학술논문
The Difficulties Encountered in Practice for the Field of Child and Adolescent Psychiatry After the Regulation on Assessment of Special Needs for Children (RASNC)/Cocuklar icin Ozel Gereksinim Degerlendirmesine Iliskin Yonetmelik (COZGER) Sonrasi Cocuk ve Ergen Psikiyatrisi Alaninda Uygulamada Karsilasilan Zorluklar
ORIGINAL ARTICLE/OZGUN ARASTIRMA
ORIGINAL ARTICLE/OZGUN ARASTIRMA
Document Type
Academic Journal
Author
Source
Turkish Journal of Child and Adolescent Mental Health. November 2021, Vol. 28 Issue 3, p191, 9 p.
Subject
Language
English
Abstract
Giris 'Ozel gereksinimi olan birey' kavrami dogustan veya sonraki gelisim surecinde icsel veya dissal cesitli nedenlerden dolayi bedensel, ruhsal, sosyal, duyusal ve zihinsel yetilerinde degisen derecelerde yeti yitimi ve islevsellikte [...]
Objectives: This study aimed to determine the challenges faced by child psychiatrists in our country during the assessment of special needs for children in practice after regulation on the assessment of special needs for children (RASNC) regulation. Materials and Methods: All specialists and academicians being the members of Turkish Association for Child and Adolescent Psychiatry were reached via e-mail between September and October 2020. A self-report questionnaire consisting of closed and open-ended questions about the variables of the individuals and processes for patients' evaluation, diagnosis, referral to the health committee and report preparation after RASNC regulation was applied to volunteer participants. Results: The average age of the participants (n=156) was 33.8 ([+ or -] 4.1) years and 67.3% of them were female. In our study, it was shown that referrals to the committee were mostly made by a child psychiatrist, some psychiatric diagnoses were not educationally approved by the guidance research center (GRC), this might affect the diagnostic decision of the physicians, while evaluating the patients after RASNC, almost half of the participants had difficulties in at least one area of cognitive development, language, speech and communication and child psychiatry, and had problems related to border violation especially with different disciplines, the hospitals they worked in did not have a defined RASNC authorized physician, and patients with the same diagnosis in different centers might differ in terms of special needs area and level. Conclusion: In order to solve the difficulties faced by child and adolescent psychiatrists, rational arrangements should be made in RASNC regulation and then relevant physicians, hospital managers and GRC personnel should be trained on the regulation. Keywords: Child psychiatry, disability, medical committee, special needs Amac: Bu calismada ulkemizde cocuk psikiyatrisi alaninda gorev yapmakta olan hekimlerin cocuklar icin ozel gereksinim degerlendirmesine iliskin yonetmelik (COZGER) sonrasi uygulamada ozel gereksinimi degerlendirme surecinde karsilastiklari zorluklarin tespit edilmesi amaclanmistir. Gerec ve Yontem: Turkiye Cocuk ve Genc Psikiyatrisi Dernegi uyesi tum cocuk ve ergen ruh sagligi ve hastaliklari uzman hekimlerine ve ogretim uyelerine, Eylul-Ekim 2020 tarihleri arasinda e-posta araciligi ile ulasilmistir. Calismaya katilmaya gonullu olanlara hekime ait uzmanlik alani konusundaki degiskenler ile COZGER yonetmeligi sonrasinda saglik kurulu hastalarini degerlendirme, tanilama, heyete yonlendirme ve rapor duzenleme sureclerine iliskin kapali ve acik uclu sorulardan olusan oz bildirime dayali anket uygulanmistir. Bulgular: Katilimcilarin (n=156) ortalama yasi 33,8 ([+ or -] 4,1) olup %67,3'u kadindir. Saglik kurulu uygulamalarina yonelik verilerde; kurula yonlendirmelerin cogunlukla cocuk ve ergen psikiyatristi tarafindan yapildigi, bazi psikiyatrik tanilarin rehberlik arastirma merkezi (RAM) tarafindan egitsel olarak onaylanamadigi, bu durumun hekimin tanisal kararini etkileyebildigi, katilimcilarin neredeyse yarisinin COZGER sonrasi saglik kurulu hastalarini degerlendirirken bilissel gelisim, dil konusma ve iletisim ve cocuk ve ergen psikiyatrisi olmak uzere en az bir alanda zorlandigi, ozellikle farkli disiplinlerle sinir ihlaliyle iliskili sorunlar yasadigi, calistiklari hastanede tanimli bir COZGER yetkili hekiminin olmadigi gosterilmistir. Calismamizda hekimlerin oz bildirimine dayali olarak COZGER sonrasi farkli merkezlerde ayni taniya sahip hastalarin ozel gereksinim alani ve duzeyi bakimindan farkliliklar gosterebildigi, ozellikle otizm spektrum bozuklugu ve zihinsel yetersizlikte rapordaki ozel gereksinim duzeyinin cocugun gercek duzeyi ile bagdasmayabildigi saptanmistir. Sonuc: Saglik kurulu raporlarinin hasta acisindan magduriyet, hekim acisindan yasal sorun olusturmaksizin duzenlenebilmesi icin, COZGER yonetmeliginde hekimlerin karsilastiklari zorluklarla ilgili cozume yonelik rasyonel duzenlenmelerin yapilmasi ve sonrasinda yonetmelige yonelik ilgili hekimlerin, hastane yoneticilerinin ve RAM calisanlarinin egitilmesi gerekmektedir. Anahtar Kelimeler: Cocuk psikiyatrisi, ozurluluk, saglik kurulu, ozel gereksinim
Objectives: This study aimed to determine the challenges faced by child psychiatrists in our country during the assessment of special needs for children in practice after regulation on the assessment of special needs for children (RASNC) regulation. Materials and Methods: All specialists and academicians being the members of Turkish Association for Child and Adolescent Psychiatry were reached via e-mail between September and October 2020. A self-report questionnaire consisting of closed and open-ended questions about the variables of the individuals and processes for patients' evaluation, diagnosis, referral to the health committee and report preparation after RASNC regulation was applied to volunteer participants. Results: The average age of the participants (n=156) was 33.8 ([+ or -] 4.1) years and 67.3% of them were female. In our study, it was shown that referrals to the committee were mostly made by a child psychiatrist, some psychiatric diagnoses were not educationally approved by the guidance research center (GRC), this might affect the diagnostic decision of the physicians, while evaluating the patients after RASNC, almost half of the participants had difficulties in at least one area of cognitive development, language, speech and communication and child psychiatry, and had problems related to border violation especially with different disciplines, the hospitals they worked in did not have a defined RASNC authorized physician, and patients with the same diagnosis in different centers might differ in terms of special needs area and level. Conclusion: In order to solve the difficulties faced by child and adolescent psychiatrists, rational arrangements should be made in RASNC regulation and then relevant physicians, hospital managers and GRC personnel should be trained on the regulation. Keywords: Child psychiatry, disability, medical committee, special needs Amac: Bu calismada ulkemizde cocuk psikiyatrisi alaninda gorev yapmakta olan hekimlerin cocuklar icin ozel gereksinim degerlendirmesine iliskin yonetmelik (COZGER) sonrasi uygulamada ozel gereksinimi degerlendirme surecinde karsilastiklari zorluklarin tespit edilmesi amaclanmistir. Gerec ve Yontem: Turkiye Cocuk ve Genc Psikiyatrisi Dernegi uyesi tum cocuk ve ergen ruh sagligi ve hastaliklari uzman hekimlerine ve ogretim uyelerine, Eylul-Ekim 2020 tarihleri arasinda e-posta araciligi ile ulasilmistir. Calismaya katilmaya gonullu olanlara hekime ait uzmanlik alani konusundaki degiskenler ile COZGER yonetmeligi sonrasinda saglik kurulu hastalarini degerlendirme, tanilama, heyete yonlendirme ve rapor duzenleme sureclerine iliskin kapali ve acik uclu sorulardan olusan oz bildirime dayali anket uygulanmistir. Bulgular: Katilimcilarin (n=156) ortalama yasi 33,8 ([+ or -] 4,1) olup %67,3'u kadindir. Saglik kurulu uygulamalarina yonelik verilerde; kurula yonlendirmelerin cogunlukla cocuk ve ergen psikiyatristi tarafindan yapildigi, bazi psikiyatrik tanilarin rehberlik arastirma merkezi (RAM) tarafindan egitsel olarak onaylanamadigi, bu durumun hekimin tanisal kararini etkileyebildigi, katilimcilarin neredeyse yarisinin COZGER sonrasi saglik kurulu hastalarini degerlendirirken bilissel gelisim, dil konusma ve iletisim ve cocuk ve ergen psikiyatrisi olmak uzere en az bir alanda zorlandigi, ozellikle farkli disiplinlerle sinir ihlaliyle iliskili sorunlar yasadigi, calistiklari hastanede tanimli bir COZGER yetkili hekiminin olmadigi gosterilmistir. Calismamizda hekimlerin oz bildirimine dayali olarak COZGER sonrasi farkli merkezlerde ayni taniya sahip hastalarin ozel gereksinim alani ve duzeyi bakimindan farkliliklar gosterebildigi, ozellikle otizm spektrum bozuklugu ve zihinsel yetersizlikte rapordaki ozel gereksinim duzeyinin cocugun gercek duzeyi ile bagdasmayabildigi saptanmistir. Sonuc: Saglik kurulu raporlarinin hasta acisindan magduriyet, hekim acisindan yasal sorun olusturmaksizin duzenlenebilmesi icin, COZGER yonetmeliginde hekimlerin karsilastiklari zorluklarla ilgili cozume yonelik rasyonel duzenlenmelerin yapilmasi ve sonrasinda yonetmelige yonelik ilgili hekimlerin, hastane yoneticilerinin ve RAM calisanlarinin egitilmesi gerekmektedir. Anahtar Kelimeler: Cocuk psikiyatrisi, ozurluluk, saglik kurulu, ozel gereksinim