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研究生:謝加娣
研究生(外文):Chia-Ti Hsieh
論文名稱:台灣居住所管理思維與精障個體復元之關係
論文名稱(外文):The Relationship between Housing Management Philosophy and People''s Recovery in Taiwan
指導教授:嚴奇峰嚴奇峰引用關係羅新興羅新興引用關係
指導教授(外文):Ghi-Feng, YenHsin-Hsin, Lo
學位類別:博士
校院名稱:中原大學
系所名稱:企業管理研究所
學門:商業及管理學門
學類:企業管理學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:93
中文關鍵詞:精神復健個體復元康復之家 (居住所)管理思維
外文關鍵詞:psychiatric rehabilitationrecoveryhousingmanagement philosophy
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促進精障個體復元並融入社區生活是精神復健的主要方法與目的,精神復健社區化已成世界主流。在台灣,心理衛生政策已行之有年,而為了落實精神疾病防治政策,推展以社區為基礎的精神健康照護理念,社區精神復健機構扮演了重要的角色。其中住宿型的社區精神復健機構「康復之家」 (居住所) 是提供精障個體從醫院返回家庭之前,一個具有保護、暫時、支持性的居住環境,其最終目標是讓個體復元而能回歸社區生活。而居住所究竟將精障個體視為失能的病人或帶著疾病限制的常人,以及居住所的服務是以專家認定個體所需還是以個體真正所需而提供,居住所管理者的想法與作法都會影響個體復元的成效,因此本研究在探討居住所管理思維對精障個體復元的影響。
本研究為質性研究,首先透過回顧相關文獻,並採用專家深度訪談法,比較、整理與分析資料,做法為 (1)文獻探討:依據哲學典範與管理思維、居住所的管理與類型與個體復元之成效等核心問題,進行文獻的蒐集、整理及分析; (2)專家訪談:包含產官學各面方專家與學者進行三階段深度訪談,蒐集與整理分析訪談內容,藉以逐步推導出研究架構與研究命題。
本研究延續台灣居住所類型原創的研究 (謝加娣、羅美麟、嚴奇峰,2015;Hsieh, Lo, and Yen, 2014, 2015; Yen, Lo, and Hsieh, 2016) 歸納出台灣實際存在四種居住所類型。這四種類型的居住所來自於居住所管理者對精障個體的基本假設與管理思維的不同,因而形成實務上對精障個體提供不同的服務內容 (Anthony, 1993) 與作法。四種居住所類型分別為「保護照顧型」、「醫療復健型」、「機構整合型」與「社區整合型」居住所。其中保護照顧型居住所,視精障個體為病人,完全採醫療模型的管理思維;醫療復健型居住所與機構整合型居住所仍傾向視精障個體為病人,主要採醫療模型的管理思維;而社區整合型居住所則視精障個體為帶著疾病限制的常人,主要採社會模型的管理思維。本研究並且透過CHIME (Leamy, Bird, Le Boutillier, Williams, and Slade, 2011) 做為評估個體復元的成效指標,結果發現四種類型居住所的服務內容與作法對個體對應著不同的復元成效,其中保護照顧型居住所僅僅讓個體達到「單一連結型」的復元成效;而醫療復健型居住所與機構整合型居住所也只能讓個體再達到「進階希望與樂觀型」的復元成效;只有社區整合型居住所能讓個體完整的達到「整合充權賦能型」的復元成效。這也是國內首次探討居住所管理思維對精障個體復元的影響關係。
本研究最後提出居住所管理及政府政策上與未來研究的建議,期能有助於精神復健社區化的深化。
The purpose of psychiatric rehabilitation is to facilitate the recovery of individuals with psychiatric disabilities and their integration into community life. Therefore, community-based psychiatric rehabilitation has become a mainstream worldwide. In Taiwan, mental health policy has been enforced for years, and community psychiatric rehabilitation facilities play a critical role in the implementation of psychiatric disability prevention policy and the promotion of community-based psychiatric health care. In particular, the housing, a type of community-based residential psychiatric rehabilitation facility, serves as a temporary, protective, and supportive residence for individuals with psychiatric disabilities after their discharge from hospital and before return to their home. The ultimate goal is to ensure the individuals’ recovery so that they can return to community life. The management philosophy and methods adopted by the housing directors influence the outcomes of the individuals’ recovery, including whether they regard the individuals as patients with disabilities or normal people constrained by diseases, and whether the provided services are based on the needs identified by experts or the real needs perceived by the individuals. Therefore, this study investigated the influence of housing management on the recovery of individuals with psychiatric disabilities.
This study adopted a qualitative approach. Data were collected by conducting literature review and expert in-depth interview. First, literature was compiled, compared and analyzed according to philosophical paradigms and management philosophy, type of housing and its management, and individuals’ recovery outcomes. Second, three-stages of in-depth interviews were performed on experts from the industry, government, and academia. The interview data were compiled to sequentially establish the research framework and propositions.
This study extended the original studies on types of housing (Hsieh, Lo, and Yen, 2014, 2015; Yen, Lo, and Hsieh, 2016) and determined four types of housing currently existing in Taiwan. The four types were categorized according to the housing directors’ assumptions toward individuals with psychiatric disabilities and their management philosophy; therefore, they provided dissimilar services for the individuals and adopted various rehabilitation approaches (Anthony, 1993). The four types of housing were “protected care,” “medical rehabilitation,” “agency integration,” and “community integration”. The housing featuring protected care regarded individuals with psychiatric disabilities as patients and thus adopted medical model for management. The medical rehabilitation and agency integration types of housing also tended to consider individuals as patients, mainly adopting medical care as its management model. By comparison, community integration type of housing treated individuals as normal people constrained by diseases and primarily implemented social model-based management. This study used Connectedness, Hope and optimism about the future, Identity, Meaning in life, and Empowerment (CHIME; Leamy, Bird, Le Boutillier, Williams, and Slade, 2011) as indicators for evaluating recovery outcomes. The results showed that the dissimilar service content and approaches of the four types of housing resulted in various recovery outcomes. The protected care type only enabled the individuals to achieve “connectedness”, and the medical rehabilitation and agency integration types helped the individuals to have “hope and optimism about the future” besides connectedness, while the community integration type resulted in the recovery outcome that achieve all indicators including “empowerment”. This study is the first domestic research in ethnic Chinese society which investigating the effect of management philosophy on the recovery outcomes of individuals with psychiatric disabilities.
Finally, suggestions regarding housing management, government policy, and future studies were proposed with the hope to enhance the community-based psychiatric rehabilitation.
目 錄
摘要 I
Abstract III
致謝辭 V
目 錄 VI
表目錄 VII
圖目錄 VIII
第壹章 緒論 1
第一節 研究背景 1
第二節 研究動機與研究目的 6
第貳章 文獻探討 8
第一節 精神復健的意涵 8
第二節 居住所管理思維的意涵 12
第三節 居住所的功能及其分類 16
第四節 復元的意涵、服務內容及進程 24
第参章 研究方法與研究架構推導 30
第一節 研究方法 30
第二節 初始研究概念 33
第三節 研究架構推導 35
第肆章 研究命題發展 43
第一節 居住所管理思維與居住所類型的關聯 43
第二節 居住所類型與個體復元的關係 54
第伍章 結論與建議 62
第一節 結論 62
第二節 建議 71
參考文獻 72
附錄 85

表目錄
表2-1「去機構化」後四種居住所類型 18
表2-2「去機構化」後四種居住所類型內容 20
表2-3 台灣四種居住所類型及其相關假定與特性 23
表3-1 受訪者名單 31
表3-2 台灣四種居住所類型與社區連結度及定位 39
表4-1 台灣四種居住所類型及其相關服務項目 46
表4-2 台灣四種居住所類型及相關服務項目重點內容 49
表4-3 台灣四種居住所類型與個體復元進成效的關係 57


圖目錄
圖3-1 初始研究概念 34
圖3-2 壓力脆弱模式 35
圖3-3 「壓力脆弱模式」調整模式 38
圖3-4 個體復元的分類與進程 40
圖3-5 研究架構 (1/3) 42
圖4-1 命題發展 43
圖4-2 居住所管理思維 44
圖4-3 研究架構 (2/3) 49
圖4-4 命題 1 (1a–1d) 50
圖4-5 命題 2 (2a–2d) 57
圖4-6 研究架構 (3/3) 61
圖5-1 本研究整體發展 62
圖5-2 管理思維的結構比較觀點 63
圖5-3 管理思維的動態發展觀點 65
圖5-4 「政府評鑑制度」、「居住所管理思維」及「精障個體抉擇」三角關係的交互作用 67
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附錄
親愛的小姐/先生:
感謝您接受此次訪談,這是一份有關「居住所管理思維與個體復元關係」的學術研究。訪談採無記名方式,且僅用於學術研究,絕不個別對外公開,請提供您的真實想法與陳述。訪談內容整理成文字稿後,將再請您做確認後發表。再次感謝您!
中原大學 企業管理學系研究所 教授 嚴奇峰
        健行科技大學 企業管理學系研究所 教授 羅新興
中原大學 企業管理學系研究所 博士候選人 謝加娣 敬上

訪談大綱 (Interview Guide)
(本訪談分三個主題進行,訪談時間預計六小時)

主題一:西方居住所理論有三種模式及思維 (參照Corrigan et al., 2009),台灣在相對比較之下,居住所的管理思維為何?
訪談重點: 1.請您表達對文獻上三種模式的看法,並說明其所包含的元素有哪些?
2.您認為居住所在台灣經營實務上,另外還包含哪些元素?
3.您認為這些元素,可能會造就台灣居住所產生哪幾種類型?

主題二:您認為台灣居住所的幾種類型,對精障個體提供了哪些基本服務內容?
訪談重點: 1.您認為台灣居住所對精障個體復元是否有滿足八項基本服務項目 (參照Anthony, 1993)?
2.您認為台灣的各類型居住所,對精障個體提供了哪些實質服務內容?
3.就您的實際運作及理解,每種類型對八項基本服務內容是如何進行的?

主題三:您認為不同居住所管理類型,與促進精障個體復元的關係為何 (參照CHIME架構, Leamy et al., 2011)?
訪談重點: 1.您認為上述各類型的居住所適用何種名稱 (參考以前研究分類)?
2.請您表達對CHIME內容的看法,並說明其在各類型居住所中的運作。
3.請您分析解釋一下,不同居住所類型對個體的復元進成效有何不同?
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