促進社區精神復健服務之使用－一個實驗方案結果之呈現

Fostering the Utilization of Psychiatric Rehabilitation Services-The Results of an Experimental Program

宋麗玉(Li-Yu Song)

《社會政策與社會工作學刊》 4卷1期 (2000/06) Pp. 157-197

摘要

本研究針對社區精神復健服務使用率偏低的問題，以中部某療養院之病患為研究對象，進行一「早期且完整之干預」的兩年實驗計畫；由社會工作人員以個案管理的方式對實驗組病患(n=45)進行實驗之干預，分為住院期問之評量、訊息傳達與教育、訂定出院計畫與轉介，與出院後對病患復健服務使用、病患功能與主要照顧者負荷程度之追蹤；而控制組(n=31)之病患則接受醫院之一般處遇方式。本研究檢驗實驗組之社區精神復健服務使用之情形是否優於控制組；並比較實驗組與控制組在出院三個月與九個月後於病患功能與照顧者負荷方面是否達顯著差異。研究發現實驗組與控制組於上述幾方面都無顯著差異；然而，本研究的假設未獲支持並不必然意涵本研究的假設不正確；其直接的原因關乎「方案執行過程」，亦即未如當初的設計般；而執行過程中的限制又與醫院內部與外部結構性因素有關。本研究分別由這些結構限制加以討論，並提出四項建議，期能增進社區精神復健服務之使用。

關鍵字

慢性精神病患 ； 社區精神復健服務 ； 病患功能 ； 照顧者負荷

並列摘要

This study aimed to test the effects of a two-year experiment, ”Early and Comprehensive Intervention”, on fostering the utilization of psychiatric rehabilitation services. Subjects were drawn upon a psychiatric ward in central Taiwan. Patients in the experimental group (n=45) received intervention from social workers who acted as a case manager. The intervention involves two parts: (1) During patients' stay in the hospital, including comprehensive assessment, information giving, explanation, and education, as well as making discharge plan and referring patients' to appropriate psychiatric rehabilitation services; (2) After discharge, including follow-up on patients' use of psychiatric rehabilitation, patients' function and caregiver burden. Whereas, patients in the control group (n=31) received regular intervention. The study examined if the experimental group used more of the psychiatric rehabilitation services than the control group, and tested if these two groups were significantly different in patients' function and caregiver burden three months and nine months after the patients discharged from the hospital. The results indicated that, in general, the hypotheses of this study were not significant. However, such results do not necessarily imply that the research hypotheses were not supported since there were problems with program implementation process, which related to the structural barriers, including insufficiency of psychiatric rehabilitation facilities and the power structure and role allocation among the different professions. Another barrier is in that patients and caregivers lacked of motivation in using and knowledge of psychiatric rehabilitation service. The author discussed this barriers and made four suggestions.

並列關鍵字

Chronic Mental Illness ； Psychiatric Rehabilitation Service ； Patients' Function ； Caregiver Burden

參考文獻

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