非自願個案願意接受服務的歷程探討-以社福中心兒少家庭的個案為例

Abstract

在脆弱家庭個案的服務實務上，存在有原本是拒絕接受服務的非自願個案，但是經社工持續介入後，非自願個案開始願意逐步配合社工建議與處遇。在這過程中，社工除了花費諸多心力與非自願個案工作外，亦可能承受難以言喻的壓力。故本研究將視角觸及非自願個案及社工，希望透過社工與非自願個案的聲音，探討非自願個案願意接受服務的歷程，了解得以扣門而入的相關關鍵。 本研究運用質性研究深度訪談，以立意取樣方式，共收取三對由社福中心提供服務的非自願個案及其主責社工，探討個案及社工各自接受服務過程及提供服務過程的感受與經驗，從兩個不同的角色來看對兩者對於介入問題的解讀及原因，到兩者所表現及感受到非自願的表現，再而梳理探究緩和非自願狀態且能繼續合作及提供服務的因素，並從服務歷程中探討得以持續服務的因素。 研究結果發現，社工與個案對於需要社工介入協助的問題認知不一樣，但個案都是或多或少同意自己是有需要被協助的議題，然而非自願個案在一開始皆非真實的個案，除了社工與個案對於需要處理的問題並非一致外，也因為個案的抗拒性與逃避性，而未實際進入到社工與個案之間的工作關係。個案的無問題感、不需要社工介入感、權控感、不被理解感，或是來自於童年不良經驗的創傷等等，是造成抗拒的原因之一，故社工必須理解與同理個案的狀況與限制，且認知因為是政府社工，而自帶權力控制的角色，故應積極真誠的與個案建立信任關係，雙方才能有繼續的合作空間。而在服務輸送的過程，社工亦應留意個案的準備度及所處改變階段，而施以不同的策略。最後，則是各網絡彼此的協助與協力，是能帶給非自願個案服務的莫大協助。 藉由研究發現，提出下列建議：在社工本身，社工應從建立服務關係開始，並對有對服務計畫的完整說明與討論，以使個案有所預期，此外，社工應穩住陣腳及理解非自願個案。於網絡合作的為網絡應避免卸責式通報及通報的說明，以及促進網絡間彼此的瞭解與建立共識，本研究冀藉此提供社工在未來面對非自願個案服務困境時，能有所參考。

In social work practice involving vulnerable families, it is not uncommon to encounter involuntary clients who initially refuse to accept services. However, through the sustained intervention of social workers, these clients may gradually become willing to cooperate with the workers' suggestions and treatment plans. In this process, social workers not only expend considerable effort working with involuntary clients but may also endure profound and often indescribable stress. Therefore, this study seeks to address both the perspectives of involuntary clients and social workers. By incorporating their voices, this study aims to explore the process through which involuntary clients come to accept services and to identify the key factors that enable social workers to gain access and establish working relationships. This study adopts a qualitative research approach, utilizing in-depth interviews and purposive sampling. A total of three pairs of involuntary clients receiving services from social welfare centers and their respective primary social workers were recruited. This study explores the experiences and perceptions of both clients and social workers regarding the process of receiving and providing services. By examining these two different roles, the study investigates how each interprets the issues related to intervention and the reasons behind these interpretations. It further analyzes how involuntariness is expressed and perceived by both parties, identifies the factors that help mitigate involuntary states and facilitate ongoing cooperation and service provision, and explores the elements that enable the continuation of services throughout the intervention process. The findings of this study reveal that social workers and clients hold differing perceptions regarding the issues that require social work intervention. Nevertheless, the clients generally acknowledge, to varying degrees, that there are issues for which they need assistance. However, at the initial stage, the involuntary clients did not engage as genuine clients. Beyond the differing views between social workers and clients on the problems to be addressed, clients’ resistance and avoidance also hindered the formation of an actual working relationship between the two parties. Factors contributing to client resistance include a lack of problem awareness, a sense of not needing social work intervention, feelings of power control, feelings of being misunderstood, and, in some cases, trauma stemming from adverse childhood experiences. Therefore, social workers must seek to understand and empathize with clients’ circumstances and limitations, while also recognizing that their role as government social workers inherently carries an element of power and control. It is essential for social workers to actively and sincerely build a trusting relationship with clients, as this is the foundation for ongoing cooperation. During the service delivery process, social workers should also attend to clients’ readiness and their stage of change, applying appropriate strategies accordingly. Finally, collaboration and mutual support across different networks play a critical role in enabling effective service delivery to involuntary clients. Based on the findings of this study, the following recommendations are proposed. For social workers themselves, it is essential to begin with the establishment of a service relationship and to provide clear explanations and engage in thorough discussions regarding the service plan, enabling clients to form realistic expectations. Furthermore, social workers should maintain stability in their professional stance and strive to understand the circumstances of involuntary clients. In terms of network collaboration, it is recommended that network members avoid shirking responsibility through perfunctory referrals or providing inadequate explanations for referrals. Instead, efforts should be made to promote mutual understanding and build consensus across networks. It is hoped that these recommendations may serve as a reference for social workers when facing the challenges of working with involuntary clients in the future.