以ImPACT課程應用家長三級介入模式提升臺灣自閉症幼兒家長之社會性溝通研究

Abstract

本研究旨在探討應用ImPACT家長三級介入模式對自閉症幼兒家長社會性溝通技巧的成效。以單一受試變更情境為研究設計，以初級自學、次級家長團體和第三級一對一教練形式，探究所有參與家長均能學會社會性溝通技巧之外，檢視三級模式是否能達到減少需要次級、第三級介入的家長人數。並且，在資源與需求適配的情形下，試圖解決家長介入的困境。全數10位參與家長，全程參與共9位。家長介入反應比率定義為親子居家互動影片5分鐘，以30秒部分時距紀錄四項技巧的平均90%以上，據此標準初級達介入反應通過3位，通過率30%；次級達介入反應5位，通過率50%；第三級達介入反應1位，通過率10%。尚有1位因疫情考量退出。研究結果顯示初級家長滿意時間彈性的自學方式；次級家長團體時間配合家長在周末進行課程，同時提供托育服務；第三級配合家長家庭作息時間，以及提供個別化回饋。透過三級不同密集度和個別化程度設計，各級通過家長均滿意此種學習方式，能解決文獻所述家長介入瓶頸。由本研究結果觀之，基於不同家庭有不同學習需求和條件，家長介入的確需要不同個別化和彈性程度設計，以滿足前述學習需求，依據研究結果提出建議及展望，以供未來家長介入研究及教學參考。Parent-implemented intervention is one of the evidence-based practices for students with autism spectrum disorders(ASD). Reflecting from the literature on stepped care and response to intervention models, a three-tier intervention model was applied to parent education with the curriculum ImPACT A single-subject changing conditions design was used to examine the implication of a three- tier intervention model in a diverse group of families (n=10) participating in a parent training program. The three tiers consisted of (a) Tier 1: self-administered learning, (b) Tier 2: group training , and (c) Tier3: one-on-one individualized coaching. Following each phase, parental skills during parent-child interactions at home were observed with parent-child interaction video clips which determine parents’ response to the intervention(s) by the average of 30 seconds partial-interval recording of four skills. Parents who met specified response-to-intervention criteria discontinued treatment and attach one-month follow up, while those that did not meet criteria continued to the next tier. Of the nine participants (90%) who completed treatment, all responded to intervention. Results suggest that the Tier 1 intervention was effective for three (30%) parent-child dyads. Five dyads (50%) responded to Tier 2 intervention and one dyad (11%) required Tier 3 intervention to meet response-to-intervention criteria. One dyad dropped out because of the concern of COVID-19. Discussion focuses on the application of a tiered model of intervention to increase efficiency by minimizing the need for more costly time-intensive interventions for parents who may not require them and also discussed the utilization of western program in Taiwan. According to the results, three-tier parent training model can content the different needs of learning of diverse families. More studies are needed in the future.