情境評量模式成效探討：應用於慢性精神病患者

The Effectiveness of Situational Assessment Model: Application of Persons with Chronic Mental Illness

鄧乃瑜(Nai-Yu Deng)

指導教授 ： 張彧

國立臺灣大學/醫學院/職能治療研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.00461

摘要

背景及目的：回到競爭性職場工作是慢性精神病患者重要的復健目標，有效的職評模式，可提供職業重建人員在協助精障者就業時，適當的建議與輔導策略。本研究欲透過與現有台灣常用職評模式之比較，探討情境評量應用於慢性精神病患者職業重建的成效。
方法：本研究共分為三組，分別為情境評量組34人、一般職評組40人、無職評組40人，共有114位領有慢性精神病身心障礙手冊並設籍於北區各縣市之精障者參與。情境評量組之參與者接受3-5天情境評量，一般職評組參與者接受目前台灣現有職評模式，無職評組則未接受任何職評。
結果：（一）服務時間面向：情境評量組在服務天數及職評天數顯著少於一般職評組及無職評組（p<0.005; p=0.03）。（二）穩定就業相關面向：情境評量組在等待天數、工作媒合次數及達到穩定就業天數顯著少於一般職評組及無職評組（p<0.005; p=0.029; p=0.002）；結案時有近七成（67.6%）參與者穩定就業且以支持性職場為主。（三）職評成效面向：情境評量組之職評總時數顯著多於一般職評組（p=0.004），然情境評量組之職評報告被轉介人員採用比例卻顯著高於一般職評組（p<0.0005）。（四）在情境評量組服務意見調查結果中，有12名（85.7%）轉介人員滿意情境評量之報告內容，並且同意情境評量的結果可提供其對於精障者就業特性的了解。
討論：（一）精障者在接受職重服務後，愈早轉介情境評量模式之職評服務，可縮短其接受職重服務的服務天數與職評天數。（二）使用情境評量可帶來較高的穩定就業率，並增加轉介人員對精障者就業特性的了解，提高工作媒合成功率，縮短等待的時間，並提早達到穩定就業的目標。（三）情境評量的評量時間雖長，卻充分運用在工作行為的觀察，相較一般職評，可期望獲得更有助益的就業特性之資訊，不僅可協助轉介人員在職重計畫的擬定，也提高其對職評報告的滿意度。
結論：整體而言，情境評量應用在慢性精神病患者之職業重建上可增加對精障者就業特性的了解，使其較早穩定就業，且就業的成果較佳，以支持性職場為主，有效地縮短接受職重服務的時間以及提高穩定就業率與轉介人員的滿意度。

關鍵字

情境評量 ； 精神障礙者 ； 職業輔導評量

並列摘要

Background and purpose: Returning to work in competitive employment is an important goal of vocational rehabilitation (VR) for persons with chronic mental illness (CMI). Effectiveness vocational evaluation provides appropriate suggestions and strategies for VR professionals when they help persons with CMI seek for a job. The purpose of this research was to compare several vocational evaluation models usually used in Taiwan to examine the effectiveness of situational assessment when being applied to persons with CMI.
Methods: Persons with CMI who had the handbook for the Disabled and lived in Northern Taiwan were classified as receiving situational assessment last for three to five days, present vocational evaluation in Taiwan, and no vocational evaluation service. Total of the participants were one hundred and fourteen and were divided into three groups, including situational assessment group (SA group, N=34), vocational evaluation group (VE group, N=40) and non-vocational evaluation group (non-VE group, N=40).
Results: (1) Service time domains: Days of service and vocational evaluation in SA group were significantly less than VE group and non-VE group (p<0.005; p=0.03). (2) Employment Stable related domains: Days of waiting, times of work matching, and days of achieving employment stable in SA group were significantly less than VE group and non-VE group (p<0.005; p=0.029; p=0.002). Almost seventy percent (67.6%) of the participants in SA group worked in supported employment when they stopped the VR service. (3) Effectiveness of vocational evaluation domains: Hours of vocational evaluation in SA group were significant more than VE group (p=0.004); however, the rate of adopting suggestions in SA group was significant higher than VE group (p<0.0005). (4) The results of services survey in SA group demonstrated that twelve VR professionals had been satisfied with situational assessment, and agreed that the results had provided them information about work characteristic of persons with CMI.
Discussion: (1) The earlier were person with CMI referred to situational assessment services, the shorter were they served in the process of VR. (2) Using situational assessment resulted in higher rate of employment stable, more information about work characteristic person with CMI, shorter waiting time, and earlier achieving goals of employment stable. (3) Although situational assessment took a long time, it was used to observe the work behavior to get helpful information about work characteristic more effectively in comparison with vocational evaluation. As a result, situational assessment not only helped the professionals make a vocational rehabilitation plan, also improved their degree of satisfaction.
Conclusion: To sum up, situational assessment applied to persons with CMI who were in the process of VR could increase understanding of their work characteristic, making them return to work earlier, having better vocational outcome, shortening the service time, and adding the rate of employment stable and the degree of satisfaction.

並列關鍵字

situational assessment ； chronic mental illness ； vocational evaluation

參考文獻

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