Inclusive early childhood education : an analysis of 32 European examples

This report is part of the three-year Inclusive Early Childhood Education (IECE) project run by the European Agency for Special Needs and Inclusive Education (the Agency) from 2015 to 2017. The project aims to identify, analyse and subsequently promote the main characteristics of quality inclusive pre-primary education for all children from three years of age to the start of primary education. This report presents the results of a qualitative analysis of 32 descriptions of examples of IECE provisions across Europe. The descriptions were submitted to the project in August 2015. The findings represent European practitioners’ perceptions of and practices for IECE. An inductive thematic data analysis method was used, in that themes or issues were initially derived from reading the descriptions. This inductive process was, however, also intertwined with relevant theory, particularly the Agency’s ‘ultimate vision for inclusive education systems’ that: ... ensure that all learners of any age are provided with meaningful, high‐quality educational opportunities in their local community, alongside their friends and peers(European Agency, 2015, p. 1). In total, 25 subthemes were identified. These were organised into a new Ecosystem Model of Inclusive Early Childhood Education, which is also presented in a comprehensive diagram (Figure 1). Two major perspectives previously used in describing the quality of ECE settings inspired this new model. These are the Outcome-Process-Structure model and the Ecological Systems model. The subthemes were subsequently grouped into five main themes: • Theme 1: The first main and central theme is ‘Child belongingness, engagement and learning’, often generally understood as active participation. This participation is regarded as both the main outcome and process of IECE. • Theme 2: Five major processesinvolving the child’s direct experience in the IECE setting enable this central outcome and process. These processes are: − Positive interaction with adults and peers − Involvement in play and other daily activities − A child-centred approach − Personalised assessment for learning − Accommodations, adaptations and support. • Theme 3: These processes are in turn supported by structural factors, consisting of the physical, social, cultural and educational environment. These factors may operate at different ecological levels. Some operate within the ECE setting and include: − A warm welcome for every child and family − Family involvement within the ECE setting. − A holistic curriculum designed for all children’s needs − An environment designed for all children − Staff who are appropriately qualified for IECE − A culturally-responsive social and physical environment − Inclusive leadership committed to respect and engagement for all individuals − Collaboration and shared responsibility among all stakeholders. • Theme 4: Inclusive processes experienced by the child are also influenced by more distant structural factors in the community surrounding the ECE setting. These include: − Collaboration between the ECE setting and the children’s families − Relevant in-service training for ECE staff − Wider community commitment and support for serving all children − Inter-disciplinary and inter-agency co-operation of services from outside the ECE setting that serve the children in the pre-school − Organising smooth transitions between home and the ECE setting. • Theme 5: Finally, the analysis found a number of structural factors operating at the macro-system level. These factors were not in direct contact with the ECE setting. However, they still influenced inclusive processes in the setting. They are: − A rights-based approach to ECE − Provision of mainstream ECE access for all − Setting up regional/national standards for a holistic IECE curriculum − Availability of initial education for teachers and other staff for IECE − Good governance and funding systems for IECE − Procedures for regular monitoring and evaluation. This overview of the ecosystem of outcomes, processes and structures for IECE is presented in the Results chapter. Five evidence-based chapters, dedicated to each of the five main themes, follow this. Each chapter presents a brief description of each of the outcome, process or structural factors within each main theme. These are accompanied by one to five quotations from each of the 32 example descriptions. The quotations illustrate and provide concrete evidence of what constitutes quality outcomes, processes and structures that are prevalent across Europe. The quotations were chosen both to reflect the different types of IECE concepts and practices, and to reflect the variety of countries and cultures where they occur. They are intended to stimulate inclusive developments in research, policy and practice in Europe and internationally. Finally, the Conclusion highlights the added value that this analysis contributes to IECE research, policy and practice. Four new insights are addressed: 1. The development of the new Ecosystem Model of IECE, inspired by two previous major models, should clarify the understanding of the issues related to quality ECE. 2. The analysis shows how, within an inclusive perspective, IECE’s primary goal is best conceived as that of ensuring quality outcomes for all children in terms of participation. This is described here as belongingness, engagement and learning. 3. The analysis shines a new light on the major processes in which children are directly involved and which mostinfluence each child’s participation and learning. These need to be a major focus of any intervention to improve ECE quality. 4. The analysis clarifies the structural factors needed to support the development of more inclusive ECE settings. It also shows how these factors are related to local and national policies and practices. Situating the structures at the ECE setting, community and regional/national levels isimportant in levering them to bring about the changes needed to enable each child to participate and learn.peer-reviewe

Inclusive early childhood education new insights and tools – contributions from a European study

Quality in early childhood education is a prominent concern for policy-makers, and has recently become a priority concern for many international and European organisations. These include the OECD, UNESCO, UNICEF, the European Commission, Eurydice and the European Agency for Special Needs and Inclusive Education, among others. Over the past three years (2015–2017), the European Agency for Special Needs and Inclusive Education (the Agency) has examined the latest policy documents and relevant research in this field. This has been a springboard for exploring the main characteristics of quality inclusive early childhood education (IECE) for all children from three years of age to the start of primary education. The project data from across Europe has provided an opportunity to closely examine how, within the inclusion perspective, early childhood education provisions are addressing the quality principles set out by the European Commission and the OECD. Sixty-four inclusive early childhood education experts from across Europe contributed to the project. They participated in data collection and analysis through descriptions of example provisions, as well as observations and discussions during field work and case study visits. This report first sets out the main policy and practice developments towards inclusive early childhood education, with particular reference to European policy issues (Chapters 2–3). It then presents the project’s three new contributions towards improving quality inclusive early childhood education (Chapters 4–6). These are: 1. A clear rationale for and an analysis of the implications of adopting an inclusive vision and goals as the main standards of inclusive early childhood policy and provision. The project found that high-quality services that benefited all children were guided by an inclusive vision and worked towards inclusive goals. As their primary outcome, they sought to ensure each child’s belongingness, engagement and learning. This reflects the changes in early childhood intervention in recent decades. The focus has shifted from ‘working with the child’ towards a holistic approach that creates an inclusive environment for all children’s engagement and learning. The report thus refers to quality early childhood education (ECE) as ‘inclusive early childhood education’ (IECE). It only uses the terms ‘early childhood education’ (ECE) or ‘early childhood education and care’ (ECEC) when referring to the literature. 2. A new Self-Reflection Tool for improving inclusive early childhood education settings. This enables practitioners to review their service’s quality in terms of the inclusiveness of the physical, social and other learning environments it offers to children and families. The tool has been validated by project experts and additional ecological studies. It is ready for use by practitioners in inclusive early childhood education settings in different education systems and countries across Europe and beyond. 3. A new Ecosystem Model of Inclusive Early Childhood Education for policy-makers and other stakeholders wishing to collaborate towards effective action in this field. This model can support policy-makers and practitioners to collaborate in planning, reviewing and improving quality IECE services. The model is founded on the project data. It is inspired by three major frameworks for quality IECE, namely: (1) The structure-process-outcome framework used by European and international policy-makers (European Commission, 2014; OECD, 2015; European Agency, 2009) (2) The ecological systems framework (Bronfenbrenner and Morris, 2006) (3) The inclusive education perspective (European Agency, 2015). It incorporates all the principles of the EU and OECD frameworks for quality early childhood education. However, it enhances their applicability by locating them at different ecological levels (inclusive early childhood education setting, home/community and regional/national levels). Finally, the report gives an account of the lessons learned during the three-year project and the resulting recommendations (Chapter 7). These are presented within the framework of the new Ecosystem Model of IECE. They are mainly directed at policy- makers, but they also point to the implications for practitioners. Indeed, they are formulated in terms of how policy-makers can support practitioners to ensure quality provisions.peer-reviewe

Inclusive early childhood education environment self-reflection tool

This Self-Reflection Tool was developed as part of the Inclusive Early Childhood Education (IECE) project, conducted by the European Agency for Special Needs and Inclusive Education from 2015 to 2017 (www.european-agency.org/agency-projects/inclusive-early- childhood-education). The project’s overall goal was to identify, analyse and subsequently promote the main characteristics of quality IECE for all children. To that end, a need was detected for a tool that all professionals and staff could use to reflect on their setting’s inclusiveness, focusing on the social, learning and physical environment. This tool is intended to help improve settings’ inclusiveness.peer-reviewe

Clinico‐biological features and outcome of patients with splenic marginal zone lymphoma with histological transformation

We describe 36 patients with splenic marginal zone lymphoma (SMZL) with transformation (SMZL-T), including 15 from a series of 84 patients with SMZL diagnosed at the Hospital Clinic of Barcelona (HCB) and 21 diagnosed with SMZL-T in other centres. In the HCB cohort, the cumulative incidence of transformation at 5 years was 15%. Predictors for transformation were cytopenias, hypoalbuminaemia, complex karyotype (CK) and both the Intergruppo Italiano Linfomi (ILL) and simplified Haemoglobin, Platelet count, lactate dehydrogenase (LDH) and extrahilar Lymphadenopathy (HPLL)/ABC scores (P < 0·05). The only independent predictor for transformation in multivariate analysis was CK [hazard ratio (HR) 4·025, P = 0·05]. Patients with SMZL-T had a significantly higher risk of death than the remainder (HR 3·89, P < 0·001). Of the 36 patients with SMZL-T, one developed Hodgkin lymphoma and 35 a diffuse large B-cell lymphoma, 71% with a non-germinal centre phenotype. The main features were B symptoms, lymphadenopathy, and high serum LDH. CK was observed in 12/22 (55%) SMZL-T and fluorescence in situ hybridisation detected abnormalities of MYC proto-oncogene, basic helix-loop-helix transcription factor (MYC), B-cell leukaemia/lymphoma 2 (BCL2) and/or BCL6 in six of 14 (43%). In all, 21 patients received immunochemotherapy, six chemotherapy, one radiotherapy and three splenectomy. The complete response (CR) rate was 61% and the median survival from transformation was 4·92 years. Predictors for a worse survival in multivariate analysis were high-risk International Prognostic Index (HR 5·294, P = 0·016) and lack of CR (HR 2·67, P < 0·001)

Transformation of follicular lymphoma

Histological transformation of follicular lymphoma (FL) to a more aggressive non-Hodgkin's lymphomas is a pivotal event in the natural history of FL and is associated with poor outcome. While commonly observed in clinical practice and despite multiple studies designed to address its pathogenesis, the biology of this process represents an enigma. In this chapter we present a state of the art review summarizing the definition of histologic transformation, its incidence, pathogenesis, clinical manifestations, treatment and outcome. Furthermore, we specifically emphasize gaps in our knowledge that should be addressed in future studies