社會(huì)心理干預(yù)服務(wù)課件

PsychosocialMentalHealthAftercareServicesJohnR.Bola,Ph.D.SchoolofSocialWorkUniversityofSouthernCaliforniaUSA社會(huì)心理干預(yù)服務(wù)CausalModelsBiomedicaldisease?orBio-psycho-socialStress-vulnerabilitymodel?生理疾??？或生理-心理-社會(huì)模式還是壓力應(yīng)對的模式？對病原的解釋AdvantagesofBiologicalDiseaseModelSimplicityChemicalimbalanceReducedresponsibilityandself-blameStigmamanagement簡單由化學(xué)元素不平衡導(dǎo)致責(zé)任及自我指責(zé)的減少對歧視的處理生理疾病模式的優(yōu)點(diǎn)SuppressionofsymptomsNotacureSide-effects只是抑制癥狀不能治愈副作用Over-RelianceonMedication過分依賴藥物Advantages:MultidirectionalcausalinfluencesPrimarysocialandpsychologicalinterventions益處多方位考慮原因以社會(huì)和心理干預(yù)為主Bio-Psycho-SocialModelofMentalIllness生理-心理-社會(huì)模式ReducestressIncreasesupportComprehensiveframeworkforintervention減少壓力增加支持全面的干預(yù)架構(gòu)Stress-VulnerabilityModel

壓力誘因模式ContinuumofMentalHealthServicesLeastrestrictiveenvironmentMaximizefunctionalrecoveryCommunity-based少受環(huán)境限制增強(qiáng)功能恢復(fù)以社區(qū)為依托心理健康服務(wù)的連續(xù)性UsingbestavailableevidenceMorehelpfultopeopleMoreeffectiveforsociety利用現(xiàn)存最佳的科學(xué)證據(jù)對患者和家人多提供有效的幫助對社會(huì)更有效益Evidence-BasedPractice循證實(shí)踐UsebestevidenceTestAdaptservicestolocalconditionsandculture

使用最佳科研證據(jù)測試其可行性調(diào)整服務(wù)，使其適應(yīng)本地實(shí)際情況DevelopingServices發(fā)展服務(wù)PsychosocialTreatmentsforSchizophreniaFamilymutualsupportClientself-helpAssertiveCommunityTreatment(ACT)SupportedEmployment家庭互助患者互助社區(qū)積極治療就業(yè)支持對精神分裂癥病患的其他社會(huì)心理治療FamilyPsychoeducationReducesrelapse,improvessocialfunctioningandreducescaregiverburden.RecognizesandusesastrengthofChineseculture–thevalueofthefamily.減少復(fù)發(fā)，提高社會(huì)功能，減少照顧者的負(fù)擔(dān)肯定和利用中國傳統(tǒng)文化的力量-家庭的價(jià)值家庭心理教育CochraneSystematicReview

(Pharoahetal.2005)DecreasedrelapseRR0.72[CI:0.6-0.8]NNT7ImprovedmedicationcomplianceRR0.74[CI:0.6-0.9]NNT7Nocleareffectondropoutorsuicide減少復(fù)發(fā)機(jī)會(huì)提高接受藥物治療的程度對自殺和退出沒有明顯效果Cochrane系統(tǒng)回顧EducationalContentSchizophrenia (stress-diathesismodel)SymptomsCourse(prognosis)Treatment(medications,stressmanagement,familyandsocialrelations,stigma)Relapseprevention精神分裂癥（壓力誘因模式）癥狀病程（預(yù)后）治療（藥物，壓力處理，家庭于社會(huì)關(guān)系，歧視）預(yù)防復(fù)發(fā)教育的內(nèi)容EducationalContentII.Problem-solvingEmotionalsupportCrisismanagementSupportimprovedfamilyfunctioning解決問題情感支持危機(jī)處理提高家庭的功能教育的內(nèi)容之二Reductionin“ExpressedEmotion”Critical/hostileOver-involved減少“表達(dá)情感”批評/責(zé)怪過分介入EducationalContentIII.教育的內(nèi)容之三Inpatientdosagereductiontrial?Whatistheleaseeffectivedosageofmedications?Isitfeasibleandinstructivetoreduceinpatientdosage?Stresslikelytoincreaseupondischarge.

藥物的最少劑量？減少住院病人藥物劑量的可行性？出院時(shí)的壓力有可能增大住院病人減少藥物劑量的實(shí)驗(yàn)SymptomManagementSymptomrecognitionSymptom-medicationrelationshipSymptom-stressrelationship認(rèn)識(shí)癥狀癥狀與藥物的關(guān)系壓力與癥狀的關(guān)系癥狀的處理DischargePlanningLivingarrangements?Socialandoccupationalconsiderations?Outpatientservices (medication, casemanagement)Continuityofhelpingrelationships?居住安排如何？社會(huì)及職業(yè)的考慮？門診服務(wù)（藥物，個(gè)案管理）幫助關(guān)系的延續(xù)？出院安排ContinuityofTreatmentDevelopongoing,supportive,andtrustingrelationshipwithfamily.Increaseunderstanding,compliance,likelihoodoflatercontactifneeded.

發(fā)展與家人持續(xù)的支持及信任關(guān)系增強(qiáng)了解,合作及以后需要時(shí)的聯(lián)系治療的延續(xù)SocialWorkand

PsychiatryFurtheringcollaborativerelationshipsRecognitionofcomplimentarystrengthsSharedcommitmenttobestclientoutcomes推動(dòng)合作關(guān)系承認(rèn)相互的互補(bǔ)性以病患的最高利益為己任社會(huì)工作者

與精神科醫(yī)生PsychosocialinterventionsManagementofsocialservicesSocialscienceresearch社會(huì)心理干預(yù)社會(huì)服務(wù)管理社會(huì)科學(xué)研究SocialWork

MentalHealthProfessionalEducation社會(huì)工作和社會(huì)福利Objectives:introducetheconceptsofmentalillnessesandpsychosocialrehabilitationtosocialworkpractitionersandstudents.Fostercooperativeinter-professionalrelationships(e.g.,psychiatry,psychology,nursing..)inthetreatmentofmentalillness.目標(biāo)：本課程旨在向不熟悉精神健康社會(huì)工作實(shí)踐的社會(huì)工作從業(yè)者和學(xué)生介紹精神疾病和社會(huì)心理康復(fù)的基本概念。同時(shí)也希望在整合性治療方法的學(xué)習(xí)過程中向其他專業(yè)人士，如精神科醫(yī)生，心理醫(yī)生，護(hù)士和職業(yè)治療師介紹社會(huì)工作者在其中扮演的角色。SocialWorkMentalHealthCurriculum發(fā)展中國心理健康教學(xué)大綱Contents內(nèi)容心理疾?。憾x及流行程度

(I)心理疾病：定義及流行程度(II)社會(huì)心理康復(fù)的概念和社會(huì)工作者的角色文化在精神疾病中的角色心理健康的政策和服務(wù)MentalIllness:DefinitionsandPrevalenceEstimates(I)MentalIllness:DefinitionsandPrevalenceEstimates(II)ConceptsofPsychosocialRehabilitationandtherolesofsocialworkersTheRoleofCultureintheConceptualizationofMentalIllnessMentalHealthPolicyandServicesContents內(nèi)容對心理疾病的生理干預(yù)對精神疾病的社會(huì)心理干預(yù)對心理疾病的社會(huì)態(tài)度：歧視融生理，心理和社會(huì)成分的綜合干預(yù)方式家庭在照顧精神病患者中的角色在心理健康服務(wù)方面的跨領(lǐng)域合作（精神科醫(yī)生，心理醫(yī)生，社工，護(hù)士等）BiologicalInterventionsforMentalIllnessPsychosocialInterventionsforMentalIllnessSocialAttitudestowardstheMentallyIll:StigmaIntegratingBiologicalPsychologicalandSocialComponentsofMentalHealthServicesTheRoleofFamilyinCareandTreatmentoftheMentallyIllInterdisciplinaryCollaborationinMentalHealthServices(Psychiatry,Psychology,

SocialWork,Nursing,etc.)

FormatandAssessment

形式與評估方式Format:Thesessionsareconductedintheformatoflectures,roleplaysanddiscussions.Eachsessionlastsfortwohours,andcanberunonaweeklybasisorasasandwichedcourse.Assessment: Inordertobegrantedacertificatefromtheorganizers,participantsmustattendatleast80%oftheclasses,andcompletetwoassign