Single point of access referral form for education support

Evidence of parent / carer permission must be provided with this referral.

At least one contact number should be supplied before we can accept the referral.
Section 1 - person making the referral / request
First name*
Last name*
Job title*
Email*
School / setting*
Department*
Address*
Address Line 1 Address Line 2 City County Postcode
Are you referring only for training?*
Yes
No

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Section 2 - child / young person’s details
Student’s first name*
Student’s last name*
Gender*
Female
Male
Date of birth*
Address*
Address Line 1 Address Line 2 City County Postcode

Home telephone
Parent’s / carer’s mobile
Young person’s mobile number (if over 16yrs)
Does child / young person receive
Pupil premium
DLA/ PIP
Nursery / school / college*
School year*
Attending*
If part time*
Language
Interpreter required
Yes
No
Religion
Ethnicity
Nationality
NHS number (where known)
GP name
GP address
Address Line 1 Address Line 2 City County Postcode

Is child / young person
EHCP
LAC
known to Children and Disabilities Team
school SEND support
subject to Child Protection / Child in Need Plan
Date moved into Redbridge
Previous local education authority
Key medical needs

School health care plan
Yes
No
Please upload
Accepted file types: jpg, png, pdf, doc, docx.
Any other information

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Section 3 - parent's / carer’s details
Who has parental responsibility?*
Parent’s / carer’s full name*
Address*
Address Line 1 Address Line 2 City County Postcode

Relationship to child / young person*
Interpreter required
Yes
No
Preferred method of contact*
Phone
Email
Telephone*
Email*

Preferred contact time
Morning
Afternoon
Either

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Section 4 - other services / professionals involved (current and past).
Please select all services involved in each section
Early years
Pre-school home visiting team
Early years advisory service
Health visitor
Other
Please specify*
Outreach
Hatton
Little Heath
Churchfield’s Lang Outreach
New Rush Hall
Newbridge
SERC equipment
VI Advisory Service
HI Advisory Service
Other
Please specify*
Other Education services
Home tuition
Educational Psychologist
Education Welfare Officer
Other
Please specify*
Health
SALT
Paediatrician
Occupational Therapist
Physiotherapist
Community Nursing Team
Continence Team
Feeding SALT
Referral made to CDC (Child Development Centre)
EWMHS (previously known as CAMHS)
Other
Please specify*
Other
Youth Offending Team
Fusion YP - Substance Misuse Service
Social Care
Connections
Other
Please specify
Please list all involvement from outside professionals in the past 12 months, and the outcome of their involvement / recommendations

Involvement Outcome Actions

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Is this student a transition student?
Yes
No
Would you like support with this?*
Yes
No

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Section 5 - reason for referral
Reason for referral*
Please identify the key area of need*
Additional needs
Autistic Spectrum
Social Communication
Receptive Language
Expressive Language
Attention and Listening
Global Learning Difficulties
Cognition and Learning
SPLD ie Memory, organisation
Hearing
Vision
Physical Disability / Physical Access to learning
Motor
Medical Needs
Auditory Processing Disorder
Multi- Sensory
SEMH
Complex Needs
Any other information. Including any formal diagnosis (please evidence where possible)
Evidence (optional)

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Section 6 - developmental history (where known)
Key developmental milestones. eg began speaking, first steps, independently sitting etc

Please use the "+" button on the right to add next key developmental milestone
Date of last eye test
Outcome of last eye test
Date of last hearing test
Outcome of last hearing test

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Section 7 - assessment details
Please list current learning levels. These must include core subject areas

Learning level Core subject area Actions

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Interventions / strategies past and present including outcomes of these (assess, plan, do and review). Please indicate all school support, external interventions and specialist provision
Please attach provision map / timetable or school data if this is easier to summarise

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Section 8 - parental concerns and relevant family history
Parental concerns / views on the referral
Additional information the family would like to be shared

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Section 9 - child / young person’s views
Child / young person’s views on the referral

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Section 10 - permissions
Please tick to confirm you have read and understood the following involvement.

I understand the SENCO / other professional will request support / advice/ assessment from S.E.A.T.S.S.

Following a referral, a member of the Team may visit your son / daughter in pre-school / school / college.
Consent*
By checking this box you confirm that you have read, understood and agree to the involvement
During this visit I understand and I give permission for a member of the Team to
Select All
Visit the school / setting
Obtain data. Medical information (where relevant), talk to key members of staff to ascertain a full picture
Observe / work directly with your child
The personal information we gather is only used by us to help your child at school and at home. It will only be shared with you, the school and directly with relevant professionals. We use the information gathered to write reports, make suggestions for the school (if any) and you. The information is stored on a secure internal database. By default, we retain it until your child is 25 years old. You may request a copy of all information we retain at any time and ask for it to be deleted or amended
Work with my child in class or outside class if the assessment requires it
Take photos / videos of my child during the assessment and the photos will be added to the report. Any unused photos will be destroyed at the time of report writing
I agree to share hospital information (if relevant)
I understand that as my Child moves through Education, their needs or the focus of support may change, and they may receive support from additional teams
Full name*

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Section 11 - training
Teams have prepared INSET sessions, but also we can create bespoke packages for your school
Please tick all areas you are interested in
Whole school CPD
Specific CPD sessions
LSA training
Parent’s sessions
Specific blocks of support / interventions
Please select
Primary
Secondary
Other
Would it be just your staff or would you be inviting staff from other schools?
Have you had training in this area before?
Would you be interested in a multi- disciplinary training day / session?
Are there any other topics / format you would like to consider?
Areas of training currently offered – please select which you require
5P (accredited training)
6 week block of motor support (gross and fine motor)
Access arrangements
AET (accredited training)
App’s to support a range of curriculum areas/ needs
Autism
Autism – a personal perspective
Back care of parents
Back care of staff
Behaviour / 5P scale
BSL- family training
Can’t write/ won’t write
Class disability awareness session
Coaching and mentoring
Disability awareness assemblies
Colourful semantics
Communication
Developing conversation / communication skills
Developing tray independence
Down’s syndrome
Engagement profile
Fine and gross motor training including happy hands, healthy hands
Hearing Impairment training
Incredible 5 point scale
Makaton (accredited training)
Mental health first aid
Motor and life skills – readiness for school (nursery / pre-school)
Moving and handling (accredited training)
Neurological profile and the impact on the learner
Numicon
PD net level training
PEEP’s and risk assessments
Pre- stage standards
Precision teaching
Revision strategies and techniques
SEN classroom support
Sensory learning
Social stories
Specific condition eg dystrophy, cerebral palsy, spina bifida
Specific language impairment
Steps to being a writer – pre writing, alternatives forms of recording
Strategies for Inclusion
Study skills / memory (secondary)
Talkabout
Teenage talkabout
Using ICT to support literacy and dyslexia
Using ICT to support non-verbal students
Using ICT to support visual Impairment
Visual impairment training
Working with additional needs
Working with students working at lower P scales
Primary schools only
Early English language learners (listening programme)
Good listening programme
Narrative programme
Parents workshop language / communication session nur / rec / yr 1
Reading workshop
Supporting students who have speech, language and communication needs
Yr 1 language project 10 week programme
Other training not listed above, please specify

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Step 1 of 11

Section 1 - person making the referral / request

Section 2 - child / young person’s details

Section 3 - parent's / carer’s details

Section 4 - other services / professionals involved (current and past).

Section 5 - reason for referral

Section 6 - developmental history (where known)

Section 7 - assessment details

Section 8 - parental concerns and relevant family history

Section 9 - child / young person’s views

Section 10 - permissions

Section 11 - training