兒少保護社工人員在調查兒少受虐案件時,常會面臨研判上之困難,需要不同醫療領域之專家協助診斷及鑑定,本研究採用質性研究方法,共邀請11位高雄市兒少保護網絡人員(兒少保護社工人員、警察、檢察官及四家區域級以上醫院之醫護人員)進行深度訪談,以探究中央政策與地方模式之角色與功能對於建構兒少保護醫療服務網絡及與網絡間協同合作的阻礙與促成因素。本研究發現1.中央政策與地方模式對於四家醫院成立「兒少保護小組」的影響,分「由下而上」及「由上而下」之兩種組成模式,四家醫療團隊人員皆對兒少保護之價值意義持正面肯定的看法,以由「由下而上」模式之參與意願最高、在籌備過程中四家醫院皆面臨人員組成及邀約與電腦資訊系統等阻力,而醫院內部高層長官支持及核心成員積極推動是促成之助力;2.成立「兒少保護小組」之醫院無專屬經費及人力資源,在小組成員條件上,須是臨床上會有接觸到兒少保護案件之醫護人員;3.兒少保護醫療服務網絡的建構對於從事兒少保護工作人員是有助益的;4.網絡間協同合作時,若沒有合作機制會造成溝通障礙且其內部成員若採抗拒態度又缺乏合作經驗下會阻礙網絡合作,但若有正向合作經驗及足夠人力、物力及財力等資源可運用會促使網絡合作之順暢度。因此,建議可從以下三方面著手1.建構高雄市兒少醫療服務網絡合作機制及其工作內涵;2.加強專業人員的兒虐研判與敏感度等教育訓練與提升專業品質;3.規劃相關預防宣導工作。
During investigation of child abuse cases, social workers engaged in children protection always face difficulty in making judgment and thus needs experts of different medical fields to assist in diagnosis and identification. The present study adopts qualitative research method and invites 11 children protection network persons (social workers, policemen, procurators and medical staffs from four hospitals of district level or above) in Kaohsiung City to accept in-depth interview, so as to investigate roles and functions of central policy and local model in establishing children protective medical service network, as well as obstructive and promoting factors for collaborative cooperation between networks. Findings of this study are as below: 1. With regard to influences of central policy and local model on establishment of “child protection team” by four hospitals, there are two composition patterns: top-down and bottom-up. Medical staffs of four hospitals all have positive opinion of value and significance of children protection. They show the strongest willing to participate in the form of “bottom-up”. During the process of preparation, four hospitals are all faced with hindrance such as personnel composition, personnel invitation and computer information system. Driving forces include hospital top-level officers’ support and core members’ active promotion. 2. Hospitals have no specialized funds and human resources for establishment of “child protection team”. Team members are restricted to medical staffs who may involve in children protection cases in clinical practice. 3. Construction of child protective medical service network is beneficial to workers engaged in children protection. 4. For collaborative cooperation between networks, lacking of cooperative mechanism will lead to communication disorder. Furthermore, internal members’ opposing attitude and insufficient experience may hinder network cooperation. Application of positive cooperation experience as well as sufficient manpower, material and financial resources will contribute to smooth network cooperation. To sum up, following three points are suggested: 1. Construct cooperation mechanism and work connotation for children medical service network of Kaohsiung City. 2. Strengthen education and training for professional persons such as child abuse judgment and sensitivity, and enhance their professional quality. 3. Plan related prevention and propaganda work.