社会工作对轻度认知障碍人群的干预服务被认为是有价值的，其能提供心理、社会支持、照护及非药物干预方面的支持，帮助稳定、延缓甚至阻断轻度认知障碍患者的病情发展。由于轻度认知障碍症状较轻且不易为患者察觉、重视，社工对轻度认知障碍患者的干预服务多在患者的日常生活区域——社区内进行。然而，社工为轻度认知障碍患者提供社区干预服务的过程并不顺利。

本研究聚焦社工参与轻度认知障碍社区干预过程中的困境遭遇，采用社工主体视角，将社会生态系统理论作为理论视角，运用参与式观察和深度访谈的研究方法收集一线社工及项目团队中的其他协同者对困境的感知与感受。

研究内容包含三个方面：首先，对医务社工参与轻度认知障碍社区干预过程中的困境进行概括梳理，提炼出主要的困境类型；其次，挖掘困境对医务社工服务开展的阻碍作用机制，探究困境如何困住了社工的专业服务；最后，对困境的本质进行探讨，并提出优化建议。研究表明社工在服务过程中经历过载的指标压力、被限制漠视的社工专业性、专业培训和督导不足、社区居民较低的服务接受度与参与度、不够显著的服务成效及不充分的资源支持六方面的困境。上述困境可视作社会工作和MCI干预两个领域各自面临的困境的统合、叠加。导致这些困境的原因包括社会工作在中国情景下所面临的普适性挑战，即生存压力较大、社会层面的专业认同感较低及人才培育不够精细化。此外，MCI的社会工作干预还面临由MCI疾病属性所带来的特殊障碍，即公众病耻感和干预见效缓慢。困境对社工服务的阻碍则体现在增加项目推进难度、限制社工对专业性的追求两个方面。

基于社会生态理论，社工为MCI人群提供社区干预服务过程中的困境可视作其与中观、宏观系统乃至社会力量互动的产物。互动双方在认知层面存有差异，在服务层面供需不匹配。认知层面，不同系统对社工角色的认知发生纠缠，并在实务过程中开展话语争夺，社工的服务主导和专业自主遭遇压制，陷入对职业身份和社工专业性的迷思；服务层面，由中观、宏观系统及社会力量构成的外部环境难以支撑服务按社工预设开展，社工与外部环境间的张力会在双方交互过程中转化外显为社工遭遇的困境。

基于上述结论，本研究就社工参与MCI人群社区干预服务的困境疏解提出政策制度、文化营造、机构和项目运营及社工个人层面的对策建议，力求能优化社工开展MCI干预服务的外部环境，并消弭社工与外部环境间的张力。

Social work intervention services for people with mild cognitive impairment are considered valuable in providing psychological, social support, nursing and non-drug intervention support to help stabilize, delay or even stop the development of mild cognitive impairment. Since the symptoms of mild cognitive impairment are relatively mild, not easy for patients to notice and pay attention to, the intervention services of social workers for patients with mild cognitive impairment are mostly carried out in their daily life area -- the community. However, the process of social workers providing community intervention services to patients with mild cognitive impairment is not smooth.

This study focuses on the dilemma encountered by social workers in the process of community intervention with mild cognitive impairment, from the perspective of social workers. The social ecosystem theory is taken as a theoretical perspective, and the research methods of participatory observation and in-depth interview are used to collect the perception and feelings of first-line social workers and other collaborators in the project team on the dilemma.

The research includes three aspects: Firstly, the dilemma of medical social workers participating in community intervention of mild cognitive impairment was summarized and the main dilemma types were extracted. Secondly, it explored the mechanism of hindering the development of medical social workers' services by the dilemma and explored how the dilemma hindered the professional services of social workers. Finally, the nature of the dilemma is discussed, and optimization suggestions are put forward. The research shows that social workers experience six difficulties in the service process: overloaded indicator pressure, restricted and ignored professional social work, insufficient professional training and supervision, low service acceptance and participation of community residents, not significant service effectiveness and insufficient resource support. The above dilemmas can be seen as a combination of dilemmas faced by social work and MCI intervention. The reasons for these dilemmas include the challenges of universality of social work in the Chinese context, namely the high pressure of survival, the low level of professional identity at the social level and the lack of refinement of talent cultivation. In addition, social work interventions with MCI face special obstacles due to the disease nature of MCI, namely, public stigma and the slow effectiveness of interventions. The obstacles to social worker services are reflected in two aspects: increasing the difficulty of project promotion and limiting social workers' pursuit of professionalism.

Based on the social ecological theory, the dilemmas of social workers in providing community intervention services for MCIS can be regarded as the product of their interaction with mezzo system, macro system and even social forces. There are differences between the two sides in cognition and mismatch between supply and demand in service. At the cognitive level, different systems' cognition of the role of social workers is entangled, and discourse competition is carried out in the process of practice. The service dominance and professional autonomy of social workers are suppressed, and they fall into the myth of professional identity and professional social workers. At the service level, the external environment composed of mezzo system, macro system and social forces is difficult to support the service development as planned by social workers. The tension between social workers and the external environment will be translated into difficulties encountered by social workers in the interaction process.

On the basis of the above conclusions, this study proposes countermeasures and suggestions at the level of policy system, culture construction, organization and project operation and individual social workers to relieve the difficulties of social workers participating in community intervention services for MCI people, so as to optimize the external environment for social workers to carry out MCI intervention services and eliminate the tension between social workers and the external environment.