AAC 재난 대비 중재 프로그램 개발 및 재난 대비 의사소통 행동과 재난 표현 어휘력에 미치는 중재 효과

Abstract

The frequency of large-scale natural disasters and social disasters due to climate change, such as global pandemics, large-scale wildfires, heat waves, cold spells, floods, and typhoons, has been increasing worldwide. The damage caused by these disasters continues to grow. Looking at the current disasters occurring, it can be considered a global crisis, and it has become an important common challenge for humanity that we must now address. In South Korea as well, we have seen an increase in the intensity and frequency of earthquakes, such as the recent one in Gyeongju in 2023, and there has been an 80.2% increase in the number of daily heat-related illness deaths compared to 2022 due to heat waves. Additionally, experiences like the unpredicted disaster of COVID-19 have heightened concerns about both natural and social disasters. In a situation where the intensity and frequency of disasters are increasing, the population of vulnerable groups, such as the elderly and people with disabilities, continues to grow. Particularly, the proportion of individuals with developmental disabilities among people with disabilities is consistently on the rise. Individuals with developmental disabilities are all classified as having severe disabilities, and the majority of them face communication difficulties. Communication is crucial in all stages of disasters (pre-disaster, during a disaster, and post-disaster). When communication breakdowns occur, individuals may not receive proper medical diagnoses, leading to incorrect treatment services. Moreover, incorrect handling may exacerbate the suffering of those in need of rescue and could even result in fatalities. Therefore, research related to disasters involving individuals with developmental disabilities is of utmost importance. However, there is limited research on disasters involving individuals with developmental disabilities in Korea and there is a significant lack of research in the fields of speech pathology and AAC (Augmentative and Alternative Communication). In this study, given the increasing frequency and intensity of recent disasters, as a speech-language pathologist, we developed an AAC (Augmentative and Alternative Communication) disaster preparedness intervention program for adults with developmental disabilities. We applied the developed program to validate its effectiveness in terms of disaster preparedness scenario participation rates and disaster vocabulary expression performance. The AAC disaster preparedness intervention program for adults with developmental disabilities was developed following these steps: First, we conducted a survey targeting firefighters to analyze the situation of people with disabilities and non-disabled individuals during disaster situations, as well as communication with rescue subjects. We gathered information regarding communication tools through this survey. Second, we conducted a survey targeting caregivers of adults with developmental disabilities to analyze the communication abilities and characteristics of adults with developmental disabilities. Third, through a review of previous disaster-related research and analysis of domestic and international data related to disasters for individuals with disabilities, we developed the 14-session program through expert validation. This program aims to address the specific needs and challenges faced by adults with developmental disabilities during disasters and improve their communication abilities in such situations. To examine the impact of the developed program on the participation rates in disaster preparedness scenarios and disaster vocabulary proficiency of adults with developmental disabilities, 28 individuals with developmental disabilities were included in the intervention. Through this, the researchers investigated whether there were differences between the group that participated in the AAC disaster preparedness intervention program and the group that did not, as well as whether there were any differences in the intervention outcomes before and after participation. The intervention results are as follows: Disaster scenario participation rates between Groups: When analyzing the disaster scenario participation rates between the two groups, there was no statistically significant difference in disaster scenario participation rates for the group that participated in the program during the pre-intervention assessment. However, during the post-intervention assessment, there was a statistically significant difference in disaster scenario participation rates for the group that participated in the program. In essence, this suggests that participation in the AAC disaster preparedness intervention program had a positive impact on disaster scenario participation rates for the group that underwent the intervention, as evidenced by the statistically significant difference observed in the post-intervention assessment compared to the pre-intervention assessment. Secondly, the analysis of disaster preparedness communication behavior occurrence rates between the two groups showed that there was no statistically significant difference in the occurrence rates for the group that participated in the program during the pre-intervention assessment. However, during the post-intervention assessment, there was a statistically significant difference in the occurrence rates of disaster preparedness communication behaviors for the group that participated in the program. Thirdly, the analysis of disaster preparedness evacuation behavior occurrence rates between the two groups showed that there was no statistically significant difference in the occurrence rates for the group that participated in the program during the pre-intervention assessment. However, during the post-intervention assessment, there was a statistically significant difference in the occurrence rates of disaster preparedness evacuation behaviors for the group that participated in the program. Fourthly, the analysis of disaster vocabulary expression performance between the two groups showed that there was no statistically significant difference in the performance for the group that participated in the program during the pre-intervention assessment. However, during the post-intervention assessment, there was a statistically significant difference in the performance of disaster vocabulary expression for the group that participated in the program. The discussion regarding the intervention results is as follows: Firstly, conducting a survey of firefighters allowed us to further confirm and incorporate their experiences and requirements related to experiences with rescuing people with disabilities, types of disasters, communication abilities and forms, communication topics, and the necessity of AAC tools. This added valuable insights into the program development process. Secondly, the survey of social rehabilitation instructors provided insights into the communication abilities, communication forms, reading comprehension abilities, AAC tool usage, and symbol utilization status of adults with developmental disabilities. This information was instrumental in informing the program development process. Thirdly, through the analysis of disaster-related data, common elements were identified and incorporated into the program. Finally, expert validation allowed us to develop the final AAC disaster preparedness intervention program. In summary, the combination of firefighter surveys, social rehabilitation instructor surveys, and the analysis of disaster-related data, along with expert validation, played a crucial role in the development of the AAC disaster preparedness intervention program and allowed for valuable insights and requirements to be incorporated into the program. The significance of this study lies in providing clinical evidence for the development of an appropriate AAC (Augmentative and Alternative Communication) disaster preparedness program for adults with developmental disabilities. When the developed AAC disaster preparedness program is applied to adults with developmental disabilities, the intervention results of this study can serve as clinical evidence regarding the relationship between communication behavior and disaster vocabulary proficiency during disaster preparedness activities. Furthermore, in the role of a member of a disaster response team, a speech-language pathologist can provide assistance during disaster preparedness, response, and recovery phases. This can serve as evidence that members of disaster response teams can play an important role in facilitating disaster-related communication for individuals with developmental disabilities.;전 세계적으로 감염병, 대형 산불, 폭염, 한파, 홍수, 태풍 등 기후 변화로 인한 초대형 자연재해와 사회재난의 발생 빈도가 높아지면서 그 피해도 계속 늘어나고 있다. 현재 발생하고 있는 재난들을 보면 인류의 위기라고 할 수 있으며, 이는 이 제 우리가 해결해야 할 중요한 공통 과제가 되었다. 재난 강도와 빈도가 높아지고 있는 상황에서 재난취약계층인 노인과 장애인 인구도 계속 증가하고 있다. 특히, 장애인들 중 발달장애인 비율은 지속적으로 증가세를 보이고 있다. 발달장애인들은 모두 장애가 심한 장애인으로 분류되며, 이들 대부분은 의사소통에 어려움을 가지고 있다. 의사소통은 재난의 모든 단계(재난 전, 재난 시, 재난 후)에서 중요하며, 의사소통 단절이 일어날 경우, 잘못된 의료 적인 진단으로 인해 올바른 치료 서비스를 제공받을 수 없게 될 수 있으며, 부적 절한 처치로 인해 구조 대상자의 고통이 더 심해질 수 있고 심지어는 사망할 수도 있다. 따라서 재난 상황에서 발달장애 성인들의 의사소통은 매우 중요하지만 발달장애인을 대상으로 한 재난 연구는 많지 않으며, 특히 언어병리와 AAC 분야의 연구는 전무한 실정이다. 본 연구에서는 최근 재난의 빈도와 강도가 높아지고 있는 상황에서 언어임상가로서 발달장애 성인들을 위한 AAC 재난 대비 중재 프로그램을 개발하고, 개발한 프로그램을 적용하여 재난 대비 시나리오 참여율과 재난 표현 어휘 수행력에 효과를 검증하였다. 발달장애 성인을 위한 AAC 재난 대비 중재 프로그램은 다음의 절차에 따라 개발되었다. 첫째, 소방관을 대상으로 설문조사를 통해 재난 상황에서 장애인 및 비장애인 구조 실태와 구조 대상자와 의사소통 등에 대해 분석하고, 의사소통 도구에 대한 정보를 파악하였다. 둘째, 발달장애 성인 시설 종사자를 대상으로 한 설문조사를 통해 발달장애 성인의 의사소통 능력 및 특징 분석을 하였다. 셋째, 재난 관련 선행연구 조사와 국내외 장애인 재난관련 자료 분석을 통해 마지막으로 전문가 타당도를 통해 14회기 프로그램을 개발하였다. AAC 재난 대비 중재 프로그램이 발달장애 성인의 재난 대비 시나리오 참여율과 재난 표현 어휘력에 어떠한 효과를 주는지를 살펴보기 위해 28명의 발달장애 성인들을 중재에 참여시켰으며, AAC 재난 대비 중재 프로그램에 참여한 중재 집단과 참여하지 않은 통제 집단간 차이와 집단 간 중재 전·후 차이가 있는지를 살펴보았다. 연구 결과는 다음과 같다. 첫째, 중재 전 평가에서 프로그램에 참여한 집단의 재난 대비 시나리오 참여율 은 프로그램에 참여하지 않은 집단 간 차이가 나타났으나, 통계적으로 유의한 차이가 나타나지 않았다. 중재 후 평가에서는 프로그램에 참여한 집단의 재난 대비 시나리오 참여율은 프로그램에 참여하지 않은 집단 간 차이가 나타났고, 통계적으로도 유의한 차이가 나타났다. 둘째, 중재 전 평가에서 프로그램에 참여한 집단의 재난 대비 의사소통 행동 발생률은 프로그램에 참여하지 않은 집단 간 차이가 나타났으나, 통계적으로 유의한 차이가 나타나지 않았다. 하지만 중재 후 평가에서는 프로그램에 참여한 집단의 재난 대비 의사소통 행동 발생률은 프로그램에 참여하지 않은 집단 간 차이가 나타났고, 통계적으로도 유의한 차이가 나타났다. 중재 전·후 프로그램에 참여한 집단이 중재 전에 비해 중재 후에 유의미하게 향상된 것으로 나타났다. 셋째, 중재 전 평가에서 프로그램에 참여한 집단의 재난 대피 행동 발생률은 프로그램에 참여하지 않은 집단 간 차이가 나타났으나, 통계적으로 유의한 차이가 나타나지 않았다. 하지만 중재 후 평가에서는 프로그램에 참여한 집단의 재난 대피 행동 발생률은 프로그램에 참여하지 않은 집단 간 차이가 나타났고, 통계적으로도 유의한 차이가 나타났다. 중재 전·후 프로그램에 참여한 집단이 중재 전에 비해 중재 후에 유의미하게 향상된 것으로 나타났다. 셋째, 중재 전 평가에서 프로그램에 참여한 집단의 재난 표현 어휘 수행력은 프로그램에 참여하지 않은 집단 간 차이가 나타났으나, 통계적으로 유의한 차이가 나타나지 않았다. 중재 후 평가에서는 프로그램에 참여한 집단의 재난 표현 어휘수행력은 프로그램에 참여하지 않은 집단 간 차이가 나타났고, 통계적으로도 유의한 차이가 나타났다. 본 연구에서는 AAC 재난 대비 중재 프로그램을 개발하고, 이를 발달장애 성인에게 적용하여 재난 대비 시나리오 참여율(재난 대비 의사소통 행동과 재난 대피 행동)과 재난 표현 어휘수행력에 미치는 효과에 대한 임상적 근거를 제시하는데 의의가 있다고 할 수 있다. 또한, 재난 팀 구성원으로서 재난 대비, 재난 대응, 재난 복구 시, 재난 팀 구성원으로 언어임상가가 중요한 역할을 할 수 있다는 근거가 될 수 있다.