早期療育社會工作之家庭處遇研究

1.社會工作者之於家庭處遇，就定義與操作兩者比較而言，發現工作者容易產生針對處遇的定義無法用具體的文字表達，而在處遇操作上，因為工作者實際擁有之實務經驗豐富，因此闡述實務經驗上較其表達之處遇定義清楚且豐富。且處遇定義的描述是偏向於任務中心或問題解決，對家庭社會心理功能的改善是比較無提及的，就實際介入狀況而言，應有少部分的介入。 2.影響社會工作者進行家庭處遇的早療家庭、社會工作者、機構等因素頗多，如早療家庭之家長信念與文化、家庭結構與功能；社會工作者之年齡與經驗、專業知能的培養、價值觀、對性別議題的敏感能力等；機構則是機構性質與資源、委託業務與工作者負荷等兩兩因素交叉影響。社會工作者是在層層影響因素下建立屬於台灣早期療育社會工作者之家庭處遇。 3.處於跨專業網絡之社會工作者其角色是需要經驗累積來塑造的。剛進入工作時的不熟悉與生澀會對自己在跨專業網絡中的角色產生懷疑，也會不清楚自己工作職責。隨著工作經驗的累積之後，通常都能在跨專業網絡中駕輕就熟，能輕易的勝任當中協調與溝通的角色，甚至是倡導角色的擔任，能建立周遭其他專業人員對社會工作的正確觀念，產生平日工作的合作機制，也能為個案與家庭發聲。而跨專業網絡中的醫師、治療師、教育人員等對社會工作者之期待多偏向於該領域之外所有事務的處理，使社會工作者必須要滿足不同專業的期待，變成其他專業人員的百寶箱。 4.社會工作者工作負荷沈重，但作為社會工作者背後的機構卻常忽略了教育訓練與支持的需求，有的訓練常只是蜻蜓點水式，使工作者在服務他人與機構之間孤立無援，常必須要倚靠自己的覺察與進修來抵抗困難、挫折與對知識的渴求。整體而言，台灣的早期療育服務，雖然在家庭處遇上尚未建立明確的模式，但在實務經驗上可發現社會工作者之間已經存在「只能意會不能言傳」的處遇模式。家庭處遇的範圍廣泛，只要是涉及家庭相關事務者，社會工作者均納為處遇範圍，而其他專業也是如此認定社會工作者的職責。可惜的是，家庭處遇工作仍因社工之個案量負荷過重、機構委託方案過多等因素，多只停留在以兒童為中心，而非以家庭為中心的工作模式中。

關鍵字

早期療育、發展遲緩兒童、家庭處遇計畫、以家庭為中心的實務

並列摘要

The study aims to understand the definition and the working model of early intervention for underdeveloped children and their families by interviewing intensively 12 social workers of different early intervention institutions. It also identifies factors which shape up daily practice into working models. The main findings are as follows: 1. When talking about family intervention, interviewees are not good at expressing the definition of the family intervention even when they actually have abundant practical experience. The working models which social workers defined are mostly based on ‘task-centre’ and ‘problem-solving’ approaches, rather than ‘social psychological’ approach. 2. Characteristics of families with underdeveloped children, personal social workers and environmental factors of organizations will influence social workers offering family intervention. The first cluster includes ‘parent’s beliefs and family culture’, ‘family's structure’ and ‘family functions’. Secondly, social workers' age, professional experiences, specialty, values, sensitive ability to gender and cultural issues also influence family intervention indirectly. Thirdly, organizational factors such as history, resource, form of contract and case load have great impact on social work practice. 3. Professional cooperation within interdisciplinary network is important in shaping social work practice. Most social workers gradually identify their roles and positions by getting experienced. With the accumulation of working experience, they are more familiar with fulfilling tasks in the interprofessional network and more competent to coordinate and communicate effectively, even as an advocator and educator to promote social work to other professionals. It helps to improve the quality of cooperative working models to benefit clients and families. 4. Support and training offered by organizations are not sufficient for social workers to cope with great pressure and work load. Limited support and discontinuous training eventually makes social workers feel isolated and helpless. They must often rely on one's own awareness to seek for resources to overcome difficulties, frustration and the hunger for knowledge. There is no enough evidence to claim that family service in the field of early intervention social work in Taiwan has a definite working model, however, some practical methods do exist. Family intervention is in extensive range, when involve family's relevant affairs, social workers must be intake to family intervention. The other professional in the network also expect social workers to do so. However, because of heavy work loading, most family interventions we identified in this study are child-centered focus, rather family-centered focus, which makes family intervention less distinctive to individual service for clients.