Access and engagement; attendance, participation; adult support; access to appropriate resources

Strengths

Needs

Progress and achievement in learningProgress in basic and key skills; available opportunities; support with disruption to education; level of adult interest

Strengths

Needs

AspirationsAmbition; child, young person confidence and view of progress; motivation, perseverance

Strengths

Needs

7

Parents and carers views (name)

Assessment summary of strengths and needsIn this section please record parental views of the child's Special Educational Needs and/or disability. Consider each of the elements but comments do not need to be recorded in every sector.

LearningParents views of progress made in school/setting. What has supported progress. How any SEND is seen to present at home.

Strengths

Needs

CareParents views on any care needs presented by the SEND and how these are met.

Strengths

Needs

Mental/Physical Health Current mental health, previous mental health history, diagnosis, medication and compliance. Conditions and impairments; registered with and use of dentist, GP, optician; immunisations, developmental checks, hospital admissions, accidents, allergies, health advice and information

Strengths

Needs

Wider familyFormal and informal support networks from extended family and others; wider caring and employment roles and responsibilities

Strengths

Needs

8

Social and community elements and resources, including educationDay care; places of worship; transport; shops; leisure facilities; crime, unemployment, anti-social behaviour in area; peer groups, social networks and relationships; religion

Strengths

Needs

9

Analysis of Need Summary of needs to be addressed and what will happen if remain unmet

Parent/carer, child, young persons view

10

Key Priorities for parent, carer, child/ren or young person(s)e.g. How will you know that things have improved? What will things look like at review?

Child or young person’s comment on the assessment and actions identified

Parent or carer’s comment on the assessment and actions identified

11

Specialist service required to support the child

County Psychological Service Early YearsSpecialist Advisory Teacher for pupils with; Community Speech Therapist

Autistic Spectrum Conditions Occupational TherapistBlind/Visual Impairment Disability NurseDeaf/Hearing Impaired Health Visitor

Physical/Medical Difficulties PhysiotherapistSevere Learning Difficulties Child & Adolescent Mental Health Service

Speech, Language and Communication Difficulties

Inclusion Support Officer

Note: These services will provide additional assessment and advice prior to any statutory assessment.

Additional documentsPlease list any additional documents attached.

12

Consent statement for information storage and information sharing

"We need to collect the information in this SEND Early Help Assessment form so that we can understand what help you may need. If we cannot cover all of your needs we may need to share some of this information with the other organisations specified below, so that they can help us to provide the services you need. If we need to share information with any other organisation(s) later to offer you more help we will ask you about this before we do it."

"We will treat your information as confidential and we will not share it with any other organisation unless we are required by law to share it or unless you will come to some harm if we do not share it. In any case we will only ever share the minimum information we need to share"

I understand that the information that is recorded on this form will be stored and used for the purpose of providing services to:

Me This infant/s, child/ren or young person/s for whom I am a parent This infant/s, child/ren or young person/s for whom I am a carer

I have had the reasons for information sharing explained to me and I understand those reasons. I agree to the sharing of information, as agreed, between the services listed below Yes No

     

I agree that the basic information (Child’s name, address and DOB, date of assessment) from the SEND Early Help Assessment will be kept on file within the local authority for statistical monitoring and evaluation. On occasions a random sample of SEND Early Help Assessments may be requested for audit purposes.

Yes No

Agreed review date      

Signed     

Name     

Date     

Assessor’s signatureSigned

     Name

     Date

     

Exceptional circumstances:Concerns about significant harm to infant, child or young person

If at any time during the course of this assessment you are concerned that an infant, child or young person has been harmed or abused or is at risk of being harmed or abused, you must follow your Local Safeguarding Children Board (LSCB) safeguarding children procedures. The practice guidance What to do if you’re worried a child is being abused (HM Government, 2006) sets out the processes to be followed by all practitioners.

If you think the child may be a child in need (under section 17 of the Children Act 1989) then you should also consider referring the child to Children’s Services. These referral processes will be included in your local safeguarding children procedures and are set out in Chapter 1 of Working Together to Safeguard Children (2013) (www.cumbrialscb.com/elibrary/content/internet/537/6683/6687/41584151459.pdf). You should seek the agreement of the child and family before making such a referral unless to do so would place the child at increased risk of significant harm.

13

Action Plan and Review For SEND Early Help Assessments an IEP can be used as an alternative to the Action Plan. Actions from the assessment should be brought forward into the delivery plan and added to where a multi-agency team around the child response is required and/or used to review progress)

Personal Details

Given name(s):       Family name:       DOB or EDD:      

Address:       Postcode:       Male Female Unknown

Co-ordinator Details

Name:       Agency/Relationship:       Email:      

Address:       Contact Number:      

Desired Outcomes(as agreed with child,

young person and/or family)

Action Who will do this? By when? Progress and Comment

For completion at review stage

DateClosed

For completion at review stage

Scale 1-10How are things now?

1 being low 10 being high

                                         

                                         

                                         

                                         

                                         

                                         

To be completed at review stage

ReviewTeam Around the Child Team (TAC) TeamAround the Family (TAF)

Date:      

People present     

(Review delivery plan and update with any agreed further action)

Next Steps     

Can the SEND Early Help Assessment be closed? Yes No

Reason for closure:       Agreed review date:      

Review Notes     

Child or young person’s comment on the assessment and actions identified     

Parent or carer’s comment on the assessment and actions identified     

Request for EHCP assessment following review