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  • 學位論文

優勢觀點於精神障礙者職業重建服務運用-以高雄市為例

Applying Strength Perspective in the Vocational Rehabilitation Services for People with Mental Disorder: The Case of Kaohsiung City

指導教授 : 林宏陽 李德純

摘要


精神障礙者因本身精神疾病影響功能狀況與其他障別有所不同,故在現有的就業模式上不盡然完全適用,而需針對精神障礙者個別狀況發展適當的職業重建服務。本研究目的旨在探討目前精神障礙者實施的職業重建服務模式現況與問題,並由優勢觀點探討其運用,以及其中發生的改變。   本研究採用深度訪談法為主要蒐集資料的方法,以優勢觀點資料分析之視角,邀請十一位職業重建專業人員共同參與本研究。分析討論運用優勢觀點於職業重建服務的相關議題,了解精神障礙者職業重建服務如何與個案建立優點助人關係、激發個人的想望,服務對象是助人關係的指導者,共同討論擬定服務計畫與媒合個案就業,以探討職業重建服務所發揮的功能。綜合研究分析與發現,對於精神障礙者職業重建服務獲得結論分為兩大部分,一是職業重建服務內容現況方面;二為職業重建服務政策體系方面。   職業重建服務內容現況方面在接觸建立關係以朋友、夥伴關係的方式僅適用於志願性個案;優點評量發掘想望階段,受限於法定服務時效,主要針對主動性個案進行服務,且職評部分缺乏整體評估個案生態環境的資源盤點;建立目標階段因法定規定要求加上個案的症狀干擾影響,影響其目標建立,只能提供符合法規規定且符合個案期待的目標去規劃;執行個人工作計畫階段則面臨個案的精神穩定狀況、法定服務期程限制,無法依個案的實際狀況作調整,無法全面落實其就業模式,加上跨系統資源連結緊密度不足與受到各個單位合作機制的問題,影響職業重建服務計畫之進行;最後結案階段,受到個人身心狀況及社會網絡支持度不高,加上服務時效,落實運用優勢觀點服務是有限度。職業重建服務政策體系方面,得到七點結論:一、專業促進落差;二、欠缺新制管理系統的實證;三、合作機制銜接不足;四、欠缺完善實務服務工作模式;五、法定服務時效壓迫和績效訂定難達到平衡;六、服務使用者就業福利權益受到限制;七、缺乏雇主端通報轉銜機制。   最後根據上述的研究結論,提出三大部分之建議:一是職業重建服務內容現況方面;二為職業重建服務政策體系方面;以及未來研究方面。

並列摘要


Mental disorder is kind of illness, that has influences on mental functions and behavior, causes pain and loses sense of behavior. It also affects functional status and hinders individuals from developing their own integrity. The purpose of this study was to investigate the current status and problems of the occupational rehabilitation services model towards metal disorder patients. In-depth interview was used as the main method for collecting data in this study. Eleven experts in the field of occupational rehabilitation for people with mental disorder were invited to this interview. Issues with regard to applying strength perspective in the vocational rehabilitation services were analyzed and discussed, thus to know the vocational rehabilitation services for people with mental disorder will establish assistant relationship with the cases and stimulate personal desire. Service object is the director for helping relationship. Joint discussion was conducted for developing service plan and promoting employment of the cases, thus to investigate functions of occupational rehabilitation services. A generalization of research analyses and findings indicated occupational rehabilitation services for people with mental disorder could be divided into two parts-current contents and policy system. In respect to contact and relationship establishment included in current contents of occupational rehabilitation services, friend or partner relationship was only applicable to voluntary cases. At the stage of merit evaluation, exploration and desire, due to limitation of legal service prescription, services were mainly provided to active cases; furthermore, occupational assessment lacks an overall evaluation of the case’s ecological environment resource check. During goal setting, as a result of legal requirements and interferences caused by these cases’ symptoms, it’s only possible to set goals that meet legal stipulations and individual expectations. At the phase of performing personal work plan, it’s unable to make adjustment in accordance with the case’s actual conditions and fully implement the employment mode because of restrictions such as stability of spiritual status and term of legal service. In addition, execution of occupational rehabilitation service program is also affected by insufficient closeness of cross-system resource connection and problem of inter-organization cooperation mechanism. For conclusion, implementation and application of strength perspective service is limited as confined physical and mental states of individuals, low degree of social network support, and effective period of the service. In terms of policy system of occupational rehabilitation series, seven conclusions were drawn: 1. Differences in professional promotion, 2. lack of empirical evidences for newly established management system, 3. deficient connection of cooperative mechanism, 4. lack of a perfect service work mode, 5. a difficult balance between pressure of legal service prescription and stipulation of performance, 6. restricted employment benefits and equities of service users, 7. lack of employer-end notification and transition mechanism. Some propositions from this research were proposed in the concluding chapter. First of all, the suggestions lie on the current status occupational rehabilitation service. The second point refers to the suggestions on the policies of occupational rehabilitation services. The third point refers to future researches which could be used as references.

參考文獻


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