The Research Of Disabled Screening Service Mode Of Children Aged 0 To 6 In Rural Areas In Gansu Province

ObjectiveThis project studied the disabled screening service mode of children aged 0 to 6 in rural areas in Gansu province..We have evaluated the operation process of screening service through analyzing the organizational framework,operation process,and operation effect.We also analyzed the advantages and problems of the operation process of the screening service model.And we summarized and evaluated screening service mode.Finally,we provided reference opinions and suggestions for formulating and improving disabled children screening service policy.MethodsUnder the guidance of the “Structural-process-results” evaluation theory,this study combined the qualitative and quantitative research to investigate the operation of disability screening services for children aged 0-6 years in pilot counties.1.Quantitative studiesCollecting and analyzing the screening and referral data of the disabled children from various institutions during the primary screening,rescreening,and diagnostic assessment stages of the implementation in pilot counties.In addition,(1)Describe the indicators such as the referral rate of screening service operations.(2)Describe the rate of detection of disabled children,the composition of various types of disabilities,the composition of disabilities in each age group,the composition of disabled child caregivers,and the educational level of caregivers of children with disabilities.2.Qualitative researchAt first,the interviews were performed with the screening service-person in five pilot place to understand the specific operational conditions of each process under the children's disability screening service model.The process were evaluated from the four aspects: service provision,institutional collaboration,and management support.At second,a semi-open questionnaire survey was taken to the parents of positively diagnosed children to understand the participation degree,the fluent and satisfaction of the referral guidance,and the opinions and suggestions for the screening services.Results1.Overview of screening service models for disabled children in pilot countiesIn organizational structure,the screening service model for disabled children is consists of the Administrative department of Health Family Planning Commission,Disabled Persons' Federation,and the Child Care Network that provides screening services.The child care network is the main part of the disabled children screening service,which is composed by the township health centers,county-level maternity and child care institutions and provincial maternity and childcare institutions.2.The operation process of children disability screening service modelThe primary screening process mainly relies on the township health centers to conduct free screening for children aged 0-6 years in the area.In this process,the children with positive or uncertified results are labeled as "primary screening referral sheet",which means referring to the district-level maternity and childcare for rescreening;The rescreening process majorly relies on the district-level maternity and childcare hospitals to conduct the primary screening positive children in the area.After rescreening,the children with issued as “rescreening referral sheet” are referred to a provincial-level maternity and child care institution for diagnostic evaluation;The diagnostic and evaluation process mainly relies on the provincial-level maternity and child care hospitals to conduct on rescreening positive children;Treatment and rehabilitation sessions shall be provided by provincial maternity and child care institutions or rehabilitation institutions for rehabilitation of children in need of rehabilitation or referral to a designated rehabilitation institution to provide rehabilitation and medical services for definite diagnosed children with disabilities.3.The operation efficiency of the disabled children screening service model.There are 43638 children aged 0-6 years have been screened in pilot place since August 2016 as of December 2017.In primary screening process,622 children were labeled as positive and the referral rate is about 81.35%;in the rescreening process,387 children were identified as positive and the referral rate is about 94.31%;after diagnosing,339 children were further identified as disabled children.A total of 52 newly diagnosed developmental abnormalities were identified,and all of them were referred for coordination.Parents of disabled children and disabled children were satisfied with screening services.4.Operational process evaluation(1)Service capabilitiesThe primary screening process: the children care workers can basically meet the needs of screening for disabled children.However,few of them have professional knowledge about children care,and their education background is very difference.The service capabilities should be further enhanced.The rescreening process: The county-level maternity and childcare institutions are equipped with child care clinics for some specialties health care persons and have human resources for screening services for disabled persons.However,it is still hard for the autism screening.The diagnostic and assessment process: the provincial maternity and childcare hospitals have enough equipment,and professional doctors to complete the diagnosis and assess work.They have enough funding to broadcast and collection information.(2)Service provisionThe primary screening process: most of the township health centers can basically complete the primary screening process.Integrated management of the township health centers is good for the conducting of screening process.However,problems are still obviously: the workload of the first screening is huge;the parent's compliance is not very well.The rescreening process: The five types of screening programs for disabled children in the outpatient clinic for child care in county-level maternity and child care institutions can basically be carried out.Most of the parents with positive result can recognize and accept the capacity of rescreening institution.The rescreening referral rate reached more than 80%.However,the biggest challenge for the rescreening process are the short supply of professional referral guidance and the related information management.The diagnostic and assessment process: The child care projects in provincial maternity and childcare institutions are well-developed.Childhood ophthalmology,hearing screening,pediatric surgery and other development advantages provide the basis for the diagnosis and intervention of disabled children.However,referral rate is low and there are few choice to diagnostic evaluation for disabled children.(3)Institutional collaborationIn general,departments with all levels are centered on screening services for disabled children and establish a communication and coordination mechanism.However,there are still obstacles in efficient communication between agencies in some areas.The problems are focus on the timely transfer and poor information feedback.(4)Management supportIn general,a preliminary evaluation mechanism was formed,while the supervision and management of health administrative departments are deficient.The higher level maternal and child health institutions has the response to supervise and administer the quality of the disability screening of lower level,while the management should strengthen.Conclusions?This is the first time to study the screening services model for the disabled children in the poor area of Gansu province.The screening services model for disabled children within 6 years is based on the primary screening process of township health centers,the rescreening process of the county-level maternity and childcare institutions,and the diagnostic and assessment process of the provincial maternity and childcare hospitals,which has the ability to help detection,diagnosis and treatment early.?The screening services model has advantages in organization and collaboration to support the operation,which has been fully recognized and well participated by disabled children and other family members.In this screening process,the functions of different institutions with various level are clear and place well.Different departments can work well,and the referral can be basically completed.The model has great social influence.?Screening service for disabled children has increased the workload of child care workers,at same time,it will also improve the wok standard.However,due to limitation from the capacity of various institution and the compliance of the related parents,there are still a lot of problems need to be solved,such as the shortage of human resources.It is necessary to strengthen the training work of the child care workers and improve the follow-up work.In addition,to form an efficient model for disabled children screening service,managerial supervision and asses need to be further improved.?The disabled children screening service model can be gradually promoted,through the developing and accumulation of experience of the children's health institutions,especially the service capacity of the primary institutions.Research suggestion1.The government needs to recognize the importance of disability screening in improving children's health and the quality of the population,and gradually formulate a service system for children's disability screening in the region.2.The government should pay more attention to identify the unique response of different departments,improve the coordination and cooperation of the departments,support supervision measures,and form a long-team mechanism.3.The function of parents of the children with disabilities should be improved,more training works about the prevention and rehabilitation of disability should be conducted,and improve the parental compliance.4.To form a more unify,standard and convenient path for screening service,the following parts should be improved: first,enhance the manage ability of county-level maternity and childcare hospitals;second,increase the amount of diagnose and evaluation departments in the screening service process.5.Pay more attention to rehabilitation needs.The system of emergency rehabilitation and assistance of local disabled children should be built as quickly as possible.