老人保護案件社工成案決策之研究

近四年來，老人保護通報案件有增加趨勢，且老人保護個案樣態多元且複雜，社工處遇過程面對諸多挑戰，使得老人保護議題值得被討論及對話。有鑑於目前臺灣老人保護工作缺乏清楚、明確的服務指標，且各縣市老人保護主責單位不一，故無一致的開案評估標準可供遵循，導致老人保護案件成案過程有諸多討論空間。本研究透過理解老人保護體系的運作及社工人員的工作處境，描繪出臺灣老人保護社會工作之圖像，進一步整理老人保護體系中社工人員之實務評估經驗，初探老人保護個案的評估指標，以及社工人員在老人保護案件中的評估決策情形與可能的成案決策影響因素，進而分析老人保護體系中社工人員的成案決策模式，期待研究結果除提高責任通報端或一般社會大眾在老人保護個案辨識與評估的專業知能外，能針對老人保護實務工作提出實質建議。本研究採質性研究方法，使用深入訪談法蒐集資料，以立意取樣、滾雪球取樣及最大變異取樣等抽樣方法，分別邀請家暴防治體系與老人福利體系的老人保護社工參與研究，並以三年的工作年資為基準，分別選取不同年資的工作者，總計訪談來自五個縣市的八位從事老人保護相關業務的社工人員。研究結果發現臺灣的老人保護服務分工模式可分為「家暴防治體系與老人福利體系雙軌並行模式」、「以家暴防治體系為主體模式」及「以老人福利體系為主體模式」，整體而言，老人保護服務有專精化及分級分類之發展趨勢，社工人員在執行老人保護服務的工作內容以「諮商協談」為必要項目，「安置照顧服務」與「福利服務」佔據最多工作時間，「法律服務」的比重則有逐漸增加的趨勢。此外，老人保護服務的特性為社工人員需面對「老人」與「家屬」雙重服務對象，甚至常面臨與個案產生服務需求認知落差之情形，老人保護社工容易有「使能者」角色難發揮，「照顧資源連結者」反變類家屬，「家庭關係協調者」面臨選邊站的兩難之角色困境。另一方面，老人保護案件成案流程依序分為「初篩分案」、「派案」、「調查評估」三階段，老人保護社工成案決策的影響因素以「個案因素」的評估考量為主，決策依據包含「個案人身安全疑慮」、「個案基本生活的維持」及「個案接受服務的意願」，但會受到「決策者」因素影響而有不同的「決策門檻」，實務上老人保護社工常將「處遇計畫的有無」作為開案與否的依據。然而此決策門檻也往往因「組織」因素而趨於「一致」，「外部」壓力更常「間接」透過「組織」導致個人決策門檻的變化與調整。依據研究結果，本研究提出未來研究、政策與實務上三方面的建議，在未來研究部分，建議相關主題可縮小研究範圍以利更深入之研究，並可納入不同服務階段之社工人員的意見，而老人保護社工的角色困境議題值得進一步深入探究。其次，在政策方面，建議法律針對老人保護定義、扶養義務人界定及社工公權力的賦予等面向進行修訂、整合老人保護服務與長期照顧服務以及發展具有實證基礎與實務價值的評估工具與量表。最後，在實務方面，建議家暴防治體系與老人福利體系建立良好的網絡溝通合作機制、組織應給予年資淺的老人保護社工足夠的支持，並致力於老人保護專業人才的培養。

關鍵字

老人保護服務；社工人員；成案決策

並列摘要

In the past four years, there has been an increasing trend in older adult protective clients, who are diverse and complex. Social workers also face many challenges. Therefore, older adult protection issues is worthy of discussion. In view of the lack of clear and definite older adult protective services indicators in Taiwan, and the controlling organization of the older adult protection varies from counties to another, there is no consistent evaluation standard for intake, resulting in a lot of room for discussion in the intake process of older adult protective services. Through understanding the operation of the older adult protective services system and the working conditions of social workers, this research tries to present Taiwan’s older adult protective social work. Furthermore, by sorting out the practical evaluation experience of social workers in the older adult protective system, we can not only explore the evaluation indicators of older adult protective services but also social workers’ assessment and decision-making situation including possible factors affecting decision-making. It is expected that the research results can not only improve the professional knowledge of older adult protective identification and evaluation abilities for mandatory reporting personnel or the general public, but also make practical suggestions for the older adult protective services. This study adopts qualitative research methods, using in-depth interviews to collect data, and uses sampling methods such as purposive sampling, snowball sampling, and maximum variation sampling. A total of eight social workers from five counties were interviewed. They do older adult protective services in domestic violence prevention system or the elderly welfare system. Based on the working experience of three years, those workers of different years were selected. The results of the study found that the collaboration of older adult protective services in Taiwan can be divided into a "dual-track parallel model", "domestic violence prevention system as the main model" and "elderly welfare system as the main model". On the whole, the older adult protective services in Taiwan have the development trend of specialization and classification. The work content of social workers contains "Counseling" which is a necessary item, "Care services" and "Welfare services" which are most time-consuming, "Legal services" which has gradually increased. In addition, the characteristics of older adult protective services are that social workers have to face the dual clients, and often face a gap in the perception of service needs. Social workers of older adult protective services play diversity role, such as enabler, resources coordinator and family counselor. Besides, they are often in a role dilemma. On the other hand, the intake process of older adult protective services can be divided into "preliminary screening", "distribution" and "investigation and evaluation". The social workers’ influencing factors of the decision-making for the protection of the elderly are mainly based on the evaluation of "case factors", including "clients’ personal safety concerns", "clients’ basic life maintenance" and "clients’ willingness to receive services". However, the decision-making of social workers will be affected by the "decision maker factors” and have different "decision thresholds". In practice, social workers for the protection of the elderly often look upon "the working plan" as the basis for opening a case. In addition, the “decision threshold” tends to be consistent due to "organizational factors”. Moreover, "external factors" often indirectly through the "organizational factors" to make social workers change their “decision threshold”. Based on the research results, there are suggestions of three aspects. First, in the part of future research, it is suggested that related topics can narrow down the scope of research, and can adopt the opinions of social workers at different service stages. Furthermore, the role dilemma issue of social workers in the protection of the elderly deserves further exploration. Secondly, in the part of policies, the law revision is recommended, including the definition of protection for the elderly, the persons bound to furnish maintenance, as well as the empowerment of social workers. Besides, older adult protective services and long-term care services should be integrated. Furthermore, the evaluation tools or scales with empirical basis and practical value should be developed. Finally, in the part of practice, it is recommended that the domestic violence prevention system and the elderly welfare system establish a good network communication and cooperation mechanism, and the organization should provide sufficient support to new social workers, and devote to cultivate professional talents in the older adult protective services.