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Next Steps

This study analyzes the relationship between exclusion from school and mental health based on previous surveys. It explores the predictors, risks, and consequences of school exclusion on children's mental well-being.

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Next Steps

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  1. Next Steps Tamsin Ford, University of Exeter

  2. Previous surveys had a huge impact Ford, T., Parker, C., Salim, J., Goodman, R., Logan, S., & Henley, W. (2018). The relationship between exclusion from school and mental health: a secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007. Psychological Medicine, 48(4), 629-641. Parker C, Tejerina-Arreal M, Henley W, Goodman R, Logan S, Ford T (2018).Are children with unrecognised psychiatric disorders being excluded from school? A secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007. Psychological Medicine 1–12. https://doi.org/10.1017/S0033291718003513 Ford, T., Macdiarmid, F., Russell, A., Racey, D., & Goodman, R. (2017). The predictors of persistent DSM-IV disorders in 3-year follow-ups of the British Child and Adolescent Mental Health Surveys 1999 and 2004. Psychological Medicine, 47(6), 1126-1137. Ford, T., & Parker, C. (2016). Emotional and behavioural difficulties and mental (ill) health. Emotional and Behavioural Difficulties 21(1) 1-7. Knapp, M., Snell, T., Healey, A., Guglani, S., Evans‐Lacko, S., Fernandez, J. L., Meltzer, H. & Ford, T. (2015). How do child and adolescent mental health problems influence public sector costs? Interindividual variations in a nationally representative British sample. Journal of Child Psychology and Psychiatry, 56(6), 667-676. Lang, I. A., Marlow, R., Goodman, R., Meltzer, H., & Ford, T. (2013). Influence of problematic child-teacher relationships on future psychiatric disorder: population survey with 3-year follow-up. The British Journal of Psychiatry, 202(5), 336-341 Martin, A., Ford, T., Goodman, R., Meltzer, H., & Logan, S. (2013). Physical illness in looked-after children: a cross-sectional study. Archives of Disease in Childhood, 99(2) 103-107. Snell, T., Knapp, M., Healey, A., Guglani, S., Evans‐Lacko, S., Fernandez, J. L., Meltzer H., & Ford, T. (2013). Economic impact of childhood psychiatric disorder on public sector services in Britain: estimates from national survey data. Journal of Child Psychology and Psychiatry, 54(9), 977-985.  Meltzer, H., Ford, T., Bebbington, P., & Vostanis, P. (2012). Children who run away from home: Risks for suicidal behavior and substance misuse. Journal of Adolescent Health, 51(5), 415-421.  Meltzer, H., Dogra, N., Vostanis, P., & Ford, T. (2011). Religiosity and the mental health of adolescents in Great Britain. Mental Health, Religion & Culture, 14(7), 703-713.  Meltzer, H., Vostanis, P., Ford, T., Bebbington, P., & Dennis, M. S. (2011). Victims of bullying in childhood and suicide attempts in adulthood. European Psychiatry, 26(8), 498-503. Meltzer, H., Ford, T., Goodman, R., & Vostanis, P. (2011). The burden of caring for children with emotional or conduct disorders. International journal of family medicine, 2011.  Meltzer, H., Doos, L., Vostanis, P., Ford, T., & Goodman, R. (2009). The mental health of children who witness domestic violence. Child & Family Social Work, 14(4), 491-501. Meltzer, H., Vostanis, P., Dogra, N., Doos, L., Ford, T., & Goodman, R. (2009). Children's specific fears. Child: care, health and development, 35(6), 781-789. Shivram, R., Bankart, J., Meltzer, H., Ford, T., Vostanis, P., & Goodman, R. (2009). Service utilization by children with conduct disorders: findings from the 2004 Great Britain child mental health survey. European Child & Adolescent Psychiatry, 18(9), 555-563.  Ford, T., Hamilton, H., Meltzer, H., & Goodman, R. (2008). Predictors of service use for mental health problems among British schoolchildren. Child and Adolescent Mental Health, 13(1), 32-40. Vostanis, P., Bassi, G., Meltzer, H., Ford, T., & Goodman, R. (2008). Service use by looked after children with behavioural problems: Findings from the England survey. Adoption & Fostering, 32(3), 23-32.  Rotheray, S., Racey, D., Rodgers, L., McGilloway, S., Berry, V., & Ford, T. (2014). Innovations in Practice: Further evidence on the effectiveness of the strengths and difficulties added value score as an outcome measure for child and adolescent services. Child and Adolescent Mental Health, 19(4), 270-273. Newlove-Delgado, T., Moore, D., Ukoumunne, O. C., Stein, K., & Ford, T. (2015). Mental health related contact with education professionals in the British Child and Adolescent Mental Health Survey 2004. The Journal of Mental Health Training, Education and Practice, 10(3), 159-169. Newlove-Delgado, T., Ukoumunne, O., Stein, K., & Ford, T. (2015). Trajectories of psychopathology in relation to mental health related service contacts over three years in the British child and adolescent mental health survey 2004. European Psychiatry, 30, 418. Rowe, R., Maughan, B., Moran, P., Ford, T., Briskman, J., & Goodman, R. (2010). The role of callous and unemotional traits in the diagnosis of conduct disorder. Journal of Child Psychology and Psychiatry, 51(6), 688-695. Sayal, K., Ford, T., & Goodman, R. (2010). Trends in recognition of and service use for attention-deficit hyperactivity disorder in Britain, 1999–2004. Psychiatric Services, 61(8), 803-810. Ford, T., Hutchings, J., Bywater, T., Goodman, A., & Goodman, R. (2009). Evaluation of the Strengths and Difficulties Questionnaire Added Value Score as a method for estimating effectiveness in child mental health interventions. The British Journal of Psychiatry, 194, 552-557. Moran, P., Rowe, R., Flach, C., Briskman, J., Ford, T., Maughan, B., Scott, S. & Goodman, R. (2009). Predictive value of callous-unemotional traits in a large community sample. Journal of the American Academy of Child & Adolescent Psychiatry, 48(11), 1079-1084. Goodman, A., & Ford, T. (2008). Validation of the Ford score as a measure for predicting the level of emotional and behavioural problems in mainstream schools. Research in Education, 80(1), 1-14. Guglani, S., Rushton, A., & Ford, T. (2008). Mental health and educational difficulties in children in contact with children's social Services. Child & Family Social Work, 13(2), 188-196. Moran, P., Ford, T., Butler, G., & Goodman, R. (2008). Callous and unemotional traits in children and adolescents living in Great Britain. The British Journal of Psychiatry, 192(1), 65-66. Ford, T., Collishaw, S., Meltzer, H., & Goodman, R. (2007). A prospective study of childhood psychopathology: independent predictors of change over three years. Social Psychiatry and Psychiatric Epidemiology, 42(12), 953. Ford, T., Hamilton, H., Meltzer, H., & Goodman, R. (2007). Child Mental Health is Everybody's Business: The Prevalence of Contact with Public Sector Services by Type of Disorder Among British School Children in a Three‐Year Period. Child and Adolescent Mental Health, 12(1), 13-20. Ford, T., Vostanis, P., Meltzer, H., & Goodman, R. (2007). Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. The British Journal of Psychiatry, 190(4), 319-325. Meltzer, H., Vostanis, P., Goodman, R., & Ford, T. (2007). Children's perceptions of neighbourhood trustworthiness and safety and their mental health. Journal of Child Psychology and Psychiatry, 48(12), 1208-1213. Ford, T., & Goodman, R. (2006). The Ford score: A simple measure for predicting the level of emotional and behavioural problems within mainstream schools. Emotional and Behavioural Difficulties, 10(3), 219-233. Sayal, K., Goodman, R., & Ford, T. (2006). Barriers to the identification of children with attention deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 47(7), 744-750. Ford, T., Hamilton, H., Goodman, R., & Meltzer, H. (2005). Service contacts among the children participating in the British child and adolescent mental health surveys. Child and Adolescent Mental Health, 10(1), 2-9. Ford, T., Sayal, K., Meltzer, H., & Goodman, R. (2005). Parental concerns about their child's emotions and behaviour and referral to specialist services: general population survey. BMJ, 331(7530), 1435-1436. Ford, T., Goodman, R., & Meltzer, H. (2004). The relative importance of child, family, school and neighbourhood correlates of childhood psychiatric disorder. Social Psychiatry and Psychiatric Epidemiology, 39(6), 487-496. Goodman, R., Ford, T., Corbin, T. & Meltzer, H. (2004). Using the Strengths and Difficulties Questionnaire (SDQ) multi-informant algorithm to screen looked after children for psychiatric disorders. European Child and Adolescent Psychiatry 13, supplement 2, 25-31. Fombonne, E., Simmons, H., Ford, T., Meltzer, H., & Goodman, R. (2003). Prevalence of pervasive developmental disorders in the British nationwide survey of child mental health. International Review of Psychiatry, 15(1-2), 158-165. Ford, T., Goodman, R., & Meltzer, H. (2003). The British child and adolescent mental health survey 1999: the prevalence of DSM-IV disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 42(10), 1203-1211. Ford, T., Goodman, R., & Meltzer, H. (2003). Service use over 18 months among a nationally representative sample of British children with psychiatric disorder. Clinical Child Psychology and Psychiatry, 8(1), 37-51. Goodman, R., Ford, T., Simmons, H., Gatward, R., & Meltzer, H. (2003). Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. International Review of Psychiatry, 15(1-2), 166-172. Goodman, R., Ford, T., Simmons, H., Gatward, R., & Meltzer, H. (2003). Using the strengths and difficulties questionnaire (SDQ) to screen for child psychiatric disorders in a community sample (Reprinted from The British Journal of Psychiatry, vol 177, pgs 534-539, 2000). International Review of Psychiatry, 15(1-2), 166-172. Goodman, R., Gledhill, J., & Ford, T. (2003). Child psychiatric disorder and relative age within school year: cross sectional survey of large population sample. BMJ, 327(7413), 472. Heyman, I., Fombonne, E., Simmons, H., Ford, T., Meltzer, H., & Goodman, R. (2003). Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health. International Review of Psychiatry, 15(1-2), 178-184. Meltzer, H., Gatward, R., Goodman, R., & Ford, T. (2003). Mental health of children and adolescents in Great Britain. International Review of Psychiatry, 15(1-2), 185-187. Vostanis, P., Meltzer, H., Goodman, R. & Ford, T.  (2003). Service Utilisation by Children with Conduct Disorders. European Child and Adolescent Psychiatry 12, 231-238. Gledhill, J., Ford, T., & Goodman, R. (2002). Does season of birth matter? The relationship between age within the school year (season of birth) and educational difficulties among a representative general population sample of children and adolescents (aged 5–15) in Great Britain. Research in Education, 68(1), 41-47. Goodman, R., Ford, T., & Meltzer, H. (2002). Mental health problems of children in the community: 18 month follow up. BMJ, 324(7352), 1496-1497. Goodman, R., Ford, T., & Simmons, H. (2002). Using the Strengths and Difficulties Questionnaire (sdq) to Screen for Child Psychiatric Disorders in a Community Sample. Year Book of Psychiatry and Applied Mental Health, 2002(1), 37-38. Goodman, R., Ford, T., Simmons, H., Gatward, R., & Meltzer, H. (2000). Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. The British Journal of Psychiatry, 177(6), 534-539. Fombonne, E., Simmons, H., Ford, T., Meltzer, H., & Goodman, R. (2001). Prevalence of pervasive developmental disorders in the British nationwide survey of child mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 40(7), 820-827. Goodman, R., Ford, T., Simmons, H., Gatward, R. & Meltzer, H. (2001). Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. British Journal of Psychiatry 177, 534-539. Heyman, I., Fombonne, E., Simmons, H., Ford, T., Meltzer, H., & Goodman, R. (2001). Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health. The British Journal of Psychiatry, 179(4), 324-329.

  3. Proportion in contact with services 1999-2002

  4. Annual national costs of mental health service use for population aged 5-15 with emotional/behavioural disorder

  5. Service contact over time between 2004 and 2007

  6. Conduct disorder (44%) • Intellectual disability, • Rented housing • Large family • Parental burden • Parental SDQ total difficulties score • SDQ peer relationship problems ADHD (44%) • SDQ peer relationships problems • Neurodevelopmental disorder Anxiety (26%) • SDQ peer relationship problems • Lower family income • Parental burden Depression (18%) • Parental psychological distress • Parental SDQ total difficulties • Conduct disorder • Living in rented housing

  7. SDQ added value score – growth charts for CAMHS Change in CAMHS case AVS Predictednon-CAMHS score 6 months later Outset Actual score

  8. Why do we need it? • The chronic and fluctuating nature of childhood psychiatric symptoms • Attenuation • Regression to the mean

  9. Where did it come from? Children in the DoH British child and adolescent mental health survey 2004 and its six-month follow up who:- • Were rated as having a psychiatric disorder • Or children with parents who had approached primary health care or teachers in relation to this child’s mental health within the previous year. • (n=604)

  10. Added value score = expected score– observed score Added value (in SDQ points) = 2.3 + 0.8*baseline total difficulties score + 0.2*baseline impact score – 0.3* baseline emotional difficulties subscale score – follow up total difficulties score. Where Expected SDQ total difficulties score given baseline scores Observed SDQ total difficulties score • Expected > observed: added value = positive; follow up score lower than expected; better than expected change • Expected < observed; added value = negative; follow up score higher than expected; worse than expected change. • Expected = observed; added value =0 => same change as in the community

  11. We explored:- Type or severity of diagnosis Age and gender Poor physical health Maternal educational level Maternal anxiety and depression Family (type, function and size) Housing tenure Neighbourhood characteristics Using stepwise linear regression, these factors explained:- 0.6% of variance of the added value score 35.9% of baseline SDQ scores 24.2% of follow up SDQ scores The lack of influence of complexity factors

  12. Does it work? • Tested with data from a community based trial of the IY parenting program that had used to the SDQ at two time points 4-8 months apart, including the impact scale and detected a difference. • If the SDQ value added scale worked it should accurately predict the effect size measured by the trial for the intervention group and while the control group should show no change • We tested the added value score against simple change scores (T1 total difficulties score – T2 total difficulties)

  13. Moderators of the AVS – Andy Fugard

  14. How to access the data for secondary analysis • Disclosure controlled version of the data set to be made available. • To be made available via NHS Digital’s Data Access Request Service (DARS). • Users will need to complete an application to access the data via DARS. • Anticipate data available on DARS and ready for applications in Spring 2019.

  15. Data linkage • Exploring possibility to link to other healthcare and education data sets. • In discussions with Department for Education to link to the National Pupil Database (NPD). • Survey participants already provided consent to link their data to NPD. • Linking to the NPD would allow additional information such as pupils attainment and attendance records and exclusion and Special Educational Needs information to be linked to the prevalence of mental health conditions already captured from the survey.

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