Conference Program

This contribution argues the prevailing confluence between educational relationship and care relationship within the hospital school, which makes the latter an educational community.

The latter, founded on the therapeutic alliance, implies the centrality of the person and, therefore, a multidisciplinary team aimed at the empowerment of the individual in fragile conditions. It is highlighted how, in the hospital school, caring also includes education and how the educational role is distributed among all those who collaborate towards an inclusive learning environment.

Thanks to the activity of the school-hospital network as educational community, it is possible to guarantee educational continuity avoiding the isolation of hospitalized students undergoing medical treatments, requiring prolonged hospitalization, and preserving the stability they need.

Hospital school represents a liminal educational context, characterized by radical vulnerability, temporal discontinuity, physical constraints, and a strong external direction of time and decisions. In such an environment, education is traditionally interpreted according to a compensatory logic, oriented towards curriculum maintenance and the prevention of dropout.

This contribution takes a pedagogical-social as well as didactic perspective and proposes a redefinition of hospital school as a privileged social laboratory of educational democracy and radical personalization of learning, transcending the deficit perspective and embracing the expression of talent as a universal educational right.

The central thesis is that, in healthcare contexts, agency cannot be considered a pre-existing resource of the student, but must be understood as a pedagogical outcome (passive healthcare vs. intentional and active educational care), intentionally constructed within conditions of dependence and vulnerability. In this sense, the semantics of the word “care” is redefined, as a new paradigm of social pedagogy, in its double meaning of “to cure” and “to care”, which recalls the double etymology of education as educare and ex-ducere.

The theoretical framework integrates critical pedagogy, the capability approach, the pedagogy of vulnerability, and Umberto Margiotta’s theory of education, reinterpreting agency as the subject’s epistemic positioning – that is, a stable internal disposition as a tendency to act actively and effectively in the real context, to transform it according to a project of improvement – and advocacy as an ethical-pedagogical practice of addressing vulnerability.

This integration gives rise to the AAT (Agency–Advocacy–Talent) model, formalized in the relationship: Talent = f (Constructed Agency X Intentional Advocacy). In this model, agency and advocacy co-construct each other in a recursive cycle that generates empowerment and potential development.

Methodologically, the AAT approach is not a standardized operational method, but rather a design approach for the construction of mediated educational environments, in which tools such as expressive workshops, authentic tasks, storytelling, narrative portfolios, personal projects, and creative digital media find a preferential place, as privileged tools for the emergence of talent as a production of meaning, rather than a performance.

From this perspective, the hospital school presents itself as a micro-ecosystem for talent development and an extreme context for testing educational democracy: not only by ensuring access to education for all, but by defending the right of every student, even the vulnerable, to build a personal vision and self-project for the future, according to the principles of educational and social justice. In this sense, talent becomes an indicator of educational justice, and vulnerability becomes not a limitation to be compensated for, but an ontological condition to be inhabited and embraced, as a generative space of possibility.

Since 1985, hospital schools have been defined in Italy's paediatric services by Ministerial Notice No. 345. However, it was not until 2019 that the National Guidelines on Hospital Schools (HS) and Home Education (HE) were issued and adopted by Ministerial Decree No. 461, despite informal teaching and educational activities having been carried out in paediatric hospitals in Italy since the 1950s.

During the 2022/23 academic year, 59,226 children and adolescents attended hospital schools. Of these, 70% were in primary or secondary school, with 5,000 in the latter. Meanwhile, the residential teaching programme involved 2,067 children and young people. While these figures suggest an efficient system, they must be interpreted carefully.

According to ISTAT, approximately 90,000 students in the 0–14 age group in Italy were hospitalised due to severe clinical conditions such as cancer, blood and haematopoietic diseases, mental disorders, congenital malformations and circulatory diseases. However, according to the hospital school portal, only just over 50% of these children use the hospital school service. Among secondary school students, the number of hospitalisations is similar, but only 4,250 young people have attended hospital school.

Of the 467,000 people aged 6–24 with a chronic condition, only 93,000 with one chronic illness and 16,000 with two chronic illnesses obtained a university degree. The comparison with the healthy population of the same age group is striking: 335,000 people have obtained a university degree.

Sadly, in our country, those affected by severe chronic diseases that require frequent hospitalisation or absence from school are still not guaranteed the right to higher education. Our public school system is structured according to an equalitarian logic of resource distribution that has become increasingly limited over the years: only the first year of school is guaranteed for all, with higher levels reserved for those who can demonstrate their worth (Sullivan, 2004; Mijs, 2016). However, those affected are often too unwell and exhausted to do so, meaning they are at risk of becoming poor and marginalised in a neoliberal society based on competition (Baldacci, 2019).

This issue probably doesn't only concern hospital schools or home instruction, but schools themselves. Things could only change if universities started talking to future teachers about the real needs of these children and adolescents. This paper aims to suggest a new approach to teacher education in both hospital and ordinary schools, so that teachers can understand the complexity of the illness experience in younger people. Finding the courage to be compassionate (Nussbaum, 2003), showing empathy for what these young people consider important in their lives (Frankl, 1993) and letting them talk about their experiences (McLaren, 2015; Giroux, 1991) are ways of helping them to recognise their own worth and to fight for their rights in the school community (Freire, 1967), rather than remaining marginalised, pitied and assisted with personalised learning plans focused to the acquisition of knowledge credits, better if STEM.

The hospital school (S.i.O.) is one of the models of excellence in the national education system and is a true laboratory for research and innovation (Ministerial Decree 641/2019). The hospital school service was the first to experiment with and validate new pedagogical and teaching models, aimed at: organizational, methodological, and evaluation flexibility; the personalization of teaching and learning activities; the educational use of technology; and special attention to the educational relationship.

The S.i.O. operates in school sections dependent on state schools, for which its operation is authorized within the hospital based on specific agreements between the schools and the hospital trusts/foundations.

Educational and teaching activities are conducted in accordance with therapeutic and healthcare priorities, a complex "balance" to establish and maintain due to the concrete risks of discontinuity in educational and learning processes, resulting in a reduction/impoverishment of educational opportunities and social isolation.

Hospital schooling allows for the continuity of studies and guarantees the fundamental rights to education and health, enshrined in the Constitution, pursuant to Articles 3, 34, and 38.

The person-patient-student status is shared by all professionals, both healthcare professionals and teachers, with whom we come into contact according to the principle of the therapeutic alliance. This establishes a coordinated professional collaboration that places the patient-student at the center of healthcare and educational-teaching efforts.

From an educational-teaching perspective, it would be essential to optimize the opportunities offered by institutional school policies from the perspective of inclusive policies (Booth & Ainscow, 2014) in terms of psychological-relational assistance, educational-teaching approaches/practices geared toward personalization, and the use of modern technologies.

Of particular interest are the National Digital School Plan, experiences such as INDIRE's Educational Avant-garde, and, above all, the National Network of Hospital Schools, which share experiences and research gained over the years and propose customizable and individualized models for an inclusive learning curriculum. With regard to the latter (the curriculum), it is important to focus not only on teaching interventions, but also on the organization of space and time, materials, and resources, and ensure that it is monitored according to the needs of the individual-patient-student.

Within this context, teachers play a significant role (Faraoni & Melchiori, 2024). Indeed, they must be understood as agents/carriers of an inclusive approach that transcends the logic of "special" and medicalization (Bocci, 2021). With reference to this last consideration, teachers' professional development/learning, both initial and in-service, is characterized as an element to be strengthened through research-training programs (Pomponi, 2025; 2025) capable of providing quality-rich responses to educational, didactic, and social challenges.

In light of this overview, it is clear that hospital education is a difficult and highly challenging "reality," both for the school and the hospital. This requires investigation into inclusive policies related to organizational processes, understood at various levels and with different stakeholders, that highlight the quality of hospital and home-based education.

Hospital school services are designed to guarantee educational continuity for students experiencing illness and prolonged hospitalization.

Hospital teachers work within a care-centered environment, significantly different from traditional classroom settings, in which the student’s health status is the priority (Benigno et al., 2017). Within this context, however, education is not a secondary activity but a constitutive dimension of the therapeutic pathway (Rodríguez et al., 2023).

Among the critical competencies required of professionals working in pediatric hospital settings is the ability to communicate effectively with children who present Complex Communication Needs (CCN), whether due to temporary or permanent disabilities (Costello, 2000).

The absence of effective communication strategies may represent an additional source of stress, frustration and isolation for hospitalized students, especially in contexts where speech is compromised (Pina et al., 2020). Augmentative and Alternative Communication (AAC) has been described as an effective strategy to enhance interaction, safety, and participation, also in intensive care and pediatric settings (Costello, 2000). At the same time, research on complex AAC interventions underscores the need for structured, systemic approaches that include training and coordinated support of all the communication partners involved (Costello, 2000; Rodríguez, 2023). The successful implementation of AAC in hospital school therefore requires a shared commitment and aligned practices between educational and healthcare professionals.

As research highlights the need for specific AAC training among health care professionals in clinical contexts, comparable structured preparation is equally necessary for hospital teachers, who operate within the same care-centered environment and support children with CCN (Woodring & Harmon, 2023). Building on these considerations, this paper argues that accessible communication in hospital schooling should be conceptualized as a shared domain of educational and health services. AAC is examined not merely as a compensatory tool, but as an infrastructural condition enabling agency, participation, and continuity for students with CCN, including those with neurological impairments, developmental disorders, medically induced communication limitations or non-native speakers.

The theoretical discussion is informed by preliminary findings from an exploratory survey conducted with Italian hospital teachers (n = 24). The majority of respondents report working regularly with students presenting CCN. While most of the participants declare familiarity with AAC strategies, only a minority indicate having received structured or formal training in AAC implementation. These data, while based on a non-representative and exploratory sample of Italian hospital teachers, suggest a structural asymmetry: communicative complexity is recurrent in hospital school, yet, unlike special education teachers, hospital teachers are not formally required to receive specific preparation in working with students with CCN.

From this perspective, accessible communication emerges as a systemic responsibility rather than an individual initiative. If communicative mediation depends primarily on personal experience or informal knowledge, students’ effective access to both learning and care may vary across contexts, raising concerns of educational and health justice. The paper calls for the integration of communicative accessibility into teacher training models and interprofessional collaboration in hospital schooling, framing it as a foundational condition for inclusive and equitable continuity in clinical-educational environments.

Severe illness and chronic pain conditions do not merely cause school attendance interruptions but impact the temporal, relational, and agentive structure of the subject's experience. In this sense, hospital and home schooling can be further valorized not only as compensatory measures for curricular continuity but as practices capable of sustaining experiential continuity in situations of vulnerability.

This contribution proposes expanding the notion of educational continuity through an ontological, phenomenological, and hermeneutic perspective on pain, understood as a temporal and transformative process of experience. Pain, especially in chronic or protracted forms, does not present itself as an isolated episodic event but as a qualitative reorganization of the experiential horizon. It reconfigures the field of perceived possibilities - what, in ecological terms starting from Gibson and in recent enactive reinterpretations (Coninx & Stilwell, 2021), has been described as the field of affordances, i.e., perceived possibilities for action - restricting access to practices, relationships, and future projects. Illness alters time perception, compromises projectuality, and modifies the sense of belonging to the school and social context.

In this framework, school interruption is not merely an organizational issue but can amplify a discontinuity already underway on the experiential level. The absence of shared educational practices risks consolidating the contraction of the subject's horizon of possibilities. Conversely, the pedagogical relationship in hospital or home settings can contribute to reopening the agentive field: through relational continuity, the ritual of learning, and linguistic and hermeneutic mediation, understood also as a dialogical space of mutual recognition (Gadamer, 2018), it supports the connection between past, present, and future, countering relational isolation and fostering the narrative coherence of the student's identity. The analysis integrates phenomenological and narrative studies on pain - including research on the ontological modelling of pain narratives drawn from a dataset of over 800 accounts (Cipriani 2025) - with a neurophenomenological perspective, recognizing that transformations in painful experience involve bodily, affective, and cognitive dimensions, including capacities for anticipation and planning, dimensions directly implicated in the student's ability to engage with educational processes. In this perspective, educational continuity concerns not only access to content but the recognition of the student as a temporal and projective subject whose experience has been reorganized by illness.

The objective is not to replace existing pedagogical models but to offer a theoretical framework capable of dialoguing with them and making explicit the temporal and relational dimensions already operative in educational practices. From this viewpoint, educational justice does not exhaust itself in formal equality of opportunities but implies support for reconstructing the horizon of possibilities of the ill student.

Hospital and home schooling thus emerges not only as a didactic intervention but as a pedagogical care practice that contributes to recomposing the existential continuity interrupted by illness.