{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:28:30Z","timestamp":1788305310361,"version":"build-2803163510"},"reference-count":33,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec id=\"S2056472425108272_as1\">\n\t    <jats:title>Background<\/jats:title>\n\t    <jats:p>Pupils in alternative education provision, known as \u2018Educated in Other Than At School\u2019 (EOTAS) in Wales, UK, are among the most vulnerable learners and who, for reasons such as mental health or behavioural challenges, do not attend a mainstream or special school.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2056472425108272_as3\">\n\t    <jats:title>Aims<\/jats:title>\n\t    <jats:p>We compared self-harm, neurodevelopmental disorders and mental health conditions between EOTAS pupils and controls with similar characteristics, before and after being in EOTAS provision.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2056472425108272_as4\">\n\t    <jats:title>Method<\/jats:title>\n\t    <jats:p>This population-based electronic cohort study included pupils in Wales aged 7\u201318 years, from the academic years 2010\u201311 to 2018\u201319. We linked data from Education Wales to primary and secondary healthcare records within the Secure Anonymised Information Linkage (SAIL) Databank. Individuals included in the EOTAS data-set were identified as cases. Controls were pseudo-randomly selected based on equivalent age and academic year distribution.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2056472425108272_as5\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>This study included 8056 pupils in EOTAS and 224 247 controls. Higher levels of deprivation, childhood maltreatment, self-harm, neurodevelopmental disorders and mental health conditions before EOTAS entry were linked to higher odds of being in EOTAS. Pupils in EOTAS provision had increased incidence of self-harm, neurodevelopmental disorders and mental health conditions, from 1 year after entering EOTAS provision up to 24 years of age, than pupils with similar characteristics not in EOTAS provision.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2056472425108272_as6\">\n\t    <jats:title>Conclusion<\/jats:title>\n\t    <jats:p>While EOTAS provision plays an important role, our findings indicate that it is not sufficient on its own to meet pupils\u2019 social, emotional, behavioural and mental health needs. Additional support and better integration with health and social services are required.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1192\/bjo.2025.10827","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T07:51:43Z","timestamp":1757577103000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study"],"prefix":"10.1192","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8088-4800","authenticated-orcid":false,"given":"Olivier Y.","family":"Rouquette","sequence":"first","affiliation":[{"name":"Swansea University"},{"name":"GESIS \u2013 Leibniz Institute for the Social Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1502-389X","authenticated-orcid":false,"given":"Marcos","family":"del Pozo Ba\u00f1os","sequence":"additional","affiliation":[{"name":"Swansea University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sze Chim","family":"Lee","sequence":"additional","affiliation":[{"name":"Swansea University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5657-6995","authenticated-orcid":false,"given":"Ann","family":"John","sequence":"additional","affiliation":[{"name":"Swansea University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"S2056472425108272_ref19","year":"2022","journal-title":"RStudio Desktop"},{"key":"S2056472425108272_ref14","unstructured":"14 World Health Organization. ICD-10 Version: 2019. WHO, 2019 (https:\/\/icd.who.int\/browse10\/2019\/en [cited 21 Dec 2021])."},{"key":"S2056472425108272_ref30","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2015.197"},{"key":"S2056472425108272_ref22","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2022.3475"},{"key":"S2056472425108272_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2022.106759"},{"key":"S2056472425108272_ref2","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s10488-020-01080-9","article-title":"Rates of mental health service utilization by children and adolescents in schools and other common service settings: a systematic review and meta-analysis","volume":"48","author":"Duong","year":"2021","journal-title":"Adm Policy Ment Health"},{"key":"S2056472425108272_ref13","unstructured":"13 NHS England. Read Codes. NHS England, 2022 (https:\/\/digital.nhs.uk\/services\/terminology-and-classifications\/read-codes [cited 21 Dec 2021])."},{"key":"S2056472425108272_ref9","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-9-157"},{"key":"S2056472425108272_ref7","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/1467-9604.12236","article-title":"There is more flexibility to meet my needs: educational experiences of autistic young people in Mainstream and Alternative Education Provision","volume":"34","author":"Goodall","year":"2019","journal-title":"Supp Learn"},{"key":"S2056472425108272_ref25","unstructured":"25 Estyn. Education Other than at School. Estyn, 2016 (https:\/\/www.estyn.gov.wales\/system\/files\/2020-07\/EOTAS%2520remit%2520report.pdf [cited 21 Jan 2022])."},{"key":"S2056472425108272_ref32","doi-asserted-by":"publisher","DOI":"10.1080\/02643944.2022.2093958"},{"key":"S2056472425108272_ref5","doi-asserted-by":"publisher","DOI":"10.53841\/bpsper.2020.44.2.99"},{"key":"S2056472425108272_ref6","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1080\/13603116.2014.961677","article-title":"Children\u2019s rights, school exclusion and alternative educational provision","volume":"19","author":"McCluskey","year":"2015","journal-title":"Int J Inclus Educ"},{"key":"S2056472425108272_ref3","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1111\/camh.12543","article-title":"Review: school-based interventions to improve mental health literacy and reduce mental health stigma \u2013 a systematic review","volume":"28","author":"Ma","year":"2023","journal-title":"Child Adolesc Mental Health"},{"key":"S2056472425108272_ref4","unstructured":"4 Welsh Government. Education Otherwise than at School (EOTAS): Framework for Action. Welsh Government, 2019 (https:\/\/gov.wales\/education-otherwise-school-eotas-framework-action [cited 21 Aug 2025])."},{"key":"S2056472425108272_ref28","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20998"},{"key":"S2056472425108272_ref1","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/S2215-0366(19)30403-1","article-title":"School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis","volume":"6","author":"Caldwell","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"S2056472425108272_ref21","doi-asserted-by":"publisher","DOI":"10.1101\/2023.10.20.23297324"},{"key":"S2056472425108272_ref8","unstructured":"8 Health Data Research Gateway. Education Wales (EDUW). Health Data Research Gateway, 2023 (https:\/\/healthdatagateway.org\/en\/dataset\/314 [cited 31 May 2023])."},{"key":"S2056472425108272_ref12","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S2215-0366(21)00367-9","article-title":"Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK","volume":"9","author":"John","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"S2056472425108272_ref20","doi-asserted-by":"publisher","DOI":"10.1214\/ss\/1009213286"},{"key":"S2056472425108272_ref11","unstructured":"11 Welsh Government. Welsh Index of Multiple Deprivation: 2011. Welsh Government, 2011 (https:\/\/gov.wales\/welsh-index-multiple-deprivation-full-index-update-ranks-2011 [cited 18 Jan 2022])."},{"key":"S2056472425108272_ref29","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20938"},{"key":"S2056472425108272_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedhc.2020.09.001"},{"key":"S2056472425108272_ref33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"key":"S2056472425108272_ref10","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-9-3"},{"key":"S2056472425108272_ref16","doi-asserted-by":"crossref","first-page":"8138","DOI":"10.1038\/s41598-023-34011-3","article-title":"An external validation of coding for childhood maltreatment in routinely collected primary and secondary care data","volume":"13","author":"John","year":"2023","journal-title":"Sci Rep"},{"key":"S2056472425108272_ref17","unstructured":"17 IBM Corporation. IBM Db2 9.7. IBM, 2009 (https:\/\/www.ibm.com\/products\/db2-database [cited 13 Aug 2025])."},{"key":"S2056472425108272_ref26","volume-title":"Equity of Curriculum Experiences for Pupils Who are Educated Other than at School (EOTAS)","year":"2023"},{"key":"S2056472425108272_ref15","doi-asserted-by":"publisher","DOI":"10.1177\/1524838014537908"},{"key":"S2056472425108272_ref18","year":"2021","journal-title":"R: A Language and Environment for Statistical Computing"},{"key":"S2056472425108272_ref27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0049808"},{"key":"S2056472425108272_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.dhjo.2009.07.001"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472425108272","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T07:51:46Z","timestamp":1757577106000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472425108272\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":33,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["S2056472425108272"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2025.10827","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e205"}}