听力障碍和言语障碍儿童保健、康复和教育服务的国际政策架构、核心内容与优先领域研究

doi:10.3969/j.issn.1006-9771.2024.04.001

Abstract

Abstract:

Objective To analyze the framework, core content and priority development areas of international policy concerning healthcare, rehabilitation and educational services for children with hearing and speech impairments.

Methods Based on the WHO's "Rehabilitation in Health Systems" and the six building blocks of health services, this study conducted a systematic analysis of the international policy framework, core content and priority areas for global healthcare, rehabilitation and education services for children with hearing and speech impairments, with reference to the WHO World Report on Hearing.

Results Regarding leadership and governance, an inter-sectoral governance system and capabilities are necessary, formed through inclusive policy-making and collaborative planning with all stakeholders to enhance ear and hearing health initiatives. In the area of financing, sustainable funding and health protection policies are vital, advocating for incremental annual investments to broaden the scope of ear and hearing healthcare services. Human resources development calls for bolstering educational and training initiatives, expanding programs for ear and hearing healthcare, speech therapy and special education professionals, to elevate service delivery proficiency. For service provision, establishing an integrated, person-centered ear and hearing care system is advocated, which weaves ear and hearing care interventions into comprehensive health strategies, acknowledging the necessities and priorities across all levels and establishing an inclusive service system in the realms of children's healthcare, rehabilitation and education. In terms of medical technology and infrastructure, the study encourages the facilitation of high-caliber hearing technologies, emphasizing the efficacy and cost-effectiveness of devices like hearing aids and cochlear implants, and fully incorporating assistive and accessible technologies into educational and rehabilitative practices to improve the comprehensive care of children with hearing loss. Digital technologies' proliferation within children's healthcare, rehabilitation and educational services is also encouraged. In the field of information systems and monitoring, the development of standardized monitoring metrics and the establishment of evaluation mechanisms for hearing healthcare services are proposed, promoting remote surveillance and services. For rehabilitation and education, the establishment of a unified monitoring data platform to augment the quality of hearing and speech rehabilitation services for children is suggested. The WHO delineates five international priority development areas for healthcare, rehabilitation, and educational services for children with hearing and speech impairments, namely early intervention and education, hearing and speech therapy, psychosocial support, social skills and community participation, and vocational education and life skills training.

Conclusion Based on the six components of the health service system, this study systematically analyzed the international policies of health care, rehabilitation and education services for hearing-impaired and speech-impaired children, and constructed the service structure and core contents of health care, rehabilitation and education services for them. Under the vision of WHO health service system, the development of hearing-impaired health and rehabilitation, and the construction of hearing-impaired health and rehabilitation service system should focus on five areas: early intervention and education, hearing and speech therapy, psychosocial support, social skills and community participation, and vocational education and life skills training.

Key words: hearing and speech impairement, health care, rehabilitation, education, international policies

CLC Number:

R764

ZHANG Qing, LI Yanqun, JIA Wenrong, LIU Qiaoyun, JIANG Ruilin. Research on framework, core content and priority areas of international policy of healthcare, rehabilitation and education services for children with hearing and speech impairments[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 373-380.

Figures/Tables 2

Table 1

International policy framework and core content of services related to hearing and speech impairments based on WHO six building blocks of health service system"

6大要素	政策架构	核心内容	主要行动
领导力与治理	发展强有力的领导和治理结构，协调听力障碍和言语障碍儿童服务的各方面	1.强调强有力的政策和立法支持，以确保听力障碍和言语障碍儿童的教育权利得到保障，包括制定和实施有关特殊教育和包容性教育的法律和政策 2.促进残疾人士的权利和福祉，包括教育、就业、健康和社会服务等领域的平等机会	制定全国范围内的儿童听力保健和康复策略监管和标准制定，确保服务质量促进政策、研究和实践之间的协调
筹资	建立可持续的融资机制，支持听力障碍和言语障碍儿童的服务	1.制定残疾人康复服务筹资战略计划 2.优化经费分配制度 3.扩大经费福利覆盖面，增加经费来源	为低收入家庭提供助听器和康复服务的资金支持政策支持，包括保险覆盖听力保健服务
人力资源	发展专业化的健康人力资源政策，包括培训听力专家、言语治疗师和特殊教育教师	教师培训和专业发展加强听力保健专业人员的培训和教育，鼓励提供关于听力障碍和言语障碍、特殊教育需求和包容性教育的培训	言语治疗师和特殊教育老师多学科团队合作，包括医生、护士和社会工作者
服务提供	确立全面和综合的服务提供政策，涵盖从早期诊断到终身管理的连续性服务	1.早期识别和干预强调对新生儿和儿童进行早期听力筛查的重要性，以便及早识别听力损失并实施及时干预；推广使用听力筛查技术和程序，特别是在高风险群体中 2.个别化教育计划为听力障碍和言语障碍儿童制定个性化的教育计划，以满足他们特定的学习需求；涉及特殊教学方法、辅助技术的使用以及对教师的特殊培训 3.提供综合性听力保健服务倡导建立和加强综合性听力保健服务，包括预防、诊断、治疗和康复；推动跨学科合作，包括听力学家、言语治疗师、教育工作者和社会工作者等 4.提高听力保健服务的可及性和质量提升听力保健服务的覆盖面，确保所有人群，尤其是低收入和边远地区的人群，能够获得高质量的听力保健服务；支持提供可负担和可持续的听力保健服务	早期筛查和干预定期听力评估听力康复服务，包括助听器和语言治疗儿童及家庭的心理社会支持
医疗技术与设备设施	确保高质量和可获得的医疗产品和技术，包括助听设备和教育资源	促进听力辅助技术的使用推广现代听力辅助技术，如助听器、人工耳蜗和其他通讯辅助设备；支持技术创新和提高辅助设备的可获得性	确保助听器和其他听力辅助设备的可获得性和负担能力使用新技术和应用程序来增强听力康复和教育
信息系统与监测	建立综合性健康信息系统，收集和分析关于听力障碍和言语障碍儿童的数据	1.建立听力障碍和言语障碍服务信息统计制度推进人口健康信息统计 2.统筹听力障碍和言语障碍服务及相关研究的健康数据并分析支持听力保健研究和数据收集，以改善政策制定和服务提供 3.推进信息化听力障碍和言语障碍服务网络系统建立推广包容性政策和实践，确保包括听力障碍和言语障碍儿童在内的残疾人全面参与和平等	建立和维护儿童听力健康数据库跟踪和评估干预效果提供给家长和教育工作者的资源和培训材料

Table 1

Table 2

References 22

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优先发展领域	主要内容	主要行动	服务方法	评价指标
早期干预和教育	早期识别听力损失，提供及时干预和教育服务	早期筛查和诊断组建多学科团队促进家庭参与	制定个性化康复计划提供助听器和听觉设备提供专业的语言治疗	听力水平语言发展社交互动家庭参与
听力和言语治疗	定期听力评估，开展听力和语言治疗	听力评估助听器配备和调试植入式听觉设备手术及调试	制定个性化治疗计划实施多模式治疗	听力功能改善语言发展沟通能力
心理社会支持	提供心理咨询和治疗、社会支持、家庭支持	心理咨询和治疗社会支持计划教育和培训	提供个性化服务支持多元化服务	心理健康状况社会参与度生活质量
社交技能和社区参与	培养社交技能，促进社区参与	社交技能训练社区活动组织社会技能辅导	小组培训个性化辅导社区参与项目	社交技能水平社区参与程度自我认知和自信心
职业教育和生活技能培训	提供与他们兴趣和能力相匹配的职业教育以及生活技能培训	职业导向辅导实践机会提供生活技能课程	个性化培训计划职业技师支持技术辅助工具	职业技能水平就业情况生活自主能力

Research on framework, core content and priority areas of international policy of healthcare, rehabilitation and education services for children with hearing and speech impairments

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