Preventing Unmet Need from Leading to School Exclusion: Empowering Schools to Identify Neurodiversity Earlier

Background: School exclusion is a key precursor for poor outcomes. The most commonly reported reason for exclusion is ‘persistent disruptive behaviour’. One possible driver of disruptive behaviour is unmet need related to neurodevelopmental conditions (e.g. Autism Spectrum Disorder, ASD). However, schools are often unaware of neurodevelopmental needs, whilst clinical services are plagued with lengthy waiting lists. Thus, children’s needs are often not identified in a timely, holistic manner. Evidence suggests the Early Years Foundation Stage Profile (EYFSP) may allow schools to identify neurodevelopmental needs. However, a population level, place-based approach is needed to understand local systems and identify potential solutions. Aims: The first aim was to understand the relationship between ASD and school exclusion across a district. The second aim was to understand how stakeholders and systems can operate cohesively to develop and implement an Electronic Neurodiversity Profiling Tool (ENPT) as a transformative way of working. Methods: Through mixed methods, the Connecting Lived Experiences with Visualisation of Electronic Records (CLEVER) framework combined analysis of population level data with stakeholder perspectives to offer a holistic understanding of the issues. For the first time in England, routine administrative data from health and education were connected to understand the relationship between ASD and exclusion, employing logistic regression analysis. Discussions across the district pointed towards the utility of an evidence-based profiling tool to support schools to develop a more timely, holistic understanding of children’s behaviour. This created an opportunity for the development of the ENPT. Semi-structured interviews were held with 7 professionals involved in the ENPT project to understand associated barriers and opportunities. Data were analysed using Reflexive Thematic Analysis. Results: Overall rates of exclusion were higher in secondary school, whilst students with pending diagnoses consistently showed a higher rate of exclusion than those with either a confirmed diagnosis of ASD, or no diagnosis at all. A diagnosis of ASD decreased the odds of exclusion in secondary school, but increased the odds in primary schools. Four main themes were identified from the qualitative analysis: ‘Making the Implicit Explicit’; ‘Communicating with Each Other’; ‘Respect and Recognition’; and ‘The Big Picture of Acceptability’. Nine subthemes were identified, spanning both the development and implementation of the tool; the issues, challenges and opportunities were often apparent in both stages. Conclusions: The results suggest that pupils awaiting a diagnosis of ASD are at an elevated risk of school exclusion. However, a diagnosis alone does not necessarily allow schools to effectively meet the needs of pupils with a neurodevelopmental condition. The findings offer exciting support for an alternative, needs-led way of working which may reduce reliance on pressured clinical services and empower schools to recognise neurodevelopmental needs much earlier, thereby reducing rates of school exclusion. It is hoped that the findings will inform the development of similar solutions beyond Bradford, serving as a ‘toolkit’ for services shifting towards a more connected way of working.