- 期刊
以家庭為中心的早期介入服務成效－運用基於ICF的協力問題解決模式
Effectiveness of Family-Centered Early Childhood Intervention Services- Application of the ICF-Based Collaborative Problem Solving Model
摘要
背景與目的：以家庭為中心的早期介入服務強調家長參與目標設定，但作法和成效仍未定。本研究目的為探討基於「國際健康功能與身心障礙分類系統」（International Classification of Functioning, Disability and Health, ICF）的協力問題解決（collaborative problem solving, CPS）模式（簡稱ICF-CPS）的可行性和家庭成效。方法：回溯型研究，分析2014年於臺北市社福與醫療單位的41位發展遲緩兒童（年齡42.1±20.7個月）及家庭資料。依ICF-CPS服務先後分協力組和等待組。協力組（n=23）家長運用檢核表瞭解兒童參與狀況，並參與ICF-CPS會議，和專業團隊進行「界定問題」、「問題解釋」、「目標設定」與「介入策略」步驟，釐清兒童優先解決問題，設定目標與策略，並運用策略於生活中。於協力組ICF-CPS會議後3個月，蒐集並分析兩組的「家庭成效調查－修訂版（Family Outcomes Survey-Revised-Chinese Version）」分數；此時，等待組（n=18）未參與ICF-CPS會議。結果：協力組家長於ICF-CPS會議可設定目標和策略，且家庭成效知道權益面向分數顯著高於等待組；醫療單位多利用休息時間或分次進行ICF-CPS會議。結論：ICF-CPS模式於臺灣社福與醫療單位可行且對家庭可能有效，但於醫療場域上實施須調整。
並列摘要
Background and Purpose: Family-centered approaches in early childhood intervention (ECI) services emphasize that professionals support the family to choose and decide prioritized goals for their children. However, the strategies and effectiveness of parents' involvement in goal-setting are not clear. The purposes of this study were to investigate the feasibility of strategies by combining the collaborative problem solving (CPS) model and the International Classification of Functioning, Disability and Health (ICF), named as the ICF-based collaborative problem solving (ICF-CPS) model for enhancing parents' involvement in goal setting and its effectiveness on families of children with developmental delays/disabilities in Taiwan. Methods: It is a retrospective study. The service records of 41 dyads with children who had developmental delays/disabilities (mean age 42.1 ± 20.7 months) and received ECI services in 2014 in 2 hospitals and 1 developmental center in Taipei City were reviewed and analyzed. They were divided into 2 groups: CPS (n = 23 dyads) and waiting (n = 18 dyads) group. The caregivers of the CPS group used the ICF-Children and Youth Version checklist to understand their child's participation and possible related factors. Each family of the CPS group attended an ICF-CPS meeting with their professional team through 4 steps: problem identification, problem explanation, goal setting, and intervention strategies. The problems prioritized by caregivers were clarified, followed by goals and intervention strategies; and caregivers were encouraged to execute the intervention strategies in their daily routines. For evaluating the effectiveness on families, the Family Outcomes Survey-Revision- Chinese Version (FOS-R-C) was used for 2 groups 3 months later after the ICF-CPS meetings of the CPS group. The waiting group did not attend the ICF-CPS meeting during the 3-month waiting period. Results: All families of the CPS group could choose and prioritize one goal in the ICF-CPS meeting. The CPS group showed higher scores in 2 parts and 8 domains of the FOS-R-C than the waiting group, with significantly higher score in the ＂Knowing Your Rights and Advocating for Your Child＂ domain. Regarding the meeting arrangement, the professional teams in hospital setting usually conducted ICF-CPS meetings in lunch or off-hours or had to complete the meeting in 2-3 regularly clinic visits, which showed time shortage. Conclusion: It is feasible and possibly effective of applying ICF-CPS model to enhance parents' involvement in goal setting in the ECI process of medical and social welfare settings. However, the procedure needs further modification to be implemented more easily in medical settings.