大專校院自殺／自傷危機處理之探討：以臺灣北區四所私立大學為例

An Investigation of Crisis Management for Suicide/Self-injury: The Experiences of Foar Private Universities in Northern Taiwan

陳莉榛(Li-Chen Chen)；胡延薇(Yen-Wei Hu)；張雅惠(Yea-Huey Chang)

校園自殺／自傷危機處理 ； 緊急個案管理 ； 學校諮商員 ； campus suicide/self-injury crisis intervention ； emergency case management ； school counselor

中華輔導與諮商學報

38期（2013 / 12 / 01）

149 - 182

繁體中文

校園危機處理為心理諮商專業之必要工作，自殺／自傷危機又是學校諮商員最常處理的事件之一。為因應校園自殺／自傷危機日增的局勢，台灣教育當局所頒布之學生憂鬱及自殺／自傷防治處理機制流程圖中，以三級預防的概念明訂校園中相關單位之自殺／自傷危機處理工作。本研究以台灣北區四所不同特色之大學諮商輔導單位及其諮商員為研究對象，探討各校自殺／自傷危機處理之個案管理所遇到的困難與解決方式，期盼透過此研究補充教育部頒訂之危機處理程序，以涵蓋更多元校園文化之處理流程。為此，本研究透過檔案研究與焦點團體的方式，依照緊急個案管理模式中之評估、轉介、聯繫、通報、召開會議、後續輔導等工作層面，收集各校在自殺／自傷危機處理程序中所遭遇的困難與因應策略。結果發現就自殺／自傷處理程序而言，受訪的學校輔導單位部分採取教育部頒布的處理流程並編製具體內部流程。而就諮商員的自殺／自傷危機個案管理實務工作上，訪問結果發現在評估、轉介與就醫方面，各校皆遇到執行的困難並發展相關的行動策略。聯繫與通報之個案管理工作則因校園行政文化發展不同處理策略。本研究依照上述困難中各校的解決策略，擬定一個調整後的自殺／自傷危機處理流程圖。

Campus crisis management has become a necessary aspect of a counselor's job. Specifically, management of suicide/self-injury crises is one of the most common occurrences faced by university-based counselors. In responding to the increasing suicide/self-injury incidences across campuses, the Ministry of Education in Taiwan stipulated a student depression and suicide/self-injury prevention and management flowchart based on the tertiary prevention concept. By studying the experiences of four university counseling centers in Northern Taiwan, this study explored the obstacles faced and the solutions adopted by each of these universities in managing crises. It is hoped that this study can help supplement the crisis management procedures formulated by the Ministry of Education and that the unique culture of the various universities can be incorporated into the emergency management procedures to help each campus responding to crises. The present study analyzed case files as well as conducted focus groups to collect information related to obstacles encountered during crisis and the corresponding management strategies used in each of the campuses. The specific elements of assessment, referral, liaison, reporting, meeting, and follow-up counseling indicated in the emergency case management model were examined. Results of the study suggest that difficulties in carrying out assessment, referral and medical treatment were found across campuses and each university has developed its own unique responding strategies. Approaches to liaison and reporting were found to be divergent across campuses due to differences in the administrative culture of each university. On the basis of the above results, the current study forwards a modified version of the suicide/self-injury crisis management reference flowchart to help address concerns across campuses.

1. 宋麗玉(1998)。個案管理之內涵與工作模式—間論個案管理模式在台灣社會工作領域之應用。社會政策與社會工作學刊，2(1)，127-156。
   連結：
2. 洪晴晴、李玉蟬(2006)。自我傷害行為的辨識與處遇。諮商與輔導，243，26-31。
   連結：
3. 洪雅鳳、羅皓誠(2006)。自殺未遂學生的危機介入處遇策略。輔導季刊，42(2)，13-24。
   連結：
4. 徐欽祥(2008)。學校危機管理的整合性觀點。學校行政雙月刊，55，32-47。
   連結：
5. 麥麗蓉、蔡秀玲(2004)。諮商員在大學校園中危機處理經驗之初探研究。中華輔導學報，15，97-122。
   連結：
6. 教育部（2004）。「校園自我傷害防治手冊」。教育部全球資訊網。2012 年1 月4 日，取自www.edu.tw/EDU_WEB/EDU_MGT/DISPL/EDU3748001/snow0116-1.doc
7. 行政院衛生署統計室。2012 年1 月4 日，取自http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=11965&class_no=440&level_no=5
8. 郭峰志（2001 年4 月30 日）。習慣性自傷行為可能隱藏嚴重精神疾病。台灣日報醫療版
9. Young, K. A., Poland, S., & Griffin, L. (1996). Making Psychology in the Schools Indispensable: Our Role in Crisis Intervention. Eric Document Reproduction Service No. ED 406616.Young, K. A., Poland, S., & Griffin, L. (1996). Making Psychology in the Schools Indispensable: Our Role in Crisis Intervention. Eric Document Reproduction Service No. ED 406616.,未出版
10. Adamson, A. D.,Peacock, G. G.(2007).Crisis response in the public schools: A survey of school psychologists' experiences and perceptions.Psychology in the Schools,44,749-763.
11. Allen, M.,Burt, K.,Bryan, E.,Carter, D.,Orsi, R.,Durkan, L.(2002).School counselors' preparation for and participation in crisis intervention.Professional School Counseling,6,96-102.
12. American School Counselor Association(2000).Position statement: Critical incident response.Alexandria, VA:Author.
13. Auger, R. W.,Seymour, J. W.,Roberts, W. B.(2004).Responding to terror: The impact of September 11 on K-12 schools and schools' responses.Professional School Counseling,7,222-230.
14. Beautrais, A. L.(2000).Risk factors for suicide and attempted suicide among young people.Australian & New Zealand Journal of Psychiatry,34(3),420-436.
15. Berman, A. L.,Jobes, D. A.(1991).Adolescent Suicide Assessment and Intervention.Washington, DC:American Psychological Association.
16. Bonner, R. L.,Rich, A. R.(1987).Toward a predictive model of suicide ideation and behavior: Some preliminary data in college students.Suicide and Life-Treating Behavior,17(1),50-63.
17. Box, G. R. Vanden(Ed.),Bryant, B. K.(Ed.)(1987).Cataclyms, crises, and catastrophies: Psychology in action.Washington, DC:American Psychological Association.
18. Brent, D. A.(1995).Depression and Suicide in Youth: Antecedent and Treatment.McGill University Meeting on Depression and Suicide in Youth,Canada:
19. Capuzzi, D.(1994).Suicide prevention in the schools: Guidelines for middle and high school settings.Alexandria, VA:American Counseling Association.
20. Fitch, T.,Nnewby, E.,Ballestero, V.,Marshall, J. L.(2001).Future school administrators' perceptions of the school counselor's role.Counselor Education and Supervision,41(2),89-99.
21. Fitzpatrick, K. M.,Piko, B. F.,Miller, E.(2008).Suicide ideation and attempts among low-income African adolescents.Suicide and Life-Threatening Behavior,38,552-563.
22. Goldacre, M.,Hawton, K.(1985).Repetition of self-poisoning and subsequent death in adolescents who take overdoses.British Journal of Psychiatry,146,395-398.
23. Gould, M. S.,Greenberg, T.,Velting, D. M.,Shaffer, D.(2003).Youth suicide risk and preventive interventions: A review of the past 10 years.Journal of the American Academy of Child & Adolescent Psychiatry,42(4),386-405.
24. Hawton, K.,Harriss, L.(2007).Deliberate self-harm in young people: Characteristics and subsequent mortality in a 20-year cohot of patients presenting to hospital.Journal of Clinical Psychiatry,68,1574-1583.
25. Jacobson, C. M.,Gould, M.(2007).The epimiology and phenomenology of non-suicide self-injurious behavior among adolescents: A critical review of the literature.Archives of Suicide Research,11,129-147.
26. James, R. K.,Gilliland, B. E.(2004).Crisis Intervention Strategies.Belmont, CA:Wadsworth/Thomson.
27. King, K. A.,Price, J. H.,Telljohann, S. K.,Wahl, J.(2000).Preventing adolescent suicide: Do high school counselors know the risk factors?.Professional School Counseling,3,255-263.
28. McAdams, C. R.,Keener, H. J.(2008).Preparation, action, recovery: A conceptual framework for counselor preparation and response in client crises.Journal of Counseling and Development,86,388-398.
29. Myer, R. A.,James, R. K.(2005).CD-ROM and workbook for crisis intervention.Belmont, CA:Thomson Brooks/Cole.
30. Ougrin, D.,Latif, S.(2011).Specific psychological treatment versus treatment as usual in adolescents with self-harm.Crisis,32(2),74-80.
31. Qin, P.,Mortensen, P. B.,Pedersen, C. B.(2009).Frequent change of residence and risk of attempted and completed suicide among children and adolescents.Archives of General Psychiatry,66,628-632.
32. Riley, P. L.,McDaniel, J.(2000).School violence prevention, intervention, and crisis response.Professional School Counseling,4,120-125.
33. Roberts, A. R.,Ottens, A. J.(2005).The seven-stage crisis intervention model: A road map to goal attainment, problem solving, and crisis resolution.Oxford Journals,5(4),329-339.
34. Rose, Stephen M.(Ed.)(1992).Case management social work practice.New York, NY:Longman.
35. Rudd, M. D.,Joiner, T.,Rajab, M. H.(2004).Treating suicidal behavior: An effective, time-limited approach.New York, NY:Guilford Press.
36. Schwartz, R.,Rogers, J.(2004).Suicide assessment and evaluation strategies: A primer for counseling psychologists.Counseling Psychology Quarterly,17,89-97.
37. Slaikeu, K. A.(1990).Crisis Intervention: A Handbook for practice and research.Needham Heights, MA:Allyn and Bacon.
38. Smaby, M. H.,Peterson, T. L.,Bergmann, P. E.,Zentner Bacig, K. L.,Swearingen, S.(1990).School-based community intervention: The school counselor as lead consultant for suicide prevention and intervention programs.The School Counselor,37,370-378.
39. Ten Have, M.,de Graaf, R.,von Dorsselaer, S.,Verdurmen, J.,van't Land, H.,Vollebergh, W.,Beekman, A.(2010).Incidence and course of suicide ideation and suicide attempts in the general population.Canadian Journal of Psychology,54,824-833.
40. Thompson, R.,Proctor, L. J.,English, D. J.,Dubowtiz, H.,Narasimhan, S.,Everson, M. D.(2012).Suicidal ideation in adolescence: Examining the role of recent adverse experiences.Journal of Adolescence,35,175-186.
41. Timmerberg, P. B.(1989).Saint Louis City in U.S.A.,Saint Louis University.
42. Tramonte, M. R.(1999).School psychology in the new millennium: Constructing and implementing a blueprint for interventing in crises involving disasters and/or violence.Annual Convention of the National Association of School Psychologist
43. Van der Feltz-Cornelis, C. M.,Sarchiapone, M.,Postuvan, V.,Volker, D.,Roskar, S.,Grum, A. T.,Carli, V.,McDaid, D.,O'Connor, R.,Maxwell, M.,Ibelshauser, A.,Van Audenhove, C.,Scheerder, G.,Sisask, M.,Gusmao, R.,Hegerl, U.(2011).Best practice elements of multilevel suicide prevention strategies: A review of systematic reviews.Crisis,32(6),39-333.
44. Wainrib, B. R.,Bolch, E. L.(1998).Crisis intervention and trauma response: Theory and practice.New York, NY:Springer Pub Co..
45. Walsh, B.(2004).New developments understanding and treating Self-injury.American Association of Suicidology 37th annual Conference Handout
46. Walsh, B.,Rosen, P.M.(1988).Self-mutilation: Theory, research, and treatment.New York, NY:Guildford.
47. White, K.,Victoria, E.,Gibson, D. M.,Reynolds, C. A.(2004).Adolescents who self-injure: Implications and strategies for school counselors.Professional School Counseling,7(3),195-202.
48. 吳錫鑫(2003)。碩士論文(碩士論文)。新竹，國立新竹師範學院輔導教學碩士在職專班。
49. 宋麗玉、曾華源、施教裕、鄭麗珍(2002)。社會工作理論─處遇模式與案例分析。台北:五南。
50. 李振林(2011)。碩士論文(碩士論文)。台北市，國防大學政治作戰學院社會工作研究所。
51. 林志成(1999)。學校危機管理與危機決策的分析。國立臺灣體育學院學報，5，235-272。
52. 林杏真(2001)。碩士論文(碩士論文)。台北，國立臺灣師範大學教育心理與輔導研究所。
53. 林家興編(2006)。大學諮商輔導工作實務。台北:心理。
54. 柯慧貞、洪友雯、方格正、劉穎樺、陳仲鉉、劉怡汝(2002)。校園自殺的防制：三級預防模式。學生輔導，80，96-111。
55. 洪昇標(2010)。社區自殺防治與危機處理模式（上）。諮商與輔導，292，46-52。
56. 胡正申(2009)。碩士論文(碩士論文)。南投，國立暨南國際大學社會政策與社會工作研究所。
57. 高永興(1990)。碩士論文(碩士論文)。台中市，東海大學社會工作研究所。
58. 張雅惠、陳莉榛、胡延薇、江捷如(2011)。從校園自殺危機處理談學校專業輔導人員養成教育。臺灣諮商心理學會2011年會員大會暨學術研討會，台北市:
59. 許文耀、吳英璋、胡淑媛、翁嘉英(1994)。自我傷害行為與身心健康的關係。中華輔導學報，2，160-179。
60. 陳莉榛、胡延薇、張雅惠(2011)。校園緊急個管之探討。兩岸四地高校輔導高峰論壇，澳門:
61. 游純敏(2000)。碩士論文(碩士論文)。南投縣，暨南國際大學社會政策與社會工作學系。
62. 黃新福(1992)。碩士論文(碩士論文)。台北，國立政治大學公共行政研究所。
63. 葉健君(2009)。碩士論文(碩士論文)。南投，暨南國際大學輔導與諮商研究所。
64. 鄭崇趁(1995)。輔導網路的理念與實務。學生輔導，46，20-27。
65. 黎麗貞(2009)。博士論文(博士論文)。彰化，國立彰化師範大學輔導與諮商研究所。

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2. 陳淑欽(2018)。大專校園內的辨證行為治療計畫。諮商與輔導，391，7-11。
3. 許育羣(2021)。當校園心理師遇到自殺議題。諮商與輔導，428，31-34+59。
4. 林木興,周桂田(2023)。化學安全三級預防及其臺灣資訊基礎建設。災害防救科技與管理學刊，12(1)，33-44。
5. 劉宗奇(2019)。青少年自殺議題與防治策略。諮商與輔導，408，40-43+39。
6. 葉芸芝(2017)。辯證行為治療法應用於大學諮商中心之挑戰。輔導季刊，53(2)，71-83。
7. (2021)。諮商心理師與社會工作者在面對自殺議題時的跨專業合作與倫理考量。社區發展季刊，174，342-355。
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9. (2024)。台灣心理師在大專校院的專業角色功能。輔導季刊，60(1)，17-28。
10. (2024)。臺灣大專校院輔導與諮商工作之挑戰與展望。中華輔導與諮商學報，69，1-36。