從參與者觀點探討兒童發展評估中心的定位與營運目標

Abstract

早期療育是利用多專業整合服務來解決醫療、教育、家庭及社會等相關問題的支持與服務，其對象為 0～6 歲發展遲緩、身心障礙之兒童，目的在於把握兒童發展的關鍵期進行介入與療育，避免因原本障礙造成二度障礙或降低原有之問題。我國早療制度參考美國並發展出獨特之發展評估模式，但由上而下的方式以及各聯合評估中心在各專業人力和空間提供等方面並不一致，導致聯合評估中心無法滿足不同家長與其他專業人員之需求，且政府一致性的設立標準，讓聯合評估中心無法因地制宜，造成資源無法適當分配。因此本研究希望藉由不同參與者的觀點來探討發展評估中心設立的定位目標與營運目標，從下而上的方式重新審視發展評估中心的不足與需要的改變。本研究採質性研究，透過焦點訪談方式，蒐集三組不同族群之聯合評估中心之參與者訪談紀錄進行分析與整理。在早療系統的運作中，聯評中心應定位在提供兒童發展評估與療育完整的醫療服務並協助公部門推動早期療育相關業務，其營運目標應設立在提升評估與療育的效能。本研究的結論與建議為：台灣早期療育的運作模式對參與者而言，聯評中心有其特殊性與必要性，但除了評估之外，聯評中心應提供療育之服務，才能滿足各類型參與者需求；建議政府應整合小兒科、復健科及兒童心智科，成立兒童發展次專科並提高估評估給付，讓聯評中心發揮效能並提高評估供給的誘因；聯評中心可視內部資源，提供參與者必須的服務，但一個理想的聯評中心應包含各專業，才能完整提供兒童發展各個面向的評估與服務。

The purpose of this qualitative study was to explore how could the Joint Assessment Center for Child Development best satisfy the needs of the participants. Data were collected through in-depth interviews and thematically analyzed. The results of this study showed that Joint Assessment Center for Child Development should not only provide evaluation, but also the rehabilitation services. Joint Assessment Center for Child Development typically adopted the multidisciplinary team model in the evaluation process. An ideal evaluation center should include personnel from all relevant professions to compose the effective multidisciplinary teams. Although parents usually desire a complete evaluation service, it is not necessary if the first line practitioner have sufficient expertise to identify the developmentally challenged children. Furthermore, it is also not necessary to initiate a complete re-evaluation of children with partial problems. Considering the availability of resources, the child development center should provide only the must-service. Based on our findings, suggestions are provided for organizations and future researchers. Those include that the sub-speciality of child development medicine should be further developed. Child Development Evaluation Center should be clearly defined and the connections between different centers should be established to avoid the overlap of work, saving labor and time. Better funding should be provided and managed.