Violência intrafamiliar contra crianças e adolescentes na perspectiva dos profissionais de saúde da família: contribuições para uma política pública de prevenção

Abstract

The intrafamiliar violence against children and teenagers is a public health problem that injures the right to life and dignity, causing serious physical, psychological and moral losses. The Programa de Saúde da Família (Family Health Program), PSF, is an important vehicle for the in locus comprehension of this phenomena, and it s an integrated part of a social support network. The objective of the study was to evaluate the knowledge and behavior of the professionals of PSF and Programa de Agentes Comunitários de Saúde (Health Communitarian Agents Program), PACS, about the intrafamiliar violence against children and teenagers. Interviews were conducted with the professionals that acted directly in the 34 teams of PSF e 3 PACS from the Secretaria Municipal de Saúde de Uberlândia (Uberlândia Municipal Department of Health), from April to October 2005. There were two versions of questionnaires: one with the term denounce in the questions and the other in which this term has been switched by notification . Most of the 233 interviewed professionals were female (187; 80%), most were between 18 and 39 years old (167; 71,7%) and most worked in the programs for more than one year (164; 70%). Many (138; 59,2%) said they had read or studied about violence in childhood and teenage, principally in newspapers and magazines (66; 47,8%). Between the participations (123) in classes or lectures mentioned by 114 (48,9%) professionals, only 16 (13%) occurred during graduation. About the definition of intrafamiliar violence against children and teenagers, explicit acts such as disrespect and aggression were easily included (193; 82,8%), and the parents (89; 38,2%) were the most mentioned as aggressors. The most identified classes of violence were the physical (215; 92,2%) and psychological (163; 69,9%). From the total, 106 (45,5%) considered themselves able to attend or recognize this phenomena. When the question was about the reason for such aptitude, the personal knowledge was the most cited criteria (71; 89,9%). In one of the 14 hypothetical situations presented, the violence has not been recognized by some (8; 3,4%) and the children was considered guilty for such act (27; 11,6%). While working in PSF and PACS, 142 (60,9%) professionals faced actual situations, most commonly related to negligence (39; 27,5%) and to the combination of physical and psychological violence (36; 25,4%). Nonetheless, most (83; 58,4%) did not notify or denounced any case. The fear for retaliation was the most cited reason (71; 30,4%) for not notifying. Among the professionals that answered the questionnaire with the term denounce (115; 49,3%), only 16 (13,9%) denounced all the cases; among the ones that answered the other version term notification (118; 50,6%), 52 (44%) didn t notify any case. The Tutelary Council was considered (141; 60,5%) the most adequate institution to receive the notifications, however a great part (193; 82,8%) was unknown of the obligatoriness of such conduct. Most (99%) expressed interest in receiving information about the subject, pointing systematic meetings and lectures (142; 60,9%) as the best means for obtaining knowledge. It was concluded that the configuration of the Equipes de Saúde da Família (Family Health Teams), ESF, in Uberlândia, specially follows the biomedical pattern of health attention, disrespecting the integrality, basic principle of PSF and Sistema Único de Saúde (Unique Health System), SUS. Most professionals are women, with a preponderance of young adults, reinforcing the tendency to feminization in health work market, and the destination of early graduated to the public system. There is few theorycal subsides for the identification of the intrafamiliar violence, once there is a lacuna in the knowledge and formation of the health professionals. They find difficulties in delimitating what is or is not violence, and the classes are not strictly defined and structured. Even though, many of them considered themselves able to recognize and attend potential situations, guided by personal criteria. The notification, as a resource of intervention, is not included in their technical procedure. Although most know the institution they should notify the cases of suspicion or confirmation of such violence, when facing reality, they don t do so, finding difficulties about the legal destinations and not assuming their paper of protectors of childhood and teenage. The fear for retaliation, the misconception of lack of need and the misinformation about what institution to communicate the cases are the most important factors for not notifying. The words denounce or notification did not influence the answers about the conduct towards the violence situations. Anyway, the need for a process of capacitation is urgent, once there is the risk of violence reproduction in its institutional form.