O'Connor M, Howell-Meurs S, Kvalsvig A, Goldfeld S
Centre for Community Child Health and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
Child Care Health Dev. 2015 Jan;41(1):15-22. doi: 10.1111/cch.12164. Epub 2014 Jun 10.
Children with special health care needs (SHCN) have or are at increased risk for a chronic condition that necessitates more health and related supports than their peers. While it is generally accepted that these children are at risk for school failure, the mechanisms through which SHCN impact on children's experiences (and therefore opportunities to intervene) at school are still relatively poorly understood. Based on the current literature, this paper provides a conceptual framework to guide further discussion of this issue in research, policy and practice. Evidence from the literature was reviewed and existing frameworks examined. We propose that SHCN impact on four interrelated domains of children's functioning: (1) body functions and structures; (2) activities of daily living; (3) social participation; and (4) educational participation. Children's functioning is further influenced by risk and protective factors that can be identified at the level of the child, family and service systems. Together, these processes contribute to shaping either positive or negative trajectories of school functioning. The mechanisms influencing school experiences for children with special health care needs are complex, with opportunities for positive interventions at a range of levels. The proposed conceptual model provides an accessible tool for guiding discussion of the support needs of this vulnerable population.
有特殊医疗需求（SHCN）的儿童患有慢性疾病，或者相比同龄人，患慢性疾病的风险更高，这使得他们比同龄人需要更多的医疗及相关支持。虽然人们普遍认为这些儿童面临学业失败的风险，但特殊医疗需求影响儿童在校经历（进而影响干预机会）的机制仍未得到充分理解。基于当前文献，本文提供一个概念框架，以指导在研究、政策和实践中对这一问题展开进一步讨论。回顾了文献中的证据，并审视了现有的框架。我们认为，特殊医疗需求会影响儿童机能的四个相互关联的领域：（1）身体功能和结构；（2）日常生活活动；（3）社会参与；（4）教育参与。儿童的机能还会受到可在儿童、家庭和服务系统层面识别的风险因素和保护因素的进一步影响。这些过程共同作用，塑造出积极或消极的学校机能发展轨迹。影响有特殊医疗需求儿童在校经历的机制很复杂，在多个层面都存在积极干预的机会。所提出的概念模型为指导讨论这一弱势群体的支持需求提供了一个便于使用的工具。
