Vigilância do desenvolvimento em Progama de Saúde da Família: triagem para detecção de riscos para problemas de desenvolvimento em crianças. / Development Surveillance in the Family Health Program: screening to identify risks for child development problems.

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

The purpose of the Family Health Program (FHP) in Brazil is to carry out continuous preventive actions with the aim to identify risks for child health and development, as well as to determine which resources are needed to reduce and eliminate any effects of the adversities. The general objective of the present study was to systemize, apply, and evaluate a procedure of "Development Surveillance", which consisted of screening and tracking risks affecting child development and behavior, as well as to identify protection resources in children and the family environment. To achieve this objective, the following specific objectives were set: a) to identify child developmental and behavioral problems; b) to identify problems in the family environment; c) to identify childrens and family environment resources; d) to verify associations among three factors as global indicators of child development, language, and behavior; childrens own variables; and childrens psychosocial environment; e) to identify the best model for predicting problems involving child development, child behavior, and kindergarten; and f) to evaluate the predictive validity of the Development Surveillance evaluation procedures. The study sample consisted of 120 non-clinical children, all from the same community (Center IV) registered with the FHP at the School of Medicine of Ribeirão Preto. Childrens ages ranged between six and 44 months. The following instruments were used for evaluation: Denver-II Screening Test, Language Development Survey, Interview Questionnaire for Psychosocial Risk,Psychosocial Risk Index (Rutter), HOME Inventory, CBCL 1½ - 5, Life Events Scale, Brazilian version of the Ways of Coping Scale, and ABIPEME Questionnaire. Data collection involved the following: home visits for child evaluation; interviews with their caretaker; and observing the family environment. Children were reevaluated after approximately one year. It was observed that 33% of the children were at risk for developmental problems. Such values are in agreement with previous studies performed in Brazil and in the United States. There was high incidence of indicators of language (39%) and behavioral (48%) problems. Factors causing psychosocial risk to the studied families include precarious housing, parentslow education and professional levels, and financial problems. In spite of the aforementioned adversities, there was good environmental stimulation and appropriate interaction within the family context, considered average value by HOME. Parentslow educational level was predictive of the risks to childs developmental problems. The expressive language at risk was predicted by both the childs history of malnutrition, as well as the familys high psychosocial risk index. Behavioral problems, on the other hand, were predicted by lack of mothers own income and by childs negative temperament. Factors predictive of children starting in kindergarten were: no morbid antecedents, mother having her own income, and using social support to cope with problems. The development surveillance screening model showed to be sensitive in detecting child developmental risks one year after evaluation. The present study findings provide the information necessary to plan preventive measures in the area of child development and mental health in the FHP.

ASSUNTO(S)

desenvolvimento infantil resiliência screening family health program child development risco risk triagem resilience programa de saúde da família

ACESSO AO ARTIGO

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