Over the last two decades, the nature of the teachers' work has undergone significant structural changes due both to political, social, organizational, technological, and philosophical factors (Curchod-Ruedi et al., 2013). In this regard, the principle of inclusion of students with special needs education (SNE) in regular classrooms - supported by international conventions, such as the United Nations Convention on the Rights of Persons with Disabilities and the UNESCO Salamanca Statement on Principles, Policy and Practice in SNE - has changed the roles and functions of many school actors. In Switzerland, as in many other countries, public schools must ensure a free and an adequate education in order to support the progress of students with SNE (Sam et al., 2020). However, data from 20 countries reveal that Switzerland is one of the least inclusive countries in Western Europe (European Agency for Development in Special Needs Education, 2010): in most Swiss provinces, the majority of children with SNE attend special schools in institutions, special classes in public schools according to their performance levels (European Agency for Development in Special Needs Education, 2012), although since 1980, an inclusive school model has emerged in Switzerland, especially in some provinces as Tessin or Valais. According to data from the Federal Statistic Office, Bless (2017) reported a separation rate in Switzerland close to 3.4%, with great differences from one canton to another (1.15% in Obwalden, 3.4% in Fribourg, 5.78% in Schaffhausen). In fact, the Swiss education system uses a wide range of options to accomplish its selective mission, which inevitably have consequences on the educational path of the pupils (Bless, 2017). In some cantons, as Fribourg, the implementation of an inclusive school model which led to the creation of an Integration Service to support the schooling of students with SNE (Conférence Suisse des Directeurs de l’Instruction Publique, 2007) didn’t take place until 1999. Since then, the number of integrated pupils has continued to increase in Fribourg, like the number of SETs working in inclusive settings.

By law, teachers must establish individualized educational goals that guide the program the school provides to each pupil (Sam et al., 2020). From a legal point of view, both SETs and regular teachers are responsible for the development of students and their social integration. In this regard, the Profile of Inclusive Teachers, published by the European Agency for Development in Special Needs Education (2012) states that the ability to work with other people and collaborate is an essential requirement for any pedagogue (Milteniene and Venclovaite, 2012). This responsibility is based on collaborative practices that require SETs to adapt to the diversity of their colleagues in terms of inclusive policies (Done and Murphy, 2018). However, this vision of harmonious relations and complementary approaches can be very different depending on the teaching contexts (Boulanger et al., 2012). In fact, the implementation of inclusive policies can interfere with the pedagogical beliefs and values of the different partners, making the roles and functions of SETs so complex that some perceive a loss of their professional identity (Maillard, 2017), leading to premature leaving teaching job and burnout risks. This loss of identity can be explained, among other reasons, by the fact that in mainstream education, curricula and teaching contents are usually not discussed or negotiated with other professionals, the mainstream teacher being generally the sole responsible for his or her class. In contrast, in special education, a large part of the functioning, programs, and contents are interpreted, discussed, negotiated, and decided upon in a multi-professional approach (Emery, 2016). Thus, working in an inclusive or non-inclusive context cannot be considered without taking into account the different variables related to collaboration. On this topic, some researchers note the difficulties of collaboration in inclusive contexts (Delorme, 2015), which could have an impact on teachers' professional burnout.

If teaching is considered a profession at risk of burnout, this is mainly explained by the high level of relational demand it places on teachers (Betoret, 2009; Gavish and Friedman, 2010; Squillaci, 2020d). The 11th revision of the International Classification of Diseases (ICD-11) defines burnout as the result of a chronic work stress not successfully managed. This syndrome is characterized by three dimensions (World Health Organization [WHO], 2018): 1. Feelings of emotional exhaustion (EE). 2. Feelings of cynicism, depersonalization (D) in relation to work. 3. Lack of personal achievement (PA). This definition is based on the three-dimensional burnout model of Maslach (Maslach and Leiter, 2016). A recent literature review (k = 45 results studies) revealed worrying percentages of burnout with only 18.4% of teachers at low risk for EE (76,4% at moderate risk and 5.2% at high risk), with 38.1% of teachers at low risk for D (60.8% at moderate risk and 1.1% at high risk) and with only 0.4 of teachers (one study out of 45 results) at low risk for PA (12.7% at moderate risk and 86.9% at high risk) (Squillaci, 2020a).

The high proportion of burnout teachers has generated a vast amount of research to identify the risk factors related to this syndrome. To this end, interpersonal variables are studied with specific attention, as studies show that burnout especially affects people in professions with high relational demands (Maslach and Leiter, 2016). The most studied factors regarding collaboration concern the quality of relationships with supervisors, parents, colleagues, and students, as well as role conflicts and lack of decision latitude (Curchod-Ruedi et al., 2009; Özer and Beycioglu 2010; Dyrbye et al., 2014). To our knowledge, there are no meta-analyses or systematic reviews available of the effects of collaboration on health in different contexts (e.g., inclusive vs. non-inclusive). The majority of research in the field tends to focus on teachers' attitudes toward inclusion. For this reason, the present research analyses the effects of the teaching contexts on perceived health by examining the collaborative variables through a systematic review of the literature and an empirical research.

Literature searches adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results of each study were reported by two persons (one author and a master-level student) in order to identify discrepancies. Literature searches of articles published between 1996 and 2016 were conducted in various databases: Medline, Pubmed, Sciencedirect, Springer, Eric, Scopus, ProQuest and PsychInfo. Key terms used in searches included Maslach Burnout Inventory OR MBI AND teachers OR special education teacher OR SETs AND risk factors OR individual OR interpersonal OR organizational. For the systematic review, articles were selected on eight inclusion criteria: 1. Are based on Maslach's model. 2. Use the MBI as a tool to assess burnout. 3. Present quantitative results in all three dimensions (EE-D-PA). 4. Include sample teachers or SETs. 5. Report means and standard deviations in the three dimensions of the MBI. 6. Have been published in scientific journals. 7. Include a sample of more than 45 teachers. 8. Include results in link with the selected interpersonal or collaborative variables (school context and lack of control, decision latitude, relationships with parents, pupils, colleagues, school principal). The literature review identified 117 cross-sectional studies, 202 study results of which 74 concerned collaborative variables (80 individual factors and 48 organizational factors). For each study (details available on request), following categories have been reported: authors, date, characteristics of the sample, means and standard deviation in the three burnout dimensions, effects of the independent variables on the three dimensions, p-value and effect size (if measured).

Table 1 highlighted 18 study results linked to collaboration and teachers’ burnout. School context can generate role conflicts influencing all the three dimensions particularly EE (16 studies out of 18) and D (12 of 18), while PA is affected to a lower extent (8 of 18) (e.g., Doef and Maes, 2002; Wilkerson and Bellini, 2006). According to the review, teaching requires the articulation of several simultaneous roles (instructive, educational, administrative and therapeutic) and carrying several roles simultaneously is considered as a risk factor for burnout (e.g., Kokkinos, 2007; Meng, 2010; Ghorpade et al., 2011). With the increasing number of partners of the educational network, the risk of role conflicts, or even interpersonal conflicts, is greater (e.g., Doef and Maes, 2002; Rascle et al., 2009; Vercambre et al., 2009). Role conflicts arise when faced with contradicting demands, incomplete information, and possible disagreements about work objectives (Billehøj, 2007; Houlfort and Sauvé, 2010). This ambiguity of professional roles influences teachers' health (Wilkerson and Bellini, 2006; Papastylianou et al., 2009). Even if no study has focused on role conflicts by examining inclusive or separate contexts, this variable must be taken into account in the assessment of SETs’ occupational health. The increasing complexity of the teaching profession, which involves diversified skills adapted to students' needs, is likely to explain teachers' burnout (Betoret, 2009).

Table 2 summarizes 10 study results analyzing links between teachers’ health and the lack of participation in decision, a variable related to all the three burnout dimensions. Effects of this variable on EE (8 studies out of 10) and D (8 studies out of 10) are more pronounced than on PA (5 out of 10 studies). Teachers who perceive a lack of autonomy and participation in decision are more vulnerable to EE (e.g., Doef and Maes, 2002; Kokkinos, 2007) and D (e.g., Näring et al., 2006; Ponnelle, 2008). PA is also affected, but to a lower extent (e.g., Skaalvik and Sidsel, 2007; Rascle et al., 2009). Only one study conducted by Fernet et al. (2012) found no link between decision latitude and at least one of the dimensions of burnout. While research results exist for teachers, they are not available for SETs due to the lack of empirical studies including this population (Antoniou et al., 2013). However, shared decisions appear to be a determinant of teachers’ professional health, regardless of the teaching context. Studies of interpersonal variables also place particular emphasis on the support provided by the various educational partners (i.e. pupils, parents, colleagues and school principals).

Table 3 summarizes 13 study results between pupils’ relationships and teachers' burnout. Disciplinary problems, disrespect, apathy, low school functioning, learning disabilities and mental illness are major sources of stress for teachers (e.g., Betoret, 2009; Fernet et al., 2012). All three dimensions are affected, in particular PA (11 studies out of 13) but also D (10 out of 13) and EE (9 out of 13). Faced with a demotivated and apathetic audience, teachers expend considerable energy during the day to maintain, as much as possible, a positive classroom climate (Otero et al., 2008). While the quality of teacher-student relationships is one of the most rewarding aspects of the profession, it can also be a source of discouragement and emotionally draining experiences (Betoret, 2009).

Table 4 synthesizes 6 study results analyzing links between parents’ relationships and teachers’ burnout (Squillaci, 2020b). As evidenced by the results, the three dimensions are affected by conflictual relationships with parents, in particular EE (4 of 6 studies) and PA (4 of 6 studies) as well as D to a lower extent (2 of 6 studies). Authors note that working with parents can be psychologically challenging and is often perceived as a significant stress factor, especially for novice teachers (e.g., Stoeber and Rennert, 2008; Betoret, 2009). Parental pressure has an impact on D and on PA (Stoeber and Rennert, 2008) while lack of parental involvement affects EE (Betoret, 2009). Conflicts with parents, questioning school decisions and practices as well as recourse lead to teacher stress, affecting his or her health (Skaalvik and Skaalvik, 2009). The lack of shared values and goals between parents and teachers hinders collaboration and increases the risk of tension between partners (Grayson and Alvarez, 2008). Positive relationships are considered as protective factors against burnout (Zabel and Zabel, 2002). Despite the lack of research results regarding this variable, its influence must be analyzed for its possible effects on the three dimensions of burnout.

Table 5 summarizes 16 studies that examined the links between interactions with colleagues and teachers’ burnout. Relationships with colleagues have an effect on all three dimensions of burnout. The majority of studies (12 of 16) reported associations with EE, 9 with D and 10 with pA. Only two studies found no association between these variables (Doef and Maes, 2002; Gavish and Friedman, 2010). Research has shown that the more positive colleagues’ supports are perceived, the less exhausted or depersonalized teachers are and the more accomplished they are at work (e.g., Ju et al., 2015; Ho, 2016). Studies have noted the negative impact of conflict, peer pressure, and negative work climate within the team on the three dimensions of teachers’ burnout (Laugaa et al., 2008; Vercambre et al., 2009). Collegial and regular interpersonal relationships among colleagues are considered protective factors for occupational health (e.g., Stoeber and Rennert, 2008; Betoret, 2009; Baran et al., 2010).

Table 6 presents a synthesis of 10 studies that examined the links between relations with supervisors and teacher’s burnout. Among them, 8 established links with at least one of the burnout dimensions, 6 studies with all three dimensions (e.g., Betoret, 2009; Ho, 2016). The effect is confirmed on EE (8 studies out of 10), on D (7 studies out of 10) and finally on PA (7 studies out of 10). Only two studies (Doef and Maes, 2002; Gavish and Friedman, 2010) found no relationship between these variables. The level of involvement of school principals, their ability to respond to teachers’ needs are considered protective factors against burnout (e.g., Meng, 2010; Fernet et al., 2012). Knowing that the teaching profession requires a certain solitude in terms of pedagogical action, feeling supported by one's superior is considered a bulwark against EE (Squillaci, 2020c). Being supported cognitively and emotionally by one's supervisor is correlated with the three dimensions (Skaalvik and Skaalvik, 2009). Lack of support from superiors appears to be more critical than lack of support from colleagues with respect to teachers’ burnout (e.g., Zabel and Zabel, 2002; Wang et al., 2015).

What can we learn from this review? Out of the 74 study results (k = 24 studies), 68 established links between the collaborative variables and at least one of the burnout dimensions. Only 7 studies found no effect between these variables. School context and work control are the variables most studied (18 studies), followed by relationships with colleagues (16 studies), with pupils (13 studies), decision latitude and relationships with the school principal (10 studies each), and to a lower extent, relationships with parents (6 studies). It is also interesting to note the proportion of studies showing an impact on all three dimensions. Emotional exhaustion seems to be the dimension most affected by collaborative variables (work control, decision latitude and relationships with school principals), D is more specifically linked to work control and decision latitude and PA to poor relationships with students. While much research has focused on variables in link with collaboration, there is a lack of data on occupational health given the teaching context. To our knowledge, no previous study has assessed the effects of inclusive or non-inclusive contexts on the SETs’ burnout.

The present study answers the following research question: How are teaching contexts related to SETs’ burnout?

H1: The first hypothesis states that the burnout averages of SETs vary according to their work context (inclusive or separate). This hypothesis has been categorized into sub-hypotheses according to the three dimensions of the Maslach model.

• H1.1: SETs’ EE mean values vary according to the context (inclusive or separate).

H2: The second hypothesis states that collaborative variables (decision latitude, relationships with principals, etc.) are differently related to the three burnout dimensions.

• H2.1: EE mean values vary according to work control, decision latitude and relationships with principals.

Table 8 presents the distribution of SETs scores on the three dimensions of the burnout.

With respect to EE, the percentages of SETs at low risk for EE score present no significant difference between the two subgroups (χ2 = 5.728; df = 3; p = 0.126). Regarding D, the percentages at low risk do not differ significantly for both subgroups (χ2 = 2.521; df = 3; p = 0.471). Outcomes indicate that the vast majority of SETs do not appear depersonalized at work. Concerning PA, the percentages of SETs at low risk for PA present no significant difference according to teaching contexts (χ2 = 5.418; df = 3; p = 0.144). These data display that the samples present a moderate risk for PA, more particularly for SETs working in integration (only 38% feeling self-accomplished at work).

The purpose of this study was to compare the occupational health of SETs working in inclusive or non-inclusive contexts while identifying collaborative variables related to burnout dimensions in this profession.

Healthy and inclusive schools? A difficult question to which this article has attempted to answer through a systematic review and an empirical research. Results suggest a positive perception of the health of SETs regardless of the teaching context, as both subgroups do not appear to be exhausted or depersonalized. Thus, whether in an integrated or non-integrated context, the resources available appear to be sufficient to allow a positive perception of health at work. In order to provide external validity to the study, these outcomes were presented to school authorities, school principals and, most importantly, to the SETs themselves. All noted that the study results reinforced their perceptions and opinions on their work experiences. These data tend to illustrate that special education allows professionals to live in healthy conditions, an encouraging sign, as research indicates the positive impact of teachers' health not only on students’ well-being, but also on their school performances (see Emilie et al., 2018).

Interpretation of these results must take into account the strengths and limitations of the study (Squillaci, 2020d; Squillaci, 2020b). One of the first limitations is related to the fact that the perceived health at work was measured by self-administered questionnaires. This procedure does not take into account all the factors that compose teachers’ perceived health. A second limitation is related to the representativeness of the sample, the compared samples are very heterogeneous in number. Despite a proportionally high rate of respondents (more than 60%), the question of whether those affected by burnout participated in the study remains open. A methodological limitation relates to the reliability of the depersonalization burnout dimension and of the School Quality survey, which were very low in the present study. Further studies are needed that make adjustments in the French translation and re-evaluate the factor structure and reliability of these two scales. However, these limitations are offset by several strengths. First, this research presents an original approach by combining a systematic review of the literature with an empirical study, in order to better understand SETs’ burnout in relation to collaborative variables. Second, this study is a necessary topic because there is hardly any research on teachers dedicated to special education. Third contribution of this research is that it counteracts the idea that SETs are an a priori population in burnout (Squillaci, 2020d). The good perceived health of both sub-samples is probably related to the generally advantageous working conditions in Switzerland. Caution should therefore be exercised in generalizing these results to other countries, as Switzerland is a country with a substantial education budget. Our findings indirectly suggest that the state has a key role in preventing burnout by allocating sufficient financial resources to maintain the health of SETs (Squillaci, 2020d). In light of these findings, future research must not disregard interventions focused on promoting a healthy and constructive partnership climate between all the actors in the school system. Additional research in this field is still needed for at least two main reasons: after data collection, the integration service has been disbanded and for the past year, the SETs are under the supervision of regular school principals. Therefore, it would be interesting to assess the burnout of SETs in relation to this new situation. For the past year as well, COVID-19 has also been pressing heavy demands on SETs who have seen their work and roles evolve over long periods of time. As a result, teachers' occupational health needs to be assessed regularly in order to prevent the apparition of burnout.