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London Borough of MertonEducation, Health and Care Plan

This Statement is an important Legal Document and should be kept carefully

C&YP Name

Forename: Surname:

Address:

Postcode:

Contact Number(s)Home: Mobile: Other:

Date of Birth:

Ethnicity Background:

Looked After: Yes: No: Borough:

Gender:

Religion (optional):

First Language:

Educational Setting/School/College/Placement:

Twitter Account /Other Social Media To be consulted with CYP before removal approved

Name of Parent(s)/Carers(s) with parental responsibility

Full Name

Relationship

Full Name

Relationship

PERSONAL DETAILS AND INVOLVEMENTSection 1

Name Title How did they contribute Dates(s) Documents attached or

included where applicable

Person/ServiceName Title In what capacity is the

service/professional involved Dates(s) Contact Details

* i) G.P. ii) School contact iii) Social worker details (if applicable) must be included in one of the above sections.

PERSONAL DETAILS AND INVOLVEMENTSection 1

Names of everyone who has contributed to this Education, Health and Care Plan

Names of known professionals/services involved with the child, young person, parent or carer

NEED CLARIFICATION EXACTLY WHAT PARTS OF NORTHAMPTON MODEL PARENTS LIKE - AS WE HAVE INCLUDED SOME ELEMENTS WITHIN SECTION 2

Part 2 Child/Young Persons Story(Summary)

Part 3 ASPIRATIONS of Child / Young Person – e.g. Education, Play, Health, Friendships, 6th Form, Further Education, Independent Living, University, Employment and Business (Summary)

For Parts 1-3 - Where the child / young person, parent or carer makes specific comments or phrases it should be clear who has made the comment.

Part 4 Child / Young Persons COMMUNICATION:

Part 5 Child / Young Persons FAMILY HISTORY:

Part 6 Parents/Carers aspirations for child / young person e.g. Education, Play, Health, Friendships, 6th Form, Further Education, Independent Living, University, Employment and Business (Summary)

Part 7 How has the child / young person and his/her family participated in the development of the plan?

CHILD/YOUNG PERSON PROFILESection 2

Part 1 Circle of Support

OPTIONALPhotograph of child or young

person

OPTIONALDiagram of child or young persons support network

Please describe the strengths and skills that have been identified in the Assessment (in priority order where possible) in

the following areas. If you have quoted from a report and/or document, reference to the report where the quote has been

drawn. If you have quoted from a report please identify clearly.

Please describe the needs that have been identified in the Integrated Assessment (in

priority order where possible) in the following areas

STRENGTHS & SKILLS IDENTIFIED NEEDS IDENTIFIED IN ASSESSMENT

OVERALL OUTCOME

Development and Learning

1. Communication and learning2. Cognition and learning3. Behaviour, emotional and social development4. Sensory and/or physical

Emotional Wellbeing


Physical Health/Medical Needs


Family Environment


STRENGTHS, SKILLS & NEEDS SUMMARYSection 3

What are the risks of not achieving this outcome?

OverallOutcomes

1.

2.

3.

Outcome Targets/Measures to achieving the outcomes?

What are the specific agreed provisions and strategies to meet the targets, as part of the overall

outcome?

By Whom?

By When?

Reviewed

1

2

3

OUTCOMES & PROVISIONSDevelopment and Learning

Section 3


OverallOutcomes

1.

2.

3.



outcome?

By Whom?

By When?

Reviewed

1

2

3

OUTCOMES & PROVISIONSEmotional Wellbeing

Section 3


OverallOutcomes

1.

2.

3.



outcome?

By Whom?

By When?

Reviewed

1

2

3

OUTCOMES & PROVISIONSPhysical Health/Medical Needs

Section 3


OverallOutcomes

1.

2.

3.



outcome?

By Whom?

By When?

Reviewed

1

2

3

OUTCOMES & PROVISIONSFamily Environment

Section 3

DATE OF REVIEW How will this plan be reviewed?

DATE OF REVIEW How will this plan be reviewed?

Lead Professional responsible for this plan will be:Name:

Title:

Telephone Number:

Email:

ARRANGEMENTS FOR PLANS REVIEW(S)Section 3

Signature: Date:Print Name:

(Name) being an authorised officer of the Authority and / or the Lead Professional


(Child or young person - if applicable)


(Parent/Carer/Guardian)

The above contributors are happy that the information contained in Sections 1, 2 and 3 accurately reflect the child or young persons profile, skills, strengths, needs; and in addition the agreed outcomes and review periods identified in this plan have been co-produced.

Any changes in circumstances such as a change of address should be sent to the Special Educational Needs Team immediately

SIGNATURESSections 1, 2 & 3

How will this be resourced/supported by:

Outcome Number Outcome Summary Education Health Social Care Voluntary

SectorFamily

Skills/Resources1

2

3

Personal Budget

Outcome Number Outcome Summary Education Health Social Care Voluntary

SectorHow will the Personal Budget be used to meet the outcomes

1

2

3

Resource & Allocations


(Name) being the SEN Multi Agency Panel Chair an Authorised officer of the Authority


(Name) being the Tri-partite Panel Chair(if applicable)


(Name) being the SEN Placement/Allocation Panel Chair(if applicable)

The above representatives agree the allocations in Section 3, in line with their individual Panel Terms of Reference, to meet the agreed Education, Health & Social Care needs identified in this plan.The agreed funding is subsequent to annual review.

Any changes in circumstances such as a change of address should be sent to the Special Educational Needs Team immediately

SIGNATURESSections 4