共同提供在職訓練服務後思覺失調症之同儕工作者的成效

An Examination of Outcomes for Peer Support Workers with Schizophrenia Participating in an Extended Vocational Rehabilitation Services Program

10.30074/FJMH.202303_36(1).0002

鄭淦元(Kan-Yuan Cheng)；高夢萍(Meng-Ping Kao)；吳靜慧(Ching-Hui Wu)

精神障礙 ； 職業重建 ； 同儕 ； psychiatric disability ； vocational rehabilitation ； peer services

中華心理衛生學刊

36卷1期（2023 / 03 / 01）

29 - 49

繁體中文;英文

研究目的：同儕支持服務是精神病人復元導向之社會心理介入之一，本研究探討與職能治療師共同提供在職訓練後，服務使用者之滿意度以及同儕工作者之成效改變。研究方法：2017年9月至2018年12月間，於某社區復健中心舉辦由6位同儕工作者與2位職能治療師共同帶領46位服務使用者，16週的長照工作訓練課程（每週2小時）和職場問題解決團體（每2週1.5小時），資料收集使用社會支持、簡明精神症狀、華人健康、整體功能、華人社會功能量表與就業資料，每一堂工作訓練後皆進行服務滿意度調查。研究結果：服務使用者對同儕工作者提供之長期照顧工作訓練服務感到很滿意，平均服務滿意度為4.7±0.6（1-5），同儕工作者來自同儕或朋友之社會支持與平均週薪有明顯增加（P＜0.05）。研究結論：同儕工作者於共同提供在職訓練服務後，部分社會支持與就業有改善，未來須更多樣本數之研究來證實這個結果。

Purpose: Peer support service is a recovery-oriented intervention for persons with mental illness. In this pilot study, we investigated an extended vocational rehabilitation service that is co-delivered by trained peers and occupational therapists. We assessed the outcomes for the peer support workers as well as the satisfaction of the people who used this service. Methods: In a community rehabilitation center, six trained peers with schizophrenia and 2 occupational therapists cooperated to provide long-term care skill training services for 46 persons with schizophrenia (2 hours every week) and a workplace problem-solving group (1.5 hours every 2 weeks) for 16 weeks between September 2017 and December 2018. Before and after providing services, the 6 trained peers completed measures related to their perceived social support, psychiatric symptoms, mental health, and social and global functioning. They also provided employment data. After each skill-training session, the service users assessed the attitude and performance of their peers, and also rated the impact of and their satisfaction with the program. Results: The service users rated their peers highly, with a mean service satisfaction score of 4.7 ± 0.6 (1 - 5). The 6 peer support workers experienced a significant increase in social support from friends or peers and increased weekly income (both p< 0.05). The other variables examined (psychiatric symptoms, mental health, and global functioning) did not show a significant change. Conclusions: The peer support services program examined had an overall positive impact on the peer service providers. These results need further evaluation with a larger scale study on a longer time frame to determine whether benefits not observed in this study may be obtained over a longer time period or with more participants in the program.

1. Bell, M.,Milstein, R.,Beam-Goulet, J.,Lysaker, P.,Cicchetti, D.(1992).The positive and negative syndrome scale and the brief psychiatric rating scale. Reliability, comparability, and predictive validity.J Nerv Ment Dis,180(11),723-728.
2. Cheng, K. Y.,Yen, C. F.(2021).The social support, mental health, psychiatric symptoms, and functioning of persons with schizophrenia participating in peer co-delivered vocational rehabilitation: a pilot study in Taiwan.BMC Psychiatry,21,268.
3. Chong, M. Y.,Wilkinson, G.(1989).Validation of 30- and 12-item versions of the Chinese health questionnaire (CHQ) in patients admitted for general health screening.Psychol Med,19(2),495-505.
4. Davidson, L.,Chinman, M.,Sells, D.,Rowe, M.(2006).Peer support among adults with serious mental illness: a report from the field.Schizophr Bull,32(3),443-450.
5. Dixon, L. B.,Dickerson, F.,Bellack, A. S.,Bennett, M.,Dickinson, D.,Goldberg, R. W.(2010).The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements.Schizophr Bull,36(1),48-70.
6. Fan, Y.,Ma, N.,Ma, L.,Xu, L.,Lamberti, J. S.,Caine, E. D.(2018).A community-based peer support service for persons with severe mental illness in China.BMC Psychiatry,18,170.
7. Gaiser, M. G.,Buche, J. L.,Wayment, C. C.,Schoebel, V.,Smith, J. E.,Chapman, S. A.,Beck, A. J.(2021).A systematic review of the roles and contributions of peer providers in the behavioral health workforce.Am. J. Prev. Med,61(4),e203-e210.
8. Hutchinson, D. S.,Anthony, W. A.,Ashcraft, L.,Johnson, E.,Dunn, E. C.,Lyass, A.,Rogers, E. S.(2006).The personal and vocational impact of training and employing people with psychiatric disabilities as providers.Psychiatr Rehabil J.,29(3),205-213.
9. Jääskeläinen, E.,Juola, P.,Hirvonen, N.,McGrath, J. J.,Saha, S.,Isohanni, M.(2013).A systematic review and meta-analysis of recovery in schizophrenia.Schizophr Bull,39(6),1296-1306.
10. Jones, N.,Corrigan, P. W.,James, D.,Parker, J.,Larson, N.(2013).Peer support, self-determination, and treatment engagement: a qualitative investigation.Psychiatr Rehabil J.,36(3),209-214.
11. Jones, S. H.,Thornicroft, G.,Coffey, M.,Dunn, G.(1995).A brief mental health outcome scale-reliability and validity of the global assessment of functioning (GAF).Br J Psychiatry,166(5),654-659.
12. Kern, R. S.,Zarate, R.,Glynn, S. M.,Turner, L. R.,Smith, K. M.,Mitchell, S. S.(2013).A demonstration project involving peers as providers of evidence-based, supported employment services.Psychiatr Rehabil J.,36(2),99-107.
13. Lloyd-Evans, B.,Mayo-Wilson, E.,Harrison, B.,Istead, H.,Brown, E.,Pilling, S.(2014).A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness.BMC Psychiatry,14,39.
14. Lysaker, P. H.,Davis, L. W.(2004).Social function in schizophrenia and schizoaffective disorder: associations with personality, symptoms and neurocognition.Health Qual Life Outcomes,2,15.
15. Marwaha, S.,Johnson, S.(2004).Schizophrenia and employment - a review.Soc Psychiatry Psychiatr Epidemiol,39,337-349.
16. Mead, S.,Hilton, D.,Curtis, L.(2001).Peer support: a theoretical perspective.Psychiatr Rehabil J,25(2),134-141.
17. Mead, S.,MacNeil, C.(2006).Peer support: What makes it unique.International Journal of Psychosocial Rehabilitation,10(2),29-37.
18. Modini, M.,Tan, L.,Brinchmann, B.,Wang, M. J.,Killackey, E.,Glozier, N.(2016).Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence.Br J Psychiatry,209(1),14-22.
19. Repper, J.,Carter, T.(2011).A review of the literature on peer support in mental health services.J Ment Health,20(4),392-411.
20. Resnick, S. G.,Rosenheck, R. A.(2008).Integrating peer-provided services: a quasi experimental study of recovery orientation, confidence, and empowerment.Psychiatr Serv,59(11),1307-1314.
21. Rosenheck, R.,Leslie, D.,Keefe, R.,McEvoy, J.,Swartz, M.,Perkins, D.(2006).Barriers to employment for people with schizophrenia.Am J Psychiatry,163(3),411-417.
22. Sledge, W. H.,Lawless, M.,Sells, D.,Wieland, M.,O’Connell, M. J.,Davidson, L.(2011).Effectiveness of peer support in reducing readmissions of persons with multiple psychiatric hospitalizations.Psychiatr Serv,62(5),541-544.
23. Song, L. Y.,Singer, M.(2001).The social functioning of persons with chronic mental illness: an empirical typology of consumers and correlates of social functioning.Int J Soc Psychiatry,47(1),36-51.
24. Sung, S. C.,Yeh, M. Y.(2007).Factors related to quality of life in depressive outpatients in Taiwan.Psychiatry Clin Neurosci,61(6),610-615.
25. Tse, S.,Tsoi, E. W. S.,Wong, S.,Kan, A.,Kwok, C. F-Y.(2013).Training of mental health peer support workers in a non-western high-income city: Preliminary evaluation and experience.Int. J. Soc. Psychiatry,60(3),211-218.
26. Verhaeghe, M.,Bracke, P.,Bruynooghe, K.(2008).Stigmatization and self-esteem of persons in recovery from mental illness: the role of peer support.International Journal of Social Psychiatry,54(3),206-218.
27. Yam, K. K. N.,Lo, W. T. L.,Chiu, R. L. P.,Lau, B. S. Y.,Lau, C. K. S.,Wu, J. K. Y.(2018).A pilot training program for people in recovery of mental illness as vocational peer support workers in Hong Kong - job buddies training program (JBTP): a preliminary finding.Asian J Psychiatr,35,132-140.
28. 勞動部 (2020)。108 年身心障礙者勞動狀況調查 (2021 年 11 月 26 日 )。取自 https://statdb.mol.gov.tw/html/svy08/0841menu.htm。