Guidance

School-aged years high impact area 4: Reducing vulnerabilities and improving life chances

Updated 19 May 2021

Applies to England

Health and life chances of children and young people can be impacted by household vulnerability and adversity. No child left behind: a public health informed approach to improving outcomes for vulnerable children looks at the factors for individual children, their families and the communities in which they live that make it more or less likely that vulnerability and adversity in childhood has a lasting impact on their lives. It advocates a holistic, multi-agency approach to addressing inequality and the broader causes of vulnerability that might otherwise be overlooked.

The school years are an important time for children and young people. It is a time of rapid growth: physically, emotionally and socially, and it lays the foundation for the future. Health and wellbeing is crucial to a child or young person’s learning (Public Health England (PHE), 2014). School nurses have a vital role in supporting children and young people to access education by working closely with families, school and other agencies. This includes 3 key stages:

• school readiness and starting school
• transition to secondary school
• leaving school and preparation to adulthood

The Early years foundation stage (2017) defines school readiness as: “the broad range of knowledge and skills that provide the right foundation for good future progress through school and life”.

Health professionals have a vital role in supporting the child and family to ensure school readiness and transition into school is seamless. School nurses can work with health visitors to support families to ensure children are prepared for school and are able to refer or signpost to other support if a child has any specific difficulties, for example, speech, language and communication.

Recent evidence sets out a case for language as a primary indicator of child well-being. Early language impacts on children’s social, emotional and learning outcomes. Almost all children learn to communicate through language, yet there are strong and persistent differences in their ability to do so, with a child’s socio-economic background an important factor. By age 3 there is already a 17-month income-related language gap, with children from disadvantaged groups twice as likely to experience language delay. Five year olds with poor vocabulary are 3 times more likely to have mental health problems as adults. Two-thirds of 7 to 14 year olds with serious behavioural problems have language impairments.

While the reasons behind the word gap in the early years are complex, exposure to a breadth and depth of vocabulary and a learning-rich home environment, supported by high-quality early years provision, are essential (Education Endowment Foundation, 2017 and Early Intervention Foundation, 2017).

Preparing for school entry can be a daunting time for some parents, carers and children. A proportion of children starting school do not have the necessary skills, including speech, language and communication skills, to access their education, which can affect their wellbeing, capacity to learn, and ability to reach their full potential (Early years foundation stage profile, 2018).

Supporting the health and wellbeing of children at school entry includes social and emotional preparation. This will help the child to build resilience, which will be crucial for preparing for other transitions, for example, primary to secondary school. Where a child has a special educational need or disability, the school nurse may work with the parents or carers, health visitor and other relevant members of the multi-disciplinary team, to positively plan to address the health care needs of the child and/or identify any additional support they might require to enable them to achieve their full potential.

Regular school attendance throughout the school-aged years has been shown to result in better health, education and socio-economic outcomes. To get the most out of school it is important that children and young people are supported to attend every day.

Good health and emotional wellbeing are associated with improved attendance and attainment at school, which in turn lead to improved employment opportunities. In addition, children who thrive at school are better placed to act on information about good health. Poor health in adolescence can last a lifetime. However, appropriate support can positively affect them as individuals, and society. Early preventative measures, including public health, can make a huge difference.

Encouraging children and young people to feel confident in accessing health services is key to engaging and involving them in decisions about their health and wellbeing and care. You’re Welcome is a set of quality criteria for young people friendly health services. It provides a systematic framework to help commissioners and service providers to improve the suitability, accessibility, quality and safety of health services for young people.

For young people who are at a life stage where they are increasing their independence and becoming less reliant on parents and carers, having health literacy skills will help them to build knowledge and skills about their health and wellbeing, and provides them with skills for life. Health literacy also empowers them to make decisions about their own health and to access and use health services appropriately.

Vulnerable children and young people

Identifying vulnerable children and young people who are at risk of health inequalities can be challenging. They are less likely to be well engaged with services and they are unlikely to be captured in national statistics, monitoring data or other forms of data, making them vulnerable because they are not recognised as a member of one group or another. Children and young people who are vulnerable are at risk of poorer outcomes.

Some children are less likely to be engaged with education and other services and are unlikely to be visible to health professionals – for example children in care who are more likely to experience moves of home and school, young carers, the homeless, travelling families, asylum seekers and refugees and children from military families. There are groups of children and young people with multiple difficulties and complex needs which significantly impede their access to, engagement with, and outcomes from, services.

Children and young people who are vulnerable to adversity, abuse or neglect are not always willing to access conventional services and may face additional challenges that impact negatively on their lives. Their chances of success are disproportionately low unless they can access appropriate early intervention and support.

The main facts include:

• rates of self-harm are particularly high amongst groups of vulnerable young people, such as those in the youth justice system
• asylum seekers are a group potentially made vulnerable by their living circumstances
• children who are under the care of the local authority face a number of inequalities that may have consequences for their health
• lesbian, gay, bisexual or transgender young people are more likely to undertake behaviours, such as smoking and recreational drug use
• children from minority ethnic backgrounds are also more likely to live in persistent poverty, which in turn leads to worse outcomes
• persistent absence from school by age 14 and slower than expected academic progress between ages 11 to 14 are risk factors associated with pregnancy before the age of 18

School nursing teams working with stakeholders, including social care and education, have a crucial role in identifying vulnerable children and young people. They can work with parents to improve health outcomes, particularly in terms of emotional health and wellbeing.

Consideration should be given to all vulnerable groups of children and young people including young carers, unaccompanied asylum seekers, travelling and homeless families and children from military families.

Young carers

Young carers include children and young people under 18 who provide regular and ongoing care and emotional support to a family member who is physically or mentally ill, disabled or misuses substances. A young carer becomes vulnerable when the level of care-giving and responsibility to the person in need of care becomes excessive or inappropriate for that child, risking impacting on his or her emotional or physical wellbeing or educational achievement and life chances.

Data compiled from the 2011 census shows almost 200,000 children and young people aged 18 and under in England and Wales were caring for parents, siblings and others. The Carers’ Trust has estimated that this may represent as many as 1 in 12 secondary school-aged pupils.

Many young carers may remain hidden due to the fear of being identified, not realising they are a young carer or through professionals not acknowledging their role and therefore failing to identify and support them.

Young carers may undertake practical tasks in the home, provide physical care, personal care and emotional support. Being a young carer may affect a young person’s health, social life and self-confidence. Many young carers struggle to juggle their education and caring, which can cause pressure and stress.

Many young carers miss school due to caring duties, and as many as two-thirds (68%) have reported being bullied at school. Young carers are 1.5 times more likely to have a special educational need or disability (2013). Over a third of young carers (38%) reported having a mental health problem.

Under the Care Act 2014, local authorities are required to consider the needs of young carers if, during the assessment of an adult with care needs, or of an adult carer, it appears that a child is providing, or intends to provide, care. They should ensure that adults’ and children’s services work together to offer young carers and their families an effective service and are able to respond to the needs of a young carer, the person cared for, and others in the family.

They are expected to take ‘reasonable steps’ to identify children in their area who are young carers. The local authority must carry out an assessment if it appears that the young carer may have needs for support and, if so, should identify what those needs are.

Identifying young carers is not always easy. Research has found that a significant proportion of young carers do not disclose their caring responsibilities to their school, and that often young people (and their families) do not recognise themselves as ‘young carers’ – Children and Families Act 2014.

School nursing teams are visible professionals that are well placed within schools and wider community settings to support young carers and play an important role in identifying young carers in the school aged population, both in and out of education. School nurses identify and support families where there may be a child or young person caring or who could become a carer. As the number of adults with long term conditions and mental health issues is increasing, children, young people and families are taking on more caring responsibilities.

Unaccompanied asylum seekers

Unaccompanied asylum seeking and refugee children can be some of the most vulnerable children in our society. They are alone and in an unfamiliar country, at the end of what could have been a long, perilous and traumatic journey. Some of these children may have experienced exploitation or persecution in their home country or on their journey to the UK. Some may have been trafficked, and many more are at risk of being trafficked, being exploited in other ways, or going missing once they arrive in the UK.

An unaccompanied asylum-seeking child is defined as an individual who is:

• under 18 years of age when the claim is submitted
• applying for asylum in their own right
• separated from both parents and is not being cared for by an adult who in law or by custom has responsibility to do so

The rise in the number of unaccompanied asylum seeking and refugee children in the UK in recent years, and a complex, rapidly changing international situation, have highlighted challenges specific to this group of children.

Between 2012 and 2016 there was a rise in unaccompanied asylum-seeking minors of nearly a 100%. In March 2017, 78% of unaccompanied asylum seeking children were aged 16 years of age and over, with 22% aged under 16 years. The majority of asylum-seeking children are young men aged 16 to 17. In 2016, unaccompanied asylum-seeking minors represented 6% of the total looked after child population in England. Of the 72,670 children being looked after by local authorities as of 31 March 2017, 4,560 were unaccompanied asylum-seeking children. This was a 6% increase in looked after unaccompanied asylum-seeking children from the previous year.

An unaccompanied asylum seeking child is entitled to the same local authority support as any other children in care, and our ambitions for these children are the same, to have a safe and stable placement, to receive the care that they need to thrive, and the support they need to fulfil their educational and other outcomes.

Homelessness

Many families with children aged from 0 to 19 are hidden from homelessness statistics, with young people and families that are living in temporary accommodation not always captured in national and local statistics. Becoming homeless can be a devastating emotional experience taking children and young people outside of familiar environments, from their home, possibly moving school and away from their friends.

Statistics have also shown that the number of couples with dependent children accepted as owed a main homelessness duty has risen from a low of 7,410 households in 2009 to 2010 to 11,200 households in 2017 to 2018, up by 51%. This number was higher in 2016 to 2017, at 12,760 households. The number of lone parents with dependent children owed a main homelessness duty has risen from a low in 2009 to 2010 of 19,440 households to 28,910 households in 2017 to 2018, up by 49%. This number was also higher in 2016 to 2017, at 29,940 households.

Children living in overcrowded conditions can miss out on the space and privacy they need to play, do homework and sleep properly. Without room to grow, many children can become sick or fall behind at school. Many children living in temporary accommodation face long, exhausting journeys to school, and are so tired they can’t concentrate in class. Moving into and between temporary accommodation can also cause severe disruption to school.

The role of school nurses

School nurses and their teams are in a unique position to build trusting and enduring professional relationships with children and young people throughout their time in education to enable them to become confident and healthy adults. It is essential that young people in secondary education or college can have access to safe, confidential and accessible services when they need health support and advice.

Working with parents and families and partner agencies, school nurses identify the most appropriate level of support and intervention for individual and population needs. Although school nurses provide leadership, they will need to work with partners to deliver a comprehensive programme of evidence-based interventions.

School nurses and their teams provide a crucial interface between children, young people and families, communities and schools having defined skills to support holistic assessment of the health and wellbeing needs of children and young people. They provide health promotion, prevention and early intervention approaches to support individual, community and population health needs.

Using their skills with the wider health and care system and their trusted relationships with other partners helps to support and enable place based and whole school action to address health inequalities. Their involvement in delivering evidence-based interventions including HPV and other immunisation programmes in the teenage years, also provide opportunities for health promotion, Making Every Contact Count to support behaviour change.

School nurses deliver care in the most appropriate setting for the local community, using the principles of the You’re Welcome Quality Criteria. This includes using technology to improve access and support for children, young people and families.

Healthy Child Programme

The Healthy Child Programme offers every family a programme of screening tests, immunisations, developmental reviews, information and guidance to support parenting and healthy choices – all services that children and families need to receive if they are to achieve their optimum health and wellbeing.

Universal

The Healthy Child Programme is universal in reach. It sets out a range of public health support in local places to build healthy communities and to reduce inequalities. It also includes a schedule of interventions, which range from services for all through extra help to intensive support.

Personalised

The Healthy Child Programme is personalised in response. All services and interventions need to be personalised to respond to families’ needs across time. For many families this will be met by the universal offer. More targeted, intensive or specialised support and evidence-based interventions should be provided early to meet ‘predicted, assessed and expressed need’ to improve outcomes.

Improving Health and Wellbeing

The high impact areas will focus on interventions at the following levels and will use a place-based approach:

• individual and family
• community
• population

The place-based approach offers opportunities to help meet the challenges public health and the health and social care system face. This impacts on the whole community and aims to address issues that exist at the community level, such as poor housing, social isolation, poor or fragmented services and duplication or gaps in service provision. School nurses, as leaders in public health and the Healthy Child Programme (5 to 19), are well placed to support families and communities to engage in this approach. They are essential to the leadership and delivery of integrated services for individuals, communities and population to provide Right Care that maximises place-based systems of care.

Individual and family

School nurses can work together with families, schools and partner agencies to ensure:

• early identification of vulnerability that may impact on the child or young person’s education or school attendance, for example being a young carer, being a child in care and experiencing more frequent moves of home and school, experiencing domestic or emotional abuse or parental substance misuse, teenage pregnancy, poor mental health of parent and/or child/young person or bullying
• support for children with complex and additional health needs, including diabetes, asthma, bladder or bowel issues (continence problems) or disability, to ensure that appropriate provision is put in place and that school staff have the knowledge and skills to care for them
• readiness for other transitions, for example infant to junior; to secondary; to college; to work; to university
• early support if the child or young person requires additional help to access learning or needs a referral to other services
• support for children and young people who are part of the youth justice system
• support for young parents to continue or return to education
• children and young people are educated about health and prevention of illness

School nurses can also:

• support children, young people and families to navigate the health and social care services to ensure timely access and support
• offer support to children and young people at school with long-term health conditions to help minimise any negative effects of their health needs on their school life
• support children and young people who may require an Education, Health and Care plan needs assessment in order for the local authority to decide whether it is necessary for it to make provision in accordance with an Education, Health and Care plan (SEND Code of Practice 0 to 25 Years)
• collaborate to support children and young people where there are identified health needs, or where they are in the child protection system, providing therapeutic public health interventions for the child and family and referring children and families to specialist medical support where appropriate
• provide support for vulnerable groups, including children in care, young carers, children with disabilities, young people not in education, employment or training and young offenders
• contribute to improving school or college attendance, offering additional support where absences may be due to hospitalisation, or frequent appointments at a hospital or GP surgery

Community

School nurses can:

• act as an effective conduit between education, health and social care, supporting work on health issues in school and making health services more accessible to children, young people, parents and carers, working with other staff to identify vulnerable children and young people and supporting access to services
• work with schools to have a whole-school approach to health and to become health promoting environments, promoting a healthy food environment and promoting physical activity, in relation to obesity and oral health
• advise schools about infection prevention and control and handwashing to prevent the spread of infections
• advise schools about medicines management and the appropriate administration of medicines during the school day, for example inhaler technique
• support the delivery of personal, social and health and economic education (PSHEE), promoting resilience and promoting good emotional wellbeing
• promote resilience and good emotional wellbeing and support schools in the implementation of statutory relationships, sex education and health
• ensure all pupils are aware of and know how to access local services – as required under relationships and sex education and health education guidance
• provide the first point of contact for children, young people and parents or carers needing health advice or information, including assessment of individual needs, support and referral on to other services as necessary

School nurses can also:

• liaise with local colleges and employers to ensure that children and young people with special educational needs or disabilities will have their needs met
• collaborate with partners in education, health and social care providing holistic care for children and young people, supporting them to reach their maximum educational potential

Population

School nurses can:

• assess, protect and promote the health and wellbeing of school aged children and young people and offer advice, care and treatment to individuals and groups of children, young people and the adults who care for them
• support the work of the National Child Measurement Programme (NCMP) and the national dental epidemiology programme
• support the work of professional special interest or development or planning groups, for example local authority young carers services
• influence, initiate and support activities for promoting health across the school and community, contributing to the statutory Relationships, Sex and Health Education (RSHE) curriculum

School nurses influence, and can take the lead in, developing effective partnerships and act as advocates to deliver change to support improvements in the health and wellbeing of children and families. They can work in partnership with other professionals and stakeholders, ensuring care and support helps to keep children and young people healthy and safe within their community.

Using evidence to support delivery

A place-based or community-centred approach aims to develop local solutions that draw on all the assets and resources of an area, integrating services and building resilience in communities so that people can take control of their health and wellbeing, and have more influence on the factors that underpin good health.

The All Our Health framework brings together resources and evidence that will help to support evidence based practice and service delivery, Making Every Contact Count and building on the specialist public health skills of school nurses.

Most health and care professionals focus on interventions which tend to be delivered on an individual basis, however health visitors and school nurses focus on individuals, families and communities’ approaches. It is critical that all professionals consider the importance of population health as an approach that aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population.

Social prescribing complements such approaches enabling public health nurses and other health and care professionals to refer people to a range of local, non-clinical services. School nurses recognise that children and young people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address individuals needs in a holistic way, taking greater control of their own health.

Measures of success or outcome

High quality data, analysis tools and resources are available for all public health professionals to identify the health of the local population. This contributes to the decision-making process for the commissioning of services and plans to improve people’s health and reduce inequalities in their area. Outcome measures could include Public Health Outcomes Framework and NHS Outcomes Framework,child and maternal health profile indicators, measures of access and service experience.

School nurses and wider stakeholders need to demonstrate impact and evidence of improved outcomes. This can be achieved by using the local measures.

Access

Measures include:

• number of children participating in the NCMP
• number of children participating in the national dental epidemiology programme for England’s biennial survey
• number of children identified with long term conditions, complex needs and disability or vulnerabilities offered support
• number of children accessing a school-based, supervised tooth brushing programmes and fluoride varnish programmes
• number of schools with drop-in sessions for young people

Effective delivery

Measures include:

• early help to identify language delay, social and behavioural issues, and referral pathways in place to specialist services where appropriate
• early identification and referral for further oral health advice or treatment
• evidence of implementation of locally devised pathways
• number of schools with plans and policies in place for managing medicine use
• number of children in care

Improving services for children and young people is part of the NHS Long Term Plan. The Child Digital Strategy includes a range of work which underpins these plans including maternity and community data sets and implementation e-Redbook (digital personal child health record). A major contribution to achieving these ambitions and strategies is the modernisation of the Healthy Child Programme.

Measuring impact

Measures include:

• referral to other services
• reception: prevalence of obesity (including severe obesity) collected via NCMP and available in
  • Annual Report on the Child Measurement Programme
  • Public Health Outcomes Framework
  • Early Years Profile
• year 6: prevalence of obesity (including severe obesity) collected via NCMP and available in the:
  • annual report
  • Public Health Outcomes Framework
  • Young Peoples Profiles
• children killed and seriously injured (KSI) on England’s roads, available in Child Health Profiles
• hospital admissions as a result of self-harm (10 to 14 years), available in the young people section of Child Health Profiles
• hospital admissions as a result of self-harm (10 to 24 years), available in Child Health Profiles
• number of persons aged 15 who are regular smokers (at least one cigarette per week), statistics on smoking from NHS Digital available in Public Health Outcomes Framework
• percentage of children achieving a good level of development at the end of reception year, published by Department for Education (DfE) and available in Public Health Outcomes Framework and in the Early Years Profiles
• percentage of children aged 5 years with one or more obviously decayed, missing (due to decay) or filled teeth, collected through the National Dental Epidemiology Programme for England and published in the Early Years Profiles and Public Health Outcomes Framework
• percentage of children aged 10 to 11 years with one or more obviously decayed, missing (due to decay) or filled teeth, collected through the National Dental Epidemiology Programme for England, and in the Young Peoples Profiles and Public Health Outcomes Framework
• rate of under 18 and under 16 conceptions

User experience

Measures include:

• feedback from school nurse service user questionnaire on satisfaction
• health and wellbeing feedback from children and young people
• parent or carers feel confident to send their children to school
• feedback on parent/carer experience of school nursing services
• You’re Welcome quality criteria
• NHS Friends and Family Test (FFT)

Other measures can be developed locally and could include measures such as local initiatives.

Connection with other areas

The high impact area documents have been developed to support delivery of the Healthy Child Programme and 5 to 19 agenda, and to highlight the link with a number of other interconnecting policy areas, for example childhood obesity, Troubled families, mental health, Drug strategy and immunisation, Social Mobility Programme. The importance of effective outcomes relies on strong partnership working between all partners in health (primary and secondary), local authority including education services, and voluntary sector services.

Best Start in Life has been identified as a priority as part of the PHE’s 5-year strategy, which runs from 2020 to 2025. Best start is a priority for government and as such is included in response to the Prevention Green Paper (Advancing our Health: prevention in the 2020s).

Improving services for children and young people is part of the NHS Long Term Plan. The Child Digital Strategy and Maternity Programme is currently developing and implementing infrastructure to improve access and timeliness of data with the aim to know where every child is and how well they are. This includes the development and implementation of a Digital Parent Child Health Record. This programme supports the ambitions and modernisation of the Healthy Child Programme.

Collaborative working

Approaches to improving outcomes through collaborative working include:

• the Public Health Outcomes Framework indicator reported and benchmarked by PHE and NHS England
• the NHS Outcomes Framework indicator 3.7ii – ‘Tooth extractions due to decay in children and admitted as inpatients to hospital, aged 10 years and under’
• information sharing agreements in place across all agencies
• integrated commissioning of services
• schools and children’s centres play a key role in supporting improved outcomes for children and families as part of the integrated planning, delivery, monitoring and reviewing approach
• partnerships can use information from Joint Strategic Needs Assessment (including Early Years Foundation Stage Profile data, health data, information about families, communities and the quality of local services and outcomes from integrated reviews) to identify and respond to agreed joint priorities
• collation of local data by top ten primary diagnoses
• commission partnership preventive support programmes to avoid hospital admissions based on local data
• primary care and community services to support out of hospital care
• improving school readiness, school attendance, appropriate use of services, management of health conditions
• demonstrate value for money and return on investment

Improvements

These include:

• improved accessibility for vulnerable groups
• integrated IT systems and information sharing across agencies
• development and use of integrated pathways including primary care and community services to avoid admissions
• systematic collection of user experience, for example FFT and consulting children and young people to inform action and create young people friendly services
• increased use of evidence-based interventions
• improved partnership working, for example health visiting, GPs, oral health services, community paediatric services
• consistent information, for example on accident prevention, for parents and carers
• identification of repeat attendance for non-elective admissions
• development of systems to capture interventions to reduce inappropriate use of services,
• using a whole-school approach

Professional or partnership mobilisation

These include:

• multi-agency training to support children’s health and wellbeing and their attendance at school
• continued multi-agency safeguarding training
• effective delivery of universal prevention and early intervention programmes
• improved understanding of data within the Joint Strategic Needs Assessment and at the local Health and Wellbeing Board – to better support integrated working of school nursing services with existing local authority arrangements and to provide a joined-up and improved service for children, young people and families
• identification of skills and competencies to inform integrated working and skill mix
• understanding barriers to primary care access

Associated tools and guidance

Association of Young People’s Health (AYPH), 2019

Delivering better oral health: An evidence-based toolkit for prevention, PHE, 2014

Digital Child Health, NHS Digital, 2020

Fair Society, Healthy Lives: The Marmot Review, University College London, Institute of Health Inequality, 2010

Health Matters: child dental health, PHE, 2017

Improving social mobility through education, DfE, 2017

Improving the oral health of children: Cost effective commissioning, PHE, 2016

Local authorities improving oral health: commissioning better oral health for children and young people, PHE, 2014

Our children deserve better: Prevention pays: Chief Medical Officer’s report 2012, Department of Health and Social Care (DHSC), 2013

Plan to boost social mobility through education, DfE, 2017

Prevention Green Paper, DHSC, 2019

Promoting children and young people’s emotional health and wellbeing, PHE, 2015

SEND Code of Practice 0 to 25 years, DHSC and DfE, 2015

Supporting pupils at school with medical conditions, DfE, 2014

Working Together to Safeguard Children, DHSC, 2018

Relationships, sex and health education statutory guidance, DfE, 2019

Stability Index, Children’s Commissioning, London, 2019

Research

About the All Our Health programme, PHE, 2020

Child and Maternal Health, PHE

Children and young people’s health benchmarking tool, PHE, 2014

Hall D and Elliman D (2006) Health for All Children (revised 4th edition), Oxford University Press

Place-based systems of care: A way forward for the NHS in England, Ham, C., Alderwick, NHS England, 2015

School aged children profiles, Child and Maternal Health Intelligence Network, PHE, 2014

The link between pupil health and wellbeing and attainment, PHE, 2014

Quality criteria for young people friendly health services: You’re Welcome DHSC, NHS England, 2020

What works in schools and colleges to increase physical activity, PHE, 2015

Guidance

Teenage mothers and young fathers: support framework, PHE and Local Government Association (LGA), 2016 (updated 2019)

Health visiting and school nursing partnership – pathways for supporting health visitor and school nurse interface and improved partnership working, DHSC, 2014

Complete routine immunisation schedule: Immunisation for health professional and immunisation practitioners, PHE, 2019

Maximising the school nursing team contribution to the public health of school aged children, DHSC, 2014

Promoting emotional wellbeing and positive mental health of children and young people, DHSC, 2014

NHS Long Term Plan, NHS England, 2020

Relationships, Sex and Health Education statutory guidance, DfE, 2019

Social prescribing, NHS England, 2020

Teenage mothers and young fathers: support framework, PHE and LGA, 2016 (updated 2019)

Safety

Road injury prevention: Resources to schools to promote safe active travel, PHE, 2016

Learning and achievement

Early Years Foundation Stage Profile: 2018 handbook, Standards and Testing Agency, 2017

Subjective wellbeing in adolescence and teacher connectedness: a health asset analysis, Garcia-Moye and others, Health Ed Journal, 2014

The WHO health promoting school framework for improving the health and wellbeing of students and their academic achievement, Cochrane library, 2014

NICE guidance

Immunisations for under 19s overview NICE advice

Immunisations: reducing differences in uptake in under 19s, NICE public health guideline [PH21], 2017

Oral health, Local authorities and partners, NICE guideline [PH55], 2014

Oral health promotion, general dental practice, NICE guideline [NG30], 2015

Schools and other educational settings, NICE

Social and emotional wellbeing in primary education,, NICE public health guideline [PH12], 2008

Social and emotional wellbeing in secondary education, NICE public health guideline [PH20], 2009

Unintentional injuries: Prevention strategies for under 15s, NICE public health guideline [PH29], 2010