Print letter template - Web viewPlease complete all sections 1-8 of this form and ask the family to complete sections 9-12 (the Family Advice Consent), in sufficient detail to provide

Form FA1 (v8.5) Statutory Assessment Request

Guidance for Islington Early Years settings, Schools and Further Education Colleges

Please complete all sections 1-8 of this form and ask the family to complete sections 9-12 (the Family Advice Consent), in sufficient detail to provide a full picture of the childs needs. We will use this information to help us decide whether to go ahead with an EHC assessment. If we agree to carry out an EHC assessment this information will also be used to inform the assessment. Requests for assessment will follow the process set out in the flowchart on page 2.

How to use existing documents

If the evidence / information already exists in reports or other documents you are sending us please summarise this and do not repeat the information in full on this request form. We ask that you cut and paste short quotes and refer to the source like this: ‘see page 4, paragraph 3 of the attached SALT report dated 28/06/2016’

Submitting the form

Requests should be emailed securely to [email protected] additional information sent with this form should:

be scanned electronically and saved either as word document or a PDF have a file name with the corresponding letter A- L in the table in section 6 to help us check

that the request is complete

Incomplete requests

Requests for assessment cannot be considered until all the necessary documentation has been received. This includes the FA1 form (including signatures), the Educational Psychologist report, evidence of attainment, interventions and child’s progress (usually SEN Support Plans and reviews) and any other documents listed in section 6.

Statutory Assessment Advice

Please make sure the information you send is up to date because if the request is agreed, the information will all be regarded as part of the statutory advice for an EHC assessment.

Further guidance and help

Guidance notes and prompts are included in red directly in the form. An example of a completed FA1 Form can be found at www.islington.gov.uk/localoffer

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http://www.islington.gov.uk/localoffer

mailto:[email protected]


EHC Assessment Request Flowchart

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1. Contact Details

ChildFirst nameSurnameAddressDate of birthGender

Telephonehomemobile

E mail addressEthnicityHome languageUnique Pupil NumberNHS NumberGPs name and addressParent / carerFirst nameSurnameAddress(if different from above)

Telephonehomemobile

E mail addressRelationship to childFirst languageParent / carer (if a 2nd person has parental responsibility)First nameSurnameAddress(if different from above)

Telephonehomemobile

E mail addressRelationship to childFirst language

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Current educational setting / school / collegeNameAddress(if different from above)

TelephoneE mail addressLocal authority areaLead professional at the setting/ schoolDate the child startedAny previous education setting(s) attended

2. Reason for asking for a Statutory EHC AssessmentHow would a statutory EHC assessment and EHC Plan support the planning and provision to meet the child/young person's special educational needs.In order for a statutory assessment to be undertaken, the balance of evidence must show that:

1. The child/young person’s learning difficulties have not responded to relevant and purposeful measures by the school and external specialists over a significant period of time (at least three terms). For very young children in early years settings it may not be possible to comment on progress over 3 terms.

2. The child/young person’s learning difficulties may call for special education provision which cannot reasonably be provided within the resources normally available to mainstream settings, i.e. the basic pupil funding and the notional SEN funding already in the setting, school or college (at least £6k each year per child)

Please list any evidence attached to this assessment request in section 6.

What future goals or outcomes are you recommending for the next phase of the child or young persons education. (These are likely to be similar for an SEN Support Plan or EHC Plan)

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3. Strengths and NeedsIn this section please briefly describe the child/young person's strengths and areas of need including information about any diagnosis or formal assessment.

Special Educational NeedsOverall summary of strengths and difficulties

Keep this section brief. 2-3 paragraphs will be enough. Further details should be subdivided under the different headings below (i.e. cognition and learning, communication and interaction)

Cognition and learning

Include strengths and needs relating to understanding, participation and engagement and learning style

Communication and interaction

Include strengths and needs relating to how they communicate, speech and language, listening and attention skills

Social, emotional and mental health

Include strengths and needs relating to social skills,interaction,friendships, emotional development and behaviour

Sensory and / or physical

Include strengths and needs related to gross and fine motor skills, sensory processing, personal care, independence and safety

The impact of these difficulties and the implications for learning and development5


Please do not prescribe the provision you think is required e.g. ‘he needs a 1:1 TA full time’ as this information will go in the provision section of any plan.

Summarise the impact of the areas of difficulty under the following 4 areas. This section will link directly to the goals and outcomes we will want to achieve.

Learning and work: Her difficulties with attention, concentration and listening skills means that she is easily

distracted where there is a lot of noise during lessons.

His learning difficulties means that he cannot work at the same level as his peers and is likely to find the secondary curriculum difficult to access.

Community participation and inclusion: Her delayed receptive and expressive language skills mean she finds it difficult to join in

activities with other young people of her own age and means that she doesn’t have any friends at the moment.

His misunderstanding of social situations can lead to behavior that often puts himself and others at risk.

Staying healthy (including mental health): His difficulties in understanding and expressing his feelings are a barrier to him establishing

supportive relationships with adults and peers and can make it difficult for him to cope in new situations.

Her learning difficulties and poor memory means that she is unable to manage her own medication.

Independence and self-help skills: His learning disabilities and poor memory means that he is not able to manage his

personal hygiene or take responsibility for money management. His impulsivity and challenging behavior means he is not able to travel independently. Her physical disabilities mean that she is unlikely to live entirely independently as an adult.

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Health NeedsSummary of strengths and difficultiesWhich relates to the child / young person’s SEN

This is a summary of the areas of difficulty that relate to the child or young person’s SEN. Health care needs, such as routine dental health needs, are unlikely to be related.

Other Health needs

Other health care needs which are not related to the child or young person’s SEN (e.g. a long term condition which might need management in a special educational setting).

The impact of these difficulties on the child / young person and family

Learning and work

Community participation and inclusion

Staying healthy (including mental health)

Independence and self-help skills:

Social Care Needs7


Summary of strengths and difficultiesWhich relates to the child / young person’s SEN

A summary of any social care needs which relate to the person’s SEN

Other social care needs

Any other social care needs which are not linked to the person’s SEN. This could include reference to any child in need or child protection plan.

Area of need could include: parent/carer strengths & difficulties, info on siblings, the family dynamic, housing/ immigration status, involvements with statutory and voluntary services, work/ training, financial income.

The impact of these difficulties on the child / young person and family

Learning and work

Community participation and inclusion

Staying healthy (including mental health)

Independence and self-help skills:

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4. Progress and AchievementPlease provide details of attendance, attainment and progress over the time. For children in early years settings it may not be possible to comment on attendance or progress over 3 terms.

% Date range covered

Attendance (over 3 terms)

Early Years Foundation Stage Current Level Last terms Level

Previous Level

1. Listening and Attention2. Understanding3. Speaking4. Moving and Handling5. Health and Self Care6. Self Confidence and Self Awareness7. Managing Feelings and Behaviour8. Making Relationships9. Reading10. Writing11. Numbers12. Shape, Space and Measures13. People and Communities14. The World15. Technology16. Exploring and Using Media and Materials17. Being Imaginative

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School age children

Include assessment information (e.g. age related bands, P levels or similar) that demonstrates current attainment levels and progress over time.

School age children Current Level

Last Year’s Level

Previous Year’s Level

NumeracyReadingWritingOther curriculum

Details of assessment system(s) used.

Please describe what assessment system you are using e.g. target tracker, PIVATS, IPAT, P scales, other system developed by the school/ college.

Please explain what different grading in the system means.

Details of current goals/ targets

If this information is in the current SEN Support Plan or individual plan please indicate this and attach a copy.

Please list any evidence attached to this assessment request in section 6

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5. Current SEN Support

Details of current Special Education provision in place


This should include:

The date that SEN Support started

Strategies used beyond differentiation which are additional to or different from those normally available

Additional resources made available to enable the child to achieve targets

Details of parent / carer involvement (e.g. home school agreements, reviews)

(If the individual plan / provision map does not include all of the elements above, separate documentation must be submitted)

The cost of the current Special Education provision in place from the schools budget

The cost of SEN provision needs to be set out in detail and we recommend completing the costings tool found online at www.islington.gov.uk/localoffer or by contacting the [email protected]

However, if the costings information is in the current SEN Support Plan or individual plan please indicate this and attach a copy.

Please list any evidence attached to this assessment request in section 6

Describe the ‘Assess, Plan, Do, Review’ cycle and how has this been revisited and built upon over time in order to identify, assess and address needs.


Include copies of reports, plans or minutes of review meetings held at various stages over the past year/18 months where appropriate. Please list any evidence attached to this assessment request in section 6

Please include:

evidence of baseline assessment from which progress can be measured

Details of parent / carer involvement (e.g.: home school agreements; reviews)

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6. Information and AdvicePlease list and provide any supporting documentation by scanning, attaching and returning it with this completed form. To assist with cross checking please reference documents with the corresponding reference number.

Items A and B below are essential. Please note that a request for a statutory Education, Health and Care Assessment cannot be considered until all the documentation listed has been received; any incomplete requests will be returned.

Ref Document name Date No of pages

A Educational Psychologist Report (essential)

BEvidence of attainment, interventions and child’s progress -- usually SEN Support Plans and reviews. (essential)

C

D

E

F

G

H

I

J

K

L

7.

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7. People working with this child and family

The Council considers all the information attached to this application and listed in section 6 above. Where we agree that an EHC assessment is required, we will also contact the people listed below for further information.

Please obtain agreement from the people you are listing that they may be included and contacted if needed.

Service and Name of Person E-mail Telephone Details of

involvement

Date of most recent

involvementLead Professional

Class Teacher

Support staff

Educational PsychologistSpeech and Language TherapistOccupational Therapist

Physiotherapist

Family Support Worker

What multi-agency arrangements have been in place (e.g. CAF, Early Support, Child in Need Review). Please provide details of types and dates of meetings in the last 12 months.

Type of meeting Dates

Are any multi-agency meetings planned within the next 3 months? If so please provide details:

Type of meeting Date /Time Venue

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8. SignaturesEducational PsychologistI confirm that I have been consulted about the request for statutory assessment of this pupil’s special educational needs and have provided a written report.

NameSignatureDate

Head Teacher/PrincipalOur school has made every effort to address this pupil’s learning difficulties, which I believe to be of a nature, severity and complexity that meet the Council’s threshold for statutory Education, Health and Care needs assessment. I also understand if this request is agreed the information included will be regarded as statutory assessment advice.

NameSignatureDate

Checklist for EHC Assessment Requests Please tick to confirm

For office use only

All sections of the FA1 form are complete in full ☐ ☐Any other specialists’ advice that is relevant to the child / young person's learning and development are attached and listed in section 6.

☐ ☐

A copy of the most recent report from an Educational Psychologist employed or commissioned by the Local Authority is attached and listed in section 6

☐ ☐

Other professionals working to support the child and the wider family have been made aware of this request for EHC assessment, and have agreed to be listed in section 7. ☐ ☐

Section 8 of the FA1 Form is signed by:the Educational Psychologist and the Head Teacher/Principal ☐ ☐

Section 12 of the form is signed by the Parent/ Carer (or young person if they are able to make their own request) ☐ ☐

The information will be sent by secure email to [email protected] Special Educational Needs, Pupil Services, 222 Upper Street, London N1 1XR

☐ ☐

This request will be returned as incomplete if any of the documents listed are not included or if it is not signed by all relevant parties.

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Family Advice and Consent

This appendix to the main form is for families to tell us their story and experiences. There are some prompts below to help you provide this information but you can present it in any way that you like.

9. About the child/ young person

Child’s history

Child’s interests, likes and dislikes

Child’s strengths and weaknesses

How your child likes to communicate and be involved in making decisions

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Child’s own hopes for the future

Parents/carers hopes for the child’s future

How your child can be supported to be heard and understood

Child/young person's support network (Family/friends)

What you feel is currently working well for your child

What you feel is not working for your child

How do you think an Education, Health and Care assessment would help your child?

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10. Other Family InformationThe other family information section is not compulsory will help to inform the need for further social care advice as part of any possible EHC assessment.

What caring responsibilities do you have for anyone else?

Are there any personal health issues, disabilities in the family that make looking after your child more difficult?

Does your child have any need for help with personal care for example bathing, dressing, toileting, which you are not able to meet?

What support is available from family/friends/others?

What leisure time activities have you tried or currently use to enable you as a parent/ carer to get a short break?

Do you have any concerns about your ability to keep the child safe in the home or in the community?

The information provided will be shared with the Islington Short Breaks Service or relevant Social Care Team who will consider any next steps towards any assessment or support for your family.

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11. Feedback on SEN Support

Please tell us your experience related to special educational needs so far by ticking a face and adding a comment.

1. Have your child’s special educational needs been identified in a timely way?

2. How well do people involve your child in the assessment of their needs?

3. How well do people involve you in the assessment of your child’s needs?

4. Is the information about the additional support being provided by the school foryour child clear?

5. Is the SEN provision for your child being delivered as planned?

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6. How do you rate the quality of the additional SEN support in place for your child?

7. How well do the professionals join up and work together?

8. Are you involved in planning support and reviewing progress for your child?

9. How helpful is the information about SEN and the EHC assessment process on the schools website?

10.How helpful is the information about SEN and the EHC assessment process on the Islington Local Offer website? (www.islington.gov.uk/localoffer )

11.How could things be improved?

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http://www.islington.gov.uk/localoffer


12. Consent for a Statutory EHC AssessmentI agree with this request for a statutory Education, Health and Care assessment of my child’s special educational needs being made by the education setting and am happy for it to be submitted to the London Borough of Islington.

As part of the application process, I / We agree for information relating to the assessment to be shared with all services ( The Islington SEND Community Support Service) and partner agencies (including Health and/or Social Care) that are involved, to facilitate decision-making.

I / we am aware that examinations and assessments are required as part of the statutory assessment process for special educational needs under Part 3 of the Children & Families Act 2014. This may include a medical examinination of the young person.

I / we agree to the sharing of any information obtained with all services and partner agencies involved. Any exceptions to this are listed in the section below.

NameSignatureDate

NameSignatureDate

The person(s) signing this consent form should either have parental responsibility of the child to whom this consent relates or the young person themselves, if aged over 16 and has sufficient understanding.

Tell us about any team/agency you would prefer for us not to share your information with

Please tell us here if there is anything else you want us to know that is particular to you and your family in relation to information sharing.

The FA1 Form should be sent by secure email to [email protected] or via post to Special Educational Needs, Pupil Services, 222 Upper Street, London N1 1XR

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Privacy Notice

Information you provide when applying for an assessment of your child’s and/or your needs will be entered onto a computerised database and may be shared with relevant partners including, but not limited to, health and/or social care agencies; some of which have been identified in section 7 of this form.

The information will be handled in-line with the Data Protection Act 1998 and will be processed for the purpose of facilitating decision-making between services and partner agencies involved with the young person being assessed under part 3 of the Children and Families Act 2014. You have the right to make a formal request in writing for access to personal data held about you or your child. You also have the right to request:

a change of any inaccurate data we hold about you or your child that we restrict our processing of you/your child’s data and/or restrict whom we share the

data with, where permitted by law withdraw consent and remove data relating to you/your child, where permitted by law

The retention of your/your child’s information will vary between organisations and will be governed by each respective organisation’s records retention policy. Islington Council will retain the information contained in this form for up to 35 years.

Islington Council also has a duty under the Children’s Act 2004 to work with partners to provide and improve services to children and young people in the area. Therefore Islington Council may use this information for other legitimate purposes and may share this information where necessary with other bodies responsible for administering services to children and young people. In certain circumstances, we may need to share information with other organisations without your consent for statutory purposes. These can include, but are not limited to, where we believe there is risk of significant harm to a child, young person or vulnerable adult, and for the purposes of crime prevention and national security. Personal data may also be shared with the Department of Communities and Local Government as part of the Troubled Families Scheme. Islington Council has a duty to protect the public funds it administers, and to this end it may use the information you have provided on this form for the prevention and detection of fraud.

You have the right to make a complaint at any point if you are not satisfied with our responses to your requests. You can do this in writing to [email protected] or by post to: Information Complaints, Digital Services, Room G17, Town Hall, Upper Street, London N1 2UD. Alternatively, you can contact the Information Commissioner's Office, at Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF. Telephone: 01625 545 700. Web: www.ico.org.uk

For more information please contact the Family Information Service on 020 7527 2000 or email [email protected]. Or visit the web page: www.islington.gov.uk/legal-information

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http://www.islington.gov.uk/legal-information


http://www.ico.org.uk/


Documents

Print letter template - Web viewPlease complete all sections 1-8 of this form and ask the family to complete sections 9-12 (the Family Advice Consent), in sufficient detail to provide