精神疾患家庭之未成子女的預防介入策略初探

Preventive Interventions for Children of Parents with Mental Illness: A Preliminary Study

陳心怡(Hsin-Yi Chen)；童伊迪(Yi-Ti Tung)；唐宜楨(I-Chen Tang)

兒少保護 ； 精神疾患家庭之未成年子女 ； 預防介入 ； 跨專業服務團隊 ； Child protection ； children of parents with mental illness (COPMI) ； preventive intervention ； an interdisciplinary team

身心障礙研究季刊

12卷2期（2014 / 06 / 01）

106 - 119

繁體中文

背景：當父母有情緒困擾或是精神疾病時，面對學齡期兒童與青少年的發展需要，往往無法理解與提供足夠的支持與照顧；同時，年幼兒童更可能面臨無法自我照顧的窘困。有鑑於兒童少年發展的不可回逆性，面對未成年子女在父母罹患精神疾病的家庭成長，及早家庭預防介入是必要的。目的：精神疾患家庭介入強調「準備」是事前連結最重要的關鍵，重視選擇性的預防介入。方法：透過文獻回顧的文本資料分析，以家庭風險與家庭互動研究為取向，強調精神疾患家庭介入的服務輸送流程設計，應將學校社工、教師、身心科門診醫護人員、精神科社工、心理師以及諮商輔導師納入跨專業服務團隊，協助兒童少年準備與發展因應精神疾病的技巧。結果：針對未成年子女處於父母有精神疾病之家庭，本文建議介入工作流程包括：（一）評估與建立基本的處遇計畫，（二）專業工作者之間建立合作網絡，協助兒童少年情緒適應與支持、（三）與精神疾患父母合作，支持教養與互動相關操作的練習與協助、（四）協助兒童少年因應準備與自我照顧能力的提升、（五）連結其他資源，協助解決經濟、藥酒癮等相關問題，以促進兒童與青少年發展。

Background: Children of parents with mental illness (COPMI) can experience insufficient care and support and are likely to be neglected or even abused. Purpose: Based on the needs of child and adolescent development, preventive interventions from a family-resilience perspective are suggested. In this approach, preparation is the most important concept for improving children's and family's response to risks caused by parental mental illness. Methods: A review of the literature is the method adopted in this paper to acquire an understanding of the topic. Results: In this paper, an interdisciplinary team model is used to create a framework to help COPMI and families develop coping skills. This includes the provision of services such as parenting support, education of children about mental illness, family conferences and so on. In cases of parental mental illness, a focus on prevention of future problems and family-focused practice in mental health are essential for building child and family resilience.

1. 宋麗玉、施教裕(2010)。復元與優勢觀點之理論內涵與實踐成效：台灣經驗之呈現。社會科學論叢，4(2)，2-34。
   連結：
2. 林淑玉(2012)。高風險家停關懷輔導處遇方案之社工壓力源初探。諮商與輔導，317，22-25+45。
   連結：
3. 張慈宜、游賀凱(2011)。與他同行—在關係的涉入中撫慰生命的刻痕。教育實踐與研究，24(1)，135-162。
   連結：
4. 國家衛生研究院、行政院衛生署國民健康局、行政院衛生署食品藥物管理局(2009)。國民健康訪問暨藥物濫用調查。取自：http://nhis.nhri.org.tw/files/2009NHIS_report_1.pdf(2014/3/26)
5. 吳岳修、施致如(2014 年 5 月 1 日)。8歲女童 10 公斤 疑長期受虐致死。自由時報。取自：http://news.1tn.com.tw/news/focus/paper/775559 (2014/5/9)
6. Neish, M. J. (2012). An evaluation into the use of the circle of security handouts within the women and children's program. http://www.copmi.net.au/images/pdf/evaluation.pdf(2014/3/26)
7. Baker, L.,Lees, R.(2014).Parental mental illness and coping: An exploratory survey.Canadian Journal of Family and Youth,6(1),115-133.
8. Beardslee., W. R.,Solantaus, T. S.,Morgan, B.S.,Gladstone, T. R.,Kowalenko, N. M.(2012).Preventive interventions for children of parents with depression: international perspectives.MJA Open,1(1),23-27.
9. Cowling, V.,Garrett, M.(2012).A child-inclusive family intervention in a community adult mental health service.Australian and New Zealand Journal of Family Therapy,33(2),101-113.
10. Davis, N. J.(2002).The promotion of mental health and the prevention of mental and behavioral disorders: Surely the time is right.International Journal of Emergency Mental Health,4(1),3-30.
11. Drost, L.M.,Cuijpers, P.,Schippers, G. M.(2010).Developing an interactive website for adolescents with a mentally ill family member.Clinical Child Psychology,16(3),351-364.
12. Falkov, A.(2009).Children of parents experiencing mental illness.The Clinician,4,7-11.
13. Foster, K.,O'Brien, L.,Korhonen, T.(2012).Developing resilient children and families when parents have mental illness: A family-focused approach.International Journal of Mental Health Nursing,21,3-11.
14. Fudge, E.,Mason, P.(2004).Consulting with young people about service guidelines relating to parental mental illness.Australian e-Journal for the Advancement of Mental Health,3(2),1-9.
15. Gladstone, B.M.,Boydell, K.M.,Seeman, M. V.,Mckeever, P.D.(2011).Children's experiences of parental mental illness: A literature review.Early Intervention in Psychiatry,5,271-289.
16. Grove, C.,Reupert, A.,Maybery, D.(2013).Gaining knowledge about parental mental illness: How does it empower children?.Child and Family Social Work
17. Liangas, G.,Falkov, A.(2014).Use of structured clinical documentation to identify patients' parental concerns and their childrens' wellbeing.Community Mental Health Journal
18. Monds-Watson, A.,Manktelow, R.,McColgan, M.(2010).Social work with children when parents have mental health difficulties: Acknowledging vulnerability and maintaining the "rights of the child".Child Care in Practice,16(1),35-55.
19. Mordoch, E.,Hall, W. A.(2008).Children's perceptions of living with a parent with a mental illness: Finding the rhythm and maintaining the frame.Qual Health Res,18,1127-44.
20. Muhlbauer, S.(2002).Navigating the storm of mental illness: Phases in the family's journey.Qualitative Health Research,12(8),1076-92.
21. Reupert, A.,Maybery, D.(2011).Programmes for parents with a mental illness.Journal of Psychiatric and Mental Health Nursing,18,257-264.
22. Reupert, A.E.,Maybery, D.(2010)."Knowledge is power": Educating children about their parent's mental illness.Social Work in Health Care,49(7),630-646.
23. Reupert, A.E.,Maybery, D.J.,Kowalenko, N.M.(2012).Children whose parents have a mental illness: Prevalence, need and treatment.MJA Open,1(suppl 1),7-9.
24. Singleton, L.(2007).Parental mental illness: The effects on children and their needs.British Journal of Nursing,16(14),847-850.
25. Verrocchio, M.C.,Ambrosini, A.,Fulcheri, M.(2013).Promotion of mental health in children of parents with a mental disorder.Ann Ist Super Sanità,49(4),406-411.
26. Zaghi, M.(2012).California State University, Northridge.
27. 吳建昌(2010)。精神疾病患者之意思能力。護理雜誌，57(6)，5-10。
28. 李朝雄(2013)。常見精神疾患。自殺防治網通訊，8(2)，2-2。
29. 高媛媛(2005)。碩士論文(碩士論文)。台中，靜宜大學青少年兒童福利研究所。
30. 高麗鈞(2011)。發揮預防的力量：風險評估為高風險家庭服務的一種實務方法。朝陽人文社會學刊，9(1)，177-197。
31. 張秀如、張君如、林青蓉、詹曇璇、蕭淑貞(2008)。家庭護理對精神分裂症父親之子女生活經驗的影響。護理雜誌，55(1)，43-54。
32. 許煌汶(2008)。家庭會議概觀。安寧療護，13(1)，58-65。
33. 許樹珍、林湫雯、洪毓婷、游淙祺(2012)。精神病患家庭關照時間流之現象探討。護理雜誌，59(6)，36-44。
34. 楊世傳(2013)。辨識與協助精神疾患學生。師友月刊，552，64-67。
35. 蕭淑貞(1999)。行政院國家科學委員會專題研究計畫成果報告行政院國家科學委員會專題研究計畫成果報告,行政院國家科學委員會。
36. 蕭淑貞(1993)。精神分裂病患家庭及一般家庭其家庭功能及教養態度之差異。中華衛誌，12(1)，57-69。
37. 簡慧娟(2014)。高風險家庭服務輸送系統之建立與發展。萬國法律，193，2-10。