多元職前準備方案對神經系統構造及精神、心智損傷者就業與功能獨立性之影響

The Benefits of a Multidimensional Pre-Vocational Preparation Program on the Employment and Functional Independence of Persons with Mental Function & Structures of the Nervous System Impairment

本研究目的係探討多元職前準備方案對神經系統構造及精神、心智損傷者（簡稱第一類身障者）就業與參與生產性活動時的功能獨立性之助益。本研究採回溯性次級資料分析，由心路台北就業服務中心提供2015年至2019年參與方案之第一類身障者的文本資料，擷取佔大多數的智能障礙、慢性精神疾病、自閉症者的資料進行統計分析，據此了解參與個案之人口學特質、所參與方案內容、參與方案中個別輔導項目時數、方案結束後六個月內就業情形以及不同就業情形之個案人口學特質、不同就業情形個案參與生產性活動之功能獨立性、參與方案前後功能獨立性的變化，以及上述這些變相與不同就業情形之關係。適時地採用敘述性統計、卡方檢定、及單因子共變異數分析以回答研究題。
研究結果：（1）在127名參與者中，以男性（64%）、智能障礙者（58%）、輕度障礙（68%）、高職學歷（76%）、參加本職前準備方案前未有三個月穩定就業經驗者（68%）居多；（2）整體成功就業率達63%，穩定就業3個月以上達52%；（3）方案結束後穩定就業三個月者以支持性就業模式佔多數（58.3%-76.4%），其次是庇護性就業與自行就業；（4）參與方案期程為4.73至9.25個月，期間參與4.27至6.25個項目，其中，參與職前方案項目數以方案結束後透過支持性與庇護性就業者顯著較多（8.41與9.43項，p = 0.004）；（5）參與個別輔導的時數以91個小時以上居多，其有超過一半（53.7%）於方案結束後透過支持性就業服務而成功穩定就業；（6）不同就業情形的參與者在障礙程度、教育程度、所參與個別輔導時數上達顯著差異（p < 0.05）；（7）整體參與者功能獨立性分數改善15.36至21.04分，且參與前、後有顯著改善（p < 0.05）；（8）不同就業結果的參與者，功能獨立性改變的程度有顯著差異（p < 0.001），其中以未就業者改善程度最低，而支持性就業者改善程度作高。
心路基金會台北就業中心的多元職前準備方案對智能障礙、自閉症與慢性精神疾病者的就業與功能獨立性有顯著的益處，主要原因來自於其個別化且彈性的實施方式，就業服務員與個案共同決定參與的項目，顯示即使是心智與神經功能受損的個案，只要參與足夠時間與適性的職前準備方案內容，在經過適當的職前訓練後，即進行就業安置，並於就業後提供持續的支持，有超過五成的機率不僅能於庇護性職場就業，甚至能於競爭性職場穩定就業，是智能障礙者、自閉症與慢性精神疾病個案較為適合的就業服務模式。

This study aimed to explore the benefits of a versatile pre-employment preparation program on employment and functional independence during participation in productive activities of individuals with mental function and nervous structure impairment (referred to as Category I disabled individuals). This study is a retrospective study analysis based on the secondary data provided by the Taipei Employment Service Center of the Syin- Lu Social Welfare Foundation for Category I disabled individuals who participated in the programs from 2015 to 2019. The analysis focused on the data of individuals with intellectual disabilities, chronic mental illnesses, and autism, who made up the majority of the participants. Variables analyzed included demographic characteristics, the content of the program they participated in, the number of hours spent in individual counseling sessions, employment status within six months after the program ended, changes in functional independence before and after participation, and the relationships between these variables and different employment outcomes. Descriptive statistics, Chisquare tests, and one-way ANOVA were appropriately employed to answer the research questions.
The findings of the study were: (1) Among the 127 participants, most were male (64%), intellectual disabilities (58%), mild disabilities (68%), vocational high school education (76%), and lacked stable employment for three months experience before participating (68%). (2) The overall successful employment rate reached 63%, with 52% achieving stable employment for over three months. (3) Among those stably employed for three months post-program, most were employed through supported employment (58.3- 76.4%), followed by sheltered and independent employment. (4) The duration of program participation ranged from 4.73 to 9.25 months, with participants engaging in 4.27 to 6.25 classes. The number of pre-employment program classes participated in was significantly higher for those who achieved supported and sheltered employment (8.41 and 9.43 items, p = 0.004). (5) The majority of participants participated in over 91 hours of individual counseling, and more than half (53.7%) of them achieved stable employment through supported employment services post-program. (6) There were significant differences (p < 0.05) in disability severity, education level, and hours of individual counseling among participants with different employment outcomes. (7) Participants' overall functional independence scores improved by 15.36-21.04 points, with significant improvements before and after participation (p < 0.05). (8) There were significant differences in the degree of change in functional independence among participants with different employment outcomes (p < 0.001), with the lowest improvement seen in those who did not gain employment, and the highest improvement in those employed through supported employment.
The diverse pre-employment preparation programs of the Taipei Employment Center of the Syin-Lu Social Welfare Foundation have shown significant benefits for individuals with intellectual disabilities, autism, and chronic mental illnesses in terms of employment and functional independence. This is primarily attributed to the individualized and flexible implementation of these programs, where professional staff and participants collaboratively decide on the items and durations to engage in them. Even among individuals with mental and neurological impairments, more than 50% of them were able to secure employment not only in sheltered workplaces but also stable employment in competitive workplaces, given adequate time and suitable pre-employment program contents provided. However, further large-scale research is needed to clarify the efficacy of different program contents for these three categories of disabilities.