Made available in DSpace on 2016-07-27T14:20:36Z (GMT). No. of bitstreams: 1 LEANDRA ASSIS BORGES LIMA.pdf: 837605 bytes, checksum: 5e07cab2673b2a7373eba816724ad56d (MD5) Previous issue date: 2014-12-12 / In Brazil the campaign for deinstitutionalization of severe mentally ill patients and their reintegration to the community began with Psychiatric Reform and Health Reform in the 1970s and intensified in the 1980s. But it was only in 1988 with the creation of the Single Health System (SUS) which has as guiding principles to universality, comprehensiveness, and fairness, that creates lwas and programs for all areas of public health. Subsequently the SUS creates, organizes and regulates programs of deinstitutionalization, as: De volta para casa (Back at home), Programa de Reestruturação dos Hospitais Psiquiátricos (Restructuring Program of Psychiatric Hospitals) and Serviço Residencial Terapêutico (Therapeutic Residential Service (SRT)). The present work focuses on one of these services created by the SUS, the Home-based Therapeutic Service (SRT); by comprehending that this is an essential device in consolidating the process of deinstitutionalization of the treatment of people with mental disorders. The creation of this device was done with the objective of replacing the leitos moradias (ward beds) (long-term care facilities) in psychiatric hospitals and subsequently begin to accommodate users of Centers for Psychosocial Care (CAPS) that in some way were unable to live with their families. Also specifically within the SRTs, the study focused on the caregivers, on the understanding that these professionals are present in the various day-to-day situations in the home, and deal directly with people who have been in the context of exclusion and chronification of asylums. Therefore, their work is essential to the process of deinstitutionalization. The present study aimed to get to know the Psychiatric Reform and the process of deinstitutionalization in the Municipality of Jataí while investigating the RT device. For both, we attempted to get to know the caregivers of the Therapeutic Residential Services and their work. It was researched the three SRTs that created in 2006, in the municipality of Jataí. It is a study of a case, of descriptive character, and exploratory. Participate in the study, the caregivers of three Therapeutic Residences of the municipality, in additional to the psychologist responsible for the team. Semi-structured interviews and participant observation have been used, the data were submitted to Phenomenological Interpretative Analysis (AFI). From the analysis and interpretation of the transcribed interviews was built a theme class of Living in homes experience . In it were grouped three strands of discussion that are interlinked and intertwined, being them: work experiences, experiences with the locals and the experiences with the support network. The main final considerations relate to the need of instrumentalization, empowerment, listening, and creating of spaces for supervision to support the work of caregivers. / No Brasil, a luta pela desinstitucionalização de doentes mentais graves e sua reintegração à comunidade iniciou-se com a Reforma Psiquiátrica e a Reforma Sanitária, na década de 1970, e intensificou-se na década de 1980. Mas foi só em 1988, com criação do Sistema Único de Saúde (SUS), que tem como princípios norteadores a universalidade, a integralidade e a equidade, que se criou a legislação e programas para todas as esferas da saúde pública. Posteriormente, o SUS criou, organizou e regulamentou programas de desinstitucionalização, como: De Volta para Casa; Programa de Reestruturação dos Hospitais Psiquiátricos e o Serviço Residencial Terapêutico (SRT). O presente trabalho incidiu sobre um destes serviços criados pelo SUS, o Serviço Residencial Terapêutico (SRT), por compreender que este é um dispositivo essencial na consolidação do processo da desinstitucionalização do tratamento de pessoas portadoras de transtornos mentais. A fundação deste dispositivo se deu com o objetivo de substituir os leitos moradias (de longa permanência) nos hospitais psiquiátricos e, posteriormente, passou a acolher usuários dos Centros de Atenção Psicossociais (CAPS) que, de alguma forma, estavam sem possibilidades de morar com suas famílias. E especificamente dentro dos SRTs, o estudo focalizou os cuidadores, por entender que estes profissionais estão presentes nas diversas situações do dia a dia na casa e lidam diretamente com pessoas que estiveram muito tempo no âmbito da exclusão e da cronificação manicomial. Portanto, seu trabalho é fundamental no processo de desinstitucionalização. O presente estudo teve como objetivo, ao abordar o dispositivo RT, conhecer o impacto da Reforma Psiquiátrica e do processo de desinstitucionalização no município de Jataí. Para tanto, buscou-se conhecer os cuidadores das Residências Terapêuticas e o seu trabalho. Pesquisou-se os três SRTs que foram criados em 2006, no município de Jataí. Foi feito um estudo de caso, de caráter descritivo e exploratório. Participaram do estudo os cuidadores das três Residências Terapêuticas do município, além da psicóloga responsável pela equipe. Foram utilizadas entrevistas semiestruturadas e observação participante; os dados foram submetidos à Análise Fenomenológica Interpretativa (AFI). A partir da análise e interpretação das entrevistas transcritas, foi construída uma classe temática de Vivências nas Residências . Nela, foram agrupados três eixos de discussão que se interligam e se entrelaçam, sendo eles: as vivências com o trabalho; as vivências com os moradores e as vivências com a rede de apoio. As principais considerações finais abordaram a necessidade de instrumentalização, capacitação, escuta e criação de espaços de supervisão que permitam dar suporte ao trabalho dos cuidadores.

Diante dos problemas econômicos e sociais ocasionados pelo fenômeno da inflação nas últimas décadas, foi instituído, no Brasil, em 1994, o Plano Real, cujo objetivo era controlar os altos níveis de inflação vivenciados nas últimas décadas e alcançar a estabilidade econômica. Nesse contexto, a obrigatoriedade das práticas de correção monetária institucionalizadas foi destituída e institui-se Lei proibindo a publicação de demonstrações contábeis corrigidas. Iniciou-se, então, o processo de desinstitucionalização das práticas contábeis de correção monetária nas empresas brasileiras. Este trabalho teve como objetivo analisar o processo de desinstitucionalização das práticas contábeis de correção monetárias em empresas brasileiras. Os pressupostos teóricos utilizados nesta pesquisa foram baseados na teoria institucional que representa uma abordagem sociológica interpretativa do comportamento humano, que reconhece fenômenos de racionalidade limitada e o caráter político da ação social. Esta abordagem fundamenta-se num modelo político, no qual o comportamento social é pautado pela legitimização e pela conformidade a padrões socialmente impostos pela socialização dos indivíduos, pelos contextos das organizações e pelos mercados. Os modelos utilizados nas análises empíricas foram baseados nas abordagens propostas por Oliver (1992) e DiMaggio e Powell (1983). A estratégia de pesquisa utilizada compreendeu aplicação de questionários e entrevistas numa população de 118 empresas brasileiras, de grande porte, constantes da Revista Exame 500 Maiores Empresas e teve como principais respondentes os contadores e gerentes de controladoria. Foram utilizados a técnica estatística multivariada Análise Fatorial, o teste ANOVA one way e o teste Kruskal-Wallis. Constatou-se que o uso e manutenção das práticas contábeis de correção monetária, no contexto brasileiro, mantêm um relacionamento estreito como fatores isomórficos: coercitivos e normativos. Sendo que as variáveis mais relevantes foram: a) obrigatoriedade imposta pela lei; b) poder institucional das entidades reguladoras; c) regulamentação do governo; e d) recomendações das empresas consultoria e auditoria. Em relação ao grau de influência das pressões políticas, funcionais e sociais no processo de desinstitucionalização destacam: a) diminuição dos índices de inflação na economia; b) mudança das leis sobre publicação; c) declínio da exigência por parte do mercado financeiro; d) custos de manter a prática; e) surgimento de novas tecnologias contábeis; f) níveis de inflação no período (mês e ano); e g) harmonização internacional das práticas contábeis. A estratégia de realizar entrevistas como os gestores das empresas que mantiveram ou ainda mantém a prática contábil de correção monetária representou um recurso de grande utilidade no delineamento do fenômeno pesquisado. Pois possibilitou, basicamente, a triangulação dos resultados. Portanto, a explicação do processo de desinstitucionalização das práticas contábeis de correção monetária é decorrente de uma combinação distinta de fatores institucionais. Sendo que os fatores observados estão aderentes aos pressupostos da teoria institucional e estão em consonância com os resultados das pesquisas realizadas no mercado americano e no Reino Unido. / In face of the economic and social costs caused by inflation in previous decades, Plano Real was brought to being in Brazil in1994. Its aim was to control the existing high inflation rates and reach economic stability. In this scenario, the enforced use of institutionalized inflation adjusted practices was withdrawn and a law is passed to forbid the issuance of adjusted accounting statements. The process of desinstitutionalization of accounting practices then began in Brazilian enterprises. This thesis aimed at analyzing the desinstitutionalization of accounting practices of inflation adjustment in Brazilian enterprises. The theoretical framework used is based on the institutional theory that represents a sociological approach to interpret human behavior; it acknowledges limited rationality phenomena and the political attribute of the social action. This approach is based on a political model in which social behavior is guided by legitimization and compliance to social patterns imposed by the socialization of individuals, by the scenario of enterprises and by the markets. The models used in the empirical analyses were founded on the approaches proposed by Oliver (1992), and DiMaggio & Powell (1983). The research strategy comprised questionnaires and interviews, carried out with a population of 118 enterprises listed among the top 500 according to Revista Exame 500 Maiores Empresas, and the main respondents were accountants and controllership managers. Data Reduction Analysis, ANOVA one way test, and Kruskal-Wallis test were used. Analysis shows that, as for the Brazilian scenario, the use and continuance of inflation-adjusted practices bear close relationship with isomorphic institutional factors: coercive and regulatory. The most relevant variables were: (i) law enforcement; (ii) institutional power of regulatory organizations; (iii) governmental regulation; and (d) advice by consulting and auditing offices. Regarding the level of influence of political, functional and social pressure for the desinstitutionalization, we can emphasize: (a) the decrease of inflation rates in the economy; (b) the changes in laws on disclosure; (c) lack of demand by financial markets; (d) costs to keep the practice; (e) the emergence of new accounting technologies; (f) levels of inflation in the period (month/year), and (g) international harmonization of accounting practices. The strategy of interviewing managers of enterprises that performed or still perform inflation-adjusted practices proved a very useful tool in the characterization of the phenomenon researched. It made the triangulation of results possible. Thus, the explanation of the process of desinstitutionalization of inflation adjustment practices results from a distinct combination of institutional aspects. These adhere to the assumptions of the institutional theory and are in agreement with the results of research carried out in the markets in The USA and The United Kingdom.

O presente estudo teve como objetivo analisar o saber e a prática das cuidadoras no contexto da residência terapêutica. Apoiou-se no referencial teórico da psicanálise. Trata-se de uma pesquisa descritivo exploratória com abordagem metodológica qualitativa, realizada em um Serviço Residencial Terapêutico, situado no interior paulista. Participaram do estudo doze cuidadoras que atuavam em cinco residências terapêuticas. Após a aprovação do estudo por um Comitê de Ética em Pesquisa com seres humanos, os dados foram coletados por meio de observação participante e entrevistas semiestruturada audiogravadas, complementadas pelo diário de campo, de abril a setembro de 2013. Os dados foram analisados, seguindo-se os pressupostos da análise de conteúdo temática. Da análise realizada, a partir dos textos produzidos, emergiram três categorias: Governança da Residência Terapêutica; A maternagem; O saber/fazer das cuidadoras. A primeira categoria, Governança da Residência revelou os diversos tipos de atividades realizadas pelas cuidadoras nas Residências, desde as atividades domésticas, de acompanhamento e encaminhamento dos moradores nas questões de saúde, e também nas atividades de lazer (festas, passeios e viagens); e como essas atividades repercutem na relação cuidador-morador. A categoria A maternagem revelou os sentimentos das cuidadoras mobilizados e atualizados pela relação transferencial com os moradores: amor, carinho, dó, raiva, saudade, medo. E como esse vínculo forte e positivo funciona como um norteador do processo de cuidado. A terceira categoria O saber/fazer das cuidadoras diz sobre a formação das cuidadoras, que operam inicialmente em sua prática a partir de um saber leigo, que permite um olhar para os moradores para além da doença e do diagnóstico, não técnico. Sendo assim, as cuidadoras se formam a partir de sua experiência de trabalho e de sua participação nas reuniões de equipe e de supervisão oferecidas pelo Serviço, onde se analisa e se compartilha as estratégias de cuidado encontradas, o não saber, as angústias, os acertos, os fracassos, entre outros / The present study aimed to assess the knowledge and practice of caregivers in the context of therapeutic residence. It was relied on the theoretical framework of psychoanalysis. This is an exploratory descriptive study with qualitative methodological approach, performed in a Therapeutic Residential Service, located in São Paulo state. The Study participants were twelve caregivers who worked in five therapeutic homes. After the study was approved by the Committee on Research Ethics on Human beings, the data were collected through participant observation and semi-structured audio recorded interview, supplemented by field diary, from April to September 2013. The data were analyzed, following the assumptions of thematic content analysis. From the analysis, coming out of the produced texts, three categories emerged: Therapeutic Residence Governance; The mothering; the caregiver\'s know-how. The first category, Residence Governance revealed various types of activities undertaken by caretakers in residences, from domestic activities, monitoring and referral of residents on health issues, and also in leisure activities (parties, outings and trips); and how these activities have an impact on caregiver-resident relationship. Category A mothering revealed the feelings of mobilized caregivers and updated by the transference relationship with the locals: love, affection, pity, anger, longing, fear. And how this strong and positive relationship functions as a guide in the care process. The third category the caregiver\'s know-how says about the training of caregivers, who initially operate in their practice from a lay knowledge, which allows a look to the residents beyond the disease and diagnosis, not technical. Thus, the caregivers are formed from their work experience and their participation in team meetings and supervision offered by the Service, where the care strategies found, the not knowing, the anguish, the successes , failures, among others, are analyzed and shared.

Esta dissertação constitui-se em uma produção de narrativas de viagem pelas ruas, trilhos e águas da Saúde Mental Coletiva a partir das experiências da narradora, na cidade de Porto Alegre. Valendo-se de sua trajetória singular de formação em Saúde Mental, a artista propõe um olhar curioso sobre a Reforma Psiquiátrica e a inserção do fazer teatral neste campo, a fim de constituir formas de inclusão da loucura na cidade e contribuir com processos de desinstitucionalização. Para fundamentar este percurso, utiliza os conceitos de Zona Autônoma Temporária, Nomadismo Psíquico e Biopolítica, bem como, apresenta ao campo da Saúde Coletiva um pouco da teoria teatral a fim de produzir intercessões entre arte, ciência e filosofia. A partir de sua participação no grupo de teatro Nau da Liberdade, que é composto por usuários, trabalhadores e estudantes da Saúde Mental, a narradora analisa a cena teatral contemporânea e propõe uma maneira de pensar a desinstitucinalização através da inserção cultural e da noção pertencimento a um bando. / This work consists in a production of travel stories through the streets, trails and waters of Collective Mental Health, from the teller’s experiences, in the city of Porto Alegre. Drawing on her unique career training in Mental Health, the artist proposes a curious look on the Psychiatric Reform and the insertion of theater acting in this field, in order to constitute forms of inclusion of madness in the city and to contribute to processes of deinstitutionalization. To support this route, she uses the concepts of Temporary Autonomous Zone, Psychic Nomadism and Biopolitics, and presents some of theater theory to the field of Public Health, aiming to create intersections between art, science and philosophy. From her participation in the theater group Ship of Freedom, which is composed of members, employees and students of Mental Health, the narrator examines the contemporary theater scene and proposes a way of thinking deinstitutionalization through the ideas of cultural inclusion and belonging to a band.

O presente trabalho objetiva evidenciar os efeitos da heterocisonormatividade na vida de sujeitos não heterossexuais e não cisgêneros que têm suas trajetórias existenciais marcadas pela injunção crime-loucura. Para tanto, explora os processos penais que delimitam a vida das pessoas em sofrimento mental que cometeram crimes, os chamados pacientes judiciários, que recebem uma medida de segurança. Utilizando-se da genealogia como aporte metodológico, adentra-se nas condições de proveniência e de emergência do "anormal", figura produzida e capturada pelo discurso médico-jurídico através de um longo processo da psiquiatrização do desejo e da sexualidade que ocorreu ao longo do século XIX até os dias de hoje. Legitimada a partir de uma determinada racionalidade científica, tal trama discursiva criminaliza moralmente as expressões da sexualidade e de gênero, colando-as entre si, para lançá-las no campo da abjeção O estudo foi composto por duas estratégias de aproximação do campo de pesquisa: 1) narrativas produzidas a partir do cotidiano de um programa de desinstitucionalização de pacientes judiciários ao qual o pesquisador encontra-se vinculado; 2) seis peças judiciais, com ênfase nos laudos psiquiátricos, de pessoas não heterossexuais e/ou não cisgêneras que receberam uma medida de segurança. A análise do material recolhido permite verificar que a base teórico-conceitual da presunção de periculosidade na qual se sustenta a tese da medida de segurança objetifica-se no laudo psiquiátrico. Tal engrenagem médico-jurídica aponta para uma valoração moral com que as expressões da sexualidade e de gênero do paciente judiciário considerado "desviante" são avaliadas. Por fim, sinalizam-se alternativas de produção de novos modelos de tratamento para o paciente judiciário, que buscam superar a ficção da presunção de periculosidade como base pretensamente científica, revisar a inimputabilidade como dispositivo jurídico que viola direitos inalienáveis dos sujeitos e, por fim, incluam as diretrizes da reforma psiquiátrica brasileira entre as garantias de acesso à saúde a todo cidadão. / The present study aims to show the effects of heterocisnormativity in the life of non-heterosexual and non-cisgender individuals whose existential trajectories are marked by the crime-madness injunction. In order to do so, it explores criminal cases that delimit the lives of people in mental suffering who committed crimes, the so-called judicial patients, who receive a measure of security. Using genealogy as a methodological contribution, it enters the conditions of provenance and emergency of the "abnormal", a figure produced and captured by the medical-legal discourse through a long process of psychiatry of desire and sexuality that occurred throughout the 19th century to the present days. Legitimized from a certain scientific rationality, this discursive plot morally criminalizes the expressions of sexuality and gender, sticking them together, to throw them into the field of abjection The study was composed of two strategies of approximation of the research field: 1) narratives produced from the daily routine of a deinstitutionalization program of judicial patients to which the researcher is linked; 2) six judicial papers, with emphasis on the psychiatric reports, of non-heterosexual and / or of non-cisgender individuals that received a security measure. The analysis of the collected material allows verifying that the theoretical-conceptual basis of the presumption of dangerousness on which the thesis of the security measure is based is objectified in the psychiatric report. Such medical-juridical mechanism expresses a moral valuation with which the expressions of the sexuality and gender of the judicial patient considered "deviant" are evaluated. Finally, alternatives for the production of new models of treatment for the judicial patient, which seek to overcome the fiction of the presumption of dangerousness as a supposedly scientific basis, are reviewed, reviewing the non-attributability as a legal device that violates the inalienable rights of the subjects and, finally, include the guidelines of the Brazilian psychiatric reform among the guarantees of access to health for every citizen.

There is much research literature on quality of life with people with varying mild to moderate levels of developmental and intellectual disabilities. A gap remained in the current literature regarding differences between the severe to profound levels of intellectual and developmental disability across residential settings. The purpose of this study was to assess the level of support of people with severe to profound levels of developmental disabilities who resided and received services either in an institution and those who receive services within the community. The theoretical foundation for this study was Maslow's theory of humanism along with the contemporary theory of quality of life. Using a quantitative research design, the Support Intensity Scale (SIS) was administered to a convenience sample of 60 adults who receive supports while residing in the community and 60 adults who receive supports and reside in an institution in the southeast U.S. The data was analyzed using 1-way analyses of variance (ANOVA) on the SIS subtest scores. Although the levels of support for the basic needs were not statistically different between the 2 residential settings, there was a significant difference in the need for medical and/or behavioral needs. The findings of this study promoted social change as these differences can be presented as part of the individualized needs assessment to prevent Reinstitutionalization of these stakeholders.

While extensive research has been conducted on the causes of intimate partner violence in the community, very little is known about rates and predictors of domestic violence perpetrated by offenders who have recently been incarcerated. Some evidence suggests that formerly incarcerated individuals may be at an increased risk to perpetrate intimate partner violence during the transition from prison to the community (e.g., Hairston & Oliver 2006; Hilton, Harris, Popham, & Lang, 2010; Oliver & Hairston, 2008). The primary goal of this dissertation was to examine the extent to which former inmates engage in domestic violence during the transition from prison to the community. A second goal of this dissertation was to determine the independent and interactive effects of selected individual, situational, and social-structural factors on post-prison domestic violence. The current dissertation project involved a retrospective study of data collected from n = 1,137 formerly-incarcerated male offenders who were released from state prison between 2004 and 2009. Data regarding individual-level factors of borderline and antisocial personality characteristics and exposure to family-of-origin violence were extracted from institutional records. Additional individual-level demographic characteristics including offenders' age, ethnicity, education need, marital status, number of children, crime of conviction, length of incarceration, and participation in correctional rehabilitation programs extracted from institutional records were also considered. The situational-level factor of offenders' employment after prison release was also collected from institutional records; and the social-structural factor of neighborhood disadvantage was collected from information available in offenders' community supervision records and Census tract-level data. The outcome measure of post-prison domestic violence was gathered from local law enforcement records. Data were entered into statistical models to predict post-prison domestic violence. Main effects on post-prison domestic violence were examined for each of the individual-level demographic characteristics, borderline and antisocial personality features, exposure to family-of-origin violence, employment, and neighborhood disadvantage. Interactive effects on post-prison domestic violence were examined between borderline and antisocial personality characteristics, exposure to family-of-origin violence, employment, and neighborhood disadvantage. Significant predicted main effects on post-prison domestic violence included age, ethnicity, education need, number of children, violent criminal history, attendance of substance abuse treatment in prison, witnessing interparental violence as a child, and neighborhood disadvantage. Significant predicted interaction effects on post-prison domestic violence included the interaction between physical abuse as a child and neighborhood disadvantage. Implications for policies regarding post-prison supervision sentencing, housing, and the advancement of programming to prevent intimate partner violence during the transition from prison to the community are discussed. Contributions to the literature on intimate partner violence, environmental transition theory, and ecological theoretical frameworks are also addressed.

This mixed methods dissertation is comprised of three papers that consider interrelated ways in which social bonds, within the context of parenting, are experienced by women recently involved with the corrections system. Types of social bonds considered include agency professionals, romantic partners, and children--all previously theorized to play a role during the reentry period. These social bonds are considered within the context of the challenges experienced during this period, and how and why these social bonds may--or may not--support women as they transition back into the community.

This thesis examined the social competency and affective functioning of people with mild intellectual disabilities through salient variables that impact on people with disabilities who have been deinstitutionalised. Its primary purpose was to extend the previous research on the impact of deinstitutionalisation by incorporating multi-dimensional self-concept, adaptive behaviour and quality of life, in combination with self esteem and locus of control, in longitudinal/comparison design. It is also aimed to examine the development of identity, self-esteem and social competencies from a qualitative perspective. Finally it assessed the efficacy of an interpersonal cognitive problem-solving intervention which incorporated techniques for the development of maintenance and generalisation and determined the impact of this intervention on real-life social behaviours. The findings have important implications for current theory of the self-concept for people with intellectual disabilities, the provision of programs and techniques to improve self-concept, and also for the provision of social skills programs to enhance the social competencies and the social integration for people who have been deinstitutionalised. / Doctor of Philosophy (PhD)

This thesis examined the social competency and affective functioning of people with mild intellectual disabilities through salient variables that impact on people with disabilities who have been deinstitutionalised. Its primary purpose was to extend the previous research on the impact of deinstitutionalisation by incorporating multi-dimensional self-concept, adaptive behaviour and quality of life, in combination with self esteem and locus of control, in longitudinal/comparison design. It is also aimed to examine the development of identity, self-esteem and social competencies from a qualitative perspective. Finally it assessed the efficacy of an interpersonal cognitive problem-solving intervention which incorporated techniques for the development of maintenance and generalisation and determined the impact of this intervention on real-life social behaviours. The findings have important implications for current theory of the self-concept for people with intellectual disabilities, the provision of programs and techniques to improve self-concept, and also for the provision of social skills programs to enhance the social competencies and the social integration for people who have been deinstitutionalised. / Doctor of Philosophy (PhD)