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1、Psychosocial Mental Health Aftercare Services,John R. Bola, Ph.D. School of Social Work University of Southern California USA,美国南加州大学社会工作学院 包教授,社会心理干预服务,Causal Models,Biomedical disease? or Bio-psycho-social Stress-vulnerability model?,生理疾病？ 或 生理-心理-社会模式 还是 压力应对的模式？,对病原的解释,Advantages of Biological D
2、isease Model,Simplicity Chemical imbalance Reduced responsibility and self-blame Stigma management,简单 由化学元素不平衡导致 责任及自我指责的减少 对歧视的处理,生理疾病模式的优点,Limits of Biological Disease Model,Environmental influences are peripheral Change occurs primarily through medication Reduces active participation in the recov
3、ery process,外围环境因素 单纯依靠药物治疗 减少康复过程中的积极参与,生理疾病模式的缺陷,Suppression of symptoms Not a cure Side-effects,只是抑制症状 不能治愈 副作用,Over-Reliance on Medication,过分依赖药物,Advantages: Multi directional causal influences Primary social and psychological interventions,益处 多方位考虑原因 以社会和心理干预为主,Bio-Psycho-Social Model of Mental
4、 Illness,生理-心理-社会模式,Reduce stress Increase support Comprehensive framework for intervention,减少压力 增加支持 全面的干预架构,Stress-Vulnerability Model,压力诱因模式,Use lowest effective / necessary dose Minimize side-effects Part of integrated treatment,用最少的剂量达到最佳的效果 减少副作用 综合治疗方案的一部分,Optimal Use of Medication,药物的最佳使用,Co
5、ntinuum of Mental Health Services,Least restrictive environment Maximize functional recovery Community-based,少受环境限制 增强功能恢复 以社区为依托,心理健康服务的连续性,Using best available evidence More helpful to people More effective for society,利用现存最佳的科学证据 对患者和家人多提供有效的帮助 对社会更有效益,Evidence-Based Practice,循证实践,Use best eviden
6、ce Test Adapt services to local conditions and culture,使用最佳科研证据 测试其可行性 调整服务，使其适应本地实际情况,Developing Services,发展服务,Evidence-Based Psychosocial Treatments for Schizophrenia,Family psychoeducation Psychsocial skills training Cognitive-behavioral therapy Vocational rehabilitation,对家庭的心理教育 社会心理技巧培训 行为意识治疗
7、职业恢复,对精神分裂症患者以循证为基础的社会心理治疗,Psychosocial Treatments for Schizophrenia,Family mutual support Client self-help Assertive Community Treatment (ACT) Supported Employment,家庭互助 患者互助 社区积极治疗 就业支持,对精神分裂症病患的其他社会心理治疗,Family Psychoeducation,Reduces relapse, improves social functioning and reduces caregiver burde
8、n. Recognizes and uses a strength of Chinese culture the value of the family.,减少复发，提高社会功能，减少照顾者的负担肯定和利用中国传统文化的力量-家庭的价值,家庭心理教育,Cochrane Systematic Review (Pharoah et al. 2005),Decreased relapse RR 0.72 CI: 0.6-0.8 NNT 7 Improved medication compliance RR 0.74 CI: 0.6-0.9 NNT 7 No clear effect on dropo
9、ut or suicide,减少复发机会 提高接受药物治疗的程度 对自杀和退出没有明显效果,Cochrane 系统回顾,Initial Objectives (Xiong, Phillips et al. 1994),Trusting, empathetic relationship. Educate the family about the illness. Enlist collaboration in medication management. Introduce talking therapy.,信任和同情的关系 教育家庭成员了解精神疾病 在药物服用方面建立合作支持的关系 介绍 “说
10、话治疗”,初步目的,Educational Content,Schizophrenia (stress-diathesis model) Symptoms Course (prognosis) Treatment (medications, stress management, family and social relations, stigma) Relapse prevention,精神分裂症 （压力诱因模式） 症状 病程（预后） 治疗（药物，压力处理，家庭于社会关系，歧视） 预防复发,教育的内容,Educational Content II.,Problem-solving Emoti
11、onal support Crisis management Support improved family functioning,解决问题 情感支持 危机处理 提高家庭的功能,教育的内容之二,Reduction in “Expressed Emotion” Critical / hostile Over-involved,减少 “表达情感” 批评/责怪 过分介入,Educational Content III.,教育的内容之三,Hospital-based Psychoeducation,Symptom recognition Medication and symptom relation
12、ship Stress and symptom relationship Foster collaboration,认识症状 药物与症状的关系 压力和症状的关系 加强合作,以医院为依托的心理教育,Inpatient dosage reduction trial?,What is the lease effective dosage of medications? Is it feasible and instructive to reduce inpatient dosage? Stress likely to increase upon discharge.,药物的最少剂量？ 减少住院病人药
13、物剂量的可行性？ 出院时的压力有可能增大,住院病人减少药物剂量的实验,Symptom Management,Symptom recognition Symptom-medication relationship Symptom-stress relationship,认识症状 症状与药物的关系 压力与症状的关系,症状的处理,Discharge Planning,Living arrangements? Social and occupational considerations? Outpatient services(medication, case management) Continui
14、ty of helping relationships?,居住安排如何？ 社会及职业的考虑？ 门诊服务（药物，个案管理） 帮助关系的延续？,出院安排,Suicide Risk,Assessment Monitoring Early warning Prevention,评估 检测 及早提醒 预防,自杀的隐患,Continuity of Treatment,Develop ongoing, supportive, and trusting relationship with family. Increase understanding, compliance, likelihood of lat
15、er contact if needed.,发展与家人持续的支持及信任关系 增强了解, 合作及以后需要时的联系,治疗的延续,Social Work and Psychiatry,Furthering collaborative relationships Recognition of complimentary strengths Shared commitment to best client outcomes,推动合作关系 承认相互的互补性 以病患的最高利益为己任,社会工作者 与精神科医生,Knowledge development requires a scientific commun
16、ity Healthy society requires commitment to the well-being of each person,知识的发展需要一个科学的社区 健康的社会需要关心每个成员的身心健康,Collaborative Partnerships,合作伙伴,Building upon what is known Evaluating new treatments How can we improve what we do?,在现存知识的基础上不断积累 评估新的治疗方法 可以如何提高服务质量?,Advancing Knowledge,更新知识,Psychosocial int
17、erventions Management of social services Social science research,社会心理干预 社会服务管理 社会科学研究,Social Work Mental Health Professional Education,社会工作和社会福利,Objectives: introduce the concepts of mental illnesses and psychosocial rehabilitation to social work practitioners and students. Foster cooperative inter-professional relationships (e.g., psychiatry, psychology, nursing) in the treatment of mental illness.,
