Behavioural and cognitive behavioural training interventions for assisting foster carers in the management of difficult behaviour.

Background The provision of training for foster carers is now seen as an important factor contributing to the successful outcome of foster care placements. Since the late 1960s, foster carer training programs have proliferated, and few of the many published and unpublished training curricula have been systematically evaluated. The advent of cognitive-behavioural therapy (CBT) and the research evidence demonstrating its effectiveness as a psychotherapeutic treatment of choice for a range of emotional and behavioural problems, has prompted the development of CBT-based training programmes. CBT approaches to foster care training derive from a ���skill-based��� training format that also seeks to identify and correct problematic thinking patterns that are associated with dysfunctional behaviour by changing and/or challenging maladaptive thoughts and beliefs. Objectives To assess the effectiveness of cognitive-behavioural training interventions in improving a) looked-after children���s behavioural/relationship problems, b) foster carers��� psychological well-being and functioning, c) foster family functioning, d) foster agency outcomes. Search methods We searched databases including: CENTRAL (Cochrane Library Issue 3, 2006), MEDLINE (January 1966 to September 2006), EMBASE (January 1980 to September 2006), CINAHL (January 1982 to September 2006), PsycINFO (January 1872 to September 2006), ASSIA (January 1987 to September 2006), LILACS (up to September 2006), ERIC (January 1965 to September 2006), Sociological Abstracts (January 1963 to September 2006), and the National Research Register 2006 (Issue 3).We contacted experts in the field concerning current research. Selection criteria Random or quasi randomised studies comparing behavioural or cognitive-behavioural-base Data collection and analysis Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Main results Six trials involving 463 foster carers were included. Behavioural and cognitive-behavioural training interventions evaluated to date appear to have very little effect on outcomes relating to looked-after children, assessed in relation to psychological functioning, extent of behavioural problems and interpersonal functioning. Results relating to foster carer(s) outcomes also show no evidence of effectiveness in measures of behavioural management skills, attitudes and psychological functioning. Analysis pertaining to fostering agency outcomes did not show any significant results. However, caution is needed in interpreting these findings as their confidence intervals are wide. Authors��� conclusions There is currently little evidence about the efficacy of behavioural or cognitive-behavioural training intervention for foster carers. The need for further research in this area is highlighted.

A Randomized Controlled Trial of Interventions to Promote Adjustment in Children With Congenital Heart Disease Entering School and Their Families

Objective: To report on a randomized controlled trial of psychological interventions to promote adjustment in children with congenital heart disease and their families. <br/>Method: Following baseline assessment, 90 children (aged 4���5 years) and their families were randomly assigned to an Intervention or Control group before entering school. 68 (76%) were retained at 10-month follow-up. <br/>Results: Gains were observed on measures of maternal mental health and family functioning. Although no differences were found on measures of child behavior at home or school, children in the intervention group were perceived as ���sick��� less often by their mother and missed fewer days from school. A regression model, using baseline measures as predictors, highlighted the importance of maternal mental health, worry and child neurodevelopmental functioning for child behavioral outcomes almost a year later. <br/>Conclusions: The intervention promoted clinically significant gains for the child and family. The program is of generalizable significance.

Apoio social, acontecimentos de vida negativos e adapta����o em fam��lias com menores em risco psicossocial

No contexto atual de prote����o �� inf��ncia, as fam��lias em situa����o de risco psicossocial constituem uma realidade, com a qual as institui����es e os profissionais se deparam e ainda pouco estudada em Portugal. As fam��lias t��m de lidar com in��meros acontecimentos de vida negativos que comprometem o adequado exerc��cio das suas fun����es parentais. Neste trabalho analis��mos o perfil psicossocial, a coes��o e adapta����o familiar, os acontecimentos de vida stressantes e de risco das suas trajet��rias de vida e circunst��ncias atuais, o seu impacto emocional, o apoio social percebido das fam��lias com menores em risco, a forma como se associam entre si e com as diversas caracter��sticas sociodemogr��ficas. Foram entrevistados 51 participantes, 33 do sexo feminino e 18 do sexo masculino, com idades compreendidas entre os 16 e os 57 anos de idade, resultando uma m��dia de idade de 36,33 anos (DP = 7,98), acompanhados pela Comiss��o de Prote����o de Crian��as e Jovens de Faro. Foram avaliadas as seguintes dimens��es: adapta����o e coes��o familiar, acontecimentos de vida stressantes ou negativos, apoio social percebido em situa����es normativas e de risco e o perfil psicossocial dos participantes. Os resultados mostraram que as fam��lias com menores em risco psicossocial apresentam elevada taxa de desemprego, precaridade educativa, econ��mica e profissional, elevado n��mero de acontecimentos de vida negativos atuais e passados relacionados sobretudo com problemas psicol��gicos, econ��micos, profissionais e conjugais que s��o vivenciados com elevado impacto emocional. Ao n��vel do funcionamento familiar, os n��veis de coes��o foram superiores aos de adapta����o familiar. Os participantes reportaram uma necessidade mais elevada de apoio emocional do que informativo ou material. A fonte de apoio social das fam��lias �� constitu��da principalmente por familiares e amigos, que experienciaram um reduzido apoio de profissionais. As fam��lias evidenciaram importantes necessidades, entre as quais o apoio social e as interven����es psicossociais assumem um papel essencial nos contextos familiares de risco.

A (des)continuidade das representa����es de vincula����o das crian��as adotadas

A presente investiga����o teve como principais objetivos estudar as representa����es de vincula����o das crian��as adotadas e a sua rela����o com: (1) aspetos individuais da hist��ria de institucionaliza����o e de ado����o (i.e., idade e dura����o); (2) aspetos familiares, nomeadamente, a comunica����o pais-filhos e o funcionamento familiar; e (3) a adapta����o da crian��a (i.e., problemas de internaliza����o, externaliza����o e sono). Participaram na investiga����o 30 fam��lias adotivas da regi��o do Algarve, num total de 89 participantes, entre os quais 30 crian��as adotadas, com uma m��dia de idades de 6.9 anos, 30 m��es e 29 pais adotivos. Os resultados obtidos sugerem que: (1) as representa����es de vincula����o das crian��as adotadas situam-se no limiar entre a inseguran��a e a seguran��a; (2) as crian��as apresentam representa����es mais seguras nos temas que evocam a rela����o de autoridade e o aux��lio em situa����es de medo e dor e representa����es menos seguras nas hist��rias que evocam a separa����o das figuras de vincula����o; (3) as crian��as tendem a utilizar, simultaneamente, representa����es parentais positivas e negativas; (4) o tempo de ado����o e a comunica����o com a m��e s��o preditores significativos das representa����es de vincula����o, assim, mais tempo com a fam��lia adotiva e menor abertura na comunica����o pais-filhos associam-se a representa����es mais seguras; e (5) as representa����es de vincula����o predizem significativamente os problemas de internaliza����o e associam-se com os problemas de sono, de tal forma que crian��as mais seguras tendem a ter menos problemas de internaliza����o e de sono. As implica����es pr��ticas dos resultados obtidos s��o discutidas com o objetivo de contribuir para uma maior adapta����o das crian��as nas fam��lias adotivas.

Determinants of mother-baby relationship evaluated during pregnancy

ABSTRACT Background Mental health promotion is supported by a strong body of knowledge and is a matter of public health with the potential of a large impact on society. Mental health promotion programs should be implemented as soon as possible in life, preferably starting during pregnancy. Programs should focus on malleable determinants, introducing strategies to reduce risk factors or their impact on mother and child, and also on strengthening protective factors to increase resilience. The ambition of early detecting risk situations requires the development and use of tools to assess risk, and the creation of a responsive network of services based in primary health care, especially maternal consultation during pregnancy and the first months of the born child. The number of risk factors and the way they interact and are buffered by protective factors are relevant for the final impact. Maternal-fetal attachment (MFA) is not yet a totally understood and well operationalized concept. Methodological problems limit the comparison of data as many studies used small size samples, had an exploratory character or used different selection criteria and different measures. There is still a lack of studies in high risk populations evaluating the consequences of a weak MFA. Instead, the available studies are not very conclusive, but suggest that social support, anxiety and depression, self-esteem and self-control and sense of coherence are correlated with MFA. MFA is also correlated with health practices during pregnancy, that influence pregnancy and baby outcomes. MFA seems a relevant concept for the future mother baby interaction, but more studies are needed to clarify the concept and its operationalization. Attachment is a strong scientific concept with multiple implications for future child development, personality and relationship with others. Secure attachment is considered an essential basis of good mental health, and promoting mother-baby interaction offers an excellent opportunity to intervention programmes targeted at enhancing mental health and well-being. Understanding the process of attachment and intervening to improve attachment requires a comprehension of more proximal factors, but also a broader approach that assesses the impact of more distal social conditions on attachment and how this social impact is mediated by family functioning and mother-baby interaction. Finally, it is essential to understand how this knowledge could be translated in effective mental health promoting interventions and measures that could reach large populations of pregnant mothers and families. Strengthening emotional availability (EA) seems to be a relevant approach to improve the mother-baby relationship. In this review we have offered evidence suggesting a range of determinants of mother-infant relationship, including age, marital relationship, social disadvantages, migration, parental psychiatric disorders and the situations of abuse or neglect. Based on this theoretical background we constructed a theoretical model that included proximal and distal factors, risk and protective factors, including variables related to the mother, the father, their social support and mother baby interaction from early pregnancy until six months after birth. We selected the Antenatal Psychosocial Health Assessment (ALPHA) for use as an instrument to detect psychosocial risk during pregnancy. Method Ninety two pregnant women were recruited from the Maternal Health Consultation in Primary Health Care (PHC) at Amadora. They had three moments of assessment: at T1 (until 12 weeks of pregnancy) they filed out a questionnaire that included socio-demographic data, ALPHA, Edinburgh post-natal Depression Scale (EDPS), General Health Questionnaire (GHQ) and Sense of Coherence (SOC); at T2 (after the 20th weeks of pregnancy) they answered EDPS, SOC and MFA Scale (MFAS), and finally at T3 (6 months after birth), they repeated EDPS and SOC, and their interaction with their babies was videotaped and later evaluated using EA Scales. A statistical analysis has been done using descriptive statistics, correlation analysis, univariate logistic regression and multiple linear regression. Results The study has increased our knowledge on this particular population living in a multicultural, suburb community. It allow us to identify specific groups with a higher level of psychosocial risk, such as single or divorced women, young couples, mothers with a low level of education and those who are depressed or have a low SOC. The hypothesis that psychosocial risk is directly correlated with MFAS and that MFA is directly correlated with EA was not confirmed, neither the correlation between prenatal psychosocial risk and mother-baby EA. The study identified depression as a relevant risk factor in pregnancy and its higher prevalence in single or divorced women, immigrants and in those who have a higher global psychosocial risk. Depressed women have a poor MFA, and a lower structuring capacity and a higher hostility to their babies. In average, depression seems to reduce among pregnant women in the second part of their pregnancy. The children of immigrant mothers show a lower level of responsiveness to their mothers what could be transmitted through depression, as immigrant mothers have a higher risk of depression in the beginning of pregnancy and six months after birth. Young mothers have a low MFA and are more intrusive. Women who have a higher level of education are more sensitive and their babies showed to be more responsive. Women who are or have been submitted to abuse were found to have a higher level of MFA but their babies are less responsive to them. The study highlights the relevance of SOC as a potential protective factor while it is strongly and negatively related with a wide range of risk factors and mental health outcomes especially depression before, during and after pregnancy. Conclusions ALPHA proved to be a valid, feasible and reliable instrument to Primary Health Care (PHC) that can be used as a total sum score. We could not prove the association between psychosocial risk factors and MFA, neither between MFA and EA, or between psychosocial risk and EA. Depression and SOC seems to have a clear and opposite relevance on this process. Pregnancy can be considered as a maturational process and an opportunity to change, where adaptation processes occur, buffering risk, decreasing depression and increasing SOC. Further research is necessary to better understand interactions between variables and also to clarify a better operationalization of MFA. We recommend the use of ALPHA, SOC and EDPS in early pregnancy as a way of identifying more vulnerable women that will require additional interventions and support in order to decrease risk. At political level we recommend the reinforcement of Immigrant integration and the increment of education in women. We recommend more focus in health care and public health in mental health condition and psychosocial risk of specific groups at high risk. In PHC special attention should be paid to pregnant women who are single or divorced, very young, low educated and to immigrant mothers. This study provides the basis for an intervention programme for this population, that aims to reduce broad spectrum risk factors and to promote Mental Health in women who become pregnant. Health and mental health policies should facilitate the implementation of the suggested measures.

Quantitative and qualitative research on brief systemic therapies carried out within the framework of an ambulatory consultation for couples and families

Abstract: This article presents both a brief systemic intervention method (IBS) consisting in 6 sessions developed in an ambulatory service for couples and families, and two research projects done in collaboration with the Institute for Psychotherapy of the University of Lausanne. The first project is quantitative and it aims at evaluating the effectiveness of ISB. One of its main feature is that outcomes are assessed at different levels of individual and family functioning: 1) symptoms and individual functioning; 2) quality of marital relationship; 3) parental and co-parental relationships; 4) familial relationships. The second project is a qualitative case study about a marital therapy which identifies and analyses significant moments of the therapeutic process from the patients' perspective. Methodology was largely inspired by Daniel Stem's work about "moments of meeting" in psychotherapy. Results show that patients' theories about relationship and change are important elements that deepen our understanding of the change process in couple and family therapy. The interest of associating clinicians and researchers for the development and validation of a new clinical model is discussed.

An exploration of intergenerational exchanges between grandparents and their older grandcildren

Changes within the family unit have resulted in changes in interactions between grandparents and older grandchildren. Existing research indicates that these relationships can result in positive outcomes. A relevant task for researchers is to continue to explore th~se intergenerational relationships. This qualitative phenomenological study explores the question: What functional patterns exist when grandparents interact with older grandchildren? Six grandparent-older grandchild pairs agreed to be involved. Kennedy's (1992) formulation of grandparent-older grandchild activity clusters was reviewed and revised. Activities were clustered related to socialization, companionship, support, entertainment, and education. Findings unique to this study indicate that shared activities were mutually chosen with consideration of activity tolerance, and were consistently evaluated as enjoyable. Partners were chosen because of a comfortable relationship established through frequent past and present interactions, and not because of family lineage preferences. Both grandparents and older grandchildren stated a desire to have a generation peer share activities with them. Exploration of dimension concepts for the "McMaster Model of Family Functioning" indicated that these relationships have potential to contribute to healthy family functioning. The implications for practice, theory development and further research are suggested.

Lien bidirectionnel entre des caract��ristiques personnelles des parents et leurs pratiques parentales dans un contexte d���intervention

Les parents d���enfants aux prises avec un trouble d��ficitaire de l���attention avec ou sans hyperactivit�� (TDA/H) sont �� risque de d��pression. Ces parents rapportent aussi des relations familiales plus probl��matiques, des exp��riences plus stressantes, un sentiment d���auto-efficacit�� plus faible �� l�����gard de leur r��le parental et des pratiques parentales plus coercitives ou inad��quates en comparaison aux parents d���enfants sans ce diagnostic. Plusieurs recherches ont relev�� que les parents d���enfants ayant un TDA/H qui ont particip�� �� un programme d���entra��nement aux habilet��s parentales (PEHP) rapportent une am��lioration g��n��rale des difficult��s ��num��r��es pr��c��demment. Le changement d���attitude et de pratiques parentales est souvent reli�� �� une diminution des sympt��mes du TDA/H chez les enfants. L���intervention peut donc contribuer �� am��liorer la condition du parent et par le fait m��me celle de son enfant. Toutefois, le TDA/H est un trouble chronique qui peut affecter certaines caract��ristiques personnelles du parent pouvant interf��rer avec la capacit�� de ce dernier �� b��n��ficier d���une intervention. Peu d�����tudes s���attardent aux caract��ristiques du parent pouvant affecter l���efficacit�� de l���intervention. Le but de la pr��sente ��tude est d�����tudier le lien bidirectionnel entre certaines caract��ristiques personnelles (d��pression, stress, sentiment d���auto-efficacit��) et les pratiques parentales dans un contexte d���intervention qui s���adresse aux parents d���enfants ayant un TDA/H. Les r��sultats d��montrent que le sentiment d���auto-efficacit�� initial du parent est pr��dicteur d���une discipline inconstante, et ce, ind��pendamment de la condition exp��rimentale. De plus, les pratiques positives initiales sont pr��dicteurs d���un sentiment d���auto-efficacit�� ��lev�� au post-test et ce, ind��pendamment de la condition exp��rimentale.

Les perceptions de personnes atteintes de troubles mentaux suite �� une formation de gestion de comportements agressifs adapt��e par et pour leurs membres de familles

Les ��crits rapportent qu���entre 10% et 40% des personnes atteintes de troubles mentaux ont pr��sent�� des comportements agressifs depuis l�����tablissement du diagnostic, et qu���entre 50% et 65% de ces comportements sont perp��tr��s envers les membres de la famille (Estroff et al., 1998). Or, les aidants naturels se sentent fr��quemment d��munis devant le comportement impulsif et agressif de leur proche atteint d���un trouble de sant�� mentale (Bonin & Lavoie-Tremblay, 2010) et la majorit�� des proches aidants ne re��oivent pas de soutien professionnel (Doornbos, 2001). �� cet effet, une ��quipe de chercheurs et d���organismes communautaires ont mis sur pied un projet de formation adapt��e par et pour les familles relativement �� la gestion des comportements agressifs de leur proche atteint d���un trouble de sant�� mentale s���appuyant sur l���approche OMEGA communautaire (Bonin et al., 2011). La pr��sente recherche est inspir��e du mod��le de Fresan et ses collaborateurs (2007), qui inclut les familles et leur proche atteint dans la pr��vention de la rechute et le r��tablissement de ce dernier. Cette ��tude avait donc pour but de d��crire et analyser, par un devis mixte, les perceptions de l���agressivit��, du fonctionnement familial ainsi que de l���observance au traitement m��dical de personnes atteintes de troubles mentaux, suite �� une formation de gestion des comportements agressifs adapt��e par et pour des membres de familles, et suivie par leur proche aidant. Des questionnaires auto-administr��s ont ��t�� remis et compl��t��s par 25 personnes atteintes et comprenaient trois instruments qui ��taient : 1. un questionnaire sociod��mographique; 2. le Basis-24 (Eisen, 2007) permettant d�����valuer la condition mentale de la personne atteinte; 3. l�����chelle de perception de l���agressivit�� permettant de mesurer la fr��quence et le niveau des comportements agressifs (De Benedictis et al., 2011); et 4. l'��chelle du fonctionnement familial permettant de mesurer le fonctionnement familial (Epstein, Baldwin, & Bishop, 1983). Des questions suppl��mentaires au questionnaire portaient sur l���observance au traitement m��dical et sur les changements observ��s. Des analyses descriptives et corr��lationnelles bivari��es ont ��t�� r��alis��es pour analyser les donn��es quantitatives. Par la suite, des entrevues individuelles ont ��t�� r��alis��es aupr��s de huit personnes atteintes de troubles mentaux dont le membre de famille avait suivi la formation de gestion des comportements agressifs. La m��thode d���analyse classique de Miles et Huberman (2003) a ��t�� utilis��e pour r��aliser l���analyse des donn��es. L���analyse des donn��es a permis de d��gager les perceptions des personnes atteintes de troubles mentaux au regard de la formation de gestion des comportements agressifs que leur membre de famille avait suivi. Ainsi, le programme de formation OM��GA adapt��e par et pour les familles permettrait d���une part de diminuer l���agressivit�� et, d���autre part, d���am��liorer le climat familial. De plus, selon les personnes atteintes, leur membre de famille ��tait plus �� l�����coute et faisait moins preuve d���intrusion, ce qui diminuaient les conflits et favorisaient une meilleure dynamique familiale. Cette ��tude a mis en ��vidence qu���il est n��cessaire d���impliquer les familles dans les programmes de pr��vention de la rechute de la maladie mentale dans les soins de premi��re ligne. Cette ��tude contribue ainsi �� l���am��lioration des connaissances sur la dynamique famille-patient et sur le r��tablissement des personnes atteintes de troubles mentaux. Aussi, cette recherche propose des recommandations pour la recherche, la pratique, la formation et la gestion en sciences infirmi��res.

R��silience familiale : revue syst��matique des ��crits qualitatifs sur le combat familial face au cancer p��diatrique

Essai doctoral pr��sent�� �� la Facult�� des arts et des sciences en vue de l���obtention du grade de doctorat en psychologie, option clinique

Changements dans le fonctionnement des familles ayant un enfant atteint d���un trouble de d��ficit de l���attention/hyperactivit�� apr��s un programme d���entra��nement aux habilet��s parentales

Au Qu��bec, le trouble du d��ficit de l���attention/hyperactivit�� (TDA/H) est celui qui requiert le plus grand nombre de consultations en p��dopsychiatrie (50 % �� 75 %). �� ce jour, l���intervention multimodale (traitement pharmacologique, programme d���entra��nement aux habilet��s parentales (PEHP) et programme d���intervention cognitive comportementale (PICC) aupr��s des enfants ayant un TDA/H) a obtenu de bons r��sultats �� long terme. Dans cette ��tude, nous avons ��valu�� les changements dans le fonctionnement familial suite �� un PEHP. La conception de ce PEHP repose sur les deux approches : l���approche syst��mique familiale de Calgary (Wright & Leahey, 2013) et l���approche de solution collaborative et proactive (Greene, 2014). Le Family Assessment Device (FAD; Epstein, Baldwin, et Bishop, 1983), version courte, a ��t�� utilis�� pour mesurer le fonctionnement g��n��ral (FG) de la famille. La collecte de donn��es a ��t�� r��alis��e aupr��s de deux groupes (groupe participant et groupe t��moin) et �� deux temps de mesure (avant et apr��s le PEHP). L�����chantillon contient 28 familles participantes et 18 familles t��moins. L���analyse de variance �� mesures r��p��t��es (ANOVA) a ��t�� utilis��e pour tester l���effet des variables ind��pendantes (Temps et Intervention) sur la variable d��pendante (FG). Les r��sultats indiquent que les parents qui participent �� un PEHP per��oivent un fonctionnement familial g��n��ral am��lior�� par rapport au groupe t��moin. L���interpr��tation des changements �� la suite du PEHP donne des pistes d���intervention infirmi��res �� ces familles afin d�����viter les impacts de ce trouble sur le fonctionnement familial �� long terme.

Caracteriza����o de fam��lias de crian��as em situa����o de viol��ncia intrafamiliar

Trata-se de um estudo descritivo do tipo explorat��rio que utilizou uma abordagem combinada quantitativa e qualitativa para caracterizar as fam��lias de crian��as em situa����o de viol��ncia intrafamiliar, atendidas pela ���Equipe de Prote����o ��s Crian��as V��timas de Maus-tratos e Viol��ncia Sexual���, no Hospital de Cl��nicas de Porto Alegre (HCPA), no ano de 1999. A coleta de dados foi realizada por um roteiro estruturado elaborado pela pesquisadora, constitu��do de quatro dimens��es pr��-estabelecidos ��� s��cioecon��mica, estrutura e funcionamento familiar, situa����o atual do abuso do contexto familiar e hist��ria pregressa da fam��lia ��� preenchido atrav��s dos prontu��rios e protocolos das crian��as atendidas no HCPA. Os dados quantific��veis foram analisados com aux��lio da estat��stica descritiva, e os qualitativos pelo m��todo de an��lise de conte��do, segundo Bardin (2000). Assim formaram sete categorias: organiza����o familiar, relacionamento familiar, percep����o dos adultos sobre a crian��a v��tima de viol��ncia, justificativas de utiliza����o da viol��ncia, a����es maternas frente �� viol��ncia, motivos da procura do servi��o de sa��de e a trajet��ria da fam��lia na institui����o hospitalar. A maioria das fam��lias pesquisadas possu��am prec��ria inser����o s��cioecon��mica com baixo n��vel de escolaridade, desempregadas, inseridas no mercado formal e/ou informal. Eram predominantes da regi��o central de Porto Alegre, demonstrando uma diversidade de arranjos e fragilidade nas rela����es familiares, com confus��o de pap��is e disputa de autoridade. Algumas fam��lias registraram aus��ncia da figura paterna Caracter��sticas importantes constatadas entre os adultos: progenitores adolescentes, jovens, vivendo responsabilidade de adulto, o elevado padr��o do uso abusivo de drogas, presen��a de aleitamento materno e gravidez n��o desejada. Houve um predom��nio de neglig��ncia em rela����o a outras formas de viol��ncia praticadas, sendo que o ato violento foi cometido de forma intencional, mas o agressor n��o apresentava justificativa para o fato. A m��e configurou-se como a maior agressora e, simultaneamente, a principal cuidadora da crian��a. Nesse estudo, a crian��a mais atingida foi a do sexo masculino, ra��a branca, evidenciando les��o e apresentando longo per��odo de conviv��ncia com o agressor que sempre era algu��m muito pr��ximo a ela. As fam��lias envolvidas procuraram atendimento de forma espont��nea, mas a queixa de viol��ncia estava impl��cita. A pesquisa permitiu contextualizar a viol��ncia como social e hist��rica, presente em larga escala na sociedade brasileira uma sociedade desigual na qual se pratica viol��ncia dentro da fam��lia contra a crian��a, legitimando uma forma de poder estruturante nas rela����es sociais e na intera����o com fatores individuais econ��micos e culturais. Assim, verificou-se a fundamental import��ncia da atua����o do enfermeiro no enfrentamento da problem��tica quest��o da viol��ncia intrafamiliar contra a crian��a.

Uma interven����o abrangente para reduzir a evas��o de escolas p��blicas

Objetivos: A evas��o escolar �� um importante problema social, educacional e de sa��de nos pa��ses em desenvolvimento. Este estudo tem como objetivos: a) realizar uma revis��o sistem��tica da literatura mundial sobre evas��o escolar, focalizando em fatores de risco e poss��veis interven����es; b) avaliar a efetividade de uma interven����o abrangente planejada para reduzir a evas��o de escolas p��blicas em uma cidade no Brasil; c) descrever as barreiras encontradas na implementa����o dessa interven����o; e d) comparar os estudantes em risco para evas��o escolar que responderam a essa interven����o com os que abandonaram a escola. M��todos: 1) Para a revis��o, foram acessadas as bases de dados computadorizadas mais importantes para a psiquiatria, psicologia e pesquisa comunit��ria. Os estudos relevantes publicados em revistas cient��ficas s��o descritos; 2) duas escolas p��blicas com taxas similares de evas��o nas s��ries fundamentais foram selecionadas. Em uma delas, um programa de interven����es universais de preven����o em diferentes n��veis foi implementado durante um ano letivo. Para os alunos que permaneceram ausentes durante dez dias consecutivos sem justificativa, foram oferecidos avalia����o de sa��de mental e encaminhamento para servi��os de sa��de mental dispon��veis na comunidade. Na segunda escola, n��o foi implementado nenhum tipo de interven����o As vari��veis de desfecho eram as taxas de evas��o escolar e de absten����es no ��ltimo trimestre; e 3) as barreiras �� implementa����o da interven����o s��o descritas. Os estudantes que responderam �� interven����o retornando para a escola e aqueles que evadiram s��o comparados quanto a vari��veis demogr��ficas, QI, transtornos mentais, psicopatologia materna e funcionamento familiar. Resultados: Na revis��o sistem��tica da literatura, 37 estudos realizados em cinco pa��ses s��o descritos. Ap��s a interven����o, houve diferen��as significativas entre as duas escolas nas taxas de evas��o escolar (p < 0,001) e de absten����o no ��ltimo trimestre (p < 0,05). De 40 alunos em risco para evas��o, 18 (45%) retornaram para a escola ap��s a interven����o. O principal problema na implementa����o da interven����o foi o pequeno comprometimento da equipe escolar. Na regress��o log��stica multivariada, apenas uma tend��ncia para diferen��a entre os grupos nos escores de hierarquia familiar do FAST foi detectada (p = 0,06). ). Conclus��es: Nossos achados sugerem a efic��cia de uma interven����o abrangente, que combina aspectos de preven����o prim��ria com outros focados em estudantes em risco para evas��o escolar, em pa��ses em desenvolvimento. �� necess��ria a prepara����o intensiva da equipe escolar antes da implementa����o da interven����o. Interven����es abordando aspectos do funcionamento familiar devem ser inclu��das no programa. S��o necess��rios mais estudos envolvendo a popula����o dos pa��ses em desenvolvimento.

A constru����o das pr��ticas de consultoria em psicologia organizacional e do trabalho

Este estudo teve como objetivo descrever a trajet��ria de empresas pioneiras na presta����o de servi��os em psicologia organizacional e do trabalho no Rio Grande do Sul, investigando as rela����es entre as pr��ticas de consultoria e as configura����es pol��ticas, hist��ricas e socioecon��micas do contexto de trabalho das ��ltimas d��cadas. A pesquisa foi desenvolvida dentro da abordagem qualitativa, fundamentada pelas orienta����es do estudo de caso. A primeira etapa da pesquisa consistiu na realiza����o de um levantamento sobre os registros de pessoa jur��dica do Conselho Regional de Psicologia do Rio Grande do Sul (CRPRS), investigando dados referentes ��s atividades desenvolvidas pelas empresas e ao tempo de atua����o no mercado Foram escolhidas para estudo de caso duas empresas, pioneiras na presta����o de servi��os em psicologia organizacional e do trabalho, criadas na d��cada de 1970 e que ainda se dedicam ao mesmo campo de atividades. Foram realizadas entrevistas semi-estruturadas com os propriet��rios das duas empresas e com os demais funcion��rios que trabalham com atividades vinculadas �� psicologia. Procedeu-se ainda o exame de documentos das empresas, como material publicit��rio impresso, manuais de treinamento e sites na internet. Constatou-se que a presta����o de servi��os em psicologia cl��nica �� o ramo de atividades escolhido pela maioria dos propriet��rios das empresas em psicologia com registro no CRPRS. Entre as empresas pioneiras, registradas na d��cada de 1970, apenas duas se dedicam �� presta����o de servi��os em psicologia organizacional e do trabalho e continuam atualmente em atividade na mesma ��rea. As empresas estudadas surgem no mesmo per��odo, na mesma cidade, com propriet��rios com a mesma forma����o acad��mica e assumem trajet��rias distintas. N��o existe um processo linear de constru����o das pr��ticas dos profissionais dessas empresas, embora possam ser identificadas algumas regularidades nas suas trajet��rias. As pr��ticas de recrutamento e sele����o predominavam entre os servi��os disponibilizados na d��cada de 1970, amplamente favorecidas pelo contexto pol��tico e socioecon��mico do per��odo do ���milagre brasileiro���. Nos ��ltimos anos, as transforma����es no contexto produtivo promoveram o fortalecimento das pr��ticas de consultoria, que assumem, para os participantes do estudo, concep����es bastante diversificadas. Ambas as empresas apresentam funcionamento familiar, mas permanecem profundamente vinculadas �� imagem e ao trabalho dos fundadores, psic��logos do sexo masculino. A quest��o de g��nero aparece como um fator importante para a longevidade das empresas no mercado. A adapta����o ao mercado, atrav��s da diversifica����o de atividades e da reprodu����o dos processos de enxugamento e terceiriza����o de servi��os tamb��m figuram como estrat��gias importantes para a sobreviv��ncia das organiza����es.

Encontrando-se em casa: uma proposta de atendimento domiciliar para fam��lias de idosos dependentes

OBJETIVO: Este estudo qualitativo teve por objetivo descrever como um sistema familiar reage perante a situa����o de depend��ncia em um membro idoso, quais recursos utiliza para manter sua estabilidade e a assist��ncia de enfermagem disponibilizada neste contexto. M��TODOS: Utilizou-se como referencial te��rico a abordagem dos sistemas familiares e como m��todo a pesquisa-a����o. Os dados foram colhidos de novembro de 2004 a janeiro de 2005, utilizando-se o genograma, o ecomapa e o levantamento de problemas. RESULTADOS: Principais demandas familiares: luto antecipado, sobrecarga do papel de cuidador, falta de conhecimento sobre a doen��a e desajustamento familiar perante a crise. Principais interven����es: incentivar a narrativa da enfermidade, oferecer sugest��es e informa����es, elogiar as for��as familiares e assegurar pronto atendimento. CONCLUS��ES: Com o atendimento �� fam��lia sob o enfoque sist��mico foi poss��vel propor as interven����es de ajuda para a melhoria da qualidade de vida familiar, de maneira que ela tamb��m vislumbrasse suas pr��prias solu����es para o enfrentamento das adversidades.