Special Educational Needs Team, London Borough of Hounslow
Blue Zone, Civic Centre, Lampton Road, TW3 4DN
Tel: 0208 583 2672
Email: SEN@hounslow.gov.uk
(delete as appropriate)
EHC Plan Agreed on:
Scheduled review date:
Version of final EHC Plan:
Insert photo of the child / young person
(where parent / young person wishes and has provided in accordance with London
Borough of Hounslow guidelines)

1. Child’s / Young Person’s Details
Name of child / young person:
Gender:
Primary Language used at home:
Other methods of communication if child / young person is non-verbal:
Religion:
Home Address:
Young person’s contact no. (if over
16yrs) ) :
Parent / Carer
Name(s):
Who is the primary carer?
Parent Carer
Telephone no.
Does the child/young person have a Health
Care Plan?
Name of GP:
GP Contact No.
GP Address:
Yes / No
Date of Birth:
Age:
Other
Languages used in the home:
Ethnicity:
Young person’s
Email (if over
16yrs):
Relationship to child / young person:
Relationship to child / young person:
Parent Carer
Email:
GP Contact no.
GP Email:
GP
Commissioning
Authority:
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:
1.1.1 Strengths
1.1.2 Needs
SECTION A: The views, interests and aspirations of the child and his or her parents or the young person
2.
Child’s / Young Person’s Profile:
2.1. Child / Young Person’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:
Page | 3

3.
Parent / Carer’s views:
SECTION B: The child or young person’s special educational needs
4. Summary of Educational Needs
4.1 Communication and Interaction:
Identified need
4.2 Cognition and learning :
Identified Need
4.3 Social, emotional and mental health:
Identified need
4.4 Sensory and / or physical:
Identified need
SECTION C: The child or young person’s health needs which are related to their SEN or to a disability
5 Health and Wellbeing
Identified Need
SECTION D: the child or young person’s social care needs which are related to their SEN or to a disability
6 Social Wellbeing
Identified Need
Page | 4

If the child / young person is aged 14years and above please complete part 7
7. Planning for Adulthood:
14 – 19yrs 19 – 25yrs
7.1 Education, Training and Employment
7.2 Independence and life skills
7.3 Independent Living
7.4 Relationships
Page | 5

Section E: Outcomes
Special Educational Needs
Outcomes
Communication and Interaction a) b) c)
Cognition and learning d) e) f)
Social, emotional and mental health g) h)
Provision to meet outcome
PROVISION
Amount and frequency of input
Who is responsible for delivering the provision / input
Section F: Special Educational Needs Provision
Timescale to review outcome
Page | 6

m) n)
Section E: Outcomes Provision to meet outcome
PROVISION
Amount and frequency of input
Who is responsible for delivering the provision / input
Timescale to review outcome i)
Sensory and / or physical j) k) l)
Health Outcomes Section G: Health and Wellbeing Provision
Social Care Outcomes (i)
Section H1: Social Wellbeing Provision
(Any social care provision which must be made for a child or young person under 18 resulting from section 2 of the Chronically Sick and Disabled Persons Act 1970)
Paragraph 9.62 Special Educational needs and disability code of practice: 0-25years
Page | 7

o) p) q) r)
Section E: Outcomes
Social Care Outcomes (ii)
Provision to meet outcome
PROVISION
Amount and frequency of input
Who is responsible for delivering the provision / input
Timescale to review outcome
Section H2: Social Wellbeing Provision
(Any other social care provision reasonably required by the learning difficulties or disabilities which result in child/young person having SEN. This will include any adult social care provision being provided to meet a young person’s eligible needs (through a statutory care and support plan) under the Care Act 2014 )
Paragraph 9.62 Special Educational needs and disability code of practice: 0-25years
Page | 8

SECTION I: Early Years Setting / 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:
SECTION J: Personal Budget Arrangements
Details of the Personal Budget (if agreed)
Provision Personal
Budget amount
Mechanism of delivery
Who is responsible to ensure arrangements are in place?
Monitoring Arrangements
Education
(list the provision for which the personal budget is allocated)
Health
(e.g. the local authority, education provider, direct payment, third party arrangements)
(e.g. local authority , education provider, parent carer, young person, other)
(how will the budget be monitored e.g. direct payments, annual review, health review, social care review)
Page | 9

Social Care
Page | 10

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 Local Authority:
.........................................................................................................................................
SECTION K: Advice and Information
Advice and
Information gathered from:
Parent Carer and
Young Person /
(Appendix A)
Education
Establishment
(Appendix B)
Health
Professional
(Appendix C)
Name Designation / Job Title Dated
Education
Psychologist
(Appendix D)
Children’s Social
Care (Appendix E)
Adults Social
Care (Appendix E)
Any other
Professional
(Appendix F)
In making this Plan under Part 3 of the Children and Families Act 2014 the Local Authority took into consideration, in accordance with Regulation 6, the evidence and advice set out in
Appendices A to F listed above.
Page | 11

Annex A:
8 Short Term Plan
Short Term targets to be achieved within the next 6-12 months. These targets will work towards the long term outcomes set out in Section E of the Education, Health and Care Plan and 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 support:
Who is responsible for delivering the support?
Arrangements for monitoring target:
Personal Budget Option
(if yes complete below):
Arrangements for managing personal budgets:
8.2 Cognition and learning
Yes / No
Short term target:
Provision to meet target:
Amount and frequency of support:
Who is responsible for delivering the support?
Arrangements for monitoring target:
Personal Budget Option
(if yes complete below):
Arrangements for managing personal budgets:
Yes / No
Page | 12

8.3 Social, Emotional and Mental Health
Short term target:
Provision to meet target:
Amount and frequency of support:
Who is responsible for delivering the support?
Arrangements for monitoring target:
Personal Budget Option
(if yes complete below):
Arrangements for managing personal budgets:
8.4 Sensory and / Physical
Yes / No
Short term target:
Provision to meet target:
Amount and frequency of support:
Who is responsible for delivering the support?
Arrangements for monitoring target:
Personal Budget Option
(if yes complete below):
Arrangements for managing personal budgets:
Yes / No
Page | 13

8.5 Health and Wellbeing
Short term target:
Provision to meet target:
Amount and frequency of support:
Who is responsible for delivering the support?
Arrangements for monitoring target:
Personal Budget Option
(if yes complete below):
Arrangements for managing personal budgets:
8.6 Social Care
Yes / No
Short term target:
Provision to meet target:
Amount and frequency of support:
Who is responsible for delivering the support?
Arrangements for monitoring target:
Personal Budget Option
(if yes complete below):
Yes / No
Arrangements for managing personal budgets:
Date of approval: ............................................................................................................
Signed by the Head of Special Educational Needs on behalf of the EHCP Panel:
.........................................................................................................................................
Page | 14