1、12008 身心障礙者口腔照護日凝聚力量!為身心障礙者口腔照護願景努力!2先進國家身心障礙者口腔醫療保健照護概況 12.13.2008 黃淳豐3D N A 時代柳澤敬子 日作家研究是人類心靈智慧的遺產,正因為如此它應該是日新又新的.但是,當人類的貪婪還有科技研發掛勾的時候,也就是問題的根源.基因發生突變表示人類基因正設法藉由多樣化來適應環境,基因多樣化就會衍生疾病.就全體人類而言沒有所謂有害基因,如果我們認為那是有害基因,是因為我們的社會不好.身障者替帶我們背起了重擔!柳澤敬子曾表示，任何研究，都不應該違反自然。當基因庫發柳澤敬子曾表示，任何研究，都不應該違反自然。當基因庫發生突變時，就表示人
2、類的基因正設法藉由多樣化來適應環境。生突變時，就表示人類的基因正設法藉由多樣化來適應環境。當基因在多樣化的情況下，一定會帶來疾病，所以會有一定比當基因在多樣化的情況下，一定會帶來疾病，所以會有一定比例的新生兒有嚴重的先天性瑕疵。如果有人生來殘缺，碰巧不是例的新生兒有嚴重的先天性瑕疵。如果有人生來殘缺，碰巧不是你或我，那是因為殘缺者代我們背起了重擔，我們必須竭盡所能你或我，那是因為殘缺者代我們背起了重擔，我們必須竭盡所能對他們伸出援手。對他們伸出援手。邱麗文邱麗文4世界人權宣言人人生而自由，在尊嚴和權利上一律平等。人人各賦理性與良知，應以手足精神相對。5DISABILITY AND REHABI
3、LITATIONDISABILITY AND REHABILITATIONWHO ACTION PLAN 2006-2011WHO ACTION PLAN 2006-2011VISION:VISION:All persons with disabilities live in All persons with disabilities live in dignity,with equal rights and dignity,with equal rights and opportunities opportunities 6國際接軌-權利躍進聯合國身心障礙者權利公約(The Conventi
4、on on the Rights of Persons with Disabilities)，2006年8月在108個締約國同意下通過，並於2008年5月3日正式生效 身心障礙者人口數在2007年底已達102萬760人，約佔全國人口的4.45%，政府於2007年7月11日公佈身心障礙者權益保障法 健康權 教育權 就業權 經濟安全權 人身安全權 第24條:直轄市,縣(市)衛生主管機關應依據身心障礙者人口數及就醫需求,指定醫院設立身心障礙者特別門診.7DISABILITY AND REHABILITATIONDISABILITY AND REHABILITATIONWHO ACTION PLAN
5、2006-2011WHO ACTION PLAN 2006-2011MISSION:MISSION:To enhance the quality of life for persons with disabilities through national,regionaland global efforts to:Raise awareness about the magnitude and consequences of disability Facilitate data collection and analyse or disseminate disability-related da
6、ta and information Support,promote and strengthen health and rehabilitation services for persons with disabilities and their families Promote community based rehabilitation(CBR)Promote development,production,distribution and servicing of assistive technology Support the development,implementation,me
7、asuring and monitoring of policies to improve the rights and opportunities for people with disabilities Build capacity among health and rehabilitation policy makers and service providers Foster multisectoral networks and partnerships1.對身障者認知2.蒐集分析解釋相關身障資訊3.支持促進與增強對身障者和家屬健康與復權之服務4.促進以社區為基礎之復權5.促進輔助技術
8、之發展製造散佈與服務6.支持政策發展推行執行與監測7.為身障者爭取權利與機會8.對身障健康與復權政策擬定者與提供服務者提升其能力(賦能)9.促進與其他領域結盟與合作關係套入口腔醫療保健或其他照護81.對身障者認知 2.蒐集分析解釋相關身障資訊3.支持促進與增強對身障者和家屬健康與復權之服 務4.促進以社區為基礎之復權5.促進輔助技術之發展製造散佈與服務6.支持政策發展推行執行與監測7.為身障者爭取權利與機會8.對身障健康與復權政策擬定者與提供服務 者提升其能力(賦能)9.促進與其他領域結盟與合作關係DISABILITY AND REHABILITATIONDISABILITY AND REHA
9、BILITATIONWHO ACTION PLAN 2006-2011WHO ACTION PLAN 2006-2011套入口腔醫療保健或其他照護9美國身心障礙者重要法案之陳述2001 P.L.107-110沒有落後的孩子法案(No Child Left Behind Act；NCLB)加強中小學教育法案並擴大了聯邦政府對中小學教育的管理。並指明特殊教育教師必須具備高的品質；特殊教育的學生必須參加州內所舉辦的統考 (陳麗如 長庚大學 教育學程中心助理教授)身心障礙孩童是國家孩子10美國身心障礙者重要法案之陳述美國直接對身心障礙者服務之法案主要有四類 :一為教育法案，二為復健法案，三為權益法案，
10、四為輔助性科技法案。(陳麗如 長庚大學 教育學程中心 助理教授)為了對障礙者的服務更符合時代趨勢，我國相關人員在掌握特殊教育工作時，亦可參考美國相關的法案內涵，以使特殊教育的服務工作更全面性，精神更能適當地發揮。台東特教 93 年6 月 第19 期 第41-47 頁 1120202020健康國民白皮書計畫970125970125全國衛生行政會議總結報告身心障礙組 目標與策初級預防 婚前健檢與各項新生兒服務之落實、促進身心障礙者之健康二級預防 通報系統及早期診斷、療育人力之提供、維持身心障礙者之健康態，避免化 三級預防 輔具開發及復建支持、持續治療及就醫可近性、提供機構照護或協助居家照護網絡、成
11、立身心障礙特別門診建立身心障礙醫療使用及相關研究國家衛生研究院衛生政策研發中心郭耿南主任何時誕生身心障礙者口腔健康白皮書?1220202020健康國民白皮書計畫(970125970125全國衛生行政會議總結報告)身心障礙組建議:應以生命程觀點來探討未來將依聯合國ICFICF制，重新歸類與鑑定身心障礙人口。國家衛生研究院衛生政策研發中心郭耿南主任?13美 國2008 人口 305,508,000 2007 GDPGDP Per capita$45,251 學習環境 Problem Based Learning(PBL),Case-Based Learning Specific task appr
12、opriate skills Community service,research and discovery校外服務:預防保健教育與服務,社區服務建議:更多專業人員一起關懷身障人士,醫學院教育納入相關身障課程,鼓勵學生參與社區服務幫助身障者.14口腔健康在美國 如果你無法保持口腔健康，那麼你將不能稱為一個健康的人。忽視口腔健康問題將遭到不必要的痛苦及疼痛，而且可能導致嚴重的併發症，增加社會成本以及財政支出，並降低生活品質。更強調”口腔健康並不只是健康的牙齒”，口腔健康是整體健康的一部份，如果口腔不健康，那就不算真正的健康“。美國公共衛生及人力資源部總監報告 口腔健康照護專業專職人員的需求 口
13、腔醫學院口腔衛生學系系主任黃純德 引述15身障者就醫便利性44To Increase A ccess for S pecial N eeds P atientsM ore oral health professionals m ust care for special needs patientsD ental school curriculum m ust include m ore didactics and clinical experience for treatm ent of special needs patients.C om m unity service clinical
14、learning is an efficient w ay for students to learn to treat special needs patients.(A nd it should be m andated that all practicing dentists have basic know ledge so they are able to treat special needs patients.)16牙科鑒定制14Commission on Dental Accreditation Commission on Dental Accreditation(CODA)(C
15、ODA)The Commission on Dental The Commission on Dental AccreditaionAccreditaionserves the public by establishing,serves the public by establishing,maintaining and applying standards that maintaining and applying standards that ensure the quality and continuous ensure the quality and continuous improv
16、ement of dental and dental related improvement of dental and dental related education and reflect the evolving practice education and reflect the evolving practice of dentistry.The scope of the Commission of dentistry.The scope of the Commission on Dental on Dental AccresitationAccresitation encompa
17、sses dental,encompasses dental,advance dental and allied dental education advance dental and allied dental education programsprogramsCODA Accreditation17從出生到死亡口腔教育與經驗41102030405060708090Childrens Dental CenterUSC Mobile ClinicChildrens Hospital of LAHollenbeck HomeSolis Dental Arts CenterLAC/USC Med
18、ical CenterUnion Rescue MissionVA Health Systems,Long BeachBIRTHDEATHQueens Care Mobile ClinicLifeline&Dental Lifeline&Dental Educational Educational Experiences,Experiences,November 2002November 2002School Sealant Project183 2C urriculum fo r T reatm ent o f C urriculum fo r T reatm ent o f S p eci
19、al&M ed ically C o m p ro m ised S p ecial&M ed ically C o m p ro m ised P atients at the U S C S cho o l o f P atients at the U S C S cho o l o f D entistryD entistryE u g en e S ekig u ch i D D S,M S E E,BS E E E u g en e S ekig u ch i D D S,M S E E,BS E E P ro fesso rP ro fesso rA sso ciate D ean
20、 fo r In tern atio n al,P ro fessio n al an d Leg islative AA sso ciate D ean fo r In tern atio n al,P ro fessio n al an d Leg islative A ffairsffairsD irecto r o f th e A d van ced S tan d in g P ro g ram for In tern atio n al D en tD irecto r o f th e A d van ced S tan d in g P ro g ram for In ter
21、n atio n al D en tistsists美國身障者牙醫養成教育課程19校外服務學習42Extramural Service Extramural Service LearningLearningEducating Local Children Educating Local Children on Oral Healthon Oral HealthSealant Process as shown to Sealant Process as shown to school kidsschool kidsP PR RE EV VE EN NT TI I O ON NP PR RE EV
22、 VE EN NT TI I O ON NMMO OB BI I L LE E C CL LI I N NI I C CMMO OB BI I L LE E C CL LI I N NI I C C17 TRAILERS&COACHES20服務學習39USCSD Objectives:Service Learning USCSD Objectives:Service Learning-“Community Clinical EducationCommunity Clinical Education”Develop community programs in partnership with n
23、onDevelop community programs in partnership with non-profit profit and forand for-profit sectors including school districts,profit sectors including school districts,governmental agencies,public benefit organizations and governmental agencies,public benefit organizations and other health care profes
24、sionals.other health care professionals.Develop a variety of mobile(mobile clinics),portable Develop a variety of mobile(mobile clinics),portable(preschool,K(preschool,K-12 school site programs)and stationary 12 school site programs)and stationary(operatories in clinics or hospitals)to provide oral
25、health(operatories in clinics or hospitals)to provide oral health care delivery experiences for all students.care delivery experiences for all students.While providing service,learn and experience the variety of While providing service,learn and experience the variety of cultural interactions and in
26、fluences on oral health.cultural interactions and influences on oral health.與營利或非營利單位,包括學校,政府機關,公營事業組織,健康照護專業等發展社區合作計劃研發攜帶式牙醫診療設備,提供學生口腔健康照護學習機會當我們提供服務時,學習與經不同文化 相互激盪對口腔健康之影響21To find disability organizations or agencies in your area,click on your home state:Alabama Alaska Arizona Arkansas Californi
27、aColorado Connecticut Delaware District of ColumbiaFlorida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana NebraskaNevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Or
28、egonPennsylvania Rhode Island South Carolina South DakotaTennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 美國各州從網站得到身障照護資訊22Dental Care for People With DisabilitiesDental Care for People With Disabilities Currently.Currently.Over 20 percent of the U.S.population has a
29、disability.These disabilities can be present at birth and last throughout life or they can develop later in life.Disabilities can range from mild to severe and may affect the mind or the body or both.People with disabilities usually have more dental problems than those who do not have a disability.S
30、ome people with disabilities need no help with brushing or flossing.Others may need just a little help.Some may depend completely on others to provide their dental care.It is very important to look at the persons specific needs to help find what works best for their dental care.舉例維吉尼亞州健康部關心身障者口腔預防保健
31、網站內容23What are some dental concerns for those with What are some dental concerns for those with disabilities?disabilities?Cavities-seen often in those who have problems brushing and flossing Gum disease-seen often in those who have problems bushing and flossing Harmful oral habits-grinding teeth,pus
32、hing on teeth with tongue Trauma to the mouth or teeth-damage from falls or seizures Side effects of medications-some dry the mouth or cause gum tissue to over grow身心障礙者關心哪些口腔問題?24 What can be done to help those with disabilities with dental What can be done to help those with disabilities with dent
33、al care?care?Use toothpaste that has fluoride in it Have dental sealants placed by a dentist Ask about the side effects of medicines that you are taking If possible,switch to medicines that have fewer oral side effects Swish with water after taking liquid medicines containing sugar Drink a lot of wa
34、ter each day Eat a well-balanced diet,limit sugary sweets and snacks Adapt tooth brushes to make them easier to hold Use electric toothbrushes,floss and floss handles我們能為身心障礙者做些什麼口腔照護?25www.disability resources org.(U.S.A.)DECOD Referral Service Dentistry for the Disabled Child and Adult National Or
35、al Health Information Clearinghouse(NOHIC)Federation of Special Care Organizations in Dentistry-Academy of Dentistry for Persons with Disabilities(ADPD)International Association for Disability and Oral Health(IADH)身心障礙者資源組織機構26Americans with Disabilities Act of Americans with Disabilities Act of 199
36、01990(George H.W.Bush)The Americans with Disabilities Act(ADA)is a federal law the prohibits discrimination against a person with a disability who is seeking employment or access to services,including dental services.The law was enacted in 1990.Under Title 3 of this law,a private dental office is co
37、nsidered a place of public accommodation.As of January 26,1992,this law requires dentists to serve persons with disabilities.27Americans with Disabilities Act Americans with Disabilities Act of 1990of 1990 The law requires that you treat the person with a disability on the same basis as you treat no
38、n-disabled patients.If,however,the disabled patient requires a procedure for which you would ordinarily refer a non-disabled patient,you may legally refer the disabled patient as well.You are required to make reasonable modifications to facilitate access to your office by persons with diabilities un
39、less it can be shown that taking those steps would result in an undue burden or fundamentally alter the nature of the services you provide 28Americans with Disabilities Act Americans with Disabilities Act of 1990(of 1990(July 26)July 26)美國身心障礙福利法（ADA）的定位是相當於身心障礙者基本權利保障的憲法，任何其他法案的精神如果與這個法案的精神、規定相違背或不一致的地方，必須以ADA 法案為最後的判準依據（Silverstein 2000），總而言之美國政府是以ADA 法案做為整個身心障礙者政策的最高指導原則，而聯邦政府的具體做為是訂定該法規範的最低實踐標準，各州政府依此準則自訂當地的實行細則。(身心障礙者人權與福利政策發展 嚴嘉楓 林金定)
