慢性精神障礙社會福利服務機構評鑑制度之適用性探討

To explore the adaptability of the exiting accreditation used for evaluating social welfare institutions that serve clients with chronic mental illness

邱裕閔(YU MIN CHIOU)

指導教授 ： 葉玲玲

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2009年)

摘要

台灣於1995年將精障者納入殘障福利法保障後，衛生署明訂養護型精障者為社會福利機構服務對象。為提昇機構服務品質、保障精障者權益，機構應依法參加主管機關辦理之機構評鑑。本研究目的為探討專收精障者社會福利服務機構評鑑制度的適切性。

本研究採深度訪談與文件分析作為研究方法。深度訪談對象包含2007年10月內政部網站所登錄收容精障者社會福利服務機構，以及受訪機構介紹3所收容精障者超過服務量半數之機構為研究對象共計19所，最後選出13所於2007年12月至2008年2月進行深度訪談。文件分析則以內政部於2008年5月出版之「第6次全國身心障礙福利機構評鑑報告」中之機構評鑑報告為文件分析對象，評鑑報告中的機構選取條件與深度訪談相同，共14篇文件進行分析。透過兩者的比較分析，進而探討身心障礙福利服務機構評鑑對收容以精障者為主機構的適切性，期待研究結果可以作為相關政策參考。

研究結果發現現行一元化評鑑制度因無法納入各類障礙者需求而適用性不足，對醫療支持、復健服務未予足夠重視，故不符精障者需求。而托育養護費設有收費上限以及社會捐款不足，機構收入無法支撐其達到評鑑標準。而營運成本中佔最大宗之人事成本，現行法規卻無法考核機構人力資源使用適切性。各小康計畫執行單位也因補助費用低於托育養護費用，而評鑑指標卻與辦理托育養護單位相同而造成機構營運困境。

本研究建議評鑑制度宜視精障者需求設計，以深入評核機構服務品質。在財務部份，透過政策引導社會大眾捐款支持機構，減輕機構經營壓力，並增加人員聘用彈性，使人事成本適當運用。對小康計畫執行機構給予合理補助，使服務對象獲良好服務品質。

關鍵字

精障者 ； 評鑑 ； 社會福利

並列摘要

Since Taiwan included patients with chronic mental illness as subjects protected by laws for the disabled in 1995, Department of Health has assigned the disabled with chronic mental illness as objects serviced by social welfare institutions. According to law, institutions should participate in the accreditations conducted by the authorities, for facilitating the quality of service supplied by the institution, and ensuring the rights of clients with chronic mental illness. The purpose of this study was to examine the adaptability of the existing accreditation used to evaluate social welfare institutions that only serve clients with chronic mental illness.

This study employed indepth interview and document analysis as research methodology. The objects of indepth interview comprised totally 19 chronic mentally patients’ social welfare institutions, including those listed on the website of Ministry of Interior during Oct of 2007, as well as three institutions that, introduced by the interviewed institutions, accepted clients with chronic mental illness as its major customers, and ultimately 13 institutions were selected to be indepth interviewed during Dec of 2007 to Feb of 2008. On the other hand, the objects of document analysis were the institutions reported in “the sixth national evaluations for social welfare” issued by Ministry of Interior during May of 2008. Criteria for selecting institutions of document analysis were the same as those of indepth interview, and finally total 14 articles were analyzed. By means of comparing research results via the two methods, the adaptability of the existing accreditation used to evaluate chronic mental clients’ social welfare institutions was further explored. We hope the findings of this research could be considered by the authorities.

Research results indicated the current simplex accreditation system is insufficient in adaptability for it cannot match multiple demands of all the disabled. This system fails to meet the requirements of clients with chronic mental illness because neither medical support nor rehabilitation service is paid ample attention. The upper limit of service fees for residential care and the deficiency of public donation make institutions incapable to reach the criteria of the accreditations. As for employee salary, the prime cost of an institution, the current accreditation system is unable to measure the efficacy of manpower arrangement. Besides, institutions executing ‘fortunate programs’ tend to encounter financial straits due to receive lower allowance than service cost for residential care but face the same index of accreditation as those used for evaluating institutions performing residential care services.

This study proposed accreditation system could be designed in accordance with the needs of clients with chronic mental illness, in order to deeply evaluate the quality of care. As for financial affairs, propositions of this study were threefold. Firstly, policies could be formulated for promoting public donation to help alleviate running pressure of institutions. Secondly, elasticity of manpower employment could be improved to enhance effective management of employee salary. And finally, institutions carrying out fortunate programs could be provided with appropriate amount of allowance, to ensure the quality of service supplied to the residents.

並列關鍵字

clients with chronic mental illness ； accreditation ； social welfare

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