家長角色在哪裡－兒童發展聯合評估之反思

The Role of Parents in the Child Development Joint Assessment

徐惠蘋(Hui Ping Hsu)

《早期療育研究學刊》 2卷1期 (2020/12) Pp. 81-100

https://doi.org/10.6658/BEI.202012_2(1).0005

摘要

兒童發展聯合評估（簡稱聯評）是一個透過專業醫療團隊來評估兒童發展的機制，它扮演守門員及橋接者角色，將兒童分成正常、異常。評估模式分為醫療本位及能力本位，臺灣現況以醫療本位模式為主，偏重於以一套「適當性的標準」由專家對個人進行診斷。從兩種發展評估模式到後續早療服務介入的家庭中心模式，家長、兒童及專業團隊的角色功能權重存在衝突。本文從兒童進入發展評估這個階段作為討論開端，發現在此階段存在的困難與衝突有：從篩檢到醫療評估路徑曲折、等待聯評曠日費時、服務空窗期、偏重標準化評估與忽略家長觀察評估、家長在綜合討論中缺席、療育建議書適配度寬鬆。進一步聚焦於家長及兒童與專業團隊在評估過程中的角色任務與衝突，分為醫療本位模式的專業權威與能力本位模式的家長權利之抗衡、家長作為服務使用者與運籌行動者之落差、黃金治療期與評估延滯期的衝突。最後，針對家長及家庭在兒童發展聯評的角色上提出：多元評估模式、提升家長權利與參與、增加生態系統導向評估之豐富度、提升療育建議書之適配度四項建議。

關鍵字

發展遲緩 ； 兒童發展聯合評估 ； 醫療本位 ； 能力本位 ； 家庭中心模式

並列摘要

The child development joint assessment is a mechanism for assessing child development through a professional medical team. The role is goalkeeper and linker. It divides children into: normal and abnormal. Evaluation model has medical model and ability model. In Taiwan, The Joint Child Development Assessment Center most adopts a medical model, with set an ＂standards of appropriateness.＂ Compared with the family-centered model of early treatment intervention, roles of parents, children, and professional teams have conflicts. First, the article discussed children entering development assessment. Difficulties and conflicts found at this stage have: tortuous paths, time-consuming waiting for joint assessment, service stagnation, focus on standardized assessment, and ignore parental observation assessment, parents absent from comprehensive discussion, low fitness of the therapeutic proposal. Second, roles and conflicts of parents, children and professional teams in the assessment process are: (1) confrontation between professional authority in the medical model and parental rights in the ability model, (2) the gap between parents as service users and logistic actors, (3) the conflict between golden treatment period and assessment delay. Finally, advising parents on the role of child development joint assessments: (1) multiple evaluation model, (2) to enhance parental rights and participation, (3) increasing the richness of ecosystem-oriented assessments, (4) improving the fitness of therapeutic proposals.

並列關鍵字

developmental delay ； child development joint evaluation ； medical model ； ability model ； family-centered model