[[alternative]]Accreditation indicators for evaluating institutions serving people with chronicmental illness in Taiwan

[[abstract]] 全面參與、機會均等為我國身心障礙福利服務精神，落實到執行層面則是以尊重差異之態度對各類身心障礙者提供個別化服務。邱裕閔於2008年針對社會福利服務機構評鑑制度應用於精神障礙福利機構做適用性探討，該研究發現因精神醫療服務與復健相關指標不足、評鑑制度無法評核生活照顧機構服務績效、評鑑制度設計以特教觀點為主等因素導致評鑑制度與精障者之需求仍有差距。本研究延續該研究結果，對社會福利服務機構評鑑制度應用於精神障礙福利機構做具體建議以供主管機關修訂評鑑指標時參考。 本研究採德菲法與文件分析作為研究方法。德菲法調查對象以機構代表與第七次評鑑時具精神醫療背景之實地評鑑委員為對象。以2010年6月內政部網站所登錄收容精障者或服務對象超過半數為精障者之社會福利服務機構為研究對象共14所，其中13所指派代表於2010年7月至9月參與調查。實地評鑑委員共7人，其中5人於2010年7月至8月參與調查。文件分析以內政部於出版之第五次、第六次、第七次全國身心障礙福利機構評鑑報告之評鑑結果為分析對象，選取條件與德菲法相同，共35篇文件可進行分析。透過三方比較分析，進而提出具體建議增列或調整指標，期待研究結果可以作為相關政 策參考。 研究結果發現評鑑制度可在生活照顧服務、復健與醫療支持服務增列相關評鑑指標，在評估頻率部份視項目予以彈性調整。本研究建議透過增列與調整評鑑指標方式，評鑑制度可符合障礙特性，深入評核機構服務績效達成個別化原則；同時透過前述方式，評鑑制度可在符合現行法令下，達成引導機構經營方向之目的。另外基於機構服務方式為長期生活照顧，宜正視精障者未來於機構內在地老化之事實，未來對老年精障者設計適當服務模式，以達適能、適齡、適性安置之原則以及全程照顧之目標。[[abstract]] Equal opportunity and full social participation are two basic principlesof social services for the disabled in Taiwan. Nevertheless, to realize thesesgoals, diversity needs of the disabled should be respected. Yu-Min Chiu reviewed existing accreditation indicators for evaluating social welfare institutions serving clients with chronic mental illness in 2007, and found three major drawbacks of the current system. First, the indicators for psychiatric and occupational rehabilitation are not enough. Second, the accreditation system can not be well applied to the care homes. Third, the accreditation system is too much focusing on the special education for the disabled that can not satisfy the needs of patients with chronic mental illness. This study further explores the appropriate accreditation indicators for evaluating social welfareinstitutions serving clients with chronic mental illness that useful suggestions may be derived for the government to adapt current accreditation system. Modified Delphi and document analysis are undertaken in this study. The participants of modified Delphi are the delegates from the institutions and the members of accreditation committee with psychiatry background. There are totally 14 social welfare institutions majorly serving chronic mental patients, which were listed on the website of Ministry of Interior in June of 2010, and 13 of them sent delegates to participate modified Delphi roundtables in July, while 5 total 7 members of accreditation committee joined the investigation during July and August of 2010. Document analyses were based on the reports of the fifth, sixth and seventh national evaluations for social welfare institutions, which were issued by the Ministry of Interior. Totally, 35 pieces of reports were analyzed. All research results through three sources were thoughtfully compared that specific suggestions to add or adapt indicators under the current accreditation system can be derived for government references. Major findings from this study are that current accreditation system can add indicators about care services, medical support and rehabilitation services,while the frequencies of evaluation for specific items can be more flexible. This study suggests that current accreditation system should add and adjust indicators to meet the needs of the disabled with chronic mental illness that may be applied to evaluate the institutions and induce them to meet therequirements of the law. Besides, the serious aging problems of the residents in the institutions should be faced that the appropriate services model to meetthe needs of the old-age residents with chronic mental illness should be developed