Title: “HOPE” - Health Outcomes for young People throughout Education
Funder: Department of Health and Social Care

Abstract: Research question: What is the impact of special educational needs or disability (SEND) provision in schools on health outcomes for children and young people? Background: SEND provision aims to improve the health and wellbeing of children and young people, but few research studies have evaluated whether this aim is achieved, for whom and in what contexts. Policy changes and cuts to funding have reduced SEND provision in mainstream schools; these pressures are likely to worsen post COVID19. Robust evidence is needed of health impacts of SEND provision to guide future policy. Aims: (1) To investigate the impact of SEND provision on children s health using linked administrative data from education (the National Pupil Database, NPD) and hospitals (Hospital Episode Statistics, HES) for all children in England. (2) To establish methods and exemplars for ongoing evaluation. Our programme will use diverse methodologies and involve young people, parents and practitioners. Work package 1: Health indicators of need for SEND and outcomes. Across age-specific cohorts in HES-NPD data (a), we will derive HES indicators of (b) need for SEND provision (using rules and data driven methods), and (c) health outcomes (for WPs 2-4). We will validate these indicators against expected rates, prognosis and risk factors (d). Work package 2: Understanding SEND provision. We will (a) map variation in criteria for SEND provision, using mixed methods, and (b) explore possible unmet need , or over-provision with providers using HES-NPD findings. (c) We will use systems analysis to synthesise influences on SEND provision, and (d) develop meta-data measuring variation by area and time for analyses (in WP3,4) and wider use. Work package 3: Impact of SEND provision on health outcomes. Using econometric causal inference methods, we will exploit externally-mediated variation in local SEND provision (WP2) to estimate causal effects of SEND on health outcomes for the whole population (a), and specific groups (b, c), and (d) compare approaches. We will conduct a cost effectiveness analysis, if significant effects are found. Work package 4: Impact of the timing and duration of SEND provision on health outcomes. We will devise (a) emulated target trials to compare children with specific health indicators; and (b) dynamic panel data models to estimate the short and long run causal impacts of timing and duration of SEND provision on health. Working with stakeholders (from WP2), we will (c) integrate these methods into policy and practice. Timelines for delivery: We start the 36 month programme with approved access to research-ready data. Protocols and findings will be published throughout, with impact analyses (WP 3,4) reported in year 3. Anticipated impact and dissemination: Health indicators for SEND need will inform commissioning and targeting of SEND provision (WP1). Mapping variation in SEND, and system analysis of influences will inform more equitable provision according to need (WP2). Impact analyses will drive more effective provision of SEND, with benefits for education and health (WP3,4). Dissemination will target researchers, public and practitioners, and national and local policy makers. Meta-data and other tools will enable re-use of data and methods.

Lay abstract: Aims We want to find out if extra help in schools for children with special educational needs or disability, called SEND provision, improves their health. Our methods will be shared to help similar studies. Background More than one in three children receives SEND provision during their school years. Most receive support in a mainstream school. One in 25 children have complex needs and need intensive support in a special school. Government reports consistently show that SEND provision is not fairly distributed and inequalities are getting worse. Children from poorer families need SEND provision more than others, but are least likely to get it. Costs of SEND provision are rising because with less support provided in mainstream schools, more children are going to special schools, which are more expensive. We want to find out whether SEND provision improves health and education outcomes, for which children and at what age, so that support can be targeted more effectively. Design and methods Our study uses routinely collected education and NHS hospital records for all children in England &ndash; around 16 million. Each year, state schools record attainment results, absences, exclusions and SEND provision. All NHS hospitals record why children attended and when. These datasets will be linked for the first time in England, using an anonymous linkage key so that no child can be identified in real life. We will analyse groups of children with and without health problems likely to need SEND provision. We follow these children in the dataset to compare how their health outcomes differ according to whether, when and for how long, they received SEND provision. We will use different methods to analyse how certain we can be that SEND provision causes a change in health outcomes. Our methods use the fact that SEND provision differs between local authorities and over time. We will consult parents and services to find out why. Their answers will affect the methods we use. We expect our results to help health and education services work better together, for example, to commission SEND provision to maximise benefits for health and education. Patient and public involvement We will involve children and parents throughout the programme in small group discussions, interviews, and in workshops to coproduce reports. Their experiences will inform our research, for example, by helping us understand who might benefit from SEND provision, how services vary and why, and what outcomes are important. We will work with the PENCRU partnership between researchers and families in Exeter, the National Children s Bureau, and with staff, parents and young people at a special school in Haringey, London. Dissemination We will make sure our work is read and used by staff, parents, young people, policy makers and researchers.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE;MENTAL HEALTH