某公立教養機構於福利社區化政策思維下服務過程的探究

The Research of the Service Process under Formation of Welfare Community in the Public Institution

楊純真(Chun-chen Yang)

指導教授 ： 陳美智

亞洲大學/人文社會學院/社會工作學系碩士班/碩士(2009年)

摘要

社會福利社區化（簡稱福利社區化）是屬於社會福利領域，近來成為台灣大力倡議且積極推動的社會福利政策之一。而在身心障礙者教養機構中推展的「福利社區化」並非意味著完全排除機構式的照顧，強調的是重視服務對象於機構中有正常化、家庭化、個別化及人性化的服務內涵，讓被照顧者得到適當的個人、家庭與社區的支持性服務，並落實教養機構「社區融合」的福利思想。
本研究透過參與式觀察法及深入訪談法，探究某公立教養機構在福利社區化政策思維下機構照顧模式及專業服務過程的分析。針對研究結果及發現，歸納以下的結論：
一、教保與醫療照護服務：（一）機構院民的居住環境與作息活動，在制度環境壓力下，已逐漸朝向人性化、家庭化的設計，並透過有系統的組織理念架構與制度安排，引導工作人員照顧服務的方向，但在實際的服務模式方面，實務工作人員的認知與行動有待提升；（二）對於障礙程度不一的服務對象採取融合照顧的理念，但因為大家庭混合式的照顧，易偏重處理障礙及問題行為嚴重、或併有精神、癲癇等疾病的院民，對於其他院民個別性的需求的重視亦有待制度資源的投入與提升；（三）教保人員在工作時間勞務分配、人員的配置方式因組織的歷史與人力結構因素，呈現照顧體制的有限性；（四）院民的醫療照護在健康管理、病情追蹤及身體老化預防措施，因年齡與障礙特性影響，需要預先規劃預防與照顧策略；（五）評鑑制度對於機構服務品質的提升與監督有所幫助，但過多的文書作業排擠照顧院民的時間與人力，若要落實院民的「個別化服務計畫」的各項專業服務，則需從機構實務工作的處境與限制，省思評鑑制度的實施內涵。
二、社區融合與社會參與：（一）推動社區融合方面，機構積極辦理多元化的融合活動、訓練課程、推動社區化支持性就業、連結社區組織資源與倡導弱勢培力策略等等，展現了機構的努力與用心，但仍受限於機構區位與交通的不便、專業團隊橫向連結鬆散等結構性的問題。（二）機構與案家的雙向互動：案家普遍的低社經地位、機構偏遠探視不便等結構性限制下，使得機構推動的家庭支持服務成效不彰，如何提升案家參與和充權，以幫助其居住於機構的子女享有更多的社會資源的連結和社區參與的機會。
本研究依據以上的結論，在政策面、機構實務工作層面及服務對象與家屬的家庭支持層面等三部份提出具體建議以供參考。

關鍵字

教養機構 ； 心智障礙者 ； 福利社區化 ； 去機構化 ； 身心障礙者

並列摘要

Welfare Community is in the scope of social welfare, and it has become one of the social welfare polices that Taiwan strives to promote in recent years.However, Welfare Community does not mean deinstitutionalization when intellectual disability institutionalization is developing Welfare Community.It stresses that we should respect those intellectual disability people and should provide family-oriented, individual-oriented and human-oriented service.We should make those people be supportive and fulfill the idea of Welfare Community in the institutionalization.
This research was conducted through the participations and interviews in order to analyze the mode of the caring organization and the process of professional service which is in a public institutionalization.The results and findings of this research conclude two points below:
1、Care giving and medical care service:（1）The living environment of the people in the institutionalization has been improving toward to human-oriented and family-oriented.Through the idea of the system, the caregivers are being taught the direction of caring service; however, not all the care givers have recognized the direction of caring service in actual service mode.（2）For different levels of intellectual disable people are all put into the same group.Due to this kind of mixed care giving, it is prone to focus on the people who have more serious mental or physical problem.The caregivers overlook other intellectual disable people’s needs.（3）The distribution on working time and labor work of caregivers is showing the limitation in the caring system.（4）The medical care of the intellectual disable people do not get enough attention and response in health management, trace of patients’ condition and precaution of physical aging.（5）The evaluation system has improved the quality of institutionalization service, but too much paper work has shorten the time and labor work to take care of the disabled. This has made ‘Individualized Service Plan’ that can not put into practice.
2、Fitting in community and participating in society:（1）The outcome of fitting in community:Holding diverse activities and training courses for the intellectual disabled in order to fit in community, creating more jobs, cooperating with other communities and so on.The institutionalization has shown a lot of efforts.However, the professional team do not present the best effect because of the bad location of institutionalization and inconvenience of traffic.（2）Interaction between the institutionalization and the families:Most of the families are underprivileged and live far away from the institutionalization.This has made the function of family support service not work well.
This research has based on the conclusion above and provided some suggestions for reference in every aspect of polices, practice and the service of intellectual disable people and their families.

並列關鍵字

institutionalization ； Intellectual disability ； Welfare Community ； deinstitutionalization ； disabilities

參考文獻

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