Magister Artium (Psychology) - MA(Psych) / While community health workers possess valuable insight into health care delivery in South Africa, their voices and experiences are seldom sought in the acquisition of knowledge surrounding relevant social concerns. This research aimed to explore community health workers’ perspectives of mother–infant bonding within the first 1000 days of life. The first 1000 days of a child’s life are a delicate yet highly consequential period affecting future physical, cognitive, and socio-emotional growth. The bond between mother and infant within the first 1000 days is especially critical as it is within the bounds of this relationship that a child is fed, cared for, and kept safe. Furthermore, mother–infant bonding lays an essential foundation for future development. However, there is a paucity of contextualized literature, particularly regarding mother–infant bonding in the first 1000 days. In practice, mother–infant interventions are often delivered by community health workers. Through their work, community health workers gain a wealth of knowledge and information about the experiences and practices of bonding within their community. Their insights are a potentially untapped resource which could be used to supplement research and interventions with local, contextualized wisdom. The aim of this research was to explore community health workers’ perspectives of mother–infant bonding within the first 1000 days in Khayelitsha, South Africa. The study utilized a qualitative methodological framework and an exploratory research design. Semi-structured individual interviews were conducted with 15 experienced community health workers, who were purposively selected from a non-governmental organization located in Khayelitsha, South Africa. Data were thematically analysed, and five primary themes emerged from the analysis, namely: (1) the importance of the first 1000 days; (2) the centrality of mother–infant bonding within the first 1000 days; (3) effective approaches to bonding are simple, natural, and free; (4) the inhibitors of mother–infant bonding; and (5) the need for support. Trustworthiness and researcher reflexivity practices were integrated throughout the research process. Ethics considerations were prioritized, and included providing informed consent, ensuring confidentiality and anonymity, and informing participants of their rights as stipulated by the University of the Western Cape Biomedical Research Ethics Committee.

Sub-Saharan Africa (SSA) has a scarcity of research on autism spectrum disorder (ASD) and available early interventions, as most of what is known about the disorder is from highincome countries. Early detection and intervention methods were found to have positive effects on developmental delays and to alleviate symptom severity in children with ASD or at risk of it. There is a need for scalable interventions in low-resource settings, which are characterised by a lack of highly-trained specialists, infrastructure and funding. This study explored the barriers and facilitators to implementing and sustaining a caregiver-coaching ASD early intervention, informed by the principles of the Early Start Denver Model (ESDM), adapted for South Africa and for delivery by non-specialists. The study also identified some changes that could be made to improve intervention adoption and sustainability. Nine multilevel stakeholders involved in the implementation of the caregiver-coaching intervention were purposively sampled, individual in-depth interviews were conducted, transcribed verbatim and thematically analysed. Major implementation facilitators included: ECD worker baseline ASD knowledge and experience; skills gained from the training received and coaching; clear in-session caregiver-coaching structure; value of strong team relationships; clear video illustration of intervention concepts; and the mastery and generalisation of skills by the ECD workers, ECD supervisors and caregivers. Implementation barriers included: the complexity of the intervention and coaching concepts; misalignment of ECD teacher training with the caregiver-coaching approach; logistical challenges; and mismatch of the video content with the South African context. Facilitators to sustain the intervention included: child outcomes; caregiver ‘buy-in;’ and competence; and the need for ongoing live supervision. Barriers to sustaining the intervention included: structural issues of poverty, transportation and unemployment. Positive child and caregiver outcomes could be offset by larger contextual and system-level issues such as poverty and the need for ongoing support, supervision and local coaching materials in South African languages. The results will inform tailoring of the intervention training and supervision approach for a larger pilot study.

Sensory inputs of hearing and vision during early childhood development support the achievement of language, speech and educational milestones. The early detection of sensory impairment is essential for facilitating early childhood development, socio-emotional well-being and academic success, in addition to obtaining sustainable educational development goals. The majority of children with sensory impairment live in low- and middle-income countries where services are often unavailable or inaccessible, because of the absence of systematic screening programmes for children, prohibitive equipment cost, a shortage of trained personnel and centralised service-delivery models. Therefore, research is needed to investigate whether a community-based mobile health (mHealth) supported service-delivery model for hearing and vision screening can increase access to hearing and vision services for children in resource-constrained settings. This study aimed to describe an implemented hearing and vision screening programme and evaluate its success in terms of acceptability (consent return numbers), coverage (number of eligible children screened), referral rates and quality indicators (duration of tests and number of hearing tests conducted under conditions of excessive noise levels). The study also explored the challenges faced during a community-based screening programme and the strategies developed to address these. Four non-professionals were appointed and trained as community health workers (CHWs) to conduct combined sensory screening using mHealth technology (hearScreen application, hearXGroup, South Africa and Peek Acuity application, Peek Vision, United Kingdom) on smartphones at preschools in low-income communities in Cape Town, South Africa. The consent form return rate was 82.0%, and the coverage rate was 94.4%. An average of 501 children were screened each month, at a cost of US$5.63 per child. The number of children who failed hearing and vision screening was 435 (5.4%) and 170 (2.1%), respectively. Failing of hearing tests was associated with longer test times (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.021–1.024) and excessive background noise levels at 1 kHz (e.g. OR for left ear: 1.688; 95% CI: 1.198–2.377). Failing of visual screening tests was associated with longer test duration (OR: 1.003; 95% CI: 1.002–1.005) and younger age (OR: 0.629; 95% CI: 0.520–0.761). The study also aimed to describe and compare the performance of two screening protocols that were used in this preschool hearing screening programme to determine optimal referral criteria that is responsive to available resources. Secondary data analysis was done to compare a protocol using a single-frequency fail criterion (which 2,147 children were screened with between 1 October 2017 and 25 February 2018) with a screening protocol using a two-frequency fail criterion (which 5,782 children were screened with between 26 February 2018 and 30 November 2018). For both protocols, screening was done at a 25 dB hearing level (HL) at 1000, 2000 and 4000 Hz. Both protocols included an immediate rescreen at the frequencies that were failed. The referral rate was 8.7% (n = 186) for the one-frequency fail protocol and 4.3% (n = 250) for the two-frequency fail protocol. Compared to the one-frequency fail protocol, children screened with the two-frequency fail protocol were 52.9% less likely to fail (OR: 0.471; 95% CI: 0.385–0.575). Gender (OR: 0.807; 95% CI: 0.531–1.225) and age (OR: 0.996; 95% CI: 0.708–1.402) had no significant effect on screening outcomes. Maximum permissible ambient noise levels (MPANLs) were exceeded in 44.7% of cases in at least one ear at 1000 Hz across both protocols. There was no significant difference between the protocols for both true positive cases and false positive cases. Protocol (OR: 1.338; 95% CI: 0.854–2.098), gender (OR: 0.807; 95% CI: 0.531–1.225) and age (OR: 0.996; 95% CI: 0.708–1.402) demonstrated no significant effect on the odds of producing true positive results. Average time for conducting the screening was 72.8 s (78.66 SD) for the one-frequency fail protocol and 64.9 s (55.78 SD) for the two-frequency fail protocol. Estimating the prevalence and describing the characteristics of sensory loss in a preschool population in low-income communities are important steps to ensure adequate planning and successful implementation of community-based hearing and vision care in this context. The study therefore also investigated the prevalence and characteristics of hearing and vision loss among preschool children (4 to 7 years) in an underserved South African community after implementing mHealth-supported community-based hearing and vision services. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were also performed with smartphones and hearing and vision testing applications (hearTest application, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). A total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6% and 4.4% of children failed hearing and vision screening, respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of the children, of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was conducted on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.001): with every 1-year increase in age, participants were 51.4% less likely to have vision loss (OR: 0.49, 95% CI: 0.39–0.60). Age was not a significant predictor for hearing loss (OR: 0.821; 95% CI: 0.667–1.011). Gender was not a significant predictor of hearing loss (OR: 0.850; 95% CI: 0.658–1.099) or vision loss (OR: 1.185; 95% CI: 0.912–1.540). The prevalence of hearing loss at a pure tone average (PTA) of 25 dB HL ranged between 2.3% (240 out of 10,390; assuming none of the non-attenders and children who were unable to be tested had hearing loss) and 3.1% (321 out of 10,390; assuming all the non-attenders and children who were unable to be tested presented with hearing loss). The prevalence of vision loss ranged between 2.2% (232 out of 10,390; assuming none of the non-attenders had vision loss) and 2.8% (286 out of 10,390; assuming all the non-attenders presented with vision loss). Findings of this research project indicate that mHealth-supported CHW-delivered hearing and vision screening in preschools provide a low-cost, efficient and accessible service that can improve the provision of affordable hearing and vision care. This service-delivery model is affordable and scalable, because the same staff, needing minimal training, and the same equipment are used to screen for both vision and hearing. Timely identification of sensory losses is essential to ensure optimal outcomes and can be facilitated through community-based hearing and vision services by trained CHWs using mHealth technology. Future studies should aim to report on outcomes and the uptake and impact of interventions on the children diagnosed with sensory impairments following identification through a decentralised screening programme. / Thesis (PhD (Audiology))--University of Pretoria, 2021. / Sonova AG / Hear the World Foundation / Speech-Language Pathology and Audiology / PhD (Audiology) / Unrestricted

BACKGROUND: Evidence supports the importance of Early Childhood Development (ECD) interventions to improve children's health, lifelong productivity, and human capital. However, ECD programs are not scaled sufficiently to reach many of the 250 million young children globally who are not meeting their developmental potential. Practical guidance is limited on how to scale ECD programs effectively. This mixed-method study explored the contextual and implementation determinants of scaling up ECD programs in Zambia, using one large-scale, community-based parenting group program (Scaling Up Early Childhood Development in Zambia (SUpErCDZ) program) as a case study. The goal was to generate recommendations for policymakers and implementers in Zambia and other LMICs. METHODS: This study was guided by the WHO/ExpandNet scale-up framework and the Intervention Scalability Assessment Tool (ISAT). A total of 30 key informant interviews were conducted with program staff, government officials, academic partners, implementing partners of other ECD programs, and donors. Qualitative transcripts were analyzed using thematic analysis according to the framework method. A budget impact analysis (BIA) was conducted using prospectively collected program cost and implementation data supplemented by online sources and interviews with program staff. The total cost of scale-up over five years using three scenarios (low, medium, and high intensity) was modeled. RESULTS: According to government officials, donors, and partners, the most common contextual factors influencing scale-up ECD programs are political commitment, availability of an overarching or multisectoral ECD policy, availability of resources, and integration of ECD programs into existing government structures. In addition, multisectoral collaboration, stakeholders’ engagement, and sociocultural factors emerged as themes essential to scale-up. From the perspective of the program staff, the key facilitators of ECD implementation were stakeholders’ engagement, sociocultural factors (cultural norms and beliefs), adaptation of the intervention to the context, integration into existing government structures, and intervention characteristics. In addition, providing incentives to Community-Based Volunteers (CBVs) emerged as critical to sustainability. The main barriers to implementation identified by the program staff were the use of culturally inappropriate activities within the ECD curriculum, lack of incentives (financial or in-kind) to caregivers and CBVs, and unforeseen contextual circumstances (COVID-19 pandemic and insecurity). The budget impact analysis showed that the total cost and budget for scaling up SUpErCDZ or a similar ECD program depends on the magnitude of the scale-up in terms of geographic breadth and depth (coverage within specific geographic areas). Based on our scale-up scenarios, the estimated cost of scaling up this program over five years ranged between US$1.74M to US$4.3M depending on the breadth (how many provinces) and depth (how many health facilities, CBVs, and caregivers) of implementation. CONCLUSION: Multiple complex and interrelated contextual and implementation factors influence the scaling up of ECD programs in Zambia. To ensure equitable access to ECD programs for children under five in Zambia, policymakers and implementers will need to consider these when planning to scale up ECD interventions in Zambia. / 2025-08-04T00:00:00Z

The critical role of children’s play in the development of peer relationships, social and communicative skills is reviewed and discussed. The difficulties experienced by a pre-school learner in engaging in peer relationships, communicating successfully in a classroom situation and constructively using play materials was explained. This was done through the use of anecdotal records, checklists, questionnaires, photographic evidence and a semi-structured interview with the learner’s parent. A pre-school play programme, using blocks, dough and puppets (BDP Programme) was devised and used to assess its influence on the acquisition of social and communicative skills by a non-social and non-communicative learner. The study found the BDP Programme to be very successful in assisting this learner to develop peer relationships and communicative skills in the peer group and thus played a critical role in the social development of this learner. / Psychology of Education / M. Ed. (Psychology of Education)

Life course literature states that early childhood development (ECD) can influence most aspects of health throughout the life-cycle. Canada ranked last among 25 wealthy nations in meeting ECD objectives. Fewer than 5% of children born have clinically detectable shortcomings in developmental health, increasing to 26% by school age with emerging socioeconomic associations. Understanding how social determinants of health (SDH) influence ECD at the household and neighbourhood scales would help identify conditions for optimal developmental outcomes. The effects of SDH on ECD in the Kingston, Ontario area were studied. SDH were classified via marginalization (ONMarg) and deprivation (Pampalon) indices. ECD was measured via 2006 Early Development Instrument (EDI) scores for children most at risk upon school entry (Grade One). The basic spatial unit of analysis was 2006 Census of Canada Dissemination Areas, subdivided into quintiles of deprivation (Q1 being the least deprived and Q5 the most). EDI results from each of the quintiles within the two indices were compared and then combined. The socioeconomic health gradient assumes that EDI scores will directly correlate to material and social deprivation. Social deprivation had a slightly greater impact than material deprivation on children’s developmental vulnerability, with Q5 being the most vulnerable in all competencies. Surprisingly, emotional health and social competence were significant areas of vulnerability for children in Q1 and Q2. “Village effects” – when social determinants at the neighbourhood level have protective effects on ECD despite material deprivation at the household level – were present within the Q3 and Q4 groups for the domains of social competency and emotional health. While the highest proportions of early childhood developmental vulnerability are found within the most deprived households, the largest numbers of vulnerable children are spread throughout the middle-class in a variety of neighbourhoods. Canadian policy should focus on mediating avoidable risks within this critical time to avoid future deleterious health effects and costs. Mapping the effects of SDH at the neighbourhood level generates knowledge that informs intersectoral action by policy makers to provide the supports needed to foster healthy children. / Thesis (Master, Geography) -- Queen's University, 2013-05-04 10:36:25.165

The aim of this study is to explore the links which exist between community development and urban food gardens. South Africa has experienced a twenty five percent growth in the urban population from 2005-2010. It is further predicted that this will increase by a further thirty six percent to thirteen million inhabitants by 2015. The practice of urban agriculture is one of the strategies that can assist in addressing development challenges in an urban setting in South Africa and around the world. Urban agriculture has the potential to provide a survival strategy for the poor and thus contribute to poverty alleviation, employment, food security, social integration and skills transfer. This research explores the economic, social and ecological benefits of the activity, questioning the ways in which the Siyakhana food garden (and larger initiative) contributes to the Siyakhana community. For the purpose of the research the Siyakhana community refers to the Siyakhana group (eight women in the inner city of Johannesburg who run Early Childhood Development Centres (ECDCs)) and the gardeners who work in the food garden. Data was collected by means of semi-structured interviews, in-depth questionnaires, participant observation and informal conversation, as well as primary and secondary sources. The data was collected for a twelve month period from June 2010 to June 2011. In total the food garden was visited thirty times during the field work and the ECDCs twelve to fifteen times each. Because of the initiatives potential in community development, the focus of the research gives in-depth insights into the Siyakhana group, their history with the initiative, details about their ECDCs and their expectations and their perceived benefits of being involved with the Siyakhana initiative. The key findings of the study are that there are two primary ways in which the Siyakhana group benefit from being involved in the Siyakhana initiative. The benefits relate to the supplementary food which the Siyakhana group receive on a weekly basis and the practical learning environment of the Siyakhana food garden. This research shows that through their connection with the Siyakhana initiative the Siyakhana group act as a conduit for inner city community development. The healthy and nutritious food from the food garden and the knowledge obtained from being involved with the initiative is shared with a range of stakeholders within the inner city. The Siyakhana food garden is a unique example of a community project which embraces the concepts of ecological health promotion in a multiplicity of ways – through the distribution of food, training, conscientisation and mobilisation. Finally the study shows that when exploring the links between urban food gardens and community development it is not a pre-requisite for the community to physically engage in the production activities of the garden for empowerment and skills transfer to take place.

O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é um dos transtornos de maior prevalência na infância e adolescência. Pesquisas recentes demonstram que, ao menos do ponto de vista cognitivo, existem diferenças importantes no desenvolvimento de crianças com TDAH quando comparadas com crianças sem qualquer diagnóstico psiquiátrico. O presente trabalho pretende contribuir para o campo de pesquisa sobre o TDAH, buscando uma compreensão mais dinâmica deste transtorno, ultrapassando o nível descritivo dos sintomas, incorporando aspectos da Psicologia do Desenvolvimento. Acreditamos que a teoria de Piaget acerca do desenvolvimento psicológico, do processo de transição do estágio pré-operatório para o estágio operatório concreto de desenvolvimento, é um subsídio teórico importante para a compreensão deste transtorno, em especial a construção operatória da noção de tempo. A hipótese geral foi a de que crianças com TDAH apresentariam déficits no desenvolvimento de noções operatórias, como a conservação, reversibilidade e apreensão temporal. Foram entrevistadas 62 crianças, com idades entre 6 a 12 anos, subdividas em dois grupos: uma amostra clínica de crianças diagnosticadas com TDAH (n=32), e uma amostra de crianças sem diagnóstico (grupo controle, n=30). A amostra clínica foi também dividida entre crianças que faziam uso de metilfenidato, e crianças não medicadas, com o intuito de observar se a medicação exerceria alguma influência no desempenho das crianças em provas piagetianas. Para a composição dos grupos, foi utilizada a K-SADS-PL, elaborada segundo os critérios do DSM-IV. Com o objetivo de avaliar os níveis de desatenção e hiperatividade, os pais e/ou responsáveis responderam a dois questionários: a versão abreviada do questionário de Conners, e o Inventário dos Comportamentos de Crianças e Adolescentes entre 6 e 18 anos (CBCL). Tendo como referência a entrevista clínica de Piaget, foram aplicadas as seguintes provas piagetianas: Conservação das quantidades discretas; Mudança de critério dicotomia; as provas de Sucessão dos Acontecimentos Percebidos e da Simultaneidade, e O tempo da ação própria e a duração interior. Os resultados demonstram haver diferença estatisticamente significativa entre o desempenho das crianças dos diferentes grupos, para as provas piagetianas como um todo (p < 0,001), e, quando analisadas separadamente, para as provas de Conservação de Quantidades Discretas (p = 0,003), Simultaneidade (p = 0,004), e O tempo da ação própria e a duração interior (p < 0,001). Crianças com TDAH apresentaram uma tendência a terem suas respostas classificadas em níveis inferiores ao esperado, quando comparadas ao grupo controle. Em relação ao uso do metilfenidato na amostra clínica, não foi observada diferença significativa entre os grupos. Apesar importante no tratamento, o metilfenidato não demonstrou ser suficiente para potencializar o desenvolvimento cognitivo de crianças com TDAH, superando os déficits observados. Esses achados corroboram a hipótese de déficit na aquisição das noções operatórias em crianças com TDAH. Assim, são necessárias novas reflexões a respeito do TDAH, considerando alternativas de intervenções que considerem os déficits observados, ultrapassando o tratamento medicamentoso. / Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent disorders in childhood and adolescence. Recent research shows that, at least from a cognitive level, there are important differences in the development of children with ADHD when compared with children without any psychiatric diagnosis. This work aims to contribute to the field of research on ADHD, seeking a more dynamic understanding of this disorder, surpassing the descriptive level of symptoms, incorporating aspects of Developmental Psychology. We believe that Piaget´s theory about the psychological development, the process of transition from pre-operative stage to concrete operative stage of development, is important for the theoretical understanding of this disorder, especially the construction of the operative notion of time. The general hypothesis was that children with ADHD present deficits in the development of operational concepts, such as conservation, reversibility and temporal seizure. Sixty two children, aged 6 to 12 years, were interviewed, and subdivided into two groups: a clinical sample of children diagnosed with ADHD (n = 32) and a sample composed by children without diagnosis (control group, n = 30). The clinical sample was divided between children who made use of methylphenidate, and children non-medicated, in order to see if the medication did some influence on the children´s performance in piagetian tasks. For the composition of groups, the K-SADS-PL was utilized, prepared according to the DSM-IV criteria. To assess the levels of inattention and hyperactivity, the parents and / or guardians answered two questionnaires: Conners´ Abbreviated Parents Rating Scale, and the Child Behavior Checklist (CBCL). According to the Piaget´s clinical interview, the following tasks were applied: Conservation of discrete quantities; Change of criteria - dichotomy; the tasks Succession of Events Perceived; Simultaneity, and The time of the action and the internal duration. Results show statistically significant differences between the performance of children from different groups, for piagetians tasks as a whole (p <0001) and, when analyzed separately, for the tasks Conservation of Discrete Quantities (p = 0003), Simultaneity, (p = 0004), and The time of the action and the internal duration. (p <0001). Children with ADHD showed a tendency to take their responses classified at levels lower than expected when compared to the control group. Regarding the use of methylphenidate in the clinical sample, there was no significant difference between groups. Although necessary of treatment, methylphenidate has not be sufficient to enhance the cognitive development of children with ADHD, overcoming the deficits observed. These findings support the hypothesis of deficits in the acquisition of concepts operative in children with ADHD. This calls for new thinking about the ADHD, considering alternatives for interventions that consider the deficits observed, surpassing the drug treatment.

INTRODUÇÃO - Este estudo exploratório apresenta e avalia uma experiência de formação de Agentes Comunitários de Saúde (ACS) do município de Embu das Artes para o uso de Indicadores Clínicos de Risco para o Desenvolvimento Infantil (IRDI). O IRDI é um protocolo de base psicanalítica, validado e inespecífico para diagnóstico, composto de 31 itens que sinalizam a construção da subjetividade do bebê expressa na relação com seus cuidadores. É dividido em quatro etapas do desenvolvimento do bebê: 0-4; 4 a 8; 8 a 12; e 12 a 18 meses. A ausência de dois ou mais indicadores sinaliza tendência para problemas de desenvolvimento ou risco psíquico aos três anos da criança. O IRDI resultou de uma pesquisa realizada entre 2000 e 2008, por psicanalistas do Grupo Nacional de Pesquisadores (GNP), a pedido do Ministério da Saúde. OBJETIVOS - Avaliar as influências da formação para a prática dos ACS e os obstáculos enfrentados; investigar os usos e apropriações do IRDI, situando modos de apropriação com potencial efeito de permanência. METODOLOGIA Foram realizados quatro encontros formativos e o acompanhamento do uso do protocolo pelos ACS ao longo de 2011 e início de 2012. Utilizou-se pré-teste e pós-teste, trabalhados por análise de conteúdo. Os discursos emergentes durante o uso do protocolo foram analisados em uma vertente qualitativa. RESULTADOS 1. A prática dos ACS com bebês é centrada na avaliação do crescimento e em aspectos funcionais do desenvolvimento; 2. O aspecto relacional entre mãe e bebê passou a ser valorizado no decorrer da formação; 3. Influências do protocolo para a prática foram relatadas por 72,5% dos participantes a mais citada foi o aprimoramento da observação e do conhecimento sobre o bebê e seus cuidadores. 4. O protocolo foi utilizado tanto para a detecção como para a orientação à família sobre o contato com o bebê, na perspectiva da Promoção à Saúde. 5. Os itens relativos à primeira faixa do bebê (0 a 4 meses) foram os mais lembrados espontaneamente pelos ACS. 6. Houve dificuldades no manejo com itens referentes ao eixo teórico Alternância Presença-Ausência na relação entre a criança e seu cuidador. 7. O acompanhamento particularizado dos profissionais permitiu manejar as resistências psíquicas, contribuindo para a permanência de participantes. 8. Modos de apropriação favoráveis ocorreram pelo enlaçamento entre aspectos dos indicadores e um traço particular do sujeito. CONCLUSÕES - A inserção do IRDI na Atenção Primária deve considerar um percurso de longo prazo e as particularidades de cada unidade de saúde. É pertinente trabalhar com uma equipe pequena por vez, com formação diversificada. A realização de encontros formativos regulares e acompanhamento particularizado por um profissional psicólogo nos serviços envolvidos é uma proposta que se mostra mais favorável para que seu objetivo se consolide / INTRODUCTION - Exploratory study about an experience of Community Health Agents (CHA) training in the use of Clinical Risk Indicators for Child Development (CRICD) in the town of Embu das Artes. CRICD is a psychoanalytic based protocol, validated and unspecific for diagnosis, composed by 31 items that indicate the occurrence of the construction of the babys subjectivity, expressed in the relation with its caregivers. It is divided in four stages of the babys development: 0 to 4 months; 4 to 8; 8 to 12; and 12 to 18. The absence of two or more indicators signalizes a tendency to developmental problems or psychic risk at the childs age of three. CRICD has resulted from a research carried out between 2000 and 2008 by a group of psychoanalysts named National Group of Research (NGR), by request of the Health Ministry. METHODS - To the realization of this research, four formative encounters were made, plus the follow-up of the use of the protocol in service throughout 2011 and beginning of 2012. The articulation of Public Health and Psychoanalysis has suggested a methodological approach with distinct boundaries. We assessed the influences of the CHAs practical training and the obstacles faced. The uses and appropriations of the CRICD were investigated, placing modes of appropriation with potential effect of permanence. Pre-test and post-test were used for content analysis. The discourses that emerged during the use of the protocol were selected and analyzed according to the qualitative perspective. RESULTS 1.The CHAs practices with babies are centered in growth assessment and in functional aspects of development. 2. The relational aspects became more evident during the training. Among the participants, 3. 72.5% have reported influences of the protocol in their practices, specially the improvement of observation and knowledge of the baby and its caregivers. 4. The CRICD was used to detection as well as to guidance for the families about contact with the baby, in the Promotion of Health perspective. 5. The items of the first group were the most recollected by the CHA. 6. Among the difficulties, we emphasize the handling of the items that refer to the theoretical axe of Alternation Presence-Absence in the relation between the child and its caregiver. 7. The particularized follow-up of the professionals allowed us to handle the psychic resistances, contributing to the permanence of the participants. 8. The favorable modes of appropriation were outlined in the situations in which there was an interface between aspects of the indicators and a particular trace of the subject. CONCLUSION- We suggest that the proposals of insertion of the CRICD in Primary Attention consider a long-term path, undertaken in one health unit per time because the resistances in institutional level have revealed themselves as a challenge. We found to be pertinent to work with a small staff with diverse educational backgrounds, composed of CHA, nursing and pediatric professionals. The most favorable proposal for its aim to be reached is the realization of regular formative encounters with a few months of space between them, during which supervision of the tasks involved is done

Crianças e adolescentes de todo o mundo são vítimas de maus-tratos domésticos, sendo a negligência, a modalidade mais recorrente e que se apresenta associada a inúmeras consequências negativas para o desenvolvimento infantil. O presente trabalho teve como objetivo estudar o fenômeno da negligência infantil e suas consequências no plano do desenvolvimento psicossocial e acadêmico de crianças em fase inicial de escolarização no contexto brasileiro, bem como os fatores de risco associados. Para isso, foram investigadas características dos cuidadores e das crianças com idade variando entre seis e oito anos, organizados em três grupos. O primeiro grupo (GRUPO 1) foi formado por casos notificados por negligência ao Conselho Tutelar; o GRUPO 2 foi formado por casos suspeitos de negligência, porém não notificados, tendo por base observações de professores no contexto escolar; o GRUPO 3 foi formado também a partir de indicações de professores de crianças sem suspeitas de maus-tratos/negligência (grupo de referência). Cada grupo foi constituído por 30 díades de crianças-cuidadores. Realizados os procedimentos relativos às normas éticas, foi efetuado o contato com o Conselho Tutelar, as escolas e as famílias. Obtidas as devidas autorizações, procedeu-se à coleta de dados, utilizando-se os instrumentos: Questionário de Caracterização Sociodemográfica; Inventário de Potencial de Maus-tratos Infantis (CAP); Child Neglect Index; Inventário de Comportamentos da Criança e Adolescente - 6 a 18 anos (CBCL); Inventário de Comportamentos da Criança e Adolescente/ Relatório para Professores - 6 a 18 anos (TRF) e Teste de Desempenho Escolar (TDE). Para descrever o perfil da amostra por grupos realizaram-se análises estatísticas. Os resultados mostraram diferença significativa entre os GRUPOS 1 e 2 (similares entre si) com relação ao GRUPO 3 no plano de diversas variáveis de caracterização, concebidas como fatores de risco, destacando-se mais baixo status socioeconômico das famílias, menor nível de escolaridade dos cuidadores, e a menor idade em que as mães teriam tido o primeiro filho. No mais, os cuidadores dos GRUPOS 1 e 2 também apresentaram maior potencial de risco para o abuso/negligência e suas práticas parentais caracterizam-se pela presença de mais indicadores de negligência, em comparação ao GRUPO 3. Com relação aos aspectos do desenvolvimento infantil e do desempenho escolar, as crianças dos GRUPOS 1 e 2 apresentaram, em sua maioria, escores similares que, de modo geral, indicaram déficits em diversos aspectos desenvolvimentais e dificuldades de aprendizagem no início da escolarização. Com base nesses resultados, pode-se concluir que as crianças notificadas por negligência, bem como as suspeitas de viverem essa problemática, manifestam igualmente problemas desenvolvimentais significativos em uma etapa muito sensível, o início da escolarização, o que suscita enorme preocupação, pois a não superação destes aumenta a possibilidade dessas crianças enfrentarem desafios cada vez maiores. O cenário descrito pelo presente estudo impõe a necessidade de investimentos na prevenção da negligência infantil, seja em termos de investigação científica, seja no que se refere às medidas de proteção. / Children and youths around the world are victims of domestic abuse, negligence being the most recurring category, which is associated with several harmful consequences for childhood development. The aims of this thesis were to investigate the phenomenon of childhood neglect and its consequences to the psychosocial and academic development of children in the initial stage of schooling in Brazil as well as the associated risk factors. To accomplish these objectives, the features of the caregivers and children with ages ranging from six to eight, were investigated which was organized in three groups. The first group (group 1) was formed by cases of neglect notified to the Child Protection Council; the second group (group 2) was formed by suspect cases of neglect, but not notified to the Child Protection Council, based on their school teachers´ observation; the third group (group 3) was also formed by indications of the school teachers, but by children not suspected to be neglected (reference group). Each group consisted of thirty dyads of child- caretaker. After carrying out all the relative procedures to the ethical issues, the Child Protection Council, schools and children were contacted. After obtaining the necessary authorizations, the data collection was accomplished, through the following instruments: Questionário de Caracterização Sociodemográfica (socio-demographic questionnaire); Child Abuse Potential Inventory - CAP; Child Neglect Index; Child and Youth Behavior Inventory, 6-18 years - CBCL; Child and Youth Behavior Inventory, 6-18 years/Teacher Report Form -TRF and Teste de Desempenho Escolar - TDE (School performance test). To describe the sample\'s profile of the groups, statistical analyses were performed. The results show similarities between groups 1 and 2, which, in contrast, are quite different from group 3 concerning several characterization variables. They are conceived as risk factors, highlighting families with lower socioeconomic status, lower education level of the caregivers and the lowest age of the mothers when the first child was born. Moreover, the caregivers of groups 1 and 2 also show higher potential risks for abuse than those of group 3. Furthermore, more neglect indicators were found in groups 1 and 2 than in group 3. Concerning the childhood development aspects and academic performances, children of groups 1 and 2, in general, show similar results, having shortfalls in several developmental aspects and learning difficulties at the beginning of the literacy stage. Based on these results, one can conclude that children notified as neglected and those of suspect cases expressed equally significant developmental problems during a sensitive period of their lives, the beginning of the literacy, giving rise to a huge concern since failure at this stage increases the chances of major drawbacks in their future. The scenario revealed by the present study points out the necessity of investments in children negligence prevention, supporting both scientific investigations and protective actions.