本研究目的在瞭解台北市高風險家庭經過社會工作人員處遇後的改變情形，同時也試圖瞭解社工員所提供的處遇為何。本研究以質化研究方法進行，藉由焦點團體以及深度訪談蒐集資料，焦點團體方面，邀請5 家承接「家庭綜合服務－臺北市高風險家庭服務方案」之機構督導5 名共同參與，深度訪談方面則是請機構督導推薦2 名於高風險家庭服務方案中任職一年以上之社工員，總共深度訪談9 名社工員。研究發現高風險家庭大多為具有多重需求的家庭，社工員於介入過程中主要扮演四種角色：直接服務提供者、系統連結的角色、系統的發展者、系統的維護和促進，並且連結多樣的資源，各網絡間合作的密度極高。經處遇過後高風險家庭可觀察到由微視到鉅視層次的改變，分析結果可由三個層次來看：個人、家庭以及家庭環境、社區和社會，個人層次為家長個人方面的改變（例如：成為家庭經濟支柱、親職照顧者能力提升、提升個人內在能力）和兒少方面的改變（例如：就托、就學穩定、身心狀況的改善、提升自我照顧能力）；家庭層次包含正向的家庭互動、家庭衝突獲得改變；家庭環境、社區和社會層次則是家庭環境獲得改善、社會支持穩定、社會參與增加。研究最後針對台北市高風險家庭服務方案的現況提出六點實務與政策上的建議，以增進高風險家庭的福祉。 Some families are suffering from the dramatic social and economic change. This dramatic change not only weakens family functioning, but also inflicts damage on children. The purpose of this study tries to examine the changes of high risk families after social work intervention and understand how social work intervenes in these families. Qualitative method is employed in the study. Data were drawn from the focus group and interviews. The focus group invited supervisors of five organizations which undertake the high-risk family service program in Taipei City. We also employed in-depth interviews with nine social workers who have worked in high-risk family service programs over one year. The study finds that high-risk families have multiple needs; the social workers perform as the role of direct service provider, system linkage, system developer and system maintenance. In addition, the changes of high-risk families after social work intervention can be organized to three levels: individual level; family level; and family environment, community and social level. The individual level includes changes related to parents (ex. Become as a family economic maintainer, become as a capable child care-giver and lift the parent‘s self ability ) and changes related to children (use child care or go to school regularly, change children’s physical or mental conditions, lift children’s self-care ability); the family level includes positive family interaction and resolution of family conflict; and the family environment, community and social level includes the improvement of the family environment, social support being stable, and the increases of social participation. Finally, the practice and research implications are provided.