Family Conversation
Record for Statutory EHC
Assessment
Name of
Child/Young Person
Current School
Key Worker:
Key Worker’s
Profession:
Key Worker’s
Contact Details:
(Telephone No and
Email Address)
Family
Conversation
Meeting Date(s)
Family
Conversation
Submission Date:
Page 1 of 10
Updated 05 September 2014
1.
CHILD’S / YOUNG PERSON’S DETAILS:
First name:
Surname:
Preferred
name:
Gender:
Date of
birth:
Religion:
Ethnicity:
First
language:
Home
address:
Parent(s) /
Carer(s)
first
language:
Contact
number:
Email
address:
2.
HEALTH DETAILS:
GP’s
name:
GP’s
address:
GP’s
telephone
number:
Health
authority:
NHS
number:
Disability/Diagnosis/
Known Condition(s):
Diagnosed by:
Page 2 of 10
Updated 05 September 2014
Current medical
treatment:
Medication(s) taken:
Health issues that
may pose a risk to the
child/young person or
to others:
Family health history:
Has a medical questionnaire been completed? Y/N
If so, is there a request for an appointment with the community paediatrician?
Y/N
3.
EDUCATION DETAILS:
Unique Pupil Number:
Current
school/setting:
School/setting
address:
School/setting
telephone number and
email address:
Previous
school/setting:
(last 12 months)
Page 3 of 10
Updated 05 September 2014
4.
SOCIAL CARE DETAILS:
Statutory/Legal
measures in place:
Local authority
responsible:
CareFirst number:
Other plans:
Name and contact
details of any
allocated social
worker
5.
FAMILY COMPOSITION:
Please provide details of <name>’s family members:
Name
Address
Relationship
Parental
responsibility?
Page 4 of 10
Updated 05 September 2014
6.
SIGNIFICANT OTHERS:
Please provide details of any people significant to <name>.
Name
7.
Address
Relationship
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?
Has parental consent been obtained to contact the above professionals/ agencies if
required? If no, please indicate which professionals/ agencies cannot be contacted
with reasons why consent was not given.
Page 5 of 10
Updated 05 September 2014
8. WHAT DO PEOPLE NEED TO KNOW ABOUT <NAME>:




9. WHAT <NAME> THINKS OF HIS/HER LIFE AT THE MOMENT:




10. WHAT <NAME> WANTS FOR HIMSELF/HERSELF IN THE
FUTURE:




11. WHAT <NAME>’S PARENTS/CARERS THINK OF HIS/HER LIFE
AT THE MOMENT:





12. WHAT <NAME>’S FAMILY WANT FOR <NAME> IN THE FUTURE:





13. WHAT DOES <NAME> FIND DIFFICULT/NEED EXTRA HELP
WITH:
Page 6 of 10
Updated 05 September 2014
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 <>’s community:




Social, emotional and mental health needs:




Independence and personal care needs:




Physical needs:




Page 7 of 10
Updated 05 September 2014
Sensory needs:




Health:




Support for <name>’s 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 <name>’s needs. This section has two parts.
14.1 WHAT IS WORKING WELL AND NEEDS TO STAY THE SAME
This section needs to identify firstly what is currently being undertaken successfully
and should therefore continue. It should also identify the outcomes
parents/carers/young people are expecting from these continuing actions.




Page 8 of 10
Updated 05 September 2014
14.2 RECOMMENDATIONS FOR ADDITIONAL ACTIONS, ASSESSMENTS OR
ADVICE
This section should identify any additional action needs to be undertaken because
things are not going well or additional action that needs to be undertaken to fill gaps
in provision identified during the Family Conversation. Again, it should identify the
outcomes parents/carers/young people are expecting from these actions.




15. KEEPING YOU INFORMED
As we progress through the Education, Health & Care Assessment process we feel it
is important to keep you informed. To enable us to do so please indicate your
preferred method of contact below:
Email
Post
Telephone
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 LA will need to take into account to support you/your family
through this process:
Page 9 of 10
Updated 05 September 2014
16. 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.
Page 10 of 10
Updated 05 September 2014