The conceptualizations of inclusion based on its fundamental characteristics are the most widespread, in which we try to identify the common elements found in “ordinary” life spaces, aimed at highlighting those phenomena that would lead to greater inclusion. Inclusive education is defined as a process useful for increasing student participation in the traditional school community and the study curriculum, decreasing their exclusion, also on a practical and political level; although this agreement is struggling to take off,[2,3] many projects promote its realization. Many voices here highlighted how the full realization of the Inclusive Education System does not consist in giving a place in the school even to those who represent some diversity, but in transforming the school system into a suitable organization for education taking charge of the different Special Educational Needs that all pupils may encounter. The concept of Special Educational Need (or Special Educational Need) refers to any developmental difficulty, in the educational and learning fields, expressed in a problematic functioning also for the subject, in terms of damage, obstacle, or social stigma, regardless of the etiology, and that requires individualized special education.[4,5] The concept of Special Educational Needs appears in official documents of The United Nations Educational, Scientific and Cultural Organization (UNESCO) in 1997, in the legislation of the United Kingdom in 2001 (Special Educational Needs and Disability Act), and in documents of the European Agency for Development and Education for Special Needs in 2003, as a tendency to consider subjects with SEN also other people of developmental age who show learning and behavioral difficulties other than disability (pp. 19). Special Educational Need has become an “umbrella” concept that contains within it macro-categories and subcategories. The Organization for Economic Co-operation and Development defines 6. Special Education Needs (SEN) as divided into three macro-categories, divided as follows:
- Category of “disability” (A): Refers to problems of the individual based on obvious biological bases require the commitment of resources; the situations traditionally considered as a disability (mental, physical, and sensory).
- Category of “difficulties” (B): The differences in learning and behavior do not seem to be due to a clear organic basis or to a social disadvantage, and need resources; are those situations of deficit in specific clinically significant learning (dyslexia, attention deficit disorder, etc.).
- Category of the “disadvantages” (C): Problematic aspects of social and/or linguistic background are the subject of further educational resources; are the set of all the other situations of psychological problems.
To understand, therefore, an SEN, clinical diagnoses are not necessarily needed, but observation and evaluation of the real interactions between International Classification Factors (ICF) factors, to understand if that specific functioning is problematic for that subject, and if this subject is in a problematic situation, based on a comparison concerning three objective criteria:
- Damage: Experienced by the student and expressed by others (students, parents, and teachers). A functioning situation is problematic for a child if it harms him directly or harms others (pp. 42).
- Obstacle: The difficulty puts him at a disadvantage for his future cognitive, affective, relational, and social development. The situation in which the damage is not directly observable.
- Social stigma: A case in which “there is no demonstrable damage or obstacle to the child or to others due to his poor educational-learning functioning” (pp. 43) and which worsens his social image.
Definitions are valid exemplifications aimed at conceptualization when they tend to assume that educational practice is subject to a series of common elements that are static in time and place, but this is not the case with inclusion which, applying itself in very heterogeneous differs in its application techniques and consequently in its theoretical conceptualization. What is hoped for in the perspective of contemporary inclusive education is a broadening of the perspective, allowed by the relocation of the needs of the individual in the broader framework of the plurality of differences in the school context, which would allow each student to be thought of as having deserving educational needs of inclusion, and to get out of any form of categorization.
Best practices for a medical and psychosocial education
The descriptions that the sector literature has offered of the concept of didactic practice are manifold, the definition on which a large part of the scientific community has found a common ground is that which makes didactic practice coincide with a set of actions and choices made in intentionally and which have an educational project as their objective, therefore, unlike experience which can be casual, a practice is a set of acts, routines, choices, carried out intentionally, about a project. The concept of practice includes both the explicit and the tacit, what is said and what is not said, what is represented, and what is hypothesized. Again, it includes language, tools, documents, images, symbols, well-defined roles, specific criteria, codified procedures, internal regulations, and contracts that the various practices make explicit for a whole series of purposes. Practice is both the foundation of learning processes and the “construction schemas” and “structuring” reference point of a social community, but above all, the “social production of meaning.” Praxis designates “the specifically human intention to action resulting from a reasonable choice, designed for the particular case, recognized as shared by the community as such, realized as it should be”; (pp. 298). The definition highlights the strong link between the knowledge of action and the responsibility of acting, becoming knowledge-in-action.[12,13] In the medical pedagogy field, the concept of practice has a dual value, not opposed to each other but an integral part of the other like two sides of the same coin. If on the one hand, it is configured as “the complex of intentional actions of teaching (learning)” on the other, it designates “the procedures for implementing these actions to a healthy population” (pp. 299). This double value derived from the fact that in the medical pedagogical and didactic field the practice is not reducible to the sum of the observable, performed actions or the reactions to them, but it is something more complex that leads to a categorization of the practices that refer to the situated professional activity. The following types of practice can be distinguished (pp. 300):
- The medical didactic practice: “the result of a search among the many possibilities (procedures, strategies, itineraries) that can be chosen to optimize the action of teaching (learning)” for the intellectual disability.[14–16]
- Educational practice and e-health: “coherent and complex form of socially and historically established cooperative human activity, which takes place in a social and healthy context characterized by the educational commitment carried out by competent professionals, to promote development.”[17–20]
- Work practice: Knowing how to do in a situation related to the realization of a project that weaves relationships between people, objects, languages, technologies, institutions, and standards.
- Reflective practice: Dialectical “movement” of reflected practice, i.e., a reflection on “doing professional” generating new knowledge whose validity is governed and limited by the situations in which it is generated and finds utility;
- Magisterial practice: It is exemplary practice, the result of the best orchestration of the variables of the teaching action. Educational practice is therefore a process involving multiple interacting and constantly evolving systems, due to the incessant restructuring of premises, interactions, inferences, expectations, cognitive strategies, and representations of relationships.[23,24] It is therefore not reducible to the set of observable acts, actions, and reactions; but it is made up of facts that exist independently of the teachers, the multidimensional team, and of behaviors, procedures, processes, and meanings, the nature of which is by no means explicit.
The possible devices for analyzing practices are many and different, all deriving from multiple and different approaches. These numerous approaches are classified, especially in the French-speaking area,[25–28] into two subsets based on the methodological options (p. 6): discourses on practices, which include investigations that stimulate health service professionals to produce texts following the actions they perform in their classroom and school work; observations of the practices, which can, in turn, be distinguished between (a) those conducted directly in the context and (b) those which take up classroom operations with various technologies and examine them afterward by interacting with the teacher-actor. This distinction, albeit relevant, would not allow us to highlight the heterogeneous panorama of approaches developed in different contexts and multiple directions about the theoretical paradigm of reference. A valid classification was made by studies (p. 17) that offered an organic, albeit not exhaustive, review of the main approaches used for the analysis of teaching and educational practices.
According to this classification, it is possible to distinguish ten different ways of approaching teaching practices: the pragmatic approach: the constitutive objective of the analysis of practices is the solicitation of reflection on the action itself. It can be traced back to the Anglo-American works of a pragmatist matrix of different authors[30–32] according to which the object of knowledge is inherent in the action itself, which is both an event and a representation of the cognitive event itself. The pragmatist perspective suggests looking at one’s own experiences through a metacognitive and introspective attitude; the investigation of learning must on the one hand make individuals aware of the experience accomplished and on the other hand, it must induce them to reflect on what has been implemented. In this way, they present themselves as subjects who reflect, with a critical distance, on their actions and the repercussions of these, as already underlined in the studies conducted by others.[33,34] Both authors highlight how the reflexive rationality in the action, which they place as the central moment of the action itself, represents a moment of evolution of thought “in” and “about” the action.
- The ergonomic approach: Analyzes the “real” task, i.e., the gestures made by the teacher in carrying out his profession. In this approach, the profession appears as an activity and is studied as a job; in this view, gestures are not standardized from the outside but depend on the one hand on style and orientation of each one,[35,36] on the other hand, on the comparison between peers and from self-comparison with the self and the use of the professional self.[37,38]
- The cognitive approach: Places its attention on the implementation of concepts and methodologies to study practice.[21,31,39,40] Researchers using this approach transfer their interest from cognitions to procedures using mainly two models: one based on the inference of direct investigation or of the observation of neural simulations conducted in the laboratory for psychologists and a psychosocial approach built on the analysis of teachers’ a posteriori verbal production.[43,44] This establishes that such research can determine an evaluation of the teaching process in its entirety, i.e., within all the phases before, during, and after[45,46] only in the planning phases or only in retrospect through situation presentations that allow the researcher to study a typical teaching situation. Within this theoretical framework, various internal currents emerged: psychological-cognitive psychology that considers daily action and thinking crossed by dimensions such as conscious/unconscious, normality/abnormality; another starting from the 80s develops from the notion of “everyday” aimed at identifying all the forms of mental functioning characterizing the subject when he thinks, feels and acts: Everyday Reasoning, Everyday Cognition, Everyday Thinking; finally, the studies that aim to analyze the dependence of the forms of teaching on the context or the situation, called situated knowledge and distributed knowledge approaches, based on the idea that cognitive processes are culturally and socially rooted.
- The clinical approach: Focuses its reflection on experiential and intersubjective medical education training. It considers observable educational events as signs to be analyzed concerning established theoretical knowledge and frameworks. This approach is divided into two main strands: the psychoanalytic direction, which places its attention primarily on individual attitudes[15,22–53] and the psychosociological orientation, which locates its research in a multi-referential vision aimed at the multiple elements of the social and of the interaction with other subjects.
- The ethnomethodological approach: Sets out to analyze practices by presenting the observable phenomenon through rules and routines, treating them as elements of empirical investigation, social practices used by subjects to give meaning to reality. Starting from the vision of its founder, who studies the curious rationality of everyday life, it tries to explain daily practice by making as its object of observation not so much the daily elements, but rather the extraordinary occurrences as events distant from the reliable ones. In this approach, the “everyday activities” take on centrality, understood on the one hand as tacit rules, which are those signals that the teacher conveys at a paralinguistic verbal level, that the learner must have learned to participate in the interaction; and on the other hand as routine, i.e., that set of actions both in terms of their functions and the fact of being transformed into systematic, structured and predictable sequences and due to their constancy, systematicity, and repetition, do not become mechanical executions, but rather useful itineraries for understanding a healthy didactic action,[51,56,57] which assume didactic and pedagogical value. The ethnomethodological approach stems from the belief that it is not the social order that determines the action, but that it is the result of the interpretations that the actors provide to behaviors in the specific context in which they take place.[58,59] In this vision, the explanation consists in identifying a rational and observable order within the context.
- The evidence-based research approach (EBE) is based on “evidence of facts” through scientifically accurate experimental investigations, the critical evaluation of which allows intervention decisions to be made.[60–62] The evidence in this approach represents proof that through careful observation and the use of information from experimental investigations, it comes to producing priorities for improvement interventions. In the context of this approach to the analysis of practices, there have been numerous international studies that support the utility of the analysis in a dimensional view. The EBE model finds the maximum fulfillment in its use with medical and special pedagogy because, on the one hand, of the fundamental principles from which the model develops and from which it is generated, on the other hand. Employing this model can develop new processes and actions to be undertaken for structural medical pedagogy in education. The model answers significant questions about the effectiveness of interventions (what works? and when does it work?) implementation, and systematic monitoring (is it working? and how can we make it work?) and on the other, it can develop the generation of new processes and actions to be undertaken for the development of a medical pedagogy in education.
Inclusion, as underlined in this paper addresses “the ability of the school system to transform itself to guarantee the participation, mental-health well-being, and academic success of all students in regular contexts, as people and not because they belong to specific groups” (p. 215). The dimension of inclusion indicated here is not that of an emergency pedagogy that is born addressed to an ideal pupil and then adapts to the real pupil by branching off into personalized paths, but is conceived as a medical psychopedagogy of raising awareness in healthy personalities and social inclusion in which planning looks at all students from the beginning, not avoiding the differences but observing them, looking at the promotion of each one to offer each one the best opportunities for personal and community growth. Compared to the traditional concept of inclusion, the theoretical perspective of evidence based, adopted in this work does not refer to disabilities or students who are identified with Special Educational Needs but has a much broader scope. The notion of inclusion recognizes that there is a risk of exclusion that must be actively prevented, and at the same time affirms the importance of involving all actors in creating a truly welcoming community, which must become sensitive to the full range of differences present in children’s life. The school must be aware of its goals and responsibilities. Clinicians must be aware of their role in the integration of the organization of the structure and the needs of the child. The challenge that the school must face is, therefore, overcoming the physical barriers, cultural and value-based by accepting and adopting the regulatory precepts, and developing and strengthening them through their application. The analysis carried out by teachers and the multidimensional team starts from the “facts” demonstrated through the “evidence” methods, lines of research, and practices suitable for promoting children with special needs inclusion. To encourage the development of inclusive actions, in the field of medicine, psychology, education, and didactic, the need for research applied to the context is evident, which must closely monitor the psychological teaching practice. The orientation of the evidence-based education and the medical pedagogy practices described in the present paper are placed in the following line: the first is based on the assumption that in infant medicine, psychological, and educational research. It is necessary to make value statements, methodologies, and explicit criteria for the evaluation of practices; the second line argues that to produce a knowledge of action it is necessary to formalize the know-how of doing through making practices available. It is necessary to rethink inclusion in a more mature vision, based on the analysis of the contexts, therefore identifying health providers, psychologists, and other professionals within the educational institution’s barriers and potential for learning and participation as key elements for healthy knowledge and development.
Financial support and sponsorship
This work was supported by the “Albanian University” research funding program.
Conflicts of interest
There are no conflicts of interest.
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