O entendimento de que toda criança é sujeita de direitos é historicamente recente no Brasil. O paradigma atual, pautado nos direitos humanos, preconiza o fim da exploração e de quaisquer tipos de abusos a essa fase da vida. Entretanto, o fenômeno ainda ocorre e as consequências podem ser de curto a longo prazo, sendo um dos fatores de risco associado à problemas cognitivos, linguísticos, afetivos e acadêmicos. O enfrentamento da questão no Brasil se estabelece a partir de várias instituições que fazem parte da Rede de proteção à criança vítima de violência, como disposto desde 1990 pelo Estatuto da Criança e do Adolescente e melhor estruturado em 2006 pelo Sistema de Garantia de Direitos, que prevê um trabalho considerado intersetorial. Todavia, a literatura aponta certa falha na comunicação entre os seus componentes. Entender o funcionamento da Rede e em que medida ela compõe um trabalho intersetorial é importante para refletir acerca de sua dinâmica e suas potencialidades. Para tanto, o objetivo desta pesquisa é compreender a composição e funcionamento da Rede de proteção. Para a realização da pesquisa utilizamos duas fontes de informação: 1) normas, orientações e diretrizes voltadas aos profissionais de grandes áreas que fazem parte da rede protetiva, separando-as pelos seguintes setores: Direitos Humanos, Justiça e Segurança Pública, Saúde, Educação e Assistência Social; e 2) entrevistas semiestruturadas com profissionais que atuam nesses setores e trabalham em uma mesma região na zona Sul da cidade de São Paulo. O material foi analisado de forma qualitativa utilizando a análise discursiva para compreender como a articulação das diferentes esferas atuantes na proteção infantil emerge como um dispositivo para o enfrentamento da violência contra crianças. Notamos que há algumas diferenças entre as atribuições esperadas por cada setor e há uma maior flexibilização dos fluxos de atendimento nos discursos dos profissionais quando comparados aos discursos normativos. Quanto às notificações de violência, destacamos desafios para sua ocorrência relacionados a falta de capacitação dos profissionais para lidar com a temática, insegurança para notificar e ainda ausência de confiança no Conselho Tutelar. Quanto a este órgão, observamos falta de legitimidade quanto a eficácia de suas ações, tornando-se apenas uma instituição necessária para a Rede protetiva porque as normas e leis assim determinam. No que se refere ao funcionamento da rede, notamos que embora os documentos afirmem a sua importância, conceituem a violência de maneira homogênea e definam encaminhamentos a serem tomados, a rede funciona de forma ainda frágil, como constatam os discursos dos profissionais. Para a construção de uma política intersetorial torna-se necessário uniformizar o fluxo de atendimento, os sistemas de informação e notificação de violência e capacitar os profissionais para este processo. Estratégias promissoras para a construção de planos intersetoriais de atendimento na região são as audiências concentradas e outras reuniões semelhantes. A institucionalização desses mecanismos poderia facilitar uma maior articulação entre os setores / The knowledge that every child is a subject of rights is historically recent in Brazil. The current paradigm, based on human rights, advocates the end of exploitation and any other type of abuse in this stage of life. However, the phenomena still occurs and its lead to short or long term consequences, and is one of the risk factors associated to cognitive, linguistic, affective and academic problems. The coping to that question in Brazil is established from many institutions that are part of a child abuse network protection, as it is recommended since 1990 by Child and Adolescent Statute (Estatuto da Criança e do Adolescente) and better organized in 2006 by the Rights Guarantee System (Sistema de Garantia de Direitos), that seeks a work considered intersectoral. Nevertheless, the literature points some failure in the communication of its components. Understand how the network works and to what extent it makes up an intersectoral work is important to reflect about its dynamic and possibilities. Therefore, the objective of this research is to understand the composition and operation of the Protection Network. In order to carry out the research, we used two sources of information: 1) standards, orientation and guidelines for professionals in large areas that are part of the protection network, separating them by the following sectors: Human Rights, Justice and Public Security, Health, Education and Social Assistance; and 2) semi-structured interviews with professionals who work in these sectors and acts in the same region in the southern part of Sao Paulo city. The material was analysed by qualitative methods using discursive analysis to understand how the articulation of the different spheres of child protection emerges as a device for coping with violence against children. We note that there are some differences between the attributions expected by each sector and there is a greater flexibility of the service flows in the professionals\' discourses when compared to normative discourses. Regarding the notifications of violence, we highlight challenges to its occurrence related to the lack of capacity of professionals to deal with the issue, insecurity to notify and still lack of trust in the Tutelary Council. Concerning this institution, we observe a lack of legitimacy regarding the effectiveness of its actions, becoming only a necessary institution for the Protective Network because the rules and laws so determine. Regarding the functioning of the network, we note that although the documents affirm their importance, conceptualize violence in a homogeneous way and define guidelines to be taken, the network works in a still fragile way, as evidenced by the professionals\' discourses. In order to build an intersectoral policy, it is necessary to standardize the flow of attendance, the information and notification systems of violence, and to empower professionals for this process. Promising strategies for building intersectoral service plans in the region are concentrated audience and other similar meetings. The institutionalization of these mechanisms could facilitate greater articulation between sectors

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Syftet med denna studie är att förstå den erfarenhet och kunskap om samverkan som deltagarna i Må bra på äldre dar - projektet fått i det hälsofrämjande samverkansprojektet. Studien fokuserar på framgångsfaktorer och hinder för samverkansprocessen, hur projektet påverkat maktförhållandena mellan de ideella och offentliga organisationerna, deltagarnas organisatoriska erfarenheter av samverkan, deras uppfattning av arbetsklimatet och upplevelse av KASAM i projektet. Forskning kring hälsofrämjande samverkan bland äldre är sparsam. En kvalitativ ansats användes med fokusgrupper som datainsamlingsmetod. 11 fokusgrupper genomfördes med 62 deltagare. Intervjuade var representanter för de deltagande organisationerna, äldre och blivande äldre som deltagit. Projektledarens svar på intervjufrågorna redovisades skriftligt. Analys av materialet genomfördes med kvalitativ innehållsanalys. Nio teman framkom vid analys av framgångsfaktorerna: 1. Ledare, eldsjälar, mål, varaktighet, att lyssna mm, 2. offentliga organisationer har störst betydelse, men alla är viktiga, 3. människor möttes och skapade en process som gav flow, 4. delaktighet, 5. gränsöverskridande ett nytt sätt att arbeta, 6. människor och organisationer lärde sig av varandra, 7. nätverksbyggandet ökade i samhället, 8.helhet och sammanhang samt 9. positivt arbetsklimat och ingen stress. Nio teman framkom vid analys av de hinder de olika organisationerna upplevt inom projektet (de äldre och blivande äldre omfattades av fem av dem och projektledarens av sju): 1.bristande stöd och legitimitet, 2. bristande resurser och resursutnyttjande, 3. bristande organisatoriska förutsättningar, 4. ojämlik makt och ekonomiska förutsättningar, 5. otillräcklig förankring, 6. revir och konkurrens, 7. bristande delaktighet och tillit, 8. bristfälliga metoder och 9. stressande arbetsklimat. Deltagarna upplevde delaktighet inom projektet. Både offentliga och ideella företrädare upplevde inte att projektet påverkat de offentliga organisationernas arbetssätt. Projektets legitimitet minskade under projekttiden. Deltagare i projektet fick ny kunskap om att arbeta i samverkan, ny kompetens om att arbeta gränsöverskridande, om vikten av att bygga relationer och skapa nätverk. Projektets arbetsklimat uppfattades både som hälsosamt och stressande. Formuläret SOC 13 användes för att mäta deltagarnas KASAM. Resultatet visare en relativt hög känsla av sammanhang i projektet bland deltagarna. Studien visar på svårigheter att bedriva hälsofrämjande arbete bland äldre. Tecken finns att den offentliga sektorn inte är redo för detta paradigmskifte. Det finns dock mycket att vinna på att initiera hälsofrämjande arbete, social gemenskap utvecklas i ett demokratiarbete med empowerment som metod, ytterst för en hållbar utveckling. / The aim of this study is to understand the experience and knowledge of intersectoral collaboration of the participants in the health promotional project “Feel good in the old age”. The study focuses on successful factors and barriers in the collaboration process, how the project have affected the power between the non governmental and the public organisations, the participants organisational experiences of collaboration, their view of the working climate in the project and their experiences of SOC in the project. Research in intersectoral collaboration in health promotion among elderly is sparse. The methodology is a qualitative study with focus groups. 11 focus groups was made with 62 participants from the different organisations – non governmental and public- and old and people becoming elderly. The project leader wrote the answers before the focus groups were made. Content analysis was used. As successful factors nine themes appeared: 1. leaders, energizers, duration, listen, 2. the public organisations are the most important but all are valuable, 3.people met and created a process with flow, 4. participation, 5. working over boundaries is a new way of working, 6. people and organisations learned from each other, 7. building of networks increased in the society, 8. sense of coherence and 9. positive working climate and no stress. Nine themes appeared in the analysis of barriers (elderly and becoming elderly was grasping five of them and the project leader seven): 1. insufficient support and legitimacy, 2. insufficient resources and use of available resources, 3. insufficient organisational conditions, 4. unequal power and economical conditions, 5. insufficient anchoring, 6. preservations and competition, 7. insufficient participation and trust, 8. insufficient methods and 9. the work in the project was under stress. The participants experienced participation in the project. Both public and nongovernmental representatives did not think the project had influenced the public organisations. The legitimacy of the project decreased during the run. The participants got new knowledge in how to work in collaboration, new competence of how to work over the boundaries and of the importance of building relationships and networks. The working climate was seen as healthy and as with stress. The SOC 13 formula was used to measure the participant’s sense of coherence in the project. The score was relatively high. The study shows difficulties in intersectoral collaboration. There are some signs that the public sector is not yet ready to change the paradigm. There are though a lot to win to initiate health promotion. A social fellowship develops in a democracy process with empowerment as the method, farthest out to reach a sustainable development / <p>ISBN 91-7997-145-8</p>

O entendimento de que toda criança é sujeita de direitos é historicamente recente no Brasil. O paradigma atual, pautado nos direitos humanos, preconiza o fim da exploração e de quaisquer tipos de abusos a essa fase da vida. Entretanto, o fenômeno ainda ocorre e as consequências podem ser de curto a longo prazo, sendo um dos fatores de risco associado à problemas cognitivos, linguísticos, afetivos e acadêmicos. O enfrentamento da questão no Brasil se estabelece a partir de várias instituições que fazem parte da Rede de proteção à criança vítima de violência, como disposto desde 1990 pelo Estatuto da Criança e do Adolescente e melhor estruturado em 2006 pelo Sistema de Garantia de Direitos, que prevê um trabalho considerado intersetorial. Todavia, a literatura aponta certa falha na comunicação entre os seus componentes. Entender o funcionamento da Rede e em que medida ela compõe um trabalho intersetorial é importante para refletir acerca de sua dinâmica e suas potencialidades. Para tanto, o objetivo desta pesquisa é compreender a composição e funcionamento da Rede de proteção. Para a realização da pesquisa utilizamos duas fontes de informação: 1) normas, orientações e diretrizes voltadas aos profissionais de grandes áreas que fazem parte da rede protetiva, separando-as pelos seguintes setores: Direitos Humanos, Justiça e Segurança Pública, Saúde, Educação e Assistência Social; e 2) entrevistas semiestruturadas com profissionais que atuam nesses setores e trabalham em uma mesma região na zona Sul da cidade de São Paulo. O material foi analisado de forma qualitativa utilizando a análise discursiva para compreender como a articulação das diferentes esferas atuantes na proteção infantil emerge como um dispositivo para o enfrentamento da violência contra crianças. Notamos que há algumas diferenças entre as atribuições esperadas por cada setor e há uma maior flexibilização dos fluxos de atendimento nos discursos dos profissionais quando comparados aos discursos normativos. Quanto às notificações de violência, destacamos desafios para sua ocorrência relacionados a falta de capacitação dos profissionais para lidar com a temática, insegurança para notificar e ainda ausência de confiança no Conselho Tutelar. Quanto a este órgão, observamos falta de legitimidade quanto a eficácia de suas ações, tornando-se apenas uma instituição necessária para a Rede protetiva porque as normas e leis assim determinam. No que se refere ao funcionamento da rede, notamos que embora os documentos afirmem a sua importância, conceituem a violência de maneira homogênea e definam encaminhamentos a serem tomados, a rede funciona de forma ainda frágil, como constatam os discursos dos profissionais. Para a construção de uma política intersetorial torna-se necessário uniformizar o fluxo de atendimento, os sistemas de informação e notificação de violência e capacitar os profissionais para este processo. Estratégias promissoras para a construção de planos intersetoriais de atendimento na região são as audiências concentradas e outras reuniões semelhantes. A institucionalização desses mecanismos poderia facilitar uma maior articulação entre os setores / The knowledge that every child is a subject of rights is historically recent in Brazil. The current paradigm, based on human rights, advocates the end of exploitation and any other type of abuse in this stage of life. However, the phenomena still occurs and its lead to short or long term consequences, and is one of the risk factors associated to cognitive, linguistic, affective and academic problems. The coping to that question in Brazil is established from many institutions that are part of a child abuse network protection, as it is recommended since 1990 by Child and Adolescent Statute (Estatuto da Criança e do Adolescente) and better organized in 2006 by the Rights Guarantee System (Sistema de Garantia de Direitos), that seeks a work considered intersectoral. Nevertheless, the literature points some failure in the communication of its components. Understand how the network works and to what extent it makes up an intersectoral work is important to reflect about its dynamic and possibilities. Therefore, the objective of this research is to understand the composition and operation of the Protection Network. In order to carry out the research, we used two sources of information: 1) standards, orientation and guidelines for professionals in large areas that are part of the protection network, separating them by the following sectors: Human Rights, Justice and Public Security, Health, Education and Social Assistance; and 2) semi-structured interviews with professionals who work in these sectors and acts in the same region in the southern part of Sao Paulo city. The material was analysed by qualitative methods using discursive analysis to understand how the articulation of the different spheres of child protection emerges as a device for coping with violence against children. We note that there are some differences between the attributions expected by each sector and there is a greater flexibility of the service flows in the professionals\' discourses when compared to normative discourses. Regarding the notifications of violence, we highlight challenges to its occurrence related to the lack of capacity of professionals to deal with the issue, insecurity to notify and still lack of trust in the Tutelary Council. Concerning this institution, we observe a lack of legitimacy regarding the effectiveness of its actions, becoming only a necessary institution for the Protective Network because the rules and laws so determine. Regarding the functioning of the network, we note that although the documents affirm their importance, conceptualize violence in a homogeneous way and define guidelines to be taken, the network works in a still fragile way, as evidenced by the professionals\' discourses. In order to build an intersectoral policy, it is necessary to standardize the flow of attendance, the information and notification systems of violence, and to empower professionals for this process. Promising strategies for building intersectoral service plans in the region are concentrated audience and other similar meetings. The institutionalization of these mechanisms could facilitate greater articulation between sectors

Puisque les déterminants sociaux de la santé sont en dehors du secteur institutionnel conventionnel de la santé, la collaboration intersectorielle apparaît comme la stratégie de choix pour agir sur ces déterminants. Comme souligné par Jackson et coll. (2006), la collaboration intersectorielle et les partenariats interorganisationnels sont des actions transversales qui doivent se produire à des niveaux structurels, sociaux et personnels et qui doivent être imbriquées dans toutes les stratégies de promotion de la santé mises de l’avant par la Charte d’Ottawa. Mais que signifie la collaboration intersectorielle, comment est-elle vécue, et comment ces processus intersectoriels peuvent-ils être réussis? L’objectif principal de ce projet de recherche était de contribuer à l’élaboration d’un cadre conceptuel de l’action intersectorielle, développé à partir de la littérature disponible et validé empiriquement par quatre études de cas, à l’intérieur d’une région du Québec (Chaudière-Appalaches). Ces quatre initiatives se sont déroulées entre 1997 et 2012 : • Cas 1 : Programme de prévention de la détresse psychologique auprès des agriculteurs • Cas 2 : Construction du parc de jeu destiné aux enfants de 0 à 5 ans • Cas 3 : Programme de cuisines collectives à Beauce-Sartigan • Cas 4 : Programme de prévention de l’alcool au volant La première partie de la thèse se concentre sur la compréhension de termes reliés à l’intersectorialité en santé, en comparant les définitions théoriques (à partir d’une revue systématique de la littérature grise et scientifique) à la terminologie utilisée sur le terrain (à partir des études de cas). La deuxième partie de la thèse consiste en une analyse transversale des quatre études de cas qui ont été élaborées autour des sept dimensions suivantes : le problème, les objectifs de santé de populations, les autres objectifs, les résultats, les acteurs, les processus et le contexte. L’analyse transversale porte principalement sur les avantages, les conditions facilitantes et les défis de l’action intersectorielle en santé, incluant une discussion sur le rôle et la légitimité du secteur santé en tant qu’instigateur du partenariat intersectoriel. Thesis Abstract Since the social determinants of health lie outside the conventional institutional health sector, intersectoral collaboration appears to be the strategy of choice to act on these determinants. As Jackson et al. note (2006), intersectoral collaboration and inter-organizational partnerships are cross-cutting actions that must occur at structural, social and personal levels, and they should be embedded in all strategies for health promotion put forward by the Ottawa Charter. But what does intersectoral collaboration mean, how it is lived, and how can these intersectoral processes be successful? The main objective of this research project is to contribute to the development of a conceptual framework for intersectoral action. That framework is developed from the literature and empirically validated by four case studies within a Quebec region (Chaudière-Appalaches). These four initiatives took place between 1997 and 2012: • Case 1: Program for the prevention of psychological distress among farmers • Case 2: Construction of a play park for children aged 0 to 5 years • Case 3: Program of collective kitchens in Beauce-Sartigan • Case 4: Program for the prevention of alcohol-impaired driving The first part of the thesis focuses on understanding terms related to intersectoriality in health by comparing the theoretical definitions (from a systematic review of scientific and grey literature) to the terminology used in the field (captured by conducting case studies). The second part of the thesis is a cross-sectional analysis of four case studies developed around the following seven dimensions: the problem, the population health objectives, other objectives, the outcomes, the actors, the processes and the context. This cross-sectional analysis focuses on the benefits, facilitating conditions and challenges of intersectoral action in health, including a discussion of the role and legitimacy of the health sector as an instigator of intersectoral partnerships.

Puisque les déterminants sociaux de la santé sont en dehors du secteur institutionnel conventionnel de la santé, la collaboration intersectorielle apparaît comme la stratégie de choix pour agir sur ces déterminants. Comme souligné par Jackson et coll. (2006), la collaboration intersectorielle et les partenariats interorganisationnels sont des actions transversales qui doivent se produire à des niveaux structurels, sociaux et personnels et qui doivent être imbriquées dans toutes les stratégies de promotion de la santé mises de l’avant par la Charte d’Ottawa. Mais que signifie la collaboration intersectorielle, comment est-elle vécue, et comment ces processus intersectoriels peuvent-ils être réussis? L’objectif principal de ce projet de recherche était de contribuer à l’élaboration d’un cadre conceptuel de l’action intersectorielle, développé à partir de la littérature disponible et validé empiriquement par quatre études de cas, à l’intérieur d’une région du Québec (Chaudière-Appalaches). Ces quatre initiatives se sont déroulées entre 1997 et 2012 : • Cas 1 : Programme de prévention de la détresse psychologique auprès des agriculteurs • Cas 2 : Construction du parc de jeu destiné aux enfants de 0 à 5 ans • Cas 3 : Programme de cuisines collectives à Beauce-Sartigan • Cas 4 : Programme de prévention de l’alcool au volant La première partie de la thèse se concentre sur la compréhension de termes reliés à l’intersectorialité en santé, en comparant les définitions théoriques (à partir d’une revue systématique de la littérature grise et scientifique) à la terminologie utilisée sur le terrain (à partir des études de cas). La deuxième partie de la thèse consiste en une analyse transversale des quatre études de cas qui ont été élaborées autour des sept dimensions suivantes : le problème, les objectifs de santé de populations, les autres objectifs, les résultats, les acteurs, les processus et le contexte. L’analyse transversale porte principalement sur les avantages, les conditions facilitantes et les défis de l’action intersectorielle en santé, incluant une discussion sur le rôle et la légitimité du secteur santé en tant qu’instigateur du partenariat intersectoriel. Thesis Abstract Since the social determinants of health lie outside the conventional institutional health sector, intersectoral collaboration appears to be the strategy of choice to act on these determinants. As Jackson et al. note (2006), intersectoral collaboration and inter-organizational partnerships are cross-cutting actions that must occur at structural, social and personal levels, and they should be embedded in all strategies for health promotion put forward by the Ottawa Charter. But what does intersectoral collaboration mean, how it is lived, and how can these intersectoral processes be successful? The main objective of this research project is to contribute to the development of a conceptual framework for intersectoral action. That framework is developed from the literature and empirically validated by four case studies within a Quebec region (Chaudière-Appalaches). These four initiatives took place between 1997 and 2012: • Case 1: Program for the prevention of psychological distress among farmers • Case 2: Construction of a play park for children aged 0 to 5 years • Case 3: Program of collective kitchens in Beauce-Sartigan • Case 4: Program for the prevention of alcohol-impaired driving The first part of the thesis focuses on understanding terms related to intersectoriality in health by comparing the theoretical definitions (from a systematic review of scientific and grey literature) to the terminology used in the field (captured by conducting case studies). The second part of the thesis is a cross-sectional analysis of four case studies developed around the following seven dimensions: the problem, the population health objectives, other objectives, the outcomes, the actors, the processes and the context. This cross-sectional analysis focuses on the benefits, facilitating conditions and challenges of intersectoral action in health, including a discussion of the role and legitimacy of the health sector as an instigator of intersectoral partnerships.

The aim of this study is to gain insight into professional`s experiences of interdisciplinary collaboration between the municipality and the forensic ward. The study was intended to contribute to an increased understanding of the professional`s experiences of what is considered to work and what is considered to lack in the interdisciplinary collaboration between the municipality and the forensic ward. The study`s empirical data was obtained through eight semi-structured interviews with five social workers from the social services and three counselors`s at the forensic ward. National and international previous research in interdisciplinary collaboration that was relevant for my study has been obtained. For the analyze I combined previous research, the result from my interviews and my theoretical framework. Conclusions show that the professionals believe that communication between social services and forensic psychiatry is good and that both parties focus on the individual patient. Conclusions also show that insufficient knowledge regarding the organizations, work areas, responsibility, and resources and that the legislation is different. All the interviewees have a wish to improve and develop the collaboration between them.