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| 題名: | 成年智能障礙者照顧模式之探討－以機構照顧與社區家園為例 |
| 其他題名: | A Discussion of Caring Models of Adults with Intellectual Disabilities Caring of Institution and |
| 作者: | 張寶純
Chang, Pao-chun |
| 貢獻者: | 應用社會學系社會學碩士班
齊偉先
Wei-hsien Chi |
| 關鍵詞: | 智能障礙者;機構化;社區照顧;去機構化
institutionalization;deinstitutionalization;Community care;Intellectual Disabilities |
| 日期: | 2009 |
| 上傳時間: | 2015-03-25 16:24:15 (UTC+8) |
| 摘要: | 西方國家對智能障礙者的照顧模式自1960年即開始提倡「去機構化」的運動，以小型化及社區化的過程漸近發展，並由國家的法治強制或支持相關方案的落實，促使智障者回歸社區生活與一般人一樣生活，使其生活正常化、 與社會融合，以保障其人權。目前台灣對智障者的服務大部分以大型機構的教養院照顧模式為主，而社區家園的模式大都尚在實驗階段，與西方各國的去機構化、社區化策略背道而馳。從相關的研究資料中發現目前智障者家長對機構照顧的模式滿意度尚高、專業人員對社區照顧模式的實行質疑、社福團體對政府資源的分配偏向只補助大型教養院經費的反對及政府為達成行政管理目標，這些相關的行動者在知識與權力交織作用下，使「機構照顧」與「社區照顧」就落入意識形態的論述之爭，而忽略智障者的真正生活需要。研究者認為這個問題不能只由制度面向來探討，而應該深入智障者的感知世界及心靈反應，由微觀的角度來探究。 本研究採用參與觀察與深度訪談研究方法，以一家大型教養院及一家社區家園為研究對象，由研究者進入智障者的生活場域進行長期的田野觀察，以微觀的角度分別對教養院及社區家園之智障者的日常生活進行觀察，並以智障者、工作人員作為訪談對象，一方面從觀察與訪談的資料中了解智障者在不同照顧模式生活經驗的異同與對其權益的影響。另一方面探討機構社區化的困難與發展的可能性，以期從中為智障者尋求其適合的生活支持與照顧模式。 本研究分別就（一）在空間及時間的自由選擇權，機構以作息表進行生活的安排與管控，院生對使用空間和行動的自由沒有選擇權，在時間上院生不能由自己決定作息的安排或自由參與活動。相對於社區家園住民在空間使用自由度較大、空間的轉換較多元，住民生活面向較豐富，較有機會學習獨立生活能力，可以得到較適切的需求滿足與生活機會。（二）金錢的支配權與物權，機構院生與家園住民的財產都由為機構管控。機構院生沒有金錢支配權，相對地，對於物的擁有權也很少，進而影響院生需求的滿足與情緒的穩定。而社區住民有小額的支配權，使其生活較多樣化，有較多的人際關係互動，生活品質較好。（三）身體權與隱私自由權，機構院生的生活受嚴密的視訊監控及透視化，在工作人員的馴服與管控下，院生被強迫要柔順，使其身體向主權與隱私權很難被尊重。反觀家園的住民因有個人的空間、作息個別化，可以自由進行個人的生活活動，有較多的自我管理身體權，隱私權相對也得到較多的尊重。（四）在情緒管理面向，首先院生與工作人員的互動因權力位置的懸殊，院生被強制順從一切的管理要求。再者院生與同儕長時間的強迫性及團體性的互動關係，使彼此容易發生衝突與摩擦，真正的友儕關係不易培養，兩者都是院生情緒壓力主要來源，因而易引發不適行為與情緒問題，但其壓力的解放常是來自作人員的懲罰性的壓制、隔離及身心的藥物控制。對照於社區家園的住民與工作人員的互動則有較多的平權關係，與同儕是屬夥伴關係，有較多的自動性與選擇性，使其在生活上承受的壓力較分散，住民有較多的空間轉換及溝通對象的選擇，自由度較大，使得壓力舒解的管道較為多，使情緒發展正向多於不適行為。 本研究建議（一）機構與社區家園要以開放的態度提供多元的服務，讓智智者可以選擇與控制自己的生活，使其生活與一般人相同。開發多元的教養方案，以提昇智障者的獨立生活能力，減少其「依賴」的形象，維護個人的尊嚴與權利，並協助其順利回到社區生活的可能性。社區家園應提供障礙程度較重的院民參與社區生活的機會，而非技術性的排除。（二）機構應撤除院生與社區接觸的阻礙，讓院生如一般人一樣自由進出社區，與所有人接觸互動，讓院生的生活與社區做真實的連結。社區家園應積極與社區互動，參與社區各種活動，提昇居民與社區的融合機會，維護其居住、工作等的社會權（三）機構應檢討管理的模式，不應將智障者視為管理的目標，工作人員以創新、開放、正常化的服務支持智障者日常生活，減少對社區照顧的排拒。
Western countries have been advocating the ＂Deinstitutionalization＂ with gradually miniaturized and communized development of the caring system for intellectual Disabilities since 1960. With the implementation of forced or supported schemes, the government has been trying to help intellectual Disabilities to have the normal life as common people have, to normalize their life for ensuring their human rights. The service of caring system for intellectual Disabilities in Taiwan mostly relies, however, on the large-scale sanatoriums. Today the pattern of community homesteads is still under experimentation, which is opposite to the development of deinstitutionalization and communization in the Western. The relevant researches show different phenomena: presently the parents of intellectual Disabilities have high satisfaction on the caring mode of organizations, professional personnel of the caring system queries about the caring pattern. Besides, social and welfare movement groups are against the government's position due to their preference to the large-scale sanatorium. Different actors interweave their knowledge and power which cause different arguments about ＂institutional care＂ and ＂community care＂. They all fall into the ideology argumentation, rather than the needs for living of intellectual disabilities. The purpose of this study is to investigate the perceptions and intelligent reactions of intellectual Disabilities in depth, instead of emphasizing the institutional problems of the caring system. The approach of this research is participant observation and in depth interviews of one large-scale sanatorium and one community Family. The researcher not only observed the life fields of intellectual Disabilities in a long-term stay, but also by interviewing intellectual Disabilities and the workers. The outcome shows the diversities of different caring methods for intellectual Disabilities and the impact on the rights which they are conscious of. On the other hand, the study shall probe into the difficulties of developing commoditized organization. A suitable living support and adequate caring system are expected to be reflected on. The results of this study show:（1）On the choosing freedom of intellectual Disabilities with respect to space and time, intellectual Disabilities of sanatorium depend completely on the daily schedules. They are unable to decide their schedules or participate in activities. In opposite, intellectual Disabilities of the community Family have more freedom and diversification on using free time and choosing spaces of preference. (2) Both large-scale sanatoriums and community Family control the possibility of using money and properties. The intellectual Disabilities of large-scale sanatoriums have no dominance on money and minimal ownership on properties at all, which have effect on the satisfaction of needs and stability of emotion. Whereas, the intellectual Disabilities of community Family have minimal dominances that cause more diversifications of living, interactions between relationships and better quality of living. (3) For physiology and privacy rights, there is less respect for large-scale sanatoriums' intellectual Disabilities, because the lives are strictly under control with both video camera and staff. These force them to be genteel and agreeable. On the other hand, the intellectual Disabilities in community Family have personal spaces, individual schedules, which makes them to be able to proceed their activities freely, to have more physiological self-managements. (4) For emotional management, the intellectual Disabilities are enforced to be obedient to the management requests, for there is hierarchical relation between the staff and the intellectual Disabilities. In addition, the conflicts and frictions between intellectual Disabilities are easily occur. Cultivating friendship between them is difficult, which often leads to the inappropriate behavior and emotion problems. Furthermore, the liberations of their stresses are usually originating from the penalizing suppress, alienation and medicine control from the staff. In community Family, there are more equal-right relations of interaction between the workers and the intellectual Disabilities. The relationship between Disabilities is based on the partnership which has more autonomy and selection. In addition, the Disabilities have more space transformation and variety choices of communication objects with additional degree of freedom, which leads to greater paths of releasing stresses and positive emotional development. This research suggests: (1) Large-scale sanatoriums and community Family should offer diverse services with an open-minded attitude on purpose for the Disabilities to choose and control their own life, which helps them to live like normal people. One should develop diverse education program for improving the independent ability for living of intellectual Disabilities, reduce the degree of dependence, maintain personal dignity and right, and assist them to return to the society. The community Family should provide opportunity for integrating in the society to all Disabilities and avoid the exclusion resulted from selection of entrance. (2) Sanatoriums should withdraw the communicate hindrance between Disabilities and society, allow them freely enter community and communicate with normal people, truly connect their life with the society. Community Family are suggested to interact actively with society with the participation on the activities, to increase opportunity for its Disabilities to blend with the society and maintain their society rights, such as those in living and working. (3) Self-criticism of management should be used for the Sanatoriums as Disabilities should not be treated as the target of the management. Furthermore, workers are suggested to support Disabilities life with creative, open-minded and normalized services and reduce the refusal of community care. |
| 顯示於類別: | [應用社會學系(社會工作與社會設計碩士班,教育社會學碩士班)] 博碩士論文-社會學碩士班(停招)
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