Please confirm that you understand the placement would be for 12 weeks, which includes reintegration time. *
Referring school *
School link contact name and email address *
Your answer
Name of Young Person *
Your answer
Young person's date of birth *
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/
DD
/
YYYY
Parent contact details (name, address, phone and email) *
Your answer
Current KS2 year group *
Is the young person... *
Required
If the young person has been identified as having SEND, what is the primary category of SEND? *
Required
Attendance to date and comments about attendance *
Your answer
Is the Pupil Welfare Officer involved?
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Details of their current learning and progress (GL Assessment / Teacher assessment). Please use previous attainment data to support patterns/ trends.
Your answer
Details of the presenting behaviours and impact on learning. What gives you the greatest concern? How long has this been the case? *
Your answer
Do you think the behaviour change is linked to any significant life event?
Your answer
What are the child's views about their behaviour/ this placement offer?
Your answer
What is the young person really good at/ enjoys doing?
Your answer
Why do you think LINK (placement with reintegration) would be helpful?
Your answer
What strategies have you already used for this young person? (plan, do review)
Your answer
Agencies/services involved *
Required
Please provide a summary of recommendations from support services that have been implemented and their impact
Your answer
McSherry Readiness Scale for Reintegration
This is a key tools used to inform of a child's progress and readiness for reintegration. Completing the form will help us to target key focus areas from the outset, and measure progress. Here is the form (you'll need to make a copy and send to the email below) https://docs.google.com/spreadsheets/d/1CZO92aojKIps59QlWPDEHrBEir309y_w-E498vo0u94
If you are having difficulty accessing the document, please email.
Please place any reports and assessment data relevant to this referral into a folder and provide the link below.
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Any other information
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Parental views - Please provide details of how the parent / carer feels about LINK (placement with reintegration) and how they feel about their child's behaviour
Your answer
Please confirm that the parents / carers are happy for us to speak to other agencies such as CAMHS or the Behaviour Advisory Teachers to gain a fuller picture of need if necessary.
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