Early special educational needs provision and health and educational outcomes during primary school in children with cerebral palsy

<ns3:p>Background Evidence is lacking on whether Special Education Needs (SEN) provision for children with cerebral palsy improves their school attainment and reduces their hospital utilisation compared to unexposed peers. Methods We assessed the causal impact of SEN provision (None, SEN Support – arranged by the school-, and Educational and Healthcare Plan [EHCP] – arranged by the local government) at start of compulsory schooling (Year 1; age 5/6 years) on unplanned hospital utilisation, school absences during primary school and mathematics attainment at Key Stage 1 (KS1, taken at age 6/7) and 2 (KS2, taken at 10/11). We used a target trial emulation framework to define groups with similar needs from linked hospital and education data on children born 2003 to 2013 in England with cerebral palsy recorded in hospital before Year 1. We employed propensity score-based methods to control for the non-random allocation to SEN provision in this population. Results In our study population, 45% (1483/3275) of children affected by cerebral palsy had SEN Support and 42% had an EHCP in Year 1. Comparing scenarios where SEN Support was/was not provided in Year 1, we found some indication that SEN provision was associated with higher rates of unplanned hospital admissions, similar rates of total absences and lower rates of unauthorised absences. SEN provision was also associated with lower probabilities of achieving the expected mathematics level at KS1 but similar probabilities at KS2. Comparing EHCP to SEN Support, we found evidence of increased rates for unplanned hospitalization, an indication of decreased rates for unauthorised absences, and a decreased probability of achieving the expected KS2 level. Sensitivity analyses that modified the definition of the cerebral palsy population confirmed these results, except for rates of unplanned hospital admissions that were increased when comparing SEN provision versus none. Discussion We found some weak and conflicting evidence on the impact of SEN provision on health and education outcomes of children affected by cerebral palsy. Although there was possibly an indication of increased rates of unplanned hospital admissions, there was also a possibly positive effect on rates of unauthorised absences. Given that the rates of total absences did not appear to be affected, it is however possible that SEN provision has an impact on the coding of absences more that on its rate. With regards to mathematical achievement, again results are mixed, indicating some levelling up by the end of primary school (when KS2 levels are assessed). For all results we cannot discount however the impact of likely residual confounding bias.</ns3:p>