Early Years SEN Top-up funding criteria - 2017 Web view · 2017-04-25These include...

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Page 1: Early Years SEN Top-up funding criteria - 2017 Web view · 2017-04-25These include gestures, signing, symbols, word boards, communication boards and books, as well as Voice ... written

Early Years Foundation Stage Special Educational Needs

Top-up Funding CriteriaCategory A: Cognition and LearningCategory B: Communication and InteractionCategory C: Behaviour, Social and Emotional DevelopmentCategory D: SensoryCategory E: Medical and Physical

April 2017

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Early Years Foundation Stage Special Educational Needs Top-up Funding

Category A – Cognition and Learning

Level Children must meet all of the following core criteria Provision may include Evidence could include

A0

Children with moderate learning difficulties (MLD)

1. Child is developmentally at least one age band below their chronological age in at least 2 of the 3 prime areas. There are also concerns about the Characteristics of Effective Learning.

2. Support needed for up to 40% of time.

3. Professional involvement from Health, Social Care and/or Education services has been sought.

4. Has a recognised need for support with personal care and/or meal times.

Differentiated small steps approaches Targeted programme of support On-going Area SENCO support Training for staff

Personalised learning programmes (IPP) SEND support planning reflects child’s

needs and recommendations from other agencies

Ages and Stages Assessments (Health) 2 Year Old Progress check identifies

developmental delay Portage MAISEY Staff training

Evidence MUST include

Professional reports Assessment in prime areas shows

developmental delay in at least 2 of the prime areas

A1Children with severe learning difficulties (SLD)

1. Child is two age bands below their chronological age on ‘Development Matters Best Fit’ profiles in 2 of the 3 prime areas.

2. Learns at a much slower rate than peers across most areas of learning and development and so makes slow progress.

3. Range of Health, Social care and Education professional involvement.

May need support to use signs and symbols to communicate with others

Explicit teaching needed to facilitate inclusion

Individualised and differentiated learning programme informed by Health and Education professionals

Training for all staff/key person Social interaction with peers Support for development of motor skills

As above and including: EYFS Best Fit judgements Staff training Known diagnoses

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4. Requires specialist adult support to access the learning and social curriculum for a large part of the time. With this support the child can access a surface level of understanding but will still experience severe difficulties in making inferences and generalisation.

A2

Children with severe learning difficulties (SLD) plus extra difficultiesAs above and including:

1. The identified additional needs should be considered as long term.

2. Either medical, physical, sensory or behavioural difficulties associated with their learning difficulties.

3. Child needs modification and explicit teaching of the curriculum for most of the timetable in order to facilitate their inclusion. This will involve detailed task analysis and teaching approaches such as prompting, explicit modelling etc. Such approaches will be required for social skills/responses, the learning of routines and personal development in addition to learning attainments.

4. Ongoing intervention from Health and Education and possibly social care.

5. Child is 2 age bands below their chronological age on ‘Development Matters Best Fit’ profiles in all 3 prime areas.

6. Child requires specialist adult support to access learning including social interaction for the majority of session time. With this level of support the child is able to access a surface level of understanding.

7. The setting requires frequent (termly) specialist advice and input for staff on

Levels achieved will be below expected EYFS age bands for all areas of learning

An individualised programme for a large part of session is needed

Social immaturity, needs support with social interaction with peers

Regular multi-agency advice planning to inform/advise and train staff and establish the individual pupil programme

Supplementary resources including furniture and specialist equipment will be required

Use of therapeutic mediums e.g. soft play, hydrotherapy, sensory and music therapy may be required

As above and including: SEND support planning reflects child’s

needs and recommendations from other agencies

EYFS best fit judgements Tracking of progress over time 3 x IPPs/IEPs detailing/identifying SMART

targets, activities/experiences and adult/specialist support strategies

Support timetable Differentiated planning Review notes Medical reports Details of personalised programme Individual Play Plan (IPP) reviews

contributed to by child, parents and outside agencies

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how to enable full access to the curriculum.

A3

Children with profound and multiple learning difficulties (PMLD)

Children with profound and multiple learning difficulties have complex learning needs. In addition to very severe learning difficulties, children have other significant difficulties such as physical disabilities, sensory impairment or a severe medical condition. Children require a high level of adult support, both for their learning needs and also for their personal care and safety.

As above but child is also likely to have:1. Significantly delayed receptive and expressive language skills which may require Alternative and Augmented Communication.2. Vulnerability at mealtimes and during free play de to delayed development of social skills leading to concerns over safety.3. Recognised need for support / supervision with personal care.4. Child requires specialist adult support to access learning including social interaction for 100% of session time.

Multi-disciplinary support from education, health and social care.

A4

Severe Learning Difficulties or PMLD with Severe Challenging behaviour

In exceptional circumstances, a child may be identified with a level of need over and above these criteria. In this very small number of cases, an allocation may be made on a time limited basis at a higher level.

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Early Years Foundation Stage Special Educational Needs Top-up Funding

Category B – Communication and Interaction

Level Children must meet all of the following criteria Provision may include Evidence could include

B0

Children with speech and language impairment or communication difficulty/delay

1. The child has either a speech and language impairment or communication difficulty/delay which is at least one age band below the chronological age of the child and may be due to social and emotional factors.

2. The child is known to the Speech and Language Therapy Service.

3. The child is known to the Area SENCO Team.

4. Trained adult targeted on-going intervention is needed for 40% of the week to enable child to access learning including social interaction with peers and adults.

5. The child has behaviour and/or emotional management needs associated with his/her communication difficulties. These are frequently associated with frustration and/or anxiety or the child’s difficulty in communicating verbally. Some children at this level are compliant but have issues with anxiety whilst others may express their anxiety through non-compliant behaviours.

Teaching of language and communication skills in play situations

Daily individual programme of activities beyond that delivered by Speech and Language Therapy Service

Whole setting training Support for peer group interaction Whole setting focus on key signs,

symbols/visual representation

SEND support planning reflects child’s needs and recommendations from other agencies

2 reviewed IPPs/IEPs which includes input from parents and child

Log of implementation of language and communication programme

Support identified in setting planning Evidence of staff attendance at

training/in-service training Evidence of Area SENCO involvement Ages and Stages assessment (Health) Every Child a Talker Monitoring Tool

Evidence MUST include

Speech and Language Therapy report Evidence that recommendations to

support communication and language development are being implemented

Evidence of behavioural/emotional management needs, for example, ABCC/STAR observations, behaviour management plan, Nurture Care Plan

Evidence showing the frequency, intensity and duration of behavioural/emotional needs

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B1 1. The child is identified by a Speech and Language Therapist as having a specific speech and/or language or communication difficulty or disorder. The difficulty is likely to have significant and/or severe impact on communication.

2. Trained/specialist adult on-going intervention is needed for a large part of the time attended, to enable child to access the areas of the curriculum: Language and Communication and Personal, Social and Emotional Development.

3. Behaviour and/or emotional management needs are associated with communication difficulties and require intervention to support peer relationships for a large part of the time.

4. Learning opportunities are presented through extensive differentiation including regular need for targeted activity preparation.

5. Modification of language content for all activities, interpreted in to the child’s particular means of communication e.g. Makaton.

6. It is likely that staff will need specific skilled training to meet the child’s communication needs.

As above and including: Teaching of specific language skills or

communication skills throughout the day in play situations, everyday learning opportunities and through the daily routine

EYFS planning identifies targeted support reflecting child’s needs and interests

Specific training for key person/inclusion support practitioner

Whole setting training, a focus on IDP (Early Years Inclusion Development Programme) and PECS if appropriate

An Early Years environment which supports language and communication e.g. use of visual support strategies and learning through play

Advice and guidance around provision of 1:1 support from Area SENCO

As above and including: SEND support planning reflects child’s

needs and recommendations from other agencies

Reports identifying language impairment/disorder/delay or communication difficulty, e.g. from Health including Speech and Language Therapy/Area SENCO

Area SENCO notes of visit Support programme including individual

and small group support timetabled into planning

2 reviewed IPPs/IEPs including input from parents, child, Area SENCO, Education and Health Teams as appropriate

Evidence of staff training and impact Log of implementation of language

programme/adult support Evidence of staff attendance at training Evidence of advice from other agencies

agreed at MAISEY Evidence showing the frequency, intensity

and duration of behavioural/emotional needs

B2As for B1 and including:

1. Child requires on-going intervention from health and education (e.g. Area SENCO, Speech and Language Therapy Service, Paediatrician). There is more than one professional that considers the child to have significant

May also require: Small group teaching Daily speech programme and use of

evidence based strategies to support child’s development and inclusion in all setting learning experiences/activities

As above and including: Detailed management plan with evidence

of how challenging behaviour or limited ability to understand consequences or the need for Augmentative and Alternative Communication (AAC) is supported (resources/time allocation/curriculum

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social communication difficulties likely to require further investigation (e.g. SCAMP).

2. Child requires trained/specialist adult support to access learning through play for 100% of funded hours.

3. Exhibits challenging behaviour that very often impacts on the safety of himself/herself or other children/staff.

4. Has a severe limited ability to understand consequences and take responsibility for his/her actions with or without intent.

5. Requires verbal communication to be supported by alternative or adapted communication (e.g. Makaton, PECS) for 100% of interaction.

6. Trained/specialist adult on-going intervention is needed intended to enable child to access learning and social interaction with adults and peers.

7. Access to a range of specialist resources.

Targeted intervention to support emotional and behavioural difficulties associated with high anxiety or limited perception skills

Where appropriate, access to specialist services

planning). This is evidenced through unaided and aided communication.

AAC describes a wide range of techniques children can use to support spoken communication. These include gestures, signing, symbols, word boards, communication boards and books, as well as Voice Output Communication Aids.

Formal in-year review including child, parents and relevant agencies

B3As for B1 / B2 and including:In exceptional circumstances, there may be a child who has extreme communication difficulties and exhibits a higher level of need than is identified by above criteria, and therefore two adults may be needed to support him/her due to particularly challenging behaviour. Such a child

1. Exhibits extremely challenging behaviour that regularly impacts on the safety of himself/herself.2. Exhibits extremely challenging behaviour that regularly impacts on the safety of other children/staff is often threatened and put at risk. 3. Exhibits extremely challenging behaviour that may result in damage to environment.

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Early Years Foundation Stage Special Educational Needs Top-up Funding

Category C – Behaviour, Social and Emotional Development

Level Children must meet all of the following criteria Provision may include Evidence could include

C0Children who exhibit challenging behaviour:

1. Have had regular advice and intervention from the setting’s INCCO.

2. Will often exhibit challenging behaviour even when a structured behaviour management plan is in place and is supported by a member of staff for 40% of the week to access learning. Intensity and duration may be lessened by targeted support but frequency remains significant at least once per session.

3. Displays some oppositional defiant behaviour / aggressive outbursts / intensive emotional distress.

4. Is very easily distracted and needs a tightly structured support to engage in play and remain on task.

5. Finds it difficult to approach / relate to peers appropriately and will sometimes use physical and verbal intimidation and aggression towards peers / adults or withdraws from peers and finds it difficult to respond to offers of friendship.

6. Regularly disrupts other children’s access to learning.

7. Have little awareness of impact of behaviour on others.

8. Professional involvement from pre-

Regular key person/adult support Whole team training on Social and

Emotional development targeting needs of the child e.g. inset/staff meeting/Early Years IDP material/N.S. Early Years Guidance

SMART behaviour plan targets which are regularly reviewed with parents/carers and informed by Education, Health or Children’s Social Care

Interventions that support emotional safety/well-being

Interventions that support social interactions with peers/adults

Family Support from provider and/or Children’s centre Family Support Worker

SEND support planning reflects child’s needs and recommendations from other agencies

Education/Health/Children’s Social Care report/s and evidence that recommendations have been implemented

2 reviewed IPPs/IEPs which includes input from parents and child

Support identified in setting planning Evidence of staff attendance at training/in-

service training Detailed risk assessments Area SENCO notes of visit

Evidence MUST include

Evidence of behavioural/emotional management needs, for example, ABCC/STAR observations, behaviour management plan, Nurture Care Plan

Detailed log of incidents showing frequency, intensity and duration of behaviours

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school services has been sought.

C1Children who exhibit severe and challenging behaviour:

1. Exhibit severe and challenging behaviour even when a structured behaviour management plan is in place and is supported by a trained/specialist adult for a large part of the session to access learning. Intensity and duration may be lessened by targeted support but frequency remains significant i.e. 2-3 times a session.

2. Have had intervention advice from Area SENCO Team.

3. Exhibit repeated oppositional defiant behaviour.

4. Exhibit high frequency distractibility and needs a highly structured support programme and adult support to access learning and stay on task for short periods.

5. Are unable to approach/relate to peers appropriately and will regularly use physical and verbal intimidation and aggression towards peers/adults or withdraws from peers and finds it very difficult to respond to offers of friendship.

6. Have displayed difficulties for two terms or more.

7. Regularly disrupts the learning of others.

8. Have limited awareness of the needs of others.

Significant periods off mainstream provision and requires flexible and individualised provision

Key person/key adult working daily with the child

Exit arrangements agreed with ‘identified safe place’ for learning as appropriate

Support focuses daily on emotional safety/well-being

Support given for all group times as well as individualised/free play opportunities

Supported opportunities to socialise with peers

On-going guidance and training for all staff, e.g. emotional safety/attachment

Regular supervision for key staff to support their well-being and level of engagement

Multi-agency planning Family Support from provider and range

other professionals Requires detailed risk assessments

As above and including: SEND support planning reflects child’s

needs and recommendations from other agencies

Education/Health/Children’s Social Care report/s and reviews with evidence that recommendations have been implemented

MAISEY recommendations IPPs/IEPs and reviews which include input

from parents and child Support clearly identified in setting

planning for 75% of time Evidence of attendance at recommended

training and impact on setting support Area SENCO notes of visit Evidence of regular key staff supervision Detailed log of incidents, showing

frequency, intensity and duration of behaviours

Evidence of ABCC/STAR observations and how these are informing support

Behaviour Management Plan Detailed risk assessments

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9. Has spasmodic awareness of the consequences of behaviour.

10.Are high risk and lacks awareness of danger.

11.Are known to a range of pre-school services, e.g. Education, Health or Children’s Social Care.

C2Children who exhibit severe and challenging behaviour:

1. Exhibits severe and challenging behaviour even when a structured and differentiated behaviour management programme is in place and is supported by a trained/specialist adult for 100% of the week to access learning. Intensity and duration may be lessened by targeted support but frequency is high.

2. Is presenting as a significant health and safety risk due to threatening and violent behaviour to peers and adults.

3. Is showing high levels of oppositional defiant behaviour and refuses to comply with appropriate and reasonable requests.

4. Is extremely distractible and requires constant adult support and prompting to engage in and stay on tasks.

5. Is unable engage/interact and play alongside peers resorting to physical/verbal aggression or relate positively.

6. Requires on-going intervention from outside agencies on a multi-professional basis.

7. Significantly disrupts the learning of others.

8. Exhibits self-harming behaviours and

As above:

Requires detailed risk assessments

As above plus:

Detailed management plan with evidence of how challenging behaviour or limited ability to understand consequences or the need for AAC is supported (resources/time allocation/curriculum planning)

Formal in-year review including child, parents and relevant agencies

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appears to have a poor self-concept.9. Is impulsive and puts self and others at

risk.10.Displays regular intense emotional

distress.11.Needs an identified area to withdraw to

if appropriate.

Early Years Foundation Stage Special Educational Needs Top-up Funding

Category D – Sensory

Level Children must meet all of the following core criteria Provision may include Evidence could include

D0

Children with a hearing impairment:1. Have a moderate hearing impairment.2. Have a moderate hearing loss in either

ear as advised by the Hearing Support Service or auditory neuropathy spectrum disorder.

3. Receive audiological and learning support by a teacher of the deaf.

4. Have a gap in linguistic development particularly vocabulary and formation of sentences or phrases.

5. Require adult support advised by support teacher for the deaf for 40% of session time.

Hearing friendly physical environment Individualised Play Plan which supports

child’s ability to talk and sign and listen Visual support strategies in place

Strategies in place to develop interaction with peers and emotional well being

Hearing Support Service recommendations inform play plans

Team training from Hearing Support Service to support all staff

Area SENCO support accessed

Ages and Stages Assessment (Health) 2 Year Old Progress check Regularly reviewed IPP plans in place Staff training MAISEY Professional reports Area SENCO visit notes Staff training Hearing Support Service involvement

D1

Children with a hearing impairment:1. Receive significant/regular audiological

and learning support by a teacher of the deaf for assessment, monitoring of progress, advice and guidance to pre-school staff.

2. Severe permanent hearing impairment

Modification of language content to allow access to concepts

Individualised plan for speaking, listening and auditory skills

Individualised play plan to support development of social skills and emotional

As above and including: Known diagnosis Detailed personalised programme in place Details of specialist equipment and

resources being used Person specification of adult support

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or moderate impairment overlain by a long standing conductive problem.

3. Have a difficulty with understanding the speech of adults and peers at an age appropriate level without individual support, whether signed, written or oral/aural.

4. Are unable to access learning without skilled adult support in targeted language sessions.

5. May use personal hearing aids and/or cochlear implants and FM systems.

well-being Hearing Support Service contribute to

individualised plans Access to a range of specialised

equipment and resources Training from hearing support service to

assist pre-school staff Access to support from range of

educational, health and social care agencies

Hearing Support Service recommendations inform play plans

D2

Children with hearing impairment:1. Receive significant high level

audiological and learning support by a teacher of the deaf for assessment, monitoring of progress, advice and guidance to pre-school staff.

2. Have severe or profound hearing loss in the better ear as advised by medical diagnosis or the Sensory Impairment Service.

3. Unable to access range of learning opportunities or understand speech of adults and peers in setting without constant individual and constant support whether signed or oral/aural.

4. Daily 1:1 support from a trained support worker in a quiet environment in order to develop listening / language skills.

5. N.B. The vast majority of children will have severe language delay and/or lip reading difficulties and/or be lacking in confidence in communicating independently in the setting.

Broad and balanced provision for learning which is commensurate with child’s aptitude needed

Modification of language to allow access to concepts

IPP in place to support the development of speaking and listening, auditory skills and early reading and mark making skills

IPP in place targets support to develop social interaction and emotional well-being

Hearing Support Service recommendations inform play plans

Access to a range of specialist equipment and resources needed

Specialist INSET for whole staff training

As above including: Provision of quiet area for specialist

support activities

Children with visual impairment:

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D0 1. Have a severe visual impairment and in a mainstream early years setting.

2. Are capable of accessing all learning opportunities with appropriate modifications.

3. Receive significant involvement from Sensory Impairment Service.

4. Require daily on-going adult intervention for 40% of session time to facilitate access to learning and ensure safety.

Regular monitoring and support by QT from sensory Impairment Service to provide advice and guidance on needs and differentiation and advice to staff

Daily targeted support to access broad learning opportunities.

IPPs and reviews focus on recommendations of Sensory Impairment Service

Support at mealtimes and outdoor play may be required

Individualised adaptations to the environment may be needed

Staff training from Sensory Impairment Service

Ages and Stages Assessment (Health) 2 Year Old Progress check Regularly reviewed IPP plans in place Staff training MAISEY Professional agency reports/assessments/

recommendations Area SENCO visit notes Staff training Sensory Impairment Service involvement Environment adaptations

D1

Children with a visual impairment:1. Have a significant visual impairment

(distance acuity 6/24-3/60 near visual threshold of between N12–N18 ).

2. Be capable of accessing all learning opportunities with appropriate modifications within mainstream setting.

3. Receive significant involvement from Sensory Impairment Service.

4. Require daily on-going adult intervention a large part of session time to facilitate access to learning and ensure safety.

5. Needs large print/images/material.

6. Will need individual adaptations to the environment, e.g. steps, blinds, lighting.

7. Need access to specialist equipment and materials.

8. The Sensory Support Service will be required to provide information on assessment, monitoring of progress, advice and guidance to setting staff. There will need to be clear evidence that

High level monitoring and support by QT from Sensory Impairment Service to provide advice on needs and differentiation and advice to staff

Daily and on-going targeted support by trained adult to access broad learning opportunities

IPPs and reviews focus on recommendations of Sensory Impairment Service

Trained adult support to offer challenge Visual materials prepared e.g.

enlargements/or adaptations in a visually comfortable size appropriate to needs

Support at mealtimes and outdoor play may be required

Individualised adaptations to the environment needed

Whole staff training from Sensory Impairment Service

As above and including: Person specification of adult support

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advice has been implemented in the setting.

D2

Children with visual impairment:1. Receive significant involvement from

Sensory Impairment Service.2. Be diagnosed as blind or experiencing a

degree of sight loss that requires access to learning through alternative non-sighted means e.g. Braille and tactile materials as appropriate to age/stage of development.

3. Requires 100% differentiated resources/materials to access learning.

As for D1 and including: High level monitoring and support by QT

from Sensory Impairment Service Mealtime and free play supervision Regular mobility training to setting and at

home ICT equipment as appropriate Support staff need specialist training- to access broad range of learning

experiences and offer challenge- to offer Braille and tactile resources- to facilitate and encourage independence

As above and including: Mobility training Alternative non-sighted specific adult

training

D3

MSI – children may have very serious medical needs which may be linked to physical disabilityChildren with Multi-sensory Impairment will:

1. Have a combination of visual and hearing difficulties.

2. Sometimes referred to as deafblind but may have some residual sight and/or hearing.

3. May also have additional disabilities which may make it difficult to ascertain their intellectual abilities.

4. Need an extremely high level – 100% of individualised specialist support and possibly support to meet healthcare needs.

Children with Visual Impairment:1. Arrangements for this band are

typically for children with profound and multiple learning difficulties when visual impairment is a significant factor.

As above and including:

Highly trained specialist support Individual adaptation to environment such

as ramps and toilet Quiet carpeted areas Access to lifts and hoists as required Technical aids Hydrotherapy Manual handling training for staff

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2. Appropriate individualised programmes of alternative forms of communication needed.

Early Years Foundation Stage Special Educational Needs Top-up Funding

Category E – Physical / Medical

Level Children must meet all of the following core criteria Provision may include Evidence could include

E0

Children with impaired mobility:1. Require therapy support e.g.

physiotherapy, occupational therapy, speech therapy.

2. Have impaired mobility.3. Require manual handling risk assessment.4. Require adult support for 40% of session

time to enable access to and adaptation of learning experiences.

5. Require adult support at mealtimes and for outdoor play.

6. May require adult support for personal care and trips.

Children with medical needs:1. Child has identified medical needs which

require adult support.2. A healthcare plan needs to be in place

which includes emergency procedures.3. Require adult support for any of the

following: mealtimes, outdoor play, personal care.

4. Require adult support for a part of the time to enable child to safely access the session.

Play Plan informed by recommendations of health professionals

Consumables to support personal care needs

Support for the management of equipment needed to support needs

Adult support to implement physical management / personal care plan

Adult support to access learning opportunities

Area SENCO guidance

Play/personal care/physical management plans/health care plans informed by health professional recommendations

Professional reports Medical advice Risk assessment Progress summaries Multi-agency planning meeting notes Special equipment and adaptations to

environment / differentiation needed to access learning

Log of staff training

Children with impaired mobility: as above and including :

As above and including: As above and including:

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E1 1. Require individual adaptation to environment e.g. adapted furniture ramps and toilets quiet carpeted areas access to lifts and hoists may be

required technical aids including ICT availability and access to hydrotherapy

2. Have impaired mobility or be in a wheelchair.

3. Trained adult support for up to 100% of session time.

4. Require long term therapy support.

5. Require adults with appropriate training in manual handling to provide support as needed.

Children with medical needs:1. Other medical needs which require adult

support e.g. severe epilepsy, asthma etc.2. Trained staff to implement healthcare plan

which includes emergency medical procedure.

3. Additional adult support to enable the child to be safely placed with good medical support.

4. Environment needs risk assessment in place to ensure safety.

5. Ongoing support and guidance from an appropriately qualified health professional.

Physical management/personal care/health care plan informed by health professionals

Time to liaise with parents, therapists, preparation etc

Time to prepare adaptations to environment and learning opportunities

On-going training for staff including at initial transition

Support to manage equipment Specialist medical procedure training

delivered by e.g. lifetime nurse Specialist training for medical procedures Adaptations to environment

Detailed personal provision plan Detailed medical procedure planning

E2

Children with impaired mobility: As for E1 and including:1. Non-independent wheelchair user unable

to transfer without support.2. Requires Alternative and Augmented

As for E1 and including: Detailed daily therapy programme Detailed healthcare planning

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Communication aid because of physical impairment.

3. Requires long term therapy support.

4. Requires manual handling risk assessment.

5. Requires adult support for toileting.

6. Requires adult support to enable access to and for adaptation of almost all learning opportunities/experiences including access to outdoor learning.

Children with medical Needs:As for E1 and including:1. Long term significant medical condition.

2. Trained adult support to access learning due to high level medical needs.

3. Requires on-going medical intervention and/or monitoring.

4. Due to both the probability and severity of the medical condition there is a need for specific emergency procedures to be implemented and shared with a number of school staff.

E3Children with Physical and Medical difficulties

1. May need Hi-tech communication aids because of physical impairment.2. Requires long term therapy support.3. Manual handling risk assessment needed – assessment indicates a full dependency on adults, needs hoists for transfers.4. Requires full-time adult support including toileting, all aspects of personal care, eating, drinking and all nutritional needs.5. Some children may need more than one person to cover at all times.6. Requires adult support to access outdoors and accessible transport and adult support for trips.7. Because of the likelihood of deterioration in the child’s medical condition an immediate response from on call trained staff is required.8. Children will need highly skilled adults who can interpret the child’s communication and ensure well-being.