多学科服务团队介入严重精神障碍残疾人支持性就业综合评价指标体系的构建研究

Development of a Comprehensive Evaluation System for Multidisciplinary Team-based Supported Employment Services for People with Severe Mental Disorders

背景严重精神障碍残疾人参与就业有利于精神康复已成为全球共识,多学科参与的支持性就业服务项目近年来成为全球范围内的研究热点,这种模式在我国尚处于探索阶段,急需一套评价指标体系,以为服务项目的建立提供指导与评价。目的为多学科服务团队介入严重精神障碍残疾人支持性就业建立科学、规范的综合评价指标体系。方法运用文献资料法和德尔菲法,建立评价指标框架,编制专家函询问卷,2019年7-9月邀请10名专家,通过前后两轮函询,根据专家意见的协调程度和集中程度,对指标进行增减和修改,建立综合评价指标及权重系数。结果通过两轮函询,构建了一个包括3个一级指标(组织与资源投入、服务过程和工作结果)、13个二级指标和60个三级指标的综合评价指标体系,并确定了各指标的权重。专家积极系数为100.0%,熟悉系数、判断系数、权威系数分别为0.930、0.850、0.890,两轮的协调系数分别为0.327和0.621,意见有较好的一致性(P<0.001)。结论专家的积极程度高,权威性和协调性较好,两轮咨询后专家意见趋于一致,筛选出的综合评价指标体系可为多学科服务团队介入严重精神障碍残疾人支持性就业服务的评价提供依据,有利于进一步借助政府平台应用推广。

Background Given a global consensus that the employment of people with severe mental disorders is beneficial to their mental rehabilitation,multidisciplinary involvement in supported employment services has become a research hotspot worldwide in recent years.However,since the service model is still at its infancy in China,the country is in urgent need of an evaluation index system that can help set up the service system.Objective To develop a scientific,standard and comprehensive evaluation system for multidisciplinary team-based supported employment services for people with severe mental disorders and determine the weight coefficients of its indicators.Methods Literature review and Delphi method were applied to establish an evaluation framework and develop a questionnaire for Delphi survey.A total of 10 experts were invited to complete two rounds of email-based questionnaire surveys from July to September 2019.According to the degrees of coordination and concentration of the experts'opinions in the survey,the indicators of the evaluation system were added,subtracted or modified to develop a comprehensive evaluation system and determine the weight coefficients of its indicators.Results The finally developed comprehensive evaluation system consists of 3 first-level indictors(governmental and resource input,service process and outcome),13 second-level indictors and 60 third-level indictors with determined weight for each indicator.The positive coefficient of experts was 100.0%.The coefficients of experts'familiarity,judgment and authority were 0.930,0.850 and 0.890,respectively.The Kendall's concordance coefficients for the two rounds of surveys were 0.327 and 0.621,respectively,suggesting that the opinions of experts were very consistent(P<0.001).Conclusion The system was developed according to the two-round survey results with high positive coefficient of experts,high level of experts'authority and coordination and consensus,may provide a reliable basis for the evaluation of multidisciplinary team-based supported employment services for people with severe mental disorders.And it is conductive to further application and popularization of the supported employment services through the government platforms.