COVID-19疫情下的兒童青少年熱線的建置與成效評估

Documentation of the Establishment and Evaluation of the Effectiveness of a Youth Crisis Hotline during the COVID-19 Pandemic

10.30074/FJMH.202303_36(1).0004

曾嫦嫦(Chang-Chang Tseng)；許文耀(Wen Yau Hsu)；湯素琴(Su-Chin Tang)；黃文怡(Wen-Yi Huang)；劉于涵(Yu-Han Liu)；姚幼玲(Yu-Lin Yao)；趙慧璇(Hui-Xuan Zhao)；林楷潔(Kai-Chieh Lin)

COVID-19疫情 ； 兒童青少年熱線 ； 行動研究 ； COVID-19 pandemic ； youth hotline ； action research ； counseling

中華心理衛生學刊

36卷1期（2023 / 03 / 01）

63 - 84

繁體中文;英文

研究目的：2021年5月全國學校因COVID-19三級防疫停課，臨床心理師發起與台北市教育局合辦「兒青心理諮商免付費專線」，希望能對台北市國高中生與家長在疫情下的壓力與焦慮提供服務。本研究以「科學家-實務者」的內涵，將專線的實施過程與效果展現，以供未來類似專線的參考。研究方法：藉由行動研究探討此專線供需失衡問題、經由反思、修正、觀察、評鑑、再修正的循環歷程論述之。研究結果：供需率獲得改善，以評量表的結果分析，不論初次或追蹤會談都呈現來電者前後壓力評值明顯的下降。經由專線諮商，發現促進家長親子溝通與教養技巧等對孩子情緒行為有正向的影響。參與的臨床心理師不僅學習自身的專業如何於電話諮商的脈絡中實踐，其親身參與的經驗也是本研究的收穫。研究結論：運用行動研究探討專線供需失衡問題，最終問題改善，且提供了三級防疫下青少年家庭心理健康服務的空窗照顧，達成預防青少年及其家庭精神健康危機的效果。

Purpose: Schools across Taiwan suspended classes during the level 3 alert of the COVID-19 pandemic and mental health services at health facilities were reduced. A group of 33 licensed clinical psychologists co-organized a toll-free counseling line for youth and their parents in cooperation with the Education Bureau of the Taipei city government to provide services to relieve students' stress and anxiety during the pandemic. The purpose of this article is to document the level of need for this service and its implementation process, and to investigate the impact of the service from a scientist-practitioner perspective as a reference for similar toll-free lines in the future. Methods: The 33 clinical psychologists counselled and interviewed callers using a questionnaire and entered the information into a google form. The questions concerned age, gender, chief complaint, parent-child interaction, characteristics of the child/youth, and the relationship between the child's emotional or behavioral disturbances and the pandemic. Before and after this conversation, they asked callers to indicate from 0 to 10 their level of stress with regard to their chief complaint. After the initial stage of hotline implementation, it became clear that the number of clinical psychologists providing services was more than needed for the number of callers. We explored the supply-demand imbalance using the action research technique of discussion through a cycle of reflection, correction, observation, evaluation, and re-correction. Results: The psychologists responded to 103 calls with complete consultation records. Of these, 33 were youth, 39 were parents, and the remainder were teachers or other adults. Forty-three were repeat callers; 18 had 2 conversations, and 25 had 3 or more conversations. According to mean difference tests, both initial and follow-up interviews showed a significant decrease in the stress evaluation rating provided before and after a given interview. Examination of changes in parent-related factors such as parenting distress, lack of confidence, and difficulty setting boundaries suggested that telephone consultation can promote parent-child communication and parenting skills. Three adolescents' had extended episodes requiring repeated follow-up care to stabilize them. They were eventually referred to a community psychotherapy center or their school's services. We addressed the supply-demand ratio for the hotline using action research techniques. Initially, the hotline used a landline that could not accept calls from cell phones. Lack of privacy prevented teens from using the hotline at home, and some parents resisted access to counseling resources. We added Skype access and invited teachers to consult the hotline before referring parents. We also reduced the number of psychologists on call to 1 per shift. The psychologists reported that they learned how to adapt their practice to the context of telephone consultation in which they have no visual cues to guide their responses; they learned to increase their attention to audio cues such as the caller's tone of voice, intonation, or delay in response in order to assess the caller's emotional state. Most of the psychologists (85%) expressed that this experience was helpful to their professional abilities. Conclusions: This project provided mental health services for teenage students and their families. It was effective in reducing perceived stress and improving parent-child communication, which can have a positive effect on children's emotional behavior, and may have prevented mental health crises for some adolescents. Participating psychologists also found the program to be professionally beneficial. Action research indicated ways to improve the service and balance supply and demand for this hotline.

1. 李維倫(2011)。反思臨床心理學訓練：探究美國「科學家—實務者」模式與專業能力學習的本質。中華心理衛生學刊，24(2)，173-207。
   連結：
2. 許文耀,張廣運(2008)。台灣臨床心理學與美國臨床心理學之比較。應用心理研究，40，59-97。
   連結：
3. 趙恩,陳國緯,李思賢(2021)。台灣公民面對新冠肺炎疫情初期之焦慮症狀與防疫作為之趨勢。台灣公共衛生雜誌，40(1)，83-96。
   連結：
4. War Trauma Foundation and World Vision International.Geneva:WHO.
5. Cauberghe, V.,Wesenbeeck, I. V.,Jans, S. D.,Hudders, L.,Ponnet, K.(2021).How adolescents use social media to cope with feelings of loneliness and anxiety during COVID-19 lockdown.Cyberpsychology, Behavior and Social Networking,24(4),250-257.
6. Cohen, Z. P.,Cosgrove, K. T.,DeVille, D. C.,Akeman, E.,Singh, M. K.,White, E.,Stewart, J. L.,Aupperle, R. L.,Paulus, M. P.,Kirlic, N.(2021).The Impact of COVID-19 on Adolescent Mental Health: Preliminary Findings From a Longitudinal Sample of Healthy and At-Risk Adolescents.Front. Pediatr,9,1-8.
7. Courtney, D.,Watson, P.,Battaglia, M.,Mulsant, B. H.,Szatmari, P.(2020).COVID-19 Impacts on Child and Youth Anxiety and Depression: Challenges and Opportunities.Can J Psychiatry,65(10),688-691.
8. Crone, E. A.,Fuligni, A. J.(2020).Self and others in adolescence.Annu Rev Psychol,71,447-469.
9. de Miranda, D. M.,da Silva Athanasio, B.,Sena Oliveira, A. C.,Simoes-E-Silva, A.C.(2020).How is COVID-19 pandamic impacting mental health of children and adolescents?.Int J Disaster Risk Reduct,51,1-8.
10. Engel, G. L.(1980).The clinical application of the biopsychosocial model.The American Journal of Psychiatry,137(5),535-544.
11. Fegert, J. M.,Vitiello, B.,Plener, P. L.,Clemens, V.(2020).Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality.Child Adolesc Psychiatry Ment Health,14(20),1-11.
12. Gadermann, A. C.,Thomson, K. C.,Richardson, C. G.,Gagné, M.,McAuliffe, C.,Hirani, S.,Jenkins, E.(2021).Examining the impacts of the COVID-19 pandemic on family mental health in Canada: findings from a national cross-sectional study.BMJ journals,11(1),1-11.
13. Hobfall, S. E.,Watson, P.,Bell, C. C.,Bryant, R. A.,Brymer, M. J.,Friedman, M. J.,Friedman, M.,Gersons, B. P. R.,joop de jong,Layne, C. M.,Maguen, S.,Neria, Y.,Norwood, A. E.,Pynoos, R. S.,Reissman, D.,Ruzek, J. I.,Shalev, A. Y.,Solomon, Z.,Steinberg, A. M.,Ursano, R. J.(2007).Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence.Psychiatry: Interpersonal and Biological Processes,70(4),283-315.
14. Jones, E. A. K.,Mitra, A. K.,Bhuiyan, A. R.(2021).Impact of COVID-19 on Mental Health in Adolescents: A Systematic Review.Int J Environ Res Public Health,18(5),2470.
15. Laursen, B.,Hartl, A. C.(2013).Understanding loneliness during adolescence: developmental changes that increase the risk of perceived social isolation.J Adolesc,36(6),1261-1268.
16. Lave, J.,Wenger, E.(1991).Situated learning -Legitimate peripheral participation.Cambridge University Press.
17. Lewin, K. (1946). Action research and minority problems. Journal of Social Issues, 2, 34-46. https://doi.org/10.1111/j.1540-4560.1946.tb02295.x
18. Neto, F.(2011).Personality predictors of happiness.Journal of Happiness,88,817-824.
19. Newcomb, T. M.(Ed.),Hartley, E. E.(Ed.)(1952).Readings in social psychology.New York:Holt.
20. Thorell, L. B.,Skoglund, C.,de la Peña, A. G.,Baeyens, D.,Fuermaier, Anselm B. M.,Groom, M. J.,Mammarella, I. C.,van der Oord, S.,van den Hoofdakker, B. J.,Luman, M.,de Miranda, D. M.,Siu, Angela F. Y.,Steinmayr, R.,Idrees, I.,Soares, L. S.,Sörlin, M.,Luque, J. L.,Moscardino, U. M.,Roch, M.,Crisci, G.,Christiansen, H.(2022).Parental experiences of homeschooling during the COVID-19 pandemic: differences between seven European countries and between children with and without mental health conditions.Eur Child Adolesc Psychiatry,31,649-661.
21. Wong, L. P.,Hung, C. C.,Alias, H.,Lee, T. S. H.(2020).Anxiety symptoms and preventive measures during the COVID-19 outbreak in Taiwan.BMC Psychiatry,20(1),376.
22. World Health Organization(2011).Psychological first aid: Guide for field workers.
23. 吳英璋,金樹人,許文耀(1991).面對壓力—身心健康手冊 ( 高中職教師 ).臺北市:教育部訓育委員會.
24. 陳淑惠、龔怡文、潘元健、劉于涵 (2007)。心理急救操作手冊第二版 ( 譯 )。台大心理系，台北市。〔譯自 National Child Traumatic Stress Network and National Center for PTSD, Psychological First Aid: Field Operations Guide, 2nd Edition. July, 2006.〕。https://www.tip.org.tw/Portals/0/88/ 心理急救操作手冊 .pdf
25. 蔡清田(2000).教育行動研究.台北:五南.
26. 賴念華 (2020)。自殺危險程度量表。校園自我傷害防治手冊 p80-84。臺北市：教育部訓育委員會。http://counseling.jente.edu.tw/download/test/106-123.pdf