SOCIAL WORKER INVOLVEMENT Please tick: Does your child (name) have ….………………………………………… Yes No a social worker? Yes No Is the social worker in a Disabled Children’s Team? If yes, please provide the name if known ..……………………………………………………….. (If not known, please contact DCS Commissioning Team to find out) Yes No Is in care (LAC)? ………………………………………………. Please tick: OVERNIGHT BREAKS Does receive ……………………………………………………. Yes No overnight breaks in a KCC run overnight breaks unit? Please tick: SSEN OR EHC PLAN Does have a SSEN or EHC ……………………………………………… Yes No plan? Yes No Is an application for EHC plan in progress? Please tick: SCHOOL Yes No Is he/she………………………………………… in a special school?
SOCIAL WORKER INVOLVEMENT Please tick: Does your child (name) ….………………………………………… have a social worker? Yes No Is the social worker in a Disabled Children’s Team? Yes No If yes, please provide the name if known ..……………………………………………………….. (If not known, please contact DCS Commissioning Team to find out) Is ………………………………………………. in care (LAC)? Yes No OVERNIGHT BREAKS Please tick: Does ……………………………………………………. receive overnight breaks in a KCC run overnight breaks unit? Yes No SSEN OR EHC PLAN Please tick: Does ……………………………………………… have a SSEN or EHC plan? Yes No Is an application for EHC plan in progress? Yes No SCHOOL Please tick: Is he/she………………………………………… in a special school? Yes No
NEW_Short_Breaks_Referral_form.docx