“HOPE” - Health Outcomes for young People throughout Education

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.