臺灣博碩士論文加值系統

本研究旨在探討行政院衛生署所屬之四家療養院自92年起向勞委會申請承辦各項職業訓練之方案成效，本研究將考慮出院慢性精神疾病患者人口學、身心功能等因素後，分析職訓方案內容（評估團隊人數別、計畫主負責治療師有否取得丙級烘焙技術士證照、計畫主負責治療師之年資、計畫主負責治療師有否社區照護經歷、輔導課程是否由跨專業之工作人員執行、輔導課程時數、職訓後就業輔導之人員）與職業訓練結訓後第1、3、6個月之就業率與就業穩定度間之關係。
本研究屬回溯觀察性因果關係研究，評價設計採準實驗四組時間序列；研究樣本採立意取樣，立意之原則為願意提供93年至96年出院慢性精神疾病患者參與職業訓練資料之行政院衛生署所屬之四家療養院，所需資料來源為學員之病歷、結訓後第1、3、6個月之職業訓練紀錄表及電話訪問（如發病年、就業狀態），共計323位樣本；性別以男性居多，年齡為18.0-59.1歲，診斷別主要是精神分裂症；手功能等級以中度障礙為其多數；注意力等級大部分屬輕度障礙；日常生活等級以良好居多。
研究結果發現，在就業率方面，經考慮性別、注意力等級別、發病年齡等3個變項，職訓方案之8個自變項中僅剩4個變項；即計畫主負責治療師是否取得丙級烘焙技術士證照、輔導課程時數、職訓後輔導人員別與職訓後之追蹤時間（結訓後之1、3、6個月）與就業率達顯著相關；即計畫主負責治療師有取得丙級烘焙技術士證照較未取得證照者就業率（51.1% ~ 62.0%）高31.4%；輔導課程時數每增加1小時其就業率可增加0.1%（以30小時為基準線），而職訓後輔導人員由社區復健中心之專任管理員執行就業輔導之就業率較職訓技術老師（29.8% ~ 52.6%）擔任就業輔導之就業率高48.2%，結訓後第六個月之就業成功率較第一個月（52.9%）顯著高10%。另在就業穩定度方面，經考慮發病年齡變項後，職訓方案之8個自變項中僅剩2個變項（計畫主負責治療師是否取得丙級烘焙技術士證照
II及職訓後輔導人員別）與就業穩定度達顯著相關；即有取得丙級烘焙技術士證照者較未取得證照者就業穩定度（64.4%；3.22/5）高(多出27.2%；1.36/5)；而職訓後輔導人員由社區復健中心之專任管理員執行就業輔導之就業穩定度較職訓技術老師擔任就業輔導就業穩定度（51.6%；2.58/5）高（多出39.8%；1.99/5）。
依據以上結果，為提升職訓後之就業率及就業穩定度，本研究建議在辦理職業訓練時，負責此職訓方案之工作人員應具備該職訓類別之專業證照；職訓中之輔導課程應多於172小時（2小時/天，連續4-6月）；職訓後之就業輔導人員應具備精神醫學及職業重建相關知識與能力。

This research is aimed to assess the effects of vocational training programs implemented in four psychiatric hospitals in Taiwan. The research has employed documentary analysis of the trainee and secondary data analysis of the content in the program to evaluate the impacts of the employment programs. The primary outcomes are the employment rate and the employment stability evaluated at the first, the third, and the sixth month after the training program, respectively.
This is a retrospective observational casual study and the study is designed as a time series quasi-experimental one. By purposive sampling, discharged chronic psychiatric patients who joined the vocational program held by the four psychiatry hospital of the Department of Health, Executive Yuan, Taiwan during 2004 to 2007 were enrolled. Medical charts, vocational training records including the data followed 1, 3, and 6 months after the training program, and the telephone questionnaire records were collected and analyzed. The total sample size of this study is 323 and the demographic data showed that the predominant portion of the samples are male gender, aged in eighteen to fifty-nine years old, diagnosed as schizophrenia, moderately handicapped in hand function , categorized as mild disability in attention level , and categorized as good performance in daily life.
The results showed that the employment rate is significantly higher when the main therapist in charge certificated with class C baking technician (31.4% higher), when the total training hours increased one hour after the 30-hours baseline course(0.1% higher), when the type of the post-training course employment counselor is the full-time administrator of the communication rehabilitation center(48.2% higher, compared to the teacher of the training course ), and when the time being employed is the 6th month after the course(10% higher), respectively. As to the employment stability, it is significantly higher when the main therapist in charge certificated with class C baking technician (64.4% higher), and when the type of the post-training course employment counselor is the full-time administrator of the communication rehabilitation center (39.8% higher, compared to the teacher of the training course), respectively.
In order to promote the employment rate and employment stability, we had several suggestions based on our results. When implanting a vocational training program, the staff should have the professional
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certification of the same vocation, the training hours should be longer than 172 hours(two hours a day, consecutive for 4 to 6 months), and the post-training employment counselor should be possessed with the knowledge and ability in psychiatrics and vocational rehabilitations.

中文摘要………………………………………………………………....Ⅰ
英文摘要…………………………………………………………………Ⅲ
致謝………………………………………………………………………Ⅴ
目次………………………………………………………………………Ⅶ
附表目次…………………………………………………………………Ⅸ
附圖目次…………………………………………………………………Ⅹ
第一章、緒論
第一節 前言………………………………………………………1
第二節 研究背景與動機…………………………………………3
第三節 研究目的…………………………………………………7
第四節 研究問題…………………………………………………7
第五節 名詞釋意…………………………………………………9
第二章、文獻探討
第一節 精神障礙者就業現況及穩定就業相關因素……………13
第二節 職業訓練於精神障礙者之運用…………………………18
第三節 精神障礙者之就業輔導…………………………………32
第三章、研究方法
第一節 研究對象…………………………………………………42
第二節 研究設計（評價與架構）與變項說明…………………47
第三節 介入內容（四家醫院之職訓模式說明）………………55
第四節 研究工具…………………………………………………58
第五節 資料收集歷程…..………………………………………61
第六節 資料整理與分析…………………………………………62
第四章、結果與討論
第一節 樣本屬性…………………………………………………64
第二節 就業率與就業穩定度之分布……………………………69
VIII
第三節 影響就業率之因素………………………………………71
第四節 影響就業穩定度之因素…………………………………89
第五節 綜合討論…………………………………………………95
第五章、結論與建議
第一節 結論…………………………………………..…………106
第二節 建議……………………………………………………..108
參考文獻
中文部份…………………………………………………………...113
英文部分…………………………………………………………...115

附表目次
表1-1 就業穩定度各程級說明表
表3-1 四家樣本醫院之屬性、成立時間與服務量
表3-2 甲醫院93-96年職業訓練種類、執行時間及參與人數
表3-3 乙醫院93-96年職業訓練種類、執行時間及參與人數
表3-4 丙醫院93-96年職業訓練種類、執行時間及參與人數
表3-5 丁醫院93-96年職業訓練種類、執行時間及參與人數
表3-6 就業穩定度各程級說明表（同表1-1）
表3-7 四家樣本醫院之職訓方案介紹表
表4-1 研究樣本屬性之分佈：類別變項
表4-2 研究樣本屬性之分佈：連續變項
表4-3 職訓結訓後第一三六個月就業率與就業穩定度
表4-4 影響職訓結訓後第一個月是否就業的單變項分析，按類別變項
表4-5 影響職訓結訓後第一個月是否就業的單變項分析，按連續變項
表4-6 影響職訓結訓後第三個月是否就業的單變項分析，按類別變項
表4-7 影響職訓結訓後第三個月是否就業的單變項分析，按連續變項
表4-8 影響職訓結訓後第六個月是否就業的單變項分析，按類別變項
表4-9 影響職訓結訓後第六個月是否就業的單變項分析，按連續變項
表4-10 影響職訓結訓後是否就業的多變項分析
表4-11 影響職訓結訓後就業穩定度的單變項分析，按類別變項
表4-12 影響職訓結訓後就業穩定度的單變項分析，按連續變項
表4-13 影響職訓結訓後就業穩定度的多變項分析
表4-14 醫院別間結訓後六個月內就業率之比較
表4-15 醫院別間結訓後六個月內就業穩定度比較
表4-16四家樣本醫院間輔導時數之比較
表4-17 四家樣本醫院間輔導人員別與具丙級烘焙技術士證照率之比較

附圖目次
圖3-1評價設計圖
圖3-2研究架構

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