特教教師參與學生情緒行為問題使用藥物治療之研究

Abstract

摘 要 本研究旨在探討國小特教教師參與學生情緒行為問題使用藥物治療行為及其藥物治療相關知識，並探討教師之藥物治療相關知識在不同基本變項、參與經驗上之差異。本研究選取台北市200位特教教師為研究對象，以自編之「藥物治療參與經驗」、「藥物治療相關知識」量表為工具，採用問卷調查方式收集資料。回收樣本共178份，回收率89%。以百分比、t檢定、單因子變異數分析做統計考驗。茲將本研究之主要發現歸納如下︰ 一、特教教師參與學生藥物治療行為 （一）經驗背景 有80.7%的台北市國小特教教師有參與經驗，這些教師中，有89.4 %認為每年大約有1-2位學生因為情緒行為問題而接受藥物治療。有95 %的研究對象認為學生接受藥物治療與教師的特教工作有關係。 （二）參與情形 教師最經常參與的項目是主動了解學生使用藥物的效果及副作用；和家長討論、評估學生的情緒行為是否應該轉介醫療單位；和家長討論藥物治療的成效；以及留意學生的情緒行為變化，作為教學及輔導的參考。教師很少或從未參與的項目是持有家長托付的藥袋（包）說明或醫師指示的注意事項；和醫師討論藥物治療成效及要求家長簽寫同意書，表示同意教師督導管理學生用藥。 （三）參與學生藥物治療之困難問題 五至七成的教師認為參與學生藥物治療最多也是最重要的困難問題有︰家長排斥或害怕孩子使用藥物治療情緒行為問題；特教教師藥物治療專業知識不夠；學生情緒行為問題複雜，不易判斷因果關係，選用處理策略；家長通常不願意讓別人知道孩子正在看精神科。最少也是最不重要的困難問題是︰教師無法取得醫院相關訊息，所以無從轉介；學校並非醫療單位，應以教育工作為主。 二、特教教師之藥物治療相關知識 本研究發現台北市國小特教教師之「藥物治療相關知識」全量表平均通過率為79%，其中「行為及藥效評估知識」平均通過率90%，「情緒行為問題與藥物治療的關係」是78%，「藥物相關知識」是69%。此外，特教教師之藥物治療相關知識在其年資、學歷、特教專業訓練、相關專業訓練及參與經驗上，並無顯著差異。 根據上述結果綜合討論後，研究者對國小特教教師、特教行政單位及未來研究者提出建議並說明研究限制。Abstract

This study intended to find out and discussed how elementary school special education teachers participated in the pharmacotherapy of exceptional students with emotional and behavioral problems. This study surveyed individual teachers’ knowledge in pharmacotherapy, and investigated the relationship between the teachers’ knowledge and their training, educational background, and duration of teaching experience. Two hundreds special education teachers were randomly selected from Taipei elementary schools as the subjects of mail list. The received surveys were 178 copies and the rate of receiving is 89%. Two questionnaires measuring pharmacotherapy knowledge were designed to collect information for this study. "The experience of participation in pharmacotherapy" and "Related knowledge in pharmacotherapy". The percentage, t-test and one-way analysis of variance were used for statistical analysis. The major findings of this study were summarized as follow:

1.Special education teachers’ participation in pharmacotherapy of students

(1) Experience of pharmacotherapy participation There were 80.7% of Taipei elementary school special education teachers who had participated in pharmacotherapy of students. Of these teachers, 89.4% had worked with one to two students who do received pharmacotherapy because of emotional and behavioral problems. 95% of teachers concluded that pharmacotherapy of students was closely related to teachers’ work in special education. (2) Participation The tasks teachers participated the most frequently include: finding the effectiveness and side effects of medication for students; discussing with parents and assessing students’ emotional and behavioral state, so as to determine appropriate referral to medical facilities; discussing the effectiveness of medications with parents; and monitoring students’ emotional and behavioral change for reference in teaching and counseling.There were tasks teachers seldom or never participated in,including: keeping students’ medication and dispensing directions, keeping doctors’ instructions in areas needed special attention, discussing effectiveness of medicine with doctors, and requesting written consent from parents authorizing teachers to monitor and dispense medication to students. (3) The difficulties experienced by special education teachers when they participated in pharmacotherapy of students Fifty to seventy percent of teachers encountered difficulties when they participated in pharmacotherapy of students .The most frequent and most serious problems were that parents rejected medical recommendations or parents feared side effects from pharmacotherapy of emotional and behavioral problems. Special education teachers did not have profound professional knowledge in pharmacotherapy. Teachers lacked causal understanding of students’ emotional and behavioral problems, due to their complexity, which then leads to difficulty developing effective management strategies. In addition, parents were usually reluctant to reveal that their child was seeing a psychiatrist, so the teachers lacked important information. The least frequent and least serious difficulties include: teachers not being able to obtain related information about treatment facilities and lacking referral practice. Teachers and school administrators regarded education as their main responsibility and schools were not designed or equipped to be treatment facilities.

2. Special education teachers’ related knowledge in Pharmacotherapy This study found that special education teachers in Taipei elementary schools answered the questions correctly in "Related knowledge in pharmacotherapy" with an average of 79%. Within this particular questionnaire, 90% of teachers obtained the correct response for the items "The knowledge in behavior assessment and medication effect", 78% obtained the correct response for the items" The relationship between emotional and behavioral problem and pharmacotherapy", and 69% obtained the correct response for the items "Related knowledge in medication". In addition, this study found that teachers’ related knowledge in pharmacotherapy appeared no significant difference among the various years of the teachers and their educational background, professional training in special education, related professional training, and experience of participation in pharmacotherapy.

3. Conclusion and limitations Based on the conclusions, some recommendations were made to elementary school special education teachers, school administrators, and other researchers who want to conduct related studies in the future. This researcher also pointed out and explained the limitations in this study.