ABSTRACT
Resumen (Analítico) La salud mental de los niños, niñas y adolescentes institucionalizados en hogares es un desafío clínico y ético para Chile y América Latina. Con el objetivo de explorar experiencias y desafíos percibidos por profesionales de la atención primaria de salud que atienden esta población, se realizó una investigación cualitativa, utilizando un cuestionario con preguntas abiertas. Los datos se analizaron mediante teoría fundamentada. Los resultados mostraron que la atención era parcializada y discontinua. La información sobre el desarrollo vital, la familia, los contextos de vulneración e institucionalización era insuficiente y fragmentada. Además, existía escasa coordinación entre las instituciones que intervienen simultáneamente con los niños, niñas y adolescentes. Se discuten las implicancias para la formación de equipos de salud mental de la atención primaria de salud y la implementación efectiva del trabajo intersectorial y multinivel.
Abstract (analytical) Mental health care for vulnerable and institutionalized children and adolescents is a clinical and ethical challenge in Chile and Latin America. This study explores experiences and challenges encountered when providing mental health care among primary health care professionals. Qualitative research was conducted using an open-ended questionnaire for interviewing professionals in a rural area of Chile. The data was analyzed using Grounded Theory. The results show a fragmented and discontinuous delivery of care as a large portion of the children's clinical and social history is unknown. There is lack of coordination with other institutions that intervene in this area. The authors discuss implications for primary health care training for children's mental health teams and the need for the implementation of effective integrated and multilevel care systems.
Resumo (Analítico) A saúde mental de crianças e adolescentes vulneráveis e institucionalizados é um desafio clínico e ético no Chile e na América Latina. O presente estudo explorou experiências e desafios do cuidado por profissionais da atenção primária à saúde que atendem esta população. A pesquisa qualitativa foi realizada utilizando um questionário de perguntas abertas para entrevistar profissionais da área rural do Chile. Os dados foram analisados usando a Grounded Theory. Os resultados mostraram um atendimento fragmentado e descontínuo. As informações sobre parte da história clínica e social das crianças, e os contextos de vulnerabilidade e institucionalização são insuficientes. Além disso, existia pouca coordenação entre as instituições que intervêm simultaneamente com os crianças e adolescentes. São discutidas implicações para o treinamento de equipes de saúde mental na atenção primária à saúde e para a implementação de sistemas efetivos de atendimento integrado e multinível.
Subject(s)
Primary Health Care , Mental Health , Surveys and Questionnaires , Qualitative Research , InstitutionalizationABSTRACT
Resumen El consumo de sustancias en adolescentes es altamente prevalente en varias regiones del mundo, y especialmente en Chile, siendo su prevención un importante desafío para la salud pública. Este artículo describe el modelo islandés de prevención del consumo de sustancias en adolescentes "Planet Youth", su adaptación y factibilidad de implementación en Chile, como primera experiencia en Latinoamérica. Este modelo comunitario está enfocado en la prevención ambiental y en la promoción de la salud de niños, niñas y adolescentes, basado en un diagnóstico local y oportuno de factores protectores y de riesgo, con colaboración de la autoridad local y la academia. Seis comunas de la región metropolitana en colaboración con la Universidad de Chile y el Icelandic Centre for Social Research and Analysis inician su implementación en 2018. Se tradujo y adaptó la encuesta islandesa que fue aplicada a 7354 estudiantes de 2° medio, cuyos resultados se retroalimentaron a colegios y municipalidades para trabajar en la modificación de los principales factores de riesgo y protección. En 2020, el proceso ha requerido algunas adaptaciones debido a la pandemia por COVID-19. Se discute acerca de factores socioculturales relevantes en la adaptación de estrategias basadas en evidencia internacional que se transfieren a un país diferente. La implementación del modelo Planet Youth es factible en Chile y ofrece una importante oportunidad para prevenir el consumo de sustancias en jóvenes de manera efectiva en Latinoamérica.
The prevalence of substance use is high among adolescents in several region around the world, specifically in Chile, and its prevention is an important public health challenge. We describe the adaptation and the feasibility to implement the Icelandic model of substance use prevention in adolescents "Planet Youth" in Chile as first experience in Latin America. This community prevention model focuses on the environment, culture and the promotion of health in adolescents, informed by local risk and protective factors. Implementation requires collaboration between academia and municipal authorities. Six municipalities of the Metropolitan Region, the University of Chile and the Icelandic Centre for Social Research and Analysis collaborated in the implementation of the Planet Youth model since 2018 in Chile. A substance use survey was translated, adapted, and applied to 7354 tenth grade students. The results were informed to schools and municipalities in order to work on modifications of the main risk and protective factors in their own community. In 2020, the prevention process has required some adaptation due to COVID-19 pandemic. We discuss sociocultural factors in the adaptation of this international prevention model transferred to Latin America. The implementation of the Planet Youth model is feasible in Chile and offers an opportunity to effectively prevent the substance use behaviors of adolescents in Latin America.
Subject(s)
Humans , Male , Female , Child , Adolescent , Substance-Related Disorders/prevention & control , Chile , Public Health , Surveys and Questionnaires , Community Support , Health PromotionABSTRACT
he aim of this study was to present preliminary results of a video-based consultation-liaison psychiatry service (telepsychiatry) to enhance the delivery of mental health services in primary health care (PHC) for institutionalized children and adolescents (ICA). A mixed-methods study was carried out at two PHC clinics in Quilpué, Chile, to assess the feasibility of a telepsychiatry service (TPS). TPS consisted of bimonthly, remotely conducted video-conference sessions between PHC teams and child and adolescent consultant psychiatrists located at the Psychiatric University Hospital in Santiago, to discuss mental health problems of ICA. During July to December 2018 thirteen TPS sessions were carried out, and a total of 15 ICA were discussed to elaborate diagnostic and/or therapeutic recommendations. The intervention was useful and acceptable to PHC providers. Participants perceived that better coordination between substitute care facilities and PHC clinics would be useful, and that training opportunities to address the mental health needs of ICA were required. A TPS to enhance the delivery of mental health services in PHC for ICA was feasible, further studies are needed to determine benefits for ICA. (AU)