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Parent Training Occupational Therapy Program for Parents of Children with Autism in Korea 时间:2017-07-07 15:12 来源:未知作者:admin 点击: 次 Abstract:Attitudes and beliefs about parent participation in occupational therapy are shifting toward family-centered practice worldwide. However, adopting a family-centered approach in a society such as Korea, where a Confucian culture of hierarchical roles is reflected in a strong medical model, can prove to be very difficult. A parent training program was developed at the HOPE Center, a pediatric occupational therapy center, to bridge the gap between the traditional medical model and the ideal family-centered model. This study examined the effectiveness of the parent training and gauged parents’ perceptions and experiences of a more family-centered approach to therapy. Four parent-child dyads living with autism participated in five months of parent training at the HOPE center. The results on the Canadian Occupational Performance Measure showed that the parent training improved the occupational performance of both children and parents. Six open-ended questions were used to investigate parents’ perceptions and experiences of parent training. Two broad themes emerged: improved self-efficacy and the cultural reality of living with autism in Korea. This study demonstrates that building parent training into an occupational therapy program may optimize the effectiveness of any therapy and introduce a more family-centered approach to therapy while maintaining cultural integrity.
1. Introduction
In western society, there has been a shift in occupational therapy service delivery models for children from medical and child-centered models in the mid-1900s to home programs and then to a family-centered model in the 1970s [1–3]. The medical model focuses on a “health problem” and its treatment, where the health professional is viewed as the “expert” who brings treatment to the individual with the health problem. The roles of all participants in this medical model are clear: the health professional is the active and powerful agent of change and the individual with the health problem is the passive and dependent recipient of treatment. Family members have little to no role to play within this model except to facilitate engagement between the health professional and the individual patient. In contrast, the family-centered model recognizes that a health problem of an individual has a significant impact on the entire family and as such, any intervention must be guided by “the needs of the entire family—the parents, the siblings, and the child with special needs” [1]. Within this model, there is no single “expert” and all participants working together collaboratively optimize the benefits of any treatment. Whilst there has been a theoretical shift from the medical model to the family-centered model in western society, research shows that, internationally, therapists continue to struggle to work collaboratively with parents within a family-centered framework as it “requires a significant change in thinking from more traditional child-focused approaches” ([2] p. 14). It also requires active participation and acceptance of a new equality within a relationship that is not in line with traditional cultural roles. This is certainly true within the cultural context of Korea, where Confucian traditions continue to strongly influence the hierarchical roles reflected in the medical model of service delivery, including occupational therapy service delivery for children.
According to Kim-Rupnow [4], “service providers such as doctors, nurses, teachers and therapists are well respected in the Korean community and the consumers tend to listen to their advice and follow their directions as passive recipients” (p. 20). This is consistent with the Confucian philosophy that underpins the cultural tradition of Korea, a philosophy that emphasizes “harmony and order within a system of prescribed roles” ([4] p. 4). The “social relationships in Korean culture are based to a large degree on a hierarchy of differences that confer status” ([5] p. 516). Accordingly, whilst there is an increasing awareness about the benefits of family-centered practice, Korean pediatric occupational therapists continue to deliver services through a traditional medical model, focusing on the physical or mental impairments of a child. Cultural expectations require Korean therapists to work directly with the child only and do not extend to an inclusive, collaborative role of families [6].
Recognizing the overwhelming gap between the theory of the family-centered model and the cultural reality of the Korean occupational therapy landscape, the present author established the Health through Occupational Performance Enhancement (HOPE) Center at Inje University in South Korea. HOPE Center was not only established to be a pediatric occupational therapy treatment center but also established to be a parent training center in the deliberate attempt to gradually move towards a more family-centered model of therapy whilst maintaining culturally sensitive expectations. At the HOPE Center, a parent-child dyad is always present throughout all treatment sessions and parents are encouraged and taught to participate collaboratively with therapists in the treatment of the child.