Children’s Services and Skills Directorate
SEND 0-25 Service

 
Consent Form for Parents/Carers

What is EBSN? 

Emotional Based School Non-Attendance (EBSN) is a broad umbrella term used to describe a group of children and young people who have severe difficulty in attending school due to emotional factors, often resulting in prolonged absences from school. 

What is the role of the EBSN team? 

The EBSN team is a team of Educational Psychologists and Assistant Educational Psychologists from the Community Educational Psychology Service (CEPS). The role of the team is to work with CYP, families, educational settings and other professionals already involved to develop a psychological formulation of the EBSN functions and a joined action plan. 

What will happen after the referral for my child is submitted? 

The EBSN team will carefully review all the information provided and decide whether it meets the EBSN team’s criteria.

Meets criteria 

Does not meet criteria 

The referral will not be accepted, and the team will contact the educational setting to explain this decision and may either request further information or signpost to a different team/service.

The referral will get accepted and a member of the team will contact you to introduce themselves and talk you through the different steps of the assessment process.

An assistant educational psychologist will meet with your child twice to collect their views on what they find difficult about school.

An educational psychologist will arrange an appointment with you to gather your views regarding your child’s EBSN difficulties.

The action plan my involve: 
•	individual work with the child
•	support for schools
•	work to support the family 

TAC meeting: parents/carers, the educational setting and other professionals already involved will gather to gain a shared understanding of the EBSN functions and come up with an action plan.

                                                                                                                                                                Yes               No 
•	

I confirm I have read and understand the above and agree to participate 
              in the EBSN team’s procedures. 

What will happen to my child’s information? 

Any information that you or your child/ young person provides on this form or whilst using our services will be used by the EBSN Team to help us tailor services for your child. Information will be treated as confidential, and stored in a secure way. It will only be shared with other council services and partner organizations to ensure our records are kept accurate and to help us identify other services your child may be entitled to. The staff from the team working with your child will report on assessment and or intervention findings and discuss with you, and your child/ young person’s school the action and support which will need to follow. In order to work effectively, the team liaises with other services working with a child/ family and shares any written advice with professionals involved in the Team working Around the Child or young person.

We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires.  For further information about how we use your information please refer to the Council’s Privacy Statement on www.solihull.gov.uk and https://www.solihull.gov.uk/About-the-Council/Data-protection-FOI/Solihull-Council-Statement/Childrens-Services-and-Skills/Special-Educational-Needs-and-Disabilities  

Your records will be kept for 25 years for audit purposes and in the event we need to provide information about the service you have received. 
               Yes	     No

•	I confirm I understand why you want my information and I have had the opportunity to consider this.

•	

I agree that the information will be shared with other professionals who are already involved with my child, or other agencies that may become involved in the course of any support offered to my child.  This will be done in accordance with Solihull’s MBC Information Sharing Protocols. This will only be information that is relevant and necessary and will only be shared with people who need that information at that time. 

                                                                                                                                                                  
•	I understand I can opt out and withdraw my consent at any time by contacting the 0-25 Children and young People’s Service Business Support Unit on 0121 7046690.

                                                                                                                                                             	      
•	I give consent for you to record and hold my information for the        
purposes explained to me. 

•	I consent to my child receiving the services provided by the EBSN team.

Name of Parent/Carer: 			 (please print) 

Signature: 								__________________

Email Address: 			       Phone number: 			  

Date: 						

Contact details

Should parents/ carers have any queries about this form you can contact Dr Louisa Jones or Dr Faye Hingley, EBSN team at EBSN Team Requests, Elmwood Place, 37 Burtons Way, Smiths Wood B36 0UG or email: EBSNteam@solihull.gov.uk