保護性社工在老人遭受卑親屬施暴案件之處遇評估模式探討

摘要本研究旨在探討保護性社工接獲老人遭受卑親屬施暴案件後之評估處遇模式，研究目的包括了解保護性社工如何評估老人遭受卑親屬施暴的危險程度、保護性社工處理老人遭受卑親屬施暴案件的處遇模式為何，以及保護性社工在處遇方面之困境及如何因應，並提出政策面及實務面之建議。本研究採取質性研究取向，以主題式分析法分析。針對服務老人遭受卑親屬施暴案件且三年以上工作經驗之保護性社工為研究參與者，總共訪談13位保護性社工。本研究結果得知，保護性社工針對老人遭受卑親屬施暴之危險程度評估方式包括：藉由通報案情內容研判受虐危險程度、老人受虐後傷勢狀況及受虐頻率或次數，相對人在施虐過程有無使用器具攻擊、老人之健康功能、相對人之狀態、家中有無支持系統或保護因子、多種評估表單使用及保護性社工專業判斷。在處遇模式方面，保護性社工會以危機介入取向、生態系統觀點、家庭為中心模式、問題解決模式、增強權能觀點及任務中心模式這六種處遇模式搭配使用。保護性社工會優先以危機介入取向評估，後續伴隨案家整體需求輔以其他模式交互使用，呈現動態處遇模式，多元模式並行的處遇方式。保護性社工在處遇老人遭受卑親屬施暴案件，會面臨多種困境：案主身處高危機情境，無意願接受社工服務、相對人狀況差，保護性社工介入處遇不佳、針對老人受虐後之保護安置機構少，費用高、保護性社工對於老人受虐傷勢難判斷、家庭暴力防治法及老人福利法之法令不足，尚有待增修之處、實務工作現場發現老人受虐通報多，但多不確實、最後則是當案主無法回應醫療決策，此時會期待由保護性社工代替案主做決定。最後，根據上述研究結果，本研究分別提出四項政策面建議及三項實務面建議。關鍵詞處遇模式老人保護老人虐待危險評估卑親屬施虐

關鍵字

處遇模式；老人保護；老人虐待；危險評估；卑親屬施虐

並列摘要

Abstract The purpose of this study is to explore the risk assessment and treatment model of protective social workers in handling elder abuse cases by lineal descendants. This study also examines the difficulties faced by the protective social workers in handling elder abuse cases. This study adopts qualitative research and uses a thematic analysis method. A total of 13 protective social workers with more than three years of working experience were interviewed for the case of serving the elderly who had been abused by lineal descendants. The results of this study show that the protective social workers’ assessment of the risk of the elderly being abused by lineal descendants includes: judging the risk of abuse by the reporting content of each case; the injury condition of the elders after being abused; the frequency of abuse that occurred; whether a weapon/tool was employed during the abuse process; the health functioning of the elderly, the status of the relative; whether there was a support system or protective factors at home; the use of various assessment forms, and the professional judgment made by the protective social workers. Protective social work employs six treatment models: crisis intervention orientation, an ecosystem approach, a family-centered approach, a problem-solving approach, an empowerment approach, and a task-centered approach. The protective social workers will give priority to the assessment of crisis intervention orientation, and then follow the overall needs of the case, supplemented by other models, thereby presenting dynamic and multi-mode treatment models. When protective social workers deal with a case where an elderly person has been abused by an inferior relative, they face various difficulties: the client is in a high-crisis situation, unwillingness to accept social worker services, the relative situation is poor, and the protective social worker’s intervention was not well handled. There were few protection and resettlement institutions for the elderly who was abused, with high costs, and it was difficult for protective social workers to accurately judge the severity of the elderly’s abuse. The laws and regulations on the Prevention and Intervention of Domestic Violence and the Elderly Welfare Law were insufficient, and there were still areas to be improved. With the uncertainty, and ultimately, when the client is unable to make medical decisions, a protective social worker is expected to make the relevant decisions on the client's behalf. Finally, according to the above research results, this research proposes four policy recommendations and three practical recommendations.