以生態性介入策略探討照顧者對智能障礙者挑釁行為的因應方式

Ecological Intervention Strategies toward People with Intellectual Disabilities Accompanied by Challenging Behaviors

10.30072/JDR.200603.0005

李宗楠(Tzung-Nan Lee)

行為認知分析 ； 挑釁行為 ； 智能障礙 ； 照顧者 ； 渥太華健康促進憲章 ； behavior analysis ； carer ； challenging behavior ； intellectual disability ； ottowa chater for health promotion

身心障礙研究季刊

4卷1期（2006 / 03 / 01）

64 - 74

繁體中文

提供智能障礙健康服務最主要的對象，不外乎是家人及機構第一線照顧員工，而這兩類照顧者經常要面對智能障礙者挑釁的行為。傳統心理學行為分析理論認為照顧者對照顧對象的挑釁行為，會因不同的認知解讀，而有不同的行為反應。這些行為反應可能反映出照顧者的壓力因應方式，進而影響所提供的照顧服務品質。探討照顧者面對挑釁行為的反應，過去文獻多以傳統心理學的角度出發，單獨以行為認知或是歸因理論來分析照顧者面對挑釁行為因應的中介因子，從中找出壓力源來制訂介入策略，然而，以長期的介入效果而言，其成效都不盡理想。此外，傳統的行為認知方法較適合一般人的行為分析，針對智能障礙照顧者（尤其是有血緣關係的照顧者），其易受到社會環境與情境因素的影響；且不同身份的照顧者會因不同的認知及歸因行為，造成對於智能障礙者挑釁行為產生不同的行為反應。因此，介入策略若僅以單一行為認知分析的方法，未必可以適用於所有照顧者，進而影響行為介入的成效。世界衛生組織於1986年制訂渥太華健康促進憲章，強調藉由建立健康的支持性環境，以及透過醫療服務體系的重整，從整個生態性的觀點來改善人們的健康狀況，以塑造永續性的經營。本文以渥太華憲章的五大行動策略：增進個人技能、加強社區參與、創造支持性的環境、重組健康服務體系與促進健康的公共政策為基礎，藉由相關文獻之分析，探討照顧者對於智能障礙者合併挑釁行為的因應方式，並結合個人行為認知、情緒與信念等分析，以永續性的介入方式，讓照顧者能妥善因應智能障礙者的挑釁行為，也使智能障礙者能接受更好的照顧服務，讓介入策略達到更有積極的意義。

Family members and front-line carers are important assets and central to the provision of high-quality services to people with intellectual disabilities, they usually experience challenging behavior from this group of people. According to traditional behavioral theory, carer's different cognitive behaviors may lead to different responses from challenging behaviors of people with intellectual disabilities, these responses may affect the quality of services for them. The traditional cognitive behavioral approaches may be only suitable for the general people, and it is doubtable for the suitable toward people with intellectual disabilities. In 1986, the Ottowa Charter for Health Promotion emphasized to draw the appropriate policies for health, and claimed on the five practicable strategies for health promotion that can be applied in mental health issues: improving personal skill, creating supportive environment, building health public policy, strengthening community action, and reorienting health services. Based on the literature reviews, we try to use this ecological intervention strategies to build sustainable policies toward people with intellectual disabilities accompanied by challenging behaviors.

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