Inclusive education is generally understood as the effort to develop an education program that supports the particularities and needs of each child, that is, an education that satisfactorily considers the diversity of all students (UNESCO, 2001). However, this conception is relatively recent.
In the middle of the 19th century, the importance of providing an education to all populations was agreed upon; however, this effort continued to segregate students, who were classified by their particular characteristics or deficits (Beltrán, Martínez and Vargas, 2015). The Warnock Report developed the concept of special educational needs (SEN) to emphasize the particularities that should be addressed, especially without classifying children (Warnock, 1978). From this report, the paradigm of educational integration was derived, which was also criticized for its intention to transform special education and not the educational system as a whole (Beltrán, Martínez and Vargas, 2015).
In the 1990s, the Salamanca Declaration promoted Education for All (EFA) and the inclusion of people with SEN, which promoted the paradigm of inclusive education (UNESCO, 1994). However, this declaration has also been criticized because it stipulated the historical premise that the education of a small portion of the child population, considered “marginal”, should be guaranteed through special education, which is ultimately a parallel educational system. Thus, what is usually done to guarantee EFA is the sum of two divided educational systems, something that is not authentically inclusive (Ainscow and Miles, 2008).
According to Echeita and Ainscow (2011), educational inclusion depends on the cultural particularities of each educational system; however, they point out four important aspects:
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Inclusion as a process is a permanent search for improvements to address the diversity of students.
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Inclusion seeks regular presence and constant participation and results in student learning.
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Inclusion requires the identification and elimination of barriers, such as the beliefs and attitudes of people about cultures, policies and practices that produce exclusion or school failure.
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Inclusion emphasizes those groups of students at risk of marginalization or school failure.
Hospitalized children and adolescents are a population at risk of exclusion. Since serious and chronic diseases must be treated with prolonged or frequent hospitalizations, patients are withdrawn from their social environments: school and family.
Educational care for this population began after the World War II, not only to teach them educational content but also to mitigate the psychological effects generated by hospitalization (Espitia and Barrera, 2020; Ocampo, 2019). Subsequently, international charts were approved, such as the European Charter of the Rights of Children in Hospital, the Rights and Educational Needs of Children and Adolescents with Medical or Mental Health Needs, and the Declaration of the Rights of the Hospitalized Child or Young Person in Treatment in Latin America and the Caribbean in the Field of Education, approved by the Latin American Parliament (Ocampo, 2019). In Latin America, several countries include educational care in the hospital context within their regulatory frameworks (Souza and Rolim, 2019; Salgado, 2020; Ardón, Leytón, Méndez, Monge and Valverde, 2017; Serradas, 2017).
This accompaniment to hospitalized children is known as hospital pedagogy, a comprehensive pedagogical and psycho-emotional intervention that seeks to guarantee the rights of children who are ill, improve their quality of life and respond to their biopsychosocial needs (Violant, Molina and Pastor, 2011; Bobadilla, Bori, Caedone, Ferreira, Lizasoáin, Molina and Violant, 2013). In addition, this care should consider the circumstances of the hospital stay that may affect the return of children to school and their daily lives.
According to Ocampo and Monsalve (2020), hospital pedagogy is a gap between the pedagogical and the hospital and between education and health. Although they are different fields of knowledge, they are not exclusive. However, actions taken to attend to the education and health of this hospitalized population, are not without tensions and complexities.
The psychopedagogical care proposed by hospital pedagogy is a continuous, dynamic and comprehensive process that is applicable to all people in different contexts and moments of their life cycle (Clavijo, López and Rodríguez, 2014, p. 61). Hospitalized children require affective support and decreased anxiety to overcome the negative effects of hospitalization through the use of free time and activities that promote happiness and interpersonal relationships (Clavijo, López & Rodríguez, 2014).
Bronfenbrenner's developmental ecology
This research is based on the contributions of Bronfenbrenner (1989) on human development, understood as “the changing conception that a person has of the ecological environment and their relationship with it, as well as their growing capacity to discover, maintain or modify its properties”(P. 29). The ecological environment is a set of structures that contain various systems at different levels in which the subject participates and transforms his or her reality.
The most immediate environment of the child, the microsystem, is a complex of interrelationships between close people who directly influence their development, such as the family. However, the subject participates in other environments, mesosystems, that directly affect their development, such as school. Then, exosystems exist as environments in which interactions or situations occur that can affect the immediate environment of the subject. Finally, at a broader level are macrosystems, a complex of systems built from ideology and social institutions common to a culture (Bronfenbrenner, 1989).
In this sense, the hospitalized child will be understood as a subject located in an ecological environment, with a microsystem, mesosystem, exosystem and macrosystem that directly or indirectly affect his or her development. In this complex of relationships between systems are located the family, the hospital and the school, as well as the structural factors of the country's hospital pedagogy.
Hospital classrooms in Colombia
In Colombia, there is no public policy on psychoeducational care for hospitalized children. In the regulatory framework, there is Decree 1470 of 2013, which regulates the flexible educational model Special Academic Support (AAE), aimed at guaranteeing the school continuity of hospitalized children. In Bogotá, the District Agreement 453 of 2010 between the Secretariats of Education and Health organizes the 31 hospital classrooms of the capital city, located in 20 locations and assigned to 25 public schools (Secretariat of Education of the District, November 23, 2021, p. 3).
Cali, the main city in southwestern Colombia, does not have a legal system that organizes hospital education; however, some hospitals have responded to this demand by creating their own programs or establishing alliances with foundations that provide education to children with cancer (Gómez, 2021).
Taking into account this national scenario, it is essential to know the intervention experiences that have been developed in this field to obtain practical knowledge that will nurture other experiences in the country and the region. There are some studies on the interventions carried out by hospital classrooms in Colombia (Barbosa, Guzmán, Marroquín, Pérez and Vaca, 2014); however, it is important to continue building knowledge in this field, which is still incipient in the country.
This study explores the experience of the Fundación Valle del Lili (FVL), a hospital that in 2018, together with Universidad Icesi and other educational institutions in the city, created Aula Lili (Lili Classroom), a comprehensive psychoeducational program that seeks to do the following:
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Contribute to the care of the physical, mental and emotional health of children and adolescents as a fundamental element of comprehensive care.
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Provide educational and school support for the development of skills through creative and flexible strategies and resources.1
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Encourage play as an opportunity for freedom, autonomy and creativity in hospitalized children and adolescents.
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Articulate, with the different actors involved, the efforts that contribute to comprehensive care processes.
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Generate permanent reflection processes that lead to the production of knowledge (Fundación Valle del Lili, 2020, p. 10).
Aula Lili program is made up of three axes: the school education axis, focused on guaranteeing the continuity of learning, the development of competencies and the link with educational institutions; the health education axis, which promotes self-care and psychological and socioemotional health; and the playful axis, focused on autonomy, psychomotor development, imagination and creativity (see Fig. 1).
Aula Lili developed its pilot phase during September 2020 and December 2021. The program identified those hospitalized children with a high level of educational risk, that is, out of school, with socioeconomic vulnerability or with a weak support network. Subsequently, the program provided an orientation for families and contacted the school of the children's school to encourage them to continue providing educational care. However, most of the schools did not cooperate, so the children were enrolled in new schools that assumed their educational processes. Then, Aula Lili provided support to the teachers of the schools for the construction of individual learning plans. When the children were at home, they attended their school classes through virtual means (Emergency Romote Education due to the COVID-19 pandemic), and when they were hospitalized, in addition to their virtual school classes, they were taught by hospital teachers. At the end of the process, a competency report was made by hospital teachers in order to inform the schools about the children's learning (see Fig. 2). The participating actors were as follows:
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Children: patients hospitalized in FVL participating in the Aula Lili program.
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Caregivers: mothers of the children.
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School teachers: teachers employed in the schools where the children were enrolled.
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Directives: principals and academic coordinators of the schools in which the children were enrolled.
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Hospital teacher: teachers employed by the Aula Lili in charge of providing the children with an education while they are hospitalized.
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Liaison teacher: the hospital teacher whose main task was to integrate the educational efforts of the hospital with those of the school in which the children were enrolled.
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Allied school: refers to one of the participating schools with which the Aula Lili established a closer relationship and previous agreements.
Following the fifth strategic objective of Aula Lili, the experience was systematized together with Universidad Icesi, and this article was produced to analyze the challenges, strengths and opportunities identified in the management of Aula Lili. This process allowed us to understand the voices of the different actors who participated in the piloting, as well as to obtain practical knowledge about implementation of the program that can be useful for this and for other hospital classrooms at the national and regional level.
[1] The pilot phase of the program linked the children with schools that led their educational processes. The hospital teachers provided the patients with school classes when they were in the hospital. In addition, a liaison teacher from Aula Lili advised school teachers about any adjustments to the learning plans, considering the child´s health condition.