Loading...
|
Please use this identifier to cite or link to this item:
https://nccur.lib.nccu.edu.tw/handle/140.119/112765
|
| Title: | 把生活找回來—演慈康復之家的生活取向服務模式
Reclaiming Life— The Life-Oriented Service Model of the Yeantsy Supported Group Housing |
| Authors: | 羅美麟
Lo, Mei-Lin |
| Contributors: | 王增勇
Wang, Tsen-Yung
羅美麟
Lo, Mei-Lin |
| Keywords: | 康復之家
個體復元
生活取向
醫療論述
詮釋現象學
精神復健
Supportive housing
Personal recovery
Life orientation
Medical discourses
Hermeneutic phenomenology
Rehabilitation |
| Date: | 2017 |
| Issue Date: | 2017-09-13 15:22:37 (UTC+8) |
| Abstract: | 台灣社區復健實踐場域強調「醫療取向」的主流照顧模式，並聚焦在醫療品質管理（機構式照顧）上，此模式阻礙了社區復健應以促進「個體復元」為目的的進步潮流。演慈康復之家從賦權理念出發，賦予個體（住民）支配自己在康復之家中應如何生活的自主權，工作者則積極在背後發揮支撐與促進「個體復元」的力量，並陪伴個體在社區中生活、工作與學習，推動個體去發展自身的生活知識與技能，最終達到「復健治療」目的。
然而主流醫療規訓知識卻越箍越緊，「我們不專業」成為演慈康復之家揮之不去的夢魘。我陷在主流論述邏輯裡糾纒、辯解而倍感艱辛，卻無法說清楚在地詮釋與發展。本文目的即在整理演慈康復之家的價值理念與工作模式，將我們協助「被精神疾病困住個體」在地生活的想法與作法，進行更完整的論述，期能長出在地的工作知識，以強化在地正當性及抵抗能力。
本文在方法學上引用詮釋現象學中「生活經驗」的概念，來探究演慈康復之家的生活世界，透過對「偶發事件」與「主題」的掌握，藉此捕捉「行動經驗」的本質與意義，並進一步形構出演慈康復之家工作模式。
在精神醫學的邏輯裡，個體面臨環境壓力源溢出自身能夠承受的生理脆弱點而致「狂」，其保護因子除了在必要時打針吃藥之外，其實還有很多可為的實踐空間。據此，本文即提問演慈康復之家還可以做什麼？可以怎麼做？為了回應這個提問，本文總結出「支撐個體健康生活」工作架構及服務理念、邏輯與內涵，取名為「生活取向服務模式」並闡明其核心精神與工作原則、生活取向基本假設與取向作為的內涵，以及如何操作生活取向服務模式協助個體回到生命主體找回尊嚴。這個服務模式從個體的改變、發展與成長著手，首先釐清個體的生活目標、偏好及個體「想要怎樣生活／可以怎樣生活」的抉擇，接續的服務則聚焦在提供支撐與協作，以便讓個體學習「可以怎樣自主生活，而不是怎樣被照顧」。
從實踐行動的過程中，我們看到生活取向服務模式與促進個體復元的世界潮流相呼應，本文也透過在地運作與實踐成果，突顯其與醫療取向復健模式在理念與實際運作上的衝突，最後針對二個取向的基本假設及取向作為，進行比較論述、辯證與總結。
Medical-oriented care models are the mainstream care models for rehabilitation in Taiwan. These models mainly focus on medical quality management (institutionalized care) and lack incentive for promoting “personal recovery.” Yeantsy Supported Group Housing empowers individuals (residents) to take control of their own livelihood in the community and staff members actively provide support and promote “personal recovery.” Staff members accompany individuals as they live, work, and learn within the community and help them acquire useful life knowledge and skills, ultimately achieving the therapeutic goal of rehabilitation.
Amid the increasing stringency of mainstream medical disciplinary knowledge, “lack of professionalism” has become a lingering nightmare for Yeantsy Supported Group Housing. The institution struggles to grasp and debate about the logic of mainstream discourses, failing to clarify local hermeneutics and development. This study organized the values and work patterns of Yeantsy Supported Group Housing and provided a complete discourse of the institution’s views and efforts in helping “individuals suffering from psychiatric disorders” in order to develop local working knowledge and reinforce local legitimacy and resilience.
The lived experience concept in hermeneutic phenomenology was adopted to explore the community of Yeantsy Supported Group Housing. “Incidents” and “themes” were observed to elucidate the nature and meaning of “experiences of action” and develop a suitable working model for Yeantsy Supported Group Housing.
In psychiatry, individuals may enter a state of “craze” when environmental stressors overwhelm their tolerance and trigger biological vulnerability. Injection and medication are common forms of treatment (protective factors). However, other viable means are also available. To determine what Yeantsy Supported Group Housing can do for these individuals, we first consolidated the service logic and content of Yeantsy Supported Group Housing to develop the Life-Oriented Service Model. We then expounded the core ideologies, work principles, and the basic assumptions and actions of the proposed service model and how to employ the model to help individuals re-discover themselves and restore their dignity. The proposed service model focuses on the changes, development, and growth of individuals. Staff members should first elucidate the life goals, preferences, and life choices of the individuals, and then focus on providing support and assistance, thereby enabling them to learn to live for themselves rather than being cared for by others.
Through practice, we validated that the Life-Oriented Service Model conformed to the world trends of promoting personal recovery. Local operation and implementation outcomes highlighted the differences in the theoretical and practical applications between the proposed model and those of conventional medical-oriented rehabilitation models. Finally, we compared discourses, debates, and summaries based on the basic assumptions and actions of the two orientations.
Keywords: Supportive housing, Personal recovery, Life orientation, Medical discourses, Hermeneutic phenomenology |
| Reference: | 參考文獻（REFERENCES）
何健民（2008）。台灣精神衛生法制之研究。國立臺灣師範大學政治學研究所在職進修碩士班碩士論文。
吳佳璇（2005）。台灣精神醫療的開拓者。葉英堃傳記。台北：心靈工坊。
沈獻程（2003）。台灣慢性精神醫療設施的歷史變遷研究。私立東海大學建築學系碩士論文。
林曉卿（2006）。無心插柳：我國精神衛生法之制定及其對心理衛生工作的影響。國立中正大學社會福利研究所碩士論文。
邱顯明專題報導（2005）。飄搖年代 龍蛇越嶺同棲。自由電子報：杜鵑棲邊城五十載系列報導五之二。
高淑清（2008）。探究生活經驗的詮釋現象學。質性研究的18堂課：揚帆再訪之旅（47-67頁）。高雄：麗文文化事業機構。
財團法人醫院評鑑暨醫療品質策進會（2006）。9 5年度台灣地區精神復健機構評鑑計畫。台北：財團法人醫院評鑑暨醫療品質策進會。
陳小慈（1993）。台灣地區精神醫療政策之分析—以精神衛生法為例。國立台灣大學社會學研究所碩士論文。
郭婉盈（2007）。在生活世界中實踐專業的慢性療養院社工。國立陽明大學衛生福利研究所碩士論文。
張燦輝（1999) 。詮釋與此在-早期海德格之詮釋現象學。香港人文哲學會網頁：http://www.arts.cuhk.edu.hk/~hkshp。1999年5月第二卷一期。
湯家碩（2014）。重訪龍發堂：精神衛生治理與一個機構的道德生涯，1980-1990。國立陽明大學科技與社會研究所碩士論文。
萬心蕊（2007）。「破牆」的分離與重返：台灣精神醫療社工返回根本的一種路線。私立輔仁大學心理學研究所博士論文。
雷庚玲（2001）。性格是天生特質還是環境塑造的結果。發展心理學（325-328）。新北市：國立空中大學。
葉英堃（1996）。承先啟後－對革新臺北市精神醫療保健的私見。臺北市立療養院民國85年年報，139-142。
劉瓊瑛譯（2008）。量身打造臨床個案管理模式：「依附關係」的角色。精神障礙個案管理-理論與實務，49-71。臺北市：心理。
謝佳容、蕭淑貞（2006）。台灣社區精神復健機構的服務現況與展望。精神衛生護理雜誌，1(2),41-49。
羅美麟（2010）。康復之「家」到底是誰的家－「居住者家園」或「評鑑委員的家」。演慈康復之家／奇岩康復之家季刊，14,1-4。
Anthony, W. A. (1993). Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s. Psychosocial Rehabilitation Journal, 16(4),11-23.
Anthony, W., Cohen, M., Farkas, M. D., & Gagne, C. (2002). Psychiatric réhabilitation (2nd ed.). Boston: Center for Psychiatric Rehabilitation.
Anthony, W., & Liberman R. (1992). Principles and practice of psychiatric rehabilitation. In Liberman (Ed.), Handbook of psychiatric rehabilitation (pp. 1-29). New York: Macmillan.
Bluebird, G. (xxxx). History of the Consumer/Survivor Movement. Retrieved from National Empowerment Center website: www.power2u.org
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.
Cannon, Erp, & Glahn (2002). Elucidating continuities and discontinuities between schizotypy and schizophrenia in the nervous system. Schizophrenia Research, 54(1-2), 151-156.
Corrigan, P. W., Mueser, K. T., & Bond, G. R., Drake, R. E., Solomon, P. (2009). Principles and Practice of Psychiatric Rehabilitation: An Empirical Approach. New York, NY: A Division of Guilford Publications, Inc.
Crow, T. (2003). Obstetric complications and schizophrenia. American Journal of Psychiatry, 130(5), 1011-1012.
Dozier, M. (1990). Attachment organization and treatment use for adults with serious psychopathological disorder. Development and Psychopathology, 2, 47-60.
Duerr, M. (1996). Hearing Voices: Resistance Among Psychiatric Survivors and Consumers (Mater"s thesis, The California Institute of Integral Studies). Retrieved from Mind Freedom International website: www.mindfreedom.org
Fabris, E. (2011). Tranquil Prisons: Chemical Incarceration under Community Treatment Orders. Toronto, University of Toronto Press Incorporated.
Farkas, M. (2007). The Vision of Recovery Today: What It Is and What It Means for Services. World Psychiatry, 6,68-74. ISSN 1723-8617
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.
Green, M. (1998). Schizophrenia from a neurocognitive perspective. Needham Heights, MA: Allyn & Bacon.
Hsieh, C. T., Lo, M. L., & Yen, G. F. (2105). Management Types of Housing and Related Ethical Debates in Taiwan--Perspectives of Manager`s Philosophy and People`s Recovery. Academy of Taiwan Business Management Review, 11(2),99-110. ISSN 1813-0534
Leamy, M., Bird, V., & Boutillier, L. C., Williams, J., Slade, M. (2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. The British Journal of Psychiatry, 199,445-452. doi:10.1192/bjp.bp.110.083733
New Freedom Commission on Mental Health (2003). Achieving the promise: transforming mental health care in America. Final report. Rockville: US Department of Health and Human Services.
Nuechterlein, Dawson, Gitlin, Ventura, Goldstein, Snyder, et al., (1992). Developmental processes in schizophrenic disorders: Longitudinal studies of vulnerability and stress. Schizophrenia Bulletin, 18(3), 387-425.
Slide, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., …… Whitley, R. (2014). Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry, 13(1),12–20. ISSN 1723-8617
Van Manen, M. (1997). Researching lived experience: Human science for an action sensitive pedagogy. Ontario: State University of New York.
Wikibooks (2013). The History of the Mental Health Consumer Movement/ The Rise of the Consumer Movement. Retrieved from https://en.wikibooks.org/wiki/The_History_of_the_Mental_Health_Consumer_Movement/The_Rise_of_the_Consumer_Movement |
| Description: | 碩士
國立政治大學
社會工作研究所
100264005 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0100264005 |
| Data Type: | thesis |
| Appears in Collections: | [社會工作研究所] 學位論文
|
Files in This Item:
| File |
Size | Format | |
|---|
| 400501.pdf | 6697Kb | Adobe PDF2 | 1199 | View/Open |
|
All items in 政大典藏 are protected by copyright, with all rights reserved.
|
