兒童發展聯合評估：從展望理論探討家長之決策過程

Abstract

2014年11月20日立法施行《兒童權利公約施行法》，效法國際兒童權益保障規範，然而在政策實務上，兒童事務極大程度地受到相關利益關係人的意識左右，許多與兒童有關的政策治理，仍深受家長的觀念未能同步，而降低政策可行性。從懷孕開始，胎兒發展即受到家長的極大化關注，從兒童早期發展政策的視角，家長是協助的角色，主管機關每年公佈的早療服務個案指標，是基於早療兒童家長的統計資料，然每年新增服務個案與通報的人數存有相當程度的差異，以2022年為例即有約26,000人，統計數據差異來源可能有：通報後不須評估、早療結案、通報後卻未評估的個案，目前這些可能差異來源比例仍舊未明。 現有研究均側重在如何提供早療兒童家長更多的支持，與如何提升治理工具的信效度等符合政策醫療意識的探討。實務上在最初經通報卻未就醫參與評估的家長，其對於兒童早期發展與接受醫療服務的觀點，基於這些觀點所做出的在地因應，均鮮少被系統性地提出與關注，以至於政策始終無法擴大協作能量。 本文採用半結構式訪談，取徑行為經濟學的展望理論，探討家長與教保人員對於參與兒童發展聯合評估的決策與價值判斷，研究樣本採用滾雪球方式招募，邀訪6位家長與3位教保人員共9位，透過展望理論分析研究對象的核心價值與決策過程，歸納多重協作者的決策阻力，再運用展望理論的風險規避概念提出政策建議。 研究發現，家長會因為聯合評估的醫療標籤與社會觀感，影響自身是否要成為參與者的決策價值判斷。兒童早期發展權益的思考，僅出現在能夠直觀回應子女發展需求的家長，以及願意接受教育傳遞知識，重組發展落後想像的家長。因此政府應該從利益關係人（家長）與權利主體（無行為能力兒童）的立場，綜合思考政策結構是否讓家長陷入難動的弱勢情境。 本研究建議須落實跨部會水平與中央地方垂直的協作，研議教育為主醫療為輔的兒童早期發展政策，讓聯合評估去標籤化，透過重組多重協作者對於聯評的醫療想像，可降低醫療標籤導致的決策困境。同時為了保障私立托育機構教保人員能夠免於擔憂營運壓力，基於兒童最佳利益做出決策，應再加大公共化力道，提高多重協作者的能動性。未來可再延伸探討另一群未主動關注子女早期發展的家長，讓無行為能力兒童有適切的早期發展權益代管機制。

The "Implementation Act of the Convention on the Rights of the Child" has been legislated and enforced since November 20, 2014, following international standards for protecting children's rights. However, in practice, children's affairs are greatly influenced by the consciousness of stakeholders, and many child-related policies are still hindered by parental perspectives that fail to align with policy goals, thus reducing policy feasibility.

From the moment of pregnancy, the development of the fetus receives considerable parental attention. From the perspective of early childhood development policies, parents play a supportive role. The annual number of early intervention service cases published by the competent authorities is based on statistical data from the parents of children receiving early intervention. Nevertheless, there is a considerable discrepancy between the number of new service cases each year and the number of reports. For example, in 2022, there was a difference of about 26,000 people. The source of this statistical discrepancy may include cases that do not require evaluation after reporting, cases where early intervention was concluded, and cases that were reported but not evaluated. The proportion of these possible sources of discrepancy remains unclear.

Existing research focuses on how to provide more support to the parents of children receiving early intervention and how to improve the validity and reliability of governance tools to align with policy and medical awareness. In practice, parents initially reported but did not seek medical evaluation or service for their children, and their perspectives on early childhood development and medical services are rarely systematically addressed and highlighted. As a result, the policy fails to expand collaborative capacity.

This study uses semi-structured interviews, drawing on the Prospect Theory of behavioral economics, to explore the decision-making and value judgments of parents and educational personnel regarding medical evaluations and participation in joint assessments on child development. Nine research participants were recruited through snowball sampling, including 6 parents and 3 educators. Through the analysis of Prospect Theory, the core values and decision-making processes of research participants are summarized, identifying the resistance in their decision-making. Policy recommendations are then proposed based on the concept of risk aversion from Prospect Theory.

The research finds that parents' decisions on whether to participate are influenced by the medical labeling and social perception of joint assessments. Considerations for children's early development rights only arise in parents who can intuitively respond to their children's developmental needs and are willing to accept educational knowledge transmission to reshape their understanding of developmental delays. Therefore, the government should comprehensively consider whether policy structures trap parents in immobile disadvantaged situations from the perspectives of stakeholders (parents) and rights holders (children without legal capacity).

This study suggests the need to implement horizontal interdepartmental and vertical central-local collaboration, developing an education-centered and medically assisted early childhood development policy. De-labeling joint assessments through restructuring multiple collaborators' medical perceptions of joint assessments can reduce decision-making dilemmas caused by medical labeling. Additionally, to ensure that personnel at private childcare institutions can make decisions based on the best interests of children without worrying about operational pressures, efforts should be made to enhance public initiatives and increase the agency of multiple collaborators. Future exploration can extend to another group of parents who do not actively pay attention to their children's early development, establishing appropriate custodial mechanisms for the early development rights of children without legal capacity.