Priorities for Improving Data Collection and Measurement of Mental Health and Wellbeing of Adolescents With Special Educational Needs Within Non-Mainstream Schools: A Delphi Study

TYPE Original Research Published 21 July 2026 DOI 10.3389/feduc.2026.1827451

Priorities for improving data collection and measurement of mental health and wellbeing of adolescents with special educational needs within non- mainstream schools: a Delphi study

Edited By Johny Daniel, Durham University, United Kingdom

Reviewed By Beata Andrea Dan, Partium Christian University, Romania Louise Gascoine, Durham University, United Kingdom

*Correspondence Mairi C. Jeffery

mairi.jeffery.16@ucl.ac.uk Received 10 March 2026 Revised 26 June 2026 Accepted 29 June 2026 Published 21 July 2026 1,2*, Suzet Tanya Lereya 1,2, Claire Powell 3 and Jessica Deighton

Mairi C. Jeffery

1,2 Citation Jeffery MC, Lereya ST, Powell C and Deighton J (2026) Priorities for improving data collection and measurement of mental health and wellbeing of adolescents with special educational needs within non- mainstream schools: a Delphi study. Front. Educ. 11:1827451. doi: 10.3389/feduc.2026.1827451 1 Evidence Based Practice Unit, University College London, London, United Kingdom, 2Anna Freud Centre, London, United Kingdom, 3UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom Introduction: As schools increasingly recognise their role in pupils’ mental health and wellbeing, there is a shift towards conducting school-based surveys to collect wellbeing data. However, there are challenges associated with data collection in non-mainstream education settings, including the availability and suitability of wellbeing measures for use with young people with special educational needs (SEN) and barriers to implementation. This mixed-method Delphi study aimed to reach a consensus on a list of key priorities for improving data collection and measurement of wellbeing of young people with SEN in non-mainstream schools. Methods: Phase 1 involved online qualitative focus groups and interviews with school staff and researchers (n = 14) to identify items for inclusion in the survey. Two online Delphi survey rounds were conducted with researchers, educational psychologists (EPs) and non-mainstream school staff members (n = 113). A final workshop using Nominal Group Technique (NGT) was held to discuss the findings and agree on a final list of key priorities. Results: From an original set of seventy-five items, a final list of eleven key priorities were selected. Identified priorities fell into four themes relating to ’survey design and accessibility’, ‘ethical and data protection considerations’, ‘communication, understanding, and support for pupils’ and ‘institutional commitment and implementation’. Conclusion: This Delphi study provides a consensus-driven framework to guide improved wellbeing measurement practices of young people with SEN in non- mainstream schools.

Copyright © 2026 Jeffery, Lereya, Powell and Deighton. This is an open-access article distributed under the terms of the Creative Commons Attribution License (Cc By). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Keywords alternative provision, mental health, special educational needs, special schools, wellbeing measurement, educational psychology Frontiers in Education 01 frontiersin.org

Introduction

part in surveys implemented by external organisations such as the #BeeWell programme and the OxWell Student Survey for Non-Mainstream Schools (OxWell, 2023; Thornton et al., 2024a, 2024b). Mental health and wellbeing data can allow schools to recognise challenges that their pupils are facing, to identify the need for targeted or universal interventions for commissioning purposes, and/or to monitor the outcome of any interventions (Public Health England and Department for Education, 2021). However, there are barriers to implementing school-based surveys, including a lack of staff time and resources, competing school priorities and schools feeling overwhelmed by demands to introduce surveys (Widnall et al., 2023). These challenges are often amplified when surveys are conducted with young people with SEN, due to additional support and accessibility requirements. Young people with SEN may need help from school staff in completing surveys, which requires additional staff time and creates difficulties in ensuring confidentiality and anonymity of young people’s responses (Davison et al., 2022; Ng et al., 2022a; Sabri et al., 2015).

’Special educational needs’ (SEN) is an umbrella term which incorporates a wide range of needs that young people may have which require additional education support, including autism, speech, language and communication needs, learning/intellectual difficulties, and social, emotional or mental health needs. There are over 1.7 million children and young people with SEN in the United Kingdom, and over 170,000 are educated in non- mainstream settings (Department for Education, 2025b). These include special schools, which are schools with a specific provision for young people with SEN, and alternative provision (AP) or pupil referral units (PRUs), which are education settings for young people who are unable to attend a mainstream school, often due to exclusion or illness (Department for Education, 2025a). The number of pupils in APs/PRUs and special schools has been increasing in recent years (Department for Education, 2025a).

More than half of children and young people with SEN in England (56.7%) have been reported to have a probable mental health problem, compared to 12.5% of those without SEN (Newlove-Delgado et al., 2021). There is growing evidence that young people with SEN may have worse mental health and wellbeing than their peers without SEN (Barnes and Harrison, 2017; Deighton et al., 2019; Newlove-Delgado et al., 2021). Young people with SEN in mainstream schools have been reported to have lower levels of psychological wellbeing and self- esteem than their peers without SEN (#BeeWell Programme, 2025). However, young people with SEN in non-mainstream schools have been found to have slightly higher levels of psychological wellbeing and self-esteem than peers with SEN in mainstream schools (#BeeWell Programme, 2025, 2026).

Smaller pupil numbers, high pupil turnover and lower survey response rates from non-mainstream settings mean that they may receive less detailed feedback based on their setting’s survey completions than mainstream schools (Franklin, 2023). In terms of the available mental health and wellbeing surveys themselves, there is still a lack of validated self-report measures for use with children and young people with SEN (Maguire et al., 2023), although surveys that are shorter and utilise pictures or symbols are generally considered to be more suitable, particularly for young people with learning difficulties (Davison et al., 2023; Ikeda et al., 2016; Maïano et al., 2023; Sabri et al., 2015). Self- report measures allow young people to be key informants on their own wellbeing, which would ensure the voices of young people with SEN are captured within national statistics. Ensuring young people’s perspectives are heard and acted upon is a key aspect of children’s rights set out in Article 12 of the UN Convention on Rights of a Child (United Nations, 1989), and equally for young people with disabilities, whose rights are also covered by the Convention on the Rights of Persons with Disabilities (United Nations, 2006). Although there are challenges with the use of self-report measures for young people with SEN (Emerson et al., 2013), some studies have found relatively low inter-rated reliability between self-report and parent/teacher report for young people with SEN (Olivier et al., 2021; van der Meer et al., 2008), which highlights the necessity of asking young people about their own wellbeing.

There is increasing recognition that schools play an important role in supporting pupils’ wellbeing, and one component of this is assessment and monitoring through surveys (Department of Health and Department for Education, 2017). There have been calls for the United Kingdom government to introduce a national programme of wellbeing measurement to understand why the wellbeing of young people is declining (Franklin et al., 2024). Benefits of national wellbeing measurement include being able to make comparisons across the education system on what works for improving young people’s wellbeing, assessment of schools’ mental health and wellbeing support, identifying groups of children at risk and creating an evidence base on the challenges surrounding transition from primary to secondary school (The Children’s Society, 2019). Young people with SEN have especially been found to struggle with this transition (McCoy et al., 2020; Neal et al., 2016). Additionally, the UK government recently issued a white paper ‘Every child achieving and thriving’, which suggests a policy shift towards improving mainstream schools to allow more young people with SEN to access inclusive education, rather than being educated in special schools, APs and PRUs (Department for Education, 2026). A component of ensuring that these reforms are successful for all children and young people with SEN will be monitoring their mental health and wellbeing as they transition between educational settings, and there is a need to consider how best to implement wellbeing measurement in non-mainstream school settings (Franklin et al., 2024).

The aim of this Delphi study was to reach a consensus among researchers, educational psychologists (EPs) and non-mainstream school staff members, on a list of key priorities for improving data collection and measurement of wellbeing of young people with SEN in non-mainstream schools. These key informant groups are well positioned to be able to report on the challenges and priorities for improving wellbeing measurement of young people with SEN, due to their experience either in non-mainstream schools, with young people with SEN or in wellbeing measurement and data collection. In the United Kingdom, EPs are often based in schools and work collaboratively with other professionals in education, health or social services to support young people with learning difficulties, social, emotional and mental health problems and issues around disability or complex

Many non-mainstream settings already carry out their own mental health and wellbeing data collection, while others take

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developmental disorders (Hill, 2013). The protocol for this study was published in JMIR Research Protocols in September 2024 (Jeffery et al., 2024a). The findings will be used to draft guidelines for special schools and alternative provision settings on monitoring the wellbeing of their pupils more effectively, and for improving school engagement and survey response rates of non-mainstream settings taking part in mental health research or data collection programmes.

wellbeing measurement and educational psychologists, based in the United Kingdom. School staff participants included senior leadership staff such as headteachers, deputy headteachers, senior mental health leads (SMHLs), heads of department or Special Educational Needs Co-Ordinators (SENCOs). Researchers included those working in the field of wellbeing measurement of young people with SEN or in non-mainstream education, and were identified from existing projects, organisations and universities.

Methods

Recruitment

Overall design

Focus groups/interviews This Delphi study had a mixed-methods design. The Delphi method was chosen as an appropriate method for topics where there is a large amount of experiential knowledge among different expert groups and has frequently been used in mental health research (Barrett and Heale, 2020; Jorm, 2015; Wittevrongel et al., 2023). The method aims to make practical recommendations that can be implemented, and, as the process is iterative, it allows participants to reflect on and revise previous responses (Barrett and Heale, 2020; Fletcher and Marchildon, 2014).

Purposive sampling, a commonly used qualitative sampling technique to capture those who are especially knowledgeable about an area of interest (Palinkas et al., 2015), was used to recruit participants for the focus groups and interviews. Separate focus groups were conducted for school staff working in non-mainstream settings (n = 8), and researchers working in the field of school-based wellbeing measurement (n = 6). School staff were recruited from the sample of schools who had taken part in the #BeeWell Programme and through Anna Freud and received a £25 ($33 USD) voucher for participation as an incentive and recognition of the time demands. Researchers were recruited via purposive and snowball sampling of professionals with research experience, including university academics who have published on mental health and SEN, and professionals in research policy or practice.

This study built on two earlier studies: 1) a scoping review conducted to identify literature on school-based measurement of mental health and wellbeing of young people with SEN Jeffery et al., 2024b 2) a qualitative interview study with nineteen young people with SEN in non-mainstream settings to understand their perspectives Jeffery et al. (2026). These findings helped to frame focus group and interview questions for the first phase of the current study.

Delphi survey rounds A series of focus groups and interviews were carried out with staff in special schools and alternative provision/PRU settings and researchers, exploring the implementation of wellbeing surveys in non-mainstream schools. A two-round Delphi survey and a final consensus workshop. See Figure 1 for the phases of this Delphi study.

With anticipated drop-out between rounds, there was an aim of 100 responses for the round 1 survey to reach the minimum number of 50 responses needed in the round 2 survey. Non- mainstream school staff participants were recruited from United Kingdom-based non-mainstream settings via emails sent to publicly available school e-mail addresses (typically administrative or headteachers). Researcher and educational psychologist participants for the Delphi survey were identified through from publicly available sources (e.g., author details on journal articles or university staff lists) and contacted via publicly available e-mail addresses. Participants were encouraged to forward the survey to colleagues knowledgeable in school- based measurement of mental health, well-being, and SEN, or other educational psychologists. A total of 1,438 e-mail addresses were contact (n = 381 special school e-mail addresses, n = 657 alternative provision/pupil referral unit, n = 309 educational psychologists and n = 91 researchers).

Ethics and consent

Ethics approval for this study was granted by the University College London Research Ethics Committee (project 26477/002). For the focus groups and interviews, the consent form was hosted on Microsoft Forms, the link to which was emailed along with the participant information sheet and privacy notice, to be completed ahead of the sessions. For the Delphi survey rounds, participant information, privacy notices and the consent form were included on the first page of the web-based survey form, which was hosted on Qualtrics (Qualtrics International Inc.). Names and identifying information of the participants were not associated with their responses. E-mail addresses were collected for the purpose of inviting participants to complete the second survey round, and for participants who indicated an interest in attending the final workshop.

Phase 1: focus groups and Delphi survey development

Participants

Design Participants were recruited from three categories: non- mainstream education staff, researchers in the field of SEN and The focus group and interview schedule, which can be found in supplementary materials, was semi-structured and questions Frontiers in Education 03 frontiersin.org Figure 1 Diagram showing stages of Delphi study and participant numbers, *other participants included counselling psychologist (n = 1), independent education and mental health consultant (n = 1), occupational therapist (n = 1), psychotherapeutic counsellor (n = 1) and SEND education consultant (n = 1).

were developed by all authors. Focus groups and interviews took place online on Microsoft Teams and were facilitated by author 1, lasting 30–70 min.

themes and subthemes. Template analysis is a 6-step process and was carried out on NVivo:

• Data familiarisation, where the researcher becomes familiar

with the data to be analysed (this may be carried out on a sub-set of the overall dataset).

• Preliminary coding, whereby the researcher, as in thematic

analysis, identifies key themes.

• Organisation of themes.
• Generation of an initial coding template. As in Howell et al.

(2022) this was guided by findings from a previous stage of this research (i.e., findings from the scoping review as well as prior researcher knowledge and familiarisation with the

Analysis A style of thematic analysis called template analysis was carried out, following the approach outlined in Brooks et al. (2015) and applied by Howell et al. (2022) to analyse focus groups for a Delphi study (Brooks et al., 2015; Howell et al., 2022). This method was chosen as the findings had the specific purpose of informing the creation of the Delphi survey, necessitating having a clear coding framework and hierarchy of Frontiers in Education 04 frontiersin.org topic). The coding template was developed by author 1 and reviewed by authors 2 and 4.

• Applying the initial coding template to further data, with modifications made as needed.
• The complete coding template is settled on and applied to the full data set (Brooks et al., 2015).

school-based data collection and measurement of mental health and well-being, on a 7-point Likert scale of importance. Sections of questions were presented in a random order to reduce bias. Scores of 5–7 were considered “important” items and scores of 1–3 as “unimportant”. The survey included an open-text box at the end of each section for participants to recommend something that was not covered by the survey. E-mail addresses were used to ensure there were no duplicate responses from participants. The results of the round 1 Delphi survey were used to generate the survey for round 2. Only participants who completed 100% of the survey were included in the analysis. Due to an unexpected level of importance ratings, thresholds were raised from ≥70% of participants rating ‘important’ (5–7), as outlined in the protocol, to ≥80%. The 80% cut-off was rounded to the nearest percentage. Changes made to the study protocol are discussed in more detail below.

Generation of Delphi survey items Issues for inclusion in the Delphi survey were identified through focus groups and interviews, in addition to a scoping review and qualitative work with young people, as previously mentioned. The survey-development method was based on a previous Delphi study (Fischer et al., 2013), and the full survey can be found in supplementary materials:

• Within the qualitative data, key concepts generated from

the discussion were extracted and grouped into categories. Additionally, relevant concepts identified in the scoping review were sorted into overall key themes.

• Key concepts were written as individual items, to create a

provisional list of items for the Delphi survey. Each item related to only one idea and were worded as a practical factor relating to an improvement that can be made in the measurement of mental health and well-being in school

• A draft survey was then created by compiling this list of

statements, using a 7-point Likert response scale of importance from 1 (not important at all) to 7 (very important).

• The draft survey statements were refined with input from

the #BeeWell Research Advisory Group Advisory group, which is an expert panel with members drawn from University College London and the University of Manchester. Additionally, colleagues at Anna Freud (including a former teacher and headteacher) reviewed the survey draft to ensure clarity of statements and that there is no overlap between statements.

• The survey was then programmed on Qualtrics, using a

‘form field’ question which would enable the round 1 and 2 surveys to be linked, for participants to be able to view their responses from the first survey.

• The survey was then piloted on Qualtrics by eight

individuals; two colleagues from the #BeeWell Programme, three from Anna Freud, a colleague from University College London and two teachers from an alternative provision setting.

Survey round 2 Respondents who completed 100% of the round 1 survey were invited to complete round 2 in June 2025. In the round 2 survey, participants received feedback on the round 1 scores of all aggregated responses (the mean scores from all respondents), alongside information about how they individually rated the statements. Participants were able to re-rate the level of importance of the statements considering this feedback. Again, due to a high-level of endorsement for many items, the threshold was higher for this round which was deemed necessary to be able to reduce the number of survey items for discussion in the final workshop. Statements which achieved ≥75% participants rating as “important” (scores of 6 or 7) were included in the list of priorities to be discussed in the final workshop.

Phase 3: final consensus workshop

A final online consensus workshop was held in October 2025 to discuss and reflect on the findings and was used to establish a final shortened list of the top priorities. Participants (n = 10) were recruited from those who completed both survey rounds and indicated an interest in attending this workshop. The workshop was online using Microsoft Teams and was facilitated by two of the authors MJ and TL.

The workshop used nominal group technique (NGT), which uses a structured approach to discussion and has been used alongside the Delphi method in other studies (Mousa et al., 2022; Rogers et al., 2025). A week before the workshop, participants received the list of items to be discussed in the workshop and were asked to consider what their top 3 would be and why. During the workshop in two ‘break-out rooms’, the facilitators prompted each participant to briefly talk about their ideas for their chosen top 3 priorities. After all participants were able to share their ideas, an open discussion was initiated. Participants were then returned to the main meeting, where they completed a final voting. The final voting was hosted on an online platform OpinionX (https://www.opinionx.co/). Participants were allocated fifteen points and asked to privately assign points to their top 5 items from the list, ranking them from most important (5 points)

Phase 2: Delphi survey rounds

Survey round 1 A 2-round online Delphi survey was conducted in Spring 2025. Participants received individual emails outlining the study purpose and consent process, with an anonymous Qualtrics link that could be shared with colleagues. Participants were asked for demographic data (age, gender, ethnicity, job role, and length of time in their field). They were then asked to rate items on Frontiers in Education 05 frontiersin.org to least important (1 point). The top items were those scoring the highest percentage of points from participants.

’survey administration’, ’survey content’, ‘involvement of staff’ and ’survey data and feedback’. These themes formed the structure for the round 1 Delphi survey. The full summary of themes and sub-themes can be found in Table 1.

Deviations from protocol

Round 1

The following deviations from the study protocol and the limitations that these may incur are acknowledged:

The first survey round included a total of 75 items across the five areas identified in the focus groups: 1) Planning and implementation (18 items); 2) Survey administration (22 items); 3) Content of surveys (10 items); 4) Involvement of staff (5 items) and 5) Survey data and feedback (20 items). After removing one duplicate response and incomplete (<100%) responses, the total number of survey responses was 113. Table 2 shows a breakdown of participant characteristics collected in the survey, for included survey responses.

• The decision to reduce the Likert scale from nine to seven

response points was guided by psychometric evidence concerning the relationship between scale length, measurement precision, and respondent burden. Four to seven response categories have been identified as the optimal range, with gains in psychometric performance tending to be negligible beyond seven points (Krosnick, 2018; Lozano et al., 2008), and another study reduced Likert scale response options from 9 to 7 points due to participants finding 9-points too complex (Lin et al., 2008).

• Due to an unexpectedly high endorsement of many of the

items, thresholds for item inclusion from the analysis of the round 1 survey were raised from ≥70% rating ‘important’ (scores of 5, 6 or 7) to ≥80%. Under the protocol thresholds, 52 of the original 75 items would be retained, and with changes to the protocol, 38 items were retained. These can be seen in Supplementary Appendix A. In the round 2 survey, 100% of items would have been retained under protocol thresholds ≥70% rating ‘important’ (scores of 5, 6 or 7). Only 1 item reached under 80% rating as 5–7. Therefore, the decision was made to raise the inclusion criteria to ≥75% participants rating as “important” (scores of 6 or 7), in order for the final workshop to have a manageable number of items to discuss. Other Delphi studies have also found high rates of endorsement leading to a lack of item reduction (Hepworth and Rowe, 2018). post-hoc changes have been utilised in other Delphi studies to identify strongest areas of consensus (Powell et al., 2022; Qasem et al., 2026). However, there are limitations to changing the pre-specified consensus criteria.

• The protocol stated that participants who completed >50% of

the round 1 survey would be invited to complete the round 2 survey. However, due to the method of linking survey responses to show participants their round 1 results within the round 2 survey, it was not possible to display this for participants who had completed <100% of the survey. Due to the higher-than-expected response rate in round 1, it was decided that the response rate was sufficient to only invite participants who had completed the whole survey 1 (n = 113). Hence, the eighteen participants who completed >50% of the survey but <100%, were not invited to round 2.

A total of 38 items were carried forward into the round 2 survey. As cut-offs were rounded to the nearest percentage, 4 statements at 79.8% were included. The full table of results from rounds 1 and 2 can be found in Supplementary Appendix B.

A post-hoc RAND sensitivity analysis was conducted to test the robustness of consensus classifications across varying disagreement thresholds. Items were classified as having no consensus due to disagreement if >20%, >25%, >30%, >33%, and >40% (the most stringent threshold tested) of participants rated in both the lower (scores 1–2) and upper (score 6–7) regions simultaneously. All retained items achieved consensus (median ≥ 6) with no disagreement flagged, and this classification remained stable across all thresholds tested. Among excluded items, the majority were classified as No Consensus (Uncertain), indicating panellists were collectively ambivalent rather than polarised. Thirteen items met the RAND consensus criteria (median ≥ 6, Consensus: Appropriate) but were not retained for round 2; this discrepancy is discussed in the limitations. A table of results of this analysis can be found in Supplementary Appendix B.

Round 2

All available data was used in the analysis of the round 2 survey, with number of responses per item ranging from 79 to 82. Using the consensus thresholds set out in the protocol, 100% of items met these criteria [≥70% rating important (scores of 5–7)]. Raising consensus thresholds to ≥80% threshold (as used in R1), meant only one item fell below this. A post-hoc RAND sensitivity analysis confirmed that all 38 items met consensus criteria (median ≥ 6, Consensus: Appropriate), with classifications remaining stable across all disagreement thresholds tested (20%, 25%, 30%, 33%, and 40%), indicating robust consensus. The cut-off for the round 2 survey was therefore raised ≥75% of respondents rating the importance 6–7 to identify the items with the highest levels of agreement, and this is discussed in limitations. Using this threshold, a total of 18 items were taken forward to the final workshop; the results table can be found in Supplementary Appendix A.

Results

Focus groups

Five key themes and sub-themes were constructed based on analysis of the focus groups and interviews. Key themes were categorised in relation to the broad stages of implementing school-based surveys: ’survey planning and implementation’,

There was a large drop-off of 70% of educational psychologists between R1 (n = 30) and R2 (n = 9); by comparison, almost all non-mainstream school staff were retained (n = 62 to n = 59). A comparison was conducted to determine whether there were

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Table 1 Themes and subthemes from analysis of focus group data.

(Continued) Frontiers in Education 07 frontiersin.org Table 1 Continued

• Ethical and data protection considerations

substantial differences between EPs and non-mainstream education staff in the mean scores and percentage of respondents rating the importance scores of 6–7. Education staff rated the importance of most items higher that EPs; however, almost all items that were retained for the workshop fell below a difference of 11.11% rating the importance 6–7. Three items were retained which had a difference of −13.3% to −18.7%, and one item was retained which had a difference of −26.31%. A table comparing responses between EPs and education staff can be found in supplementary materials.

This theme encompasses safeguarding pupils’ rights, privacy, and autonomy in the survey process and includes the following statements: (1) Ensuring confidentiality (i.e., identifiable information is

not disclosed to unauthorised parties) of pupils’ data (2) Ensuring young people understand what they are

consenting to

• Communication, understanding, and support for pupils

This theme covers helping young people comprehend the survey and express their genuine views and includes the following statements: (1) School staff to explain questions to pupils who are

Workshop

unclear of the meaning (2) Teachers to not affect young people’s responses

Ten participants attended the final workshop to discuss the results of the Delphi survey rounds and agree on a final list of key priorities. Participants were from non-mainstream schools (n = 3), research organisations (n = 2), and educational psychologists (n = 5). Eleven statements were ranked as the top items out of the 18 items from the round 2 survey. See Figure 2 for the breakdown of scores.

to question (3) Explaining the purpose of surveys to pupils

• Institutional commitment and implementation

This theme focuses on the role of leadership and teachers in successfully running wellbeing surveys and includes the following statements:

The top items can be categorised into four overall themes: (1) School leadership commitment to enable successful implementation of wellbeing surveys (2) Teacher commitment for implementing wellbeing

• Survey design and accessibility

This theme was the most highly rated, and focuses on ensuring surveys are inclusive, understandable, and relevant to all young people, with the following statements:

• The accessibility of the language used in surveys
• Avoiding abstract or overly complex concepts
• Having a wide coverage of wellbeing domains in surveys (e.g., Relationships, mental health, life satisfaction)
• Offering specific surveys to young people that align with their special educational needs

surveys

Discussion

The aim of this mixed-methods Delphi study was to identify a list of stakeholder-agreed priorities for improving wellbeing measurement of young people with special educational needs in non-mainstream schools. Participants were staff in non-

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Table 2 Continued Table 2 Participant characteristics (N = 113).

mainstream education settings, educational psychologists and researchers, based in the United Kingdom. Overall, many statements were highly rated in the survey rounds, demonstrating that participants found many of the issues to be important considerations. However, the final workshop selected a list of eleven key priorities for improvement, which can be categorised into four themes: survey design and accessibility; ethical and data protection considerations; communication, understanding, and support for pupils; and institutional commitment and implementation.

Survey design and accessibility

A theme of the key priorities for improving wellbeing measurement related to the design and accessibility of wellbeing surveys. Research organisations (including universities and charities) need to ensure that there are available mental health and wellbeing surveys which are validated for use with young people with SEN in non-mainstream settings. Whilst this is improving and there are some recently developed mental health and wellbeing measures, such as the WellSEQ, ID-SWEMWS, ID-Kidscreen10 and NPC Well-being Measure (Boström and Eriksson, 2015; Boström et al., 2018; Davison et al., 2023; Sabri et al., 2015), there is still more that can be done in this area.

Different versions or lengths of surveys need to be available which are accessible to a range of special educational needs and disabilities; this has been done in other surveys for use in non- mainstream education settings (Ng et al., 2022; Sabri et al., 2015). Within the focus groups, use of pictures was discussed as one way to improve accessibility, which has been found in other studies (Davison et al., 2023; Ikeda et al., 2016), but this topic did not score as highly in the Delphi survey rounds.

Ethical and data protection considerations

A theme surrounding ethical and data protection considerations was identified in the final list of priorities. Previous qualitative research has found that young people have concerns about the anonymity of their wellbeing survey data and the possibility of their school seeing their responses (Demkowicz et al., 2020). This is especially a consideration where teachers provide additional assistance to young people

(Continued) Frontiers in Education 09 frontiersin.org Figure 2 Results from final workshop voting.

completing mental health and wellbeing surveys, such as explaining the meaning of questions and responses, which makes anonymity and confidentiality more challenging (Davison et al., 2022; Ng et al., 2022; Sabri et al., 2015).

focus groups, there was disagreement between researchers and teachers about who should administer surveys with young people. Teachers felt that someone who knew the young person might be better placed to support them (e.g., by explaining the questions in a way that the individual young person would understand), while researchers emphasised the benefit of surveys being administered by external individuals who understood research procedures. Ensuring that teachers can implement surveys without altering the wording of questions to such an extent that it changes the validity of questionnaires, may mean that training or guidance for teachers on how to support young people would be beneficial.

The consent process is also an important factor. In the focus groups, special school staff were concerned about whether their pupils had a full understanding of what they are consenting to. Schools need to ensure that young people understand consent processes as far as possible, along with explaining who will have access to wellbeing survey data and what it will be used for.

Communication, understanding, and support for pupils

Institutional commitment and implementation

In the survey rounds and final workshop, items related to school staff explaining questions to pupils and explaining the purpose of surveys to pupils scored highly. However, within the

The final key theme of the final priority list relates to institutional commitment and implementation. Within focus

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groups, there was discussion about the amount of school staff time needed for administering surveys, particularly in supporting young people to complete them. Implementing mental health and wellbeing surveys may place a burden on staff capacity, at a time when non-mainstream settings are facing increasing costs and funding challenges (Long et al., 2023). Additionally, managing survey data, including interpretation, providing feedback to school governors, teachers, parents/carers and young people, and implementing any findings within the school, all place demands on school staff time. Non-mainstream settings therefore have a vital role to play in the success of wellbeing survey data collection through ensuring school leadership and teacher commitment to carrying out and prioritising wellbeing surveys, ensuring there is dedicated time (e.g., within the curriculum or timetable) when wellbeing surveys can be completed and clear communication about data use and confidentiality to parents/carers and pupils. A Delphi study on priorities and core components for school-based identification of mental health difficulties in mainstream primary schools similarly highlighted the importance of school culture and embedding identification within a whole school approach, for successful implementation of mental health identification programmes (Soneson et al., 2022).

psychologists between survey rounds 1 and 2, with only nine respondents in round 2. A comparison of results between EPs and education staff was conducted and overall results were similar; but one item ‘having a wide coverage of wellbeing domains in surveys (e.g., relationships, mental health, life satisfaction)’ that was rated less important by EPs, was included within the final priority list. Despite the under-representation of EPs in round 2, EPs were over-represented as participants in the final workshop (50%), which means that the views of EPs are still incorporated within the key priorities.

Another limitation of this study was that due to participant availability, the number of participants in the final workshop was small (n = 10), which may limit the representativeness of the final priorities list. However, the items selected from the workshop were among the highest scoring in the round 2 survey, which can be seen in the results table (Supplementary Appendix A).

A deviation from the pre-specified protocol was required due to unexpectedly high levels of item endorsement, which is acknowledged as a limitation of this study. High levels of agreement is a problem of Delphi studies using Likert scales (Hepworth and Rowe, 2018), and ranking of items was considered not feasible due to the large number of items in R1, and the greater difficulty for participants in ranking Delphi items (Del Grande and Kaczorowski, 2023). Without changes to the protocol, a large number of items would have been retained between survey rounds which would have limited the overall usefulness and manageability of the study’s recommendations. Therefore, the pragmatic decision was made to raise consensus thresholds to determine the most important items for improving wellbeing measurement in non-mainstream schools. The results based on protocol consensus thresholds and amended thresholds can be found in Supplementary Appendix A. A RAND sensitivity analysis was conducted to determine whether additional items met consensus criteria; however, for R1, there were 13 items met the RAND consensus criteria that were not retained for R2. For transparency, these are flagged in Supplementary Appendix B; their exclusion from R2 is a limitation of this study.

The Children’s Society reported in 2023 that 60% of surveyed teachers agreed that children’s wellbeing should be measured in school annually, which shows a recognition that teachers have of the importance of wellbeing measurement (The Children’s Society, 2023). Schools can use wellbeing survey data to make improvements, such as justifying funding requests to local authorities, or to clarify elements of a school development plan. Equally, external research organisations need to work with schools to establish frequency or timing of surveys and could improve school engagement in wellbeing surveys by providing incentives, which has been done in a mainstream primary school health and wellbeing survey in Wales (SHRN, 2024b, 2024a).

Strengths and limitations

A strength of this Delphi study was that it took a mixed- methods approach, with qualitative focus groups in round 1, which helped to generate a deeper understanding of some of the challenges of implementing wellbeing surveys in non- mainstream schools. Another strength was the survey response rate (82 participants completed both rounds), and the range of stakeholders that were included: non-mainstream school staff who have experience with the practicalities of implementing mental health and wellbeing surveys for young people with SEN, along with researchers working in the field of mental health and SEN and educational psychologists. This study incorporated the perspectives of young people with SEN who were interviewed as part of an associated study Jeffery et al. (2026), although the final list of priorities reflects only the views of adult participants.

Recommendations

Recommendations from this Delphi study are:

• Accessibility: Ensuring the accessibility of the language and

content used in wellbeing surveys for use in non- mainstream settings, such as avoiding abstract or overly complex concepts, and offering types of surveys that align with young people’s special educational needs.

• Confidentiality: Considering the need for confidentiality

and privacy of young people’s survey responses, including ensuring that young people understand what confidentiality entails and who might have access to their data.

• Communication: Ensuring young people understand what

they are consenting to, the purpose of collecting wellbeing data and the meaning of survey questions.

A limitation of this study is that the proportion of responses from researchers was much lower (14%); researchers may have a different perspective on data collection issues than school staff. Similarly, there was a much greater drop-off of educational

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• Fidelity: Ensuring that care is taken to not alter the

meaning of survey questions when providing additional explanation or support, as this could influence young people’s responses.

• Commitment: Ensuring school leadership and teacher

commitment to implementing surveys.

Conceptualization, Investigation, Methodology, Supervision, Writing – review & editing. CP: Conceptualization, Supervision, Writing – review & editing. JD: Conceptualization, Supervision, Writing – review & editing.

Funding

The author(s) declared that financial support was received for this work and/or its publication. The #BeeWell Programme is funded by several organisations, see https://beewellprogramme.org/about/ funders/CP is (in part) supported by the National Institute for Health and Care Research (NIHR) Children and Families Policy Research Unit (PR-PRU-206114). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Conclusion

Wellbeing survey data can be a valuable resource for school improvement, advocacy, and securing funding and for ensuring that young people in non-mainstream schools are represented in national statistics about young people’s mental health and wellbeing. This Delphi study established a set of eleven key priority recommendations for improving school-based measurement of mental health and well-being, which have been agreed upon by stakeholders in special school and alternative provision settings, educational psychologists and researchers in mental health and SEN. The key priorities can inform researchers implementing school-based well-being surveys, to enable them to improve their engagement in special schools and alternative provision settings, ensure surveys are accessible, and increase survey response rates of young people with SEN.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

Data availability statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

The datasets presented in this article are not readily available due to ethical and privacy restrictions, as participants did not consent to their data being shared publicly or with third parties. Anonymised data may be available from the corresponding author on reasonable request, subject to approval from the UCL Research Ethics Committee and a formal data sharing agreement. Requests to access the datasets should be directed to mairi.jeffery.16@ucl.ac.uk.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher’s note

Ethics statement

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

The studies involving humans were approved by University College London Research Ethics Committee. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

Supplementary material

MJ: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Writing – original draft, Writing – review & editing. SL:

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/feduc.2026. 1827451/full#supplementary-material

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