PTR-F家庭支持模式對發展遲緩行為問題兒童及父母之研究

Abstract

過去的研究證實，以家庭為本位的介入方案可以有效幫助父母處理兒童在家中所出現的挑戰行為以及減少父母的親職壓力。因此，本研究的主要目的是為了探討以家庭為本位的預防-教導-增強介入模式（Prevent-Teach-Reinforce for Families, PTR-F）對於具有挑戰行為的發展遲緩兒童之家庭的影響。本研究以兩個家庭有出現挑戰行為問題的發展遲緩兒童為研究對象，並採用PTR-F 模式作為以家庭為本位的介入，並探討孩子挑戰行為之變化、兩位母親對於孩子的行為支持計劃（Behavioral Support Plan, BSP）之執行精準度，以及團隊（研究者和母親）在介入過程中之精準度。PTR-F模式主要分五個階段實施：（一）組隊（Teaming）；（二）評量（Assessment）；（三）介入（Intervention）；（四）教練（Coaching）；（五）評價（Evaluation）。本研究採用單一受試撤回實驗設計，整個實驗為期約四個月。在實驗結束時，研究者透過訪問兩位母親所得的質性內容，建立本研究之社會效度。研究結果顯示，兩位孩子的挑戰行為在實驗階段間變化（基線期一至介入期一；基線期二至介入期二）具超過50%之差距。此證明了PTR-F模式對兩位孩子的挑戰行為具有明顯的介入效果。此外，兩位母親也達到了平均值80%以上的高執行精準度以及平均值90% 以上的高介入過程精準度。本研究的觀察者間一致性為95%以上。最後，本研究亦討論PTR-F家庭介入模式的建議和限制，並提出未來PTR模式之執行和研究之建議，以供相關研究與實務人員參考。The past studies had proven family-based intervention programs helped parents in addressing their child’s at home challenging behaviors and reduced parenting stress level. The purpose of this study is to investigate the impact of the Prevent-Teach-Reinforce for Families (PTR-F) model as the main family-based intervention program on families with developmentally delayed young children who have challenging behavior problems. Two Taiwanese families with developmentally delayed children who have challenging behavior problems were involved by using the PTR-F model as the family-based intervention. The dependent variables included the changes of the child’s challenging behaviors, the implementation fidelity of both mothers based on their child’s behavioral support plan (BSP), and the procedural fidelity of the researcher and the mother. The PTR-F is implemented in the 5-Steps process: (a) Teaming; (b) Assessment; (c) Intervention; (d) Coaching; and (e) Evaluation. Follow-up was conducted three weeks after the end of the intervention for one family. An ABAB single-subject design is utilized which took about four months in both families. The results showed both children have more than 50% changes in their level of challenging behavior across phases (A1 to B1; A2 to B2). The PRT-F was proved effective for both children. Besides, a high mother’s implementation fidelity with an average of above 80% and a high procedural fidelity were reported with an average of above 90% in this study. The average mean of inter-observer agreement (IOA) was obtained for both families at about 95%. The social validity of the study was confirmed by both mothers, too. Lastly, this study also provided the limitations and recommendations for future study and implementation for reference.