Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 1 | 11 POLICY BRIEF Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom Joni Kusters1, Mareike Annemarie Millner1, Karina Omelyanovskaya1, Mehmet Mikail Tangerli1, Agata Laszewska2, Robin van Kessel1 1Department of International Health, Faculty of Health, Medicine, and Life Sciences, Maastricht University, The Netherlands 2Department of Health Economics, Center for Public Health, Medical University of Vienna, Aus- tria Corresponding author: Robin van Kessel, PhD r.vankessel@maastrichtuniversity.nl mailto:r.vankessel@maastrichtuniversity.nl Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 2 | 11 Abstract Context: Access to education is a fundamental right that should be realised to the degree that every child can develop their talents to the fullest potential. Therefore, children with special education needs and disabilities (SEND) have the right to claim resources and aid to function in schools and should not be excluded from any level of mainstream education. However, the process towards executing this fundamental right is slowed down by existing ableist structures. Policy Options: This policy brief analyses inclusive education policies from the perspective of four different European Countries (Italy, the Netherlands, Poland, and the United Kingdom). The data was synthesised using four types of ableism that are addressed in this policy brief. The gaps within definitions and argumentation were identified and discussed to provide recommendations concerning education for people with SEND. Recommendations: The evaluation provided three significant recommendations towards inclu- sive education systems by addressing ableist structures. Firstly, it is crucial to reduce the linguistic gaps between national educational policies and the underlying national laws. Secondly, it is nec- essary to include the target group and raise awareness for SEND to reinforce societal and scientific perspectives, and influence policy decision-making. Lastly, it is important to address the discrep- ancies between the inclusive education policies and the structural capacity. The synergy between these two key factors is crucial for an effective implementation of inclusive education. Keywords: SEND, SEN, Disabilities, Ableism, Policy, Autism, Inequality Acknowledgments: We thank Robin van Kessel, our senior advisor, and Dr Katarzyna Czaban- owska for the opportunity to explore this topic as part of the Leadership track in the Master Gov- ernance and Leadership in European Public Health. Authors’ contributions: All authors contributed equally to this work. Conflict of interest: None declared Source of funding: None declared Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 3 | 11 Introduction Autism is a neurodevelopmental condition that mainly manifests in language compre- hension and behavioral differences (1). It is a part of the neurodiversity framework, which advocates that individuals with biological differences do not necessarily “need a correc- tion” (1). Just as the perception of autism and other developmental conditions has changed over time from an impairment, a disorder, or a disability, national and international poli- cies and laws targeting these conditions have changed accordingly. The latest international cornerstone of this change is found in the Convention on the Rights of Persons with Disabilities (2). It adopted a broad categori- zation of special educational needs and disa- bilities (SEND) and indicated that— irre- spectively of the type of SEND—every indi- viduals’ human rights should be enforced and respected (2). Article 24 of the CRPD de- clares that access to education is a fundamen- tal right that should be realized to the degree that every child can develop their talents to the fullest potential and effectively partici- pate within society. It specifies that children with SEND have the right to claim resources and aid to function in schools, and that they may not be excluded from any level of main- stream education (2). However, discrepan- cies continue to exist for people with SEND in accessing education, such as lack of re- sources and lack of appropriate infrastructure (3). These discrepancies stem from various sources, one of which is a lack of uniformity in terminology regarding SEND, which is rooted in the everyday use of ableist language when drafting policies for people with SEND (4,5). Ableism is prejudice towards individu- als with SEND. This prejudice can manifest itself through (6): affective emotions, behav- ioral actions and practice, and cognitive be- liefs and stereotypes. The expression of ableist attitudes through these three attitude categories does not necessarily consist of bla- tantly negative attitudes towards people with SEND. Nario-Redmond describes that “prej- udice often occurs between individuals inter- acting at the interpersonal level”, and “rep- resents beliefs and motivations that derive from belonging to particular groups – groups of ‘us’ and ‘them’ – groups often motivated to maintain their status difference” (6). This ‘us’ versus ‘them’ mentality is one of the main barriers in equity-related issues con- cerning inclusion (6,7). People with SEND are not only affected by aggression targeted towards their SEND. They are also exposed to pity or paternalistic attitudes from the gen- eral population. These attitudes are based on the assumption that atypical people might re- quire ‘help’ from abled people to function and flourish within society (6). However, this can lead to the infantilization of people with SEND or to various degrees of ostracism. This ostracism should be a public concern as ableism does not only affect a minority con- sistently but may impact the majority of the population intermittently/temporarily at some point during their lifetime (8). Accord- ing to the theory of social constructivism, there is a discrepancy between SEND’s soci- etal and individual perspective (9). Just as terminology and perception of racial minori- ties and gender change, so can the societal perspective on SEND. This continuous pro- cess requires ableism to be addressed and acknowledged to prevent an environment where outsiders are privileged, and insiders are disadvantaged (9). The four main types of ableism addressed within this policy brief are academic-, institutional-, cultural, and lan- guage ableism as presented in Appendix I. Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 4 | 11 All these types refer to insufficient recogni- tion of SEND, the existence of pervasive and archaic policies that disadvantage individuals based on their abilities, and the application of non-inclusive language, furthering the dual- istic thinking of normal and abnormal (10– 12). A potential response to these types of ableism can be found in inclusive education - education in which children with SEND par- ticipate alongside typical students in educa- tion (13). Inclusive education impacts stu- dents both with and without SEND (13). Generally, inclusive education had a positive impact on academic efforts and social atti- tudes and beliefs in children without SEND (13). Five significant positive effects of at- tending class alongside children with SEND were: 1. Reduced fear of human differences, com- plemented by comfort and awareness 2. Increase of social cognition, such as in- creased tolerance and effective communi- cation 3. Self-improvements in the form of in- creased self-esteem, perceived status, and sense of belonging 4. Advancement in morality and ethical principles 5. Caring friendships Children with SEND benefited socially (e.g. forming and maintaining positive peer rela- tionships and better social skill development) and academically (e.g. increasing years of completed education) from being included in mainstream education (13). Context The policy brief aimed to map ableism within four European countries (Italy, Poland, the Netherlands, and the United Kingdom) by ex- ploring the use of language in their SEND and inclusive education policies. These four countries have all signed the Salamanca Statement 1994 and therefore have a com- mon ground in their goals regarding an inclu- sive education system for children with SEND (14). The brief focused specifically on the inclusion practices regarding people on the autism spectrum, as one policy brief would not be able to adequately address the full range of neurodiversity. The policy brief will serve as a call to action to the authorities within the medical, social and educational fields of European countries’ contexts. It will give recommendations to further inclusion and decrease ableist structures. Policy Options Italy The Italian government started integrating persons with SEND in mainstream education in the 1970s (15). An important example of Italian integration is the implementation of Law 517/77. It aimed to address institutional ableism by eradicating the idea that SEND should be seen as an ailment instead of a di- mension of diversity (16). However, the as- sessment by D’Alessio shows that policies after 1977 seemed to digress from using in- clusive language (17). Law No. 104/1992, which was supposed to remove barriers to in- clude people with SEND within mainstream education, heavily relied on the medical per- spective. The same pattern could be observed in the update of the national guidelines on au- tism (17). The heavy inclusion of the medical model re-linked SEND and defect (institu- tional ableism) and re-established the ‘they versus us’ mentality (cultural ableism) and language non-inclusion (18). Moreover, Ferri reports that the most apparent ableist struc- tures could be observed in the gaps within the practical implementation of current inclusive values (19). The main complaints concerned alleged discrimination/exclusion in schools, Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 5 | 11 challenges against the level of support school’s offer, and lack/incorrect implemen- tation of inclusion strategies (15,19). In the European Court of Human Rights a case of a primary school pupil (G.L.) on the autism spectrum, Italy did not successfully provide tailored support or adequate, equal conditions to continue primary school education. The Italian government blamed the poor enforce- ment of inclusive rights on a lack of financial resources (20). The European Courts of the Human Rights’ case revealed that ableist structures remain in place, hindering inclusive education within the Italian system (9,20). D’Alessio contests that financial resources are the main problem. The author believes that the poor implemen- tation of inclusion strategies within schools is a consequence of substantial decentralization and power imbalances between the state and educational facilities. In educational institu- tions, ministerial documents tend to be treated as recommendations and guidelines instead of legislation (18). The lack of con- sistency in implementing inclusion strategies and the resulting access barriers for people with SEND showed recognizable patterns of academic ableism (10). Poland Pogodzińska defined four education options for children with SEN: (1) regular schools without any programs for pupils with SEND, (2) regular schools, with a focus on providing inclusive education, (3) integration schools for pupils with SEND, and (4) special schools and special residential schools (21). Polish education is based on the rule that all individ- uals with SEND will be provided with suffi- cient aid to participate within society (22). Compared to the 1990s, the inclusion of chil- dren with SEND in mainstream education has significantly improved. According to Plichta the number of children with SEND who at- tended special schools has decreased fourfold due to the implementation of integration clas- ses in the last 25 years: in 1990-1991, the number of children with SEND was 84.317, whereas it was only 24.303 in 2015-2016 (23). However, research of the European Par- liament demonstrated that there is still a lack of understanding of how to implement inclu- sive education policies in practice (20, 22) Moreover, the Supreme Audit Office ob- served that only half of the audited institu- tions had met the criteria for implementing inclusive education. In seven out of ten au- dited schools, no educational strategies for the pupils with SEND were implemented (24). The lack of inclusive education policies was ascribed to a wrong interpretation of SEND (21). Students with SEND were often still perceived as disabled and advised to fol- low education in special schools. Po- godzińska argued that SEND should not equate to a necessity of sending individuals to special schools but that pupils with SEND should have the choice to receive guidance within the same educational environment as students that do not have SEND (21). The Netherlands The inclusion of people with SEND in the Netherlands is grounded in the law of ‘Equal Treatment on the Grounds of Disability and Chronic Illness’, and intends further equal so- cial participation and offer protection against discrimination based on ‘disabilities or chronic illnesses’ (25,26). In this legal docu- ment, the meaning of ‘disabilities or chronic illnesses’ was not specified and used as an overarching term. From secondary sources, it became evident that the terms ‘disabilities and chronic illnesses were defined as long- term physical, mental, and psychological dis- orders (26,27). The use of overarching terms Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 6 | 11 and the lack of specificity are examples of in- stitutional ableism. Additionally, a report on the CRPD implementation from the Nether- lands Institute of Human Rights stated that the law ‘Equal Treatment on the Grounds of Disability and Chronic Illnesses’ and the Ap- propriate Education Act, the legal basis of the “Education that fits “- a policy which aimed to find the best fitting educational context per individual, were not designed to achieve in- clusive education (3,28). Mainstream schools were, more often than not, not properly equipped to accommodate SEND children. Therefore, these children ultimately had to at- tend separate special schools (3). The availa- ble legislation gave the impression of inclu- sion in different contexts, including educa- tion, but in practice, barriers remained. De- spite the existence of the law, many people still experience discrimination in educational institutions. For instance, autism-related dis- crimination posed difficulties which can be seen in the denied access to higher education institutions of 55 students on the autism spec- trum (29). The United Kingdom The Equality Act 2010 in the United King- dom (UK) stated that that a person has a dis- ability if (a) they have a physical or mental impairment, and (b) the impairment has a substantial and long-term adverse effect on the person’s ability to carry out normal day- to-day activities (30). However, the UK De- partment for Education defined SEN as “a child or young person has SEN if they have a learning difficulty or disability which calls for special educational provision to be made for him or her” (31). Besides, a child of com- pulsory school age or a young person has a SEN if they (a) have significantly greater dif- ficulty in learning than the majority of others of the same age, or (b) have a disability which prevents or hinders them from making use of facilities of a kind generally provided for oth- ers of the same age in mainstream schools or mainstream post-16 institutions (31).This stands in stark contrast to the definition by Equality Act 2010, as stated above. The dif- ferences in the definitions were linked to a pupil’s biological diversity (e.g., physical or mental impairment) versus their ability to learn (e.g., relative learning difficulties). Additionally, the Department Education stated that SEN knows four dimensions; health, behavioral, social, and emotional needs (32). These different dimensions had little to no description and were not mentioned in the Equality Act 2010 (30). As the Equality Act 2010 focuses on pupils with disabilities, it as- sumes that children with SEN can be consid- ered disabled in practice. The statement of the Department for Education on comparability and feasibility of provisions for children with SEND confirmed this finding: “Children and young people with such conditions do not necessarily have SEN, but there is a signifi- cant overlap between disabled children and young people and those with SEN. Where a disabled child or young person requires spe- cial educational provision, they will also be covered by the SEN definition” (31). This discrepancy between the definitions pro- vided by the statutory guidance by the De- partment for Education and the Equality Act (2010) was an example of issues related to language ableism (10). This could eventually result in a continuation of how children with SEN are medicalized and perceived as disa- bled (10). Recommendations This policy brief aimed to address ableism and the discrimination against people with Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 7 | 11 SEND, hindering the implementation of in- clusive education. In order to create an over- view of the extensiveness of ableism, we dis- tinguished four specific types of ableism: ac- ademic, institutional, cultural, and language ableism. To illustrate the possible ways able- ism could manifest, we explored the educa- tional policy environments of four European countries (Italy, the Netherlands, the United Kingdom, and Poland) due to the close asso- ciation that education policy has had with SEND-related measures. All these countries have ratified the CRPD and signed the Sala- manca statement, stating that they would im- prove the inclusion of people with SEND within their educational systems. Significant improvements towards inclusive educational systems included integrating spe- cial education and mainstream education, and additional provisions for children and indi- viduals with SEND. However, more im- provements need to be made. We have iden- tified three critical improvements based on our findings. Firstly, the analysis on policy documents showed that there are discrepancies concern- ing definitions within the policy documents and the underlying laws. Whereas the policy documents addressed SEND as an overarch- ing theme within educational policies, the un- derlying laws leaned towards defining SEND as disabilities, thus reinforcing the ableist thinking. During the implementation of in- clusive education policies, we would recom- mend to rely on a consistent manner of defin- ing and addressing SEND. When addressing SEND in educational policies, public health professionals need to be aware of the differ- ences in the medical and social perspectives of SEND to improve inclusive education. This would require a certain degree of repre- sentation of SEND population groups, as will be discussed in recommendation two. Sec- ondly, to prevent further discrimination and stigmatisation of individuals with SEN, it is crucial to develop awareness to address soci- etal and cultural perceptions of ableism. If the limited knowledge about SEND is not in- creased, stigmatisation of individuals will be maintained. Therefore, individuals with SEND and SEN-oriented professionals should more often be at the forefront of the inclusive education discussion. Institutions or educational facilities could integrate individ- uals on a volunteer basis to improve the mod- ern perception of ableism. In order to raise awareness about inclusive education, we would suggest familiarising in- clusive education professionals with their tar- get group and involving SEND individuals in political decision-making to prevent further stigmatisation of these specific population groups. This could be achieved by engaging with stakeholders and interested parties advo- cating SEND inclusion in decision-making processes to reinforce the actual target group’s perspectives in policies concerning them. Lastly, we want to emphasise the need for in- clusive infrastructures, such as equipped playgrounds, study halls, libraries, food ar- eas, and elevators to increase mainstream school access for students with SEND. Our analysis of the European Countries con- cluded that a synergy needs to be in place be- tween inclusive education policies and the in- frastructural capacity in practice. Having in- clusive education policies in place would not directly result in the effective implementation of inclusive education, as structural barriers could inhibit the effectiveness of these spe- cific policies. Including infrastructural capac- ity within national contexts would be a criti- cal factor in ensuring that children with SEND have the freedom to choose between different types of schools without fear of be- ing discriminated against and excluded by their peers. In general, children in schools Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 8 | 11 should more often be introduced to the idea of having a diverse circle of peers as it will contribute to both their personal develop- ment, as the dismantling of societal ableism. Conclusions The equal access to education for people with SEND has progressed positively since the CRPD. Perspectives have changed concern- ing the inclusion of people with SEND within educational policies, aiming for a less segre- gated approach and opting for more inclusive policies towards these population groups. This process is valuable, but it is important that inclusive education is a continuous pro- cess subject to societal perspectives and norms which are to this day influenced by medical perspectives, and the infrastructure to include people with SEND in what we still call ‘mainstream education’. References 1. Baron-Cohen S. Editorial Perspective: Neurodiversity – a revolutionary concept for autism and psychiatry. J Child Psy- chol Psychiatry Allied Discip. 2017;58(6):744–7. 2. United Nations. United Nations Conven- tion on the Rights of Persons with Disa- bilities (CRPD). 2006; 3. van Kessel R, Roman-Urrestarazu A, Ruigrok A, Holt R, Commers M, Hoeks- tra RA, et al. Autism and family involve- ment in the right to education in the EU: policy mapping in the Netherlands, Bel- gium and Germany. Mol Autism. 2019 Dec 9;10:43. 4. United Nations. Rights of persons with disabilities: Report of the Special Rap- porteur on the rights of persons with dis- abilities. 2019. 5. Smyth F, Shevlin M, Buchner T, Biewer G, Flynn P, Latimier C, et al. Inclusive education in progress: policy evolution in four European countries. Eur J Spec Needs Educ. 2014;29(4):433–45. 6. Nario-Redmond MR. Ableism: the causes and consequences of disability prejudice. Hoboken: John Wiley & Sons, Ltd; 2020. 7. United Nations. United Nations Human Rights Declaration. 1948;2. 8. World Health Organisation. World re- port on disability. Disability and rehabil- itation. 2011. 9. Bogart KR, Dunn DS. Ableism Special Issue Introduction. J Soc Issues. 2019;75(3). 10. Dolmage J. Academic Ableism. Ann Ar- bor, MI: University of Michigan Press; 2017. 11. Chaney P. Institutional Ableism, Critical Actors and the Substantive Representa- tion of Disabled People: Evidence from the UK Parliament 1940–2012. J Legis Stud. 2015;21(2):168–91. 12. Darrow A-A. Ableism and Social Jus- tice. Oxford Handb Soc justice Music Educ. 2015;204. 13. Hehir T, Grindal T, Freeman B, Lamoreau R, Borquaye Y, Burke S, et al. a Summary of the Evidence on Inclu- sive Education. Inst Alana. 2016;1–34. 14. United Nations. Salamanca Statement and Framework in Action. 1994; 15. Ianes D, Demo H, Zambotti F. Integra- tion in Italian schools: Teachers’ percep- tions regarding day-to-day practice and its effectiveness. Int J Incl Educ. 2014;18(6):626–53. 16. Calder-Dawe O, Witten K, Carroll P. Being the body in question: young peo- ple’s accounts of everyday ableism, visi- bility and disability. Disabil Soc. 2020;35(1):132–55. Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 9 | 11 17. Autism Europe. Italy updates national guidelines on autism. 2018. 18. D’Alessio S. Inclusive Education in Italy A Critical Analysis of the Policy of Inte- grazione Scolastica Simona. Vol. 3, So- ciety. Integration. Education. Proceed- ings of the International Scientific Con- ference. 2011. 19. Ferri D. Inclusive Education in Italy: A Legal Appraisal 10 Year after the Signa- ture of the UN Convention on the Rights of Persons with Disabilities. Ric di Peda- gog e Didatt – J Theor Res Educ. 2017;12(2). 20. Autism Europe. The European Court of Human Rights condemns Italy for dis- crimination against an autistic pupil. 2020. 21. Pogodzińska P. Country Report on Po- land for the Study on Member States’ Policies for Children with Disabilities. 2013. 22. Constitutional Committee of the Na- tional Assembly. The Constitution of the Republic of Poland of 2nd of April, 1997. Dz Ustaw. 1997;78(483). 23. Plichta P. Edukacja dzieci i młodzieży- wybrane wyzwania i obszary nierówn- ości [Education of children and youth - selected challenges and areas of inequal- ity]. Dziecko krzywdzone Teor badania, Prakt. 2017;16(1):146–71. 24. Supreme Audit Office. Wsparcie osób z autyzmem i zespołem aspergera w przygotowaniu do samodzielnego funkc- jonowania [Support for people with Au- tism and Asperger syndrome to prepare them to live a self-determined life]. 2020; 25. European Agency for special needs and inclusive education. Country policy re- view and analysis: Netherlands. Brus- sels; 2020. 26. College of Human Rights. Onderwijs met een beperking. Available from: https://mensenrechten.nl/nl/sub- page/onderwijs-met-een-beperking 27. Council of State. Wet gelijke behande- ling op grond van handicap of chro- nische ziekte. 2003. 28. Holtmaat R. Autism-related discrimina- tion in the field of education. 2013; 29. Schuman H. Passend onderwijs: pas op de plaats of stap vooruit. Tijdschr voor Orthop. 2007;46(6):266–78. 30. Parliament of the United Kingdom. Equality Act. 2010. 31. Department for Education. Special edu- cational needs and disability code of practice: 0 to 25 years. 2015. 32. Department for Education. Ensuring a good education for children who cannot attend school because of health needs. 2013. 33. Smith L, Foley PF, Chaney MP. Ad- dressing classism, ableism, and hetero- sexism in counselor education. J Couns Dev. 2008;86(3):303–9. 34. McLaughlin J. The medical reshaping of disabled bodies as a response to stigma and a route to normality. Med Humanit. 2017;43(4):244–50. https://mensenrechten.nl/nl/subpage/onderwijs-met-een-beperking https://mensenrechten.nl/nl/subpage/onderwijs-met-een-beperking Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 10 | 11 Appendices Appendix 1 - The four main types of ableism Academic ableism: educational institutions fail to recognize the specific needs of people with SEND and assume they will thrive in mainstream education without specific having these needs met (10). Individuals with SEND are regarded as study and research objects rather than students, teachers and even policymakers–as a result, marginalized groups are even more stigmatized (10). Structural ableism creates barriers for people with SEND, such as lack of access to resources as well as participation in society. It thus contributes to further institutionalization of ableism (10). Institutional ableism: the existence of systematic, pervasive and habitual policies that disad- vantage individuals based on their abilities (11). The reality of unconscious ableism plays a sig- nificant role on different societal levels, and it is a social construct which many people are unaware of (11). The dominant perspective of modern society sees SEND statutes as a defect, rather than a dimension of difference (11,33,34). Therefore, in a societal context, health and wellbeing are strongly associated with the absence of conditions. Being unhealthy or unwell, in turn, is deter- mined by the presence of developmental needs, which are generally described as disabilities, im- pairments, and disorders (16). This results in a belief that people with developmental conditions need to be fixed to be a full member of society (16,33). In a health care context, this results in the urge towards medicalizing behavior of people with SEND (16). Cultural ableism: the persistent way of binary social organization which is closely related to the western traditions of dualistic thinking (34). This results in the classification of people in everyday life as being either abnormal or normal (34). This day-to-day classification which we enact, both consciously and subcon- sciously, is referred to as everyday ableism (16). Language ableism: application of non-inclusive language which furthers the dualistic thinking of normal and abnormal (12). The correct use of language is essential, as language is a crucial factor in how the perception of others can be influ- enced. The main reason for SEND-related, inappropriate terminology is often the lack of aware- ness (12). Appendix II. Methods and Search Strategy The data was collected based on four identified key forms of ableism (academic, institutional, cultural, or language ableism) and consequently analyzed within the policy mapping procedure. The data synthesis process for the four selected countries consisted of four consecutive steps: (1) Identifying, screening and assessing educational policies on their inclusion towards peo- ple with SEND. Relevant educational policies concerning children with SEND were extracted from national sources. (2) Identifying, screening and assessing relevant academic articles on their inclusion towards people with SEND. These articles were used in addition to national policies when language-related barriers occurred. The search strategy Appendix II was executed using PubMed and Scopus. The content of the articles was screened for inclusion of student populations with SEND and the im- plementation of national SEND-related policies. (3) Coding of documents based on the four ableism types. Content from national policy doc- uments was evaluated on the presence of ableist reasoning, definitions, and discrepancies. The content of the policy documents was reviewed for argumentation gaps and definitions that rely on the medical perspective rather than the social dimension of SEND. Definitions concerning SEND Kusters, J.; Millner, M.A.; Omelyanovskaya, K.; Tangerli, M.M.; Laszewska, A.; van Kessel, R. Addressing ableism in inclusive education policies: a policy brief outlining Italy, Poland, the Netherlands and the United Kingdom (Policy brief). SEEJPH 2021, posted: 18 August 2021. DOI: 10.11576/seejph-4681 P a g e 11 | 11 © 2021 Kusters et al.; This is an Open Access article distributed under the terms of the Creative Commons Attrib- ution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and re- production in any medium, provided the original work is properly cited. were extracted from these policies. Underlying laws were analyzed to attain complete definitions of SEND and to analyse discrepancies between the documents. In addition, academic articles were analysed using the framework, e.g., arguments on national policies concerning SEND definitions and practical implementations. (4) Synthesising and reporting the data. The results of the evaluations of the policies and ad- ditional papers were discussed for each respective country, highlighting discrepancies in defini- tions, theory, and practice. Search do- main Definition Key words Population group Children with SEND (Children OR students or pupils) AND (SEND OR SEN OR disabilit* OR ableis* OR impairment* OR “special educa- tion need*”) Policy do- main Educational policies (Education* OR school* OR policy OR polcies) National context Italy, the Netherlands, Po- land, and the United King- dom (Ital* OR Netherlands OR Dutch OR Polish OR Poland OR “United Kingdom” OR UK) Countries Search Queries Italy (Children OR students or pupils) AND (SEND OR SEN OR disabilit* OR ableis* OR impairment* OR “special education need*”) AND (Education* OR school* OR policy OR polcies) AND (Ital*) The Nether- lands (Children OR students or pupils) AND (SEND OR SEN OR disabilit* OR ableis* OR impairment* OR “special education need*”) AND (Education* OR school* OR policy OR polcies) AND (Netherlands OR Dutch) Poland (Children OR students or pupils) AND (SEND OR SEN OR disabilit* OR ableis* OR impairment* OR “special education need*”) AND (Education* OR school* OR policy OR polcies) AND (Polish OR Poland) TheUnited Kingdom (Children OR students or pupils) AND (SEND OR SEN OR disabilit* OR ableis* OR impairment* OR “special education need*”) AND (Education* OR school* OR policy OR polcies) AND (“United Kingdom” OR UK) Italy Poland The Netherlands The United Kingdom