Guidance for Early Years completion of the “My Story”
1. Early Years practitioners are to complete the “My Story” with the child’s parent
as part of the Early Years process for children seeking involvement from the
SEN team.
2. The “My Story” information/document will be used for any future referral for an
Educational Health Care Plan. It has been agreed that the “My Story” document
will be completed to ensure all views and needs of the child have been captured.
3. If more than one parent has shared their views, please ensure that you gain
both parents signatures.
4. Please complete all sections of the form.
5. If you are a professional giving your own professional view, it must be clear the
reason why you are completing this form.
6. If the child has a Common Assessment Framework (CAF) form, relevant details
from the CAF can be included in the “My Story”, provided the CAF information is
relatively up to date, i.e. it has been completed within the past 6 months. Please
ring 0161 607 4239 to enquire whether the young person has a CAF.
7. Completing “My Story” will not automatically guarantee an EHCP for the child.
8. If the request does not progress to an EHCP, the “My Story” can be used to
explore services or resources that may be available to support the child as part
of the Salford Local Offer
9. The “My Story” can also be used to aid transition planning, alongside the
Starting Life Well “All about me” document.
10. For any additional support please contact Starting Life Well on 909 6508
Or email SLW@salford.gov.uk
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1.
Photograph
Optional
(Parent’s consent required)
My Story
Child’s information
My Name;
Date of birth
Address
My Background and Religion
My ethnicity is:
My religion is:
My first language is :
What is important to us now?
Parent’s view
Child’s view
2
How best to support my needs
Health Needs:
Education:
Equipment :
Social Care:
Aspirations
Now:
Future:
3
Please indicate with a tick, which you feel is the most appropriate statement to
describe your child’s needs for each of the following areas of your child’s life.
Lots of
difficulties
Some
difficulties
OK
Going
quite well
Going
really well
Health
Learning and development
Social Emotional or Mental
Health
Communication and
Interaction
Parent Information
Background
Background (e.g premature birth, medical history, past factors that have led to your
child needing additional support)
Details of previous educational provision
Why do you think that your child requires additional support?
4
What issues might affect caring for your child? (e.g. not understanding information due
to learning difficulties, unable to concentrate due to autism, accessibility of resources)
What’s Important to me/us
What’s important to you regarding your child’s learning?
Why is this important for your child’s learning?
What currently works well at your child’s nursery/setting?
What could be improved at your child’s nursery/setting?
5
What type of schooling would you like for your child? (Please tick)
Mainstream School


Mainstream provision with additional support delivered within school to meet child’s
needs
Early Years setting (Private voluntary and Independent)
Specialist Provision/School

Specialist provision / School (learning difficulties)
Resourced provision - mainstream schools which are additionally resourced to
meet a particular special educational need



Language Resource Unit
Moderate Learning Difficulties Unit
Autistic Spectrum Disorder Unit
What provisions do you think your child requires in nursery/ school setting?
(Please circle)
One–to-one and/or small group learning support
Assistive technology ( electronic equipment )
Staff with expertise of working with your child’s needs
Differentiated teaching
Accessible information ( symbol based materials )
Accessible environment e.g. ( Wheel chair )
Changing facilities ( if applicable to your child’s needs )
Sensory aids( hearing / vision etc )
Defined areas( Work stations )
Access to therapies( speech therapy, physio etc )
Other (please state)
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
6
Why do you think your child needs these provisions to be made in nursery/school
setting?
7
Professionals who support your child
From the following list of professionals whose views would you liked to be
considered in the assessment?
Professional
GP
Health Visitor
Social Worker
Paediatrician
Physio / Occupational
Therapist
Early Support / Portage
Audiologist
Educational Psychologist
Speech and Language
Therapist /CDW
Specialist feeding team
Advisory team for
Sensory Impairment
Family Support
Clinical Psychiatrist
Lead Professional
Other Specialist (please
state)
Name/contact details
Further Details (Please circle)
Does your child have a CAF (Common Assessment Framework)*
Has your child had a Special Educational Need Statement done
previously?
Does your child have a Medical Care Plan or need one to be
developed?
Does your child have or use any specialist equipment or resources?
(e.g. hearing aid, wheel chair ,ICT equipment)
Does your child have a diagnosis?
Has your child had time in hospital?
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
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Is your child on medication?
Yes / No
Personal Information (Parents)
Full Name/s
Dates of Birth
Address
Phone Numbers
Email Address
Religion
Ethnicity
First Language
Consent for Assessment (To be completed with parent /those with parental
responsibility)
If the assessment takes place I give my consent to:

A psychological assessment for my child
YES/NO

The release of health information
YES/NO

The child’s CAF being distributed
YES/NO

Information being passed to Salford Information,
Advice & Support Service
YES/NO
( Please note that should the assessment go ahead you may be invited to a local clinic so that
your child’s health and progress can be reviewed by a Paediatrician to allow up to date advice
provided. It is essential that you attend the medical appointment to avoid delays in completing
the assessment.)
Parent/Carer Signature…………………………………………
Date ……………………
Parent/Carer Signature ……………………………………….
Date ……………………..
If the form has been completed on behalf of the parent(s) the person completing the form
should sign below.
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Designation ……………………………………………………
Signature …………………………………………….. ………..
Date …………………………
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