臺灣全國自殺關懷訪視計畫參與人員遭遇的挑戰

Abstract

背景：自殺防治為重要的公共衛生議題，臺灣自殺防治策略包括全面性、選擇性和指標性三個層次，其中的指標性策略包含自2009年起逐步針對自殺企圖或自我傷害者建立的全國性關懷訪視計畫。這項計畫透過自殺關懷訪視員的定期訪視，評估個案的自殺風險程度，給予心理支持，並提供相應的資源轉介服務。然而，過去的研究尚未系統性了解參與此項全國性自殺關懷訪視計畫的工作人員所遭遇的挑戰。

目的：本研究探討自殺關懷訪視計畫中不同層級工作人員，包括自殺關懷訪視員、承辦自殺關懷訪視計畫的單位主管，以及承辦自殺關懷訪視計畫衛生局行政人員，在執行自殺關懷訪視相關業務時所面臨的困難與挑戰。

方法：本研究使用107年衛生福利部委託之「自殺關懷訪視業務現況及成效評估計畫案」之質性訪談資料，包括訪談27位自殺關懷訪視員、32位承辦自殺關懷訪視計畫的單位主管，以及22位衛生局承辦自殺關懷訪視業務的行政人員，並利用架構分析法（Framework Method）分析訪談資料。

結果：研究結果分為四個部分，包括：i） 自殺關懷訪視計畫中不同層級工作人員的主要工作內容；ii） 開始執行自殺關懷訪視前階段所遭遇的挑戰（包括經費運用與規劃、各縣市承辦計畫行政流程，和聘任自殺關懷訪視員）；iii） 執行中階段所遭遇的挑戰（包括通報、與其它網絡單位合作、訪視、評估、轉介、督導和教育訓練，以及行政工作）；與iv） 執行後階段所遭遇的挑戰（即成效評估）。

結論：本篇研究呈現在民國107年的時空背景下，自殺關懷訪視執行時所遭遇的困難與挑戰，並據以提出提升訪視業務之品質與成效的可能方案。

Background: Suicide prevention is a critical public health issue, and Taiwan’s suicide prevention strategies encompass approaches at three levels: universal, selective, and indicated levels. The indicated strategies include a nationwide aftercare program for individuals with suicide attempts or self-harm behaviors established since 2009. This program involves regular visits by aftercare workers to assess the risk of suicide, provide psychological support, and offer appropriate referrals to relevant resources and services. However, there has been a lack of systematic investigations into the challenges faced by the workers participating in the aftercare program.

Objective: The purpose of this study was to explore the challenges and difficulties faced by workers at different levels participating in the aftercare program, including aftercare workers, unit supervisors commissioned to implement the aftercare program, and administrative staff of the health bureaus responsible for planning and commissioning the aftercare program.

Methods: The study analyzed interview data from the “Aftercare program status and effectiveness evaluation project” in 2018 funded by the Ministry of Health and Welfare, including interviews with 27 aftercare workers, 32 unit supervisors, and 22 administrative personnel. The interview data was analyzed using the framework method.

Results: The study results were summarized into four parts, including i） a description of the main responsibilities of workers at different levels in the aftercare program; ii） challenges encountered in the pre-implementation phase （including budget utilization and planning, administrative processes for project implementation across counties and cities, and the recruitment of aftercare workers）; iii） challenges during the implementation phase （including case reporting, collaboration with other network units, visiting the individuals with suicide attempt or self-harm, risk assessment, referral, supervision and training, and administrative work）; and iv） challenges in the post-implementation phase （effectiveness evaluation）.

Conclusion: This study presented the difficulties and challenges faced during the execution of the national aftercare program in the context of the year 2018 and proposed potential solutions to enhance the quality and effectiveness of program.