Proposed / Final / Proposed Amended / Amended Version X
(delete as appropriate)
The Education, Health and Care Plan
(*Version appropriate to suit age range)
EHCP Agreed on:
Scheduled review date:
Version of final EHCP:
Insert photo of young person
(where parent / carer / young person /
young adult wishes and has provided in
accordance with London Borough of
Hounslow guidelines)
[Name]
Draft EHCP: 08/02/2016
Page 1
1.
Child’s / Young Person’s / Young Adult’s Details*
Name of child / young
person / young adult:
Date of Birth:
Gender:
Age:
Primary Language used at
home:
Other Languages
used in the
home:
Religion:
Ethnicity:
Home Address:
Young person’s / young
adult’s telephone no.
(where applicable):
Young person’s /
young adult’s
(where applicable)
Email:
Parent / Carer Name(s):
Relationship to
child / young
person / young
adult:
Who is the primary carer?
Relationship to
child / young
person / young
adult:
Parent Carer Telephone
no.
Parent Carer
Email:
Does the child/young
person/young adult have
a Health Care Plan?
Yes / No
Name of GP:
GP Contact no.
GP Contact No.
GP Email:
GP Address:
GP
Commissioning
Authority :
Draft EHCP: 08/02/2016
Page 2
Is the child / young person
LAC (Looked After Child)
Who has parental
responsibility if
LAC:
Telephone no:
Email:
1.1.
Summary of strengths and needs:
.
2.
Child’s / Young Person’s / Young Adult’s Profile:
2.1.
Child / Young Person / Young Adult’s aspirations:
2.2.
Things that are important to me:
2.3.
Things that I need more help with:
2.4.
The things that are working for me:
3.
Parent / Carer’s views: (incorporated into the plan – outcomes discussed with them)
Draft EHCP: 08/02/2016
Page 3
4.
4.1.
4.1.1.
Summary of Needs
Educational Needs
Communication and Interaction:
Identified need
Long Term Outcome
Provision to meet Outcome
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option
Timescale to review outcome
4.1.2.
Cognition and learning:
Identified Need
Long Term Outcome
Provision to meet Outcome
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option
Timescale to review outcome
Draft EHCP: 08/02/2016
Page 4
4.1.3.
Social, emotional and mental health:
Identified need
Long Term Outcome
Provision to meet Outcome
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option
Timescale to review outcome
4.1.4.
Sensory and / or physical:
Identified need
Long Term Outcome
Provision to meet Outcome
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option
Timescale to review outcome
4.2.
Y/N
Y/N
Health and Wellbeing
Long Term Outcome
Provision to meet Outcome
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option
Timescale to review outcome
Draft EHCP: 08/02/2016
Y/N
Page 5
4.3.
Social Wellbeing
Long Term Outcome
Provision to meet Outcome
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option
Timescale to review outcome
5.
Y/N
Planning for Adulthood:
14 – 19yrs
19 – 25yrs
5.1.
Education, Training and Employment
5.2.
Independence and life skills
5.3.
Independent Living
5.4.
Relationships
Draft EHCP: 08/02/2016
Page 6
6.
Monitoring and Review of Plan
Sections 2 – 5 in the EHCP will be reviewed at the end of the respective key stage or earlier
where there is a specific and appropriate reason to do so.
Annex A Short term targets will be reviewed through education annual reviews and / or
appropriate health and social care review mechanisms.
7.
Education / Training Provision
(Mainstream, Centre, maintained special school, non-maintained special school,
Independent, alternative provider, maintained college, specialist college, training provider)
Type of provision:
Name of provision:
Date of Proposed / Proposed Amended Education, Health and Care Plan: .................................
Date of Final / Amended Education, Health and Care Plan:........................................................
Signed by the Head of Special Educational Needs on behalf of the EHCP Panel:
................................................................................................................................................
Draft EHCP: 08/02/2016
Page 7
Annex A:
8. Short Term Plan
Short Term targets to be achieved within the next 12 months. These targets will work towards the
long term outcomes set out in part 4 of the Education, Health and Care Plan. These will be reviewed
at the Annual Review or as specified below.
8.1. Communication and Interaction
Short term target
Provision to meet target
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option
Arrangements for monitoring
8.2. Cognition and learning
Short term target
Provision to meet target
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option (if yes
complete below)
Arrangements for managing
personal budgets
Arrangements for monitoring
Draft EHCP: 08/02/2016
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8.3. Social, Emotional and Mental Health
Short term target
Provision to meet target
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option (if yes
complete below)
Arrangements for managing
personal budgets
Arrangements for monitoring
8.4. Sensory and / Physical
Short term target
Provision to meet target
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option (if yes
complete below)
Arrangements for managing
personal budgets
Arrangements for monitoring
8.5. Health and Wellbeing
Short term target
Provision to meet target
Amount and frequency of
input
Who is responsible for
delivering the provision /
input?
Personal Budget Option (if yes
complete below)
Arrangements for managing
personal budgets
Arrangements for monitoring
Draft EHCP: 08/02/2016
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8.6. Social Care
Short term target
Provision to meet
target
Amount and
frequency of input
Personal Budget
Option
Arrangements for
managing personal
budgets if applicable
Who is responsible for
delivering the
provision / input?
Arrangements for
monitoring
Date of approval:
...............................................................
Signed by the Head of Special Educational Needs on behalf of the EHCP Panel:
................................................................................................................................................
Draft EHCP: 08/02/2016
Page 10