家外安置的新選項：兒少團體家庭工作者對特殊需求兒少處遇經驗探討

Abstract

在《兒童權利公約》的精神下，提供小規模、家庭化的家外安置服務，已為國內替代性照顧政策所首要關注的目標。然而在親屬安置、寄養家庭服務面臨數量不足，因此國內仍以安置機構作為主要家外安置選項，然而安置機構一致性、高權控的照顧模式被認為難以回應到具特殊需求的兒少。因此在這樣的脈絡下，政府單位於近10年前開始推動「特殊需求兒童及少年團體家庭服務」，期待其小規模、高密度的環境，能夠補足安置機構無法個別化處遇的限制，與有效回應到特殊需求兒少多元與複雜的需求。然而即便團體家庭已經運作10年多，國內現有針對團體家庭相關學術研究討論仍有限，在政策與實務操作上也仍有定位不明的議題。因此本研究的目的便在於從工作者角度探討其在團體家庭的處遇與工作經驗，以及工作者自身如何看待團體家庭服務、特殊需求兒少。

本研究採質性研究方法，並以半結構式深度訪談法作為資料蒐集方法，訪談共11名的曾經、現職於團體家庭的工作者（包含社工與生輔員）。研究發現主要又能分為特殊需求兒少（包含定義、照顧經驗、工作者回應策略）、以及團體家庭於實務中的現況（在替代性照顧服務中的定位、挑戰與議題、整體服務建議）。

針對特殊需求兒少的定義，研究結果發現在團體家庭實務服務中，特殊需求的概念主要能從生心理狀態（如情緒障礙、第一類身心障礙、邊緣智能等）、外顯情緒與行為表現（過高的情緒與行為表現）、需要如諮商、醫療等額外資源協助、難以適應團體安置生活環境，以及進入到安置體系便是一種「特殊」等部分來定義，顯示出可能部分在家外安置中的兒少需求在此評估制度之下被忽略與隱形，同時以外顯負向行為、難以適應團體安置生活作為定義，背後所隱含的價值取向是否是基於兒少需求，還是因為未解決實務中俗稱「難置兒」需求、在團體生活制度之下，這些具有外顯負向行為議題的兒少是團體之中的「特殊」，是需要去反思的；而進一步探討工作者在處遇特殊需求兒少的經驗上，工作者則指出特殊需求兒少相較於一般兒少有較高的情緒需求，同時也較容易展現出更高張與更高頻率的情緒、負向行為議題。此外，或許是因為受到身心議題的影響，特殊需求兒少的生活自理能力相較於同齡兒少是更退化的，同時學習速度也是更為緩慢、需要工作者不斷重複教導與提醒。而本研究也發現到工作者所呈現的照顧經驗多為負向照顧經驗與感受，探究其因一方面來自於兒少本身高難度的照顧特質，另一方面一部分也是來自於外界、主責單位、組織、工作者本身對於專業照顧者的期待，期待要看見兒少的處遇進展，然而當兒少的處遇狀況不如預期、議題仍不斷時，受到來自不同照顧期待的壓力下，工作者便容易因此產生負面的感受與壓力、與不斷在投入更多心力，但卻感受不到回報的無力感的循環中。為回應上述的特殊需求兒少的照顧需求，工作者也發展出不同的處遇與回應策略，包括引進多元與專業資源（如創傷知情）、個別化操作，以及在情緒與攻擊行為下發展從事前預防到事後所因應的策略。而從本研究中也發現到不論工作者採取與發展哪些回應策略，最重要的仍是工作者是否具備足夠的專業知能與多元可以運用的資源，在知能與資源都不足的情況下，工作者是很難有效的去回應兒少，同時也會在過程中產生照顧壓力、耗竭。

對於工作者如何看待團體家庭服務在國內整體替代性照顧服務的定位與角色，研究發現政策和主責單位期待團體家庭能以照顧特殊需求兒少和已經無其他安置住所的兒少為主，使得團體家庭被定位為家外安置順位的最後選項。然而這樣的發現卻凸顯出矛盾的團體家庭矛盾的實務現況，一方面政策視團體家庭為家庭式的照顧模式，但一方面卻又將團體家庭視為最後的安置順位，與《兒童權利公約》中強調小規模、社區式照顧優先的精神不相符。此外，雖然政策期待團體家庭為家庭式照顧服務，但實務操作上卻仍難以避免「團體」的本質，團體家庭服務或許同時具有「團體」與「家庭」的特質，而也因為這樣同時具有「團體」與「家庭」的特質，工作者認為團體家庭在照顧特殊需求兒少上能夠有個別化、彈性化、兒少個人空間，以及因為團體家庭多設置在一般家戶住宅中，有助於兒少和社區之間的連結，進而在未來能夠更順利自立。然而，現階段團體家庭服務，仍然有許多不足與運作上的挑戰，包括照顧人力不足、團體家庭無明確法規、有多元需求，但資源不夠，以及外界對於團體家庭、特殊需求兒少的期待與想像，而除了被賦予高照顧期待外，經常面對兒少高張的情緒、行為，也往往容易造成工作者的壓力與創傷經驗。而面對團體家庭服務在實務操作上的挑戰與困境，工作者也分別提出相關的建議，如：考量特殊需求兒少的安置比例、照顧人力補充、建立團體家庭適用的制度、多元與充足的照顧資源、工作者自我照顧等建議。

最後，本研究根據研究結果提出研究討論，並根據研究結果提出針對政策、實務、研究等面向提出相關建議，以下分別論述之：政策面向包括：（一）照顧資源的挹注；（二）招募與培訓適任的專業照顧人力；（三）建立團體家庭專屬的法規與規範；（四）團體家庭不應該是安置最後選項；（五）特殊需求兒少定義的反思與修正。實務面向的建議為：（一）建立對特殊需求兒少照顧的相關知能與心理預期；（二）安置相關工作經驗的重要性；（三）密集的團隊討論；（四）工作者支持：諮商、個督；（五）合理的照顧期待；（六）團體家庭照顧經驗分享。研究的面向則提出：（一）深入探討各團體家庭的處遇工作方法；（二）不同角度的研究對象；（三）疫情之下的家外安置照顧經驗。

In the spirit of The Convention on the Rights of the Child（CRC）, providing small, family-like substitutional service has become the primary concern of child welfare system in Taiwan. According to previous research, residential care is considered to be difficult to respond to children with special needs. However, there are challenges in the promotion of kinship care and foster care. In the past 10 years, government have begun to promote group home for children with special needs. As a new type of substitutional service, it is expected that its small, less restrictive and family-like environment can respond to the diverse and complex needs of children effectively, which the residential care is unable to do. However, there are limited studies on group home in Taiwan, and also the issues with unclear positioning exist between policies and practical practice. Therefore, the purpose of this study is to discuss the treatment and work experience of children with special needs in group families from the perspective of workers, and how workers view group family services.

This study adopts qualitative research and semi-structured in-depth interview method as the research method, interviewing a total of 11 former and current workers in group home. The results of the study found that in practice, the definition of children with special needs can be defined mainly from emotional (such as emotional disorders, type I physical and mental disabilities, borderline intelligence, etc.) and behavioral performance, additional resource assistance（such as counseling and medical assistance, etc.）, and environmental adaptation. Also, entering the out-of-home care is a kind of "special". This suggests that some of the needs of children in out-of-home care may be overlooked and invisible under this assessment system. Moreover, the definition based on behavioral performance and environmental adaptation questions about whether the underlying value orientation is based on the needs of children or because the needs of so-called "difficult-to-place children" in practice have not been resolved, and these children with external negative behavior issues are considered "special" in the residential facility.

In terms of experience with children with special needs, workers pointed out that children with special needs have higher emotional needs than ordinary children, and are also more likely to show higher tension and higher frequency emotions and negative behaviors issues. In addition, perhaps due to the impact of physical and mental issues, the self-care ability of children with special needs is more degraded than the children of same age. At the same time, their learning speed is are slower, and workers need to teach and reminded them repeatedly. In response to the above-mentioned care needs of children with special needs, workers have also developed different treatment and response strategies, such as finding professional resources, individualizing operations, and forming pre-prevention to post-event treatment under emotional and aggressive behaviors. The study also found that the care experiences shared by workers were mostly negative. This is due, on the one hand, to the high difficulty of caring for these children, and on the other hand, to the expectations of organizations, and the workers themselves for professional caregivers. They expect to see progress in the children’s situation, but when the situation does not improve as expected and issues continue to arise, the pressure from different caregiving expectations can cause workers to experience negative feelings and pressure and feel powerless in a cycle of investing more effort but without returns.

In response to the special needs of children's care mentioned above, workers have also developed different strategies for treatment and response, including introducing diverse and professional resources (such as trauma-informed), personalized interventions, and strategies that address to emotional and aggressive behaviors. However, this study found that regardless of the response strategies that workers adopt and develop, the most important factor is whether workers possess sufficient professional knowledge and diverse resources that can be utilized. In situations where knowledge and resources are lacking, it is difficult for workers to effectively respond to children's needs, and may also experience care stress and exhaustion.

As for how workers view the positioning and role of group home services in out-of-home care in Taiwan, the study found that policies and responsible units expect group home to mainly accommodate children with special needs and children who have no other resettlement accommodation. This also makes group home being considered the last option in the out-of-home care. In addition, although the policy expects group families to provide family care services, it is still difficult to avoid the essence of "group" in practice. Group home may have the characteristics of "group" and "family" at the same time. According to the characteristics of "group" and "family", the workers believe that group families can have individualization, flexibility, and personal space in caring for children with special needs, and because group home are mostly set up in community, it is helpful for the connection between children and the community.

However, there are still many operational challenges in group home services, including insufficient caregivers, no regulations for group home, insufficient resources for multiple needs, and having high expectations for group home workers and children with special needs. Furthermore, being endowed with high expectations of care, facing children's intense emotions and behaviors, it can also cause stress and traumatic experiences for workers. In the face of the challenges and difficulties in the practical operation of group home, the workers suggest that, such as: considering the placement ratio of children with special needs, supplementing caregivers, formulating laws and regulations for group home, providing diverse and sufficient care resources, and self-care.

Finally, the paper recommends for policy, practice, and further research based on the research results. Policy recommendations include: (1) supplement care resources, (2) recruiting and training suitable professional workers, (3)establishing exclusive regulations and norms for group home, (4) group home should not be the last option in out-of-home care, and (5) reflection and revision of the definition of children with special needs.

The practice recommendations are：(1) establishing relevant knowledge and psychological expectations for caring for children with special needs, (2) the importance of residential facility work experience, (3) intensive team discussions, (4) worker support, including counseling and personal supervision, (5) reasonable care expectations, and (6) sharing of group home care experiences.

The research recommendations are: (1) in-depth exploration of the treatment and work methods of each group home, (2) research from different perspectives, and (3) the experience of out-of-home care under the COVID-19.