الملخص
Resumo O artigo aborda a implementação da estratégia de Redução de Danos (RD) por equipes multiprofissionais nos Centros de Atenção Psicossocial Álcool e outras Drogas (Caps AD) do Distrito Federal. A partir dos aportes teóricos dos estudos sobre implementação de políticas públicas e da sociologia das profissões, buscou-se refletir sobre as implicações do multiprofissionalismo para a tradução da RD em ações práticas junto aos usuários dos serviços. Realizou-se pesquisa de campo nas sete unidades de Caps AD do Distrito Federal, onde as atividades cotidianas foram observadas e profissionais foram entrevistados. A análise revelou que: (1) há variação substantiva na forma como os profissionais atuantes nos Caps AD interpretam e praticam a RD; (2) suas diferentes formas de entendimento e ação associam-se à formação profissional em distintos campos de conhecimento (psicossocial versus biomédico); e (3) estas divergências podem resultar em conflitos entre profissionais e implicar consequências negativas para os usuários dos serviços. Discute-se, também, os meios encontrados pelas gerências para a gestão e mitigação destas implicações. Os achados contribuem para reflexões mais amplas sobre os desafios que se impõem à sustentabilidade do modelo de atenção proposto para os Caps AD.
Abstract The article focuses on the implementation of the Harm Reduction strategy by multiprofessional teams in the Centers for Psychosocial Attention to Users of Alcohol and other Drugs (CAPS AD) at the Brazilian Federal District. Based on theoretical propositions from the fields of policy implementation and sociology of professions, it sought to reflect upon the implications of different professional perspectives about the concept of Harm Reduction, and its translation into practice, for the aims of the Ministry of Health Care Policy for Alcohol and Other Drugs Users and its beneficiaries. Our study is supported by empirical research involving qualitative fieldwork on the seven units of CAPS AD in the Federal District. Our findings suggest that: (1) there is substantive variation in the way CAPS AD professionals interpret and practice harm reduction principles; (2) this variation is associated with professional education in distinct fields of knowledge (psychosocial versus biomedical); and (3) divergences among professionals may result in conflicts and produce negative consequences for service users. We also discuss the means by which service managers seek to mitigate those negative implications. These findings contribute to broader reflections on the challenges for sustainability of the Caps AD model.
الموضوعات
Humans , Male , Female , Patient Care Team , Public Policy , Substance-Related Disorders , Harm Reduction , Alcoholism , Mental Health Servicesالملخص
The article argues that variations in the outcomes of the same public policy can be explained by different practices and enforcement styles adopted by front-line bureaucrats. Based on extensive field research on the enforcement of labor legislation in Brazil, the author develops a typology of the outcomes of labor inspection in terms of levels of compliance with labor regulations in different economic activities. Findings from comparative analysis (across and within cases) indicate consistent associations between the enforcement style adopted by labor inspectors that combines sanctions with technical and/or legal assistance, and the reconciliation of labor rights with increased company performance and competitiveness.
Dans cet article, on avance que des différences dans les résultats d'une même politique publique peuvent s'expliquer à partir des différentes pratiques et styles d'implantation adoptés par des bureaucrates. Prenant appui sur une longue recherche sur le terrain concernant la mise en place de la politique d'inspection du travail au Brésil, on pose une typologie de ses résultats quant au respect de la législation du travail dans diverses activités économiques. Des analyses comparatives révèlent des associations systématiques entre, d'un côté, l'adoption par les inspecteurs d'un style d'implantation qui associe sanctions et orientation technique et/ou légale et, d'un autre, l'harmonie des droits du travail avec de plus grandes performances et une compétitivité des entreprises.