Evaluation of special educational needs and disability provision in English primary schools using administrative health and education data in the ECHILD database.

Introduction: Schools worldwide balance whole-class teaching with additional provision for children with special educational needs or disability (SEND). Robust evidence on equity and effectiveness of SEND provision is essential to address growing demand and rising costs globally. Objectives: To synthesise findings from the Health Outcomes for young People throughout Education (HOPE) evaluation of variation in SEND provision and its impact on health and education outcomes in English primary schools. We integrated findings from 14 sub-studies using administrative data in the Education and Child Health Insights from Linked Data (ECHILD) database and 10 mixed methods sub-studies. Methods: Analyses of ECHILD data followed children from birth to age 11 years. We examined how variation in SEND provision was associated with health conditions, and school, social and organisational factors. Using target trial emulation, we estimated the impact of SEND provision on hospital admissions, school absences and attainment. We surveyed and interviewed young people, parents, and professionals and reviewed information about services to understand SEND processes and contexts. Results: Of 3.8 million children born 2004 to 2013, 30% had SEND provision recorded by age 11. Health conditions were only partially associated with SEND provision, which was also related to male gender, social disadvantage, low attainment and type of school. SEND provision modestly reduced rates of unauthorised absences in subgroups of children but showed no measurable benefit on hospital admissions or school attainment. Mixed methods studies highlighted benefits of early, responsive support, challenges posed by limited capacity, harms caused by delayed or inadequate provision, and need for parent advocacy to access SEND provision. Discussion: Weak evidence of benefits of SEND provision in causal analyses likely reflects unmeasured confounding, lack of measures of provision received and insensitive outcomes in ECHILD data. SEND policies need robust evidence from analyses across jurisdictions using administrative data, enhanced with better measures, experimental methods and contextual evaluation.