Chapter 12 - Education, Health and Care (EHC) Early Years Pathway (0-5)

12.1 Introduction

The revised Special Educational Needs and Disability (SEND) Code of Practice 0-25 states that all children are entitled to an education that enables them to:

Achieve the best possible educational and other outcomes
Become confident young children with growing ability to communicate their own views and be ready to make the transition into compulsory education.

12.2 Key Points at which SEND may be identified in the Early Years

From Birth to Two Years Old

Many of the more complex needs - developmental, sensory and physical - are identified at birth. Early health assessments, such as the hearing screening test for new born babies, enable very early identification of a range of medical and physical needs.

It is important therefore that health services, including paediatricians, GPs and health visitors, who work with children and their families, understand the process for accessing support.

The needs of children between the ages of 0-2 can change very quickly. Wigan’s graduated approach to meeting needs, through the support set out in the Local Offer, may often be more valuable to parents at this time so that an EHC needs assessment may not be necessary.

Wigan is implementing the Greater Manchester Combined Authority (GMCA) 8 Stage Assessment Model for Early Years which aims to increase the number of children who are ready for school. Through the introduction of a series of “Ages & Stages” questionnaires the progress of individual children can be assessed and monitored, enabling targeted intervention to be put in place. The 8 Stage Assessment Model and other resources can be found on the Early Years page of the SEND Local Offer website.

From Two to Five Years Old

As part of the Healthy Child Programme, health visitors currently check communication and language, personal, social and emotional and the physical development of 2 year olds. The Integrated Review at present takes place at 2 to 2 and a half and is a holistic child development review, between parents, Health Visiting Team and the child's Key person from the setting. This is Stage 5 of the 8 Stage Assessment Model. The Ages and Stages Questionnaire 3 (ASQ3) and Ages and Stages Social and Emotional (ASQ SE) and the Early Years Foundation Stage assessments will be completed at this point.

If there are significant emerging concerns or special educational needs (SEN) or a disability has been identified, a targeted plan should be drawn up to support the child’s learning and development, involving other professionals as necessary. Evidence of a delay at this stage may not indicate a long term severe and persistent difficulty which would impact over time on the child’s ability to access education or require an EHC Assessment. Equally, difficult or withdrawn behaviour doesn’t necessarily mean a child has SEN.

Early Notification from Health Services that a child may have SEN

Where the health services anticipate that a child will have SEN when they start school, they can refer the child to the Local Authority (LA). The Designated Medical Officer (DMO) for SEN must ensure that there are appropriate referral arrangements in place. This will be via an Early Notification with parent/carer consent.

12.3 Types of Provision

There is a range of universal and targeted provision available for children age 0-5 and their families. Children can access 15 hours free nursery entitlement from the beginning of the term after they turn 3 years old. At the time of preparing this document, the Government is considering offering 30 hours for some eligible families via the Childcare Bill. Funding is available for some vulnerable 2 years olds including some with SEN or a disability enabling them to access 15 hours free nursery provision.

Early Years providers should regularly review and evaluate the quality and breadth of support they offer or can access for children with SEND and maintained nursery schools must co-operate with the LA in reviewing provision that is available locally and in developing the Local Offer. The LA should engage with the providers of relevant early years’ education, particularly those in receipt of early education funding.

Information about these services can be found within Wigan’s Local Offer and the Our Town Directory (external link).

12.4 A Graduated Approach

All children in Wigan early years settings have an entitlement to access a high-quality early years environment. Early years practitioners will use lively, interactive teaching methods and make maximum use of different learning styles.

What does Inclusive Quality First Teaching looks like?

High achievement for all through explicit high expectations and high aspirations
The learning needs of all the children are considered, ensuring support and challenge for all children
Session planning, involving everyone working with the child, takes account of prior learning based on observation and assessment. This enables learning objectives to specific, focused, child-led, child initiated and differentiated appropriately with clear success criteria
A well planned and resourced learning environment which encourages independence
A planned range of teaching skills, strategies and approaches are deployed to engage all children
Practitioners consider the use of language, ensuring it is matched to the needs and circumstances of the learner
Adults model good practice by working together, scaffolding and demonstrating, being involved in children’s play and activities
Practitioners provide clear explanations of teaching points and use appropriate questioning to develop understanding and to set challenges
Special Educational Needs provision and resources are provided using an “Assess, Plan, Do, Review” approach in conjunction with relevant agencies and services
Children are fully engaged in their learning, having opportunities to work both independently and collaboratively
Positive praise and effective feedback promotes further learning
Everyone involved in the setting is deployed appropriately and knows how to support learning.

What can Quality First Teaching achieve?

Motivated children who enjoy learning
Engaged learners who know they are making progress
Empowered learners who take responsibility for their own learning
Independent learners who take risks and are resilient.

12.5 Early Intervention

In addition to formal checks, providers will plan and offer activities which facilitate continuous assessment and help children to reach their full potential. While children develop at their own pace, delay in learning and development in the early years may not necessarily indicate that a child has a learning difficulty or disability that calls for special educational provision. If a child’s progress in any prime area; personal social emotional development (PSE), communication and language (C&L), physical development (PD), gives cause for concern, practitioners must consider whether a child may have SEN or a disability which requires support

It is particularly important in the early years that there is no delay in making any necessary special educational provision. Early action to address identified needs is critical to the future progress and improved outcomes that are essential in helping the child to prepare for adult life. All settings should adopt a graduated approach with four stages of action: assess, plan, do and review.

Children and their families should experience well coordinated assessment and planning leading to timely, well informed decisions. General principles that underpin effective assessment and planning processes include:

Involving children and parents in decision making by using a person-centred approach
Providing information, advice and support enabling them to take part effectively in any assessment and planning process
Sharing information – as far as possible a “tell us once” approach should be adopted
Timely provision of services
Cross agency working to identify joint outcomes where possible.

As young children’s needs may change very quickly, we believe that early intervention can support some children more effectively than undertaking an EHC assessment. For some children this may also reduce the need for an EHC assessment in the future.

Where there are concerns, there should be a graduated response; firstly determining if there are any causal factors such as underlying learning or communication difficulties. If housing, family or other domestic circumstances may be contributing to presenting behaviour, a multi-agency approach should be adopted. It is strongly recommended that this is via an Early Help Framework.

Education starts at home so partnership and liaison between home and the setting is vital both pre-admission and once in the setting. It is also important to liaise with services and professionals that may support the child, their family and their setting.

12.6 Support for Parents and Practitioners

Where a child in this age group is identified as having SEN, there is a variety of support, training and provision parents can access, such as:

Early Years Key Working - aims to improve the delivery of services for disabled children and their families through better co-ordination, providing a single point of contact for families and through key working. Wigan SENDS are commissioned to provide an Early Years Key Working Service to children and their families living within the borough who have been identified as having additional needs. The service is available to:
- - Families who have children aged between 0-5 years
- - Families whose children are in receipt of two of more services across health and care
- - Families who have on-going advocacy needs.
Portage - a home-visiting educational service for pre-school children with additional support needs and their families, offering a carefully structured system to help parents support their child’s early learning and development.
Specialist Support Services - such as Health Visitors, Educational Psychologists, Therapists, Specialist Teachers of the Deaf or Visual Impairment or Early Years Support Workers, who may visit families at home, to provide practical support, answer questions and clarify needs.

Early years settings should consider, in consultation with the child’s parents, involving appropriate specialists where a child is not making expected progress.

To see the range of sources of support available in Wigan, please see Chapter 5 - Sources of Support.

12.7 Graduated Response to SEND

Additionally, the five triangular tables on the following pages provide additional guidance to what professionals and settings may consider as part of a graduated response to supporting early years children with additional needs and include:

Identifying of additional needs; Good Practice
Communication and Language
Personal, Social and Emotional
Physical and Sensory
Procedures for nursery providers working with children who have SEND.

Resources and referral forms can be found at the Early Years page of the SEND Local Offer website.

Please refer to the Glossary for a description of the terms and acronyms used in the following tables.

Graduated Response - Identification of Additional Need: Good Practice for All Needs
Graduated Response - Prime Area: Communication and Language
Graduated Response - Prime Area: Personal, Social and Emotional
Graduated Response - Prime Area: Physical
Procedure for nursery providers working with children who have SEND

12.8 Early Intervention Support Mechanisms

Multi-agency working will underpin support for settings in meeting children’s needs. Setting and professionals will follow the graduated response and coordinated assessment principals outlined above. For some children targeted support may be the next step.

Multi-agency Inclusion Meetings (MIMs) will consider:

Referrals for children with SEND not eligible or accessing their free entitlement
Signposting to other services
General problem solving
Further professional input into cases
Additional advice to settings including coordinated assessments
Progress/tracking of individual cases
Gathering information to support provision planning especially specialist settings
Initial indications as to whether an EHC assessment would be appropriate
Identifying packages of support for families e.g. Early Bird, DCATCH etc.
Early Support Key-working requests
Feedback from integrated 2 year old check
Discuss Early Notifications from Health
Consider referrals for Early Years Additional Resources.

For children who have been identified as having a delay in any of the 3 prime areas (Personal, Social and Emotional, Communication and Interaction, Physical Development) settings can access support from ELCC.

Requests for support are considered based on evidence of intervention and the child's response to these interventions. It is acknowledged that children who have similar needs will require varying amounts of support depending on the relevance and appropriateness of the curriculum and environment they are offered.

It is envisaged that by providing early intervention children’s needs can be supported ahead of referral to the EHC pathway

Targeted Individual Support 1 (TIS1)

There are 2 levels of TIS1: TIS1a and TIS1b. This will be in addition to the resources usually available to the setting.

TIS1a can be provided to settings on a monthly basis or half termly basis for children with a 20-39% delay via:

A Targeted Support Worker (TSW) through Early Learning and Child Care Team (ELCC) following appropriate intervention and in liaison with ELCC
The Specialist Sensory Education Team

TIS1b is provided more frequently (weekly or fortnightly) as a result of the child having more complex needs (40%+ delay)

A Targeted Support Worker (TSW) through Early Learning and Child Care Team (ELCC) following appropriate intervention and in liaison with ELCC
The Specialist Sensory Education Team
Specific support as a result of complex physical/medical needs
Additional top up funding maybe considered if a child has 50%+ delay, this will be based on the needs of the individual child, the setting and the ratios and will be determined by ELCC in conjunction with SENDS.

In all cases, the setting will have referred the child to ELCC using the EY Inc. 4 form.

The setting will arrange regular reviews with external agencies and professionals involved with the child, as appropriate. Updates will be provided to the Targeted Support Worker (TSW) who will feedback to ELCC. Reviews should consider the progress made towards set targets and decide upon the next course of action, i.e.

To cease TIS 1a/b support
To reduce TIS 1a/b support
To continue TIS 1a/b support
To refer for Early Years Additional Resources which may include TIS 2 support or an EHC needs assessment.

Criteria for TIS1a/b support and referral forms can be found on the Early Years page of the SEND Local Offer website.

Early Years Additional Resources (EYAR)

In readiness for a child moving into reception, an application for Early Years Additional Resources can be made if the child:

Has been in receipt of TIS1b
Needs support over and above what the setting is able to provide through their resources including on entry to school
Needs are long term, severe and persistent complex
Meets the criteria set out in Section 12.9 below.

The Early Years Referral Group will consider referrals.

If it is unclear whether an early years child’s needs are long term, severe and persistent, but it is felt that a child needs some shorter term additional support on transition, then a TIS2 (Targeted Individual Support 2) top up may be allocated. The severity criteria for TIS2 is the same as for an EHC needs Assessment and is outlined below. The child must have received a minimum of 2 terms TIS 1b support prior to consideration for EYAR application.

Where agreed, EYAR (TIS2) support may be provided up to the end of the Autumn term of Year 1. Referrals for EYAR will only be accepted until the 31st December of the reception year.

If it is clear that a child has long term, severe and persistent needs, i.e. the significant delay is likely to persist for more than 12 months, an EHC needs assessment will be initiated and the EHC pathway will be followed as identified in Chapter 11. At this stage Key Working offer will be discussed with the family.

Key Working as part of the EHC pathway

As a Local Authority Wigan are committed to ensuring that a Key Working approach is adopted across all Education, Health and Care agencies to enable families to access the support that they need. Once an application for Early Years Additional Resources (EYAR) has been received and a decision has been made at the EYAR Panel to proceed with an EHC assessment, an indicative level of Key working will be discussed. This level of support will be determined by the family and child’s perceived needs.

A designated key worker can be provided through two main sources (as outlined below)

1. Early Years Key Worker

Families who are offered an Early Years Key Worker to support them through the EHC process are likely to have a higher level of need and require support to coordinate a range of services and actions across Education, Health and Care. The family may also require a lot of support to submit their views, wishes and aspirations as part of the process. In addition, if a family is already receiving support from an Early Years Key Worker, the Key Worker will be asked to continue supporting the family throughout the EHC process.

More information about Early Years Key Working can be found on the Local Offer

2. Independent Support

Independent Support is a time limited, government funded programme which aims to provide support to children, young people and their families specifically in relation to the EHC process.

Families who are offered this kind of Key Working support are likely to have low level support needs and generally require a point of contact throughout the EHC process. The Independent Supporter can support the family to submit their views, wishes and aspirations as part of the EHC process as well as signpost them to other services, the Local Offer and provide information around personal budgets.

More information about Independent Support can be obtained by contacting Embrace Wigan and Leigh directly on 01942 233 323.

As both of the above services are optional, there may be occasions when families opt out of accessing Key Working Support. As such, any Key Working responsibilities that may need fulfilling could be undertaken by:

The designated Assistant EHC Plan Coordinator or EHC Plan Coordinator
A familiar worker from Education, Health or Social Care services e.g. nursery worker, social worker etc.

12.9 Criteria

Through the processes described above, information about and tracking of progress of early years’ children with SEND will be in place. For the majority of young children with SEND, their needs are likely to be best met through the services set out in the Local Offer.

A local authority will conduct an EHC needs assessment for children under compulsory school age when:

It considered it may need to make special educational provision in accordance with an EHC Plan.

The local authority will also take into account whether:

It considers that the special educational provision required to meet the child’s needs can reasonably be provided from within the resources normally available to their mainstream early education provider or school
It seems likely that the child will need an EHC plan in school.

Guidance and Rationale for the Criteria

Most children with additional needs will have those needs met from within the resources of their educational setting. These resources relate to both those identified as part of a setting's budget, and extra resources such as support services and outside agencies.

For very few children, an application for Early Years Additional Resources may be necessary.

The EYAR application and supporting evidence must consider key questions

Are the needs of the child/young person severe and complex?
What are the barriers to learning?
What extra support has already been tried and for how long?
What educational progress is being made at the current time?
Have the views of the young person and parents/carers been taken into account?
What difference will TIS2 or an EHC needs Assessment make?

In order to determine where a child is functioning, settings should submit the Early Years Pupil Report alongside current progress since the report was last submitted. As the Early Years Outcomes are wide, in order to determine if a child has exceptional or significantly low levels of functioning, the following table will be used to provide approximate ages (in months) of functioning across the 3 prime areas:

Early years outcomes age bands
	A	B	C	D	E	F
Early years outcomes	0-11	8-20	16-26	22-36	30-50	40-60
ESDJ steps	1-2-3-4	4-5-6-7	7-8-9	9-10-11	11-12-13	13 -14 -EYFS goals
Emerging	0	8	16	22	30	40
Working within (developing)	6	14	21	29	40	50
Secure (achieved)	11	20	26	36	50	60

The tables below outline the criteria for EYAR. It is important to consider:

Severity of need
Process of support (To be considered alongside the graduated response triangle tables and early years processes in place via ELCC and SENDS)
Likely future support need.

Table 1 - Children with profound and multiple learning difficulties (PMLD)
Severity of need	Children with PMLD: Have difficulty carrying out feeding, toileting and self-help skills without adult assistance Require a significantly modified and predominantly sensory curriculum in addition to significant medical input within the educational setting Most children with PMLD: Have a significant cognitive learning difficulty, usually with motor and sensory impairments, as well as complex health/medical care needs Have communication difficulties and will be working at a very early developmental stage Children with PMLD are likely to: Have severe developmental delay Have impaired ability to communicate and interact with the environment. These may be due to multiple impairments, e.g. combinations of physical, sensory and medical needs. They may also have ASC, and behavioural needs, ranging from challenging to passivity.
Process of support	Multi-agency involvement and assessment of additional needs Programme of additional support which has been followed over time, including target-setting and review in collaboration with parent/carer, and including the child’s perspective Setting to attend ELCC’s Inclusion Progress Meetings (IPMs) If the child is not in a setting, the key professional should update MIM’s meetings.
Likely future support needs	Intensive and specialist support to access the physical environment e.g. if non-mobile, will require moving and handling plan, postural management programme, specialist equipment Intensive support required for personal care Access to a significantly differentiated and predominantly sensory curriculum learning programmes delivered by experienced teaching and support staff Regular and consistent access to a range of therapy intervention delivered by specialist staff Oversight by medical staff.

Table 2 - Children with delays/difficulties in communication and language, physical difficulties, personal, social and emotional
Severity of need	Exceptional or significantly low levels of functioning. Delay will indicate that the child is working at or below approximately 50% of their chronological age, at the time of assessment, in the 3 prime areas (PSE, C&L, PD) E.g. a child approaching 60 months would be working within or below 16-26 months; a child approaching 48 months would be working within or below 8-20 months. (See 'Early years outcomes age bands' table for how the approx. month in age will be calculated).
Process of support	Persistence of need/delay after addressing possible short-term factors Programme of additional support which has been followed over time, including target-setting and review in collaboration with parent/carer, and including the child’s perspective Involvement required of 2 or more specialist agencies Setting to review progress in liaison with the TSW and undertake training as advised If the child is not in a setting, the key professional should update MIM’s meetings.
Likely future support needs	Intensive support required to access learning and development activities due to developmental or social, emotional and mental health needs when compared to expectations of their chronological age Higher levels of support than 1) the ratios that would usually be provided 2) what is able to be provided from the settings available resources; in addition to a significantly differentiated curriculum.

Table 3 - Children who have a delay in one area of significant need (e.g. PD, Sensory or PSE), but not a significant developmental delay
Severity of need	Children with significant physical/sensory/medical needs may not present with a significant development delay but would require intensive levels of support to access the curriculum due to: Severe or profound visual/hearing loss Physical disability requiring intensive levels of support to access or use specialist equipment and/or significant personal care support Children with a significant delay in the area of PSE only, will exhibit frequent and severe inappropriate behaviours which persist despite a joint home/setting behaviour management plan being in place for a cycle of plan, do, review. There must be evidence of implementing advice from outside support agencies.
Process of support	Persistence of need/delay after addressing possible short-term factors Programme of additional support which has been followed over time, including target-setting and review in collaboration with parent/carer, and including the child’s perspective Involvement required of 2 or more specialist agencies Setting to review progress in liaison with the TSW and undertake training as advised. If the child is not in a setting, the key professional should update MIM’s meetings.
Likely future support needs	Physical/Sensory: Intensive support required to access the physical environment e.g. moving and handling plan, specialist equipment A physical difficulty requiring specialist input: Daily postural management programmes; specialist aids; specialist handling training and care programmes; risk of life threatening medical emergency requiring rapid intervention; long term support for feeding and drinking under specialist health supervision Intensive support required to access learning and development activities due to physical/sensory needs when compared to expectations of their chronological age, e.g. child would require high levels of support than 1) the ratios that would usually be provided 2) what is able to be provided from the settings available resources; in addition to be able to access the curriculum, adapted to meet their physical/sensory needs High level of support for medically identified personal care needs e.g. to administer regularly prescribed medication; tracheostomy; feeding via equipment (i.e. PEG/NG tube); stomas/catheterisation. Personal, Social, Emotional: Intensive support required to access learning and development activities due to personal, social, emotional needs when compared to expectations of their chronological age Higher levels of support than 1) the ratios that would usually be provided 2) what is able to be provided from the settings available resources; in addition to a significantly differentiated curriculum.

12.10 EHC Assessment and Review Processes

The LA will carry out assessments in line with Wigan EHC Pathway ( Chapter 11).

All early years children following the EHC Pathway until the end of the reception year will have the offer of a dedicated key worker to support the family through the process. Some families will already have a key worker who will fulfil this role.

Local authorities should consider reviewing an EHC Plan, for a child under 5 years old, at least every 3-6 months to ensure that provision continues to be appropriate. Such reviews should complement the duty to carry out a review at least annually, but maybe streamlined and not necessarily require the attendance of the full range of professionals, depending on the needs of the child. The child’s parents will be fully consulted on any proposed changes to the EHC plan and made aware of their right to appeal to the SEND Tribunal.

A flowchart highlighting some of the key points of this process can be accessed via Early Years page of the SEND Local Offer website

12.11 Transition to school

For a child transferring to school with an EHC Plan, the review and any amendments must be completed by 15th February in the calendar year of the transfer. In Wigan, we recommend that reviews take place in the autumn term of the pre-school year. Transition meetings will be arranged by the nursery, inviting parents, professionals involved and the welcoming setting. A representative from SENDS will endeavour to attend the transition meeting.

For a child transferring to school identified via SEN Support (i.e. the settings own resources), a transition meeting will be arranged by the nursery, inviting parents, professionals involved and the welcoming setting. Where ELCC and/or SENDS have been involved they will endeavour to attend the transition meeting.

Admission of a child outside their normal age group (Delayed Entry)

The parents of a summer born child (born between 1 April and 31 August) may request their child starts school in the September following their fifth birthday and may request they are admitted out of their normal year group to reception rather than Year 1. For summer born children with Special Educational Needs (SEN), the Special Educational Needs and Disability Service (SENDS) would want to consider what progress would be made and if this would close the gap between them and their peers if their entry to mainstream school were to be delayed by 12 months.

Requests for delayed entry to mainstream provision for children with SEN would be considered on an individual basis but it is envisaged that children would be able to make progress appropriate to their needs in their chronological age group with appropriate levels of support.

Deferred entry is when a child will start school later in the academic year in which they turn 5. The offered place must be taken up by the summer term of the academic year, or the beginning of the term after the child turns 5 whichever is the soonest and will go through school in line with their chronological peers.

Details of these policies are available from the School Organisation Team.