Request for professional information/advice from an Educational
Psychologist to support a statutory integrated assessment for a
child/young adult
Context
This information is sought in accordance with the Children and Families Act 2014.
The Local Authority is seeking advice as part of a statutory integrated assessment.
Child/Young Person's Details
Surname
Educational
Setting
Forename
Date of Birth
Address
Year Group
Parent/Carer
Name
Relationship
Address (If
different from
above)
Child Looked
After Yes/No
Parent/Carer
Name
Relationship
Address (If
different from
above)
Social Worker
Type of Advice
Statutory Integrated Assessment
Review of Education, Health and Care plan
Statutory Re-Assessment
Conversion Advice from a Statement to EHC Plan
Advice Givers Details:
Name
Job Title
Qualifications
Service
HCPC No.
Was the child/young person known to your service prior
Yes
No
to this request?
If so what has been your services involvement with the child/young person over the
last 12-18 months?
Section A: Sources of Information
The following sources of information have been used directly to prepare this
psychological advice:
Date
Author/Contact
Source of Information
Section B: Relevant Background
The purpose of the current Educational Psychologist's involvement
Relevant background information and history of the child/young person (to include a
description of the concerns raised)
Please indicate if current strategies and resources reflect the previous professional
advice given
Are there any additional significant factors – If the answer is yes please attach
copies of relevant information/advice
Health Yes/No
Attendance Yes/No
Home Circumstances
Yes/No
Social Relationships
Yes/No
Section C: Views
Set out the views of the parents, young person and staff from the educational setting.
Child/Young Person:
Parent/Carers:
Staff from the Educational Setting:
Section D: Psychological Assessment
Standardised Assessment
Standardised Assessment Results
Section E: Identified Strengths and Special Educational Needs
Communication and Interaction
Cognition and Learning
Social Emotional and Mental Health Difficulties
Sensory and/or Physical Needs
Independence and Self Help
Section F: Summary of strengths and areas requiring intervention
Summary
Section G: Outcomes Recommended
What additional support do you feel is required over and above that already
provided?
Outcome
Steps towards
Achieving Outcome
Timescales to
Achieve Outcome
Special Educational
Needs Provision
Required
Name of
Educational
Psychologist
Signature
Date of
Completion
Educational Psychologist
Provision & Performance –
XXXX Team
Inclusion Disability Support
Service
If advice is provided by a Trainee Educational Psychologist, the supervising
Educational Psychologist must countersign this advice
Name of
Date
Educational
Psychologist
Signature