Made available in DSpace on 2015-05-07T14:27:05Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1305954 bytes, checksum: a60f249cac237f70c2213e28b2a5fc1c (MD5) Previous issue date: 2008-12-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Physical Exploration of children and adolescents like strength of work is essentially a chronic problem, gone by complex elements. Becomes object of attention of the society who see, in your reality, children exerting unhealthy occupations and dangerous, despite of all legislation of granted integral protection in the Brazilian right. In this direction, the coexistence between the exploration of childhood and adolescence together with the norms in the Brazilian legislative texts creates a true antagonism, guided for social, economic and cultural aspects. The general objective of the study consists of analyzes of the form which has been assured to the young the basic right to the physical integrity, tracing a theoretical and practical parallel between the guarantee of the norms and the reality of the exploration the one that many of them come being exposed like strength of work. The research has the methodology qualified in two aspects: with regard to the ends: It‟s explicative, because it looked to elucidate the factors that originate the physical exploration of children and adolescents like strength of work, as well as the main parameters of the public politics created to deal with the problematic one, glimpsed, over all, in the analysis of the reality lived for the small workers, evidenced in critical subtility. With regard to the means: bibliographical and of field. Bibliographical, because for the theoretical base, a deepened revision of literature concerning thematic of the children‟s work was made. This activity for what it looked to draw a short trajectory of the problem, including his principal characteristics and transformations, survived by the society along the history complemented by the analysis of the basic rights secured to the child and to the adolescent. In this direction, the Federal Constitution of 1988 is important. The investigation was also of field, because it disposed of the collection of data through interviews containing itineraries defined with hard-working children or in situations of risk in the city of João Pessoa PB. The analysis of the legislation shows that the Brazilian state has one of the most advanced legal systems of the world in which it refers to the protection of the physical entirety of the child and of an adolescent, but dissonant of the social reality of poverty, misery and exclusion survived by the children workers, suited the unemployment and the social, cultural and economical profile of the Brazilian society. There are not bases substantiated for criticism to the Brazilian legislation: his character of protection and respect to the peculiarities of the childhood and youth they are well-known and his inadequacy in front of the reality does not refer to his content, but his distance of this society marked by the inequality. Why does the legislation become really efficient, is it necessary to conjugate and to perfect efforts, since the law does not guarantee his fulfillment without a least integration between the society and the legislative and state-owned mechanisms that have the mission to face and to eradicate the children's work. / A exploração física de crianças e adolescentes como força de trabalho é um problema essencialmente crônico, contornado por elementos complexos. Torna-se objeto de atenção da sociedade que vê em sua realidade menores exercendo ocupações insalubres, perigosas e penosas frente a toda legislação de proteção integral concedida no direito brasileiro. Nesse sentido, a coexistência entre a exploração da infância e adolescência e aquilo que é normatizado nos textos legislativos pátrios cria um verdadeiro antagonismo, norteado por aspectos sociais, econômicos e culturais. O objetivo geral do estudo consiste em analisar como tem sido assegurado aos jovens o direito fundamental à integridade física, traçando um paralelo teórico e prático entre a garantia normatizada e a realidade da exploração a que muitos deles vêm sendo expostos, como força de trabalho. A pesquisa tem a metodologia qualificada em dois aspectos: quanto aos fins, explicativa, porque buscou esclarecer os fatores que originam a exploração física de crianças e adolescentes como força de trabalho, os seus aspectos, bem como os principais parâmetros das políticas públicas criadas para lidar com a problemática, vislumbrados, sobretudo, na análise da realidade vivenciada pelos pequenos trabalhadores, constatada em nuances críticas. Quanto aos meios, bibliográfica e de campo. Bibliográfica, porque para a fundamentação teórica foi realizado um aprofundamento na revisão da literatura acerca da temática do trabalho infanto-juvenil, atividade esta que buscou traçar uma breve trajetória do problema, englobando suas principais características e transformações, contextualizadas nas mudanças sócio-econômicas vivenciadas pela sociedade ao longo da história, complementada pela análise dos direitos fundamentais assegurados à criança e ao adolescente. Nesse sentido, teve destaque a Constituição Federal de 1988, examinada de maneira correlata à evolução legislativa constitucional e infraconstitucional no tratamento das principais questões relacionadas à infância e a juventude, principalmente no âmbito do universo da exploração, pauperização, e enraizamento histórico do trabalho precoce. A investigação foi também de campo, porque contou com a coleta de dados por meio de entrevistas contendo roteiros pré-definidos com menores trabalhadores ou em situações de risco no município de João Pessoa PB. A análise da legislação revela que o Estado brasileiro possui um dos ordenamentos jurídicos mais avançados do mundo no que se refere à proteção da integridade física da criança e do adolescente, mas dissonante da realidade social de pobreza, miséria e exclusão vivenciada pelos pequenos trabalhadores, assentada no desemprego e no perfil social, cultural e econômico da sociedade brasileira. Não se percebe respaldo fundamentado para críticas à legislação brasileira: seu caráter de guarda e respeito às peculiaridades da infância e juventude são notórios e sua inadequação frente à realidade não se refere ao seu conteúdo, mas a sua distância dessa sociedade marcada pela desigualdade. São direitos concedidos que não se efetivam às camadas sociais menos favorecidas, excluídas. Para que a norma torne-se verdadeiramente eficaz, deve-se conjugar e aperfeiçoar esforços, pois a lei não garante sua efetivação sem uma integração mínima entre a sociedade e os mecanismos legislativos e estatais que têm a missão de enfrentar e erradicar o trabalho infanto-juvenil.

O presente estudo trata, a partir de uma abordagem crítica do debate no campo dos Direitos Humanos, da análise do extermínio de crianças e adolescentes no Rio de Janeiro, tendo em perspectiva que esses homicídios retratam a criminalização da pobreza como principal mecanismo de ação do Estado diante do agravamento da questão social e suas expressões. Inicialmente, a apresentação do arcabouço conceitual referencia as particularidades das violações dos direitos de crianças e adolescentes no contexto da formação sociohistórica brasileira, trazendo o debate na constituição do mito das classes perigosas. Em seguida procuramos compreender o contexto da crise capitalista contemporânea e a trajetória da consecução de direitos para crianças e adolescentes, circunscritos entre os avanços legais e o adensamento do processo de criminalização da infância e juventude pauperizada. Concluímos com a análise dos índices de homicídios da Região Metropolitana, a partir dos anos 90, abordando-os como resultado de um processo sistemático de extermínio de crianças e adolescentes, a culminância da violência cotidiana a qual estão submetidas, em contraposição a doutrina da proteção integral e da universalização de direitos. / This work comes from a critical approach to the debate in the field of Human Rights, the analysis of the extermination of children and adolescents in Rio de Janeiro, taking into perspective that these homicides portray the criminalization of poverty as the main mechanism of action of the State due to the worsening of the "social question" and its expressions. Initially, the presentation of the conceptual framework references the particular violations of the rights of children and adolescents in the context of the Brazilian socio-historical formation, bringing the debate on the constitution of the myth of the "dangerous classes. Then try to understand the context of contemporary capitalist crisis and the trajectory of achieving rights for children and adolescents between the circumscribed legal advances and the thickening of the criminalization of children and impoverished youth process. We conclude with an analysis of homicide rates in the Metropolitan Region, from 90s, approaching them as a result of a systematic process of extermination of children and adolescents, the culmination of everyday violence which are submitted in opposition to the doctrine of protection comprehensive and universal rights.

O Estatuto da Criança e do Adolescente (ECA) criado em 1990, ampliou a atuação do estado brasileiro na implementação das políticas públicas aos adolescentes. Há muitas instituições que visam atender esta população, entretanto, o sinergismo delas é pouco conhecido. Este estudo tem por objeto o projeto político de atenção aos adolescentes no nivel municipal e visa subsidiar a sua renovação. A partir do ECA, houve a ampliação da compreensaõ deste grupo social. Os objetivos são: conhecer os programas de atendimento aos adolescentes, verificar como se apresentam configurados e delinear as possibilidades e limites de execução de um planejamento da atenção aos adolescentes. A metodologia utilizada é quali-quantitativa, na perspectiva do materialismo histórico e dialético. Os dados empíricos foram coletados junto aos programas existentes no município, através de entrevistas e documentos. Vinte e sete programas institucionais foram identificados cadastrados de forma oficial no Conselho ou nas secretarias municipais, dezenove instituições participaram do estudo, representando quarenta e sete projetos. Os resultados mostraram que os programas são diferentes entre si em termos de tamanho, motivação do projeto, orientação laica ou religiosa, qualificação e quantidade dos trabalhadores e público alvo, porém possuem em semelhança o viés assistencialista. Enquanto a maioria delas está centrada em complementação escolar e ensino profissionalizante, outras atendem exclusivamente os adolescentes autores de atos infracionais. Embora presente numericamente, as instituições de atenção ao adolescente não se encontram ainda orquestradas em prol da consecução do ECA. / In Brazil since the Child and Adolescent Statute (ECA) was established in 1990, the state has been allowed to amplify public policies toward such social group. We assumed Oliveira’s point of view that adolescence is a social phenomenon. Adolescents can show in terms of quality of life and health-disease distinct profile according to their social group or family origins. Since ECA many institutions have created to attend adolescents. The objective of this study was to comprehend how these institutions have been organized in the City of São Carlos, setting northeast of São Paulo State, Brazil. The methodology was descriptive and the data was collected by interviews with the directors of the institutions and their proposals and reports. Twenty institutions have been studied. They have showed differences in terms of objectives, age of the target public, religious orientation, type and amount of workers. While most institutions have focused on leisure activities and professional education, some of them only assist adolescents who have committed any kind of illegal action, Although there are many different projects to assist adolescents, it seems that their actions still are not integrated towards the implementation of the Child and Adolescent Statute.

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Maciel.pdf: 2381988 bytes, checksum: ca2fd2583547e7c12f3000352cb35667 (MD5) Previous issue date: 2015-08-26 / Understanding the phenomenon of sexual violence requires different approaches and interventions that give account of the various dimensions and expressions that have, since it is a decisive subject of multiple factors such as social, economic, political and cultural. Situations as cases of abuse require the active participation of the state in rescuing the dignity of the child and adolescent, but often the same State, through its agents, is not prepared to face. We aimed to assess the Service Sexual Violence Victims and domesticated SAVVIS from the look of the team's professionals, operating in the Maternity Moura Tapajoz since 2006. He had a critical approach with quantiqualitativos and analysis data was the triangulation of data and information obtained by the content analysis technique using interviews and participant observation. For quantitative analysis, we used a sample of 255 calls of children and adolescents for the period January to July 2015, obtained from medical records and database of 270. universe for the qualitative, semi-structured interviews took place with 13 Professional members of SAVVIS team. In participant observation was accompanied by the attendance of 40 users between first and outpatient follow-up from which you can, as well as contribute to the overall analysis, build and analyze flowchart descriptor. Had the guiding question: "As the care and health care for victims of sexual violence in SAVVIS in Manaus?" The victims were in the age group 12-14 years (36%), followed by 11 years (7.8%), the remaining 51.2%, well distributed in other ages. In 50% of cases, situations can be described as intrafamilial abuse, having as a main perpetrator step father (15%), followed by unknown (13.7%) with known family (11.8) and father ( 8.2), other aggressors total (51.2%). It was found that the perpetrator in 68% of cases are of age, and 96.5% of the cases were committed by an offender at a time. The service service, it was found that in the monitoring process of the victims is compromised in the absence of social service professionals to join the team, receiving only occasional support in specific situations of maternity professionals. There were 44% of cases of recurrence of sexual violence in cases treated with 92% evasion in returns, which undermines the whole process of care. The high proportion corresponds to 7% of cases. The team has limitations to perform their work, especially due to problems whose solutions are not in their field of competence as the physical space and the limited availability of professionals to perform follow-up satisfactorily. The health care with respect to the host is played with a quality host guided by the PNH and discusses comprehensiveness under construction. The team can be defined as multidisciplinary, featuring an important step towards achieving interdisciplinarity in attendance. Found inadequate to the Ministry of Health standards in places such as the lack of criteria on completion of medical records, inadequate physical space and not performing legal abortion. It is necessary to promote training involving the concepts of interdisciplinarity and comprehensiveness in attendance, as well as implement measures to culminate in a more communicative relationship with safety net. We conclude that the SAVVIS is an important service in the city Manaus, but still partially reaching the health goals it sets itself needing to invest in a larger planning, monitoring and evaluations of their work / A compreensão do fenômeno da violência sexual exige diferentes abordagens e intervenções que deem conta das diversas dimensões e expressões que apresentam, uma vez que se trata de um tema determinantes de múltiplo fatores como sociais, econômicos, políticos e culturais. As situações como os casos de abuso exigem a participação ativa do Estado no resgate da dignidade da criança e do adolescente, mas muitas vezes este mesmo Estado, através de seus agentes, não está preparado para enfrentar. Objetivamos analisar o Serviço de Atendimento a Vítimas de Violência sexual e Domestica- SAVVIS a partir do olhar dos profissionais da equipe, em funcionamento na Maternidade Moura Tapajóz desde 2006. Teve uma abordagem crítica, com dados quantiqualitativos e sua análise se deu pela triangulação de dados e informações obtidos pela técnica de análise de conteúdo utilizando entrevistas e observação participante. Para análise quantitativa, utilizou-se uma amostra de 255 atendimentos de crianças e adolescentes do período de janeiro a julho de 2015, obtidos através dos prontuários e banco de dados de um universo de 270. Para a qualitativa, realizou-se entrevistas semiestruturadas com 13 profissionais integrantes da equipe do SAVVIS. Na observação participante acompanhou-se o atendimento de 40 usuários entre primeira vez e acompanhamento ambulatorial a partir do qual pode-se, além de contribuir para uma análise geral, construir e analisar do Fluxograma descritor. Teve como questão norteadora: “Como ocorre o atendimento e o cuidado em saúde das vítimas de violência sexual no SAVVIS na cidade de Manaus?” As vítimas eram na faixa etária de 12 a 14 anos de idade (36%), seguidos de 11 anos (7,8%), os 51.2% restante, bem distribuído nas demais idades. Em 50% dos casos, as situações podem ser descritas como abuso sexual intrafamiliar, tendo o padrasto como principal agressor (15%), seguido de desconhecidos com (13,7%), conhecidos da família com (11,8) e pai (8,2), demais agressores somam (51.2%). Constatou-se que o agressor em 68% dos casos é maior de idade, e em 96,5% das ocorrências foram praticadas por um agressor por vez. Quanto ao Serviço de atendimento, verificou-se que no processo de acompanhamento das vítimas fica comprometido diante da ausência de profissionais de serviço social para integrar a equipe, recebendo apenas apoios pontuais em situações específicas dos profissionais da área da maternidade. Houve 44% de casos de reincidência da violência sexual nos casos atendidos com 92% de evasão nos retornos, o que compromete todo o processo de atendimento. A proporção de alta corresponde a 7% dos casos. A equipe tem limitações para desempenhar seu trabalho, especialmente em razão de problemas cujas soluções não estão no seu âmbito de competência como o espaço físico e a pouca disponibilidade de profissionais para realizarem o acompanhamento a contento. O cuidado em saúde no que tange ao acolhimento é desempenhado com um acolhimento de qualidade pautado na PNH e apresenta a integralidade em processo de construção. A equipe pode ser definida como pluridisciplinar, caracterizando uma etapa importante para alcançar a interdisciplinaridade no atendimento. Constatou a inadequação à norma do Ministério da Saúde em alguns pontos como: a falta de critérios no preenchimento dos prontuários, inadequado espaço físico e a não realização do aborto legal. Faz-se necessário promover treinamentos que envolvam os conceitos de interdisciplinaridade e integralidade no atendimento, além de implantar medidas que culminem em uma relação mais comunicativa com rede de proteção. Conclui-se que o SAVVIS é um serviço relevante na cidade Manaus, mas ainda atingindo parcialmente os objetivos em saúde a que se propõe necessitando investir em um maior planejamento, monitoramento e avaliações do trabalho desenvolvido

A violência doméstica é uma realidade evidenciada com grande frequência e apontada como um grave problema de saúde pública em nosso país. Ela se concretiza, sobretudo contra pessoas em fase de desenvolvimento como crianças e adolescentes. Nosso estudo teve como objetivo conhecer e descrever as ações na Atenção Primária à Saúde prestadas pelo(a) enfermeiro(a) às crianças e aos adolescentes vítimas de violência doméstica em Unidades de Saúde da Família localizadas no Distrito Oeste do Município de Ribeirão Preto - SP. Trata-se de um estudo com abordagem qualitativa, se delineando como pesquisa social estratégica, com modalidade de estudo de caso. Para a coleta de dados, foram realizadas entrevistas semiestruturadas, diário de campo e uma visita na Secretaria Municipal de Saúde de Ribeirão Preto, especificamente a Divisão de Vigilância Epidemiológica no Núcleo de Violência e Acidentes. Participaram do estudo 05 enfermeiras que atuam nos 05 Núcleos de Saúde da Família no Distrito Oeste da cidade de Ribeirão Preto. A análise dos dados foi realizada por meio da análise de conteúdo, modalidade temática. Emergiram dois núcleos temáticos principais: Ações Municipais na Atenção à Criança e ao Adolescente Vítima de Violência Doméstica e Enfermagem na Atenção Primária à Saúde: barreiras no combate à violência doméstica. No primeiro núcleo foi abordado as ações no Município de Ribeirão Preto para o combate à violência doméstica em crianças e adolescentes. Embora os esforços da Secretaria Municipal de Saúde promovendo eventos com o objetivo de promover à capacitação e educação permanente dos profissionais de saúde, muitas vezes, há dificuldade destes eventos serem inseridos nas agendas dos enfermeiros atuantes no Núcleo de Saúde da Família. Como rede de apoio social à criança e adolescente vitimizadas foram ressaltadas pelas entrevistadas à comunidade, os vizinhos e a escola. Encontramos em uma entrevista o tráfico de drogas atuando na proteção das vítimas de violência doméstica, o que nos evidenciou certa falência da atuação dos meios de proteção. No segundo núcleo foram apontados alguns fatores que dificultam a ação dos(as) enfermeiros(as) no combate à violência doméstica tal como a falta de capacitação dos conselheiros tutelares, que dificultam a articulação e o estabelecimento de vínculo com os profissionais de saúde. O medo dos(as) enfermeiros(as) em relação ao agressor, a falta de capacitação dos(as) enfermeiros(as) para executar ações contra a violência doméstica, tais como a prevenção, a notificação, o encaminhamento e acompanhamento das vítimas são fatores que dificultam o combate à violência contra crianças e adolescentes. Entendemos que estas considerações acerca das ações no combate à violência doméstica devem ser valorizadas não só pelos(as) enfermeiros(as), mas também por todos os profissionais que atuam nos serviços de atenção à infância e adolescência. / Domestic violence is a reality very common manifested and indicated as serious problem of health public in our country. It happens, mostly, against people in developing as children and adolescents. The aim of our study is to know and to describe the actions in primary health care accomplished by the nurses to children and adolescents victims of domestic violence in Family Health Center in the West District of the municipality of Ribeirão Preto - SP. In this study is used a qualitative approach, in which is considerate a strategy of social research, a modality of case study. For data collection, it was used semi structured interviews, field diary and one visit to Health Municipal Department in Ribeirão Preto, especially the Division of Epidemiological Surveillance in the Violence and Accident Center. The study included 5 nurses which work in 5 family health centers in west district of Ribeirão Preto. The analysis of data was made through the content analysis, thematic modality. Two main theme centers appeared: \"Municipal Actions in Attention to Child and Adolescent Victims of Domestic Violence\" and \"Nursing in Primary Health Care: limits in the domestic violence combat\". On the first center was discussed the actions in the city of Ribeirão Preto to combat the domestic violence against children and adolescents. Although the Municipal Department of Health`s effort to realize events to promote the permanent professional training and education of health professionals, often, there is a difficult to the nurses of Family`s Health Center to include in their agenda. The interviewed emphasized as social support network the community, the neighbor and school. The drug traffic was cited in the interview as protection of domestic violence\'s victims, what reveal failures in actions of protection. On the second center was pointed out some factors which difficult the action of nurses in the combat domestic violence such as lack of professional training of tutelaries, what make difficult the articulation and the establishment of the bond with health professionals. The fear of nurses in relation of aggressor, the lack of professional training of nurses to execute actions against domestic violence, such as prevention, notification, routing and follow up victims are factors which make difficult the combat violence in child and adolescent. Such considerations in relation the actions against domestic violence must be valued not only by the nurses, but also by all the professionals which deal in the attention services to children and adolescents.

O presente trabalho propõe refletir sobre o instituto jurídico da guarda e da adoção, contribuindo com alguns elementos teóricos da psicanálise que possam elucidar como esse processo ocorre subjetivamente, sem deixar de fora, nesse raciocínio, a questão do gozo, central na psicanálise e o contexto trazido pelas modificações dos referenciais simbólicos iniciados na modernidade. Inicialmente, expõe-se o conceito de lei jurídica na história a fim de se levantar uma reflexão sobre a lei na atualidade, dentro do ordenamento jurídico brasileiro, trazendo problemáticas do direito em relação ao seu papel na sociedade. Posteriormente, aborda-se o conceito de Lei na psicanálise, marcando a diferença entre essas áreas. Num segundo momento, o foco recai sobre o instituto da guarda e da adoção no sistema jurídico, pensando, principalmente o primeiro instituto como um meio para se concretizar a adoção. Logo em seguida, trouxemos a guarda e a adoção pela ótica da psicanálise, utilizando-se como referencial teórico basicamente a teoria de Lacan, especialmente as modificações trazidas pela última clínica deste autor, momento em que desloca a dialética do desejo do centro da teoria para a questão do gozo. A pesquisa revelou que a adoção não opera somente no registro simbólico, como a maioria dos trabalhos encontrados se restringem, mas ocorre nos três registros psíquicos: real, simbólico e imaginário. Ao final retomamos a adoção na psicanálise dentro do contexto pós-moderno, apontando as influências sofridas pelo discurso capitalista, que produz ilusões narcísicas de completude diariamente e esclarecemos a diferença entre Lei do bem dizer e lei do dizer o bem / The proposal of this paper is to contribute to the custody and adoption legal institute, seeking some theoretical elements of psychoanalysis to elucidate how this process occurs subjectively. For that, we approache Lacan´s concept of Lust - a central topic in psychoanalysis - and the context brought by the changes in the symbolic references which emerged in modernity. The starting point of this investigation is the concept of law in the history, in order to raise a debate on the law nowadays within the Brazilian legal system, discussing some issues of law in relation to its role in society. Subsequently, the focus places on the institution of guardianship and adoption in the legal system, considering the first institute as a means for achieving adoption. To work on these themes - custody and adoption - by the psychoanalytic perspective, we use primarily theoretical teachings of Lacan, especially the changes brought about by the last clinic of Lacan, at which shifts the dialectic of desire from the heart of his theory to the question of Lust. The survey revealed that the adoption does not work only in the symbolic dimension, like most works found claims, but occurs in all three records: real, symbolic and imaginary. At the end we return to the adoption in psychoanalysis within the postmodern context, pointing out the influences experienced by capitalist discourse that produces narcissistic illusions of wholeness. For this purpose we clarify the difference between the Law of well say and the Law of say good

Topic: Structuring of inpatient behavioral programming in child-adolescent psychiatric, residential treatment, and juvenile justice settings. Purpose: To review the underlying theory underpinning current practices and recommend remedies to the uncovered problems. Sources: A review of the literature from 1965 to 2001 from selected nursing and medical psychiatric and mental health publications. Conclusions: Intensive professional and staff education and greater precision in communication about patients' behaviors are needed in many settings. There is also a need to move away from generic treatment approaches and return to individual treatment planning based on individual assessments and the unique needs of an increasingly volatile and complex in-patient population.

台灣的社會和家庭型態在近年來快速變遷，家中存在的壓力使兒童及少年成為容易受傷害的一群，許多關於兒少保護的資料皆顯示出兒童及少年受虐的比例逐年不斷地攀升。兒少保護工作具有相當高的危險性和挑戰性，各縣市從事兒少保護的社工員即擔負此重責大任，當發現兒少有危險或原生家庭無法提供其適當的照顧時，則社工員會運用公權力將兒少帶離原生家庭。家外安置是根據兒童及少年福利法而建立的制度，根據法規的精神，若受虐兒少存在立即的危險情況或原生家庭目前不適合居住等情形時，則社工員會進行家外安置，以確保兒少的利益。 　本研究透過質性研究的方法，探討兒保社工員在面對受虐兒少是否需進行繼續安置時，其抉擇的因素為何，並了解其在抉擇的過程中面臨到的問題及處理方式為何。透過本研究希望瞭解：第一，兒少保社工員對於家外安置的看法為何？第二，影響兒少保社工員採取繼續安置的抉擇因素為何？第三，兒少保社工員在繼續安置抉擇過程中面臨到的問題及處理方式為何？本研究並進行北部五縣市（台北縣、桃園縣、基隆市、新竹縣、新竹市）跨區域的比較，了解北部各縣市的差異性。最後，將研究結果形成建議，提供兒少保護相關領域的社工員未來在面對這樣議題時的參考。 　　依據研究目的，研究者邀請北部地區十七位在兒少保護機構工作超過一年以上的社工員進行一對一的深度訪談，研究結果如下列幾點： 一、社工員認為家外安置的功能是：「公權力的示範」、「給孩子一個安全的生活環境」、「可能產生負面效果的權宜之計」、以及「暫時舒緩家中存在的壓力」。 二、社工員考量受虐兒少是否繼續安置的抉擇因素包括：兒少年齡、兒少意願和自主性、兒少與原生家庭的依附程度、兒少身心狀況、兒少自我保護功能、兒少人身安全、兒少受虐程度、兒少受虐歷史、兒少受虐型態、施虐者施虐原因、施虐者身心狀況、施虐者親職功能、施虐者對於處遇的配合程度、施虐者改變的動力和程度、其他親屬的照顧資源、家庭其他成員的保護能力、安置能否發揮功能、社工員人身安全的考量、安置資源有無、施虐者對兒少的脅迫。 三、決定受虐兒少需進行繼續安置最關鍵的因素為兒少人身安全是否可確保以及家庭功能的整體評估。 四、各個縣市在安置處理模式和安置資源使用狀況存在差異性。 五、兒少保社工員對於緊急安置和繼續安置考量的差異在於：行政裁量VS.法院裁定；公權力初步展現VS.較長期的家庭重建；立即性保護兒少安全VS.長期間掌控兒少的風險。 六、社工員在安置過程中面臨到的困境主要有兩類，一為評估面上的困難，包括教養的尺度難以衡定、客觀證據力不足時該如何判斷、如何評斷出什麼是正確的資訊、精神虐待類型難以評估；二為執行面上的困難，包括安置資源不足、72小時的時間限制、後送單位品質的問題、青少年後續配套資源的不足、關於安置的法律議題不熟悉、相關網絡成員的壓力、來自外界聲音的壓力、社工員人身安全的憂慮。 　　最後，本研究對於社會工作實務、政府政策、以及進一步研究的部份提出建議，提供給相關領域的機構和工作人員作為參考。 / In Taiwan, types of the society and families are changing rapidly in recent years. Pressure at home makes children and adolescents vulnerable. Statistical data about child and adolescent protection indicates that the percentage of abuse is climbing year after year. Jobs of child and adolescent protection are highly dangerous and challenging. Social workers in different cities and counties take these great responsibilities. When they find out any children/adolescents are in danger or families-of-origin can not provide proper care, the social workers would use public power to bring those children away from their families-of-origin. Out-of-home placement is a system based on Child and Youth Welfare Law. According to spirit of law, if there exists immediate danger for children and adolescents, or families-of-origin are not appropriate for living, social workers would proceed with out-of-home placement to ensure their well-being. This research is using qualitative method to discuss what determines social workers’ decisions to proceed with continuous placement, and what problems they face in the process of making decisions and how they deal with them. This research aims at understanding the following questions. First, what are child and adolescent protection social workers’ point of views regarding out-of-home placement? Second, what affects social workers’ decisions to proceed with continuous placement? Third, what problems do child and adolescent protection social workers face when they are making decisions of continuous placement and how do they cope with those problems? This research also conducted a cross area comparison between five cities/counties in north part of Taiwan including Taipei County, Taoyuan County, Keelung City, Hsin-Chu County, and Hsin-Chu City to understand difference in them. Finally, suggestions are made based on research results to provide reference for child and adolescent protection social workers when in the future they face these kinds of issues. 　　Based on objectives of the research, the researcher invited seventeen social workers that have worked over one year in child and adolescent protection institutions in north part of Taiwan for one-to-one in-depth interviews. Research results are as follows. First, social workers think the functions of out-of-home placement are, “demonstration of public power”, “to provide a safe environment for children”, “a tentative strategy with negative effects” and “a temporary release of stress at home”. Second, the factors that determine social workers’ decisions of continuous placement include children and adolescents’ ages, their inclination, autonomy, attachment to their family-of-origin, physical and psychological conditions, self-protection function, personal safety, children and adolescents’ degree of abuse, history of abuse, types of abuse, and abusers’ reasons to abuse, abusers’ physical and psychological conditions, abusers’ parenting function, degree of cooperation with placement, abusers’ motivation and degree of change, other family caring resource, other family members’ abilities of protection, effectiveness of placement, safety consideration for social workers, availability of placement resource, abusers’ threats to children and adolescents. Third, the key factors to decide continuous placement for abused children and adolescents are whether safety of children and adolescents can be assured and overall evaluation of family function. Forth, cities and counties are different in terms of placement types and usage of placement methods. Fifth, the difference between considerations of emergent and continuous placement is: administrative discretion VS. court discretion, preliminary effect of public power VS. longer-term family reconstruction, immediate protection of children and adolescents VS. risk of long-term control of children and adolescents Sixth, the main difficulties that social workers face in the process of placement fall into two categories. One is difficulty of evaluation, including difficulty to judge whether the discipline is appropriate, how to judge when there is no enough objective evidences, how to screen the right information, difficulties to determine types of mental abuse. The other is difficulty of implementation, including insufficiency of placement resource, time limit of 72 hours, problems of placement family quality, insufficiency of supporting resources for adolescents afterwards, unfamiliarity with legal issues of placement, pressure from other network members, pressure from the public voices, and concerns about social workers’ safety. Last, the research provides suggestions regarding social work practices, government policies, and further research for related institutions and workers’ reference.

In recent years, there has been an ever increasing emphasis placed on the collection and use of patient reported outcome measures (PROM) in mental health services. This emphasis stems from a culture of evidence based practice, wherein PROM are shown to improve therapeutic outcomes at the clinical level, as well as provide information for the appropriate development of services and commissioning at a national level. This study uses an online survey to explore the use of PROM by mental health staff (n=112) in various Child and Adolescent Mental Health Services across England. Attitudes toward routine outcome monitoring practices and perceived competency around PROM use were also measured. Results found that although significant numbers of staff were using PROM, the amount of data being collected falls short of policy targets. Staff’s attitudes towards the practice are shown to be ambivalent, whereas overall perceived levels of competency were reasonably good. The relationships between attitudes, competence and PROM usage are discussed and a prediction model for PROM usage is developed in light of existing psychological theory. Results showed that training played an important role in the uptake of PROM and implications for the dissemination of training programs are emphasised.

<b>Introduction</b>: Maternal antenatal depression has been associated with an increased risk of offspring psychopathology and more recently with disturbed infant sleep; in particular, shorter sleep duration, more awakenings and sleep problems. The exact mechanisms through which risk may be transmitted remain unknown, as does the question of whether all infants are equally susceptible to the effects of antenatal depression. The primary objectives of this thesis were to examine: i) The role of two potential moderators on the association between antenatal depression and infant sleep: infant reactive temperament and the serotonin transporter polymorphism 5-HTTLPR ii) The association between antenatal depression and infant sleep using objective behavioural and physiological measures. iii) Infant sleep and temperament in a pilot randomised controlled trial (RCT) following treatment of antenatal depression <b>Methods</b> i) The role of infant reactivity and 5-HTTLPR as potential moderators was examined in two large longitudinal cohorts: the Avon Longitudinal Study of Parents And Children (ALSPAC) and the Generation R study, based in the UK and The Netherlands respectively (n=8,991 and n=2,441). ii) An Oxford based pilot longitudinal family study (n=16) iii) A pilot randomised controlled trial of women with antenatal depression who received Cognitive Behavioural Therapy (CBT) or Care as Usual (n=25). <b>Results</b> i) There was evidence that reactive temperament moderated the association between antenatal depression and infant sleep; boys seemed to be most affected exhibiting more awakenings, sleep problems and shorter sleep duration. 5-HTTLPR did not moderate this association. ii) Antenatal depression was associated with shorter infant sleep duration 5 months postpartum iii) Improvement in depression was associated with shorter infant sleep duration and easier temperament 2 months postpartum <b>Conclusion</b>: This thesis suggests that not all infants are equally susceptible to environmental influences and this may prove important in targeting interventions. The role of genetic factors in conferring any susceptibility remains unclear. Actigraphy offering accurate representation of activity levels and timing during the day and night was a significant methodological advantage, but recruitment to a study incorporating these proved challenging. Finally, psychological interventions during pregnancy appear to have beneficial effects for child development.