ABSTRACT
INTRODUCTION: Child/adolescent mental health (CAMH) problems are associated with high burden and high costs across the patient's lifetime. Addressing mental health needs early on can be cost effective and improve the future quality of life. OBJECTIVE/METHODS: Analyzing most relevant papers databases and policies, this paper discusses how to best address current gaps in CAMH services and presents strategies for improving access to quality care using existing resources. RESULTS: The data suggest a notable scarcity of health services and providers to treat CAMH problems. Specialized services such as CAPSi (from Portuguese: Psychosocial Community Care Center for Children and Adolescents) are designed to assist severe cases; however, such services are insufficient in number and are unequally distributed. The majority of the population already has good access to primary care and further planning would allow them to become better equipped to address CAMH problems. Psychiatrists are scarce in the public health system, while psychologists and pediatricians are more available; but, additional specialized training in CAMH is recommended to optimize capabilities. Financial and career development incentives could be important drivers to motivate employment-seeking in the public health system. CONCLUSIONS: Although a long-term, comprehensive strategy addressing barriers to quality CAMH care is still necessary, implementation of these strategies could make.
INTRODUÇÃO: Problemas de saúde mental na infância/adolescência (SMIA) trazem diversos prejuízos e geram altos custos. A assistência precoce pode ser custo efetiva, levando a melhor qualidade de vida a longo prazo. OBJETIVOS/MÉTODO: Analisando os artigos mais relevantes, documentos do governo, base de dados e a política nacional, este artigo discute como melhor administrar a atual falta de serviços na área da SMIA e propõe estratégias para maximizar os serviços já existentes. RESULTADOS: Dados apontam evidente falta de serviços e de profissionais para tratar dos problemas de SMIA. Serviços especializados, como o CAPSi (Centro de Atenção Psicossocial Infanto-Juvenil) estão estruturados para assistir casos severos, mas são insuficientes e desigualmente distribuídos. A maioria da população já tem bom acesso às unidades básicas de saúde e um melhor planejamento ajudaria a prepará-las para melhor assistir indivíduos com problemas de SMIA. Psiquiatras são escassos no sistema público, enquanto psicólogos e pediatras estão mais disponíveis; para estes recomenda-se capacitação mais especializada em SMIA. Incentivos financeiros e de carreira motivariam profissionais a procurarem emprego no sistema público de saúde. CONCLUSÕES: Apesar de estratégias complexas e de longo prazo serem necessárias para lidar com as atuais barreiras no campo da SMIA, a implantação de certas propostas simples já poderiam trazer impacto imediato e positivo neste cenário.
Subject(s)
Adolescent , Child , Humans , Mental Health Services , Primary Health Care , Public Sector , Quality Improvement , Brazil , National Health Programs , Physicians, Primary Care , PsychiatryABSTRACT
CONTEXT AND OBJECTIVE: Previous studies have attempted to understand what leads physicians to label patients as 'difficult'. Understanding this process is particularly important for resident physicians, who are developing attitudes that may have long-term impact on their interactions with patients. The aim of this study was to distinguish between patients' self-rated emotional state (anxiety and depression) and residents' perceptions of that state as a predictor of patients being considered difficult. DESIGN AND SETTING: Cross-sectional survey conducted in the hospital of Universidade Federal de São Paulo (Unifesp). METHODS: The residents completed a sociodemographic questionnaire and rated their patients using the Hospital Anxiety and Depression Scale (HADS) and Difficulty in Helping the Patient Questionnaire (DTH). The patients completed HADS independently and were rated using the Karnofsky Performance Status scale. RESULTS: On average, the residents rated the patients as presenting little difficulty. The residents' ratings of difficulty presented an association with their ratings for patient depression (r = 0.35, P = 0.03) and anxiety (r = 0.46, P = 0.02), but not with patients' self-ratings for depression and anxiety. Residents from distant cities were more likely to rate patients as difficult to help than were residents from the city of the hospital (mean score of 1.93 versus 1.07; P = 0.04). CONCLUSIONS: Understanding what leads residents to label patients as having depression and anxiety problems may be a productive approach towards reducing perceived difficulty. Residents from distant cities may be more likely to find their patients difficult.
CONTEXTO E OBJETIVO: Estudos têm tentado compreender o que leva os médicos a rotularem pacientes como "difíceis". Entender este processo é particularmente importante para os médicos residentes, que estão desenvolvendo atitudes que podem ter impacto a longo prazo em suas interaç ões com pacientes. O objetivo deste estudo foi de distinguir entre o estado emocional (ansiedade e depressão) auto-avaliado pelos pacientes e a percepção dos residentes desse estado, como preditor de pacientes serem considerados difíceis. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado no hospital da Universidade Federal de São Paulo (Unifesp). MÉTODOS: Os residentes responderam a um questionário sociodemográfico e pontuaram seus pacientes com a Hospital Anxiety and Depression Scale (HADS) e o Difficulty in Helping the Patient Questionnaire (DTH). Os pacientes completaram a HADS de forma independente e foram avaliados usando o Karnofsky Performance Status Scale. RESULTADOS: Em média, os residentes avaliaram seus pacientes como mobilizadores de pouca dificuldade. Os escores de dificuldade dos residentes apresentaram associação com os escores de depressão (r = 0.35, P = 0,03) e ansiedade (r = 0,46, P = 0,02) que atribuíram aos pacientes, mas não com os escores de ansiedade e depressão na auto-avaliação dos pacientes. Residentes provenientes de cidades distantes mostraram-se mais propensos a classificar os pacientes como difíceis de ajudar do que os residentes provenientes da mesma cidade do hospital (pontuação média de 1.93 versus 1.07, P = 0,04). CONCLUSÕES: Compreender o que leva os residentes a classificar pacientes como tendo problemas de ansiedade e depressão pode ser uma abordagem produtiva para reduzir a dificuldade percebida. Residentes de cidades distantes do local do hospital podem ser mais propensos a considerar seus pacientes como difíceis.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Attitude of Health Personnel , Internship and Residency , Medical Staff, Hospital/psychology , Physician-Patient Relations , Age Factors , Analysis of Variance , Anxiety/psychology , Cross-Sectional Studies , Depression/psychology , Diagnostic Self Evaluation , Karnofsky Performance Status , Surveys and Questionnaires , Socioeconomic FactorsABSTRACT
Physical punishment is a form of intrafamilial violence associated with short - and long - term adverse mental health outcomes. Despite these possible consequences, it is among the most common forms of violent interpersonal behavior. For many children it begins within the first year of life. The goal of this study was to determine the feasibility of involving public sector primary health care providers to inform parents about alternatives to phuysical punishment. The study used a qualitative design utilizing focus groups and survey questionnaires with parents and providers at six clinic sites chosen to be representative of public sector practice settings in Costa Rica and in metropolitan Santiago, Chile. The data were collected during 1998 and 1999. In the focus groups and surveys the parents voiced a range of opinions about physical punishment. Most acknowledged its common use but listed it among their least preferred means of discipline. Frequency of its use correlated positively with the parents' belief in its effectiveness and inversely with their satisfaction with their children's behavior. Some parents wanted to learn more about discipline; others wanted help with life stresses they felt led them to use physical punishment. Parents reported they chose other family memebers more frequently as a source of parenting information than they did health care providers. Some parents saw providers as too rushed and not knowledgeable enough to give good advice. Providers, in turn, felt ill equipped to handle parents' questions, but many of the health professionals expressed interest in more training. Parents and providers agreed that problems of time, space, and resources were barriers to talking about child discipline in the clinics. Many parents and providers would welcome a primary-care-based program on physical punishment. Such a program would need to be customized to accommodate local differences in parent and provider atitudes and in clinic organization. Health care professionals need more training in child discipline and in the skills required to interact with parents on issues relating to child behavior