Family Conversation Record for Statutory EHC Assessment
	
Name of Child/Young Person		
Education Provision
(e.g. school, college, training provider) 		
Key Contact at education/ or training provision		
Key Contact’s job role:		
Key Contact’s Details:
(Telephone No and Email Address)	

Family Conversation Meeting Date(s)		

1.	CHILD’S / YOUNG PERSON’S DETAILS:

First name:		Surname:	
	
Preferred name:		Gender:		
Date of birth:		Religion:		
Ethnicity:		First language:		
Home address:

Parents address if not the same as above:	 	Parent(s) / Carer(s)  first language:		
Contact number:		Email address:		

How would you prefer to be contacted?  Phone      Email         Letter

Has a medical questionnaire been completed? Yes/No
(this is an essential part of a request for an assessment)

If so, is there a request for an appointment with the community paediatrician? Yes/No

2.	EDUCATION DETAILS:

Has this child attended any other school/education setting in the last 12 months?     Yes/No
Previous school/setting:
(last 12 months)		

3.	SOCIAL CARE DETAILS:
Does this child have in evolvement with social care services?    Yes/No
Name and contact details of any allocated social worker		

4.	SIGNIFICANT FAMILY MEMBERS :
Please provide name & details of family members: 
Name	Address	Relationship	Parental responsibility?	

   				

				

			

5.	KEY CONTACTS:
Please provide details of any agencies/services that currently have contact with the family, including the nature of involvement. Please also attach copies of current reports/assessments from these workers.
Name	Service/ Agency	Contact details (Address/ Tel. No/ Email)	Report provided Y/N?	Can we contact
Y/N?	

					

6.	WHAT DO PEOPLE NEED TO KNOW ABOUT (Name)
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7.	WHAT MAKES (Name) HAPPY:
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8.	WHAT DO PEOPLE LIKE/ADMIRE ABOUT (Name):
•	
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9.	WHAT ARE (Name)’s STRENGTHS: 
•	
•	
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•	

10.	WHAT (Name) WANTS FOR HIMSELF/HERSELF IN THE FUTURE:
•	  
•	  
•	  
•	

11.	HOW DOES (Name) WANT TO BE SUPPORTED?
•	 
•	 
•	   
•	

12.	ASPIRATIONS FOR (name) AND FOR THEIR FAMILYy
•	
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•	
•	

13.	WHAT DOES (Name) FIND DIFFICULT/NEED EXTRA HELP WITH:
Be mindful that the key worker will need to consider all aspects of education, health and care when discussing issues under the following headings

Education and learning - for life and work:

How (name)communicates and interacts with others:

Friendships, relationships and being part of community:

Social, emotional and mental health needs:

Independence and personal care needs:

Physical needs:

Sensory needs:

Health:

Support for family:

14.	ACTIONS
A clear explanation of what actions are required, from the point of view of the child/young person/parent/carer to meet needs. This section has two parts.

14.1 WHAT IS WORKING WELL AND NEEDS TO STAY THE SAME
This section needs to identify what is currently being undertaken successfully and should therefore continue. 

14.2 IF IT IS AGREED THAT WE WILL CARRY OUT AN EHCP ASSESSMENT, AND THAT YOUR CHILD NEEDS AN EHCP, WHAT SUPPORT DO YOU HOPE THEY WILL GET AT THE END?

15. CONSENT:
We agree that this is an accurate record of the family conversation and we understand that the information provided in this document will be used to ensure that the council’s records are correct. It may also be shared with other agencies and service providers to ensure that <name> receives an appropriate service.

Parent/Carer:	Signature:	Date:		
Parent/Carer:	Signature:	Date:		
Key Worker:	Signature:	Date:		

The information contained within this record has been compiled from a variety of sources for the purposes of creating an initial overview of your child’s/young person’s needs. While all efforts have been made to ensure the accuracy of this information, no reliance should be placed upon it for the purposes of specific delivery or resource allocation, as this will be agreed at the creation of the EHC Plan.

If you have any access issues, for example a disability, language or literacy barrier please provide details of any additional support requirements or reasonable adjustments that the Local Authority will need to take into account to support you/your family through this process: