家長支援療育方案對零至三歲幼兒與家庭之成效研究

Effectiveness of a Parent Support Program for Families with Developmentally Delayed Children Aged 0 to 3 Years

基於零至三歲發展遲緩幼兒早期療育的重要，本研究為期兩年，以跨專業合作方式運作家長支援療育服務模式，主要目的在探究本療育方案的成效。本研究共有20 名發展遲緩幼兒及其家人、15 名個案管理老師及8 名專業小組成員參與，幼兒入案年齡介於二至三十五個月，參與療育的時間從七至二十個月不等。以「速率改變指標」（PCI）和「目標達成評量」（GAS）分析的量化資料及訪談家長的質性資料，探究本療育方案對幼兒與家庭成果的效果。由結果可知，除生理或情緒問題較嚴重的四名幼兒進步較有限外，大多數幼兒均在發展與行為上有明顯增長，也達成療育目標，對家長在心理、教養和資訊上的幫助上更顯現正向的效果。本研究結果不但肯定此一家長支援療育服務方案的可行性，更帶動社區化早期療育資源中心之設立。惟如何改變家長對直接服務與過度療育的迷思，以及如何提供家長個別化的支援，將是早療工作者未來須面對的挑戰。

Purpose: The purpose of this 2-year study was to investigate the effectiveness of an early intervention parent support program emphasizing team collaboration and empowering parents of developmentally delayed children aged 0 to 3 years. Methods: Twenty families, 15 case managers with childcare backgrounds, and a group of 8 professionals, including special educators, physical therapists, occupational therapists, speech therapists, and nurses, were involved. Each case was assigned a case manager who met parents once each week and joined group sessions once each month. The intake time varied from 2 to 35 months, and the duration of the intervention varied from 7 to 20 months. Child and family outcomes were analyzed using the Proportional Change Index (PCI), Goal Attainment Scaling (GAS), and data from parent interviews. Results: Based on the results of PCI and GAS analyses, only 3 of 20 children in the program did not show significant developmental gains in the subscales or total score of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT) and did not achieve the expected outcomes of intervention goals. The effects of intervention were evident in the parent support group as a whole, but few or no developmental gains or accomplishments of intervention goals were found in cases of children with severe and profound physical or emotional disabilities, such as epilepsy, heart disease, or emotional disorders. According to the interviews of 19 parents, the program resulted in obvious changes in either the behavior or the developmental ability of the children, positive impacts on the emotional adjustment of the families, improvements in parenting skills, and increased information access. Conclusion/Implications: Both quantitative and qualitative data in this study indicate that this early intervention parent support program is feasible and may be translated into practice by establishing community-based early intervention resource centers. In this program, early childhood teachers with limited experience working with parents of children with disabilities or developmental delays can competently act as case managers using support and consultation from other professionals. However, early interventionists must also confront challenges from parents who rely on excessive therapy and direct services for their children rather than responsive interaction in daily activities. It is also crucial for early interventionists to provide individualized support for parents with varied needs.