Ateneo General de la Residencia de Psicopedagogía: En busca de una oportunidad: Intervenciones psicopedagógicas en la clínica con adolescentes / General Athenaeum of the Psychopedagogical Residence: In search of an opportunity: Psychopedagogical interventions in the clinic with teenagers

Ateneo centrado en la intervención, la intervención psicopedagógica, y la intervención temprana y oportuna en la adolescencia. Se determinan qué imaginarios acompañan el concepto de adolescencia situando el discurso médico, normativo y social. Finalmente, se profundiza acerca de los espacios que desde el Sistema de Salud, y más específicamente desde el equipo de psicopedagogía del Hospital Vélez Sarsfield, se ofrecen a la población adolescente. Se incluyen fragmentos de entrevistas y reflexiones aportados desde la propia experiencia profesional.

Home-Based Telemental Health: A Proposed Privacy and Safety Protocol and Tool.

Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto.Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.

¿Hay alguien ahí?: Experiencias en la clínica psicopedagógica grupal con púberes en tiempos de pandemia / Anyone there?: Experiences in the psychopedagogical clinic group with pubescents in times of pandemic

Escrito del Equipo de Psicopedagogía del Centro de Salud Nº 10, perteneciente al Área Programática del Hospital Dr. José María Penna, de la Ciudad de Buenos Aires. Debido a la pandemia la atención clínica presencial debió ser suspendida, y se continuó con la asistencia a los pacientes de manera virtual. Con algunxs se realizaron seguimientos telefónicos con lxs referentes familiares y en algunos casos con lxs niñxs así como también se mantuvieron comunicaciones con las escuelas, derivaciones e interconsultas; con otrxs se logró cierta continuidad en el tratamiento por lo general a través de videollamadas de whastapp. Este es el caso del grupo de tratamiento de púberes del que se propone compartir y reflexionar. En la sede de este equipo, el abordaje clínico grupal data ya de varios años pero particularmente el grupo de púberes surgió en el año 2018. Por tanto, en un primer momento, se propone historizar y contextualizar al grupo de tratamiento psicopedagógico así como también compartir la concepción de la clínica grupal. Además, se comparten la conceptualización de la pubertad que sostiene el equipo y los procesos psíquicos esperables que se dan en este tiempo articulado con el contexto actual. (AU)

Dá el primer paso y los caminos aparecerán: Percepciones de los/as adolescentes sobre el taller de Orientación Vocacional Ocupacional / Take the first step and the paths will appear: Perceptions of adolescents about the vocational orientation workshop

El Equipo de Psicopedagogía del Área Programática del Hospital Vélez Sarsfield, implementa desde el año 1998 procesos de Orientación Vocacional Ocupacional (OVO) en el marco de la Atención Primaria de la Salud (APS), la cual tiene como objetivo generar la participación, autogestión y responsabilidad en el cuidado de la salud de la población en general. El proceso de OVO busca que los/as estudiantes sean protagonistas de su elección, pudiendo llegar a tomar decisiones autónomas y significativas respecto a su futuro y, de esta manera, optimizar así su calidad de vida. Particularmente en este contexto de pandemia por Covid19, se decidió re-pensar de qué modo continuar con la oferta de esta actividad a pesar del impedimento de llevarlos a cabo de forma presencial; se consideró necesario mantener estos espacios donde se pudiera acompañar a los/as adolescentes ante la incertidumbre de la elección de una carrera o trabajo. Por tal motivo, se pensó en la idea de diseñar y llevar a cabo un Taller de OVO de forma virtual y acotado en cantidad de encuentros. La presente investigación tiene como objetivo analizar las percepciones de los/as adolescentes que iniciaron y culminaron el Taller de Orientación Vocacional Ocupacional, realizado de manera virtual en el periodo de octubre a diciembre de 2020, en relación al dispositivo de Orientación Vocacional Ocupacional. (AU)

HIV/STI Service Delivery Within Juvenile Community Supervision Agencies: A National Survey of Practices and Approaches to Moving High-Risk Youth Through the HIV Care Cascade.

Justice-involved youth (JIY) are at considerable risk for human immunodeficiency virus (HIV), but are disconnected from treatment and prevention. Juvenile justice agencies providing community supervision (CS) are well positioned to provide HIV prevention, testing, and prompt referral to treatment for JIY. However, we lack an understanding of juvenile CS agency responses to HIV/sexually transmitted infection (STI) needs among JIY. We conducted a nationwide systematic assessment of how juvenile CS agencies identify, refer, and move youth through the HIV care cascade using a nationally representative sample of 195 juvenile CS agencies across 20 states. Two-thirds of CS agencies did not offer any HIV-/STI-related services, and 82% reported no collaboration with health agencies. Screening or referral for HIV risk behaviors was reported by 32% of the CS agencies and 12% for any intervention or prevention for HIV/STI risk behaviors. Between 21% and 30% of agencies were unaware of the location of local HIV/STI services. HIV/STI prevention training was not a priority for directors and was ranked second to last out of 16 training topics. Agencies where staff expressed need for HIV risk training and where specific court programming was available were more likely to provide or refer for HIV/STI screening and/or testing. Agencies were more likely to provide or refer for services if they provided pre-trial/pre-adjudication supervision, parole, or court programming. Considering the low provision of HIV/STI-related services and limited collaboration between health and justice agencies, interventions that promote cross-system collaboration designed to minimize barriers and facilitate identification, referral, and linkage to HIV services for JIY are necessary.

Os cuidados da Estratégia Saúde da Família a um adolescente vítima de bullying: uma cartografia / Mapping the provision of care to an adolescent victim of school bullying by the Family Health Strategy in Brazil

Resumo O cuidado ao adolescente envolvido em situações de "bullying" é necessariamente intersetorial, de tal modo que ultrapassa os limites do cenário escolar e amplia-se para o setor da saúde. Partindo desse princípio, este estudo buscou cartografar a produção do cuidado ofertada a um adolescente em situações de "bullying" pela Estratégia Saúde da Família. Para tal fim, foi utilizado o método da cartografia, através do fluxograma analisador e do diário de campo. Deste modo, mapas do cuidar foram produzidos pelos profissionais de saúde, entretanto esse cuidar mostrou-se descompassado, árido e pouco resolutivo. Apesar disso, através do uso dos instrumentos de pesquisa, foi possível inaugurar outras formas de amparo ao adolescente. A equipe, ao visualizar seu trajeto em busca de suporte, repensou modos engessados de fazer saúde e, assim, tornou-se possível produzir um cuidado com outras possibilidades de vida, para além do aspecto biológico. A atenção à saúde do adolescente envolvido com o "bullying" mostrou-se oscilante na Estratégia Saúde da Família. No entanto, por meio da cartografia, ficou evidente o papel crucial da atenção primária em suportar o adolescente, o que poderia contribuir para a cessação do ciclo da violência.

Abstract The provision of care to adolescents who are victims of bullying is necessarily intersectoral and, as such, goes beyond the limits of the school context. Underpinned by this principle, this study mapped the care provided to an adolescent victim of bullying by the Family Health Strategy, using cartography to elaborate an analytical flow chart of the pathway taken by the patient through the health service. The care maps produced by the health professionals involved in the process showed that care was out of step, dry and had a low level of resolvability. Despite these findings, the use of this instrument allowed the health team to propose other forms of support for the adolescent. After visualizing the pathway taken by the patient through the care network, the team was able to rethink limiting approaches to health care and discover other care possibilities that go beyond physical dimensions. The care provided by the Family Health Strategy was shown to be inconsistent. However, the mapping activity clearly showed that primary care services play a crucial role in providing appropriate support to adolescent victims of bullying and breaking the cycle of violence.

[Family Care Centres for health protection and promotion of individuals and communities: a reflection at the time of the Coronavirus]. / Il consultorio familiare per la tutela e promozione della salute dei singoli e delle comunità: una riflessione ai tempi del Coronavirus.

THE CONTEXT: among the community health services representing a resource to face the COVID-19 emergency, there are the Family Care Centres (FCCs). A national study coordinated by the Italian National Institute of Health (ISS) and funded by the Italian Ministry of Health, recently described their activities and needs, highlighting a large interregional variability in the number of centres and staff availability. Ante and post-natal care, cervical cancer screening and actions addressed at teenagers are the FCCs strategic activities. THE CF IN FRONT OF COVID-19: despite the need to limit the offer of care to the services that cannot be postponed during the lockdown, many FCCs have been exemplary in promptly reorganizing activities in the new context. The paper presents a selection of experiences carried out from March to June 2020 by some FCCs in different Italian Regions concerning FCCs strategic activities. CONCLUSIONS: the combined reading of some of the results of the ISS study and of the activities implemented during the COVID-19 pandemic offers a measure of the ability of the FCCs to respond to the needs of the community and to adapt to change. These services based on an innovative health model deserve enhancement and support.

Supportive Community Resources Are Associated with Lower Risk of Substance Use among Lesbian, Gay, Bisexual, and Questioning Adolescents in Minnesota.

Research has indicated that lesbian, gay, bisexual, and queer/questioning (LGBQ) adolescents have disproportionately high rates of substance use compared to heterosexual peers; yet certain features of schools and communities have been associated with lower substance use rates in this population. To advance this field, research examining multiple levels of influence using measures developed with youth input is needed. With community, school, and student data, this study tested hypotheses that LGBQ students attending high schools and living in communities with more LGBQ-supportive environments (assessed with a novel inventory tool) have lower odds of substance use behaviors (cigarette smoking, alcohol use, marijuana use, prescription drug misuse, and other drug use) than their peers in less supportive LGBQ environments. Multilevel models using data from 2454 LGBQ students (54.0% female, 63.9% non-Hispanic white) in 81 communities and adjusting for student and school covariates found that LGBQ adolescents who lived in areas with more community support had lower odds of frequent substance use, particularly among females. Expanding and strengthening community resources (e.g., LGBQ youth-serving organizations, LGBQ events such as a Pride parade, and LGBQ-friendly services) is recommended to further support LGBQ adolescents and reduce substance use disparities.

Adolescent friendly services: quality assessment with simulated users / Servicios amigables para adolescentes: evaluación de la calidad con usuarios simulados

ABSTRACT OBJECTIVE To assess the quality of adolescent friendly health services. METHODS Qualitative assessment using the simulated user technique in first level clinics of Health Services of Morelos, Mexico, during 2018. Ten out of 17 facilities with non-exclusive adolescent friendly services were randomly selected. An additional facility with exclusive adolescent friendly services was included as an intensive subsample. Four adolescents served as simulated users interpreting different cases in the clinics. The total of 43 semi-structured exit interviews were conducted, and two nominal groups were made to assess the perceived quality from the adolescents' perception of friendliness and experience. Thematic analysis of the data obtained was performed. RESULTS Staff attitude was highlighted as a key element in the adolescents' experience. Failures were found, such as the existence of bureaucratic barriers to access, lack of signage in clinics, lack of privacy and confidentiality, failure of physical examination during the appointment and lack of monitoring of the reasons for appointment. The exclusive clinic for adolescents offered more appropriate friendly services compared with nonexclusive clinics. CONCLUSION Although the service is accessible in most of the clinics visited, it is still far from being friendly according to international recommendations. The exclusive clinic for adolescents stood out for having better structured mechanisms that can be implemented in nonexclusive clinics to improve the care process.

RESUMEN OBJETIVO Evaluar la calidad de los servicios de salud amigables para adolescentes. MÉTODOS Evaluación cualitativa utilizando la técnica de usuario simulado en clínicas de primer nivel de los Servicios de Salud de Morelos, México durante 2018. Se seleccionaron aleatoriamente 10 de 17 establecimientos con servicios amigables no exclusivos para adolescentes. Se incluyó adicionalmente un centro con servicios amigables exclusivo para adolescentes como submuestra de tipo intensivo. Cuatro adolescentes fungieron como usuarios simulados interpretando diferentes casos de consulta en las clínicas. Se realizaron 43 entrevistas semiestructuradas de salida y se hicieron dos grupos nominales para evaluar la calidad percibida a partir de la percepción de amigabilidad y la experiencia de los adolescentes. Se realizó análisis temático de los datos obtenidos. RESULTADOS La actitud del personal destacó como un elemento clave para la experiencia de los adolescentes. Se encontraron fallas como la existencia de barreras burocráticas para el acceso, falta de señalamientos en las clínicas, falta de privacidad y confidencialidad, fallas en la exploración física durante la consulta y falta de seguimiento de los motivos de consulta. La clínica exclusiva para adolescentes ofreció servicios amigables más adecuados en comparación con las clínicas no exclusivas. CONCLUSIÓN Aunque en la mayoría de los establecimientos visitados el servicio es accesible, aun distan de cumplir con las características de amigabilidad de acuerdo con las recomendaciones internacionales. La clínica exclusiva para adolescentes destacó al contar con mecanismos mejor estructurados que pueden ser implementados en clínicas no exclusivas para mejorar el proceso de atención.

Tomando decisões na atenção à saúde de crianças/adolescentes com condições crônicas complexas: uma revisão da literatura / Making decisions on health care for children / adolescents with complex chronic conditions: a review of the literature

Resumo O perfil da assistência pediátrica passou por mudanças no Brasil e no mundo. Essa mudança se torna mais visível em pesquisas que tratam de dados de internação hospitalar ou de atenção ambulatorial especializada. Esse fato nos encaminha à ideia de que é nesses espaços que essas crianças e sujeitos que delas cuidam são mais visíveis e negociam decisões. Objetivamos, através de uma revisão da literatura, analisar o estado da arte das discussões e das definições sobre tomada de decisão, fazendo uma interpretação do material produzido à luz das perspectivas teóricas de Mol sobre as lógicas que se desenham a partir dos atores e de suas redes no que se refere à atenção às doenças crônicas; e a perspectiva das trocas de bens de cuidado no diálogo entre Martins e Moreira, acionando a Teoria da Dádiva. Concluímos que a tomada de decisão pode ser entendida como um processo de planejamento de cuidado onde participam familiares, pacientes e profissionais de saúde e está ligada ao modelo de cuidado centrado na família. Como dificuldades, citamos a predominância de uma lógica que privilegia uma escolha digna de crítica por oferecer risco de iniquidades, como a não discussão das opções de escolha e o acionamento das famílias prioritariamente em momentos de decisões difíceis.

Abstract The profile of pediatric care has gone through changes in Brazil and in the world. This process becomes more visible in surveys that deal with hospital admission or specialized outpatient care data. This fact leads us to the idea that it is in such spaces that these children and subjects who care for them are more visible and negotiate decisions. We aim to perform a state of the art literature review on decision making discussions and definitions, analyzing the current research in light of the theoretical Mol perspectives on the actors' logics of chronic diseases care; And the perspective of care goods exchanges in the dialogue between Martins and Moreira, triggering the Theory of Gift. The synthesis of the literature shows that decision making may be understood as a care planning process in which family, patients and health professionals are involved, and is linked to the family-centered care model. In terms of difficulties, we point out the prevalence of a dynamic that favors a criticizable choice because of the risks of inequality, such as the lack of discussion on the options and the actuation of the family mostly in times of difficult decisions.

Prioritizing the sexual and reproductive health and rights of adolescent girls and young women within HIV treatment and care services in emergency settings: a girl-centered agenda.

BACKGROUND: Extensive documentation exists on a range of negative sexual and reproductive health outcomes and rights violations occurring during humanitarian emergencies. We explore two central questions: Do existing policies, services, and research adequately address the SRH rights, priorities and HIV risks of adolescent girls and young women in emergency settings? What are the missed opportunities for holistically addressing the vulnerabilities experienced by those living with HIV during rapid onset disasters and long term, protracted emergencies? Authors review considerations informing real-time decision making, and highlight missed opportunities to apply a gendered lens in the delivery of AGYW-centered SRHR/HIV services. METHODS: A scoping review identified studies on HIV intervention and outcomes in emergency settings, published in the peer-reviewed literature (2002-2017). This exercise was complemented with a desk review of normative guidance, frameworks, and implementation guidelines on HIV and SRH in emergency responses, and by consultations with subject matter experts. RESULTS: The existing frameworks and guidance pay scant attention to the sexual reproductive health and rights of young women living with HIV (WLHIV), focusing mainly on prevention of mother to child transmission (PMTCT), antiretroviral therapy (ART), HIV testing services, and linkage to treatment services. Applying a gendered sexual and reproductive health lens to the response offers opportunities to identify critical implementation questions, and highlight promising practices, to better tailor current services for AGYW. CONCLUSIONS: A plurality of competing needs crowds out dedicated time and space to effectively integrate HIV and sexual and reproductive health interventions in emergency settings. Political will is required to advance multi-sectoral cooperation, through joint planning, rights-informed learning and integrative responses, and to promote creative solutions for ART continuation, drug supply and HIV testing, treatment and care. Recent advancements in policy and practice would suggest that a more AGYW-centered response is feasible.

Adolescent vaccinations: updates for the general practitioner.

PURPOSE OF REVIEW: Adolescent providers have a unique opportunity to interface with adolescents during a transformative time period. Optimizing vaccinations may protect teens against preventable but potentially deadly diseases. Healthcare providers must be aware of the evolving vaccination data and up-to-date recommendations for vaccinations. RECENT FINDINGS: In spite of the Center for Disease Control recommendations, there is a gap between the actual and desired vaccination rates of adolescents. Tetanus, diphtheria, and acellular pertussis, meningococcal against ACWY serotypes, and human papillomavirus (HPV) are vaccinations unique to the adolescent period. There has been a marked increase in pertussis cases over the last 2 decades. Either of the meningitis B vaccines may be given to 16-18 year olds and are effective in controlling college outbreaks. Increasing evidence continues to demonstrate the safety and efficacy of the HPV vaccination, although a substantial number of adolescents remain unvaccinated. Fortunately, there are proven strategies to remedy this. SUMMARY: Adolescent providers should be aware of the increase in pertussis cases over the past 2 decades and the Category B recommendation for meningococcal B vaccine at 16-18 years, and they should work towards closing the gap between the actual and desired HPV vaccination rates.

Políticas públicas na atenção à saúde mental de crianças e adolescentes: percurso histórico e caminhos de participação / Child and adolescent mental health policy: history and paths to participation

Resumo Na reforma psiquiátrica brasileira, é importante a participação de pessoas com experiência de sofrimento psíquico enquanto atores sociais na construção desse processo, que envolve a criação de novas políticas públicas, práticas, saberes e modos de relação com essa experiência. A partir do questionamento acerca do percurso histórico específico da saúde mental infantojuvenil e da participação de crianças e adolescentes nesse processo, foi feita uma revisão narrativa da literatura que busca evidenciar os momentos principais dessa trajetória, no que concerne à produção de políticas públicas e legislações. A revisão consistiu na busca de documentos técnicos e institucionais da área temática da Saúde Mental em base de dados nacionais, além de documentos legais. O material analisado versou sobre um conjunto de marcos da atenção à saúde mental de crianças e adolescentes e a análise assinalou os caminhos trilhados na construção desse campo. Ainda, na perspectiva de um comentário, foi discutida a participação de crianças e adolescentes com sofrimento psíquico nesse processo. Este artigo destaca a necessidade de construir garantias concretas de participação dessa população, possibilitando que assumam o papel de protagonista na luta pela construção e garantia de direitos.

Abstract People with mental disorders play an important role in the mental health reform process, which involves the creation of new public policies, practices, knowledge, and ways of relating to this experience. Using a guiding question addressing the history of child and adolescent mental health in Brazil and the participation of child and adolescent mental health service users in the policy construction process, a narrative literature review was undertaken framing the main policy developments and advances in this area within the overall context of the Brazilian mental health reform. A search of technical, institutional, and legal documents in the thematic area Mental Health was conducted using a national database. The material analyzed addressed milestones in child and adolescent mental healthcare, highlighting the paths taken in building this field. The article also discusses the participation of child and adolescent mental health service usersin this process in the form of a commentary. Finally, the article highlights the need to guarantee the participation of this group to enable them to play a leading role in the struggle for the construction and realization of rights.

A Mixed Methods Evaluation of Adolescent Friendly Health Clinic Under National Adolescent Health Program, Puducherry, India.

OBJECTIVES: To assess the awareness and utilization of Adolescent Friendly Health Clinic (AFHC) services among school going adolescents (14-19 y) and to explore the forces 'for' and 'against' the utilization of AFHC services in Puducherry, India. METHODS: This mixed-methods study was conducted in two primary health centres. Record review assessed the utilization of AFHC service. Survey assessed the awareness on AFHC services and self-reported illnesses and their treatment seeking behavior. Group interviews were conducted with adolescent girls, boys and healthcare providers. A summative content analysis was done to organize the 'for' and 'against' forces for service utilization. RESULTS: Of the 311 adolescents, less than 50% were aware of the services available at AFHC. Utilization of Weekly Iron and Folic Acid Supplementation was good. Only 2-10% of adolescents consulted the outpatient services of the Primary Health Centre for the treatment of their health problems. The authors found low utilization of AFHC services (15% among girls, zero among boys). One of the reasons for low utilization was poor awareness. Though free sanitary napkins motivated the girls to avail the services, boys considered the AFHC as a girl's clinic. Healthcare providers suggested that building rapport and trust with adolescents and their parents, involving school teachers and ensuring privacy in the clinic would increase the utilization. CONCLUSIONS: There is a huge gap between the awareness and utilization of AFHC services. The reasons for non-utilization were poor awareness and misconceptions about the clinic. Training of health staffs on communication skills, and supportive supervision could improve the utilization.

Salud adolescente y la mirada de los actores institucionales en cinco provincias del norte argentino. Paradigmas, percepciones y programas / Saúde adolescente e o olhar dos atores institucionais em cinco províncias do norte argentino. Paradigmas, percepções e programas. / Adolescent health and the look of institutional actors in five provinces in the north of argentina. Paradigms, perceptions and programs

Objetivo: Este artículo analiza las miradas de los diferentes funcionarios/as involucrados en las problemáticas de salud detectadas en la población adolescente, destacando las estrategias e intervenciones diseñadas para responder tales necesidades y cómo la gestión logra articularse para alcanzar los objetivos de política planteados. Metodología: Se diseñó un mapeo de actores común a las jurisdicciones analizadas (Chaco, Jujuy, Salta, Misiones y La Rioja), efectuándose entre 10 y 12 entrevistas por provincia, mediando consentimiento informado, entre los meses de octubre y noviembre de 2016. Resultados: La recolección de opiniones y experiencias de gestión muestran que no existe una estrategia en salud adolescente en el país, aunque sí abordajes planificados aislados, tanto desde algunos programas nacionales, o a través de algunas iniciativas específicas implementadas desde las provincias. Ello no implica necesariamente falta de compromiso de las/os funcionaras/os involucrados: la alta rotación agudiza el desafío, en tanto la coordinación informal descansa en vínculos individuales, que requieren recomponerse en cada cambio de responsable.

Objective: This article analyzes the opinions of public servants involved in health problems concerning adolescents, focusing on the strategies and interventions designed to address such needs, and how they manage to articulate actions in order to achieve objectives. Method: A common mapping of actors was designed for the analyzed locations (Chaco, Jujuy, Salta, Misiones and La Rioja), 10-12 interviews were done in each province, prior informed consent, between October and November 2016. Results: The opinions gathered and management experiences show that there is no stated strategy in adolescent health in the country; however, there are isolated planned approaches as part of national programs, or through specific initiatives in the provinces. This does not necessarily imply lack of commitment from civil servants: their high turnover exacerbates the challenge; informal coordination relies on individual links, which require reorganization with every change of person in charge. Conclusions: The study shows gaps leading to identify and implement policies for adolescents. These gaps go from the recognition or not of a new paradigm based on persons of rights as well as its correlation with real actions showing that such paradigm is recognized and translated into concrete actions, knowledge transmission and consistent allocation of resources. As a result, it is observed that there is not a shared strategy regarding adolescence health in the country; instead we find non-coordinated and isolated approaches, with many gaps, particularly related to mental health and addictions.

O objetivo deste trabalho analisa os olhares dos diferentes funcionários / as envolvidos em problemas de saúde detectados na população adolescente, salientando as estratégias e intervenções desenhadas para acodir a tais necessidades e como a gestão consegue articular para atingir os objetivos políticos propostos. Metodologia: Desenhou-se um mapeamento de atores comuns às jurisdições analisadas (Chaco, Jujuy, Salta, Misiones e La Rioja), realizado entre 10 e 12 entrevistas por província foi projetado, após consentimento informado, entre os meses de outubro e novembro de 2016. Os resultados : A coleta de opiniões e experiências de gestão mostram que não existe uma estratégia sobre a saúde dos adolescentes no país, embora haja abordagens planejadas isoladamente bem de alguns programas nacionais como através de algumas iniciativas específicas implementadas a partir das províncias. Isto não implica necessariamente uma falta de compromisso dos/as funcionários/as envolvidos: a alta rotatividade alavanca o desafio, enquanto a coordenação informal repousa em vínculos individuais, que requerem se recompor a cada troca de responsáveis. Conclusões: O estudo mostra a presença de lacunas no olhar que leva a identificar e implementar políticas para a adolescência. Essas lacunas se estendem desde o reconhecimento ou não de um novo paradigma baseado em sujeitos de direito, bem como em sua contraparte real em ações que mostrem que este paradigma é efetivamente reconhecido e traduzido em intenções, conhecimentos sobre a sua abordagem, e alocação de recursos consistentes com tais princípios. Como resultado, observa-se que não há necessariamente uma estratégia comum sobre a saúde dos adolescentes no país, mas abordagens planejadas isoladamente, com faltas marcadas, particularmente relacionados ao tratamento da saúde mental e adicções.

Varones adolescentes en la Ciudad de Buenos Aires: barreras de género en la prevención y atención de la salud / Adolescent males in the City of Buenos Aires: gender-based barriers to health care and prevention

RESUMEN La presente investigación surge a partir de identificar la dificultad para incluir las experiencias y necesidades de los varones adolescentes en el diseño de los modelos clínicos dirigidos a esa franja etaria y etapa vital. Por tal motivo, se decidió indagar la dimensión subjetiva de género en las prácticas que el sector salud dirige a la prevención y atención de la salud de los varones adolescentes, con el objetivo de visibilizar si estas se convierten en barreras para el avance en este campo. Para ello, se realizaron entrevistas semiestructuradas a 21 profesionales de distintas disciplinas integrantes de equipos de salud y a 14 varones adolescentes usuarios del sistema de salud de la Ciudad Autónoma de Buenos Aires; además se implementaron dispositivos grupales de indagación a adolescentes varones estudiantes de escuela secundaria, y se realizaron entrevistas en profundidad a informantes claves. Se ha identificado que las propias dinámicas institucionales no responden de modo adecuado a los riesgos que enfrentan los varones adolescentes -dentro de los cuales las construcciones hegemónicas de género cumplen un importante papel- ya que están ancladas en paradigmas biopolíticos de exclusión.

ABSTRACT This study is based on our previous work, in which we found evidence of the difficulties in including the experiences and needs of adolescent males in the design of clinical models aimed at that age group. We identified a need to explore the subjective dimension of gender in the practices of the healthcare sector directed at adolescent males, in order to determine if they constituted barriers to advancement in this field. Semi-structured interviews were conducted with 21 professionals from different disciplines who made up healthcare teams, as well as 14 adolescent males using healthcare services in the City of Buenos Aires. Additionally, group techniques were employed with adolescent male secondary school students, and in-depth interviews were conducted with key informants. We were able to determine that institutional dynamics do not adequately respond to the risks faced by adolescent males - for whom hegemonic constructions of gender play an important role - given that they are based on exclusionary biopolitical paradigms.

Mental health in children and adolescents: cision of the professionals on challenges and possibilities in building up intersectoral networks / Salud mental infanto-juvenil: la visión de los profesionales sobre las posibilidades y los desafíos en la construcción de redes intersectoriales / Saúde mental infantojuvenil: visão dos profissionais sobre desafios e possibilidades na construção de redes intersetoriais

Abstract Objective: To analyze the possibilities and challenges in building intersectoral networks in mental health in the professional's view involved in the care for children and adolescents treated at the Child and Adolescent Psychosocial Care Center. Methods: A qualitative, descriptive and exploratory research, held from May to June 2014, performed a town in southern Brazil. Data were collected through semi-structured interviews with 26 workers intersectoral networking and submitted to thematic analysis. Results: The articulation of different services and intersectoral care devices, and challenges to be overcome, the individual treatment plan, social policies that realize the real needs of users, including family and the medical-hegemonic model, were pointed out as possibilities. Conclusion: The care raised to the intersectoral level is a necessity and a way to achieve new perspectives on care and its articulations to consolidate the Child and Adolescent Mental Health policy.

Resumen Objetivo: Analizar las posibilidades y los desafíos en la construcción de redes intersectoriales en salud mental, según la opinión de los profesionales involucrados en el cuidado de niños y adolescentes atendidos en el Centro de Atención Psicosocial para Niños y Adolescentes. Métodos: Investigación cualitativa, descriptiva y exploratoria, realizada en el período de mayo a junio de 2014, en una ciudad en el sur de Brasil. Se recolectaron los datos por medio de entrevistas semiestructuradas con 26 trabajadores de redes intersectoriales y luego se los sometieron al análisis temático. Resultados: Se apuntaron como posibilidades la articulación de los diferentes servicios y dispositivos de atención intersectoriales, y los desafíos a superar, el plan de tratamiento individual, las políticas sociales que dan cuenta de las necesidades reales de los usuarios, incluyendo la familia y el modelo médico-hegemónico. Conclusión: El cuidado elevado al plan intersectorial es una necesidad y un modo de lograr nuevas miradas sobre el cuidado y sus articulaciones para consolidar la política de Salud Mental del Niño y del Adolescente.

Resumo Objetivos: Analisar as possibilidades e desafios na construção de redes intersetoriais em saúde mental na visão dos profissionais envolvidos no cuidado a crianças e adolescentes atendidos no Centro de Atenção Psicossocial Infantojuvenil. Metodologia: Pesquisa qualitativa, descritiva e exploratória, realizada no período de maio a junho de 2014, em um município do Sul do Brasil. Os dados foram coletados por meio de entrevistas semiestruturada com 26 trabalhadores da rede intersetorial e submetidos à análise temática. Resultados: Apontaram-se como possibilidades a articulação de diferentes serviços e dispositivos de cuidado intersetorial, e desafios a serem superados, o plano terapêutico singular, as políticas sociais que percebem as reais necessidades dos usuários, a inclusão da família e o modelo médico-hegemônico. Conclusões: O cuidado elevado ao plano intersetorial é uma necessidade e um modo de lograr novos olhares sobre o cuidado e suas articulações para consolidação da política de Saúde Mental da Criança e Adolescente.