Early Years Foundation Stage
Special Educational Needs
Top-up Funding Criteria
Category A:
Category B:
Category C:
Category D:
Category E:
Cognition and Learning
Communication and Interaction
Behaviour, Social and Emotional Development
Sensory
Medical and Physical
December 2015
Early Years Foundation Stage
Special Educational Needs Top-up Funding
Category A – Cognition and Learning
Level
A0
Children must meet all of the following
core criteria
Children with moderate learning difficulties
(MLD)
1. Child is developmentally delayed in
more than one EYFS area of learning
and there are concerns about the
characteristics of learning.
Provision may include



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Differentiated small steps approaches
Targeted programme of support
On-going Area SENCO support
Training for staff
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
Evidence could include



Personalised learning programmes (IPP)




Portage
SOGS
2YO Progress check identifies
developmental delay
MAISEY
Professional reports
Staff training
personal care and/or meal times.
A1
Children 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.
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.

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
A2
Children with severe learning difficulties
(SLD) plus extra difficulties
As 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
how to enable full access to the
curriculum.

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:

Early Years (School) Action Plus
planning (multi-agency) EYFS best fit
judgements


Tracking of progress over time
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Support timetable
3 x IPPs/IEPs detailing/identifying
SMART targets, activities/experiences
and adult/specialist support strategies
Differentiated planning
Review notes
Medical reports
Details of personalised programme
Individual Play Plan (IPP) reviews
contributed to by child, parents and
outside agencies
Children with profound and multiple learning difficulties (PMLD)
A3
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.
2.
3.
4.
Significantly delayed receptive and expressive language skills which may require Alternative and Augmented Communication.
Vulnerability at mealtimes and during free play de to delayed development of social skills leading to concerns over safety.
Recognised need for support / supervision with personal care.
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.
Severe Learning Difficulties or PMLD with Severe Challenging behaviour
A4
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.
Early Years Foundation Stage
Special Educational Needs Top-up Funding
Category B – Communication and Interaction
Level
B0
Children must meet all of the following
criteria
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. Ongoing intervention/advice from Area
SENCO Team or Speech and
Language Therapy Service is needed.
3. Trained adult targeted on-going
intervention is needed for 40% of the
week to enable child to access learning
including social Interaction.
4. The child has behaviour and/or
emotional management needs
associated with his/her communication
difficulties and so requires intervention
to support adult and peer relationships
for part of the week. Some children at
this level are compliant but have issues
with anxiety whilst others may express
their anxiety through non-compliant
behaviours.
Provision may include

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.


Evidence could include

Early Years (School) Action Plus planning

Speech and Language report and
evidence that recommendations have
been implemented

2 reviewed IPPs /IEPs which includes
input from parents and child
Support for peer group interaction.

Whole setting focus on key signs, symbols
/ visual representation.
Log of implementation of language and
communication programme

Support identified in setting planning

Evidence of staff attendance at training/inservice training
1. The child is identified by a Speech and
B1
Language Therapist as having a
specific speech and/or language
disorder or a communication difficulty
most likely to be a disorder.
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.
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:

Early Years (School) Action Plus planning
(based on multi-agency advice) 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
As for B1 and including:
May also require:
As above and including:
B2

from North Somerset education service 
1. Child requires on-going intervention
2.
3.
4.
5.
6.
7.
(VLS / Area SENCO)
Child requires trained / specialist adult
support to access learning through
play for 100% of funded hours.
Exhibits challenging behaviour that
very often impacts on the safety of
himself / herself or other children/staff.
Has a severe limited ability to
understand consequences and take
responsibility for his/her actions with or
without intent
Requires verbal communication to be
supported by alternative
communication for 100% of interaction.
Trained / specialist adult on-going
intervention is needed intended to
enable child to access learning and
social interaction with adults and
peers.
Access to a range of specialist
resources


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.
Targeted intervention to support emotional
and behavioural difficulties associated with
high anxiety or limited perception skills
Where appropriate, access to specialist
services

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.
As for B1 / B2 and including:
B3
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.
Early Years Foundation Stage
Special Educational Needs Top-up Funding
Category C – Behaviour, Social and Emotional Development
Level
C0
Children must meet all of the following
criteria
Children who exhibit challenging
behaviour:
1. Have had regular advice and
2.
3.
4.
5.
6.
7.
8.
intervention from the setting’s INCCO.
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.
Displays some oppositional defiant
behaviour / aggressive outbursts /
intensive emotional distress
Is very easily distracted and needs a
tightly structured support to engage in
play and remain on task.
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
Regularly disrupts other children’s
access to learning
Have little awareness of impact of
behaviour on others
Professional involvement from preschool services has been sought.
Provision may include
Evidence could include

Regular key person / adult support

Early Years (School) Action Plus planning

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

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
SMART behaviour plan targets which are
regularly reviewed with parents/carers and
informed by Education, Health or
Children’s Social Care

Support identified in setting planning

Evidence of staff attendance at training/
in-service training


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
C1
Children who exhibit severe and
challenging behaviour:

Significant periods off mainstream
provision and requires flexible and
individualised provision

Key person / key adult working daily with
the child
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. 23 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
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

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

Requires detailed risk assessments
Family Support from provider and range
other professionals

Early Years (School) Action Plus planning
(based on multi-agency advice) 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

Area SENCO notes of visit

Evidence of regular key staff supervision

Detailed log of incidents

Evidence of ABC / STAR observations and
how these are informing support

Detailed risk assessments
C2
Children 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 multiprofessional basis
7. Significantly disrupts the learning of
others
8. exhibits self-harming behaviours and
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
As above
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.
Requires detailed risk assessments
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
Children with a hearing impairment:
D0
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.
Children with a hearing impairment:
D1
1. Receive significant / regular audiological
2.
3.
4.
5.
and learning support by a teacher of the
deaf for assessment, monitoring of
progress, advice and guidance to preschool staff.
Severe permanent hearing impairment or
moderate impairment overlain by a long
standing conductive problem.
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.
Are unable to access learning without
skilled adult support in targeted language
sessions
May use personal hearing aids and or
cochlear implants and FM systems
 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
 Modification of language content to allow
access to concepts
 Individualised plan for speaking, listening





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


development of social skills and emotional
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
2YO Progress check
Regularly reviewed IPP plans in place
Staff training
MAISEY
Professional reports
Area SENCO visit notes
Staff training
Hearing support service involvement
As above and including:


Known diagnosis

Details of specialist equipment and
resources being used

Person specification of adult support
and auditory skills
 Individualised play plan to support
SOGS
Detailed personalised programme in
place
 Hearing support Service recommendations
inform play plans
Children with hearing impairment:
D2
1. Receive significant high level audiological
and learning support by a teacher of the
deaf for assessment, monitoring of
progress, advice and guidance to preschool 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.
Children with visual impairment:
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
 Broad and balanced provision for learning
which is commensurate with child’s
aptitude needed.
As above including:
 Provision of quiet area for specialist
support activities
 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 wellbeing.
 Hearing Support Service recommendations
inform play plans
 Access to a range of specialist equipment
and resources needed
 Specialist INSET for whole staff training
 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






SOGS




Area SENCO visit notes
2YO Progress check
Regularly reviewed IPP plans in place
Staff training
MAISEY
Professional agency reports/assessments/
recommendations
Staff training
Sensory Impairment Service involvement
Environment adaptations
 Staff training from Sensory Impairment
Service
Children with a visual impairment:
D1
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
advice has been implemented in the
setting.
Children with visual impairment:
D2
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 above and including:

 High level monitoring and support by QT
Person specification of adult support
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 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
As above and including:


Mobility training
Alternative non-sighted specific adult
training
- to access broad range of learning
experiences and offer challenge
- to offer Braille and tactile resources
- to facilitate and encourage independence
D3
MSI – children may have very serious
medical needs which may be linked to As above and including:
physical disability
 Highly trained specialist support
Children with Multi-sensory Impairment
will:
 Individual adaptation to environment
such as ramps and toilet
1. Have a combination of visual and
hearing difficulties
 Quiet carpeted areas
2. Sometimes referred to as deafblind but
 Access to lifts and hoists as required
may have some residual sight and/or
hearing.
 Technical aids
3. May also have additional disabilities
 Hydrotherapy
which may make it difficult to ascertain
 Manual handling training for staff
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
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
Children with impaired mobility:
E0
1. Require therapy support e.g.
physiotherapy, occupational therapy,
speech therapy
2. Have impaired mobility
Provision may include

Play Plan informed by
recommendations of health
professionals

Consumables to support personal care
needs
Evidence could include

EYA Plus Play / personal care /
physical management plans/
healthcare plans informed by health
professional recommendations

Professional reports
3. Require manual handling risk assessment
4. Require adult support for 40% of session
time to enable access to and adaptation of
learning experiences

Support for the management of
equipment needed to support needs

Medical advice


Risk assessment

Progress summaries
5. Require adult support at mealtimes and for
outdoor play.
Adult support to implement physical
management / personal care plan


Multi-agency planning meeting notes
6. May require adult support for personal care
and trips
Adult support to access learning
opportunities


Special equipment and adaptations to
environment / differentiation needed to
access learning

Log of staff training
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
Area SENCO guidance
E1
Children with impaired mobility: as above
and including :
1. Require individual adaptation to
As above and including:

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 /
healthcare 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
As above and including:

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
As for E1 and including:

Detailed daily therapy programme

Detailed healthcare planning
2. Requires Alternative and Augmented
Communication aid because of physical
impairment
3.
4.
5.
6.
Requires long term therapy support
Requires manual handling risk assessment
Requires adult support for toileting
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.
Children with Physical and Medical difficulties
E3
1.
2.
3.
4.
5.
6.
7.
May need Hi-tech communication aids because of physical impairment.
Requires long term therapy support
Manual handling risk assessment needed – assessment indicates a full dependency on adults, needs hoists for transfers.
Requires full-time adult support including toileting, all aspects of personal care, eating, drinking and all nutritional needs.
Some children may need more than one person to cover at all times.
Requires adult support to access outdoors and accessible transport and adult support for trips.
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.