题名

發展智能障礙者社區居住與生活:美英兩國探討比較

并列篇名

Community Living for Adults with Intellectual Disabilities: Comparative Study in the US and UK

DOI

10.6785/SPSW.200509.0139

作者

周月清(Yueh-Ching Chou)

关键词

智能障礙者 ; 社區居住與生活 ; 社會融合 ; 獨立生活 ; 社區照顧 ; intellectual disabilities ; mental retardation ; learning disabilities ; community living ; independent living ; community care

期刊名称

社會政策與社會工作學刊

卷期/出版年月

9卷2期(2005 / 09 / 01)

页次

139 - 196

内容语文

繁體中文

中文摘要

本文探討比較美、英兩國成年智障者從教養院搬到社區居住與生活改革源起、進程與配套措施,以文件研究方法從事文獻資料收集,含電腦檢索圖書館與網站期刊與書目及各國官方與非官方文件。研究發現:近代,美國發展智能或發展障礙者社區居住與生活重要改革事件為:1999年最高法院Olmstead決議障礙者有權利在社區生活;英國2001年學習障礙者白皮書,強調「對人支持」(supporting people)與「重視人的價值」(valuing people),規定地方政府2004年4月前所有住在長期停留醫院之學習障礙者搬到社區生活。美英兩國比較發現其相同處為:智障者社區居住與生活改革自1960年代以來持續進行,近代因重要事件及改革政策,有更具體成果,以重度、極重度及有挑戰性行為成年智障者為對象。相關實證性研究一致發現住在社區小型一般住宅,即使針對有密集性支持需求之重度智障者,比住在傳統教養院或大型者,成本效益高。兩國不同處,美國屬於其醫療補助項下之改革措施,英國為其社區照顧一環;美國困境為其等候排隊住到社區一般住宅者眾多,英國則需致力於資源結合與配置適當性。

英文摘要

This study utilizes literature review to collect governmental documents and empirical studies regarding adults with intellectual disabilities living in the community in the United States and Britain in order to analyze the similarities and differences of their polices and services. Both the US and Britain initiated ”deinstitutionalization” in the 1960s. Currently in the US the Supreme Court decision in Olmstead v. L. C. in 1999 brought big effect on the policies revolution to support persons with mental retardation/developmental disabilities living in the community. In Britain, recent policy for supporting adults with learning disabilities to live in the community independently is the 2001 White Paper-Valuing people: A new strategy for learning disability for the 21St century. Adults with severe/profound intellectual disabilities and with challenging behaviors who stay in the institutions are the primary targets moving into the community in the US and Britain at the present. Based on the consistent findings of the empirical studies in the US and Britain, community-based ordinary housing is more cost-effective than the institution-based or large scale housing.

主题分类 社會科學 > 社會學
参考文献
  1. (1995).Disability Discrimination Act.
  2. U.S. Public Law 106-402: Developmental Disabilities Assistance and Bill of Rights Act of 2000
  3. In Public General Acts a and Measures of 1990 (Part II).London:HMSO.
  4. Administration on Developmental Disabilities(ADD)-Making a Difference in the Lives of People with Developmental Disabilities
  5. Alien, D.(1989).The Effects of Deinstitutionalisation on People wit! Mental Handicaps: A Review.Mental Handicap Research,2(1),18-37.
  6. Alien, D.,K Lowe.(1995).Providing Intensive Community Suppor to People with Learning Disabilities and Challenging Behaviour: A Preliminary Analysis of Outcomes and Costs.Journal of Intellectual Disability Research,39(1),67-82.
  7. American Association on Mental Retardation (AAMR)(2002).Mental retardation: Definition, classification and systems of supports (10th ed).Washington, DC:AAMR..
  8. Anderson, L.,B. Prouty,K. C. Lakin(2000).Parallels in Size of Residential Settings and use of Medicaid-fmanced Programs.Trends and milestones Mental Retardation,38(5),468-471.
  9. Balla, D. A.(1976).Relationship of Institution Size to Quality of Care: A Review of the Literature.American Journal of Mental Deficiency,81(2),117-124.
  10. Bayley, M.(1973).Mental Handicap and Community Care: A Study of Mentally Handicapped People in Sheffield.London:Routledge and Kegan Paul.
  11. Beecham, J.,M. Knapp,S. McGilloway,M. Donnelly,S. Kavanagh,A. Fenyo,N. Mays(1997).The Cost-effectiveness of Community Care for Adults with Learning Disabilities Leaving Long-stay Hospital in Northern Ireland.Journal of Intellectual Disability Research,41,30-41.
  12. Best-Sigford, B.,R. H. Bruininks,K. C. Lakin,B. K. Hill,L. W. Heal(1982).Resident Release Patterns in a National Sample of Public Residential Facilities.American Journal of Mental Deficiency,87(2),130-140.
  13. Bewley, C.,C. Glendinning(1994).Involving Disabled People in Community Care Planning.England:Joseph Rowntree Foundation.
  14. Bogdan, R.(1996).Intellectual Disabilities in the Nordic Welfare States: Policies and Everyday Life.Norway:Norwegian Academic Press.
  15. Booth, T.,K. Simons,W. Booth(1990).Outward Bound: Relocation and Community Care for People with Learning Difficulties.Milton Keynes, England:Open University Press.
  16. Braddock, D.,E. Emerson,D. Feice,R. J. Stancliffe(2001).Mental Retardation and Developmental Disabilities Research Reviews.
  17. Bradshaw, J.,J. Ditch,H. Holmes,P. Whiteford(1993).A Comparative Study of Child Support in Fifteen Countries.Journal of European Social Policy,3(4),255-271.
  18. Campbell, J.(1996).Options for Long Term Care.London:HMSO.
  19. Canadian Association of Independent Living Centres (CAILC)(2000).Eligibility Criteria for C. A. I. L. C. Membership (ECCM) Document.Canada:CAILC.
  20. Canadian Association of Independent Living Centres (CAILC)(1992).Description of the Core Programs of Independent Living Centres.Canada:CAILC.
  21. Canadian Housing Information Centre,Canadian Mortage and Housing Corporation (CMHC)(1992).A Socio-demographic Protile of Canadians Experiencing Health or Activity Linitations.Research and Development Nights,9,1-4.
  22. Fact Sheet: Assuring Access to Community Living for the Disabled
  23. President will Propose $1.75 Billion Program to Help Transition Americans with Disabilities from Institutions to Community Living
  24. Conroy, J. W.(1996).The Small ICF/MR Program: Dimensions of Quality and Cost.Mental Retardation,34(1),13-26.
  25. Cooper, D.(1996).Legislation: A Practical Example-young People and Education.Beyond Disability: Towards an Enabling Society,134-144.
  26. Cullen, P.(2001)。台灣成年心智障礙者社區居住-經驗分享與模式發展初探。台北:財團法人心路社會福利基金會。
  27. Dalgleish, M.,R. Matthews(1981).Some Effects of Staffing Levels and Group Size on the Quality of Day Care for Severely Mentally Handicapped Adults.The British Journal of Mental Subnormality,27,30-35.
  28. Davies, L. M.(1988).Community Care: The Costs and Quality.Health Services Management Research,1(3),145-155.
  29. Facing the Facts: Services for People with Learning Disabilities: A Policy Impact Study of Social Care and Health Services
  30. White Paper: Valuing people: A Strategy for Learning Disabilities for the 21st Century
  31. Department of Health and Social Security (DHSS)(1971).White Paper: Better Services for the Mentally Handicapped.London:HMSO.
  32. Department of Health, Social Services mspectorage (SSI)(1992).A Review of Literature 1986-1991 on Day Care Services for Adults.London:HMSO.
  33. Department of the Environment, Transport and the Regions (DETR)(2001).Supporting People: Policy into Practice.London:DETR.
  34. Deutsch, K. W.(1987).Comparative Policy Research: Learning from Experience.New York:St. Martin's Press.
  35. Dockrell, J.(1995).Community Care: Asking the User.London:Chapman and Hall.
  36. Residential Support Services and Person Centred Planning (Draft)
  37. Emerson, E.(1999).Residential Supports for People with Intellectual Disabilities: Questions and Challenges from the UK.Journal of Intellectual and Developmental Disability,24(4),309-319.
  38. Emerson, E.,C. Hatton(1996).Deinstitutionalization in the UK and Ireland: Outcomes for Service Users.Journal of Intellectual and Developmental Disability,21(1),17-37.
  39. Emerson, E.,C. Hatton(1994).Moving Out: the Impact of Relocation from Hospital to Community on the Quality of Life of People with Learning Disabilities.London:HMSO.
  40. Emerson, E.,J. Robertson,N. Gregory,C. Hatton,S. Kessissoglou,A. Hallam,M. Knapp,K. Jarbrink,P. N. Walsh,A. Netten(2000).Quality and Costs of Community-based Residential Supports, Village Communities and Residential Campuses in the UK.American Journal on Mental Retardation,105(2),81-102.
  41. Emerson, E.,J. Robertson,N. Gregory,S. Kessissoglou,C. Hatton,A. Hallam,M. Knapp,K. Jarbrink,A. Netten,C. Linehan(2000).The Quality and Costs of Community-based Residential Supports and Residential Campuses for People with Severe and Complex Disabilities.Journal of Intellectual and Developmental Disability,25(4),263-279.
  42. Feice, D.,A. Repp(1992).The Behavioral and Social Ecology of Community Houses.Research in Developmental Disabilities,13,27-42.
  43. Feice, D.,E. Emerson(2001).Living with Support in a Home in the Community: Predictors of Behavioral Development and Household and Community Activity.Mental Retardation and Developmental Disabilities Research Reviews,7,75-83.
  44. Feice, D.,K. Lowe,J. Perry,H. Baxter,E. Jones,A. Hallam,J. Beechman(1998).Service Support to People in Wales with Severe Intellectual Disability and the Most Severe Challenging Behaviours: Processes, Outcome and Costs.Journal of intellectual and Developmental Disability,42,390-408.
  45. Goffman, E.(1961).Asylums: Essays on the Social Situation of Mental Patients and Other Inmates.England:Penguin Books.
  46. Gustavsson, A.(1996).Intellectual Disabilities in the Nordic Welfare States: Policies and Everyday Life.Norway:Norwegian Academic Press.
  47. Haney, J. I.(1988).Integration of Developmentally Disabled Individuals into the Community.Baltimore:Paul H. Brookes.
  48. Hatton, C.,E. Emerson,C. Kieman(1995).Trends and milestones: Deinstitutionalization in Europe.Mental Retardation,33,132.
  49. Hatton, C.,E. Emerson,J. Robertson,D. Henderson,J. Cooper(1996).Factors Associated with Staff Support and Resident Lifestyle in Services for People with Multiple Disabilities: A Path Analytic Approach.Journal of Intellectual Disabilities Research,40,466-477.
  50. People with Disabilities
  51. Hemming, H.(1986).Follow-up of Adults with Mental Retardation Transferred From Large Institutions to New Small Units.Mental Retardation,24,229-235.
  52. Hemming, H.,T. Lavender,R. Pill(1981).Quality of Life of Mentally Retarded Adults Transferred from Large Institutions to New Small Units.American Journal of Mental Deficiency,86(2),157-169.
  53. Hill, B. K.,K. C. Lakin(1986).Classification of Residential Facilities for Individuals with Mental Retardation.American Retardation,24,107-115.
  54. Annual Report 2000
  55. Residential Services/or Persons with Developmental Disabilities: Status and Trends through 2000
  56. Joint Committee of the Board of Education and Board of Control(1929).Report of the Mental Deficiency Committee.London:HMSO.
  57. Klein, J.(2000).Journal of Vocational Rehabilitation.
  58. Klein, J.,D. Nelson(2000).Home Ownership for People with Disabilities: The State of the States in 1999.Journal of Vocational Rehabilitation,15,67-77.
  59. Kleinberg, J.,B. Gallign(1983).Effects of Deinstitutionalization on Adaptive Behavior of Mentally Retarded Adults.American Journal of Mental Deficiency,88(1),21-27.
  60. Kock, U.,H. Saxby,M. Thomas,D. Feice(1988).Community and Family Contact: An Evaluation of Small Community Homes for Adults with sSevere and Profound Mental Handicaps.Mental Handicap Research,1(2),127-140.
  61. Lakin, K. C.,C. C. White,B. K. Hill,R. H. Bruininks,E. A. Wright(1990).Longitudinal Change and Interstate Variability in the Size of Residential Facilities for Persons with Mental Retardation.Mental Retardation,28(6),343-351.
  62. Lakin, K. C.,L. Anderson,R. Prouty(1998).Decreases Continue in out-of-home Residential Placements of Children and Youth with Mental Retardation.Mental Retardation,36(2),165-167.
  63. Landesman-Dwyer, S.(1981).Living in the Community.American Journal of Mental Deficiency,86(3),223-234.
  64. Larson, S. A.,K. C. Lakin(1989).Deinstitutionalization of Persons with Mental Retardation: Behavioral Outcomes.Journal of the Association for Persons with Severe Handicaps,14,324-332.
  65. Larson, S. A.,K. C. Lakin,L. Anderson,N. Kwak,J. H. Lee,D. Anderson(2001).Prevalence of Mental Retardation and Developmental Disabilities: Estimates from the 1994/1995 National Health Interview Survey Disability Supplements.American Journal on Mental Retardation,106(3),231-252.
  66. Mabbett, D.,H. Bolderson(1999).Comparative Social Policy: Concepts, Theories and Methods.Oxford:Blackwell.
  67. Mansell, J.(1994).Specialized Group Homes for Persons with Severe or Profound Mental Retardation and Serious Behavior Problem in England.Research in Developmental Disabilities,15(5),371-388.
  68. Minnesota Department of Human Services(1992).Health Care Administration: Program Reimbursement Rates.Brochure:
  69. Medicaid Community-based Attendant Services and Supports Act of 2001-MICASSA (S. 1298): A Summary
  70. Neuman, W. L.(1997).Social Research Methods: Qualitative and Quantitative Approaches(3th ed).Boston:Allyn and Bacon.
  71. Nisbet, J.,M. Clark,S. Covert(1991).Critical Issues in the Lives of People with Severe Disabilities.Baltimore:Paul H. Brookes.
  72. Office of The Deputy Prime Minister (ODPM),Department of Health(DH)(2002).Housing and Support Options for People with Learning Disabilities (Draft 4 (16.7.02).UK:ODPM.
  73. Perry, J.,D. Feice(1994).Mental Handicap Research.
  74. Pratt, M. W.,M. A. Luszcz,M. E. Brown(1980).Measuring the Dimensions of the Quality of Care in Small Community Residences.American Journal of Mental Deficiency,85(2),188-194.
  75. Rawlings, S.(1985).Behaviour and Skills of Severely Retarded Adults in Hospitals and Small Residential Homes.British Journal of Psychiatry,146,358-366.
  76. Raynes, N. V.,M. W. Pratt,S. Roes(1979).Organizational Structure and the Care of the Mentally Retarded.UK:Croom Helm.
  77. An Independent Evaluation of the Quality of Services and System Performance of Minnesota's Medicaid Home and Community Based Services for Persons with Mental Retardation and Related Conditions
  78. A Quidebook on Consumer Controlled Housing for Minnesotans with Developmental Disabilities
  79. Rubin, A.,E. Babbie(2001).Research Methods for Social Work (4th ed).CA:Brooks/Cole.
  80. Secretary of State for Social Services,the Secretary of State for Scotland,the Secretary of State for Wales(1979).Report of the Committee of Enquiry into Mental Handicap Nursing and Care (Jay Report; Chairman: Peggy Jay).London:HMSO.
  81. Secretary of State, UK(1996).Disability Discrimination Act 1995: Guidance on Matters to be Taken into Account in Determining Questions Relating to the Definition of Disability.London:HMSO.
  82. Shiell, A.,C. Pettipher,N. Raynes,K. Wright(1993).A Cost-function Analysis of Residential Services for Adults with a Learning Disability.Health Economics,2,247-256.
  83. Strategies for Change: Implementing Valuing People at the Local Level-Developing Housing and Support Options: Introduction and Context Setting
  84. Smith, J.,K. C. Lakin,R. W. Prouty(2001).State Profiles of Selected Service Indicators, 1977-2000.Minneapolis:University of Minnesota.
  85. Stancliffe, R. J.,E. Emerson,K. C. Lakin(2001).Community Living and People with Intellectual Disability: Introduction to Part II.Journal of Intellectual and Developmental Disability,26(1),5-14.
  86. Executive Order: Community-based Alternatives for Individuals with Disabilities
  87. Thomas, M.,D. Feice,U. de Kock H. Saxby,A. Repp(1986).The Activity of Staff and of Severely and Profoundly Mentally Handicapped Adults in Residential Settings of Different Sizes.British Journal of Mental Subnormality,32,82-92.
  88. Topliss, E.,B. Gould(1981).A Charter for the Disabled.Oxford:Basil Blackwell and Martin Robertson.
  89. News Release: HHS Approves Nevada Plan to Help More Disabled Adults Live at Home
  90. A Compendium of HHS Technical Assistance Activities Related to Administration's Community-Integration Initiative
  91. News Release: President will Propose $1.75 Billion Program to Help Transition Americans with Disabilities from Institutions to Community Living
  92. News Release-Bush Administration Announces Nearly $40 Million in Rental Housing Vouchers To Help Families with Disabilities
  93. Fair Housing Laws and Presidential Executive Order: The Fair Housing Laws
  94. World Health Organization(WHO)(2002).Towards a Common Language for Functioning, Disability and Health: ICF.Geneva:WHO.
  95. 內政部(2003)。身心障礙者保護法暨相關法規彙編。台北:
  96. 內政部(2004)。成年心智障礙者社區居住與生活服務試辦計畫。台北:
  97. 內政部(1996)。推動社會福利社區化實施要點。台北:
  98. 內政部(2001)。台閩地區身心障礙福利機構第五次評鑑訪評時間及日期一覽表。台北:
  99. 內政部兒童局(2004)。身心障礙福利機構院民 (生 ) 十八歲以下住宿人數調查彙整表。台中:
  100. 內政部營建署(2005)。整體住宅政策。台北:
  101. 任麗華(2000)。身心障礙福利機構接受政府補助經費執行績效之評估。內政部。
  102. 李崇信(2001)。台灣成年心智障礙者社區居住-經驗分享與模式發展初探。台北:財團法人心路社會福利基金會。
  103. 周月清(2000)。障礙福利與社會工作。台北:五南。
  104. 周月清(2001)。芬蘭健康照護與社會工作-參與 「第三屆社會工作健康與心理衛生國際會議」心得報告。社區發展,96,247-254。
  105. 周月清(2000)。英國社區照顧:源起與爭議。台北:五南。
  106. 周月清(2002)。台灣障礙者及老人社區照顧-國家、地方政府、與家庭照護之角色為何?。東吳大學社會工作學報,8,19-74。
  107. 周月清(2000)。香港社區照顧緣起與發展現況及其對台灣的省思。社區發展,92,215-232。
  108. 周月清(1993)。發展二十一世紀智障「包含於」正常人生活的服務工作。社區發展,64,199-202。
  109. 周月清(2001)。台灣成年心智障礙者社區居住-經驗分享與模式發展初探。台北:財團法人心路社會福利基金會。
  110. 張淑娟、黃寶瑩(2001)。台灣成年心智障礙者社區居住-經驗分享與模式發展初探。台北:財團法人心路社會福利基金會。
  111. 陳美鈴(1997)。台灣推動社區照顧之回顧。福利社會雙月刊,61,31-36。
  112. 陳美鈴、李崇信、周月清(2001)。台灣成年心智障礙者社區居住-經驗分享與模式發展初探。台北:財團法人心路社會福利基金會。
  113. 陳寶珠(2001)。台灣成年心智障礙者社區居住-經驗分享與模式發展初探。台北:財團法人心路社會福利基金會。
  114. 陶番瀛、吳秀照(2003)。身心障礙福利機構教保工作人員需求調查。內政部。
被引用次数
  1. 蘇宛君(2017)。國立臺灣歷史博物館心智障礙者教育活動之研究。國立臺北藝術大學博物館研究所碩士班學位論文。2017。1-135。