發展遲緩兒童及其家庭參與作息本位模式的療育經驗探究

The Experience of Children with Developmental Delays and Their Families Participating in Routines-Based Model of Early Intervention

本研究旨在探討臺灣作息本位早期介入模式(Routines-Based Early Intervention, RBEI)在發展遲緩兒童及其家庭療育中的經驗與影響。RBEI由美國學者R. A. McWilliam提出，強調以家庭為中心，透過自然情境中的作息晤談，幫助家庭設定功能性目標並提供支持性服務。此模式以日常生活為核心，將療育融入家庭日常活動，支持兒童技能的自然發展與家長的主動參與。本研究採用質性方法，選取8名參與RBEI超過半年的家長進行深度訪談，並使用資料分析歸納法探討其經驗與成果。研究發現，RBEI有效提升兒童的功能性發展，並顯著減輕家長壓力，增強家庭整體生活品質。相較傳統醫療或機構型療育，RBEI更加注重家長的充權與家庭參與，支持家長將療育策略落實於日常生活。建議未來針對RBEI在臺灣的推廣與實施宜強化專業人員的跨領域合作與家長溝通能力；提供家長充裕支持如培訓與情緒輔導；整合早療資源以減少家長因多重建議而產生的困惑。

 

Objectives

Children naturally learn and develop skills through daily routines in environments such as home, nursery, and kindergarten. By independently meeting their basic needs, such as eating and dressing, they gain essential life skills. Routines-Based Early Intervention (RBEI), developed by American scholar Dr. R. A. McWilliam, is an early intervention therapy model designed to help children aged 0 to 6 years with developmental delays learn in natural, everyday situations. This model focuses on enhancing children’s functional and family goals through a family-centered approach supported by an interprofessional team. Primary service providers implement RBEI by offering support-based therapeutic services, such as in-home visits, family counseling, and childcare partnership counseling, to empower families and facilitate children’s development within their natural environments. The purpose of this study is to: (1) Explore the experiences of children with developmental delays and their families in accessing various early childhood care services. (2) Investigate the experiences of children with developmental delays and their families participating in the Routines-Based Early Intervention model. (3) Examine the effectiveness, benefits, and challenges of the Routines-Based Early Intervention therapy. As this model is still in the developmental stage in Taiwan, the findings of this study aim to provide insights for early intervention institutions to adapt the Routines-Based Early Intervention model and deliver more effective and appropriate services.

Method

Routines-Based Early Intervention (RBEI) has only recently gained traction in Taiwan. For professionals, parents of children with developmental delays, and researchers, RBEI represents a relatively new approach to early intervention services. Given its novelty, this study adopts a flexible, exploratory methodology to understand its application and impact. This research employs a qualitative approach grounded in the principles of exploration and understanding, which is particularly suited to capturing the nuanced experiences of children with developmental delays and their families. Social workers, who view each child and family as unique, recognize the importance of exploring these individual life stories. Qualitative research allows for a deeper understanding of these experiences, focusing on the subjective realities constructed through interactions in therapy and daily life. The participants of this study include service users from an early treatment daycare center (referred to as “the institution”) under a social welfare organization. The sample consists of eight parents—four currently receiving services and four who have completed the program. To ensure the richness and objectivity of the research, the study employs methodological triangulation, incorporating participant observation, in-depth interviews, and an analysis of service records. This approach enables the study to thoroughly explore the participants’ experiences, offering a comprehensive understanding of how RBEI is implemented and its impact on families.

Results

Taiwan currently employs both the Routines-Based Early Intervention (RBEI) model and the classroom-based intervention model. These approaches are implemented across five key service areas: (1) Treatment in medical institutions during the health insurance payment period. (2) Treatment in early intervention institutions outside the health insurance payment period. (3) Home-based treatment provided by early intervention institutions. (4) Daycare centers within early childhood education institutions. (5) Kindergartens. Characteristics of Routines-Based Early Intervention, RBEI can be classified based on the following dimensions: Service Target: Focused on family-centered care, prioritizing the needs of children and their families. Service Field: Integrates comprehensive services that are delivered both in institutional settings and at home. Service Settings: Applicable in diverse contexts, including time-based therapy, home-based services, early childhood care institutions, and kindergartens. Service Areas: Encompasses medical care, education, and social welfare sectors. Collaboration Model: Operates through an interprofessional team approach. Challenges of the Interprofessional Team Model. The interprofessional team model, while integral to RBEI, has faced criticism due to the following challenges: Time and Effort: Both professionals and parents of children with developmental delays must dedicate considerable time to prepare for team meetings. Perceived Inefficiency: Parents often regard participation in team meetings and associated paperwork as unproductive or burdensome. Limited Parental Engagement: In open discussion settings, parents may feel hesitant to express their views or actively participate. To address these issues, RBEI includes one-on-one interviews conducted by a designated team member. These private consultations enable parents to discuss their children’s problems, daily routines, and functional goals in a supportive and focused environment. This approach minimizes the challenges of large group meetings while enhancing parent-provider collaboration. This study, using purposive sampling, selected eight parents (four currently participating in RBEI and four who had completed the program) and analyzed data through in-depth interviews and the analytic induction model. The findings are as follows: (1) Emerging Development: RBEI is still in its developmental stage in Taiwan, gradually integrating into segmented therapeutic practices. (2) Focus on Comprehensive Services: Implementation emphasizes comprehensive service providers and a support-based intervention approach. (3) Parental Stress Relief: RBEI effectively reduces parental stress by offering practical, family-centered support. (4) Family-Centered Approach: The model prioritizes family involvement, tailoring interventions to individual family needs. (5)Behavioral Support: Behavioral consultation and demonstration help parents implement functional goals and alleviate parenting challenges. (5) Flexibility: RBEI is versatile, applicable in any setting, time, or by individuals, including non-professionals. (6) Support for Educators: Collaborative consultations address challenges faced by preschool teachers and assist parents in integrating strategies from various interventions. (7) Enhanced Functional Outcomes: Children show significant functional improvements, which in turn positively influence parental involvement and satisfaction. (8) Service Provider Impact: The characteristics and quality of comprehensive service providers significantly affect RBEI outcomes. (9) Comparison with Past Models: Families highlighted differences between RBEI and their previous early intervention experiences, noting unique advantages of the RBEI model.

Conclusion and Suggestion

Innovation and Transformation in Early Intervention: The study revealed that many treatment units have yet to fully implement family-centered approaches. It is recommended that early intervention practitioners collaborate closely with families to integrate family-centered practices into their work. Adopting the Routines-Based Early Intervention (RBEI) model does not necessitate abandoning existing methods; instead, practitioners can select suitable strategies from the 13 elements of RBEI to enhance the effectiveness of treatments and services. This approach allows for a gradual transformation toward a more holistic and inclusive intervention model. Focusing on the Autonomy of Primary Caregivers: Traditional child-centered therapies often overlook the needs of the primary caregivers who provide ongoing support at home. It is crucial for professionals to recognize and address the emotional and practical needs of parents. Researchers suggest that practitioners should engage with parents empathetically, listen to their concerns, and provide emotional support. Setting family-oriented goals during the intervention process can help parents feel empowered and more actively involved in their child’s progress. Highlighting the Role of Family Members: Family members play a vital role in the development of children with developmental delays. Practitioners are encouraged to discuss with parents how to incorporate Routines-Based Early Intervention into daily life, ensuring alignment with family members’ expectations and facilitating effective communication within the family. Setting collaborative family goals can motivate other family members to actively participate in the child’s life, therapy, and related activities. This inclusive approach strengthens the support system for the child and fosters a more cohesive family environment.