Made available in DSpace on 2015-04-14T13:20:34Z (GMT). No. of bitstreams: 1 452446.pdf: 916267 bytes, checksum: 0f4d3458ff22d89a4e55f43a498c9547 (MD5) Previous issue date: 2013-01-29 / The study examines the theoretical and conceptual approach of the social determination of the health-disease process and the focus of the social determinants of health, looking beyond the elucidation of them, enjoying them in the light of their contributions and implications for strengthening the Brazilian Health Reform Project. The concept of social determinants of health was one of the main pillars of critical thinking which founded the collective health and scientifically substantiated the Brazilian Health Reform Project. However, it suffered from theoretical investments in the structuring years of the United Health System (SUS). The issue returned to the agenda of discussions with the constitutions of the Social Determinants of Health from the World Health Organization (OMS) and the subsequent publication of this report. Despite the similarities, the two constructs can be distinguished. Understanding that the option for various approaches implies in the clarity of its fundamentals, reference horizons, underlying ideologies, scope and purposes, it is necessary to clarify the benchmarks adopted, since the parameters are supported on philosophical, theoretical and ethical-political. Far from being a purely conceptual debate, the claim rests on the search for the essence of the approaches, as well as its transformative potential in face of colossal challenges of a reality that defies and enforces the critical reading skills to develop responses that have as a goal the radicalization of democracy, one of the flags of the Brazilian Health Reform. Therefore, we sought to answer the following questions: how the theoretical approaches on social determinants of health understand the phenomenon health - disease and the relationship between health/society? In which historical context develop the distinct constructs about social determinants of health? What corporate projects are underlying to the approaches about the social determinants of health? Under what theoretical, methodological, ethical and political fundamentals the constructions are based on the social determinants of health? How to present a political viewpoint and methodological proposals for health work-based conception of social determinants of health? This is a theoretical investigation, aimed at studying theories and uncovers theoretical frameworks. Thus, consisted of a literature review, an exploratory and descriptive, with qualitative approach in order to seek and to understand the explanations, the concepts, the theoretical and methodological frameworks and the ethical-political reference, besides the operational propositions underlying the theoretical perspectives studied. Resorted to the technique of content analysis to the data treatment. Composed the study theoretical treatises written by thinkers recognized in the field of community health by their notorious contribution on the subject and specific institutional publications on the topic. / O estudo analisa a abordagem te?rico-conceitual da determina??o social do processo sa?de-doen?a e o enfoque dos determinantes sociais da sa?de, buscando, para al?m da elucida??o dos mesmos, apreci?-los ? luz de suas contribui??es e implica??es para o fortalecimento do Projeto da Reforma Sanit?ria Brasileira. O conceito de determina??o social da sa?de foi um dos principais pilares do pensamento cr?tico que fundou a sa?de coletiva e fundamentou cientificamente o Projeto da Reforma Sanit?ria Brasileira. Entretanto, padeceu de investimentos te?ricos nos anos de estrutura??o do Sistema ?nico de Sa?de (SUS). O tema retornou ? pauta de discuss?es com a constitui??o da Comiss?o para os Determinantes Sociais da Sa?de da Organiza??o Mundial da Sa?de (OMS) e a subsequente publica??o de seu relat?rio. N?o obstante as semelhan?as, as constru??es distinguem-se. Entendendo que a op??o pelas mais variadas abordagens implica na clareza de seus fundamentos, horizontes de refer?ncia, ideologias subjacentes, alcance e prop?sitos, faz-se necess?rio o esclarecimento dos referenciais adotados, visto que se sustentam em par?metros filos?ficos, te?ricos e ?tico-pol?ticos. Longe de ser um debate puramente conceitual, a pretens?o repousa na busca pela ess?ncia das abordagens, bem como seu potencial transformador frente aos colossais desafios de uma realidade que desafia e imp?e capacidade de leitura cr?tica para elabora??o de respostas que tenham como horizonte a radicaliza??o da democracia, uma das bandeiras da Reforma Sanit?ria Brasileira. Para tanto, procurou-se responder as seguintes quest?es: como as abordagens te?ricas sobre determina??o social da sa?de entendem o fen?meno sa?de-doen?a e a rela??o sa?de/sociedade? Em que contexto hist?rico se desenvolveram as distintas constru??es sobre determina??o social da sa?de? Que projetos societ?rios s?o subjacentes ?s abordagens sobre determina??o social da sa?de? Sob quais fundamentos te?ricos, metodol?gicos, ?ticos e pol?ticos est?o embasadas as constru??es te?ricas sobre determina??o social da sa?de? Como se apresentam do ponto de vista pol?tico e metodol?gico as propostas de trabalho em sa?de baseadas na concep??o da determina??o social da sa?de? Trata-se de uma investiga??o te?rica, ou seja, voltada a estudar teorias e desvendar quadros te?ricos de refer?ncia. Assim, consistiu em uma pesquisa bibliogr?fica, de natureza explorat?ria e descritiva, com abordagem qualitativa, tendo em vista que se buscou a compreens?o de explica??es, concep??es, quadros te?rico- metodol?gicos e ?tico-pol?ticos de refer?ncia, al?m das proposi??es operacionais subjacentes ?s perspectivas te?ricas estudadas. Recorreu-se ? t?cnica de an?lise de conte?do para o tratamento dos dados. Compuseram o estudo produ??es te?ricas de autoria de pensadores reconhecidos no campo da sa?de coletiva por sua not?ria contribui??o sobre o assunto e publica??es institucionais espec?ficas sobre o tema.

Made available in DSpace on 2015-02-24T18:18:35Z (GMT). No. of bitstreams: 1 MoemiaGOM_TESE.pdf: 1892425 bytes, checksum: 572b24c0c2d92d3892f64edef82f2ede (MD5) Previous issue date: 2010-05-17 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This research analyses politic Project for nursing education, in its articulation with economical, political and social context of 1970s and 1980s in national level and, in special, nurse formation process in FAEN/UERN space, situating it on the context of Brazilian sanitary reformation movement and participation movement. The thesis is firmed on the sense of explaining whether that movement circa the nurse formation process has been able to build necessary instruments for the transformation of biomedical formation model historically consolidated, in the perspective of conceiving another model anchored on social determination of health/illness process, with the purpose of assuring ethical and political commitment with the SUS praised by sanitary reformation. The study visualized the object considering its specificity, its concrete historical determinations and institutional as well as organizational relationships that permeate possibilities of valorizing it, analyzing it, interpreting it and rebuilding it. Its operationalization occurred in three movements, it means, bibliographical review; documents study; interviews and focal groups realized with professors of the institution. We can apprehend as main results that the nurse formation process has incorporated widely spread conceptions by the sanitary reformation movement and participation movement, assuming the commitment with transformation of health services and social reality. Nevertheless it prevails, still, amongst some professors in the same institutional space, the commitment to a predominantly technicist formation, focused on instrumental knowledge. Opinion divergence explicit diversity of conceptions circa education and, as consequence, distinct political commitments, also contradictory to formation. Thus, there is a lacuna between what is foreseen on political pedagogical project and what is rendered in FAEN/UERN, evidencing the clash related to conceptual bases of formation project. Interpretations, divergent political attitudes and resistances to the process allowed several formation ways. However, formation under new conceptual bases, find limits on the context of social politics implemented in Brazil during the 1990s, neoliberal-based, expressed on expansion and consolidation of health private system, managed by market rules, strengthening biomedical formation model. Notwithstanding, there is a favorable to its implementation, starting from the first years of 21st century, moment when Brazilian sanitary reformation reappear on health speech, as well as facing the policy of permanent education in health. This reality explicit a process of dialectical tension between instituted and institutor, anticipating the moment of scission or adaptation and return to what is already known. Despite of clashed, knowledge, accumulated experience, contribution to services, the construction of partnerships out of university space and articulation with national movement of (re)orientation of nurse formation, have been constituted as vital instruments to offer support to formation in FAEN/UERN. Still, we consider necessary the (re)visitation to FAEN/UERN politic pedagogical Project considering the existing and implemented construction, without, yet, depreciate the norther axis of the project at the reaching of its intentionality / Este estudo analisa o projeto pol?tico para a educa??o em enfermagem, em sua articula??o com o contexto econ?mico, pol?tico e social dos anos 1970 e 1980 em n?vel nacional e, em especial, o processo de forma??o do enfermeiro no espa?o da FAEN/UERN, situando-o no contexto do movimento da reforma sanit?ria brasileira e do movimento participa??o. A tese se firma no sentido de explicar se o movimento em torno do processo de forma??o do enfermeiro foi capaz de construir instrumentos necess?rios ? transforma??o do modelo de forma??o biom?dico, historicamente consolidado, na perspectiva de conceber um outro modelo ancorado na determina??o social do processo sa?de/doen?a, visando assegurar o compromisso ?tico e pol?tico com o SUS preconizado pela reforma sanit?ria. O estudo visualizou o objeto considerando sua especificidade, suas determina??es hist?ricas concretas e as rela??es institucionais e organizativas que permeiam as possibilidades de valor?-lo, analis?-lo, interpret?-lo e reconstru?-lo. A sua operacionaliza??o ocorreu em tr?s movimentos, ou seja, a revis?o bibliogr?fica; o estudo de documentos; as entrevistas e os grupos focais realizados com os docentes da institui??o. Podemos apreender como principais resultados que o processo de forma??o do enfermeiro incorporou as concep??es amplamente difundidas pelo movimento de reforma sanit?ria e pelo movimento participa??o, assumindo o compromisso com a transforma??o dos servi?os de sa?de e da realidade social. No entanto prevalece, ainda, entre alguns docentes no mesmo espa?o institucional, o compromisso com uma forma??o predominantemente tecnicista, centrada no conhecimento instrumental. A diverg?ncia de opini?es explicita a diversidade de concep??es sobre educa??o e, consequentemente, compromissos pol?ticos distintos e contradit?rios com a forma??o. Assim, existe uma lacuna entre o que est? previsto no projeto pol?tico pedag?gico e o que ? concretizado na FAEN/UERN, evidenciando o embate relativo ?s bases conceituais do projeto de forma??o. As interpreta??es, as posturas pol?ticas divergentes e as resist?ncias ao processo foram viabilizando diversos modos de forma??o. Por?m, a forma??o sob novas bases conceituais, encontra limites no contexto das pol?ticas sociais implementadas no Brasil nos anos 1990, de base neoliberal, expressos na expans?o e consolida??o do sistema privado de sa?de, regido pelas regras do mercado, fortalecendo o modelo de forma??o biom?dico. Entretanto, existe um cen?rio favor?vel a sua implementa??o, a partir dos primeiros anos do s?culo XXI, momento em que a reforma sanit?ria brasileira reaparece no discurso da sa?de, bem como, diante da pol?tica de educa??o permanente em sa?de. Essa realidade explicita um processo de tens?o dial?tica entre o institu?do e o instituinte, antecipando o tempo de cis?o ou de adapta??o e retorno ao j? conhecido. Apesar dos embates, o saber, a experi?ncia acumulada, a contribui??o para os servi?os, a constru??o de parcerias fora do espa?o da universidade e, ainda, a articula??o com o movimento nacional de (re)orienta??o da forma??o do enfermeiro, se constitu?ram em instrumentos imprescind?veis para dar sustenta??o ? forma??o na FAEN/UERN. Entretanto, consideramos necess?ria a (re)visita ao Projeto Pol?tico-Pedag?gico da FAEN/UERN considerando a constru??o existente e implementada, sem contudo desvirtuar o eixo norteador do projeto no alcance da sua intencionalidade

Made available in DSpace on 2015-04-14T13:20:39Z (GMT). No. of bitstreams: 1 462521.pdf: 2954329 bytes, checksum: 63e938ace6778c8888ba7b37460f49d6 (MD5) Previous issue date: 2014-08-29 / This thesis deals with the construction of the right to health care with the participation of and emphasis on the dialectic reading of the history of the public policies on health care in Brazil since the conception of the health movement, in a contextof State reforms and of the construction of the popular democratic project. Its goal is to analyze how the debate about SUS [Unified Health Care System] materializes as a model of universal care, in the public spaces as of the political participation of the collective actors of the popular field in the reform movement. Thus, the indicators which guided the analysis are: what political participation could have produced health care as a social right? and: how are the public spaces conformed within the institutional design of health care in RS? This was done based on the documental analysis of the CES [State Health Conferences] Resolutions/RS, the Conference Reports and State Health Plans which guided the historical path. Besides this, fourteen collective actors indicated based on the technique of the snow ball , through thematic oral narrative, contributed by explaining the main strategies, articulations, mobilizations and political education in this process. These actors are identified with the union movement (Fetag [Agricultural Workers Federation]/RS, the Rural Department of CUT [Worker s Unified Center] Fetraf [Family Agriculture Federation]/South), the Sindsepe [Public Servants Union]/RS, the Sindfarm [Pharmacists Union]/RS, the community Movement, the Fracab [Riograndense Federation of Community Associations and Neighborhood Associations] /RS, as well as CUT/RS, the NGOs (CAMP [Multi-professional Consultancy Center]/RS, CEAP [Center of Popular Education and Consultancy]/RS), the social movements (MMC [Rural Women s Movement]/RS), Mental Health Forum, the church (CEBs [Ecclesial Base Communities]), besides the professional representation (Cress [Regional Social Work Council]) and the Philanthropic Hospitals Federation of RS. The narratives were obtained through interviews collected and taped with authorization, transcribed and codified by the NVIVO Software, a system of qualitative analysis which makes possible a more rapid organization, presentation, interpretation and disclosure of the data. The content analysis according to Bardin (1977) was used. The results indicate that this movement or these movements defending the right to health care and the institution of SUS can be divided into three phases: the first occurred toward the end of the 70s and beginning of the 80s. During this period the mobilizing political agenda of the social movements was the construction and the guarantee of rights in the perspective of Social Security, land, work and access to health care. In the public spaces the struggle was for autonomy with regard to the traditional structures. And the strategies used by the collective actors were base organization, mobilization, political articulation and formation. These are tools potentialized by the strategy of Popular Education, through base nuclei, discussion groups, health care commissions and also the Seminars and the Congresses. It is a movement which forms its leaders as well as disputes spaces in society. In the second phase, now in the context of the 90s, one observes, on the one side, a movement for Political Democratization, with regulation of rights through legislation, a new conception of health care with participation in the public spaces, having as particularities the decentralization of the CES/RS in RS and, on the other side,a context of State Reforms with advancement of the Neoliberal Project, with an ebbing of the social movements and purposeful resistance in the public spaces, centrality in administration, allied to the advance of the Privatist Project . And a third phasewith an emphasis on the model of national development; in RS, however, the health care crisis deepens, one perceives the advance of the Public Foundations of Private Law and an increasing loss of deliberative power of the Health Councils. New resistance movements arise bringing into the scenario some historic struggles, the political representation , direct participation , representativeness and still other issues such as quality and access to health care actions and services, among others. One observes that, stemming from the political participation of the leader workers and their strategies of mobilization, organization, articulation and political education as a tool of popular education it was possible to construct the necessary mediations among the societal political forces (social movements, unions, churches, NGOs) and the state political forces (government and its institutions, workers, parties) for a Popular Project in the 80s. However, in the 90s, on the one side, we see the ebbing of the social movements, a participation of purposeful resistance in the public spaces and a loss of political strength in the popular field and, on the other side, the centralization of power in the administrations and the judicialization of rights. However, the public spaces of the Health Councils and Conferences still maintain some power in the mediation of the relations between the State and the society, but they need to include new collective actors and guarantee a plurality in the participation. / Esta tese trata da constru??o do direito ? sa?de com participa??o e ?nfase na leitura dial?tica da hist?ria das pol?ticas p?blicas de sa?de no Brasil a partir da concep??o do movimento sanit?rio, em um contexto de reformas do Estado e de constru??o do projeto democr?tico popular. Ela tem a finalidade de analisar como se materializa o debate do SUS, enquanto modelo de aten??o universal, nos espa?os p?blicos a partir da participa??o pol?tica dos atores coletivos do campo popular no movimento de reformas. Assim, os indicadores que orientaram a an?lise s?o: que participa??o pol?tica pode ter produzido a sa?de como direito social? e como se conformam os espa?os p?blicos no desenho institucional na sa?de no RS? Isso foi feito a partir da an?lise documental das Resolu??es do CES/RS, dos Relat?rios das Confer?ncias e dos Planos Estaduais de Sa?de, que orientou o caminho hist?rico. Ademais, quatorze atores coletivos indicados a partir da t?cnica da bola de neve, via narrativa oral tem?tica, contribu?ram explicitando as principais estrat?gias, as articula??es, as mobiliza??es e a educa??o pol?tica nesse processo. Esses atores est?o identificados com o movimento sindical (Fetag/RS, o Departamento Rural da CUT Fetraf/Sul), o Sindsepe/RS, o Sindfarm/RS, o Movimento comunit?rio, a Fracab/RS, bem como a CUT/RS, as ONGs (CAMP/RS, CEAP/RS), os movimentos sociais (MMC/RS), o F?rum de Sa?de Mental, a igreja (CEBs), al?m da representa??o profissional (Cress) e segmentos da Federa??o dos Hospitais Filantr?picos do RS. As narrativas foram obtidas por meio de entrevistas coletadas egravadas com autoriza??o, transcritas e codificadas pelo Software NVIVO, sistema de an?lise qualitativa que possibilita a organiza??o, apresenta??o, interpreta??o e divulga??o mais r?pida dos dados. Utilizou-se a an?lise de conte?do segundo Bardin (1977). Os resultados indicam que esse movimento ou esses movimentos em defesa do direito ? sa?de e da institui??o do SUS podem ser divididos em tr?s fases: a primeira ocorreu em fins dos anos de 1970 e in?cio dos anos de 1980. Nesse per?odo, a agenda pol?tica mobilizadora dos movimentos sociais era a constru??o e a garantia de direitos na perspectiva da Seguridade Social, terra, trabalho e acesso ? sa?de. J? nos espa?os p?blicos a luta era pela autonomia em rela??o ?s estruturas tradicionais. E as estrat?gias utilizadas pelos atores coletivos foram a organiza??o de base, a mobiliza??o, a articula??o e a forma??o pol?tica. Trata-se de ferramentas potencializadas pela estrat?gia da Educa??o Popular, via n?cleos de base, dos grupos de discuss?o, das comiss?es de sa?de e ainda dos Semin?rios e dos Congressos. ? um movimento que tanto forma seus dirigentes quanto disputa espa?os na sociedade. Na segunda fase, j? no contexto dos anos de 1990, constata-se, de um lado, um movimento de Democratiza??o Pol?tica, com regulamenta??o de direitos via legisla??o, nova concep??o de sa?de com participa??o nos espa?os p?blicos, tendo como particularidades a descentraliza??o do CES/RS no RS e, de outro, um contexto de Reformas do Estado com avan?o do Projeto Neoliberal, com refluxo dosmovimentos sociais e resist?ncia propositiva nos espa?os p?blicos, centralidade na gest?o, aliados ao avan?o do Projeto Privatista. E uma terceira fase 2003 com ?nfase no modelo de desenvolvimento nacional; no RS, por?m, aprofunda-se a crise na sa?de, percebe-se o avan?o das Funda??es P?blicas de Direito Privado e a crescente perda de poder deliberativo dos Conselhos de Sa?de. Surgem novos movimentos de resist?ncia, trazendo para o cen?rio algumas lutas hist?ricas, a representa??o pol?tica, a participa??o direta, a representatividade e ainda quest?es como qualidade e acesso a a??es e servi?os de sa?de, dentre outras. Constata-se que, a partir da participa??o pol?tica dos trabalhadores dirigentes e de suas estrat?gias de mobiliza??o, de organiza??o, de articula??o e de educa??o pol?tica ( fazer com ) enquanto ferramenta da educa??o popular foi poss?vel construir as media??es necess?rias entre as for?as pol?ticas societais (movimentos sociais, sindicais, igrejas, ONGs) e as for?as pol?ticas estatais (governo e suas institui??es, trabalhadores, partidos) para um Projeto popular nos anos de 1980. J? nos anos de 1990, de um lado, vemos o refluxo dos movimentos sociais, uma participa??o de resist?ncia propositiva nos espa?os p?blicos e a perda de for?a pol?tica do campo popular e, de outro, a centralidade do poder nas gest?es e a judicializa??o dos direitos. Entretanto, os espa?os p?blicos dos Conselhos e das Confer?ncias de Sa?de ainda mant?m certa pot?ncia na media??o das rela??es entre o Estado e a sociedade, mas necessitam incluir novos atores coletivos e garantir a pluralidade na participa??o.

Made available in DSpace on 2014-12-17T15:46:24Z (GMT). No. of bitstreams: 1 MonicaMRN_DISSERT.pdf: 2365239 bytes, checksum: ee4f78ae549113c89a3d87843b87b283 (MD5) Previous issue date: 2011-09-29 / This study aimed to analyze the work of social workers at the Hospital Universit?rio Onofre Lopes (HUOL), with the analytical approach the contracting process with the HUOL with the National Health System (SUS), which is set from 2004. Thus, this study sought in times of state reform, restructuring and tension between enlargement / reduction of social and labor rights, understanding the limits and possibilities of social work in HUOL, analyzing how these determinations bounce in the practice of social workers included in the collective process of health work. From a theoretical and methodological historical and dialectical materialism, we conducted literature search, in which developed book report and readings of texts, articles, books that focus on the central categories of the study, namely: Work, Social Work, Health, Health Reform , Project ethical and professional politician. Operationalized also a documentary research, on the Brazilian Public Health Policy, (SUS) and of the Education, as well as research field in which we conducted interviews with 11 social workers, employees packed the HUOL. We conclude that social workers did not participate in the discussion process of contracting the HUOL with the Municipal Health Secretariat of Natal, RN, manager of health and full resetting of user access, via reference setting - counter-referral services provided by the hospital brought the main demands on Social Work guidance regarding the functionality of SUS, and the social intervention in the struggle to guarantee such access. However, the data show that the expansion of demands that require the intervention of the social worker at HUOL is not associated with quantitative growth of these professionals need. Such conditions inflect the possibilities of materialization of the professional ethical-political project, even though that these professionals worry and seek the intellectual improvement, quality of service and to guarantee the social rights of users in the professional practice everyday / Esta pesquisa buscou analisar o trabalho dos assistentes sociais, no Hospital Universit?rio Onofre Lopes (HUOL), tendo como recorte anal?tico o processo de contratualiza??o do HUOL com o Sistema ?nico de Sa?de (SUS), que se configurou, a partir de 2004. Assim, este estudo procurou apreender os limites e possibilidades do trabalho do assistente social no HUOL, analisando como as determina??es deste tempo de reforma do Estado, reestrutura??o e tens?o entre amplia??o/redu??o dos direitos sociais e trabalhistas, rebatem no exerc?cio profissional dos assistentes sociais inseridos no processo coletivo de trabalho em sa?de. A partir de um referencial te?rico-metodol?gico materialista hist?rico e dial?tico, realizamos pesquisa bibliogr?fica, na qual desenvolvemos leituras e fichamentos de textos, artigos, livros, que enfocassem as categorias centrais do estudo, quais sejam: Trabalho, Servi?o Social, Sa?de, Reforma Sanit?ria, Projeto ?tico-pol?tico profissional. Operacionalizamos, tamb?m, uma pesquisa documental, acerca da Pol?tica de Sa?de P?blica, SUS e de Educa??o, bem como pesquisa de campo, na qual realizamos entrevistas com 11 assistentes sociais, lotadas no quadro de pessoal do HUOL. Conclu?mos que as assistentes sociais n?o participaram do processo de discuss?o da contratualiza??o do HUOL, com a Secretaria Municipal de Sa?de de Natal, RN, gestor pleno de sa?de e que a redefini??o do acesso dos usu?rios, via regula??o de refer?ncia contra refer?ncia aos servi?os disponibilizados pelo hospital trouxe como principais demandas ao Servi?o Social as orienta??es a respeito da funcionalidade do SUS, bem como a interven??o do assistente social na luta pela garantia deste acesso. Por?m, os dados mostram que a amplia??o das demandas que requerem a interven??o do assistente social do HUOL est? comprometida em virtude da redu??o desses profissionais, fato que se agravou nos ?ltimos dezesseis anos. Tais condi??es inflexionam as possibilidades de materializa??o do projeto ?tico-pol?tico profissional, mesmo que estas profissionais se preocupem e busquem o aprimoramento intelectual, a qualidade do servi?o prestado e a garantia dos direitos sociais dos usu?rios

Made available in DSpace on 2014-12-17T15:38:51Z (GMT). No. of bitstreams: 1 ShyrleyBG_DISSERT.pdf: 2114425 bytes, checksum: f08a567de42af6302c6b562315cbc90d (MD5) Previous issue date: 2011-04-08 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Psychologists‟ insertion in mental healthcare ambulatory clinics occurred during the decade of 1980, in the context of the claims disseminated by sanitary and psychiatric reforms, of the formation of minimum mental healthcare teams and of the retraction of the private clinic. Historically, this migration had been accompanied by the importation of practices traditionally applied at the clinics. Furthermore, the lack of clear guidelines from the Health Ministery occasioned the opening of ambulatory clinics with diversified structures at each city. The objective of this dissertation was to study the practices of psychologists at mental healthcare ambulatory references at Aracaju-SE. Were interviewed psychologists of these services and managers of the municipal health secretary using a semi-structured interview guideline, in addition to the analysis of management reports. It was observed that the mental healthcare references had experienced substantial changes referred to its structures and operation, leading to a present framework of expansion and readjustment. It was realized that there is an effort by the psychologists to maintain individual and group assistance, using adjustments in the frequency of the sessions and in the focus of the activities. Besides the progresses, the relation with the psychiatrist still works basically through the medical record, blocking advances on joint discussions of the cases. Some advances toward the amplified clinic are notable, like the overcoming of the isolated usage of psychiatric diagnostic and the replacement of the line‟ criterion by the urgency one. Sheltering had become an interesting strategy on flux ordination, however the mismatch between offer and demand seems to be a matter which extrapolates the psychologists‟ sphere at the references. For this reason the narrow of the relation with family healthcare centers seems to be the major challenge to be faced by psychologists at mental healthcare ambulatory references / A inser??o do psic?logo nos ambulat?rios de sa?de mental ocorreu na d?cada de 1980, no contexto das reivindica??es propagadas pela reforma sanit?ria e psiqui?trica, da forma??o de equipes m?nimas de sa?de mental e da retra??o da cl?nica privada. Historicamente, essa migra??o foi acompanhada da importa??o de pr?ticas tradicionalmente aplicadas no consult?rio. Ademais, a falta de diretrizes claras por parte do Minist?rio da Sa?de ocasionou a abertura de ambulat?rios com estruturas diversificadas em cada munic?pio. O objetivo desta disserta??o foi estudar a atua??o do psic?logo nas Refer?ncias Ambulatoriais em Sa?de Mental de Aracaju-SE. Foram entrevistados psic?logos desses servi?os e gestores da secretaria municipal de sa?de a partir de roteiro semiestruturado, al?m da an?lise de relat?rios de gest?o. Observou-se que as Refer?ncias em Sa?de Mental sofreram transforma??es substanciais quanto ? sua estrutura e funcionamento, levando a um quadro atual de expans?o e de readequa??o. Percebeu-se um esfor?o por parte dos psic?logos em manter os atendimentos individuais e de grupo, a partir de ajustes na frequ?ncia nas sess?es e no foco das atividades. N?o obstante os progressos, a rela??o com o psiquiatra ainda se processa basicamente pelo prontu?rio, impedindo de avan?ar na discuss?o conjunta dos casos. S?o not?veis alguns avan?os em dire??o ? cl?nica ampliada, como a supera??o do uso do diagn?stico psiqui?trico de forma isolada e da substitui??o do crit?rio fila pelo de urg?ncia. O acolhimento tornou-se uma estrat?gia interessante de ordena??o do fluxo, por?m o descompasso entre oferta e demanda parece ser uma quest?o que extrapola o ?mbito dos psic?logos das refer?ncias. Por essa raz?o, o estreitamento da rela??o com as unidades de sa?de da fam?lia parece ser o maior desafio a ser enfrentado pelos psic?logos das Refer?ncias Ambulatoriais em Sa?de Mental