以家庭為中心實施早期介入之困境：從案例敘說談起

Difficulties of Implementing Family-Centered Early Intervention According to Narratives

早期介入相關文獻皆支持以家庭為中心的服務模式，但目前臺灣仍以兒童或機構中心的服務為主，因此非常需要更深入了解以家庭為中心的服務過程和實務。本研究以一早期療育社區資源中心為場域，採質性研究取向，從專業人員觀點探討實施以家庭為中心早期介入之服務過程與困境為何。研究分析發現關鍵主題之間有相當的連結與動態的交互影響，故研究者以四個案例來描述這些連結與動態的互動過程。主要研究發現如下：一、包括家庭需求的多重與複雜性、不同文化背景對家庭結構的影響、專業人員培育所置入的服務觀點，以及機構間合作關係與機制的缺乏等因素，皆會交互影響服務決定與作法。二、專業人員需要將關係拉遠一點來看，以提供更多支持家庭面對危機和發現家庭的韌性與可能。三、過度的案量與行政業務以及不健全的福利薪資制度等因素造成專業人員的耗損。四、正向人際關係所提供的互動平台和機構理念的引導，是專業人員在面對多層系統的服務困境與複雜的角色期待時的重要支持。這些結果顯示，落實以家庭為中心早期介入服務之困境來自多重層次的情境且交互影響，須從生態觀點才能有效地釐清其脈絡與互動關係。未來的研究可從不同的情境層次探討其中不同因素的影響範圍與重要性，以及具體的因應與支持策略。

Purpose: Most of the literature related to the early intervention field supports the approach of family-centered service delivery. However， in Taiwan， practices remain primarily dominated by the child- or institution-centered approach. Therefore， further in-depth understanding of the process and practices of family-centered service delivery is necessary. This study inquired the following from the perspectives of professionals: First， how is the family-centered service delivery model implemented? Second， what are the difficulties encountered by professionals during the implementation process? Methods: This study was conducted at a community-based early intervention resource center in Northern Taiwan. The participants were four social workers and three home-based teachers working at the center during the period of data collection. Because the implementation of family- centered services involved and was considerably influenced by interpersonal interactions in a natural context， a qualitative research approach was adopted in this study. Data were primarily collected through meeting observations and interviews during August 2012 to January 2013. The constant comparative method was employed to conduct data analysis. Results/Findings: Analysis revealed that the emerging themes correlated and interacted with each other substantially. Hence， the researcher used four narratives to describe the correlations and dynamics of the process. The main findings are presented as follows: 1. Factors such as the multiple and complex needs of families， influences of cultural background on family structures， perspectives instituted through professional training， and lack of interagency collaboration interact and affect service decisions and practices. 2. Professionals must consider their relationships with families in the long term and support the families in challenging risks and discovering their tenacity and possibilities. 3. An overload of cases and administrative work as well as inadequate welfare and salary systems cause burnout and loss of personnel. 4. Platforms constructed by positive interpersonal relationships and a clear agency vision support professionals in overcoming dif ficulties from multiple ecological systems and complex role expectations. Conclusion/ Implications: The results show that factors influencing family-centered early intervention service delivery derive from multiple levels of context and interact. Therefore， adopting the ecological paradigm to delineate the path of influences and interactions is necessary. Future studies can examine the scope and degree of importance of influential factors in different levels of contexts and response strategies.