醫務社工評估兒童虐待與通報決策之研究

Abstract

本研究旨在探討醫務社工如何處遇兒童保護個案的評估與責任通報，並透過質性研究設計，深入訪談國內北、中、南部共九名現任職於醫學中心之醫務社工。研究目的包括：「了解醫務社工在兒童虐待的個案評估與通報決策的現況」、「分析影響醫務社工通報決策的因素」及「對醫務社工的通報決策提出實務面與政策面的建議」。 研究結果發現醫務社工在評估兒童虐待個案有六種方式，依據方式使用多寡排序，首要以參考醫療診斷為每個受訪者皆會使用的方式；其次是運用評估工具、參考法規條文、了解福利需求；再來是個人經驗判斷；最後為查詢兒保系統。而在進行法定責任通報則有三種決策模式：醫療團隊共同決策、醫師決策並由醫務社工或護理師執行通報，以及醫務社工自行決策，但這三種模式在本研究參與者的使用模式會依個案狀況來選擇使用，並不會僅選用一種模式進行決策暨通報。 影響社工通報決策的因素包含是否有明確的醫療診斷、兒童是否曾有被主管機關「家庭暴力暨（及）性侵害防治中心」列管追蹤的紀錄、兒童是否現有接受社政兒少保護社工服務、及兒童受傷情形是否符合「兒童及少年福利與權益保障法」內的罰則與規範。如果醫務社工與醫療團隊對通報兒童虐待個案抱持不同意見時，可能會降低醫務社工的通報意願。此外，有受訪者表示，沒有任何因素會影響醫務社工去降低執行通報兒童虐待個案的意願。 本研究參與者最後提出四點建議，包含落實醫療專業人員接受兒童虐待案件之教育訓練、社政體系應落實跨縣市兒少保護個案之轉案流程、兒少保護專題課程在醫學教育中的重要性，與提升醫事人員使用網路通報系統的意願。

The purpose of this study is to investigate how a medical social worker deals with the assessment and responsibility in the reporting of child abuse cases. Through qualitative research and design, the author conducted in-depth interviews with nine medical social workers currently working in medical centers in the northern, central and southern parts of the country. The research aims include: “Understanding the current status of medical social workers in case assessment and reporting of child abuse”, “Analysis of factors influencing decision making by medical social workers”, and “Recommendation of practical and policy aspects of reporting decision-making by medical social workers.” The results showed that medical social workers employ six ways to assess child abuse cases: medical diagnosis; assessment tools, welfare needs, reference to statutory provisions, judgment of personal experience; query of the child protection system. There are three models of decision-making in mandated-reporting among medical social workers: the medical team makes the decisions, the doctors make decisions and the medical social worker does the reporting, and the medical social worker makes the decisions. Medical social workers use different decision-making models based on individual case circumstances. The factors affecting the decision-making of medical social workers’ reporting of child abuse cases include: whether there is a clear medical diagnosis, whether the child has a record in the child protection system, whether the child is currently receiving protection services, and whether or not the child’s situations were in compliance with the regulations of the Child and Adolescent Welfare and Protection of Rights and Interests Act. If the medical social worker and the medical team hold different views on the reporting of child abuse, it may reduce the willingness of the medical social worker to report. In addition, some interviewees stated that there is no factor that will reduce their willingness to report child abuse cases. The participants of this study provide four suggestions: the implementation of on-job training for medical professionals to understand and deal with child abuse abuses, the social protection system should implement the referral process for child protection cases across counties and cities, the medical education should stress the issues of child protection, and promoting the willingness of medical personnel to use the online reporting system.