基于增能理论的残疾儿童康复需求评估关键技术及实施策略研究

Comprehensive rehabilitation is the basis for the development of disabled children, which helps disabled children to achieve the goal of “disabled but useful” , enhance the development ability and quality of life, and reduce the burden of family and society. Researches at home and abroad suggest that to achieve the comprehensive rehabilitation of children with disabilities need to clear the demand from the empowerment of purpose and build the path and mode to meet and implement the requirements. In recent years, the government has invested a lot of resources, but still faces many problems, such as poor rehabilitation effect, low parent satisfaction and so on. Our research group found that the main reason is that the current model is still limited to the biomedical model and has not yet formed a suitable comprehensive rehabilitation mode for disabled children, which suggest that we need to build a comprehensive rehabilitation model for children with disabilities based on empowerment theory. Therefore, our study will construct a theoretical framework for the comprehensive rehabilitation of children with disabilities based on empowerment theory firstly .And then we will develop two key techniques for the rehabilitation needs assessment of children with disabilities: requirements assessment tools and implementation paths. Finally, we will structure the implementation strategy of comprehensive rehabilitation for disabled children and make empirical studies. According to the evaluation results to optimize the key technology and implementation strategy, and form a methodological system and guidelines for the implementation of strategy and service model to provide theoretical and methodological support for the comprehensive rehabilitation of disabled children in China.

全面康复是保障残疾儿童发展的基础，有助于残疾儿童实现“残而不残”、“残而不废”，提升发展能力和生存质量，减轻家庭和社会负担。国内外研究提示，要实现残疾儿童全面康复需要从“赋权增能”的目的出发明确需求，构建满足和落实需求的路径和模式。近年来，我国政府投入大量资源，但仍面临康复效果不理想、家长满意度不高等诸多问题。课题组分析发现影响有效性的主要原因是现行模式仍局限于生物医学模式，尚未形成适宜的残疾儿童全面康复模式，提示需要基于增能理论去构建“发现-满足-落实”残疾儿童需求的全面康复模式。因此，本研究首先基于增能理论构建残疾儿童全面康复的理论框架，然后研制残疾儿童康复需求评估的两大关键技术：需求评估工具和实现路径，最后构建残疾儿童全面康复实施策略并进行实证研究。最终根据评价结果优化关键技术及实施策略，形成实施策略及服务模式构建的方法学体系与指南，为我国开展残疾儿童全面康复提供理论与方法学支撑。

残疾儿童的全面康复是其正常发展的基础，是实现其“残而不废”、提升发展能力和生存质量的保障，有助于减轻残疾儿童家庭和社会负担。本研究在课题组前期研究基础上，分析残疾儿童康复服务需求现状及问题，厘清各要素之间的作用机制，研制基于增能理论视角的残疾儿童康复需求评估工具，基于残疾儿童“发现异常-知晓康复-接受康复”过程，明确并构建残疾儿童康复需求评估工具的定位和实现路径，应用评估工具开展实证研究，提出残疾儿童全面康复需求评估工具的优化策略，为我国开展有效开展残疾儿童康复需求评估提供理论和技术支撑。.本研究首先明确了“残疾儿童康复”的内涵，通过对理论框架进行功能分析，确定理论框架包涵五个一级维度，涉及13个要素，明确了要素之间的逻辑关系，构建了基于增能理论的残疾儿童全面康复理论框架。其次，分析并总结了我国在残疾儿童康复服务中存在的问题，明确了评估工具的功能和要素，确定了残疾儿童康复需求评估的框架，最终形成了以23张全面康复需求评估表为核心的残疾儿童全面康复需求评估工具；并通过对16名残疾儿童家长进行关键知情人访谈、38名供方进行了意向调查、对54名残疾儿童家长进行了问卷调查，证明了评估工具在实际应用中的可操作性和可行性。再次，提出残疾儿童全面康复需求评估工具实现路径的“全过程-分阶段-理想化”功能定位，形成实现路径的实施方案，并开展实证研究。最后，基于实证研究收集的各方反馈意见，总结需求评估工具及其实现路径存在的问题，针对实施目标，结合解决工具优化、实施形式、实施保障、服务供给、康复理念方面存在问题的措施集，本研究研制了六大实施推广策略，形成了实施策略及服务模式构建的方法学体系与指南。