以家庭為中心之兒童復健服務：家長感受之初探

Parents’ Perceptions of Family-Centered Services in Pediatric Rehabilitation Programs: A Preliminary Study

目的：以家庭為中心的服務（Family-Centered Service, FCS）是目前國內外兒童復健界的目標。身心障礙兒童的家長比起一般兒童的家長有較高的親職壓力，研究證實若早期療育服務提供者提供以家庭為中心的服務對於家長及兒童均有正面的影響。本研究目的為初探台北市家長對兒童復健服務過程以家庭為中心的服務之執行程度之感受及初探其相關因子。方法：照護過程評量表（Measure of Processes of Care, MPOC-20）是目前最常用於評量家長對身心障礙兒童接受兒童復健服務過程中所感受以家庭為中心之執行程度的工具之一，MPOC-20 具良好的心理計量特性與理論基礎。本研究使用MPOC-20 台灣版於台北市3 家醫學中心之5 個兒童復健單位進行問卷收集，共136 位接受兒童復健服務之家長參與此研究。結果：台北市家長填寫MPOC-20 台灣版中的第一向度「合作關係與完整、支持性的照護」之平均分數最高，第三向度「關於孩子的具體資訊之提供」次之，第二向度「一般資訊之提供」之平均分數最低。兒童優先治療目標為認知之家長在「提供具體資訊」向度的分數顯著較優先治療目標非認知者低、兒童優先治療目標為語言之家長在「合作與完整及支持」向度的分數顯著較優先治療目標非語言者低。結論及政策建議：有復健需求之兒童的家長對台北市3 家醫學中心之5 個兒童復健單位所提供的兒童復健服務感受到能夠給予家長尊重及支持，並提供全面及一致的照護。然而，兒童之治療相關書面資訊及療育相關訊息的提供則相當不足。早期療育政策、健保給付制度、醫院/診所提供的服務及衛生局督考均應給予以家庭為中心的復健服務足夠的資源，如人力、硬體軟體設備等，以期提升發展遲緩或身心障礙兒童及其家庭的健康與安適。

Objectives: Family-Centered Service (FCS) has been acknowledged as the ‘best-practice’ model in pediatric rehabilitation. Parents of children with disabilities have higher levels of parental stress than parents of typically developing children. Research evidence showed that FCS resulted in better parental psychosocial well-being and better psychological adjustment of children. However, the extent of FCS implemented in pediatric rehabilitation programs as perceived by parents in Taiwan has not yet been investigated. The aim of this study is to investigate parents’ perceptions of the extent to which FCS behaviors being implemented in outpatient pediatric rehabilitation clinics in Taipei city, as well as its related factors. Methods: The extent to which the service was family-centered as perceived by parents was evaluated with the Traditional Chinese (Taiwanese context) version of the Measure of Processes of Care (MPOC-20), which was translated from the MPOC-20. The Traditional Chinese (Taiwanese context) version of the MPOC-20 comprises of three scales: (1) Cooperative, integrated and supportive care; (2)Providing general information; (3)Providing specific information about the child. One hundred and thirty six parents from 5 outpatient pediatric rehabilitation clinics of three medical centers in Taipei city participated in this study. Descriptive analyses were used to describe the demographic characteristics of the participants and the extent to which FCS being implemented in outpatient pediatric rehabilitation clinics using the traditional Chinese (Taiwanese context) version of MPOC-20. Results: Parents rated high in ‘cooperative, integrated and supportive care’, whereas low in ‘Providing general information’ as well as ‘Providing specific information’. Parents of children with cognition training as treatment priority rated significantly lower in ‘Providing specific information’ than those whose children’s treatment priority was not cognition training, and parent of children with speech training as treatment priority rated significantly lower in ‘cooperative, integrated and supportive care’ as compared to those whose children’s treatment priority was not speech training. Conclusion and policy implications：The parents in Taipei city perceived the services being respectful, supportive, coordinated, and comprehensive; however, parents felt they received insufficient therapy related information from therapists. In order to promote the health and well-being of children with developmental disabilities and their families, implementing FCS in pediatric rehabilitation programs should be considered as a priority in the policy of early intervention, the payment system of the National Health Insurance, clinical service delivery and health service evaluation by Bureau of Health.