某一區域性發展遲緩兒童聯合評估及早期療育計畫之系統性評價

Abstract

目的: 本研究針對某一區域性發展遲緩兒童聯合評估及介入計畫進行系統性的評價，包括：1) 主動推廣是否對早療計畫的收案及個案參與有所影響；2) 早療計畫對於兒童的發展及照顧者的心理健康是否有助益；3) 過程因素和結果的關係。 方法: 於2009年2月至7月間在基隆長庚醫院接受傳統早療介入的個案視為歷史性對照組 (第一組)；而2009年8月至2010年1月接受整合性介入計畫的個案作為主要的研究對象(第二組)。第一組的個案照顧者在初次評估 (前測) 及六個月後 (後測) 分別填寫學齡前兒童行為發展量表 (CCDI)。第二組兒童的照顧者在前測和後測分別填寫滿意度問卷、中國人健康問卷(CHQ)、家庭關懷度指數 (Family APGAR)、及CCDI。 結果: 第一組共有36位個案；第二組有50位個案。第二組兒童的照顧者對於計畫一般是滿意的。兒童個案的性別可以獨立預測照顧者對早療評估硬體的可近性與費用滿意度，以及持續回診與否。第一組兒童的溝通表達、概念理解、環境理解、身邊處理、和一般發展在介入期間有顯著進步；第二組兒童在精細動作及一般發展有顯著改善。照顧者的CHQ和family APGAR分數在介入期間則無顯著改變。兒童發展的進步和回診與否、組別之間並無顯著的關聯性。 結論: 在早療介入期間兒童發展在許多面向呈現顯著的進步，而個案的性別在早療計畫中的影響值得進一步再探究。本研究提供一個早療計畫的系統性評估資料，包含過程與結果的分析，其結果可以應用於未來發展遲緩兒童早療評估及介入計畫的改善。

Objectives: This study aimed to systemically evaluate a regional program for integrated assessment and early intervention for children with development delay. We examined whether the effort of practicum will be beneficial for the recruitment and retaining of the program; whether the program is effective for the child development and well-being of the caregivers; and to determine the relationships of process issue with outcome. Methods: Children enrolled in the Traditional Intervention program of Chang Gung Memorial Hospital at Keelung (CGMH-K) from Feb 2009 to Jul 2009 were regarded as historical control (Group 1). Children who attended Integrative Intervention program during Aug 2009 to Jan 2010 were treated as the main study group (Group 2). For Group 1, patients’ major caregivers were requested to fill Chinese Child Development Inventory (CCDI) only at pretest and posttest (6 months later). The caregivers of children in Group 2 filled CCDI, Chinese Health Questionnaire (CHQ), family APGAR and Satisfaction Questionnaire at the first visit (pretest) and at posttest (6 months later). Results: There were 36 cases in Group 1, and 50 cases in Group 2. Caregivers enrolled in program were overwhelmingly satisfied with most services. Gender was an independent factor to predict satisfaction with accessibility and cost of the program, and revisit to the program. There were significant improvements in expression language, conceptual comprehension, situation comprehension, self help, and general development for children in Group 1. There were significant improvements in fine motor and general development for children in Group during the intervention. There were no significant changes for scores of CHQ and family APGAR of children’s caregivers. The progressions of children’s development were not significantly associated with their revisit and grouping. Conclusion: Global improvements in children’s development were noticed during intervention. The role of patient’s gender playing in early intervention program warrants further investigation. A systemic evaluation in a macroscopic view was performed for the early intervention program with both outcome and process perspectives. We could further apply these results to improve the integrated assessment and early intervention program for children with development delay in the future.