Emerging integrated care models for children and youth with mental health difficulties in Norway: a horizon scanning study.

BACKGROUND: The implementation of Integrated Care Models (ICMs) represents a strategy for addressing the increasing issues of system fragmentation and improving service customization according to user needs. Available ICMs have been developed for adult populations, and less is known about ICMs specifically designed for children and youth. The study objective was to summarize and assess emerging ICMs for mental health services targeting children and youth in Norway. METHODS: A horizon scanning study was conducted in the field of child and youth mental health. The study encompassed two key components: (i) the identification of ICMs through a review of both scientific and grey literature, as well as input from key informants, and (ii) the evaluation of selected ICMs using semi-structured interviews with key informants. The aim of the interviews was to identify factors that either promote or hinder the successful implementation or scale up of these ICMs. RESULTS: Fourteen ICMs were chosen for analysis. These models encompassed a range of treatment philosophies, spanning from self-care and community care to specialized care. Several models placed emphasis on the referral process, prioritizing low-threshold access, and incorporating other sectors such as housing and child welfare. Four of the selected models included family or parents in their target group and five models extended their services to children and youth beyond the legal age of majority. Nine experts in the field willingly participated in the interview phase of the study. Identified challenges and facilitating factors associated with implementation or scale up of ICMs were related to the Norwegian healthcare system, mental health care delivery, as well as child and youth specific factors. CONCLUSION: Care delivery targeting children and youth's mental health requires further adaptation to accommodate the intricate nature of their lives. ICMs have been identified as a means to address this complexity by offering accessible services and adopting a holistic approach. This study highlights a selection of promising ICMs that appear capable of meeting some of the specific needs of children and youth. However, it is recommended to subject these models to further assessment and refinement to ensure their effectiveness and the fulfilment of their intended outcomes.

Atendimento psicossocial à mulher que comete ofensa sexual / Psychosocial attention for women that commit sexual offenses / Atención psicosocial para mujeres que cometen delitos sexuales

Objetivamos apresentar uma proposta de atendimento psicossocial grupal oferecida para mulheres adultas que cometeram ofensa sexual, cuidadoras e mães. A experiência está sendo desenvolvida no Distrito Federal, Brasil, com pessoas do gênero feminino provenientes de encaminhamento judicial. Carece que os profissionais das áreas da justiça, saúde, serviço social e psicologia avancem no estudo e na compreensão desta temática, de modo a pensarem a atuação e o apoio terapêutico a essas mulheres. O modo de atendimento é focal e breve, com ênfase na criação de um ambiente lúdico como facilitador das interações grupais e da discussão sobre os temas: identidade; confiança nas relações afetivas e sociais; vivência pessoal com violência física e sexual; configuração de gênero; e expressão da sexualidade e futuro. A abordagem individual também se baseia no enfoque dos temas mencionados. O oferecimento de ajuda à mulher cuidadora ou à mãe tem participação ativa na interrupção do circuito abusivo sexual, pois essa violência é extremamente ocultada, ocasionando uma prolongada vulnerabilidade para as vítimas. Ressalta-se o valor do texto indicando a descrição de ação voltada para uma população permanentemente não estudada e evitada em seu reconhecimento. Os limites desta proposta encontram-se na falta de outras iniciativas que possibilitem uma discussão sobre essa experiência.(AU)

We aim to present a proposal of a group psychosocial intervention offered for adult female sexual offenders, caregivers, and mothers. The intervention is being developed at Federal District, Brazil, with female people coming from judicial referrals. Professionals in the areas of justice, health, social work, and psychology need to advance in the study and understanding this theme to think about action and therapeutic support for these women. The intervention is a focal and brief approach, with emphasis on the creation of a ludic environment as a facilitator of group interactions and discussion about the themes: identity; trust in affective and social relationships; personal experience with physical and sexual violence; gender configuration; and sexuality expression and future. The individual approach is also based on focusing on these themes. The offering of help to the female caregiver or the mother has an active participation in the interruption of the sexual offense circuit, since this violence is extremely hidden, bringing a prolonged condition of vulnerability to the victims. The value of this text is highlighted indicating the description of an action directed to a population that is permanently not studied and whose recognition is avoided. The limits of this proposal are found in the absence of other initiatives that would allow a discussion about this experience.(AU)

Este texto presenta una propuesta de atención psicosocial grupal destinada a mujeres adultas que han cometido delito sexual, a cuidadoras y madres. La intervención se está desarrollando en el Distrito Federal (Brasil), con personas del género femenino provenientes de remisiones judiciales. Es necesario que los profesionales de las áreas de justicia, salud, trabajo social y psicología avancen en el estudio y comprensión de esta temática para pensar en el desempeño y apoyo terapéutico de estas mujeres. El servicio es enfocado y breve, con énfasis en la creación de un ambiente lúdico como facilitador de interacciones grupales y discusión sobre los temas: identidad; confianza en las relaciones afectivas y sociales; experiencia personal con violencia física y sexual; configuración de género; y expresión de la sexualidad y el futuro. El enfoque individual también se centra en estos temas. La oferta de ayuda a la mujer cuidadora o a la madre es importante para la interrupción del circuito de abuso sexual, ya que esta violencia es extremadamente oculta y provoca una vulnerabilidad prolongada a las víctimas. Se destaca el valor del texto con la descripción de la acción dirigida a una población que no es objeto de estudios ni reconocida. Los límites de esta propuesta se encuentran en la ausencia de otras iniciativas que permitan un debate sobre esta experiencia.(AU)

Implicações da prática profissional no acolhimento institucional de crianças: perspectiva de cuidadoras / Implications of professional practice in children's institutional sheltering: caregivers' perspective / Implicaciones de la práctica profesional en el alojamiento institucional de niños: perspectiva de cuidadoras

Este estudo qualitativo teve como objetivo compreender, a partir da teoria de bioecológica de desenvolvimento, as implicações da prática profissional no processo de acolhimento de crianças em uma casa-abrigo, na perspectiva de cuidadoras. As participantes foram 10 profissionais de uma casa-abrigo localizada na região sul do Brasil. Utilizou-se a entrevista semiestruturada e a organização e análise dos dados sustentou-se na Grounded Theory, com auxílio do software Atlas.ti 8.4.14. Os resultados evidenciaram uma centralização das ações de acolhimento e atenção em torno dos cuidados físicos das crianças. As ações para promover suporte e cuidados emocionais dentro da casa-abrigo eram delegadas às profissionais da equipe técnica da instituição. Observou-se que as dificuldades encontradas pelas cuidadoras diziam respeito à falta de segurança e preparação para responder e acolher as demandas emocionais das crianças, as quais estão presentes em diversos momentos do processo de acolhimento. Percebeu-se que as práticas institucionais afetaram decisivamente tanto as ações de acolhimento das participantes e o suporte emocional oferecido às crianças na passagem pela casa-abrigo quanto as cuidadoras, no sentido de vivenciarem no trabalho sentimentos de insegurança. Os resultados tensionam ecologicamente a interação nos processos proximais presentes no desenvolvimento humano. Advoga-se pela reflexão sobre as implicações das práticas institucionais de uma casa-abrigo e o desenvolvimento infantil, visando o cuidado integral dos acolhidos.(AU)

Based on the developmental bioecological theory, this study analyzes the implications of professional practice in children's user embracement at a shelter from the caregivers' perspective. Semi-structured interviews were conducted with 10 professionals from a shelter located in southern Brazil. Data organization and analysis was performed based on Grounded Theory using the Atlas.ti 8.4.14 software. Results showed that embracement and attention focus on the physical care of children. Support and emotional care activities were delegated to the institution's technical team. Caregivers faced difficulties regarding the lack of security and preparation to respond to and accept the children's emotional demands, which arise at different moments in the embracement process. The institutional practices decisively affected both user embracement actions and the emotional support offered to the children, as well as the caregivers, in the sense of experiencing feelings of insecurity. These findings ecologically tension the interaction in the proximal processes present in human development. Further reflections on the implications of institutional shelter-based practices for child development are needed to provide comprehensive care.(AU)

Este estudio cualitativo tuvo como objetivo comprender, desde la perspectiva de la teoría bioecológica del desarrollo, las implicaciones de la práctica profesional en el proceso de acogida de niños en una institución infantil desde la perspectiva de las cuidadoras. Las participantes fueron 10 profesionales de una institución de acogida infantil ubicada en la región Sur de Brasil. Se utilizó la entrevista semiestructurada, y para la organización y análisis de datos se aplicó Grounded Theory, con el uso del software Atlas.ti 8.4.14. Los resultados mostraron que las acciones de recepción y atención se centran en el cuidado físico de los niños. Las acciones de promoción de apoyo y cuidado emocional dentro del alojamiento se asignaron a los profesionales del equipo técnico de la institución. Se observó que las dificultades encontradas por las cuidadoras estaban relacionadas con la falta de seguridad y preparación para responder y aceptar las demandas emocionales de los niños, las cuales se encuentran presentes en diferentes momentos del proceso de acogida. Se notó que las prácticas institucionales afectaron decisivamente tanto las acciones de acogida de las participantes como el apoyo emocional que la institución brinda a los niños durante su paso, así como a las cuidadoras en el sentido de experimentar sentimientos de inseguridad en el trabajo. Estos resultados tensan ecológicamente la interacción en los procesos proximales presentes en el desarrollo humano. Se aboga por reflexionar sobre las implicaciones de las prácticas institucionales en los alojamientos institucionales y el desarrollo infantil, apuntando a la atención integral de los acogidos.(AU)

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Expectativas de mães e cuidadoras sobre participação em um programa de prevenção à violência / Expectations of mothers/caregivers regarding the participation in a violence prevention program / Expectativas de madres/cuidadoras sobre la participación en un programa de prevención de la violencia

O presente estudo qualitativo objetivou compreender as expectativas de mães e cuidadoras sobre a sua participação no Programa ACT para Educar Crianças em Ambientes Seguros na versão remota, no período da pandemia de covid-19. Também visou identificar a percepção das participantes sobre educar uma criança em um ambiente seguro. Foram realizadas entrevistas semiestruturadas on-line com doze mães e cuidadoras, antes da participação no Programa ACT. Os resultados indicaram diferentes expectativas sobre a participação no Programa ACT, entre elas: adquirir novos conhecimentos, aprimorar as habilidades parentais, trocar experiências, receber auxílio no momento da pandemia de covid-19 e possibilitar para a criança um desenvolvimento saudável. Na percepção das mães e cuidadoras, a versão remota do Programa ACT apresenta aspectos positivos; entre eles, a participação de pais e cuidadores que não residem na cidade em que é oferecida a intervenção. No entanto, apontaram como fatores negativos a ausência do contato físico e as interrupções que podem acontecer a partir das falhas de internet. Para as mães e cuidadoras, educar a criança em um ambiente seguro estava relacionado a promover os direitos estabelecidos no Estatuto da Criança e do Adolescente (ECA), como educação, saúde, lazer, cuidado, afeto, assim como protegê-la de situações de violência. Considera-se que as expectativas das participantes estavam alinhadas aos objetivos do Programa ACT. Torna-se prioritário oferecer programas de prevenção à violência aos pais e cuidadores, em especial em momentos adversos como o da pandemia de covid-19, a fim de promover o desenvolvimento e a saúde das crianças, assim como prevenir situações de violação de direitos.(AU)

This qualitative study aims to understand the expectations of mothers and caregivers about participating in the ACT Raising Safe Kids Program in its remote version, during the COVID-19 pandemic period. It also aims to identify the participants' perception of raising a child in a safe environment. Semi-structured on-line interviews were conducted with 12 mothers/caregivers, prior to participation in the ACT Program. The results indicated different expectations regarding the participation in the ACT Program, for example: acquiring new knowledge, improving parenting skills, exchanging experiences, receiving support during the COVID-19 pandemic, and enabling the child to have a healthy development. In the perception of mothers and caregivers, the remote version of the ACT Program has positive aspects, such as the participation of parents and caregivers who do not live in the city where the intervention is offered. However, they pointed out as negative factors absence of physical contact and interruptions due to internet failures. For the mothers/caregivers, educating children in a safe environment was related to promoting the rights established by the Brazilian Child and Adolescent Statute, namely education, health, leisure, care, affection, as well as protecting them from situations of violence. The expectations of the participants were aligned with the objectives of the ACT Program. Offering violence prevention programs to parents and caregivers is a priority, especially in adverse moments such as the COVID-19 pandemic, in order to promote the development and health of children, as well as prevent situations of violation of rights.(AU)

Este estudio cualitativo pretendió comprender las expectativas de madres y cuidadoras sobre la participación en el Programa de ACT para Educar a Niños en Ambientes Seguros en la versión remota, en el periodo de la pandemia de la COVID-19. También se propuso identificar la percepción de las participantes sobre educar a un niño en un ambiente seguro. Se llevaron a cabo entrevistas semiestructuradas en línea con 12 madres/cuidadoras, antes de la participación en el Programa ACT. Los resultados señalaron diferentes expectativas con la participación del Programa de ACT, entre ellas: adquirir nuevos conocimientos, perfeccionar las habilidades parentales, intercambiar experiencias, recibir auxilio en el momento de la pandemia de la COVID-19 y posibilitar al niño un desarrollo saludable. En la percepción de las madres y cuidadoras, la versión remota del Programa de ACT presenta aspectos positivos, como la participación de padres y cuidadores que no residen en la ciudad donde es ofrecida la intervención. Sin embargo, señalaron como factores negativos la ausencia del contacto físico y las interrupciones, que pueden ocurrir por fallas en Internet. Para las madres/cuidadoras, educar al niño en un ambiente seguro estaba relacionado a promover los derechos establecidos en el Estatuto del Niño y del Adolescente de Brasil, como educación, salud, ocio, cuidado, afecto, así como protegerlo de situaciones de violencia. Se considera que las expectativas de las participantes estaban alineadas con los objetivos del Programa de ACT. Es prioritario ofrecer programas de prevención a la violencia a los padres y cuidadores, en especial en momentos adversos como el de la pandemia de la COVID-19, con el fin de promover el desarrollo y la salud de los niños, así como prevenir situaciones de vulneración de derechos.(AU)

Notas sobre o pesquisar em cena(s) / Notes on researching in scenes / Notas sobre la investigación en escena(s)

O presente artigo tem como objetivo apresentar a construção metodológica desenvolvida em uma pesquisa de mestrado, na qual sustentamos a escrita de cenas como método de pesquisa da escuta clínica. As cenas do trabalho em questão foram recolhidas ao longo do tempo, no contorno da experiência de um projeto de extensão universitária de atenção à infância e adolescência em situação de vulnerabilidade social, situado em uma comunidade periférica. Apresentamos, neste texto, as interrogações que se elaboraram em torno da escolha pelo trabalho com cenas, e compartilhamos o resgate histórico dessas como um método de escrever a clínica, bem como a retomada de sua análise a partir da tradição psicanalítica. Amparadas nesta teoria e em leituras e contribuições do filósofo francês Jacques Derrida, embasamos a noção de que a cena se constitui como um lugar de produção, ao engendrar a configuração particular de elementos significantes nos processos de subjetivação e de construção social. A cena não é, então, compreendida aqui como uma representação do que acontece na clínica, mas como um modo de produzir a escuta e os seus processos de investigação.(AU)

This article aims to present the methodological construction developed in a master's research, in which the writing of scenes as a method of clinical listening research was endorsed. The scenes from the study in question were collected over time, from the experience gained in a project conducted within a university extension program on care in childhood and adolescence in social vulnerability, in a peripheral community. In this study, we present some questions that were elaborated surrounding the choices of working with scenes; and we share the historical rescue of this work as a method of writing on clinic practices and resuming their analysis from the psychoanalytic tradition. Based on the psychoanalytic theory and on the readings and contributions of the French philosopher Jacques Derrida, we corroborate the notion that the scene is constituted as a place of production, engendering the particular configuration of significant elements in the processes of subjectivation and social construction. Here, the scene is not a representation of clinical practice but one mode of producing listening and its research processes.(AU)

Este artículo tiene como objetivo presentar la construcción metodológica desarrollada en una investigación de maestría, en la que sostenemos la escritura de escenas como método de investigación de la escucha clínica. Las escenas del trabajo en cuestión se recogieron a lo largo del tiempo desde la experiencia en un proyecto de extensión universitario de atención a la niñez y adolescencia en situación de vulnerabilidad social aplicado en una comunidad periférica. En este texto, presentamos los interrogantes que se elaboraron en torno a la elección por el trabajo con escenas y compartimos el rescate histórico de las mismas como un método de escribir la clínica y la reanudación del análisis a partir de la tradición psicoanalítica. Amparadas en el psicoanálisis y en lecturas y contribuciones del filósofo francés Jacques Derrida, nos basaremos en la noción de que la escena se constituye como un lugar de producción, engendrando la configuración particular de elementos significantes en los procesos de subjetivación y de construcción social. La escena no es aquí una representación de lo que pasa en la clínica, sino un modo de producir escucha y sus procesos de investigación.(AU)

A relação com o saber nas atividades lúdicas escolares / The relationship with knowledge in school recreational activities / La relación con el saber en las actividades lúdicas escolares

O brincar é uma atividade importante para o desenvolvimento infantil, porque melhora aspectos cognitivos, emocionais e físicos. Além disso, jogos e brincadeiras podem ser explorados como recurso educacional. Partindo do entendimento da ludicidade enquanto um processo subjetivo, este trabalho investigou a relação com o saber estabelecida durante as brincadeiras, buscando compreendê-las em suas dimensões epistêmica, social e identitária. Dezesseis estudantes do 5º ano do ensino fundamental foram entrevistados a partir de um roteiro baseado no instrumento "balanço do saber", proposto por Bernard Charlot. As questões foram adaptadas para possibilitar apreender o que as crianças dizem aprender durante as brincadeiras em que participam, com ênfase naquelas realizadas em sala de aula. Os resultados da análise de conteúdo realizada mostraram que, apesar de existirem conflitos sobre como se estabelecem as funções lúdica e educativa, quando a brincadeira infantil é utilizada como recurso pedagógico, os sujeitos podem identificar benefícios no processo de aprendizagem por meio dela. Aponta-se, também, a necessidade de considerar a condição social da criança no ambiente escolar para o sucesso ao utilizar essas atividades como práticas pedagógicas.(AU)

Child's play is an important activity for child development since it improves cognition, emotional, and physical aspects. Games can also be explored as an educational resource. Starting from the understanding that playfulness is a subjective process, this work has investigated the relationship to the knowledge stablished during games, aiming to understand it in its epistemic, social, and identitary dimensions. A group of 16 5th grade students were interviewed from a script based on the instrument "balance of knowledge," as proposed by Bernard Charlot. The questions were adapted to enable the apprehension of what children say they learn on the games they play, emphasizing those which are played in classrooms. The results of the content analysis performed have showed that, despite the conflicts on how both playful and educative functions are stablished when child's play is used as a pedagogic resource, the subjects can identify benefits on the process of learning with it. The need to consider the child's social condition in the school environment to reach success when using these activities as pedagogical practices is also pointed out.(AU)

Jugar es una actividad importante para el desarrollo de los niños, porque mejora aspectos cognitivos, emocionales y físicos. Por tanto, los juegos son explorados como recurso educativo. Partiendo de la comprensión de que lo lúdico es un proceso subjetivo, este trabajo analizó la relación con el saber que se establece durante el juego, con el objetivo de comprenderlo en sus dimensiones epistémica, social e identitaria. Se entrevistó a dieciséis estudiantes de quinto grado a partir de un guion basado en el instrumento "balance del saber" propuesto por Bernard Charlot. Las preguntas fueron adaptadas para permitir la aprehensión de lo que los niños dicen que aprenden en sus juegos, enfatizando los que se juegan en las aulas. Los resultados del análisis de contenido realizado mostraron que, a pesar de que existen conflictos sobre cómo se establecen ambas funciones lúdica y educativa cuando se utiliza el juego infantil como recurso pedagógico, los niños pueden identificar beneficios en el proceso de aprendizaje a través del juego. Se señala la necesidad de considerar la condición social del niño en el entorno escolar para alcanzar el éxito al utilizar estas actividades como prácticas pedagógicas.(AU)

Plano EVA-TO: plano de enfrentamento à violência autoprovocada do Estado do Tocantins com ênfase na atenção integral à saúde / EVA-TO Plan: plan to face self-inflicted violence in the State of Tocantins with an emphasis on comprehensive health care

O Plano de Enfrentamento à Violência Autoprovocada do Estado do Tocantins com Ênfase na Atenção Integral à Saúde foi desenvolvido para fortalecer a rede de atenção psicossocial, em colaboração com o Sistema Único de Saúde (SUS) e o Sistema Único de Assistência Social (SUAS). Elaborado pelo Grupo de Trabalho "Flor de Pequi", o plano tem como objetivo qualificar a Rede de Atenção à Saúde, orientando gestores e profissionais de saúde na prevenção da violência autoprovocada, automutilação e suicídio, além de promover o acolhimento e compartilhamento do cuidado na rede de atenção à saúde. O documento foi elaborado em resposta a demandas relacionadas aos dados de violência autoprovocada, solicitações do Conselho Estadual de Defesa de Direitos da Criança e do Adolescente e do Conselho Regional de Psicologia. A metodologia, discussão, metas, ações e monitoramento também são abordados no plano.

The Plan for Confronting Self-Inflicted Violence in the State of Tocantins with an Emphasis on Comprehensive Health Care was developed to strengthen the psychosocial care network in collaboration with the Unified Health System (SUS) and the Unified Social Assistance System (SUAS). Elaborated by the "Flor de Pequi" Working Group, the plan aims to enhance the Health Care Network by providing guidance to managers and health professionals in the prevention of self-inflicted violence, self-harm, and suicide, while promoting care and support within the health care system. The document was created in response to demands related to self-inflicted violence data, requests from the State Council for the Defense of the Rights of Children and Adolescents, and the Regional Psychology Council. The plan also addresses methodology, discussion, goals, actions, and monitoring.

El Plan de Enfrentamiento a la Violencia Autoinfligida en el Estado de Tocantins con Énfasis en la Atención Integral de Salud fue desarrollado para fortalecer la red de atención psicosocial en colaboración con el Sistema Único de Salud (SUS) y el Sistema Único de Asistencia Social (SUAS). Elaborado por el Grupo de Trabajo "Flor de Pequi", el plan tiene como objetivo calificar la Red de Atención a la Salud, brindando orientación a los gestores y profesionales de la salud en la prevención de la violencia autoinfligida, la automutilación y el suicidio, además de promover el cuidado y apoyo dentro de la red de atención sanitaria. El documento fue elaborado en respuesta a demandas relacionadas con datos de violencia autoinfligida, solicitudes del Consejo Estatal para la Defensa de los Derechos de la Niñez y la Adolescencia y del Consejo Regional de Psicología. El plan también aborda la metodología, la discusión, las metas, las acciones y el monitoreo

Terapia Ocupacional com crianças e jovens em pandemia: análise de processos de trabalho e reflexões para uma prática emancipatória / Occupational Therapy with children and young people during pandemic: analysis of work processes and reflections for an emancipatory practice / Terapia Ocupacional con niños y jóvenes en pandemia: análisis de procesos de trabajo y reflexiones para una práctica emancipativa

Contextualização: A partir de práticas de terapeutas ocupacionais na cidade de São Paulo, durante a pandemia do coronavírus, este artigo apresenta dois processos de trabalhos de terapeutas ocupacionais com crianças e jovens. Síntese dos elementos do estudo: análise dos processos de trabalho das profissionais no âmbito do SUS. Ferramentas específicas fundadas emuma abordagem crítica foram identificadas e descritas: análise do cotidiano com desenvolvimento de recursos adaptativos; análise de elementos da reprodução social; mapeamento, análise, proposição e legitimação de atividades significativas; articulação de recursos materiais para engajamento nestas atividades. Conclusão: Enfatizaram-se as contradições do modo de produção capitalista e das estruturas sociais ao produzir reflexões sobre uma prática situada e contextualizada.(AU) Palavras-chave: Terapia Ocupacional. COVID-19. Infância. Juventude. Saúde Coletiva

Contextualization: Based on the practices of occupational therapists in the city of São Paulo, during the coronavirus pandemic, this article presented two work processes of occupational therapists with children and young people. Synthesis of the study's elements: analysis of the processes of professionals in the work within the scope of SUS. Specific tools based on a critical approach were identified and described: daily analysis and the development of adaptive resources; analysis of elements of social reproduction; mapping, analysis, proposition and legitimization of meaningful activities; articulation of material resources to engage in these activities. Conclusion: The contradictions of the mode of production and social structures were emphasized while producing reflections on a situated and contextualized practice.(AU) Keywords: Occupational Therapy. COVID-19. Childhood youth. Collective Health

Objetivo: A partir de las prácticas de los terapeutas ocupacionales en la ciudad de São Paulo, durante la pandemia del coronavirus, este artículo presentado dos procesos de trabajo de terapeutas ocupacionales con niños y jóvenes. Síntesis de los elementos del estudio: análisis de los procesos de trabajo de los profesionales, en el ámbito del SUS. Se identificaron y describieron herramientas específicas basadas en un enfoque crítico: análisis diario con el desarrollo de recursos adaptativos; análisis de elementos de reproducción social; mapeo, análisis, propuesta y legitimación de actividades significativas; articulación de recursos materiales para participación en estas actividades. ConclusiónLas contradicciones del modo de producción y las estructuras sociales se enfatizaron al producir reflexiones sobre una práctica situada y contextualizada.(AU) Palabras clave: Niñez. Colaboración intersectorial. Terapia ocupacional. Participación comunitaria

"Because the resources aren't there, then we fail. We fail as a society": A Qualitative Analysis of Human Trafficking Provider Perceptions of Child Welfare Involvement among Trafficked Mothers.

BACKGROUND: Little is understood about child welfare involvement (CWI) in cases where the birth mother has experienced human trafficking. OBJECTIVES: The aim of this study was to explore provider perceptions of the impact of CWI for the trafficked mother. METHODS: Participants were selected among providers caring for trafficked birth mothers. Semi-structured interviews were conducted with providers and qualitative content analysis was conducted. RESULTS: Interviewees reported reasons for CWI, positive and negative impacts of CWI and provided recommendations for systems improvement. CONCLUSION FOR PRACTICE: Recommendations from this exploratory study include mechanisms to support trafficked mothers, train hospital social workers, and systems change. During the prenatal period, strategies to support the trafficked mother may include addressing gaps in social determinants of health, ensuring appropriate medical and mental health care, early screening and referral to substance use treatment services, enhancing community support, and working to develop safety plans for survivors and their families. Enhanced engagement of social workers and all providers to improve understanding of the unique complexity of trafficked mothers is needed. Education should include an understanding that judgement of a caretaker's ability to parent should be current and holistic and not reflexive based on history in the electronic medical record. An exploration of the child welfare system itself should also be undertaken to identify and modify discriminatory laws and policies. Finally, efforts to address social determinants of health in the community and enhance the trauma-informed nature of child welfare referrals could improve the lives of trafficked mothers.

Call to action: Prioritizing sleep health among US children and youth residing in alternative care settings.

Sleep health is a critical but under-recognized area of concern for the more than 650,000 children served by the US child welfare system each year. While sleep is vital to optimal child health and development, it is likely harmed by the multiple adversities and traumas experienced among children and youth residing in alternative care settings (ie, kinship care, nonrelative foster care, group homes). Children residing in alternative care settings have experienced, at a minimum, the trauma of removal from a biological parent's care and would benefit from holistic, comprehensive care approaches inclusive of sleep health. Furthermore, few studies are currently available to guide practitioners and policymakers in promoting sleep health among these children. In this Call to Action, our goal is to draw attention to the sleep health of children residing in alternative care settings. We highlight the need for a more robust evidence base to address major knowledge gaps and outline concrete steps toward building future promising sleep health-promoting practices and policies supporting children residing in alternative care settings.

A cidade e a infância: possibilidades da saúde mental na atenção básica / The city and the childhood: mental health care possibilities in primary care / La ciudad y la infancia: posibilidades de salud mental en atención primaria

Este estudo se configura como um relato de experiência sobre o encontro entre infância e Atenção Primária à Saúde, a partir do trabalho em uma Unidade de Saúde da Família do município de Porto Alegre, por meio do núcleo profissional da psicologia. Essa vivência faz parte do percurso formativo do Programa Atenção Básica da Residência Integrada em Saúde da Escola de Saúde Pública do Estado do Rio Grande do Sul. A partir do encontro com as demandas relativas à saúde mental de crianças nesse contexto, que frequentemente se apresentavam como questões individuais, comportamentais, e carregavam expectativa de correção, buscou-se problematizar as lógicas de cuidado em tensionamento nesse cenário, considerando a realidade do cotidiano de trabalho. Sobretudo, buscou-se problematizar as possibilidades de acompanhamento de crianças, para além do encaminhamento, na atenção primária em saúde. Para tal, apresentamos concepções ampliadas com relação à infância, considerando que esse período não trata apenas de um corpo orgânico em desenvolvimento, mas também de um sujeito em constituição. Assim, como possibilidade de intervenção com as crianças na Atenção Básica, utilizou-se um dispositivo grupal que se mostrou uma potente estratégia de acolhimento e de envolvimento da equipe na escuta das questões da infância na Unidade de Saúde.(AU)

This study is a report about the intersection of childhood and Primary Health Care based experience, in a Family Health Unit in the municipality of Porto Alegre, based on the Psychology professional center. This experience is part of the educational path at the Primary Care Program of the Integrated Health Residency from the Public Health School of the state of Rio Grande do Sul. From the Mental Health demands of children in this context, which often presented themselves as individual, behavioral issues, and carried an expectation of being corrected, we sought to problematize the logics of care in tension in this scenario, considering the reality of the everyday job. Above all, we aimed to problematize the possibilities of follow up on the children, beyond the referral, in Primary Care. To this end, we presented expanded conceptions regarding childhood, considering that, this period is not just about a developing organic body, but also a subject in constitution. Thus, as a possibility of intervention with children in Primary Care, the use of group device proved to be a powerful strategy for welcoming and involving the team in listening to childhood issues in the Health Unit.(AU)

Este estudio es un reporte de experiencia sobre el encuentro entre la infancia y la Atención Primaria de Salud, a partir del trabajo en una Unidad de Salud Familiar en la ciudad de Porto Alegre, a través del núcleo profesional de Psicología. Esta experiencia es parte del curso de especialización del Programa de Atención Primaria de la Residencia Integrada en Salud de la Escuela de Salud Pública del Estado de Rio Grande do Sul (ESP / RS). A partir del encuentro con las demandas relacionadas con la Salud Mental de los niños en este contexto, que a menudo se presentaron como problemas de comportamiento individuales y tenían la expectativa de corrección, buscamos problematizar la lógica de la atención en tensión en este contexto, considerando la realidad de la vida cotidiana de trabajo. Sobre todo, buscamos problematizar las posibilidades de acompañar a los niños, además de la derivación, en Atención Primaria de Salud. Con este fin, presentamos conceptos ampliados en relación con la infancia, considerando que este período no es solo un cuerpo orgánico en desarrollo, pero también de un sujeto en constitución. Así, como una posibilidad de intervención con niños en Atención Primaria, se utilizó un dispositivo grupal, que resultó ser una potente estrategia para acoger e involucrar al equipo en la escucha de los problemas de la infancia en la Unidad de Salud.(AU)

Role of Pediatricians in Early Childhood Nurturing Care Related to Safety and Security.

The five components of nurturing care for early childhood development (good health, adequate nutrition, responsive parenting, early opportunities for learning, and safety and security) are essential for the attainment of the optimal developmental potential of a child, and enabling him/her to become a productive adult. Safety is a state of protection from hazards caused by natural forces or unintentional human error, whereas security comprises of protection from hazards resulting from deliberate, harmful actions or inimical behavior. Unlike the other components, safety and security have been least addressed by health programs in India. The forms of lapses in safety and security in young children include injuries, neglect and maltreatment (physical, emotional, sexual abuse), the magnitude of which is difficult to ascertain in the community. Many mishaps can be avoided by simply understanding child development, taking precautions, and environmental modification. Issues related to safety and security are usually not addressed in routine office practice. Pediatricians have multiple roles and responsibilities. They need to utilize every opportunity to discuss preventive and promotive health care with parents. Converting immunization days to holistic well child visits is an ideal strategy, in which parents can be educated about preventing avoidable injuries and informed about how to keep their children safe and secure. Pediatricians should recognize indicators of volitional injury, neglect and abuse, and be competent in their management. They need to be aware of child rights and the legal protective measures as well as their own their legal obligations. They should network with various agencies involved in child welfare and protection.

Impact of a screen, triage and treat program for identifying chronic disease risk in Indigenous children.

BACKGROUND: The First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis project was a point-of-care screening program in rural and remote First Nations communities in Manitoba that aimed to identify and treat hypertension, diabetes and chronic kidney disease. The program identified chronic disease in 20% of children screened. We aimed to characterize clinical screening practices before and after intervention in children aged 10-17 years old and compare outcomes with those who did not receive the intervention. METHODS: This observational, prospective cohort study started with community engagement and followed the principles of ownership, control, access and possession (OCAP). We linked participant data to administrative data at the Manitoba Centre for Health Policy to assess rates of primary care and nephrology visits, disease-modifying medication prescriptions and laboratory testing (i.e., glycosylated hemoglobin [HbA1c], estimated glomerural filtration rate [eGFR] and urine albumin- or protein-to-creatinine ratio). We analyzed the differences in proportions in the 18 months before and after the intervention. We also conducted a 1:2 propensity score matching analysis to compare outcomes of children who were screened with those who were not. RESULTS: We included 324 of 353 children from the screening program (43.8% male; median age 12.3 yr) in this study. After the intervention, laboratory testing increased by 5.8% (95% confidence interval [CI] 1.1% to 10.1%) for HbA1c, by 9.9% (95% CI 4.2% to 15.5%) for eGFR and by 6.2% (95% CI 2.3% to 10.0%) for the urine albumin- or protein-to-creatinine ratio. We observed significant improvements in laboratory testing in screened patients in the group who were part of the program, compared with matched controls. INTERPRETATION: Chronic disease surveillance and care increased significantly in children after the implementation of a point-of-care screening program in rural and remote First Nation communities. Interventions such as active surveillance programs have the potential to improve the chronic disease care being provided to First Nations children.

Percepciones y sentimientos de niños argentinos frente a la cuarentena COVID-19 / Perceptions and feelings of Argentine children regarding the COVID-19 quarantine

La Subcomisión de Derechos del Niño y el Comité de Pediatría Social, de la Sociedad Argentina de Pediatría, realizaron un trabajo de campo que permitiera dar voz a nuestros niños, niñas y adolescentes (NNA) durante la cuarentena y el aislamiento social obligatorio impuestos en nuestro país por la pandemia mundial por la enfermedad por el nuevo coronavirus (COVID-19). Los objetivos fueron relevar el impacto sobre sus sentimientos, emociones y deseos; evaluar y comparar las repercusiones personales, familiares y sociales antes, durante y después de la cuarentena; e identificar las necesidades de apoyo y contención.Los resultados de la investigación permiten afirmar que los niños han sido los más afectados y los menos escuchados. La cuarentena ha tenido un enorme impacto individual, social y familiar en los NNA, y reclama un abordaje holístico, comprometido y mancomunado de la sociedad civil, las familias, los profesionales de la salud, los docentes y las autoridades políticas.

The Subcommittee on the Rights of the Child and the Social Pediatrics Committee of the Sociedad Argentina de Pediatría carried out a fieldwork that allowed us to give a voice to our children and adolescents (NNA), during quarantine and social isolation mandatory imposed in our country by the global pandemic COVID-19. The objectives were to analyze the impact on their feelings, emotions and desires; evaluate and compare personal, family and social repercussions pre, intra and post quarantine; and identify support and containment needs.The results of the research allow us to affirm that children have been the most vulnerable and the least listened to. The quarantine has had an enormous individual, social and family impact on children and adolescents and calls for a holistic, committed and joint approach from civil society, families, health professionals, teachers and political authorities

[Perceptions and feelings of Argentine children regarding the COVID-19 quarantine]. / Percepciones y sentimientos de niños argentinos frente a la cuarentena COVID-19.

The Subcommittee on the Rights of the Child and the Social Pediatrics Committee of the Sociedad Argentina de Pediatría carried out a fieldwork that allowed us to give a voice to our children and adolescents (NNA), during quarantine and social isolation mandatory imposed in our country by the global pandemic COVID-19. The objectives were to analyze the impact on their feelings, emotions and desires; evaluate and compare personal, family and social repercussions pre, intra and post quarantine; and identify support and containment needs. The results of the research allow us to affirm that children have been the most vulnerable and the least listened to. The quarantine has had an enormous individual, social and family impact on children and adolescents and calls for a holistic, committed and joint approach from civil society, families, health professionals, teachers and political authorities.

La Subcomisión de Derechos del Niño y el Comité de Pediatría Social, de la Sociedad Argentina de Pediatría, realizaron un trabajo de campo que permitiera dar voz a nuestros niños, niñas y adolescentes (NNA) durante la cuarentena y el aislamiento social obligatorio impuestos en nuestro país por la pandemia mundial por la enfermedad por el nuevo coronavirus (COVID-19). Los objetivos fueron relevar el impacto sobre sus sentimientos, emociones y deseos; evaluar y comparar las repercusiones personales, familiares y sociales antes, durante y después de la cuarentena; e identificar las necesidades de apoyo y contención. Los resultados de la investigación permiten afirmar que los niños han sido los más afectados y los menos escuchados. La cuarentena ha tenido un enorme impacto individual, social y familiar en los NNA, y reclama un abordaje holístico, comprometido y mancomunado de la sociedad civil, las familias, los profesionales de la salud, los docentes y las autoridades políticas.

Health Service and Functional Measures of Benefit of a Medical Home in Children with Autism.

OBJECTIVES: A medical home is a model of patient-centered, comprehensive care recommended by the American Academy of Pediatrics for all children. The aims of this study were (1) to determine if the presence of a medical home is associated with improved health service outcomes of children with autism, and (2) to determine if the presence of a medical home is associated with improved key functional outcomes in children with autism. METHODS: This study used data from the 2016-2017 National Survey of Children's Health. We used a medical home construct of 14 survey questions as the main independent variable in logistic regression models estimating cross-sectional association, and also evaluated the interaction between medical home and demographic and household characteristics, including race, income, household composition, and autism severity in regression for outcomes. RESULTS: Overall, the presence of a medical home was associated with increased parent reporting of shared health care decision-making, receipt of preventive pediatric care, and reduced frustration in accessing services. Some functional outcomes were also positively associated with the presences of a medical home in children with parent-reported mild autism symptoms; children who had a medical home visited the ED less often than children without a medical home. This did not persist for children with moderate or severe parent-rated autism. CONCLUSIONS FOR PRACTICE: Based on parent-reported, cross-sectional data from a large, nationally representative sample of families with a child with autism, the presence of a medical home was positively associated with some improved health services and functional outcomes.

Life Course Health Development in Pediatric Practice.

The development of health is a cumulative, dynamic, and lifelong process responding to a variety of biological and behavioral influences, of which those in childhood are especially influential and, indeed, formative. Reflecting the balance of positive and adverse experiences during childhood, initial trajectories for future health and development emerge. Preventive pediatric care can anticipate and respond to those experiences and the personal and social circumstances in which they occur. These actions can promote better health and prevent chronic illness during adulthood. Building on the life course health development framework, ways to positively affect patterns of individual and population health practice are identified. Maximizing the opportunity to influence children's health over their lifetime will require purposeful partnerships with other entities with which children and their families interact as well as improvements in pediatric care processes. The latter includes expanding the databases that drive service (such as registries, care plans, and referrals) and adopting proactive, strengths-based, patient and family-centered, comprehensive, multidisciplinary models of care.