資源匱乏地區發展遲緩兒童社區療育據點服務實施情形之探討

The Study of Community Based Services for Children with Developmental Delays in Low Resource Communities

本研究目的在檢視資源匱乏地區之社區療育據點服務實施概況，以2010 年接受中央政府單位補助辦理據點服務之四個機構為研究對象，透過實地訪視及文件分析蒐集研究資料，輔以電話訪談釐清文件資料有疑慮之處。研究結果發現： 一、機構與政府單位的協調、專業人員與服務使用者的互動，以及專業人員間的支持，有助於據點服務的推展及滿足兒童及其家庭的需求，顯見於據點設置、定點式及走動式服務規劃、專業人力協調之相關討論；二、機構與據點設置區域的社會服務單位建立合作關係，提供早療服務，從中增進家長之資源使用的近便性。囿於目前未有相關法規釐清機構間合作的權責，資源的連結及共享大多建立在機構的努力及彼此的信任和配合；三、「家長參與」此一理念對於服務成效具正向影響，但是，專業人員需顧及兒童及其家庭之特質與作息，避免造成家長的親職壓力。由於政府單位並未提供家庭支持性服務的費用，使得專業人員不易推展相關服務；而現有的服務也鮮少與區域特質有所連結；四、政府現有對據點服務的補助遠低於機構式的服務，每名兒童補助金額差距高達6,056.67 元至17,390.47元。最後，研究者依據研究結果，提出五項實務工作的建議：一、政府單位應關注療育資源匱乏的地區；二、政府單位宜採納跨部門之合作方式，協助機構辦理據點服務；三、政府單位宜提供家庭支持性服務的補助經費，增強機構對於家庭的關懷；四、機構宜落實專業團隊會議，增強團隊成員對於服務內容的了解；五、機構宜關注服務使用者的個人經驗，具體呈現服務成效。此外，本研究亦對於未來研究提出兩項建議：一、宜呈現兒童及其家庭或社區居民的服務使用經驗及主觀感受；二、應呈現服務承辦機構與在地機構的合作情形。

Purpose: In Taiwan, non governmental organizations have implemented the community based services in recent years. Until 2009, the R.O.C.'s Children's Bureau Ministry of the Interior declared a trial program of home- and community-based services for children with developmental delays and provided subsidies for non profit organizations to execute services in low resource communities. This study explored current situation of community based services for the purpose of early intervention in low resource communities. Methods: Data were collected from four case management centers brought by the trial program for community based services in 2010. The data were collected through practical field observation, document analysis and telephone interview. This study recruited seven research participants, professionals within this research field, to attend practical field observation. And their speech was also recorded and analyzed. Findings: The results of this study indicate (1) the coordination between social service agencies and governments, the effective interaction between professionals and service users, and the positive cooperation between professionals were important for implementing services and satisfying the needs of children and their families. Additionally, this study also suggests that the establishment of community intervention settings, the practice of fixed point and mobile services and the collaboration between professionals are factors needed to be concerned. (2)Four centers cooperated with local social service agencies to offer early intervention services and to increase the service accessibility for families. However, community resource connecting and sharing was currently basing on the acceptance among agencies due to a lack of policy planning for interagency collaboration. (3) Even though parental participation has positive effects on service effectiveness, professionals should concern about the characteristics and daily activities of children and their families and avoid raising parental stress. Due to the shortage of government subsidies for professionals to provide family supportive services, existing services were less relative to local culture. (4) Government subsidies for community based services were found less than those for centered based services which means the difference of subsidies for each child was from NT$ 6,056.67 to 17,390.47 per year. Conclusion/Implications: The following implications for practices were suggested: governments should concern about low resource communities; to assist community intervention and to provide subsidies for family supportive services, meanwhile, co-organizers should understand services for each family through team meetings and pay attention to service using and effectiveness. Future study is needed to provide more information about the experiences and subjective perception of children, family and local residents and to discover about the cooperation between co-organizer and local agencies.