臺灣博碩士論文加值系統

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。

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.

口試委員會審定書 i
誌謝 ii
中文摘要 iv
英文摘要 v

前言 1
第一章、 文獻回顧 4
第一節、 慢性精神病 4
壹、 慢性精神病之功能損傷 4
貳、 身心障礙等級對慢性精神病之定義 4
參、 小結 5
第二節、 影響精障者工作的因素 6
壹、 人口特性面向 6
貳、 醫療面向 7
參、 環境支持面向 8
肆、 心理社會功能面向 9
伍、 認知功能面向 9
陸、 小結 10
第三節、 就業服務模式之職業輔導評量 11
壹、 標準化心理測驗 12
貳、 工作樣本 13
參、 情境評量 14
肆、 現場試作 16
伍、 其他相關評量方式 17
陸、 小結 17
第四節、 工作行為 18
壹、 工作習慣 19
貳、 工作態度 20
參、 社交技巧 20
肆、 工作技巧 20
伍、 工作品質 21
陸、 小結 21
第五節、 名詞定義 22
壹、 慢性精神病 22
貳、 工作行為 22
參、 情境評量 22
第二章、 研究目的 23
第一節、 研究問題 23
第二節、 研究假設 24
壹、 服務時間面向 24
貳、 穩定就業相關面向 24
參、 職評成效面向 24
第三章、 研究方法 25
第一節、 研究設計 25
第二節、 研究對象 25
第三節、 研究工具 26
第四節、 研究步驟 29
第五節、 結果測量 32
第六節、 資料分析 36
第四章、 研究結果 37
第一節、 參與者之人口學特徵 37
第二節、 不同職重服務模式比較結果 38
壹、 服務時間面向 38
貳、 穩定就業相關面向 38
參、 職評成效面向 40
第三節、 情境評量組服務意見調查 41
第五章、 討論 42
第一節、 情境評量有效縮短職重服務時間 42
第二節、 情境評量在協助精障者穩定就業上之效益 43
壹、 提高結案時的穩定就業率 43
貳、 縮短穩定就業所需的時間 45
參、 增加工作媒合的成功率 46
第三節、 情境評量與一般職評兩種職評模式之成效探討 47
壹、 情境評量時間長但效益大 47
貳、 情境評量提供較有利的就業安置相關資訊 48
第六章、 結論與建議 50
第一節、 研究結論與主要發現 50
第二節、 研究限制 51
第三節、 未來研究方向 52
參考文獻 53
附錄 61

表目錄
表1醫療諮詢單 61
表2情境工作行為評量表 64
表3功能表現記錄單 71
表4情境工作行為評量之情境變項設計原則 73
表5服務意見調查問卷 76
表6實驗組個案服務追蹤表 77
表7控制組個案資料及服務追蹤表 79
表8參與者人口學特徵 83
表9情境評量組與一般職評組轉介來源 84
表10不同職重服務模式比較結果 85
表11三組結案狀況 86
表12轉介人員對情境評量之服務意見調查 86

圖目錄
圖1精神障礙者職業輔導評量模式 87
圖2職業重建服務時程圖 88
圖3研究流程圖 89
圖4情境評量組與一般職評組轉介來源 90
圖5情境評量組參與者接受評量之天數 90
圖6九十五年度至九十八年度一般就業率 91
圖7三組工作媒合次數分佈圖 91
圖8一般職評組在各項分測驗之平均評量時數及使用人次 92

書籍
中文部分
王敏行、陳靜江（主編）（民96）。身心障礙者職業輔導評量手冊（再版）。臺北市：行政院勞工委員會職業訓練局。
英文部分
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期刊
中文部分
范珈維、張彧、潘璦琬（民96）。精神障礙者重返工作之因素探討：文獻回顧。台灣職能治療研究與實務，3(2)，61-71。
英文部分
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專門及研究報告
中文部分
行政院主計處（民98）。全國人力資源概況。
勞委會（民95）。身心障礙者勞動狀況調查結果。
勞委會（民96）。身心障礙者勞動狀況調查結果。
張彧（2006）。精神障礙者職業輔導評量服務模式研究報告。九十五年度北部地區身心障礙者職業輔導評量服務資源網期末報告。
張彧（2007）。精神障礙者職業輔導評量服務模式研究報告。九十六年度北部地區身心障礙者職業輔導評量服務資源網期末報告。
會議專刊或專題研討會論文
英文部分
Institute on Rehabilitation Issues (2003). A New Paradigm for Vocational Evaluation: Empowering the VR Consumer through Vocational Information. 30th Institute on Rehabilitation Issues.
學位論文
英文部分
Montgomery, K. (1996). Comprehensive vocational evaluation and the successful rehabilitation of individuals with chronic mental illness. Unpublished master’s project, East Carolina University, Greenville, NC. As cited in Institute on Rehabilitation Issues (2003). A New Paradigm for Vocational Evaluation: Empowering the VR Consumer through Vocational Information. 30th Institute on Rehabilitation Issues.
法令
中文部分
身心障礙者職業輔導評量實施方式及補助準則（民97年修正）。
身心障礙者權益保障法（民96年修正）。
身心障礙等級（民90年修正）。