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Dissertação de mestrado em Educação Especial (especialização em Intervenção Precoce), O importante trabalho das Equipas de Intervenção Precoce é muitas vezes o primeiro e único suporte das famílias e das suas crianças. Diariamente, estas equipas procuram apoiar as famílias e crianças nos seus esforços de capacitação das famílias que atendem E fazem-no no sentido de sempre melhorarem as suas práticas. Como meio de instrumentos de trabalho conjunto entre a equipa e a família são usados, entre outros, o Ecomapa e a Entrevista Baseada em Rotinas (EBR). O objetivo deste estudo é compreender se estes instrumentos satisfazem completamente a equipa, na qual a família está incluída, ou se os adaptam às suas necessidades. Este trabalho evidenciará também alguns anseios e espectativas das equipas que aceitaram colaborar nesta investigação. Os resultados apontam para a utilização plena do ecomapa por parte dos profissionais das equipas, no entanto no que concerne à EBR os profissionais referem que dado a extensão da mesma, utilizam-na com pequenas adaptações., The important work of the Preventive Intervention Teams is many times the first and only support for children and their families. These teams look to support families and children on a daily basis, by giving the participating families competencies so that they improve their practices. In order to do this, and for the teams and the families to work in conjunction, some of the tools used are ECOMAP and Routine Based Interview, among others. The target of this study was to understand if these tools are adequate for the work of the team within the family they were working with. This study was also meant to highlight some of the concerns and expectations of the teams that agreed to participate in this research. The results indicate that the full use of Ecomap by professionals is very productive, on the other hand, the Routine Based Interview, given its wide scope, is used with some adaptions.

Relatório de Estágio apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos, realizada sob orientação científica da Assistente Social Doutora Carla Manuela Trinchete Reigada e coorientação da Professora Doutora Ana paula Gonçalves Antunes Sapeta, do Instituto Politécnico de Castelo Branco. Submitted by Ascensão Figueira (ascensaofigueira@ipcb.pt) on 2019-04-11T13:58:55Z No. of bitstreams: 1 FINAL_05.04.2019_JoanaHenrique_A.pdf: 8075421 bytes, checksum: 3a84edeb553ff887fa9ee735dbf7abab (MD5) Approved for entry into archive by Lurdes Grilo (lurdesgrilo@ipcb.pt) on 2019-04-12T10:28:54Z (GMT) No. of bitstreams: 1 FINAL_05.04.2019_JoanaHenrique_A.pdf: 8075421 bytes, checksum: 3a84edeb553ff887fa9ee735dbf7abab (MD5) Made available in DSpace on 2019-04-12T10:40:44Z (GMT). No. of bitstreams: 1 FINAL_05.04.2019_JoanaHenrique_A.pdf: 8075421 bytes, checksum: 3a84edeb553ff887fa9ee735dbf7abab (MD5) Previous issue date: 2019-03-26

When adopting an ecological perspective of Early Intervention (EI), social support became a key concept for understanding families and ways of coping with a child who is at-risk or have been diagnosed with Special Educational Needs. Research findings demonstrate that social support, personal well-being, parenting interactional styles, and child development are both conceptually and empirically related, and that variation in child development is attributable to social support and well-being more so than to family Social Economic Status. Social supports play an essential role when planning intervention with young children and their families. This article will provide an evidence based review of the concept and its importance in Early Intervention and it will present a case study to illustrate and operationalize the ideas discussed in the article. Al adoptar una perspectiva ecológica de Atención Temprana (AT), el apoyo social se ha convertido en un concepto clave para comprender a las familias y las formas de tratar con un niño en riesgo o con necesidades educativas especiales. Los resultados de la investigación muestran que el apoyo social, el bienestar personal, los estilos parentales y el desarrollo infantil están relacionados conceptual y empíricamente, y que los cambios en el desarrollo infantil son más atribuibles al apoyo social y al bienestar, de la familia que a su estatus socioeconómico. El apoyo social juega un papel esencial en la planificación de la intervención con niños pequeños y sus familias. Este artículo proporcionará una revisión basada en evidencia del concepto y su importancia en AT y presentará un estudio de caso para ilustrar y poner en práctica las ideas discutidas en el artículo. When adopting an ecological perspective of Early Intervention (EI), social support became a key concept for understanding families and ways of coping with a child who is at-risk or have been diagnosed with Special Educational Needs. Research findings demonstrate that social support, personal well-being, parenting interactional styles, and child development are both conceptually and empirically related, and that variation in child development is attributable to social support and well-being more so than to family Social Economic Status. Social supports play an essential role when planning intervention with young children and their families. This article will provide an evidence based review of the concept and its importance in Early Intervention and it will present a case study to illustrate and operationalize the ideas discussed in the article.***“Eu senti-me só”: a importância do apoio social para a intervenção Precoce***Adotando uma perspetiva ecológica de Intervenção Precoce (IP), o apoio social tornou-se um conceito-chave para entender as famílias e formas de lidar com uma criança em risco ou com Necessidades Educacionais Especiais. Os resultados da investigação demonstram que o apoio social, o bem-estar pessoal, os estilos de interação dos pais e o desenvolvimento infantil estão conceitualmente e empiricamente relacionados, e que as mudanças no desenvolvimento infantil se atribuem mais ao apoio social e ao bem-estar, da família do que ao seu estatuto sócio económico. Os apoios sociais desempenham um papel essencial no planeamento da intervenção com crianças pequenas e suas famílias. Este artigo fornecerá uma revisão baseada em evidências do conceito e sua importância na IP e apresentará um estudo de caso para ilustrar e operacionalizar as ideias discutidas no artigo.Palavras-Chave: Intervenção Precoce, Apoio Social, Apoio Formal e Informal, Ecomapa

A Intervenção Precoce (IP) consiste na prestação de serviços, dirigidos à criança dos zero aos seis anos de idade e suas famílias, com o objetivo de reduzir os efeitos dos fatores de risco ou diminuir o impacto de diferentes problemáticas no processo de desenvolvimento da criança. O presente relatório, descreve e analisa a importância da Intervenção Precoce, com base em dois estudos de caso de duas crianças com Trissomia 21 de 2 e 4 anos de idade, apoiadas no Instituto Christel Manske em Hamburgo, na Alemanha. Utilizaram-se como instrumentos de recolha de dados e caraterização dos casos: uma ficha de Anamnese e a Schedule of Growing Skills II (SGSII) para proceder a avaliação do desenvolvimento psicomotor das crianças e definir os respetivos perfis de desenvolvimento. Para conhecer os recursos e necessidades das famílias utilizamos: o Ecomapa; a Entrevista baseada nas Rotinas (EBR) e o Inventário das necessidades e interesses da família. O relatório engloba uma revisão da literatura relativa à Trissomia 21 e valor da Intervenção Precoce, enquadramento institucional legal, bem como a descrição e reflexão sobre o processo de intervenção com as referidas crianças que evidencia melhorias significativas após o processo de intervenção, não explicáveis pelos efeitos da maturação exclusivamente. Early Intervention (EI) consists on providing services, aimed for the child and the family, in order to reduce the effects of risk factors on the child's development. The present study explores the importance of an early intervention program conducted at Christel Manske Institut in Hamburg – Germany, with two children diagnosed with Down-Syndrome, aged 2 and 4 years old. We used as tools for data collection and characterization of cases: the Anamnesis as a description of the clinical history of both children, the Schedule of Growing Skills II (SGSII) to evaluate psychomotor development and establish the development profiles of the children pre and post intervention. To know the resources and needs of the families we used the Ecomap, the Routines Based Interview (RBI), and the Inventory of needs and interests of the family. The present report includes a review of the literature about Down-Syndrome, the importance of early intervention, the legal institutional framework of the intervention we conducted, as well as a presentation and discussion, of the intervention process and the significant changes on the children under study, not only explained trough the effects of growing. Die Frühintervention besteht aus der Bereitstellung von Dienstleistungen, die auf das Kind und die Familie ausgerichtet sind, um die Auswirkungen von Risikofaktoren oder Mangel auf die Entwicklung des Kindes zu reduzieren. Die vorliegende Studie untersucht eine Form der Frühintervention, welche im Christel Manske Institut in Hamburg, mit zwei Down-Syndrom Kindern (2 und 4 Jahre alt), durchgeführt wurde. In dieser Studie wurden folgende Tests und Datenerfassungsmethoden verwendet: Schedule of Growing Skills II (SGS II) sowie eine Anamnese zur Beschreibung der klinischen Vorgeschichte beider Kinder. Diese dienen der Evaluation psychomotorischer Entwicklung und der Erfassung des Entwicklungszustandes vor und nach der Intervention. Ein Umweltzirkel, Routine Based Interview (RBI) und ein Fragebogen über die Bedürfnisse und Interessen der Familie wurden ebenso durchgeführt Die vorliegende Studie enthält auch eine Überprüfung der Literatur über Down-Syndrom sowie dem rechtlichen institutionellen Rahmen der therapeutischen Arbeit. Aufgezeigt wird in dieser Arbeit der Interventionsprozess der psychomotorischen und verhaltensbezogenen Frühintervention der untersuchten Fälle sowie deren Auswirkung und Bedeutung für die Arbeit mit Down-Syndrom Kindern.

Background: The family-centred cultural construct of filial responsibility forms the core foundation of the traditional mosaic of a typical intergenerational Singapore-Chinese family. Due to modernization, several generations co-habiting within the same household or living in separate households have shrunk to smaller-sized immediate and extended families residing in mostly high-rise apartments. This change has impacted on the social norm of traditional intergenerational Singapore-Chinese caregiving. Currently, there are gaps in understanding the intergenerational Singapore-Chinese families and caregiving in dementia. Only a few studies to date have discussed the intersection on intergenerational family care, but an in-depth exploration of intergenerational Singapore-Chinese families’ cultural beliefs and values is an important consideration when attempting to understand the family and determine their support and maintenance of relational bonds. Aims: The aim of this longitudinal, case study research using a participatory approach was to better understand the everyday caregiving experience of intergenerational Singapore-Chinese families within the context of each family unit living together in Singapore ‘under one roof’. Family biographies were co-constructed with five intergenerational families living ‘under one roof’ during repeated and scheduled visits with each participating family over a period of between six to 15 months. The interviews included the completion of a 23-item structured questionnaire, co-construction of a genogram and ecomap with each family, drawings, audio recordings and digital photographs of the home environment, items and activities. Results: Narrative analysis of the five intergenerational cases resulted in the emergence of three themes that explained and explored the various dynamics in the data, namely: i) Family values, and its supporting sub-themes of culture; religion; and filial piety; ii) Family support, and its supporting sub-themes of timeliness; internal support network; and external support network; and iii) Family bonds, and its supporting sub-themes of relational; closeness and conflict; and challenges. Data analysis also generated a meta-theme ‘Intergenerational Family Connections’ which was supported by three properties: i) Strongly held beliefs and practices; ii) Shared space; and iii) Supporting family togetherness. Conclusion: This study has led to an in-depth understanding of the everyday experience of the intergenerational Singapore-Chinese families of a person with dementia, within the shared context of their family construction. This study makes an original and significant contribution to knowledge through the development of a new theoretical model on intergenerational family connections in dementia care. The findings will better inform formal and informal service providers and policy makers on how best to support and maintain the relational dynamics of intergenerational Singapore-Chinese families who provide care for the person with dementia at home.

A assistência farmacêutica, no âmbito do Sistema Único de Saúde (SUS), é muitas vezes realizada com o objetivo primordial de garantir o abastecimento dos medicamentos nas Unidades Locais de Saúde. Freqüentemente, os cuidados com os pacientes e a promoção do uso racional dos medicamentos são marginalizados. Contudo, durante o desenvolvimento do seguimento farmacoterapêutico, são identificados problemas relacionados aos medicamentos (PRM) e dificuldades na adesão ao tratamento farmacológico, os quais estão relacionados a questões familiares e sociais, e têm contribuído para o não-sucesso terapêutico, portanto pontos-chave a serem considerados durante a Atenção Farmacêutica. Foi realizado o seguimento farmacoterapêutico de quatro pacientes atendidos em uma unidade de saúde do município de Florianópolis. Para a resolução dos PRMs, adotou-se abordagem que inclui os contextos familiar e social e, que utiliza ferramentas como o genograma e o ecomapa, além do trabalho interdisciplinar. Observou-se a importância da família e dos grupos de apoio para a resolução dos PRMs e a necessidade do farmacêutico de aprimorar a prática de atenção farmacêutica mediante a utilização de tais ferramentas. Percebeu-se, ainda, a importância das visitas domiciliares para conhecer melhor o ambiente familiar e a necessidade de trabalho interdisciplinar para melhorar a qualidade do atendimento.The main objective of pharmaceutical policy management within the scope of SUS (Brazilian National Health System) is to guarantee the supply of drugs to local health centers, therefore displacing patient care When drug-related problems (DRP) and difficulties in adhering to the prescribed treatment are identified during the development of pharmaceutical follow-up, family and social issues have been shown to be reasons for unsuccessful treatment. They are key points to be considered during Pharmaceutical Care. The methodology chosen for this study was the pharmaceutical care of four patients monitored in a Health Unit in the city of Florianópolis. To solve drug related problems an approach was adopted that included family and social contexts using tools such as genogramming, ecomapping and interdisciplinary work. Family and support groups were shown to be important in addressing DRPs and there appears to be a need for the pharmacist to improve Pharmaceutical Care Practice by using these tools. The importance of home visits to gain a better understanding of the family environment was also observed, as well as the necessity of interdisciplinary work to improve the quality of care.

Los procedimientos de evaluación en profesiones como psicología, trabajo social, entre otras, surgen dentro del contexto histórico del modernismo empiricista. Se asume su objetividad, rigor de medición, neutralidad valórica, y experticia científica. En el contexto del constructivismo, varios de los fundamentos de la evaluación tradicional se cuestionan. Este tipo de crítica no significa amenazar determinados tipos de procedimientos, sino buscar una profundización de ellos. El replanteamiento de herramientas de evaluación como el genograma y ecomapa, sugiere explorar potenciales novedosos para las prácticas de evaluación en las profesiones que utilizan este tipo de procedimiento.

Los procedimientos de evaluación en profesiones como psicología, trabajo social, entre otras, surgen dentro del contexto histórico del modernismo empiricista. Se asume su objetividad, rigor de medición, neutralidad valórica, y experticia científica. En el contexto del constructivismo, varios de los fundamentos de la evaluación tradicional se cuestionan. Este tipo de crítica no significa amenazar determinados tipos de procedimientos, sino buscar una profundización de ellos. El replanteamiento de herramientas de evaluación como el genograma y ecomapa, sugiere explorar potenciales novedosos para las prácticas de evaluación en las profesiones que utilizan este tipo de procedimiento. The evaluation procedures of the professions of psychology, social work, and others, emerge within the historical context of modern empiricism. Its objectivity, rigor of measurement, neutral value, and scientific expertise is assumed. In the context of constructivism, many of the traditional foundations of evaluation are questioned. This type of critique is not meant to threaten certain types of procedures, but to look for a deeper understanding of them. Rethinking of tools of evaluation like the genogram and ecomap, suggests the exploration of new potentials for the practices of evaluation in the professions that use this type of procedure.

A assistência farmacêutica, no âmbito do Sistema Único de Saúde (SUS), é muitas vezes realizada com o objetivo primordial de garantir o abastecimento dos medicamentos nas Unidades Locais de Saúde. Freqüentemente, os cuidados com os pacientes e a promoção do uso racional dos medicamentos são marginalizados. Contudo, durante o desenvolvimento do seguimento farmacoterapêutico, são identificados problemas relacionados aos medicamentos (PRM) e dificuldades na adesão ao tratamento farmacológico, os quais estão relacionados a questões familiares e sociais, e têm contribuído para o não-sucesso terapêutico, portanto pontos-chave a serem considerados durante a Atenção Farmacêutica. Foi realizado o seguimento farmacoterapêutico de quatro pacientes atendidos em uma unidade de saúde do município de Florianópolis. Para a resolução dos PRMs, adotou-se abordagem que inclui os contextos familiar e social e, que utiliza ferramentas como o genograma e o ecomapa, além do trabalho interdisciplinar. Observou-se a importância da família e dos grupos de apoio para a resolução dos PRMs e a necessidade do farmacêutico de aprimorar a prática de atenção farmacêutica mediante a utilização de tais ferramentas. Percebeu-se, ainda, a importância das visitas domiciliares para conhecer melhor o ambiente familiar e a necessidade de trabalho interdisciplinar para melhorar a qualidade do atendimento. The main objective of pharmaceutical policy management within the scope of SUS (Brazilian National Health System) is to guarantee the supply of drugs to local health centers, therefore displacing patient care When drug-related problems (DRP) and difficulties in adhering to the prescribed treatment are identified during the development of pharmaceutical follow-up, family and social issues have been shown to be reasons for unsuccessful treatment. They are key points to be considered during Pharmaceutical Care. The methodology chosen for this study was the pharmaceutical care of four patients monitored in a Health Unit in the city of Florianópolis. To solve drug related problems an approach was adopted that included family and social contexts using tools such as genogramming, ecomapping and interdisciplinary work. Family and support groups were shown to be important in addressing DRPs and there appears to be a need for the pharmacist to improve Pharmaceutical Care Practice by using these tools. The importance of home visits to gain a better understanding of the family environment was also observed, as well as the necessity of interdisciplinary work to improve the quality of care.