Made available in DSpace on 2016-03-15T19:41:18Z (GMT). No. of bitstreams: 1 Maria Luiza Guedes de Mesquita.pdf: 3223053 bytes, checksum: 7233fde246c91329017c898671a1ca6b (MD5) Previous issue date: 2012-12-14 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Prader-Willi Syndrom (PWS) is a genetic disorder caused by the lack of expression of the genes from the paternal chromosome region 15q11-13 that suffer from genomic imprinting. Cardinal symptoms of the disorder are neonatal hypotony, hyporeflexia in the six first months of age and the ulterior development of hyperfagia, obesity, behavioral problems and intellectual disability in varied levels. Studies indicate that, despite the evident neurobiological factors involved in the pattern of hyperfagia and behavioral alterations, parent training is still considered fundamental and one of the most adequate intervention options for children and adolescents with the syndrome. Parenting practices adapted to the main demands of personal care can result not only in improvement in behavioral problems, but also improves indicators of family relations and can cause a reduction of parental mental health problems. The study had the objective of developing, applying and assessing the efficiency of a parent training program for behavioral management of children and adolescents with PWS. The sample was composed of five children/adolescents with genetic diagnosis of PWS, age range 6 to 16 years old. Data collection procedures and tools were: a) Questionnaire for assessing the knowledge of mothers about the syndrome; b) Child Behavior Checklist for Ages 6-18 (CBCL/6-18); c) Adult Self-Report for Ages 18-59; d) Parenting Styles Inventory maternal and paternal educational practices; e) anthropometric examination of body weight indicators; f) Wechsler Intelligence Scale for Children WISC III. The research was composed of four phases: pre-intervention assessment, intervention, post-intervention assessment, follow-up. Parallel to intervention, it was carried out a nutritional intervention program, which was the subject of an MA dissertation developed by the Post-Graduation Program in Development Disorders. Data collected with behavioral assessment tools was analyzed through their specific patterns. Descriptive analysis of the data were carried out through the use of tables and figures of simple frequency and comparison of data related to children, adolescents and mothers that took part in the study at the phases of pre-intervention, post-intervention and follow-up. The main results indicate that the group presented expressive improvement in all emotional and behavioral aspects, as well as in the indicators of body weight (mainly due to nutritional intervention). Socialization indicators did not present improvement due to the inadequate obtention of food in these socialization environments. Mothers started to adopt parenting educational practices based on positive monitoring, reduced or eliminated the use of risk practices and acknowledged harm effects of the use of negative parenting practices with their children. The study concluded that the group of mothers learned to identify and manage several factors that impaired physical health, behavior and academic performance of their children and the need of the involvement of parents, grandparents and siblings in the proper care and behavioral management of the child with the syndrome. / A Síndrome de Prader-Willi (SPW) é uma doença genética cuja causa decorre da falta de expressão de genes da região cromossômica 15q11-13 paterna que sofrem o fenômeno de imprinting genômico. Os sintomas cardinais da doença são hipotonia neonatal e hiporreflexia nos primeiros seis meses de vida e posteriormente o desenvolvimento progressivo de hiperfagia, obesidade, problemas de comportamento e deficiência intelectual em níveis variados. Estudos apontam que, apesar do evidente envolvimento neurobiológico no padrão de hiperfagia e nas alterações comportamentais, continua sendo considerado prioritário o treinamento parental como uma das opções de intervenção mais adequadas para crianças e adolescentes com a síndrome. Práticas parentais adaptadas às principais demandas de cuidado da pessoa podem resultar não só em melhoras de problemas de comportamento desta, mas também na melhora de indicadores de relacionamento familiar e redução de problemas de saúde mental dos pais. O estudo teve como objetivo geral desenvolver, aplicar e avaliar a eficácia de um programa de treinamento parental para manejo de comportamentos de crianças e adolescentes com SPW. A amostra foi composta por cinco crianças/adolescentes com diagnóstico genético de SPW, na faixa etária de 6 a 16 anos e suas mães. Os instrumentos e procedimentos de coleta de dados foram: a) Questionário para verificação de conhecimentos das mães sobre a síndrome, b) Inventário de Comportamentos de Crianças e Adolescentes de 6 a 18 anos (CBCL/6-18); c) Inventário de Auto-avaliação para Adultos de 18 a 59 anos (ASR/18-59), d) Inventário de Estilos Parentais (IEP) - Práticas educativas maternas e paternas, e) Exame antropométrico de indicadores de peso corporal, f) Escala de Inteligência Wechsler para crianças WISC-III. O estudo foi realizado em quatro fases: avaliação pré-intervenção, intervenção, avaliação pós-intervenção e seguimento. Paralelamente à fase de intervenção do estudo foi conduzido um programa de intervenção nutricional tema de uma dissertação de mestrado desenvolvida no Programa de Pós-Graduação em Distúrbios do Desenvolvimento. Os dados provenientes da aplicação dos instrumentos de avaliação comportamental foram analisados por meio das padronizações específicas destes. Foram conduzidas análises descritivas dos dados mediante uso de tabelas e gráficos de frequência simples e comparação dos dados referentes às crianças, adolescentes e mães participantes entre as fases de pré-intervenção, pós-intervenção e seguimento. Os principais resultados apontaram que o grupo de crianças/adolescentes apresentou melhoras expressivas em todos os aspectos emocionais e comportamentais e indicadores de peso corporal (esses últimos associados predominantemente à intervenção nutricional). Indicadores de socialização não apresentaram na amostra a mesma melhora devido à obtenção inadequada de comida nesses ambientes de socialização. As mães passaram a adotar práticas parentais educativas baseadas na monitoria positiva, diminuíram ou extinguiram o uso de práticas de risco e reconheceram os efeitos prejudiciais do uso de práticas parentais negativas em relação ao manejo do filho. O estudo permitiu concluir que o grupo de mães apreendeu a identificar e manejar diversos fatores que prejudicavam a saúde física, o comportamento e a aprendizagem escolar dos filhos e a necessidade do envolvimento de pais, avós e irmãos no cuidado e manejo comportamental adequado do filho acometido pela síndrome.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-04-03T15:39:06Z No. of bitstreams: 1 carlaferreiradepaulagebara.pdf: 1785421 bytes, checksum: 400e4b3b476aa0017757992cf2fe8276 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-04-03T19:04:35Z (GMT) No. of bitstreams: 1 carlaferreiradepaulagebara.pdf: 1785421 bytes, checksum: 400e4b3b476aa0017757992cf2fe8276 (MD5) / Made available in DSpace on 2017-04-03T19:04:35Z (GMT). No. of bitstreams: 1 carlaferreiradepaulagebara.pdf: 1785421 bytes, checksum: 400e4b3b476aa0017757992cf2fe8276 (MD5) Previous issue date: 2009-11-13 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / A presente pesquisa teve como objetivo principal analisar as crenças dos Agentes Comunitários de Saúde (ACS) do município de Lima Duarte a respeito da violência doméstica (VD) contra crianças e adolescentes, relacionada ou não ao uso de álcool e drogas ilícitas. Participaram da pesquisa todos os 30 ACS do município que, num primeiro momento, responderam a um questionário auto-aplicável, estruturado, individual e anônimo, composto por 21 questões. Num segundo momento, após análise estatística dos dados quantitativos, os ACS foram convidados a participar de um Grupo Focal. Os dados qualitativos foram analisados através da técnica de análise de conteúdo. Os resultados indicaram uma forte tendência dos entrevistados a considerar os problemas relacionais e intrafamiliares como geradores de VD contra crianças e adolescentes, assim como o álcool e as drogas. Além disso, os resultados deste estudo deixam clara a necessidade de se pensar em intervenções eficazes no plano institucional visto que, no espaço pesquisado, não se desenvolve um projeto específico de prevenção e combate à VD, nem uma política voltada à capacitação dos ACS para lidar com esta problemática. / The aim of this research is first and foremost to analyze the beliefs of communitarian health agents from Lima Duarte about domestic violence and its connection with alcohol and drugs. In the beginning, all the 30 communitarian health agents completed a structured, individual and confidential questionnaire. After, they were invited to participate in a focus group. The data collected was studied with the content analysis technique and revealed the professionals tendency to consider relationship and family problems, alcohol and drugs as important factors of domestic violence against children and teenagers. The results of the research also made it clear that there is dire necessity for effective institutional interventions in Lima Duarte, since there is no project intended to prevent domestic violence, neither a programme capable of preparing communitarian health agents to deal with this issue.

Orientador: José Roberto Rus Perez / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-23T18:12:46Z (GMT). No. of bitstreams: 1 Monfredini_MariaIsabel_D.pdf: 1785874 bytes, checksum: 88b4c75f3f57fe0096b72bbdfcdfb97d (MD5) Previous issue date: 2013 / Resumo: Este estudo exploratório se caracteriza por uma pesquisa bibliográfica, com o objetivo geral de compreender o desenho da política de proteção integral ancorado na intersetorialidade do Sistema de Garantia de Direitos da Criança e do Adolescente, para identificar as inter-relações com o campo da educação no Brasil. Insere-se na análise de políticas públicas, sendo o caminho metodológico pautado na caracterização da proteção integral e do Sistema de Garantia de Direitos numa perspectiva interdisciplinar, por estar estruturado com uma dimensão pedagógica especial, que requer ações intersetoriais e articuladas. A interlocução analítica tem como principal referência o Estatuto da Criança e do Adolescente que, após vinte e três anos de promulgação, continua tendo uma leitura fragmentada, contribuindo para o distanciamento da visão de totalidade em que vivem e estão imersos crianças e adolescentes. Um pressuposto tem na questão da intersetorialidade e da articulação a vertente estruturante para que os improvisos sejam evitados e as intervenções se consolidem efetivamente com a instituição de protocolos interinstitucionais. Apontamos a articulação concentrada de todos os atores/operadores do Sistema de Garantia, como alternativa para consolidar uma prática organizada, estruturada e totalizante, visando superar a situação que está a demandar respostas efetivas, com propostas que rompam ou modifiquem a situação de ameaça ou de violação de direitos. Para tanto, encurtar a distância entre os marcos legais, normativos e regulatórios e a operacionalização da política de atendimento, transversal e intersetorial, é condição necessária e que vem rebater nos dilemas e problemas das políticas sociais setoriais. Apreender como a educação se insere e participa deste processo, fundamentou o nosso objeto de estudo, considerando a escola como um espaço de cuidado, onde se processam as relações para a manutenção do direito à educação. A complexidade sinaliza que consensos teóricos e operacionais, permanecem postos como desafios, assim como a construção intersetorial de diálogos e acordos na operacionalização da proteção integral e dos direitos, nos arranjos institucionais e nas práticas decorrentes, para a estruturação da gestão da infância e da adolescência. Correlacionado está também à necessidade profissional, pois estar inserido neste Sistema não equivale dizer que se tem a necessária clareza de sua amplitude e complexidade. É preciso qualificar o conhecimento para desenhar e cimentar as especificidades territoriais. Vários direitos encontram expressão e se entrecruzam com o campo da educação, mas, especificamente, tomamos como parâmetro o direito à convivência familiar, que permite entender o quanto a escola pode ser um local que contribui para romper as discriminações em torno da criança e do adolescente acolhido institucionalmente. Para demonstrar uma alternativa de prática intersetorial, priorizamos considerações mais gerais sobre as audiências concentradas, ocorridas no âmbito da justiça da infância e da juventude. / Abstract: This exploratory study is characterized by a bibliographic research, with the overall goal of understanding the structure of the full protection policy anchored in the intersectoriality of the System and the Guarantee of the Rights of the Child and Adolescent to identify the interrelationships with the field of education in Brazil. It is part in a public policy analysis, being the methodological process based in the characterization of integral protection and of the System and the Guarantee of Rights from an interdisciplinary perspective, to be structured with a special pedagogical dimension that requires intersectoral action and articulated. The analytic dialogue has as main reference the Statute of Children and Adolescents that after twenty-three years of enactment, still has a fragmented understanding, contributing to the detachment of the total reality that live and are immersed the children and adolescents. There is an assumption in the issue of intersectoriality, and articulation the structuring axis for the improvisations be avoided and interventions be consolidated efficiently with the establishment of interinstitutional protocols. The articulation concentrated of all the actors / operators of the System the Guarantee is pointed as an alternative to consolidate a practice organized, structured and totalizing, aiming to overcome the situation that is to demand effective responses, with proposals that break or modify the threat situation or violation of the rights. Therefore, shorten the gap among the legal frameworks, normative and the regulatory and the practice of attendance policy, intersectoral and transversal it is necessary and that comes rebut in the dilemmas and problems of sector social policies. Grasping as the education is part of and takes part in this process, it was the object of study, considering the school as an area of care where happens the processing of relationships for the maintenance of the right to education. The complexity indicates that theoretical consensuses and operational, remain as challenges, as well as the intersectoral construction of dialogues and agreements in the operations of full protection and of the rights, in the institutional arrangements and in the practices arising to the structure of management of childhood and adolescence. Correlated is also the professional necessity because to be inserted in this system is not equivalent to saying that it has the necessary clarity of scale and complexity. It is needed qualify the knowledge to draw and cement the specifications territorial. Various rights find expressions and intercross with the field of education, but, specifically, we take as a parameter the right to family coexistence, that allows to understand how the school may be a place that contributes to break the discrimination around the child and adolescent institutionally accepted. To demonstrate an alternative of practical intersectoral it was prioritized more general considerations about the hearings concentrated, that occurring in the context of justice of children and youth. / Doutorado / Politicas, Administração e Sistemas Educacionais / Doutora em Educação

It is increasingly clear that pain and emotions are closely interconnected. Pain does not only cause psychological distress, but psychological distress also amplifies pain through neurological mechanisms. Treatment of both chronic and acute pain would benefit from acknowledging the psychological mechanisms of pain neurophysiology. Psychological acceptance predicts increased pain tolerance and decreased pain intensity and discomfort in experimentally induced pain and improved physical and psychosocial functioning for persons with chronic pain. The overall aim of this thesis was to evaluate acceptance-based interventions for persons suffering from pain. In Study I the effect of a manualised ACT-based self-help intervention for adults with chronic pain was evaluated in an RCT (n=90). The results showed improvements in satisfaction with life, physical functioning and pain intensity for the ACT group. Both the ACT and the control group improved regarding depression and anxiety. In Study II the mediating effect of acceptance for treatment change was evaluated, using data from Study I (n=64). The results showed indirect effects of treatment via acceptance for physical functioning but not for satisfaction with life. In Studies III and IV, instruments to measure psychological flexibility in relation to pain were developed for children with cancer, and their parents respectively, using factor analysis. The results showed that a two-factor solution for the child scale (n=61) and a three-factor solution for the parent scale (n=243), best represented the data. In Study V, an acceptance-based intervention was preliminarily evaluated in a single-subject study (n=5) for children reporting pain during cancer treatment. The intervention consisted of an approximately 15-minute long pain exposure exercise. All participants reported reduced discomfort of pain, and three of the participants reported reduced pain intensity. The results suggest that a manualised ACT-based self-help intervention is a valuable addition to the treatment repertoire for persons with chronic pain and that acceptance may mediate the effect of treatment on physical functioning. Furthermore, instruments to measure acceptance in the context of acute pain in children with cancer are now available, although further validation is needed. Lastly, the results indicate that an acceptance-based intervention may help children undergoing cancer treatment to cope with pain.

The purpose of this essay was to examine how mental illness among children and adolescents is conveyed in a few of the Swedish daily and evening newspapers in an attempt to create an understanding of the depiction. This was examined by analyzing 14 articles in three Swedish daily and evening newspapers, Svenska Dagbladet, Dagens Nyheter and Aftonbladet during the period 2015–2019. To answer the study's purpose and research question, a qualitative text analysis was used, which was supplemented with the social constructivist perspective and the framing theory. The conclusion of the study showed that these three Swedish daily and evening newspapers tended not to present a holistic perspective on the phenomenon of children and adolescents' mental illness. The depiction was mainly about research and experts that were allowed to speak on the subject, which resulted in the description of children and adolescents' mental illness being primarily from a scientific perspective. The articles did not address the affected children and adolescents to the extent required, which meant that their perspectives were not communicated. Based on the framing theory and social constructivism, this can be interpreted as part of the maintenance of social constructions and norms around mental illness.

Fragestellung: Sowohl die Childhood Group der International Obesity Task Force (IOTF) als auch die European Childhood Obesity Group (ECOG) empfehlen den Body-mass-Index als Beurteilungskriterium für Übergewicht und Adipositas bei Kindern und Jugendlichen. Im Erwachsenenalter erfolgt die Definition von Übergewicht und Adipositas anhand fester Grenzwerte, bei der Beurteilung von Kindern und Jugendlichen müssen die alters- und geschlechtsspezifischen Veränderungen des BMI berücksichtigt werden. Methode: Unter Heranziehung von 17 bereits durchgeführten Untersuchungen aus verschiedenen Regionen Deutschlands wurden BMI-Perzentile für Kinder und Jugendliche erstellt. Die Berechnung der Perzentile basiert auf den Körperhöhen- und Körpergewichtsdaten von 17.147 Jungen und 17.275 Mädchen im Alter von 0–18 Jahren. Ergebnisse und Schlussfolgerung: Die vorgestellten Perzentile sollten als Referenz für deutsche Kinder und Jugendliche angewendet werden. Die Arbeitsgemeinschaft „Adipositas im Kindes- und Jugendalter“ (AGA) hat in ihren Leitlinien die Anwendung der hier vorgestellten 90. und 97. Perzentile zur Definition von Übergewicht und Adipositas empfohlen. / Objectives: Both the Childhood Group of the International Obesity Task Force (IOTF) and the European Childhood Obesity Group (ECOG) recommend to use the body mass index (BMI = weight in kilograms/height in meter2) to evaluate overweight and obesity in children and adolescents. Whereas it is customary with adults to use fixed cut off points to define overweight and obesity, in children and adolescents age and sex specific developmental changes in BMI need to be addressed, which are due to physiological alterations of fat mass. Method: Because a national reference population for children and adolescents does not exist in Germany, a BMI reference data set was compiled. Therefore measurements of height and weight from 17 different regional studies including 17147 boys and 17275 girls aged 0 to 18 years were used. Results and conclusions: We recommend the use of the presented percentiles as reference to asses under- and overweight (obesity) in German children and adolescents. In the guidelines of the “Arbeitsgruppe Adipositas im Kindes- und Jugendalter”(AGA) the 90th and 97th BMI percentiles as calculated in this reference population are proposed as cut-off points for the definition of overweight and obesity in German children and adolescents.

Background: Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany. Objectives: The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation. Methods: The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7–17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/ hyperactivity disorder (FBBHKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined. Results Overall, 14.5% of the children and adolescents aged 7–17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed. Conclusions: The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

Background: The consideration of impairment plays a crucial role in detecting significant mental health problems in children whose symptoms do not meet diagnostic criteria. The assessment of impairment may be particularly relevant when only short screening instruments are applied in epidemiological surveys. Furthermore, differences between childrens’ and parents’ perceptions of present impairment and impairing symptoms are of interest with respect to treatment-seeking behaviour. Objectives: The objectives were to assess parent- and self-reported impairment due to mental health problems in a representative sample of children and adolescents; to describe the characteristics of highly impaired children with normal symptom scores; and to investigate the associations between symptoms in different problem areas and impairment. Methods: The mental health module of the German Health Interview and Examination Survey for Children and Adolescents (the BELLA study) examined mental health in a representative sub-sample of 2,863 families with children aged 7–17. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children 11 years and older. Results: Considerable levels of distress and functional impairment were found with 14.1% of the boys and 9.9% of the girls being severely impaired according to the parental reports. However, self-reported data shows a reversed gender-difference as well as lower levels of severe impairment (6.1% in boys; 10.0% in girls). Six percent of the sampled children suffer from pronounced impairment due to mental health problems but were not detected by screening for overall symptoms. Childrens’ and parents’ reports differed in regard to the association between reported symptom scores and associated impairment with children reporting higher impairment due to emotional problems. Conclusions: The assessment of impairment caused by mental health problems provides important information beyond the knowledge of symptoms and helps to identify an otherwise undetected high risk group. In the assessment of impairment, gender-specific issues have to be taken into account. Regarding the systematic differences between childrens’ and parents’ reports in the assessment of impairment, the child’s perspective should be given special attention.

[pt] Esta pesquisa tem como objetivo a análise da contribuição da política de assistência social na Rede Municipal de Atenção Integral à Criança e ao Adolescente de Niterói (Rede DCA) a partir da atuação do Centro de Referência Especializado de Assistência Social (CREAS) no fluxo de atendimento aos casos de violência doméstica intra e extrafamiliar, privilegiando os entraves e possibilidades do trabalho intersetorial na efetiva garantia dos direitos de crianças e adolescentes. Trata-se de um estudo qualitativo, concretizado através da realização de entrevistas semiestruturadas com onze profissionais de diversas instâncias do Sistema de Garantia de Direitos da Criança e do Adolescente de Niterói, submetidas à análise de conteúdo em sua modalidade temática. Os resultados apontam que a Rede DCA se configura como uma relevante iniciativa, decorrente da mobilização política de atores e instituições do poder público e da sociedade civil organizada, direcionada à proteção integral a crianças e adolescentes em Niterói, mesmo com os entraves ainda encontrados. O fluxo de atendimento aos casos de violência doméstica intra e extrafamiliar representa conquista coletiva a favor da delimitação das atribuições dos órgãos e serviços envolvidos no atendimento a crianças e adolescentes vítimas da violência doméstica e indica a capacidade de atuação intersetorial cada vez mais tangível de ser alcançada pela Rede DCA a partir do incremento das ações interdisciplinares e interinstitucionais já consolidadas. No entanto, o desafio identificado na compreensão acerca das atribuições do CREAS somado às dificuldades de interlocução entre os atores sociais partícipes do fluxo de atendimento, fazem com que este ainda não se mostre efetivo na operacionalização de ações intersetoriais necessárias à proteção integral a crianças e adolescentes. / [en] This research aims to analyze the social assistance policy contribution to the Municipal Children and Adolescents Integral Attention Network of Niterói (Rede DCA) as from the actions taken by the Social Assistance Specialized Reference Center (CREAS) at the attendance flow of intra and extrafamilial violence cases, emphasizing the hindrances and possibilities of intersectorial work in the effective assurance of children and adolescents rights. It is a qualitative study, that was accomplished through semi structured interviews with eleven professionals in different levels of the Children and Adolescents Rights Assurance System of Niterói, submitted to content analysis as from its theme modality. The results show that the Rede DCA configures a relevant initiative, resulting from the political mobilization of actors and institutions from public authority and organized civil society, directed at the integral protection of children and adolescents in Niterói, even with the hindrances still found. The attendance flow of intra and extrafamilial domestic violence cases represents a collective achievement in favor of attendance to children and adolescents victims of domestic violence involved services and organs attributions delimitation and indicates the intersectorial acting capacity more and more tangible to the Rede DCA as from the development of interdisciplinary and interinstitutional actions already consolidated. However, the challenge identified in the understanding of CREAS assignments added to the difficulties of interlocution between the participants social actors in the attendance flow, makes this still not effective in operationalize intersectorial actions needed for integral protection of children and adolescents.

Socialt samspel är en viktig komponent för individens utveckling av verklighetsuppfattning, personlighet och identitet. Eftersom barn och ungdomar med autism har nedsättningar som påverkar deras sociala samspel blir insatser kring social färdighetsträning en åtgärd som påverkar deras och hela deras familjs livskvalitet. Denna studie undersöker hur praktisk användning av den manualbaserade sociala färdighetsträningen KONTAKT-gruppbehandling upplevs av vårdpersonal i Sverige. Kvalitativa intervjuer har genomförts med 17 personer inom vård som har erfarenhet att vara KONTAKT-tränare från sex olika regioner i Sverige. Frågeställningar som lyftes i denna studie handlar om i) Hur uppfattar vårdpersonalen användningen av den manualbaserade sociala färdighetsträningen KONTAKT i arbetet med barn och ungdomar med autism och deras föräldrar? ii) Vilka upplevelser har vårdpersonalen av sin roll som KONTAKT-tränare? och iii) Finns det eventuella gap mellan teori och praktik kring användningen av den manualbaserade träningen av sociala färdigheter KONTAKT inom olika delar av vårdverksamheten? Utifrån grundad teori har en teoretisk modell genererats som beskriver respondenternas upplevelse av KONTAKT-tränarens roll, vilken påverkar och påverkas av tidsaspekter och samspelsförmågor. Studiens resultat indikerar att känslan av meningsfullhet och lärdom genom erfarenhet upplevs i rollen som KONTAKT-tränare. Studien visar att med rollen följer ett ansvar att planera och rekrytera deltagarna till KONTAKT-gruppbehandling. Rollen som KONTAKT-tränare beskrevs av respondenterna påverkas av tidsaspekter som kopplas till det praktiska utförandet utifrån behandlingsmanualen. Studiens resultat indikerar att det i rollen som KONTAKT-tränare krävs en förmåga att samspela med föräldrar, andra i team (kring rekrytering), partner/kollega (den andra KONTAKT-tränaren) och barn eller unga med autism inför och under pågående gruppbehandling. I studien diskuteras implikationer för organisation och implementering. Det långsiktiga syftet med denna studie är att bidra till utveckling av insatser som stödjer barn och ungdomar med autism och deras anhöriga. / Social interaction is an important component for the individual's development of perception of reality, personality, and identity. Because children and adolescents with autism have disabilities that affect their social interaction, interventions in social skills training become a measure that affects their and their entire family's quality of life. This study examines how practical use of the manual-based group training treatment KONTAKT is experienced by clinicians in Sweden. Qualitative interviews with altogether 17 caregivers from six different regions in Sweden were conducted with the aim of answering the following research questions: i) How do caregivers perceive the use of the manual-based social skills training concept KONTAKT when working with children and adolescents with autism and their parents? ii) What experiences do the caregivers have in their role as a KONTAKT coach? and iii) Are there any gaps between theory and practice regarding the use of the manual-based social skills training concept KONTAKT in different areas of care giving activities? Based on grounded theory, a theoretical model has been generated that describes the respondents' experience of the role as a KONTAKT coach, a role that affects and is affected by time aspects and cooperation ability. The results of the study indicate that the feeling of meaningfulness and learning through experience is experienced in the role as a KONTAKT coach. The study shows that the role comes with a responsibility to plan and recruit participants for KONTAKT group treatment. The role as a KONTAKT coach was described by the respondents as affected by time aspects that are linked to the practical implementation of the manual. The results of the study indicate that the role as a KONTAKT coach requires the ability to interact with parents, others in the team (around recruitment), partners / colleagues (the other KONTAKT coach) and children or adolescents with autism before and during ongoing group treatment. The study discusses implications for the organization and implementation of the treatment. The purpose of this study is to contribute to the development of interventions that support children and adolescents with autism and their relatives.