Impact of special educational needs provision on hospital utilisation, school attainment and absences for children in English primary schools stratified by gestational age at birth: A target trial emulation study protocol.

Abstract

Introduction: One third of children in English primary schools have additional learning support called special educational needs (SEN) provision, but children born preterm are more likely to have SEN than those born at term. We aim to assess the impact of SEN provision on health and education outcomes in children grouped by gestational age at birth.

Methods: We will analyse linked administrative data for England using the Education and Child Health Insights from Linked Data (ECHILD) database. A target trial emulation approach will be used to specify data extraction from ECHILD, comparisons of interest and our analysis plan. Our target population is all children enrolled in year one of state-funded primary school in England who were born in an NHS hospital in England between 2003 and 2008, grouped by gestational age at birth (extremely preterm (24-<28 weeks), very preterm (28-<32 weeks), moderately preterm (32-<34 weeks), late preterm (34-<37 weeks) and full term (37-<42 weeks). The intervention of interest will comprise categories of SEN provision (including none) during year one (age five/six). The outcomes of interest are rates of unplanned hospital utilisation, educational attainment, and absences by the end of primary school education (year six, age 11). We will triangulate results from complementary estimation methods including the naïve estimator, multivariable regression, g-formula, inverse probability weighting, inverse probability weighting with regression adjustment and instrumental variables, along with a variety for a variety of causal contrasts (average treatment effect, overall, and on the treated/not treated).

Ethics and dissemination: We have existing research ethics approval for analyses of the ECHILD database described in this protocol. We will disseminate our findings to diverse audiences (academics, relevant government departments, service users and providers) through seminars, peer-reviewed publications, short briefing reports and infographics for non-academics (published on the study website).