Minh, NguySn Mai Hi/flng, Nguyen Thj H6ng Tliijy, L6 Minh HUOng
luy trinh can thiep s6m tre tiT ki dUa vao cpng dong
hdnh Ngpc Minh\ Nguyen Mai Hlf((ng^
guyen Thj Hfing Thiiy^, Le Minh HUdng*
Email: tnminh.nhp@gmail,com Email: malhuongnhp@yatioo,com Email' iiguyenhongttiiiy123@yahoo com Emait: [email protected] t^nti vi$n Nhi Tmng ifdng 8/S79 La ThSnti, Oflng Oa, Ha NOi, Vi^t Nam
T 6 M TAT: Can thiep rii lo^n phi tu kf dUa vao cdng ding la mdt md hinh can thi$p nhim dem lai eg hgi ve hda nhip xa hgi mdt cich binh ding cho tit ci tri em va ngudi tg kl tai chinh nai mi hg sinh song. Can thidp duge thgc hi$n di/a trin viic kit hgp nhQng nguin nhan luc va vit lUc ed sin tai chinh gia dinh tri vi ngay trong mdi trudng smh boat, hgc tip eua tri. B$nh vign Nhi da x^y dgng mdt quy trinh can thigp sdm tre tg ki dga vao cdng ddng va da tUng budc ip dung ed hidu qui. Ouy trinh gdm cAc bade: (1) Danh gia phin logi;
(2) Dao tgo cho cha me/ngudi ehSm soc; (3) Can thigp tai cac tuyin co sd theo ba hinh thdc: Trung tam can thiep sdm, trudng mam non kit hgp can thidp ci nhan, gia dinh; (4) Danh gii dinh ki. Cac hoat ddng can thi$p liy tri vi gia dinh lam trung tim, cd si/ tham gia cua nhdm chuyen gia da nginh: cin bg y ti, cin bd tSm li, giao vidn giio due ddc biet, cac nhi tri ligu chuydn sdu va sd dgng cac phUdng phip can thigp dua trin bing chUng... Can thiit cd suphii hdp tich cue giQa cae bd, nganh di tao dieu kign cho quy trinh dUdc thi/c hiin thing nhat, phi biin ring rii d cdng ddng.
Tif KHOA: Roi loan pho tu kl; can thigp sdm; cpng dong.
• • Nhan b^l 11/3/2019 -> NhSn ket quS phSn bien v^ chinh siJa 15/5/2019 •¥ Duyet (fang 25/5/2019.
1.D$t van de
Roi loan pho tir ki (RLPTK) (Autism Spectrum Disorder) la thuat ngir chi mgt roi loan phirc tap ve phat trien sinh hpc than kinh, gom cac bieu hien d5c trung cf cac miic dp khac nhau va keo dai trong 3 ITnh vuc: kho kh3n tucmg tac xa hpi;
khiem khuyet ve giao ti6p c6 lai va khong loi; hanh vi, sa thich bi thu h?p va ISp lai. Nghien curu tai cac nuac tren the giai cho biet, ti 1^ mSc RLPTK la khoang 1% dan s6 [1].
RLPTK. anh huong sau sSc den qua trinh phat trien ciia ca nhan, lam giam kha nang thich nghi hoa nhap xa hpi ciia tre, dong thai la ganh nSng cho gia dinh va xa hpi.
N3m 2008, don vi tu ki true thupc khoa Tam than, Benh vifn Nhi Trung uang dupe thanh lap, la dan vj tu ki dau tien thuQC Benh vi?n Nhi trong ca nuoc vcri dpi ngu day du bac sT nhi, bac sT tam than nhi, cac nha tam li, giao due dac biet va dieu duang nhi. Tii do tai nay, da co nhieu doan chuyen gia tir Australia, MT sang dao t^o nhieu dpt ve li thuyet, thirc hfknh chan doan va can thi?p som (CTS) cho tre tu ki (TTK) vai cac li thuyet tong quan, huong dan mo hinh lim vi?c va dio tiio cho phy huynh (ACT NOW - Monash), chuang trinh More than Words, giao tiep sam va PECS, ABA... M6i nam co khoang 400 TTK dupe CTS tai khoa, trfi CO nhifiu tiln bp tren cac ITnh vyc va cha m? dupe huong ih\, dio tao vk cac hoat dpng can thi?p tai nha [2]. Khoa rim than ciing d3 th\rc hi?n nhiSu nghien cuu khoa hpc, 3ien soan nhieu tii li?u cho cac nha chuyen mon, to roi, so ay dinh cho cha m?, thg-c hi?n cac khoa dio tao lien tuc :ho cin bp y te tuyen duoi vi cac ca nhan, to chuc. Tuy ihien, hoat dpng t^i b?nh vi?n chua ddp ung day dii nhu :au ve CTS t\r ki, cin thiet phai xay dyng mpt quy trinh
•an thi?p d\ra vao cpng dong nh5m cung cap nhimg dich
vu, hoat dpng phii hpp vdi tinh trang, nhu cau cua TTK, gia dinh tai chinh dia phuong ma tre sinh song.
De xay dung quy trinh can thiep mpt each toan dien cho TTK, can c6 su tham gia, phoi hpp hanh dpng giiia Bp Y te, Bp Giao due, Bp Lao dpng, Thuang binh vi Xa hpi.
Cling cac to chiie xa hpi nhu cau lac bp gia dinh co con mSc chiing tir ki, cac gia dinh va nguoi than ciia tre. Viee hoat dpng theo mpt quy trinh thong nhat tu trung uong den dia phucmg va cpng dong se dem lai hi?u qua tot nhat ve can thi?p cho cac tre mac RLPTK. Trong npi dung chuyen de nay, chiing toi se trinh bay "'Quy trinh CTS TTK dua vdo cdng ddng " dupe xay dijng boi Khoa Tam than, B^nh vi?n Nhi Trung uong.
2. Npi d u n g n g h i e n cuTu
2.1. Khai niem va cd sd khoa hpc cua can thiep sdm CTS la nhung hoat dpng dupe thue hi?n ngay sau khi phat hien tre em c6 cac dau hieu tu ki, khong nhat thiet eho d6n khi chan doan xac dinh. CTS cho TTK bao gom: cac bi?n phap can thiep - li nhung phuang phap, chucmg trinh, he thdng nhim giiip tre phat trien; cie dich vu - la nhung dia di£m va to chuc cung cap cae bien phap tri li?u. Dac diem cua CTS [3];
- Lay gia dinh ldm trung tdm: Co su tham gia ciia eac thanh vien trong gia dinh TTK phoi hpp ciing vol cac chuyen gia; Co tinh linh hoat: co the dupe thyc hi?n o cac trung tam CTS hoSc trucmg mam non, ho^c tai gia dinh. Gia dinh dupe huong din va trg giiip trong qua trinh can thi?p.
- Cd edu true tot: Ngudi thyc hi?n la nhung ngudi dupe dio tao trong ITnh vuc can thi?p ty ki; Cd chuang trinh ea nhan hda danh cho mdi TTK. Chuang Irinh nay dugc len
So 17 thing 5/2019
N G H | £ N COTULfLUAN
kk hoach dua vio mot danh gia toin dien, can nhac den nhu ciu ciia tre vi gia dinh, ngudn luc dia phuong...; Theo doi va danh gia thudng xuyen sy tien trien cua tre de thay d6i chuang trinh phii hpp vai giai doan phat trien; Dupe td chirc CO he th6ng, dl tiep can doi vdi gia dinh TTK; Cung cap moi trudng hpc tap thuan loi: Tre dupe an toan, dugc tao digu kien dk phat huy nang luc ca nhan; Cd eac hoat dong phii hop nhSm ho trg tre di hpc hda nhap; Co hoat dgng giiJp tre co co hpi tiep xiic vdi tre ciing liia phat trien binh thudng.
- Dua tren cdc bdng chung khoa hpc: Dupe thiet ke cho tre mic RLPTK, dua tr&n dac digm va nhirng thieu sdt, nhu ciu ciia TTK; Tap trung vao viee phat trien cac kT nang ehu y, giao tigp, bit chudc, ngdn ngtr, kT nang xa hdi, nhan thiic;
Bao gdm eac chign luge giiip tre hoc cac kT nang mdi va sir dung chiing trong cac bdi canh khae nhau (khai quit hda);
Xac dinh nhung mue tieu dich, hay edn gpi la muc tieu iru tien, cac hinh vi co van de vi day tre eac hinh vi thay the.
Theo to chiic CDC, cic trieu chiing ty ki co the phat hien tu khi tre con rit nho, khoang 18 thing [4]. Chinh vi vay, CTS trudc 5 tu6i dac biet la trudc 3 tudi se cai thien hieu qua dieu tri vi lim tang chat lugng song ciia tre va gia dinh sau nay. CTS ap dung dong thdi vdi ca tre da dupe chan doan tu ki va tre co dau higu nghi ngd ty ki.
2.2. Quy trinh can thi§p s6m tre tiT ki difa vao cgng dong - De xuat cua Benh vi^n Nhi Trung ddng
2.2.1. Nhu cau can thiep sdm dda vao cpng dong Can thiep RLPTK dya tren gia dinh vi egng ddng la mpt ehien lupc phat trien nham dem l^i co hgi ve hda nhap xa hpi mgt each binh dang cho tat ca tre em va ngudi ty ki tai chinh noi mi hg sinh sdng. Can thiep dya tren vige kgt hgp nhQng ngudn nhan lye va vat lyc co san tai gia dinh tre va trong moi trudng sinh hoai, hpc tap ciia tre. Hai uu diem cua mo hinh nay la khong tach TTK ra khoi gia dinh va epng ddng ma tre da gan bd tir nhd va cim thay an toin;
tiet kiem chi phi cho gia dinh TTK dua tren viec tan dung nhQng ngudn lye san co ciia gia dinh va dia phuong trong qua trinh can thi^p.Tren thuc te, can thiep TTK dua tren gia dinh va cong ddng da dugc ap dung tren 40 nam qua t^i nhieu noi tren the gidi, d5c biet tai nhung nudc dang phat trien tuong ddng vdi Viet Nam nhu: .\n Dp, Thai Lan, Trung Qudc. Tai Vigt Nam. tiep can dya vao gia dinh vi cpng dong da dugc nganh Y te sdm tnen khai vdi cac rdi loan khuyet tat khac nhau. Vdi RLPTK. hign nay dang cd mgt s6 chuang trinh/dy an thii nghiem tai cic tinh nhu Thii Binh, Hoa Binh, Thai Nguyen. Ddng Nai. Die Lie...
Theo nghien ciiu ciia Gabovitch va Curtin (2009): Gia dinh li thanh vien ndng cot c6 the giup xae dinh cac lua chpn djch vy \ a myc tieu phat trien ciia diia tre, do dd ho trp tich eye gia dinh dem lai nhirng ket qui khi quan cho sy phat trien tong the ciia TTK [4]. Tuy nhien. cac nhi nghien ciiu ciing da chi ra ring de qua trinh can thigp TTK t?i gia dinh d?t dupe ket qua tot. eha m? va cac thanh vien trong gia dinh ciia TTK cin dugc eung cap cac kign thiic.
kl nang chuygn sau ve cac phuang phap can thigp ma da
dupe chimg minh hieu qui qua thyc nghiem. Ngoai ra, cha me cung cin dupe gidi thieu vg cac luat va quy dinh ve ffio due dac biet, cac dich vu cin thiet va sin cd. vi tim thg nio dk ra quygt dinh vg each thiie hd trg TTK trong mdi giai doan phat trign khac nhau.
2.2.2. Muc dich can thiep sdm tr^ td ki tai cpng dong - Tao diku kien thuan loi de tre phit trien tdi uu cac nJng lyc bin than.
- Giam thigu nhung thigu sdt vi anh hudng do RLPTK mang lai cho tre, gia dinh va cpng ddng; Chuan bj cho tre nhung kl nang hpc tap khi dgn tudi di hpc: Giiip tre tro nen ddc lap nhit cd the, nang cao chit lugng cugc sdng cho tre va gia dinh.
- Giiip gia dinh tre chii ddng, tieh cue vi thuc hi?n dugc nhung hoat ddng can thiep.
- Giiip xay dyng mgt mang ludi, mdt sy phoi hpp ho^l dpng lien nganh va giira eac can bp y te hi trung uong iJen dia phucmg.
2.2.3. Pham vi ap dung can thiep sdm
- Ddt lufmg tham gia CTS: Tit ea tre dudi 6 hidi diipc chin doan mic RLPTK cac miie dp khac nhau, ho$c tii co dau hieu nghi ngd ty ki.
- Cdc thdnh vien tham gia CTS TTK: Bk CTS d^t hi^u qua phai cd phoi hpp ciia nhdm cac chuygn gia da nginh;
cac chuygn gia (y te, tn ligu chuyen sau) va cha m?, giio vien, cie ngudn luc khae ciing chung siic, ho trg Ian nhau dg dam bio tinh thdng nhit, tinh ddng bp va hi?u qui trong suot qua trinh CTS. Sy phdi hpp nhdm da nginh khong chi mang lai Igi ich cho TTK ma eon mang tai Igi ich cho moi thanh vign cung nhu toan bd nhdm vg kha ning ty giao dtfC, tu quin li ciing nhu tao dugc niem tin ehung trong CTS cbo TTK (xem So d6 1).
Sa dd 1: Cdc thdnh phdn tham gia CTS TTK 90 TAP CHI KHOA HQC GIAO DIJC V l f l NAM
Th^nh Ngoc Minh, Nguyen Mai Ht/dng, Nguyen Thi Hong Thuy, U Minh Hddng
2.2.4. Quy trinh can thiep sdm H tU ki dda vao cong dong
crdd 2: Quy trinh CTS TTK tgi cpng ddng Cic binVc thirc hi^n quy trinh:
Birde 1: Ddnh gid: giiip xay dung dupfc chutmg trinh a/I thipp phu hpfp v&i tung tre.
Cic hoat ddng danh gia:
Boi v&i tri:
- Mirc dg tu ki: Dya vio cdng eu danh gia la Thang ddnh lid mirc dp tu ki tre em CARS (Childhood Autism Rating Scale). Thang CARS sir dung vdi mye dich phan loai ba nirc do ty ki khae nhau la: Ty ki nhe; Ty ki trung binh; Tu ii ning.
- Miirc dp phat trien: Sii dung edng cu danh gia cae kT nang shat trien Denver II (Denver Developmental Screening Test t'ersion 11). Test kiem tra mdt each kha toin dien sy phat Tien ciia tre, tap trung vao 4 ITnh vyc: ca nhan - xa hpi; van tpng tinh te - thich iing; ngdn ngu'; van dpng thd. Kgt qua lua ra li chi so DQ (Developmental Quotient): Phit trien linh thudng: DQ tren 70%; cham phat trien nhe: DQ tir )0% dkn 70%; Cham phat trign vira: DQ tir 30% din 50%;
!^ham phat trien nang: DQ dudi 30%.
- Danh gii ve cae giai do^n giao tigp theo chuang trinh Wore than words: Giai doan giao tigp ty phit: giao tiep d nirc rit thip, khdng chii dpng, bit thudng; Giai doan giao iep ygu cau: giao tiep d miic don gian, theo nhu cau ciia re; Giai doan giao tiep sdm: cd su chia se qua lai; Giai doan
;iao tigp ddi tic: cd su tucmg tae phii hop.
B6i v&i gia £nh: Dya vio mOt bing hdi ddng nhat, danh [ia: Kien thirc, kT nang cha me/ngudi chim sde; Cic mdi
|uan h?, hinh vi - cam xiic eua cdc thanh vien trong gia tinh; Moi trudng gia dinh: kinh te, thdi gian, kha ning day re...
001 v&i xa hgi: Cac ngu6n luc tai dia phucmg gdm cac
"ung tam CTS, cac giao vien can thi?p ca nhan, cie trudng iam non t^i dia phuang.
K^t qui danh gia: Se phin nhdm tre de dua vio cie huong trinh, boat dpng can thiep phii hgp (xem So dd 2).
Ba&c 2: Bdo ttfo cho eha mp ho^c ngudi tr^rc tiep eham k: cung cip kign thiic, kT nang CTS TTK de eha me vi
ngudi cham sde ed the ap dung tai gia dinh sau khi tre dupe danh gia phan loai. Thdi gian: 3 tuan.
Ve li thuyet: Cha me TTK se dugc tham gia vao cac budi tu van nhdm vi tu van ci nhan. Cae buoi tu van nay nhim muc dich cung cap thdng tin vg RLPTK: Cac trieu chimg cdt ldi, trieu ehiing di kem, diln bign...; cung cip thdng tin ve eae bien phap vi hinh thiic can thiep tu ki hien nay tai Viet Nam. Trong 3 tuan, cha me se cd 04 budi tu vin nhdm vdi nhung chu de khae nhau, mdi buoi tu van keo dii 120 phiit.
Ve thue hdnh cdc kT ndng CTS tgi gia dinh: Sau khi dupe danh gia phan loai, TTK d ca ba nhdm se dku phai trii qua 3 tuan tai benh vien Nhi de nhan nhung can thiep ban diu.
Nhimg hoat ddng can thiep ban dau nay nham tao thuan loi eho nhirng can thiep tiep theo d tuyen co sd. Vi du nhu tre tao dugc thoi quen tach cha me, tre lam quen vdi lich trinh can thiep, ho^t dpng can thiep... Ddng thdi, trong qui trinh nay, eha me se dugc tryc tigp tham gia qua trinh can thi?p bang each ap dung nhu:ng kT ning dugc hgc de thyc hinh tren chinh con minh dudi sy hudng dan ciia can bg. Qua cac hudng dan "cam tay chi vi?c", cha me khong nhiing hieu mi cdn dugc dao tao de thyc hien thanh thuc nhiing ky nang can thiep.
Cac hoat dgng khac:
- Cung cap va hudng dan su dyng tai lieu, video vg can thiep.
- Theo ddi va hudng dan sir dung thuoe neu co.
- Hudng dan tim ngudn trg giiip tai dia phuang (m?ng ludi cac cha me tu ki), cac trung tam, dich vu can thiep TTK tai dia phuang.
- Trao ddi, chia se ciia cac cha me vdi nhau ve kien thire, kinh nghiem nudi day TTK. Viec cac cha me co dupe su ddng cim, tdn trgng, gap gd lan nhau se giiip giam di sy mac cam, nang cao nang lyc bin than va tao ra mgt mang ludi trao ddi, chia se giCra nhiing gia dinh cd TTK tai cdng ddng.
Bu&c 3: Can thipp tgi cdc tuyen easa: TTK dugc chuygn vg cae CO sd giao due phii hgp vdi tinh trang vi nhu cau, kha nang chi tra eiia gia dinh va nguon luc hien cd tai dia phucmg. Cd 3 hinh thiic can thiep tai cac ea sd giao dye nhu sau:
- Trung tdm CTS: Day li hinh thiic giao due chuyen biet dinh cho tre dugc dinh gia thudc nhdm 1 theo bude I. O day, tre hoe ban tni tai trung tam, hang ngiy tre hpc 1 - 2 tiet ca nhan mdt co mdt trd, mdi tiet khoang 30 phiit, thdi gian edn lai tre se dugc can thiep tri heu theo nhdm. Mdi nhdm eo cd khoang tir 10 din 15 tre dupe dinh gia co cung muc dp phat trign. Cac hoat ddng trong mdi budi thudng dugc chia thanh tir 5- 6 hoat ddng nhd. Cac phuang phap can thiep dugc sir dung li nhimg phuong phap da dupe nghien ciiu, cd bing chiing khoa hpc \e hieu qua, hay gap li ABA (phan tich hanh vi ung dyng); PECS (giao tigp bing trao ddi tranh); am ngu' tri lieu; hoat dgng tn ligu; EDSM (md hinh CTS Denver)... Ngudi thye hien li nhihig giio vign dac bi$t, chuyen vien tri lieu, can bd tam li, kT thuat vien ...
S6l7thang 5/2019
N G H I E N COrU Lf LUAN
da dupe dio tao ehuyen sau d mdi ITnh vyc, cd kinh nghiem lim vi?c vdi TTK vi sin sing trao ddi, hd trg, giiip dd gia dinh TTK.
- Hpc hoa nhdp tai truang mdm non kit hgp gid can thiep cd nhdn: Vdi nhung TTK dugc dinh gii thudc nhdm 2 d budc 1, tre cd thg tham gia cae hoat dong hpc tap hda nhap tai trudng mim non, song song kgt hgp gid can thiep ca nhan.
Tnrdng mim non: Mpt trong nhimg nguygn tic can thiep TTK li khuygn khich loi da kha nang va thdi gian TTK dupe giao tiep, sinh hoat, hgc tap vdi eac ban ciing liia binh thudng. Vi vay, de dat dugc digu do, viee dua TTK hgc hda nhap tai cac trudng mam non, dong thdi hudng dan, tap huin cho giao vien mam non de cd thg thuc hinh can thiep ngay tai trudng la digu rat quan trpng. Giio vien tai trudng mam non cin cd kign thiic co ban ve RLPTK, tir do ho trp tre tham gia mgt each toi da cac hoat dgng nhu tre binh thudng tai trudng. Giao vien cung la ngudi theo doi su tign bg ciia tre, tu vin kip thdi cac hoat dgng, dich vu cho gia dinh nham hd trp tre tdt hem.
Gid can thiep ei nhan: Thudng keo dii 60 phut, tan suit tiiy miie do, dieu kien gia dinh va ngudn luc hien cd tai dja phuang. Gid ci nhan cd the dupe thyc hien ngay tai trudng mim non, hoic tai trung tam, hoae tai gia dinh vdi giao vign rieng. Ngudi thyc hi^n: Can bg tam H, giao vien giao due die biet hoae giao vign da dugc dao tao ve can thiep ty ki.
Npi dung can thigp gid ca nhin tiiy thupc vao dac diem, khi nang vi nhu cau cda TTK vi gia dinh.
- Can thiep tgi gia dinh: Gia dinh co vai tro dae bi?t quan trpng trong qua trinh can thigp TTK. Cie hoat dpng can thigp tai gia dinh phy thugc vio nhu eau ctia tre va ning lyc ciia cha me hoac ngudi cham soc. Sau khi dupe dio tao d budc 2, TTK vi cha me hoic ngudi cham sde trd ve gia dinh, ip dyng cac kien thiie, kT nang de cd nhirng hoat ddng can thi?p tich eye, phii hpp vi lau dii cho tre.
Nhdn xet: Tai budc nay, vai trd ciia giao due li chu dao.
GiQa trung tam/trudng hpc vi gia dinh can phdi hop chat che nhim ning cao hieu qua ciia can thigp. Can ed mdt sy chi dao va giam sat ehat che ciia cac ban nginh ciia Sd Giio dye, Sd Lao dpng, Thucmg binh va Xa hpi doi vdi he thong cic trung tam, dich vy can thiep tu ki tai dia phuang.
Ngoii ra, giao vien thye hign can thiep ty ki can cd chinh sach dai ngg rigng. Can thiep ty ki la mot qua trinh lau dii, tdn kem. Vi viy, TTK can dugc xep loai khuyet tat dg dugc hudng cic chinh sach uu dai ciia xi hpi. Vi viy, d budc niy, cic cin bp nganh Lao dgng, Thuang binh va Xa hgi, chinh quyen cac cap, cac co quan doan thg khie can vao eupc dg hd trp gia dinh, tre.
Bir&c 4: Ddnh gid dfnh ki sau moi khoang ih&i gian 3
thdng: Danh gia sy tiln trign ciia cac hoat dpng can thif p ty ki, phdi hpp vdi giao vien, cha m? de digu chinh, bd sung ehuong trinh can thiep, tim hieu nhiing khd khin, thuan Igi ciia chucmg trinh CTS cua ci nhan tre.
Vai tri: Dinh gia lai miie dp eua tu ki, giai doan giao tigp, cae kl ning phat trien; Danh gii cae van dg mdi phit sinh.
Vai gia dinh: Danh gii l^i kiSn thiic, kT ning ciia cha m?/
ngudi cham sde; Dua ra nhung hudng din, tu van kjp thoi phii hpp vdi timg giai doan phat trien ciia tre.
Nhgn xet: Khdng cd mdt ehuang trinh hay mpt bien phap can thi^p duy nhat phii hgp vdi mgi tre hoic mpi giai do?n phit trign ciia tre. Vi vay, nhiing dieu chinh hoat dpng can thi?p Ii cin thiet, giiip dem lai hipu qui tdi iru cho can thi^p, lam giam sy lang phi vg thdi gian ho^c edng site, kinh te khi theo dudi mpt can thiep khong phii hgp. Tuy nhien, qua trinh danh gii nay phai dugc thyc hien thudng xuyen vai nhirng ehuygn gia cd kinh nghipm va vdi sy tham gia tich eye eua cha me hoac ngudi chim sde ehinh.
3. K e t luan va k h u y e n nghj 3.1. Ket luan
CTS TTK dya vao cgng ddng la chign luge can thigp hifu qui, phii hpp vdi nhu ciu cua TTK va gia dinh tre. Quy trinh CTS TTK tai cpng ddng lay tre va gia dinh lim hung tam, eo sy tham gia da nganh, lim vi?c nhdm bdi nhieu chuyen gia khic nhau. Quy trinh bao gdm nhihig hoat dpng ndi tiep nhau, eu the nhu sau:
Bude 1: Dinh gii phan loai.
Bude 2: Dio tao cho cha m? hoac ngudi tryc tigp cham sde tre nhiing kign thirc, kT ning CTS ty ki t?i gia dinh.
Budc 3: Can thi?p tai cac tuygn ca sd: Hinh thirc trung tam CTS; Hinh thiic hpc hda nh^p tai trudng mim non kel hpp can thiep ci nhan theo gid; Can thi?p tai gia dinh.
Bude 4: Dinh gii dinh ki sau moi khoang thdi gian 3
3.2. Khuyen nghj
Can cd sy phdi hpp ddng bp vi thdng nhit giita y te va cac lyc lupng xa hpi khac, dac biet la giio dye trong CTS TTK. Sau khi nganh Y tg thyc hien chin doan, phan lo^i va hudng dan cha m? can thi?p, nginh Giao dye can tiep noi thuc hign cie hoat dpng can thi?p, ddng thdi y te tiep tyc danh gii vi xii li eac vin dg siic khde eiia TTK de tao thu^n Igi, ting hieu qui eiia can thi?p (Vi dy nhu sii dyng thuoc eho cac rdi loan hanh vi). Ngoii ra, cin sy tham gia ciia W nginh Lao dpng, Thuong binh vi Xi hpi vi cic ban nghii^
khic dg giiip dua ra nhihig chinh sach ho trp, tao ca hpi cho TTK hda nhap cpng ddng.
TAI lifu tham khio
[11 Elsabbagh M et al, (2012), Global prevalence of autism and other pervasive developmental disorders: A revievt- of existing evidence, Br J Nutr, 114 (5), pp.663-672.
Thinh Ngpc Minh - Nguyen Mai Huong - Nguyen Thi Hong Thuy, (2016), Hogt dpng danh gid. chdn dodn ire [3]
mdc roi logn phi tv ki Igi Khoa Tdm than - Bpnh t if" ^ Trung uang tir 2011-2015, T?p chi Khoa bgc Giio dtic. s6 (J$c biet, tr. 84-87.
Schertz, H., Baker, C , Hurwitz. S , & Benner, L, (20111 Principles of early inlerventton reflected in lotUir 92 TAP CHi KHOA HQC 61A0 DIJC Vl^T NAM
research in autism spectrum disorders. Topics in Early Childhood Special Education 31(1): 4-21.
[4] Gabovitch, E. M., Curtin, C, (2009), Family - centered care for children with autism spectrum disorders: A
[5]
Hi/dng, Nguyen Thi Hong Thuy, U Minh Hi/dng
review, Mamage and Family review, 45 (5), pp.469-498.
Centers for Disease Control and Prevention, Data and Statistics on autism spectrum disorder, https://www.cdc.
gov/acbddd/autisni/data.html
:HE COMMUNITY-BASED EARLY INTERVENTION PROCESS JQR CHILDREN WITH AUTISM
hanh Ngoc Minh \ Nguyen Mai Huong^
Iguyen Thi Hong Thuy^ Le Minh Huong'
Email, lnminh.nhp@gmail com Email, [email protected] Email: iguyenhongthuyl [email protected] Email' !ehuong@m3il ru ietnam National Children's Hospital Jo 18/879 La Thanfi, Dong Da, Hanoi, Vietnam
ABSTRACT: Assisting children with autism and their families to achieve positive outcomes is a continuous and ongoing process. The community-based early intervention is an effective strategy which brings opportunities for children to integrate in daily life, it also facilitates the generalization of skills beyond the lamiliar home setting and across the child's natural environment A community- based early intervention process developed by the Psychiatry Department, National Hospital of Pediatrics has 4 steps: (1): Evaluation and classify the severity of disorder; (2): Parent /primary caregivers training; (3) Intervention in three types of services: Special centers; kindergartens plus individual sessions; home; (4) periodic follow up. Evidence-based practice involves the multidisciplinary treatment approach of different available resource: children and their families, healthcare professionals, educators, and other service providers. It is suggested that a conjunction between ministries of Health, of Education and others should be made to unify the process and to spread it in community.
KEYWORDS: Autism; early intervention; community.
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