台灣社區心理衛生中心績效評核模式之建立---以賦權評估理論為基礎

Abstract

本研究旨在建立台灣地區社區心理衛生中心績效評核模式。具體之目的為(1)瞭解各中心方案規劃與評估之現況。(2)建立中心人員對績效評核之共識。(3)瞭解中心人員知能需求並辦理系列課程。(4)邀請專家學者、中心人員及社區民眾對中心績效評核項目配分權數與評分標準等提供意見。(5)透過說明會整合各方看法，並歸納研究結論，研擬出適合不同型式中心之評核作業模式。(6)彙編方案評估資源手冊。本研究以賦權評估理論為基礎，針對全台25縣市衛生局管轄之中心與南投區之中心進行問卷調查並輔以人員訪談。研究主要發現與結果如下：一、目前各中心發展以衛生行政主導為主，工作內容包含個案輔導、團體輔導、自殺三級預防、自殺次級預防、災難心理衛生、社區危機處置、社區群體預防宣導與教育、資源網絡連結拓展、專業諮詢、教育訓練、心理衛生研究、行政管理與其他業務。二、各中心多採內部評估，以執行過程評估居多，且皆無特別編列評估經費，近1/5的中心未曾做方案評估與分析。三、各中心人員兼辦其他業務情形嚴重，每人平均兼辦2.17項工作，從事非中心相關業務與行政管理之時間約占工時近六成。四、各中心人力資源配置不足且極度不均，每位工作人員負擔服務人口數平均約25萬2千人，且差距甚大(例如北縣中心1人之服務人口數是370萬人，負擔最重；高市中心人員所需服務之人口數為北市中心人員服務人口的3倍之多)。五、2004年衛生署補助各縣市中心經費，平均每位民眾僅獲0.58元，並呈現人口愈多個人所得經費愈低現象。六、2005年度各中心獲衛生署補助經費負成長者居多。七、2005年度有7個中心除獲得衛生署經費外，亦得到縣市政府或國民健康局、台中縣921震災重建基金會等補助款項(占其中心年度總經費的16~90%不等)。八、透過工作坊營造全國52%衛生局醫政主管與57%中心人員對中心功能與架構、衛生署評核理念、未來擬訂績效評核項目與方式等之共識。九、中心人員對「資源網絡連結拓展」與「社區危機處置」之知能需求度最高，其次為「社區群體預防宣導與教育」與「自殺次級預防」。十、方案評估系列課程分別於花蓮、台中、苗栗辦理三個場次，計有衛生署、衛生局與中心等主管及承辦人員123人參與。十一、評核評分參考表草案內容效度之專家審查結果，其中項目權數被1/3以上專家評為不適當者計有10項。專家另提出評核依據之56個增列建議及項目說明之7個增列或修正建議。十二、中心人員對完成績效評核普遍缺乏信心，不確定因素主要來自人力、經費、專業知能不足等問題。十三、「個案輔導」均名列專家學者與都市、鄉鎮、離島民眾所評十二個評核項目「重要程度」前三位。另外專家學者與鄉鎮、離島民眾亦將之評為十二個項目中「相對重要性」最高者。十四、中心人員與專家學者均將「資源網絡連結拓展」列為十二個評核項目中重要程度之前三位。中心人員另評「社區群體預防宣導與教育」為相對重要性最高者，「資源網絡連結拓展」居次。十五、專家學者、中心人員與社區民眾對都市與非都市型中心十二個評核項目的重要程度與相對重要性之評定不具一致性，但對山地離島型中心的評定一致性則達顯著。十六、評核制定說明會計有衛生署、衛生局與中心之主管、主任、承辦人員，及專家學者、學會與公會代表等53人參加。十七、 評核草案要點決議會議計有衛生署、研究單位與協同主持人、離島中心代表、山地縣市代表等13人參加。十八、完成方案評估資源手冊(411頁並含光碟1片)，計有12個中心提供149份各式表單工具，其中以「執行過程評估」方面最多，方案類別則以「個案輔導」方面最多，「自殺三級預防」方面居次。歸納研究結果，本研究擬訂出一「台灣地區直轄市及各縣(市)衛生局社區心理衛生中心績效評核作業模式」，內容計有評核之目的、範圍、項目、架構圖、組織、期程與分區作業規範，項目比例、需提項目數、計算公式、加權配分、獎勵事項等，以及包含有十二個評核項目之「評核內容」、「評核標準」、「評核依據」、「說明」等欄位之評分參考表。基於以上主要發現與結論，本研究亦對衛生署未來辦理中心績效評核及相關配套措施提出14項建議，以及對提昇衛生局管理績效及中心服務品質相關之人力資源管理與發展、方案經費編列、方案規劃與執行、方案評估、中長程發展等提出29項建議。 The purposes of this study were: (1) To understand the current status of program evaluation (PE) activities, budget allocations and service time in Community Mental Health Centers (CMHCs). (2) To hold a Team Building Workshop of administrators and staffs. (3) To assess the training needs for CMHC’s administrators and staffs, who were requested to participate in 3 training sessions in order to develop their knowledge-skill-attitude about program evaluation. (4) To invite mental health professionals, CMHC’s staff members and community residents to express their opinions on the Performance Measurement Guidelines. (5) To hold the meeting to explain the draft of the Performance Measurement Guidelines. (6) To publish the Program Evaluation Resource Manual. The research results were as follows: (1) The service programs provided by all CMHCs included individual counseling, group counseling, suicide tertiary prevention, suicide secondary prevention, disaster mental health, crisis intervention, preventive education, resources integration, consultation, training, mental health research, administration & management, and others. (2) Most of the centers did internal evaluation but had no budget for it; most of program evaluations were “Process Evaluation”. (3) The average categories of non-CMHCs services provided by per staff member was 2.17 items. 58 percent of service times had spent in the administration & management and others. (4) The average service population of catchment area was 252,000 persons. (5) According to 2004 budget of the Department of Health for 19 CMHCs, the more of population in the catchment area, the less the average budget per resident gains. (6) According to 2005 budget of the Department of Health for 18 CMHCs, most of centers had decreasing budget. (7) About 16~90% of 18 CMHC’s annual budget also came from counties and cities government. (8) The 52 percent of Medical Affairs Section Director of all Health Bureau and 57 percent of all CMHC’s staffs attended a team building workshop. (9) 3 training sessions of “program planning and evaluation” were held in Hualien, Taichung and Miaoli. 123 persons from Health Bureau and CMHCs had attended. (10) Most staff members of CMHCs had no confidence to finish program evaluation. These reasons were lacked of human capital allocation, professional knowledge and skills. (11) The mental health professionals and community residents were asked to rate the relative importance of 12 programs, and “individual counseling” is rated the most important service. (12) The CMHC’s staff members and mental health professionals were asked to rate the relative importance of 12 programs, and the “preventive education” was rated as the most important program, and the second was “resources integration”. (13) 53 persons from Department of Health, Health Bureau, CMHCs, professional associations and societies had attended the forum of the Performance Measurement Guidelines. (14) The Program Evaluation Resource Manual has published. 12 CMHCs offer 149 materials and instruments. The most important result of this study was to set the “Performance Measurement Guidelines for Community Mental Health Centers which were administrated by Health Bureau in Taiwan”, the content of guideline included the purpose, steps, framework, expert team, time table, counting formula, reference table et al. Based on the findings and conclusion of this study, 14 recommendations of CMHCs Performance Measurement and related policies were given to Department of Health, and 29 recommendations of CMHCs human resource management, program planning, implementation and evaluation were given to Health Bureau and CMHCs.