實踐健康特殊需求兒童收養之兒童最佳利益與國內收養優先原則：收養社工與收養家庭實務觀點探究

Abstract

我國經法院裁定完成收養的兒童中，一般兒童多由國內家庭收養，惟健康特殊需求兒童於國內媒合上仍面臨較高困難，目前僅約二成健康特殊需求兒童由國內家庭收養，其餘多透過跨國境收養尋找家庭。然而《兒童權利公約》、《海牙收養公約》及我國《兒童及少年福利與權益保障法》皆強調兒童最佳利益與國內收養優先原則。當健康特殊需求兒童於國內媒合困難、等待時間延長，或需透過跨國境收養找尋永久家庭時，收養社工如何理解並實踐此二原則，以及國內成功收養健康特殊需求兒童之家庭經驗，即為值得探究之議題。 基於此背景，本研究旨在探討收養社工如何理解並實踐「兒童最佳利益」與「國內收養優先」原則並納入收養家庭的經驗與需求視角，研究目的主要為了解健康特殊需求兒童收養服務現況，探究收養社工如何在健康特殊需求兒童收養服務中衡量與落實「兒童最佳利益」及「國內收養優先」原則，以及收養家庭的收養歷程與服務使用經驗，包含收養服務的資源與支持對於收養家庭需求的回應。本研究所指健康特殊需求兒童為患有身心障礙、發展遲緩或疾病，或有情緒行為及其他健康議題之0至12歲兒童。本研究採用質性研究方法，以立意抽樣為主、滾雪球抽樣為輔，向國內合法收出養媒合服務機構招募收養社工與收養家庭，並透過收出養父母社群平台招募符合條件之收養家庭。研究共訪談7位收養社工與5組收養家庭，以半結構式深度訪談蒐集資料，並以主題分析法進行資料整理與分析。 研究發現，健康特殊需求兒童收養服務相較於一般兒童收養服務，更需收養社工投入兒童健康資訊整理、醫療與早療資源連結、家庭準備、媒合評估、入家支持及裁定後追蹤等工作。健康特殊需求兒童的收養困難，並非僅源自兒童本身需求，而是兒童健康與發展狀況、收養家庭照顧能力、支持系統及制度資源條件交互作用的結果。收養家庭是否願意並能夠承接健康特殊需求兒童，與其對兒童需求的理解、照顧能力、工作與生活彈性、資源使用能力及外部支持是否充足密切相關。 在兩項原則的理解與實踐上，收養社工多從兒童成長時機、出養必要性、原生家庭照顧可能性、兒童需求、家庭照顧能力及兒童表意等面向理解兒童最佳利益；同時也認為若健康特殊需求兒童能於國內獲得穩定且適合的家庭，較能維持其文化、語言、生活脈絡、身分認同及未來尋親可能，因此國內收養優先在多數情境下與兒童最佳利益具有一致性。然而受訪社工並未將國內收養優先理解為僵化的等待原則，當兒童因健康特殊需求而長期無法於國內媒合，致可能錯失進入永久家庭的適當時機時，社工將重新衡量等待時間、國內媒合可能性、兒童發展需求與跨國境收養可能性，顯示兩項原則在實務中呈現持續衡量與動態調整。 在促進國內收養的實務策略與家庭經驗方面，收養社工透過情境式討論、親職準備教育團體、收養家庭同儕影響力與親職實習等方法促進收養家庭期待調整，也藉由客製化資格審查評估、收養期待過度開放的把關、專案活動與計畫等策略為健康特殊需求兒童媒合符合其需求的收養家庭。收養社工整體協助收養家庭逐步理解健康特殊需求兒童的樣貌與照顧需求，並在較充分理解兒童需求的基礎上評估自身承接能力。不過健康條件仍是收養期待中較難鬆動的界線，社工促進媒合的努力亦受到家庭開放度、資源條件與制度支持程度所限制。另一方面，收養家庭運用正式與非正式資源因應健康特殊需求兒童的到來，收養家庭的經驗也顯示媒合前的健康資訊與發展評估雖有助於形成初步理解，但仍難以完全預測兒童入家後的適應狀況，部分健康、發展或情緒行為需求亦可能於共同生活後才逐漸浮現。且收養健康特殊需求兒童並非止於法院裁定，而是家庭持續理解兒童需求、調整親職角色、連結醫療早療與教育資源，並因應照顧壓力與家庭支持需求的長期歷程。 根據研究發現，本研究建議建立健康特殊需求兒童分類與服務指引，依兒童健康與發展需求及家庭照顧資源進行評估，並加強健康資訊揭露與資源說明，以提升收養家庭準備程度及媒合適切性。其次，強化兒童最佳利益與國內收養優先原則之動態衡量實踐，從兒童、收養家庭、媒合與制度及文化等面向持續衡量，協助健康特殊需求兒童獲得永久且穩定的家庭照顧。再者為建立健康特殊需求兒童收養之連續性支持制度，透過標準化親職教育、情境式討論、親職實習與同儕經驗分享，並結合定期關懷、親職與心理支持，以及醫療、早療、教育與福利等跨系統資源，以提升收養家庭因應兒童需求變化及長期照顧之能力。未來研究則可納入不同健康特殊需求類型、未完成收養歷程之家庭、健康特殊需被收養者，同一收養歷程中社工與收養家庭經驗，以及公部門或法院等不同角色於收養中的互動及影響。

Adoption policies are shaped by both domestic laws and international conventions, including the Hague Adoption Convention, the United Nations Convention on the Rights of the Child (CRC), the Protection of Children and Youths Welfare and Rights Act, and Taiwan’s Second National Report on the CRC. These legal and policy frameworks emphasize the Best Interests of the Child (BIC) and the Principle of Subsidiarity. However, in Taiwan, children with special health care needs face significantly greater challenges in adoption placement. Currently, only about 20 percent of these children were adopted domestically, while approximately 80 percent were placed through intercountry adoption. This indicates the difficulty of matching children with special health care needs with domestic adoptive families and highlights the important role of intercountry adoption as a pathway to permanent family placement. In this study, children with special health care needs refer to children aged 0 to 12 who have physical or mental disabilities, developmental delays, illnesses, emotional or behavioral issues, or other health-related conditions. As these children often face difficulties in domestic matching, prolonged waiting, and the possibility of intercountry adoption as a pathway to a permanent family, it is important to examine how adoption social workers understand and implement the principles of the Best Interests of the Child and Subsidiarity. This study therefore explores the current practices and challenges of adoption services for children with special health care needs, focusing on how social workers weigh these two principles in practice and how adoptive families experience the adoption process, service use, and related support. This study adopts a qualitative research design. Participants were recruited mainly through purposive sampling, supplemented by snowball sampling. Recruitment was conducted through licensed adoption placement agencies in Taiwan and online communities for adoptive parents. A total of seven adoption social workers and five adoptive families participated in this study. Data were collected through semi-structured in-depth interviews and analyzed using thematic analysis. The findings show that adoption services for children with special health care needs require more intensive assessment and support than services for children without identified special health care needs. Across different service stages, social workers must consider children’s developmental and health conditions, family resources, long-term caregiving capacity, and the availability of institutional support. The adoption difficulties faced by children with special health care needs should therefore be understood through the interaction among children’s needs, adoptive families’ caregiving capacity, family support systems, and broader institutional resources. Regarding the understanding and practice of the Best Interests of the Child and the principle of Subsidiarity, adoption social workers considered factors such as the timing of the child’s development, the necessity of adoption, the possibility of care by the birth family, the child’s needs, the adoptive family’s caregiving capacity, and the child’s right to be heard. They also viewed domestic adoption as generally consistent with the child’s best interests when it could provide a stable and suitable family while preserving the child’s culture, language, life context, identity development, and future possibility of searching for origins. However, social workers did not understand Subsidiarity as a rigid waiting principle. When children with special health care needs remained unmatched domestically for a long period and risked missing the appropriate timing for entering a permanent family, social workers reconsidered waiting time, domestic matching possibilities, the child’s developmental needs, and the possibility of intercountry adoption. This shows that the two principles are continuously weighed and dynamically adjusted in practice. To promote domestic adoption, social workers used scenario-based discussions, parenting preparation groups, peer support among adoptive families, and parenting practicum to help families adjust their expectations. They also used customized qualification review, matching assessment, screening of overly open expectations, and project-based activities to match children with special health care needs with families able to meet their needs. These strategies helped families better understand children’s needs and assess their own caregiving capacity. Nevertheless, health-related conditions remained difficult to adjust, and matching efforts were limited by families’ openness, available resources, and institutional support. Adoptive families also used formal and informal resources to respond to the arrival of children with special health care needs. Their experiences showed that pre-matching health information and developmental assessments offered only an initial understanding and could not fully predict post-placement adaptation. Some health, developmental, emotional, or behavioral needs emerged only after cohabitation. Thus, adopting a child with special health care needs does not end with court finalization; rather, it is a long-term process in which families continue to understand the child’s needs, adjust their parenting roles, connect with medical, early intervention, and educational resources, and cope with caregiving stress and support needs. Based on the findings, this study recommends developing classification and service guidelines for children with special health care needs based on their health and developmental needs and available family caregiving resources, while strengthening health information disclosure and resource guidance to improve adoptive family preparedness and matching quality. It also suggests strengthening the dynamic application of the Best Interests of the Child and the Principle of Domestic Adoption Priority across four dimensions: the child, adoptive family, matching and institutional factors, and culture, to support permanent and stable family placements. Finally, a continuous support system should be established across the pre-adoption, placement, and post-finalization stages through standardized parent education, scenario-based learning, parenting practicum, peer support, regular follow-up, psychological and parenting support, crisis intervention, and interprofessional collaboration across medical, early intervention, educational, and social welfare services. Future research may examine different types of special health care needs, families who did not complete the adoption process, perspectives of adoptees with special health care needs, and the roles and interactions of social workers, families, public authorities, and courts.