跨科際專業整合早期療育模式輔導教養院初步研究

A Trans-Disciplinary Model for the Early Intervention of Children in Residential Facilities-A Preliminary Study

廖華芳(Hua-Fang Liao) ； 劉淑玉(Su-Yu Liu) ； 黃惠聲(Huei-Hsin Huang) ； 林麗英(Li-Yin Lin) ； 楊素端(Su-Tuan Yang) ； 李佳蕙(Ghia-Huei Lee) ； 郭美雀(Mei-Chuai Kuo) ； 林銀秋(Yin-Chiu Lin) ； 吳淑芬(Shu-Feng Wu)

《中華民國物理治療學會雜誌》 23卷1期 (1998/01) Pp. 12-24

https://doi.org/10.29616/JPTAROC.199801.0002

摘要

最近修正公佈之「兒童福利法」、「身心障礙者保護法」與「特殊教育法」皆明文規定，對於身心障礙兒童應提供團隊合作之早期介入，且擬定個別化服務計畫（簡稱IPP）。然而國內大部份的教養機構由於專業人力之缺乏，一直無法提供較好品質之療育。在早療各種團隊合作模式中，「跨科際專業整合模式」為較好之模式，為瞭解此模式實施於教養院之成果，乃進行此研究。研究方法為外聘相關專業人員，計有物理治療師、職能治療師、語言治療師及特教老師，於團隊介入之前與教養院工作人員，包括社工人員與教保人員，進行會商。決定採用以教養院內保育人員為主要許發者之「跨科際專業整合模式」，為每個個素擬定一份IPP。IPP內容包括孩童之功能、主要問題、長短期目標與提供之相關服務。每個月定期為一個個案召開專業團隊個案討論會，並請家長同時參與。專業團隊於討論會前半段時間實際評估孩童，並根據家長及保育員提出需解決的問題討論整合成療育重點，討論會後半段時間專業人員則直接教導保育員執行療育工作，整個討論會過程皆錄音、錄影，以作為日後保育員輔導之參考資料。同一個案於討論會後一個月，再進行一小時的團隊諮詢，以瞭解保育員實際執行所遭遇的困難，並給予協助。此個案討論會並做為全院的保育人員與監護工的在職訓練課程，期望專業團隊介入之知識與技巧能運用於其他的院童。接受本研究團隊介入之5位院童計3男2女，年齡在5歲至6歲之間，皆為重度多重障礙。討論會完成半年後，專業團隊成員到院進行追蹤、評估成果目標與過程目標。結果顯示，個案IPP平均的長短期目標達成比率為65%；89%案童教養人員（保育員、褓姆、家長）對本計畫滿意，67%覺得孩童經過介入後有進步；45%院童教養者覺得壓力有減輕，但67%保育人員覺得此計畫之執行加重其壓力；所有的保育人員及監護工經此團隊介入所得到的知識與技巧都可運用到其他院童上。 67%專業人員覺得此模式之效益高於成本。因此，此模式雖仍有缺點待改進，但對於缺乏專業人力之教養院，此模式值得推廣。

關鍵字

早期介入 ； 專業團隊 ； 發展障礙 ； 教養院 ； 個別化服務計劃

並列摘要

According to recently amended laws, government (the health, social welfare or education department) should provide early multi-disciplinary intervention and an individualized planned program (IPP) for each child with disability. The content of IPP usually includes description of function and major problems of the child, related services which will provide to the child, long- term goal and more immediate objectives of various function for the child. Children living in residential facilities usually lack proper training, due to shortages of professional personnel. A transdisciplinary model, one of the multi-disciplinary approaches, has been recommended as the best model for early intervention, but it has not been used for children in residential facilities. In this pilot study, we investigated the usefulness and result of program evaluation of a trans-disciplinary program. The variables of program evaluation were the percentage of IPP goals achieved, the satisfaction of the caretakers and guidance counselors, and the cost-benefit analysis of this program. The team members included a physical therapist, an occupational therapist, a speech therapist, a special educator, a social worker and guidance counselors. The latter two were staff members of the residential institution. In this study, the guidance counselor acted as the main facilitator for the child and designed an IPP for each child, according to the suggestions of the team members. The guidance counselor executed the training program of IPP. The other team members instructed the techniques of training program to the guidance counselor. Five children (3 boys and 2 girls) aged from 5 to 6 years, were included. All were severely handicapped with multiple disabilities. A 3-hour conference was held for each child, including assessment of the child and program instruction to the guidance counselor. The basic information and initial assessment of each child done by the guidance counselor were sent to the team members before the conference. The long term IPP goals were determined in this meeting as well. Parents and the other staff members of theresidential facility were invited to join this conference. Video and tape recorders to record the processes of the conference were used as later teaching materials for the guidance counselor and caretaker.
Program evaluations were performed 6 months later. The results showed that 65% of the goals of the IPP was met. Eighty-nine percent of the caretakers, guidance counselors and parents of the children were satisfied with this program, and they felt that the children had improved after this program. Sixty-seven percent of the professionals felt that the benefits of this program outweighed the cost. Therefore, such a multi-disciplinary intervention program may be valuable in promoting the function of handicapped children in residential facilities.

並列關鍵字

Early intervention ； Developmental disabilities ； Residential facilities