Actions for children’s mental health on Unified Health System (SUS) Primary Health Care: an integrative review of Brazilian literature

Esswein, Georgius Cardoso; Rovaris, Aline Facchin; Rocha, Gabrielli Pohlmann; Levandowski, Daniela Centenaro

doi:10.1590/1413-81232021269.2.15602019

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Sumário

HEALTH POLICY, IMPLEMENTATION OF PRACTICES • Ciênc. saúde coletiva 26 (suppl 2) • 2021 • https://doi.org/10.1590/1413-81232021269.2.15602019 copy

Actions for children’s mental health on Unified Health System (SUS) Primary Health Care: an integrative review of Brazilian literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper aimed to characterize actions directed to children’s mental health (CMH) in Primary Health Care (PHC), based on an integrative review of Brazilian literature (2006-2017). The searches were carried out from LILACS, SciELO and VHL Network databases. After applying the inclusion and exclusion criteria, 13 articles were identified for analysis, which were presented in three thematic axes: 1) Characterization of the demands on CMH for PHC; 2) Actions and interventions on CMH carried out in PHC; and 3) Difficulties and propositions for the implementation of actions on CMH in PHC. The literature points, as the main actions, the identification of CMH problems and their referral to care by specialties. Some studies described specific actions of professionals such as physicians, pediatricians, and psychologists. Interventions of a local character or in partnerships with universities were also identified. The analysis of this material indicated that PHC has been considered as an important field of action in CMH, but that nevertheless requires greater investments, especially in professional training and work organization.

Key words:
Mental health; Child; Primary Health Care; Review

Descriptors	Number of results found
Descriptors	LILACS	SciELO
Atenção primária à saúde AND Saúde da criança AND Saúde mental	02	14
Primary health care AND Child health AND Mental health	02	66
Saúde mental AND Criança AND Atenção primária à saúde	30	14
Mental health AND Child AND Primary health care	26	66
Saúde mental AND Pré-escolar AND Atenção primária à saúde	03	01
Mental health AND Child, preschool AND Primary health care	02	02
Serviços de saúde mental AND Criança AND Atenção primária à saúde	12	05
Mental health service AND Child AND Primary Health Care	08	04
Total	85	172
Descriptors	VHL Network
Atenção primária à saúde AND Saúde da criança AND Saúde mental	65
Saúde mental AND criança AND atenção primária à saúde	65
Saúde mental AND pré-escolar AND Atenção primária à saúde	12
Serviços de saúde mental AND criança AND atenção primária à saúde	37
Total	179
Descriptors (non-indexed)	VHL Network
Saúde mental infantil AND Atenção básica	27
Infância AND Atenção básica AND Saúde mental	12
Infância AND Atenção primária à saúde AND Saúde mental	18
Saúde mental infantil AND Atenção primária à saúde	28
Serviços de saúde mental AND Criança AND Atenção básica	33
Saúde da criança AND Saúde mental AND Atenção básica	58
Saúde mental AND Criança AND Atenção básica	58
Saúde mental AND Pré-escolar AND Atenção básica	13
Total	247

Authors/Year	Objective	Study type/Methodological focus
Tanaka and Lauridsen-Ribeiro²⁴24 Tanaka OY, Lauridsen-Ribeiro E. Desafio para a atenção básica: incorporação da assistência em saúde. Cad Saude Publica 2006; 22(9):1845-1853. (2006)	Assess how mental health issues are approached by physicians in PHC in the children’s medical appointment.	Empirical/Mixed
Braga and Morais²⁰20 Braga SG, Morais MLS. Queixa escolar: atuação do psicólogo e interfaces com a educação. Psicol USP 2007; 18(4):35-51. (2007)	Discuss whether the recent educational and health politics and if the studies about scholar demand in school clinics in public health services have engendered significant changes in psychologists’ practices in primary care public health units (UBS).	Empirical/Quantitative
Ferriolli et al.²2 Ferriolli SHT, Marturano EM, Puntel LP. Contexto familiar e problemas de saúde mental infantil no Programa Saúde da Família. Rev Saude Publica 2007; 41(2):251-259. (2007)	Assess the association between variables in the family context and the risk for emotional/behavioral problems in children enrolled in a Family Health Program (PSF).	Empirical/Quantitative
Tanaka and Lauridsen-Ribeiro²¹21 Tanaka OY, Lauridsen-Ribeiro E. Ações de saúde mental na atenção básica: caminho para ampliação da integralidade da atenção. Cien Saude Colet 2009; 14(2):477-486. (2009)	Investigate the mental health programs (PSM) approaches during PHC appointments.	Empirical/Mixed
Cavalcante et al.²⁵25 Cavalcante CM, Jorge MSB, Santos DCM. Onde está a criança? desafios e obstáculos ao apoio matricial de crianças com problemas de saúde mental. Physis 2012; 22(1):161-178. (2012)	Understand how the matrix support has been used as a tool for health care of children with mental health problems in the Family Health Strategy (ESF)	Empirical/Qualitative
Carvalho et al.⁵5 Carvalho RN, Gondim ACS, Azevedo EB, Cavalcanti PB, Ferreira Filha MO, Queiroz D. Concepções dos profissionais da Estratégia Saúde da Família sobre intervenção precoce em saúde mental. Rev Gaucha Enferm 2013; 34(1):79-85. (2013)	Know the concepts of Family Health Strategy (ESF) professionals on Early Intervention (EI) and to what extent they used these concepts in their professional practices.	Empirical/Qualitative
Sinibaldi⁶6 Sinibaldi B. Saúde mental infantil e atenção primária: relações possíveis. Rev Psicol UNESP 2013; 12(2):61-72. (2013)	Problematize how the relationships have been built between the Primary Health Care (PHC) services and childcare in Brazil.	Theoretical
Becker et al.²²22 Becker ALMM, Souza PH, Oliveira MM, Paraguay NLBB. A articulação da rede de proteção à criança e a aplicação intersetorial do círculo de segurança como alternativas à medicalização. Rev Paul Pediatr 2014; 32(3):247-251. (2014)	Describe the clinical case of a child with aggressive behavior and recurring death-theme speech, and report the experience of the team of authors, who proposed an alternative to medication through the establishment of a Protection Network and the inter-sector implementation of the Children’s Circle of Security concept.	Case Report
Arpini et al.²⁷27 Arpini DM, Zanatta E, Marchesan RQ, Savegnago SDO, Bernardi PH. Intervenções precoces na infância: observando a relação mãe-bebê em um serviço de saúde. Psicol Rev 2015; 21(1):37-50. (2015)	Present the activities developed in an extension project, which aims to observe the relationship between children, from zero to two years old, and their mothers, in the assistance carried out in the Child Program in a Basic Health Unit (UBS), targeting to detect possible early risks to child development.	Experience Report
Gomes et al.²³23 Gomes FMA, Cintra AMO, Ricas J, Vecchia MD. Saúde mental infantil na atenção primária à saúde: discursos de profissionais médicos. Saude Soc 2015; 24(1):244-258. (2015)	Understand the PHC physicians’ meanings and significations related to Child Mental Health (CMH).	Empirical/Qualitative
Tszesnioski et al.²⁶26 Tszesnioski LC, Nóbrega KBG, Lima MLLT, Fagundes VLD. Construindo a rede de cuidados em saúde mental infantojuvenil: intervenções no território. Cien Saude Colet 2015; 20(2):363-370. (2015)	Describe the healthcare network for children undergoing psychic distress and promote interventions in the territory, pointing out changes that took place by means of these actions.	Empirical/Qualitative/ Action Research
Silveira et al.²⁸28 Silveira TBD, Oliveira AMND, Algeri S, Susin LRO, Baisch ALM, Marques L A, Silva PAD. A invisibilidade da violência psicológica pelos profissionais de saúde. Rev Bras Crescimento Desenvolv Hum 2016; 26(3):345-351. (2016)	Identify the procedures carried out by health professionals who work in family primary health care (PHC) centers to recognize cases of psychological violence against children.	Empirical/Qualitative
Santos and Celeri¹⁵15 Santos, RGH, Celeri EHRV. Rastreamento de problemas de saúde mental em crianças pré-escolares no contexto da atenção básica à saúde. Rev Paul Pediatr 2017; 36(1):82-90. (2017)	Study the applicability of the Strength and Difficulties Questionnaire (SDQ 2,4-p) as an instrument to identify CMH in preschoolers, in the context of PHC; and to characterize the CMH in the sample analyzed by comparing the data in SDQ (2,4-p) with those in the Child Behavior Check List (CBCL 1½-5 years).	Empirical/Quantitative

Authors/Year	Sample/participants composition	Data collection (application target) and analysis	Evidence level (according to Souza et al.¹⁹ criteria)
Tanaka and Lauridsen- Ribeiro²⁴ (2006)	(Properly described) 411 children (5-11 years old), 206 parents e 11 pediatricians from a PHC Center in the city of São Paulo (SP, Brazil)	Data collect (Properly described) - Medical record (children) - Skills and Difficulties Questionnaire (SDQ) and Child and Adolescent Behavior Inventory (CBCL) (responsible for children) - Questionnaires to identify concerns about mental health problems (fathers and mothers) - Semi-structured interviews (pediatricians) Data analysis (Properly described) - Statistical analysis - Thematic analysis for the interviews	Level 4
Braga and Morais²⁰ (2007)	(Properly described) 104 children (6-12 years old) who needed, in the second trimester of 2005, mental health services of a PHC Center from the north region of the city of São Paulo (SP, Brazil)	Data collect (Poorly detailed) - Medical record (n=104 children) Data analysis (Poorly detailed) - Statistical analysis	Level 4
Ferriolli et al.² (2007)	(Properly described) 100 children (6-12 years old), and their relatives, mainly biological mothers (82%), registered in ESF (Family Strategy Program) in the city of Ribeirão Preto (SP, Brazil)	Data collect (Properly described) - Skills and Difficulties Questionnaire (SDQ) for screening mental health issues in children (caregivers) - Family Environment Resource Inventory (RAF) (caregivers) - Socioeconomic and cultural level scale (caregivers) - Adverse Events Scale (EEA) (caregivers) - Inventory of Stress Symptoms for Adults (ISSL) (caregivers) - Beck Depression Inventory (BDI) (caregivers) Data analysis (Properly described) - Statistical analysis	Level 4
Tanaka and Lauridsen- Ribeiro²¹ (2009)	(Properly described) 411 children (5-11 years old), 206 parents and 11 pediatricians from a PHC Center in the city of São Paulo (SP, Brazil)	Data collect (Poorly detailed) - Children’s medical record - Skills and Difficulties Questionnaire (SDQ) and Child and Adolescent Behavior Inventory (CBCL) (responsible for children) - Questionnaire for Family characterization (responsible) - Semi-structured interviews (pediatricians) Data analysis (Poorly detailed) - Statistical analysis - Thematic analysis for the interviews	Level 4
Cavalcan te et al.²⁵ (2012)	(Properly described) 6 workers from ESF and CAPS (Psychosocial Care Center) involved in the matrix support activities in mental health and children’s relatives seen along these activities, in the city of Fortaleza (CE, Brazil), in the Regional Executive Secretaries (SER) IV e V.	Data collect (Properly described) - Semi-structured interviews (professionals involved in the matrix support and children’s family members attended) Data analysis (Properly described) - Paul Ricoeur’s phenomenological hermeneutic analysis (interviews)	Level 4
Carvalho et al.⁵ (2013)	(Properly described) 10 professionals who work in three ESF Teams (3 nurses, 2 auxiliary nurses, 1 social assistant, 2 physicians and 1 physiotherapist). All of them worked in the health services for more than 6 months and were involved with the EI program implemented in the city of Campina Grande (PB, Brazil).	Data collect (Poorly detailed) - Semi-structured interviews (professionals) Data analysis (Properly described) - Content analysis, thematic categorical type	Level 4
Sinibaldi⁶ (2013)	(There is no structured method) Theoretical study	(There is no structured method) Analysis and discussion of the literature about the relationship between primary health care and childcare in Brazil.	Not applicable
Becker et al.²² (2014)	(Properly described) 5-year-old boy, with several complaints from the day care center, which he attends full day time, about his aggressive and violent behavior. He was diagnosed and medicated by the Health Center. Despite actions (conversations, group work, psychological and psychiatric monitoring), the child maintained the behavior.	(Properly described) Case report: Description of interventions carried out in the case by a group of students from UNICAMP, based on the concept of the Security Circle.	Level 5
Arpini et al.²⁷ (2015)	(Properly described) Experience report on the activities of an academic extension project, carried out by psychology students from UFSM, which intervenes on the mother-child relationship, qualifying it and detecting possible risk signs for child development.	(Properly described) Experience report: Presentation of the activities carried out by the extension course based on its characterization, method of action and main results.	Level 5
Gomes et al.²³ (2015)	(Properly described) 12 physicians of ESF teams and 5 pediatricians who works in PHC Centers without ESF, with graduated time between two and 35 years (M=20.9) and working time in PHC Center between 6 months and 16 years (M=6.4), in the city of Divinópolis (MG, Brazil).	Data collect (Poorly detailed) - Semi-structured interviews (professionals) Data analysis (Properly described) - Analysis from a socio-historical or historical-cultural perspective.	Level 4
Tszesnioski et al.²⁶ (2015)	(Properly described) 7 children (from 1 to 5 or from 6 to 9 years old), with psychic suffering history, and their relatives, subscribed in a ESF of the Sanitary Destrict IV from the city of Recife (PE, Brazil).	Data collect (Properly described) - Semi-structured questionnaire to characterize participants, clinical data, care network (family/responsible) - Field journal - Home visits photographs Data analysis (Properly described) - Action research: Questionnaire information and home visits supported the analyzed interventions - Thematic analysis (records of interventions - field diaries and photographs) - Construction of an ecomap for the presentation of results	Level 5
Silveira et al.²⁸ (2016)	(Properly described) 7 professionals from a PHC center in a city of Southern Brazil (1 Community Health Agent, 2 Nurses, 2 physicians, and 2 Nursing technician).	Data collect (Properly described) - Semi-structured interviews (professionals) Data analysis (Properly described) - Content thematic analysis (interviews)	Level 4
Santos and Celeri¹⁵ (2017)	(Properly described) 48 children (31 to 50 months) subscribed in a PHC Center of a city in the interior of the metropolitan region of São Paulo, those which the responsible person provided information.	Data collect (Properly described) - Brazil Economic Classification Criterion (CCEB) (responsible) - Skills and Difficulties Questionnaire (SDQ) (responsible) - Behavior Inventory for Children between 1½ and 5 years old (CBCL 1 ½-5) (responsible) Data analysis (Properly described) - Statistical analysis	Level 4

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[1] Collaborations

GC Esswein worked at all stages of this paper. AF Rovaris and GP Rocha worked on the conception, methodology and review. DC Levandowski worked on the design, structuring, critical analysis, and revision of the entire text.