精神障礙者復元統合模式之驗證—復元階段量表發展與優勢觀點 (I)

Abstract

復元自1990年起已成為西方精神復健之終極目標，近二十年來關於復元定義、復元階段、復元結果與促進復元之因素已有許多論述。以復元取向的精神復健方案，皆強調以正常化和人本主義為根基，以優勢觀點為介入原則與策略增強案主權能。台灣關於復元之論述不多，筆者曾為文介紹此觀點，但未有系統地實施促進精障者復元之方案，並評估其成效。本研究擬以三年之研究，試圖於高雄長庚醫院日間留院與另一復健機構實施優點個管模式，評估能否增強案主權能，進而促進復元。再者，筆者過去根據質化深度訪談資料形成復元統合理論，整合復元基石變項、促進復元之環境支持變項、復元過程要素、與復元結果，因此本研究亦透過此長期追蹤資料，檢視此理論之實證效度。首先第一年將發展復元階段量表，作為後續兩年之用，追蹤精障者復元階段與復元結果之變化。預計兩年內施測四次。第一年的量表發展之樣本包括社區復健機構學員與居住於社區復元良好者，共400名；第二年與第三年參與實驗方案之樣本包括高雄長庚日間留院100名與另一復健機構50名學員，共150名，施測四次。第一年之資料分析著重在復元階段量表之信度與效度檢驗，第二年與第三年的分析則檢視根據復元統合理論演譯而得之三個假設模式。此研究將檢視兩個與精障者復元有關的理論，一為解釋理論(統合理論)，一為處遇理論(優點個管模式)，因此具有理論之意義。再者，所發展之復元階段量表亦可用於未來的相關研究，整體而言有助於促進精障者復元方案發展，增進其福祉。

Recovery has been the goal for the psychiatric rehabilitation since 1990. During the past two decades, there are many literature dealt with the definition, recovery stage, recovery outcomes, the essential component process, and the facilitator of recovery. Literature has revealed that the recovery oriented rehabilitation programs are based on normalization and humanism, and adopting strengths perspectives to empower persons with psychiatric disability. Despite the abundant literature in the West, there is a lack of study and discussion concerning recovery in Taiwan. The investigator has written one introductory article on this issue and conducted a qualitative study and established the Unity model of recovery. Due the paucity on this issue, the investigator proposes a three-year study with three aims: (1) to develop an instrument to measure the stage of recovery. This instrument will be used in the following two-year experimental study. (2) To launch an experimental program based on the Strengths based case management and evaluate its effectiveness on facilitating recovery. (3) Utilizing the longitudinal data to examine empirical evidence of the Unity Model. The sample (N=400) for the first year study will be drawn from the participants in the rehabilitation programs and searched from community for the well recovered persons. The experiments will take place in the day care center of Kaoshiung Chen Kung hospital and in a community psychiatric rehabilitation center. It is estimated 150 participants and four data points. The data analysis for the first year will focus on examining the reliability and validity of the scale. For the second and third year, model examination will be conducted. This study will have potential theoretical contributions and will benefit the well-being for persons with psychiatric disability.