A assistência em saúde mental e, mais especificamente, os cuidados às pessoas que fazem uso problemático de álcool e outras drogas foram por muito tempo negligenciadas pelo Estado. Atualmente, existem diferentes formas de tratamento para o uso problemático de drogas, contudo, as políticas públicas atuais têm aumentado o financiamento para internações em Comunidades Terapêuticas. O objetivo deste estudo é compreender os sentidos construídos sobre a internação em Comunidades Terapêuticas por indivíduos que passaram por estas instituições e atualmente são usuários de um Centro de Atenção Psicossocial II álcool e drogas. Para isto, foram realizadas entrevistas semi-estruturadas com pessoas em tratamento em um CAPS- AD do município de Ribeirão Preto SP, que passaram por pelo menos uma internação em Comunidades Terapêuticas. Foi realizada uma análise de categoria temática tendo como referencial epistemológico o construcionismo social, levando-se em consideração a influência dos tempos longo, vivido e curto na produção de sentidos. A discussão realizada dialogou com a literatura sobre a Reforma Psiquiátrica. O projeto foi aprovado pelo Comitê de Ética em Pesquisa, respeitando-se os critérios éticos da resolução n.º 466 de 12 de Dezembro de 2012. A análise e resultados foi realizada com 10 entrevistas, sendo construídas quatro categorias: 1) Comunidades Terapêuticas e equipamentos da rede de atenção psicossocial; 2) Momentos marcantes como desencadeadores da decisão de internação e suas expectativas; 3) Funcionamento das Comunidades Terapêuticas; e 4) A saída da Comunidade Terapêutica: decisão e experiências na sociedade. As políticas públicas, ao abrir espaço para financiamento das, CTs, tem investido em um modelo pouco estudado e que age em contradição com as diretrizes da Reforma Psiquiátrica. As CTs trabalham unicamente com a abstinência propondo atividades domesticas, do campo (laborterapia) e espirituais, como principais intervenções. Há uma construção social, pautada no discurso moral religioso e jurídico, de que as internações prolongadas seriam a resolução para os problemas relacionados ao uso de drogas, sendo as CTs privilegiadas pelo financiamento público. Contudo, os usuários e familiares são constantemente enganados e expostos a situações de violência (coerção, imposição e punições). Tem-se desconsiderado a complexidade desse campo, impactando na forma como usuários de drogas são descritos e se descrevem. / Mental health assistance and specifically problematic alcohol and drug use care has been neglected by state policies for a long time. Nowadays, there are different sorts of possible treatments for problematic drug use, however, the current public policies has grown funding for Therapeutic Communities (TC) inpatient treatment. This study aims to comprehend the constructed meanings regarding Therapeutic Communities inpatient treatment experienced by patients whose had been treated by this kind of strategy and now are under treatment on Centro de Átenção Psicosocial - Álcool e Drogas of Ribeirão Preto (CAPS-AD).To achieve this, semi-structured interviews were conducted with people on treatment in a CAPS- AD Ribeirão Preto - SP, who have undergone at least one inpatient experience on Therapeutic Communities. A thematic-categorial analysis was carried out using social constructionist epistemology as reference, taking into account the influence of the long-time, short-time and lived-time in the production of meanings. The discussion held dialogued with the literature on the Brazilian psychiatric reform. The project was approved by the Research Ethics Committee, respecting the ethical criteria of Resolution No. 466 of December 12, 2012. The presented analysis and results were based on 10 interviews, being constructed four categories: 1) Therapeutic Communities and equipment of psychosocial care network; 2) Memorable moments as triggers of inpatient admission decision and their expectations; 3) Operation of Therapeutic Communities; and 4) The output of the Therapeutic Community: decision and experiences in society. The public policies fostering funding for TCs, has invested in an understudied model and acts in contradiction with the guidelines of the Brazilian Psychiatric Reform. The TCs works only with the perspective of abstinence treatment, proposing as key interventions: domestic, field (larbotheraphy) and spiritual activities. There is a social construction based on moral-religious and legal discourse that extended inpatient stays would be a resolution for problems related to drug use, and this has made the CTs privileged by public funding. However, TCs users and their family members are constantly deceived and exposed to violence (coercion, enforcement and punishment). It has disregarded the complexity of this field, impacting the way drug users are described and describe themselves.

D.Cur. / The postpartum-period is a very emotional time for the mother with a new baby, which increases her need for support. Various factors contribute to this need for support, such as the change from the extended family to the nuclear family, which has reduced the number of network persons. The hospitalisation period of the mother after the birth of a baby has also decreased drastically, owing to the high medical costs associated with the birth of a baby. This results in the mother being discharged from the hospital much earlier and her accessibility to professional support being limited thereby. This source of support, namely the professional person who provides the mother with support, is also insufficient since the growth of the population far exceeds that of the nursing occupation, and the need is to huge for only professional persons to provide in. If the mother does not receive the necessary support that she may need, it could lead to postpartum-depression, which has a detrimental effect not only on the mother but also on the new baby and the mother's family. This research is therefore vitally important to the midwife, as it ensures a healthy mother and baby, not only in the hospital environment but also at home in her community where she must live and raise her baby. Community support to the mother during the postpartum-period is a relatively unfamiliar field in midwifery. Although the term community support is often used, the definition thereof has not yet been clarified, and it is used in different contexts, with different meanings. The term community support to the mother has therefore not yet been adequately described within the context of the postpartum-period. The objective of this research is to investigate and describe, and analyse the term community support to the mother during the postpartum-period, and to identify the characteristics of community support to the mother during the postpartum-period, as well as the network persons who must provide this community support to the mother, in order to establish the necessary guidelines for the provision of sufficient community support to the mother during the postpartum-period.

Despite the fact that a lot of information exist in the literature regarding factors leading to drug abuse, consequences of drug abuse for adolescents; little exists that focuses on family support for adolescents after rehabilitation. The purpose of this study was to explore family support for adolescents after rehabilitation for drug abuse. The study was based on semi-structured interview based qualitative research. Findings during interviews was that the families have no clear understanding or are not skilled as to how to continue supporting the adolescents after they are discharged from the rehabilitation centre. What was also interesting according to the participants was that even in the rehabilitation centres families are not made part of or involved during the rehabilitation process. There is a need to make the rehabilitation centres aware that families need to be involved during the rehabilitation process of the adolescent so that it becomes easy for the families to continue supporting the adolescents after they have completed the rehabilitation process. / Health Studies / M.A. (Health Studies)

published_or_final_version / Social Work / Master / Master of Social Work

Frente ao custo social dos quadros de abuso e dependência de substâncias psicoativas, diversos modelos explicativos têm sido propostos, sejam eles baseados em preceitos morais, religiosos, experiências de grupos de autoajuda ou na pesquisa científica. As Comunidades Terapêuticas (CTs) são uma modalidade de atendimento a usuários abusivos e dependentes de substâncias psicoativas que se baseiam em vários desses modelos, que se mostram bastante diversas em sua organização e nos serviços oferecidos, mas relativamente coesas em termos dos seus princípios. Diversos estudos têm tentado explicar os aspectos relacionados a esse modelo de tratamento, sugerindo sua eficácia. Apesar disso, existem poucas pesquisas compreensivas acerca das mudanças psicológicas que ocorrem nas pessoas que passam por esse tipo de instituição. No Brasil, a escassez de trabalhos acadêmicos sobre as CTs aponta para a necessidade de estudos sobre seus componentes terapêuticos, a fim de conhecer melhor os alcances e limites desse tipo de tratamento. A presente investigação visou estudar as mudanças psicológicas de pessoas que passaram por tratamento numa CT da região de Ribeirão Preto (SP), por meio de entrevistas de avaliação no início e no final de sua internação. Os participantes do estudo foram sete homens entre 21 e 35 anos de idade, nível socioeconômico médio baixo e dependentes de crack (predominantemente), cocaína e álcool. Para a realização das avaliações, foram utilizados um roteiro de entrevista semiestruturado, o Inventário Multifásico Minnesota de Personalidade, Improved Readability Form (MMPI-IRF) e cartões selecionados do Teste de Apercepção Temática (TAT). Os dados obtidos foram categorizados e analisados a partir de dimensões e domínios do processo de mudança na CT, conforme embasamento teórico de autores da área. O conjunto de dados foi interpretado a partir de teorias psicodinâmicas de personalidade. Os resultados mostram que o tratamento promoveu melhoras no funcionamento psicológico em graus diferentes para dois subgrupos de participantes, em todas as dimensões do processo de mudança. Os resultados são discutidos em termos das diferenças entre os subgrupos em aspectos como a estrutura e o nível de funcionamento da personalidade e qualidade da introjeção das experiências durante o tratamento. Ainda, são feitas considerações acerca do método de pesquisa adotado e dos alcances e limites do tratamento em CTs e sugestões para estudos futuros no Brasil. / Considering the high social cost of substance abuse and dependence, several models have been proposed, based on moral and/or religious principles, self-help groups experiences or scientific research. The Therapeutic Community (TC) is a treatment modality for substance abusers based in many of the models above, which shows a variety in terms of its organization and services offered, as well as a relatively cohesion of principles along these institutions. Several studies have been trying to explain the aspects related to such treatment modality, suggesting its efficacy. In spite of this, there are few comprehensive studies regarding the psychological changes people treated in the CT go through. In Brazil, the lack of academic studies on the TC suggests the need of comprehending its therapeutic components, in order to point out both flaws and successful points of such treatment modality. The present study aimed to study the psychological changes of people treated in a TC in the region of Ribeirão Preto (State of São Paulo Brazil), who were interviewed both in the beginning and the end of their stay in the institution. The participants were seven men, aged between 21 and 36 years old, average-low socioeconomic level who were predominantly crack abusers, with cocaine and alcohol dependents also included. In order to perform the assessment, the instruments used were a semi-structured interview guide, the Minnesota Multiphasic Personality Inventory Improved Readability Form (MMPI-IRF) and selected cards of the Thematic Apperception Test (TAT). All data was categorized and analyses using the dimensions and domains of the change process in the TC, according to the theoretical frame of authors in this field. Still, the data set was analyzed from a psychodynamic theoretical frame. The results show that the treatment promoted improvements in psychological functioning in different degrees for two subgroups of participants, along all dimensions of the change process. These results are discussed in terms of the differences observed in terms of level of psychological functioning and structure of the personality, as well as the introjection quality of treatment-related experiences. Still, considerations are made regarding the research method adopted and both high points and flaws of the treatment on the TC and the status of directions for future research in Brazil.

Drawing on original research on the effectiveness of a therapeutic community (TC) in reducing recidivism among juvenile male offenders, Correctional Rehabilitation and Therapeutic Communities: Reducing Recidivism Through Behavior Change provides a comprehensive review of the current state of drug treatment for the offending population, especially the link between juvenile offending and substance abuse. The book assesses the factors predicting successful completion of treatment as well as the methodological limitation of previous TC program reviews, and suggests policy implication and routes for future research. Using improvements such as multiple outcome criteria, long-term follow-up, matching groups on risk and needs, and the employment of a standardized instrument to measure program quality, Correctional Rehabilitation assesses the degree to which participation in the TC affects antisocial attitudes and reduces delinquency. Readers will explore how TCs can be designed to influence adolescent drug offenders and ultimately reduce recidivism. This book is essential reading for students, researchers, practitioners, and other stakeholders focusing on the development of treatment programs. / https://dc.etsu.edu/etsu_books/1145/thumbnail.jpg

Despite the fact that a lot of information exist in the literature regarding factors leading to drug abuse, consequences of drug abuse for adolescents; little exists that focuses on family support for adolescents after rehabilitation. The purpose of this study was to explore family support for adolescents after rehabilitation for drug abuse. The study was based on semi-structured interview based qualitative research. Findings during interviews was that the families have no clear understanding or are not skilled as to how to continue supporting the adolescents after they are discharged from the rehabilitation centre. What was also interesting according to the participants was that even in the rehabilitation centres families are not made part of or involved during the rehabilitation process. There is a need to make the rehabilitation centres aware that families need to be involved during the rehabilitation process of the adolescent so that it becomes easy for the families to continue supporting the adolescents after they have completed the rehabilitation process. / Health Studies / M.A. (Health Studies)

Submitted by Ana Carla Almeida (ana.almeida@ucsal.br) on 2018-04-19T18:28:28Z No. of bitstreams: 1 TESEMARCELOGIMBA.pdf: 3170537 bytes, checksum: 32e746a4c49e7d5509d7b4ab8cdab711 (MD5) / Approved for entry into archive by Rosemary Magalhães (rosemary.magalhaes@ucsal.br) on 2018-04-25T15:03:32Z (GMT) No. of bitstreams: 1 TESEMARCELOGIMBA.pdf: 3170537 bytes, checksum: 32e746a4c49e7d5509d7b4ab8cdab711 (MD5) / Made available in DSpace on 2018-04-25T15:03:32Z (GMT). No. of bitstreams: 1 TESEMARCELOGIMBA.pdf: 3170537 bytes, checksum: 32e746a4c49e7d5509d7b4ab8cdab711 (MD5) Previous issue date: 2018-02-05 / Inserido na linha de pesquisa Família nas Ciências Sociais, esta pesquisa doutoral versa sobre narrativas de trajetórias de pessoas usuárias de drogas institucionalizadas em Comunidades Terapêuticas no Brasil e Portugal. O recorte histórico-geográfico está matizado pelos anos de 2014 a 2017, com residentes no Estado da Bahia-BR e na cidade do Porto-PT. Observou-se, através de aproximação qualitativa com base em entrevistas em profundidade, que as vulnerabilidades podem ser agravadas com uso de drogas, interferindo de forma significativa nas relações familiares, sociais e nos projetos de vida. Isto posto, esta tese de doutorado tem como objetivo descrever e analisar a história de vida referente a um grupo de pessoas que consumiam crack e outras drogas até o ingresso em Comunidades Terapêuticas (CTs). Foi elaborado por meio de revisão bibliográfica e de pesquisa de campo em cinco Comunidades Terapêuticas, participaram das entrevistas: três profissionais do Governo do Estado da Bahia das áreas de Direitos Humanos e drogas, seis profissionais das Comunidades Terapêuticas (Assistentes Sociais, Psicólogos(as) e Monitor(a)) e onze pessoas internadas entre as cinco Comunidades Terapêuticas. Como metodologia de pesquisa adotou-se a Grounded Theory (Teoria Fundamentada nos Dados) e como instrumento de recolha foram utilizados três tipos de entrevistas: uma para os(as) profissionais do Estado da Bahia; uma para os(as) profissionais das Comunidades Terapêuticas e outra para os(as) internos(as). Construídas especificamente para esta investigação, com escopo de analisar: o início de uso das substâncias psicoativas, processo de acesso e aquisição das drogas, as violências sofridas e praticadas, políticas públicas sobre drogas desenvolvidas no Brasil e as vivências em Comunidades Terapêuticas e os contextos relacionais. Os principais resultados revelam que: o início do uso de substâncias psicoativas sofre grande influência de grupos de amigos/pessoas da intimidade, despertando a curiosidade; que as maiores violências (físicas e psicológicas) e práticas de delitos ocorrem na busca das substâncias psicoativas; as pessoas estão mais sujeitas às infecções sexualmente transmissíveis (ISTs/AIDS) por terem seus corpos transformados em “moeda de troca” e negligenciarem em medidas de segurança (por exemplo: uso de preservativos); as mulheres estão sujeitas à gestação indesejada ou não planejadas; a necessidade de adequação das políticas públicas sobre drogas e as Comunidades Terapêuticas. Apesar das críticas, são equipamentos de importância, para os Governos (Brasil e Portugal) como políticas de enfrentamento a dependência das drogas. / Inserted in the research line Family in the Social Sciences, this doctoral research deals with narratives of trajectories of people using drugs institutionalized in Therapeutic Communities in Brazil and Portugal. The historical-geographical cut is shaded by the years 2014 to 2017, with residents in the State of Bahia-BR and in the city of Porto-PT. It was observed, through a qualitative approach based on in-depth interviews, that vulnerabilities can be aggravated by drug use, interfering significantly in family, social and life projects. This put, this doctoral thesis aims to describe and analyze the history of life referring to a group of people who consumed crack and other drugs until joining Therapeutic Communities (CTs). It was elaborated through a bibliographical review and field research in five Therapeutic Communities. The interviews were: three professionals from the Government of the State of Bahia from the areas of Human Rights and drugs, six professionals from the Therapeutic Communities (Social Assistants, Psychologists, and Monitor (a)) and eleven people interned among the five Therapeutic Communities. Grounded Theory (Data Based Theory) was used as research methodology and three types of interviews were used as a collection tool: one for the professionals of the State of Bahia; one for the professionals of the Therapeutic Communities and another for the interns. Specifically constructed for this research, with scope to analyze: the beginning of use of psychoactive substances, process of access and acquisition of drugs, violence suffered and practiced, public policies on drugs developed in Brazil and experiences in Therapeutic Communities and relational contexts . The main results reveal that: the beginning of the use of psychoactive substances is influenced by groups of friends / people of intimacy, arousing curiosity; that the greatest violence (physical and psychological) and practices of crimes occur in the search for psychoactive substances; people are more susceptible to sexually transmitted infections (STIs / AIDS) because their bodies have become a "bargaining chip" and neglect security measures (eg, use of condoms); women are subject to unwanted or unplanned pregnancies; the need for adequacy of public policies on drugs and the Therapeutic Communities. In spite of the criticisms, they are important equipment, for the Governments (Brazil and Portugal) like policies of facing the dependence of the drugs.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-16T15:14:35Z No. of bitstreams: 1 vanessaaparecidadasilva.pdf: 2289852 bytes, checksum: 090d3bed6c01133061407ed3f4caec4c (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-16T15:44:21Z (GMT) No. of bitstreams: 1 vanessaaparecidadasilva.pdf: 2289852 bytes, checksum: 090d3bed6c01133061407ed3f4caec4c (MD5) / Made available in DSpace on 2017-03-16T15:44:21Z (GMT). No. of bitstreams: 1 vanessaaparecidadasilva.pdf: 2289852 bytes, checksum: 090d3bed6c01133061407ed3f4caec4c (MD5) Previous issue date: 2016-11-22 / As Comunidades Terapêuticas (CT’s) são instituições com metodologia baseada na convivência em comunidade e em atividades espirituais e laborais. No Brasil, foram difundidas por religiões cristãs, se popularizando pela oferta de tratamento da dependência química. As controvérsias em torno das CT’s acirraram após sua incorporação na Rede de Atenção à Saúde, em 2010. Esta medida do Governo Federal foi alvo de críticas feitas por especialistas em drogas, que questionam a laicidade e a eficácia dessas instituições. Será em torno da legitimidade ou não, da presença religiosa enquanto implementadora de políticas sociais e públicas, a questão desta dissertação. Os dados coletados em pesquisa bibliográfica e documental foram complementados por breve etnografia da Fazenda da Esperança. Na análise, utilizamos como referencial teórico os trabalhos de Goffman (1992), de Turner (1974; 2005) e Csordas (1997; 2002). A pesquisa será apresentada em três capítulos: o primeiro capítulo constrói historicamente a relação entre a Igreja Católica e assistência social, considerando seu posicionamento católico sobre as drogas. O segundo capítulo dissertará sobre o papel que as CT’s possuem dentro da rede pública de assistência aos dependentes químicos. O terceiro capítulo apresentará a Fazenda da Esperança, trazendo os aspectos metodológicos para o desenvolvimento dos objetivos dessa pesquisa. Na conclusão, serão apresentadas perspectivas sobre a influência da Igreja sobre as políticas públicas sobre drogas e sobre como a instituição se pensa dentro da sociedade. / The Therapeutic Communities (TC’s) are institutions with methodology based on community acquaintanceship and spiritual and professional activities. In Brazil, it was spread by Christian church, popularizing by the offering of chemical psychoactive substances dependency treatment. The controversies around the TC’s enhance after it is incorporation into the Health Care Network, in 2010. This Federal Government resolution was critical object done by drug’s experts, who question the secularity and effectiveness of these institutions. It is going to be around the legitimacy or not, of religious presence as social and public policy implementer, the subject of this thesis. The collected data in bibliography and documentary research were supplemented by a brief ethnography of Fazenda da Esperança. In the analysis, were used as theoretical reference the papers of Goffman (1992), of Turner (1994; 2005) and Csordas (1997;2002). The research will be presented on three chapters: the first chapter historically set up the relation between Roman Catholic Church and social assistance, regarding the positioning catholic on drugs. The second chapter descant over the role that TC’s hold inside the public assistance network to psychoactive substances dependent. The third chapter will introduce the Fazenda da Esperança, bringing the methodological aspects to the development of the objectives of this research. On the conclusion, it is going to be presented perspectives concerning the Roman Catholic Church influence on drug’s public policy and how the institution think itself inside the society.

M.Cur. / The purpose of this study was to do a needs assessment of mothers with their first baby in the postpartum period in respect of community support. Since there are as yet little or no support systems in South Africa, it is important to firstly determine the needs of the mother before these community support systems can be mobilised by the midwife and can function efficiently. Semi-structured questionnaires that were compiled from literature were given on one occasion to mothers with their first baby in the postpartum period at community clinics to complete. These results were then collated to identify the needs of the mothers to thereby mobilise the necessary community support systems, in order to sufficiently support mothers in the postpartum period and thus create a healthier community. Recommendations were made on the application in practice, education, and further research that can be carried out in this field.