This dissertation research focused on the determination of appropriate outcome measures for community-based psychosocial rehabilitation programs for the mentally ill from the perspective of knowledgeable citizens. Specifically, this research identified a conflict between the Mississippi Department of Mental Health, as the certifying agency, and the Mississippi Division of Medicaid, as the funding agency, with regard to the transitional employment component of the psychosocial rehabilitation program. In order to ascertain whether transitional employment should be retained in the psychosocial rehabilitation program, survey questionnaires and in-depth interviews were completed with one hundred and sixty-eight consumers and twenty-three staff in six psychosocial rehabilitation Clubhouse programs in north central Mississippi. The survey questionnaires and interviews focused primarily on the effects of demographics, diagnosis, and barriers to employment on the willingness of consumers with mental illness to participate in transitional employment. Eleven independent variables were identified including age, living arrangements, years of attendance in the psychosocial rehabilitation program, diagnosis, stigma/attitudes, external influence, symptoms of mental illness, training/experience/education deficits, social/cognitive/behavior deficits, financial barriers, and total barriers to employment. Mixed methodology found convergence between quantitative and qualitative findings with regard to seven independent variables and differences with regard to four. Mixed methods found age, living arrangements, and years of attendance in the psychosocial rehabilitation program were not predictive of willingness to participate in transitional employment. Mixed methods found that stigma/attitudes, external influence, symptoms of mental illness, and total barriers to employment were predictive of willingness to participate in transitional employment. Symptoms of mental illness were found to have the greatest impact. Mixed methods also differed in the findings with regard to four variables. While no statistical significance was found to support diagnosis, training/experience/education deficits, social/cognitive/behavior deficits, or financial barriers as predictors of willingness to participate in transitional employment, substantively these variables are important. Based on the findings, the study recommends adjustments and considerations by the Mississippi Department of Mental Health, the Mississippi Division of Medicaid, and the psychosocial rehabilitation programs that will reconcile the differences and lead to the development and implementation of appropriate outcome measures.

本研究主要目的在於瞭解(一)精神障礙者成功適應工作的情形、(二)適應工作期間的權能感受，以及(三)就業服務人員協助其適應工作與增強其權能之策略運用。藉由受訪者回顧參與過渡性就業期間的經驗以瞭解工作適應狀況和權能感受間的關係和影響。研究中以質化之深度訪談法進行資料蒐集，研究參與者的選取主要是來自中華民國康復之友聯盟「台北交誼中心」和「高雄交誼中心」，涵蓋十位精神障礙會員與兩位就業服務人員，並以半結構式的訪談方式進行資料蒐集。本研究結果歸納為以下重點: 一、影響精神障礙者工作適應的因素，主要分為三大層面:個人(就業動機、個人特質與能力、面臨的工作困難、採取的因應方法)、人際(家庭系統與職場系統)、社會環境(會所模式與醫療院所)，而三者間具有循環且交互影響的作用。 二、精神障礙者的工作適應情況，則可區分為以下三個指標:外在滿意度(出席狀況、準時、工作主動性、工作專注力、工作配合度、工作效率及雇主評價)、內在滿足(正向感受與負向感受)、以及工作任期，其中他們的外在工作表現多能達到雇主要求，內在滿足則是正向感受遠多於負向感受，而工作任期是綜合外在滿意度與內在滿足的工作適應表現，他們皆能穩定就業，達到工作期滿。 三、精神障礙者的權能感受與工作適應狀況息息相關，而多半展現在個人(能夠接納自己與肯定自我、覺察自我效能、建立正向自我形象、激發正向內在動力、自我增權、能夠自我選擇與決定、覺得與所處的環境有良好的適配度)與人際層面(具備與人溝通的知識和技巧、與他人互動時能肯定自我、能夠與他人形成夥伴關係、得到他人的尊重)。 四、就業服務員是精神障礙者的適應工作職場的支持主力，主要是扮演「先鋒」、「支持」與「後盾」等重要角色；亦是運用多元的增強權能策略提升其權能感受之關鍵人物。 五、依據精神障礙者的工作適應與權能感受型態區分為四大取向，分別為「內外權能展現取向」、「內在權能增強取向」、「外在支持調適取向」、「懷才不遇取向」。依循四取向之脈絡，筆者延伸發展出最為理想之核心類屬，即「內外權能實現取向」。 依據研究發現，筆者針對工作適應之關鍵角色--就業服務員提出下列幾點建議(一)對精神障礙者之個人處遇策略:增加精神障礙會員的社交能力、運用更多元的增強權能策略來激發復元因子；(二)催化雇主對精神障礙會員之認識與接納；(三)強化會所過渡性就業與就業職場間的連結；(四)建立友善且接納的社會環境。本研究結果分析與研究限制皆於文中提出說明，提供未來相關研究與實務之參考。 / The study explored the states of persons with psychiatric disability succeeding in work adjustment and empowerment during the Transitional Employment service, and the strategy that employment service staffs adopted to help psychiatric disabilities to adapt their jobs and empower them. Through the survey participants’experiences during the period of participating in the transitional employment service, the study attempted to find out the relationship between work adjustment and empowerment. Qualitative method of the profound experiences was utilized to collect data. The survey participants included 10 persons with psychiatric disability and 2 employment service staffs. All of them were selected from TAMI (The Alliance for the Mentally Ill of R.O.C.,Taiwan) and interviewed by using semi-structured interviewing method. The major findings of this study were as follows: 1.The factors that affected the work adjustment of persons with psychiatric disability were divided into three perspectives：individual (employment motivations, personal characteristic and capability, difficulties encountered at work, and the coping strategies), interpersonal (family and workplaces system) and social environment (the clubhouse and hospitals). Moreover, the three levels of factors had interactive impact on the subjects. 2.The state of psychiatric disability’s work adjustment was divided into three aspects：satisfactoriness (attendance, punctuality, positiveness, concentration, cooperation, working efficiency, and evaluation from the employers), satisfaction (positive and negative feelings),and tenure. For the most part, their performance at work could fulfill the employer’s requests, they have much more positive feelings than negative ones, and as the tenure, which was an integrated performance of both satisfactoriness and satisfaction, they were able to work steadily until the tenure expired. 3.To extend the psychiatric disability’s work adjustment and performance above, the empowerment of persons with psychiatric disability almost revealed itself at both individual (their capabilities to accept and approve of themselves, to perceive self-efficacy, to establish positive image, to stir positive internal motivation, to empower themselves, to make choices and decisions, and to fit the environment) and interpersonal (to possess the knowledge and techniques to communicate with others , to approve themselves while interacting with others, to build up partnership, and to obtain others’ respect) aspect. 4.Employment service staffs played an important role in supporting the psychiatric disability’s work adjustment at workspaces. For the most part, they served as pioneers, supporters, and backing; meanwhile, they were the key persons that adopted multiple strategies to empower the subjects. 5.Based on the states of work adjustment and empowerment, the subjects were categorized into four major types of orientation. Overall, the core category of the subjects extracted was “demonstration of internal and external power”. According to the findings, the investigator brought up some suggestions: 1.The treatment of psychiatric disability’s individual situation：improve psychiatric disability members’ ability to establish interpersonal relationship and adopt multiple empowerment strategies to stimulate resilience. 2.Encourage employers to understand and accept the psychiatric disability members. 3.Strengthen the connection between the Transitional Employment service of the clubhouse and workspaces. 4.Establish a friendly and acceptable social environment. The analysis and restriction of the study was brought up in the article, providing references to future related study and practice.