矯正機關毒癮愛滋收容人團體處遇模式之研究

A Study of Model and Effect of Support Group on People Living with IDU and HIV/AIDS in Prisons of Taiwan

張麗玉(Li-Yu Chang)

指導教授 ： 黃源協

國立暨南國際大學/人文學院/社會政策與社會工作學系/博士(2010年)

https://doi.org/10.6837/NCNU.2010.00030

摘要

論文摘要

本研究目的探討整合性團體處遇模式對毒癮愛滋收容人的愛滋認知、愛滋態度、社會支持與憂鬱程度等面向之社會與心理調適效果，以及其社會心理調適之影響內涵，進而修正及建構毒癮愛滋收容人之短期團體處遇模式，研究發現提出矯正機構毒癮愛滋收容人處遇之實務及相關政策參考。
本研究係採實驗組控制組前後測實驗設計，以六週的整合性團體處遇模式介入，採用量化與質性的研究方法。研究對象分別於團體前、團體結束及團體結束後一個月進行愛滋認知、愛滋態度、憂鬱程度、社會支持等四個項度量表的資料收集，並且團體處遇結束後針對團體目標、團體氣氛及滿意度之評量，以瞭解團體成員對團體過程之評量，並且進一步針對團體結束後之實驗組成員以深入訪談及焦點團體的方法以瞭解團體處遇後之改善內涵及建議，以建構適合於毒癮愛滋收容人之整合性團體處遇模式。研究樣本係選自高雄及屏東地區等四個矯正機關之毒癮愛滋收容人為對象，參與者有效樣本數為116人，採立意取樣與隨機抽樣的配對方式，分為實驗組60人與控制組56人。
在量化分析之研究結果發現，團體處遇的介入可以有效顯著地降低毒癮愛滋收容人的憂鬱程度，且顯著提升整體社會支持狀況，對於愛滋認知有正向的影響。研究結果，驗證此整合性的團體處遇模式，對毒癮愛滋收容人確實具有顯著社會支持提升及降低憂鬱程度等之成效影響；另外透過對實驗組成員之團體評量，顯示團體處遇過程有正向的團體氣氛、高團體滿意度、以及具有高度達成團體目標的效果，研究顯示團體處遇擴展了毒癮愛滋收容人的對愛滋衛教及相關醫療資訊的了解與認知、感染愛滋後問題的分享及情緒紓發、尋求正向的助力與減少阻力、提升自我照顧技巧、面對愛滋或毒品困擾、增強正向人際互動與行為改變動機、以及協助成員探討未來生涯規劃的可能性等七個目標之達成。
在質性研究結果發現，在26位深入訪談、團體紀錄及焦點團體等資料分析，研究發現毒癮愛滋收容人之壓力源有毒品使用行為、多次入監服刑、愛滋感染等三重主要壓力；在認知方面，其因愛滋認知的不足，造成使用毒品共用針具/稀釋液/溶器等而感染愛滋；支持系統方面，家庭主要是提供毒癮愛滋收容人子女的照顧及部份的經濟協助，入監後有些人則依賴獄友的支援；對於因應方面，則呈現危機狀況，如離婚、家庭解組、因毒品犯罪而反覆入監所服刑等。對於團體處遇影響內涵包括微視系統、中介系統及鉅視系統等，可分為個人心理、認知、態度、家人關係、同儕互動、社會支持、對價值觀及減害計劃政策運用等面向，其內涵包含：在個人的心理：從封閉心情中走出來，變得較開朗及想得開；有助於對壓力的調適及重新調整自己的心態；了解戒毒的阻力；較能放鬆地抒發情緒及分享自己的感受；增強自我信心；壓力較減輕。對個人認知方面：增加對愛滋相關資訊議題的瞭解與討論；學習面對愛滋的問題及自我健康照顧；學習面對毒癮問題及找到戒毒的助力和方法；學習生涯目標的規劃。對個人態度方面：引發更多正向的想法以及感到生命有希望；對自己的看法變得比較正向及喜歡自己；變得更重視自己的生命；增進自我了解及積極態度面對未來。對家庭方面：增進與家人的書信聯繫、改善與家人的互動關係。對同儕方面：歸納了解到因為交友及環境使然而染上毒癮，故出監後規劃離開原來的朋友圈；另外也彼此提供生活借鏡及典範；增進同儕間之相互扶持與勉勵等。對社會支持方面包括主動尋求社會支持、社會支持網絡的擴充、增進正向人際關係的互動等。對社會價值觀的調整，許多成員表示未來出監回歸社會也想當志工助；政策環境方面則選擇運用美沙冬替代療法來解決毒癮問題等，以及發現毒癮愛滋收容人之17項非理性信念。
依本研究成效評量及修正建議，建構兩種以六次共十二小時及八次共十六小時的短期『整合性團體處遇模式』，並且依不同對象及需求提出矯正機關愛滋防治之團體處遇模式的金字塔三模式：大團體愛滋衛教模式、團體愛滋座談諮詢模式、及短期團體諮商模式，並且提出「環境壓力調適模型(SCEO)」。且依研究結論，提出對團體處遇模式、矯正機關、相關臨床實務工作者、與方案政策等建議。

關鍵字

矯正機關:毒癮 ； 愛滋 ； 整合性團體處遇 ； 憂鬱 ； 社會支持 ； 社會心理調適

並列摘要

Abstract
The purpose of this study was to make a objective appraisal that the model and effects of compound support groups therapy (CSGT) on the psychot-social adjustment on people living with IDU and HIV/AIDS in prisons of Taiwan.
The study is a quasi experimental pre-post control group design. The participants of experimental group met once a week for 6 weeks support groups therapy. We use quantitative and qualitative methods. The participants were non-random to select from the 4 prisons of south Taiwan. Then randomize sampling to the experimental groups and control groups. In quantitative method, four questionnaires include cognition of AIDS/HIV(+), attitude of AIDS/HIV(+), depression, and social support that were made during pre-test, post-test and follow-up test data collection and also to realize the change of groups atmosphere, group goal, satisfied with groups. The 116 participants include experimental group with 60 participants and control group with 56 persons. After that, in qualitative analysis, individual interview from 26 participants and 4 focus groups are performed to collect in-depth data from the participants of experimental groups. Each of the support group therapy is consisted of one facilitator, one co-facilitator, one or two assistants, and the members.
In quantitative analysis, We found that the support group therapy significantly reduced melancholy and increased social support and AIDS cognition of people living with IDU and HIV/AIDS in prisons. This study also proves the support groups therapy are effectaully.In group therapy analysis found that the participants of experimental group had positive change of groups atmosphere, group goal, satisfied with groups therapy.The group goal were finished including to promote AIDS cognition and resource, to help members to express feelings about having HIV/AIDS and share their grief, to look for positive power and reduce negative power, to increase self-care skill and life energy, to face themselves about AIDS and IDU problem, to promote positive relationship and change act, and to help members to discuss the future of life.
In qualitative analysis, we found the participants of group therapy effective change of their ecosystem in micro system, meso system, and macro system that included to increase individual support system, to promote family support, to increase peer support and resource system, and to change scoial value system. There were to include in optimistic, more thinking, more interaction, out of self-contained, extend the social support network, reset himself, learn face the problems, improve the attitude to family and treasure life. Overall through this support groups therapy, there are positive psycho-social adjustments to the individual HIV/AIDS patients in Social relationship. In study, we had found the 17 delusional beliefs of the participants.
According to the result of this study, the two treatment models of the compound support groups therapy (CSGT) made into two hours once a week for 8 weeks and 6 weeks for the IDU and AIDS prisoner of defferent need.We found to induce three model of group treatment of HIV/AIDS prevetion that are HIV/AIDS education group model, HIV/AIDS consistory group model,and support group therapy model.Recommendations were to provide social support model to prisoner of IDU and HIV/AIDS treatments, social work of prison and clinical nursing. And it also recommend add the content of group therapy work to the advanced training of social worker, nurses and psychiatrist to improve the ability of IDU and HIV/AIDS clinical treatment model. Suggestions for future research and applications are presented.

並列關鍵字

Prison ； IDU ； HIV(+)/AIDS ； Compound Support Group Therapy(CSGT) ； Depression ； Social Support ； Psycho-social Adjustment

參考文獻

莫藜藜、鍾道詮（2006）。從愛滋社工者的工作經驗初探「部分社工者不願提供服務給愛滋感染者或病患」之現象。台灣社會工作學刊，6:1-31。

參考文獻

中文部份

行政院法務部網站(2010) http://www.moj.gov.tw

行政院衛生局疾病管制局全球資訊網 (2009)http://www.cdc.gov.tw/mp1.htm