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UCL Great Ormond Street Institute of Child Health

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The HOPE Study

What is the HOPE Study researching?

The HOPE Study (Health Outcomes of young People throughout Education) is a new study at UCL and is funded by the National Institute for Health Research Programme for Applied Health Research. The Hope Study is investigating the impact of adjustments for special educational needs or disability (SEND) on children’s health using linked education and hospital data for all children in England (the ECHILD database).

HOPE Study Child Sensory Learning

The HOPE Study aims to provide enduring public health benefits by establishing methods and tools for the ongoing evaluation, monitoring and improvement of SEND services for better health and wellbeing in children and young people.

The findings will enable policy makers, service providers and users to make evidence-informed decisions about benefits from SEND provision for health and education and which children benefit.

Why is this research needed?

The provision of special educational needs support (known as SEND) has declined over the last decade, which may have led to unmet need. We aim to find out whether lack of adequate SEND support to those who need it harms the health and development of children, and whether this increases demands on health care, as well as education and social care. Effective provision of SEND support means targeting support to those who need it. This study aims to provide evidence about the benefits of SEND provision and which children benefit from different types of support. Findings from HOPE will enable policy makers, service providers and families to make evidence-informed decisions about who might benefit from adjustments in school for children with SEND as services recovery from the COVID-19 pandemic.

The HOPE study will assess whether the intensity and duration of the type of support provided to children with additional needs improves health as well as participation in school activities, for example by reducing absence due to health difficulties. We will find out whether SEND provision leads to improved health, by measuring the number of hospital contacts or admissions in children with and without the level of SEND provision that would be expected for their health condition.

How is the research being carried out?

The HOPE Study will use diverse methodologies and involve young people, parents and practitioners.  Our research methods will use the fact that SEND provision has not been evenly distributed across local authorities, the amount of provision has varied over time and services have been impacted by the COVID-19 pandemic. This will make it possible to compare outcomes in children who received support with similar children who did not receive support for SEND. Different methods are being used to analyse how certain we can be that SEND provision causes a change in health outcomes. Four interlinked work packages within the HOPE Study will work on developing iteratively investigate and inform each other's findings throughout the programme. 

Young people, parents and practitioners are key to this work. We thank the group of young people from FLARE, who decided what the study should be called. We will involve young people, parents and practitioners to develop the study and help us interpret our findings. Learn how you can get involved here: Get involved.

HOPE image of study methods and work package interaction
Work package 1 - Health indicators of need for SEND and outcomes

This work package develops the data cohorts and Health Episode Statistics data indicators (also known as coding clusters or phenotypes) to define the study population likely to need SEND provision.

Methods: Systematic reviews and qualitative synthesis of stakeholder views to define key health indicators and outcomes; quantitative methods to define health indicators of need for SEND and outcomes and descriptive analyses of prognosis and risk factors associated with need for SEND provision.

Work package 2 - Understanding SEND provision

This work package uses mixed methods to evaluate and map variation in criteria, policies and user experiences of the timing, setting and duration of SEND provision across England. Findings will be compared, reconciled and summarised in a systems analysis. The final output will be metadata of indicators of timing and location of various policies and practices to be used in analyses in other work packages.

Methods: Qualitative evaluation of practices reported by stakeholders and service users and literature reviews; descriptive data analyses; systems analysis to integrate findings; quantitative methods to derive metadata combining linked hospital and education data for all children with information on variation in policies and local practices.

Work package 3 - Impact of SEND provision on health outcomes

This work package exploits changes in SEND provision due to external factors such as policy changes, funding interventions or variation in local criteria, to compare children with similar health conditions who did/did not receive SEND provision. Researchers will use different analytic methods to estimate the impact of alternative SEND provisions on health outcomes. Analyses will use the ECHILD database (linked hospital and education data) and the meta-data from WP 2.

Methods: Quantitative data analyses using econometric causal methods; stakeholder involvement to inform model development.

Work package 4 - Impact of the timing and duration of SEND provision on health outcomes

This work package aims to expand on the work of WP 3 by investigating specific features of SEND interventions, such as the age at first intervention and its duration, on selected sub-populations for whom sufficiently detailed data will be available. Addressing questions of interventions sustained over time requires addressing the challenges posed by the time-varying nature of the information and the possible feedback over time between SEND provision and the health outcomes that are to be evaluated. To deal with these challenges, researchers will use an emulated target trial approach and will initially focus on comparing early versus deferred SEND provision for children born too small or too early. Findings will also guide services and researchers on the use of linked administrative data for future evaluations of SEND provision on health.

Methods: Quantitative data analyses using biostatistical and econometric causal methods to evaluate the impact of the timing and duration of SEND provision on specific groups and over an extended period; stakeholder involvement to inform prioritisation of target interventions and eligible groups