Inclusion Support Request Form

Eligibility Criteria This inclusion support is for:  individual children who have been identified as requiring Special Educational Needs (SEN) support by the setting via:

o Information gathering from progress checks, assessments and observation in conjunction with parental information.

o Identification through early intervention services that SEN inclusion funding would support transition

o Decision by panel that the child requires additional support in order to make progress with any or all of the following areas; communication and language, physical development and personal, social and emotional development.

 Aged 2, 3 and 4 years old accessing their Early Years Entitlement

 Children in Ealing settings who do not have an Education, Health and Care (EHC) Plan

Where a child appears to be behind expected levels, or where a child’s progress gives cause for concern, practitioners should consider all the information about the child’s learning and development from within and beyond the setting, from formal checks, from practitioner observations and from any more detailed assessment of the child’s needs. From within the setting practitioners should particularly consider information on a child’s progress in communication and language, physical development and personal, social and emotional development. Where any specialist advice has been sought from beyond the setting, this should also inform decisions about whether or not a child has SEN.1

1 Special Educational Needs and Disability Code of Practice 0-25 years Information Provision Agreement The setting will complete the Inclusion Fund Request Form and return it to ……. for processing. Setting support plans for individual children should be reviewed as part of this process. This will help to identify children that require higher level support and those who no longer require support. The setting will include Early Years Foundation Stage (EYFS) assessment data for the named child for the prime areas (Personal, Social and Emotional Development, Communication and Language and Physical Development). Setting Details

Setting Name /contact details (including email/phone/ URN)

Operating Weeks

Senco

EYC

Child’s Details

Name of Child

Date of Birth Years and months e.g. 3.4

Hours Attending

Other professionals involved? (please provide reports)

DAF – Disability Is the setting in receipt of DAF for this child? Access Fund

Parent Discussion

This request has been discussed with parents and consent form signed (please tick)

Where a setting identifies a child as having SEN they must work in partnership with parents to establish the support the child needs (SEND Code of Practice, 2015).

Area of need Intervention (if What you will use (please link to the Desired impact any) already in the inclusion fund 4 broad areas of (including timeline) place for SEN)

Give an overview of the child’s progress in response to existing strategies/interventions mentioned above ( please attach attainment grid as specified above) What does the setting need to provide that is additional to and different from every day provision for all children in the setting?

Suggested Interventions please visit https://www.egfl.org.uk/topics/early-years/send-and- inclusion-early-years information on interventions and the SEND toolkit.

I confirm that the details included in this form are accurate to the best of my knowledge. I have included all the relevant information. I agree to work in partnership with the LA and relevant health professionals to support the outcomes for the named child. This may include sharing examples of good practice. I am aware that I may be subject to a review visit to show use of funds through my provision mapping.

Signed

Name

Date

Position

Ealing Council and its agents may use the information you have supplied to us under the terms of the Data Protection Act 1998.

Please keep a copy of your completed form and send a signed copy securely to:

OR use secure email system Egress to [email protected]

SEN Inclusion Fund

Early Start SEND & Inclusion Manager Ealing Council Early years Childcare & SAFE 2nd Floor SE, Perceval House 14-16 Uxbridge Road Ealing W5 2HL

Examples of Evidence that may support application process

Specialist Assessments Reports Pathways Health Professionals Progression of child through ESCAN Nursery health / SEN pathways Specialist ( e.g. VI Hospital, teacher/HI teacher) Paediatrician e.g. social and Diagnosis Therapy communication / complex ISP’s needs pathway / EHCP Developmental reviews pathway ( 1year / 2 years ) Assessments by Early Start

Setting/ Context/ Health Care Diagnosis Interventions Health Care Plan Consideration of impact on Size Risk assessment learning and development / Ratio Training ( of staff e.g. and or therapies required Capacity epilepsy/epipen) Interventions offered Linked site ( e.g. specialist CC provision) Level of setting support by EYC’s ( low/ middle/ high)

Setting based assessments Parents views Developmental reviews by What have parents told you key persons in partnership about their child’s strengths / with parents. areas for development 2 year progress summary

Outcome of Application as agreed by panel. Date Funding Level Consultancy Amount Package