專業評估與使用者自覺：探討嘉義縣市早療服務之家庭需求

早期療育服務是指跨專業團隊合作、以家庭為中心的服務目標，提供未滿六歲發展遲緩兒童及其家庭服務。故關注焦點不僅是兒童個人，更從家庭照顧者及其他成員需求角度整體性評估家庭需求，連結並整合資源以促進發展遲緩兒童身心發展及提升家庭適應與成長之能力。但在實務場域卻發現家長自覺需求與專業評估產生落差，導致服務無法順利輸送。本研究期待透過家長（即早療兒童的主要照顧者）的角度瞭解其自覺需求及早期療育社會工作者對家庭需求的觀察與評估重點，並進一步探討「社工專業評估與觀察」與「家長自覺需求」之間的一致性與落差。據此，本研究以半結構深度訪談的方式來蒐集3位現職嘉義縣市早期療育通報轉介中心之社工師及6位接受上述3位社工服務的早療家長，透過質化研究的方式來歸納整理訪談資料。本研究主要發現為：一、家長自覺需求主要為資訊、支持性、社會性支持、專業支持、經濟支持等5類需求。未特別提及休閒娛樂的需求，其原因為照顧發展遲緩兒童產生的經濟壓力相對地剝奪了休閒娛樂的需求。二、早期療育家庭評估重點包含家庭功能、家庭結構面、家庭生態面，至於家庭關心的問題需求、家庭發展面及家庭的優勢與復原力是執行家庭評估中容易忽略的評估面向。原因為社工專業能力的限制，以及受限於服務表單、組織行政。三、專業評估與使用者自覺需求落差之原因可從兩方面談： 1.社工自覺造成需求落差的原因為社工專業權威評估、家長對早療資訊的認知不足、家長對早療資訊共識過程不一致。 2.家長自覺需求落差的原因為社工無法同理家庭情境、對社工的不信賴、社工服務介入的時間點不同步。其產生落差的原因是相互映證的，社工需同理家庭的情境，尊重家庭自覺需求，讓家庭產生信賴，瞭解早期療育，服務才可順利輸送，讓家庭需求得到服務，達到早期發現，早期治療之目標。

關鍵字

早期療育；發展遲緩兒童；家庭評估；家庭需求

並列摘要

Early intervention services refer to multidisciplinary teamwork, of which the purpose is centered on providing services to developmentally delayed children below 6 years old and their family members. Rather than focusing on the children themselves, the complete assessment of the needs of the whole family is built on the perspective of family caregivers and other members' needs, linking and integrating resources to elevate the growth of developmentally delayed children, and promote their abilities to family adaptability and growth. However, the subjective needs of their parents may come in significantly below the professional assessment in actual situations, making the services unable to be delivered.. This study aims to, through the perspective of the parents, understand the parents’ subjective needs (the primary caregivers of developmentally delayed children) as well as to understand the observations and evaluation of social workers in regards to family needs. Furthermore, the study explores the consistency and the gap between “professional assessments and observation of social workers” and the “subjective needs of the parents.” Semi-structured in-depth interviews are conducted in this study by 3 social workers of child development early intervention referral center in Chiayi, along with 6 parents who accept services from the above social workers. The major findings of this study go as follows: A. Parents’ subjective needs shall be mainly information, support, social support, professional support, and economic support, etc. For those needs that are not mentioned in the study, such as leisure and entertainment, the economic pressure from caring developmentally delayed children has relatively deprived them of the needs for leisure and entertainment. B. Early intervention evaluation includes: family function aspect, family structure aspect, and family ecology aspect. In regards to the issue of the need for family care, family development as well as family advantage and its capability to recovery are often ignored when executing family evaluation, which is due to the limitations of a social worker’s professional abilities, in which they are limited to only being able to perform listed services, as well as following the guidelines of the organization administrations. C. Third, the reasons for a gap between professional evaluation and subjective needs of the party can be addressed from two aspects: 1. Social workers consider that the reason of how the gap in needs is induced because of the inconsistency between social workers’ professional authority evaluation, lacking of adequate information concerning ECI for the parents, and the insufficient understanding of the process of ECI information. 2. The reason for making a gap between subjective needs of parents and the social workers is that the social workers hasn’t had great sympathy with the family’s situation, the family distrusts the social workers, and the social workers’ services are not always synchronized. In order for a family to become trusting, social workers must sympathize with one’s family situation, and respect the family’s subjective needs. The earlier a family can gain a thorough understanding of early intervention, the earlier adequate services can be delivered smoothly so that families can obtain the services needed, thereby attaining the goal of early discovery and early treatment for developmentally delayed children.