台北市醫療機構兒童早期療育服務之調查

A Survey on Early Intervention for Children in Medical Institutions in Taipei City

廖華芳(Hua-Fang Liao) ； 李宜靜(I-Jing Lee) ； 吳文豪(Wen-Hao Wu) ； 林麗英(Li-Yin Lin) ； 高麗芷(Lee-Jyy Kau)

《中華民國物理治療學會雜誌》 24卷3期 (1999/05) Pp. 161-173

https://doi.org/10.29616/JPTAROC.199905.0001

摘要

為推動台北市發展遲緩兒童早期療育（簡稱早療）之工作，台北市政府衛生局聯合中華民國物理治療學會、中華民國職能治療學會、中華民國聽力語言學會進行此調查，目的為瞭解台北市提供早療之醫療機構之分佈人力、服務量、服務內容與意願。方法：本研究為調查研究，由作者共同設計調查表內容，並於1998年4月至5月間派員實地訪查台北市提供物理治療、職能治療或語言治療服務之65家醫療機構。結果：訪查中有20家(31%)提供早療服務，經宣導後14家(22%)表示將在一年內提供早療。由行政區面積與機構數比例來看，仍有分佈不均之現象。目前提供之早療服務量，計每月提供兒童物理治療(PT)2494人次，兒童職能治療(OT)2815人次，兒童語言治療(ST)2656人次，兒童心理治療(Psy) l90人次，加護病房早期介入324人次，裝具輔具164人次，發展評估631人次，聽力檢查948人次、到家輔導2人次，親職教育15人次。因此較符合個別化家庭服務方案原則之到家輔導與親職教育並不普遍。此外，20家提供早療服務之醫療機構中僅9家(45%)有早療團隊病例討論會。提供早療之20家醫療機構早療專業人力計：小兒神經科次專科醫師15人，小兒精神科次專科醫師14人，兒童物理治療師33.3人，兒童職能治療師 32.5人，兒童語言治療師13.9人，而潛在早療專業人力計複健科專科醫師58人，物理治療師126人，職能治療師101人，語言治療師33人，心理治療師20人，聽力師24人，社工人員144人，營養師112人。作者推估台北市3歲以下發展遲緩兒童每月需PT 1996人次，OT 1596人次，ST 1464人次，Psy 241人次。3歲-6歲兒童對醫療機構之早療需求則因特殊教育法之推動較難推估，由家長調查結果顯示目前早療服務仍供不敷需。結論：分析目前狀況，若增加早療機構數，或可增進早療機構分布之平均，然對供給量助益不多。建議應藉早療專業人員之培訓與獎勵措施來增加服務供給量；另應著重提升品質，如完整之團隊評估、良好之專業團隊介入模式、提供到家輔導與親職教育。此外為考慮早療服務之可近性與多元化，醫療與教育、社福體系之協調合作宜早日規劃，以建構成本效益良好之早療制度。

關鍵字

兒童 ； 早期療育 ； 衛生服務供需

並列摘要

Purposes: (1) to investigate the geographic distribution of early intervention programs provided by medical institutions; (2) to estimate the vo-lume content and personnel of early intervention; (3) to design a financial support plan in order to promote early intervention services based on the result of this survery. Method: The questionnaire were sent to 65 medical institutions which provide physical therapy, occupational therapy and followed by site visits. Data concerning personnel, space, equipment and early intervention programs were collected. Results: Twenty institutions provide early intervention services for children with developmental delays and 14 more institutions plan to follow in one year. The number of treatments per month in these 20 institutions were: physical therapy (PT) 2494, occupational therapy (OT) 2815, speech therapy (ST) 2656, psychology (Psy) 190, intensive care unit 324, orthotics 164, developmental evaluations 631, hearing tests 948, home visits 2 and parental classes 15. Only 9 institutions (20%) held professional team case conference for children with developmental delay. The demand for early intervention for children under two years of age in medical institutions of Taipei, is estimated to be 1996 sessions per month for PT, 1596 for OT, 1464 for ST, and 241 for Psy. The numbers of related professionals in the 20 institutions are: physiatrists 58, pediatric neurologists 15, pediatric psychiatrists 14, physical therapists 126 (pediatric physical therapists 33.3), occupational therapists 101 (pediatric occupational therapists 32.5), speech therapists 33 (pediatric speech therapists 13.9), psychologists 20, audiologists 24, social workers 144, and nutritionists 112. It is recommended that the government provide more educational courses to train enough competent developmental therapists to fulfill the need for services. In the future, the early intervention program should emphasize a team approach, be home-based and include parental education to assure a better quality of service. The government should organize an inter-agency coordination system among medical, educational and social welfare institutes to improve cooperation among different agencies and accessibility of early imtervension services.

並列關鍵字

Child ； Early intervention ； Health services