發展遲緩兒童早期療育需求與資源使用之研究-以彰化縣為例

The study of the need and the use of resources for children with developmental delay in early intervention

陳汝珍(JU- ZEN CHEN)

指導教授 ： 黃源協

國立暨南國際大學/人文學院/社會政策與社會工作學系/碩士(2014年)

https://doi.org/10.6837/NCNU.2014.00289

摘要

本研究採質性的研究法，以彰化縣為研究場域，研究對象為四名服務使用者與七名服務供給者，本研究之目的有三：
一、由服務使用者觀點探討其在使用早期療育服務之障礙因素、因應方式與對服務體系的期待。
二、由服務供給者觀點探討其在供給早期療育服務之障礙因素、因應方式與對服務體系的期待。
三、依據研究結果，作為服務單位與政策制定者規劃政策、改進措施之參考。

本研究綜合分析服務使用者觀點與服務供給者觀點有其共同與獨特之處，以下進行摘要描述：

一、資源使用之障礙因素
（一）共同處：在服務使用者層面，同樣聚焦於家長的心理因素、家庭成員的支持度，以及醫療支出大等議題。在服務體系層面，同樣地關注到法令規章缺彈性、行政作業流程無效率、專業團隊的溝通不足、資源的可近性不足、以及資源不充足障礙。
（二）獨特處：服務使用者觀點與服務供給者觀點對於障礙因素也存在著不同角度的觀察。在服務使用者層面，兩個觀點對照顧問題的歸因不同，在服務體系層面，服務供給者觀點對於幼兒園拒收現象與家長療育態度有另一番的體會。

二、障礙之因應方式
（一）共同處：在服務使用者層面，同樣關注家長具有復原的力量、家長位居資源網絡的核心，以及家長對醫療的信賴度高；在服務體系層面，同樣地關注到療育與訓練方法具有多元性、多元性服務使得障礙逐漸改善、經費補助與教育資源逐漸挹注。
（二）獨特處：在服務使用者層面，服務使用者呈現出豐富的問題解決略，而服務供給者為輔助角色，協助家長建構支持網絡；在服務體系層面，服務供給者觀點則提出對服務體系現狀之觀察。

依據上述研究結果，針對政策與管理面、實務面與未來之研究方向提出以下之建議：

一、政策與管理面之建議：落實在地服務的理想、培育專業人力與提供繼續教育、法規宜有彈性措施、增加語言治療之健保給付額度、營造支持的友善環境、即時更新療育資訊。
二、實務工作面之建議：鼓勵專業間的合作方案、增加家長的社會參與度、提供多元的專業療育方法、提供家長親職教育之方案。
三、未來研究方向之建議：早期療育體系中進行的團隊運作、社會工作者在早期療育中的個案管理角色。

限於時間、研究者之能力與研究場域，研究者提出上述不同層面之建議，希望未來之研究者以更細膩的角度，省思早期療育服務之輸送議題，以利服務單位與政策制定者規劃完整與周延的服務方案。

關鍵字

障礙 ； 早期療育 ； 發展遲緩 ； 社會福利服務

並列摘要

Using qualitative research methods, I studied four service users and seven service providers in Changhua County. The purposes of this study are as followed:

Ⅰ. From the service users’ perspective, I investigated the obstacles and responses after their using of the early intervention services, and then I investigated the expectations of these users on the service system.
Ⅱ. From the service providers’ perspective, I investigated the obstacles and responses after the providing of the early intervention services, and then I investigated the expectations of these users on the service system.
Ⅲ. The conclusion of this study will provide a reference to the service unit and policy makers of relevant fields on further planning and improvements.

According to comprehensive analysis of service user perspective and service provider perspective, they are unique but still have something in common. The descriptions of this study are as followed:

Ⅰ. Obstacles of using resources:
1. Commonness：On the service users’ dimension, we still focus on the psychological factors of the parents, the degree of support of family members, and the high expense on medical treatment. On the service dimension, our attention is focused on the inelasticity of laws and regulations, the inefficiency of administrative processes, the lack of communication of professional teams, and the inadequacy of the accessibility of resources.
2. Uniqueness：These two perspectives have different opinions on obstacles on the using of resources. On the service users’ dimension, the two perspectives have different explanations when facing the problems occurred in care taking. On the service providers’ dimension, the service providers have different understanding on the phenomenon of kindergartens’ declination and the intervention attitude of the parents.

Ⅱ. The way of response:
1. Commonness: On the service users’ dimension, I focused on the parents own resilience. The parents are the center of the Resource Network, and the medical staff has earned the trust of the parents; on the service providers’ dimension, it’s focused on the diversity in habilitation and the training methods. Diversity service gradually improved the obstacles, and the fund and educational resources are provided eventually.
2. Uniqueness: On the service users’ dimension, the service users provide plenty of problem-solving strategies, then the service providers are supporters for the parents to construct the support network; on the service providers’ dimension, the service providers proposed their observations of the status in the service system.

Based on the findings above, this research provided suggestions for the policy and management levels, the practices levels, and for further research directions. The suggestions are as followed:

Ⅰ. Suggestions on the policy and management levels: We should implement the ideal of local services, nurture professionals and provide in-service education. Regulations should be flexible, and we have to increase the amount of NHI benefits of speech therapy. Creating a friendly environment and updating the information of intervention will be an urgent requirement.
Ⅱ. Suggestions on the practices levels: We encourage cooperation programs between the professionals, increasing social participation of parents, providing professional intervention of diversified methods, and providing parenting education program.
Ⅲ. Suggestions on future research directions: How to carry out the team operation in early intervention? What is the case management for social workers in early intervention?

Based on limited time, ability of researchers, and the research areas, I provided the suggestions of different levels above, in the hope of providing some help to the future researchers who shall use a more delicate angle to research on the issues of transportation of early intervention services. These researches will help the service units and policy-makers on planning a complete service programs.

並列關鍵字

obstacles ； Developmental Delay ； Early Intervention service ； social welfare services

參考文獻

張美雲、林宏熾（2007）。發展遲緩兒童家庭社會支持與賦權增能之相關研究。特殊教育學報，26，55-84。

傅秀媚（2002）。早期療育中跨專業團隊評估模式相關問題研究。特殊教育學報，16，1-22。

中文部分

內政部兒童局全球資訊網。發展遲緩兒童早期療育。民國99年11月3日，摘自http://www.cbi.gov.tw/CBI_2/internet/main/index.aspx。

方世杰、楊舒閔(2007)。組織團隊之知識流通的探索性研究－社會網絡理論與社會交換理論之觀點。第八屆管理學域學術研討會論文集，47-63。