Pupils with Special Educational Needs in Basic Education Schools and Teachers' Sickness Absences - a Register-Linkage Study

By Ervasti, Jenni; Kivimäki, Mika et al. | Scandinavian Journal of Work, Environment & Health, May 2012 | Go to article overview

Pupils with Special Educational Needs in Basic Education Schools and Teachers' Sickness Absences - a Register-Linkage Study


Ervasti, Jenni, Kivimäki, Mika, Kawachi, Ichiro, Subramanian, S. V., Pentti, Jaana, Ahola, Kirsi, Oksanen, Tuula, Pohjonen, Tiina, Vahtera, Jussi, Virtanen, Marianna, Scandinavian Journal of Work, Environment & Health


Objectives We examined whether having a high percentage of pupils with special educational needs (SEN) in basic education schools increases the risk of sickness absence among teachers and whether this risk is dependent on the pupil-teacher ratio (PTR), an indicator of teacher resources at school.

Methods We obtained register data on 8089 teachers working in 404 schools in 10 municipalities in Finland during the school year 2004-2005. We used multilevel multinomial regression models to examine the risk of teachers' short- and long-term sickness absence in relation to the percentage of SEN pupils and the PTR at school. We tested the equality of trends in groups with high and low the PTR using PTR ? SEN interaction term.

Results After adjustment for teacher and school characteristics, the risk for long-term absences was higher among teachers at schools with a high percentage of SEN pupils than among teachers at schools with a low percentage of SEN pupils [odds ratio (OR) 1.5, 95% confidence interval (95% CI) 1.2-1.8). This was also the case for short-term absences (OR 1 .4, 95% CI 1 .2-1 .7). In analyses stratified by the PTR levels, the association between the percentage of SEN pupils and long-term absences was 15% higher among teachers with a high PTR than among those with a low PTR (P- value for interaction=0.10).

Conclusions Teachers' sickness absenteeism seems to increase with a higher percentage of SEN pupils, especially when the PTR is high. Teacher resources at schools that have a high percentage of SEN pupils should be well maintained to ensure the health of teachers.

Key terms absenteeism; children; comprehensive school; exceptional children; multilevel modeling; pupilteacher ratio; register study; school resource; sick leave; special education; student.

An increasing number of school children have special educational needs (SEN) related to physical, mental, or emotional challenges, although the definition may vary in different countries. In the US, the percentage of SEN pupils has grown steadily from 8% in 1976-1977 to 13% in 2008-2009 (1). Similarly in Finland, the percentage of SEN pupils has grown from 3% in 1995 to 9% in 2009 (2). In the UK during 2006-2010, the percentage of pupils with formal evaluation of SEN has remained at 3%, but the percentage of SEN pupils without formal evaluations has increased from 16% to 18% (3). Inclusion of SEN pupils in regular education, also referred to as mainstreaming, was part of the United Nation's Salamanca Declaration (4) in 1994, and the development of education for SEN pupils shows that developed countries seem to follow this declaration (5).

Although from the perspective of SEN pupils' wellbeing, inclusive education is probably a better alternative than segregated special education (6-8), there are some data that suggest that teachers may perceive the inclusion of SEN pupils in general classes as emotionally straining. This is because inclusion may be associated with increased disciplinary problems in the class leading to increased risk of burnout symptoms (9) and sick leave among teachers (10).

From a societal perspective, the key to the wellbeing of both pupils and teachers may lie in school resource allocation, usually defined as the pupil-teacher ratio (PTR). In both the short- and long-term, small classes (<20 pupils) in the first three grades have been found to have a positive effect on pupil outcomes such as academic achievement, referrals to special education, and discipline problems (11,12). Studies on the benefits of reduced class sizes for pupils' health have shown mixed findings (13), and the health benefits of reduced class sizes for teachers are unknown. However, general education teachers indicate that they would have more positive attitudes towards the inclusion of SEN pupils if class sizes were reduced to 20 pupils (14).

In the present study, we examined whether the percentage of SEN pupils at Finnish basic education schools was associated with the rate of sickness absence among teachers. …

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