Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Columns   |    
Global Mental Health Reforms: Challenges in Developing a Community-Based Program for Maltreated Children and Adolescents in Brazil
Sandra Scivoletto, Ph.D.; Mauro Vitor de Medeiros Filho; Elina Stefanovics, Ph.D.; Robert A. Rosenheck, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300439
View Author and Article Information

Dr. Scivoletto and Mr. Medeiros Filho are with The Equilibrium Program, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil (e-mail: sscivoletto@gmail.com). Dr. Stefanovics and Dr. Rosenheck are with the Department of Psychiatry, Yale University, New Haven, Connecticut. José Miguel Caldas de Almeida, M.D., and Matt Muijen, M.D., Ph.D., are editors of this column.

Copyright © 2014 by the American Psychiatric Association


This column describes the planning and development of The Equilibrium Program (TEP) for multiply traumatized and neglected children and adolescents with mental and general medical problems in São Paulo, Brazil. The program is a partnership between university faculty, various service providers, the courts, and the city government. In the first step, child psychiatry faculty from the University of São Paulo visited central-city areas and group shelters to talk to street youths to better understand their needs. A nearby community sports center building was chosen to be a center where youths could access services and engage in recreational activities and where the work of family integration could be facilitated. A multidisciplinary team conducts an in-depth assessment and creates an intervention plan, overseen by a case manager. Challenges to implementing such programs are discussed.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).



Sadowski  LS;  Hunter  WM;  Bangdiwala  SI  et al:  The World Studies of Abuse in the Family Environment (WorldSAFE): a model of a multinational study of family violence.  International Journal of Injury Control and Safety Promotion 11:81–90, 2004
Runyan  DK;  Shankar  V;  Hassan  F  et al:  International variations in harsh child discipline.  Pediatrics 126:e701–e711, 2010
[CrossRef] | [PubMed]
Garland  AF;  Hough  RL;  McCabe  KM  et al:  Prevalence of psychiatric disorders in youths across five sectors of care.  Journal of the American Academy of Child and Adolescent Psychiatry 40:409–418, 2001
[CrossRef] | [PubMed]
Scivoletto  S;  Silva  TF;  Cunha  PJ  et al:  The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil.  Clinics 67:3–9, 2012
[CrossRef] | [PubMed]
Tucci  AM;  Kerr-Corrêa  F;  Souza-Formigoni  ML:  Childhood trauma in substance use disorder and depression: an analysis by gender among a Brazilian clinical sample.  Child Abuse and Neglect 34:95–104, 2010
[CrossRef] | [PubMed]
Chaffin  M;  Friedrich  W:  Evidence-based treatments in child abuse and neglect.  Children and Youth Services Review Journal 26:1097–1113, 2004
Shipman  K;  Taussig  H:  Mental health treatment of child abuse and neglect: the promise of evidence-based practice.  Pediatric Clinics of North America 56:417–428, 2009
[CrossRef] | [PubMed]
Cohen  JA;  Mannarino  AP:  Factors that mediate treatment outcome of sexually abused preschool children: six- and 12-month follow-up.  Journal of the American Academy of Child and Adolescent Psychiatry 37:44–51, 1998
[CrossRef] | [PubMed]
Cohen  JA;  Mannarino  AP:  Predictors of treatment outcome in sexually abused children.  Child Abuse and Neglect 24:983–994, 2000
[CrossRef] | [PubMed]
Nguyen  HT;  Dunne  MP;  Le  AV:  Multiple types of child maltreatment and adolescent mental health in Viet Nam.  Bulletin of the World Health Organization 88:22–30, 2010
[CrossRef] | [PubMed]
Edwards  VJ;  Holden  GW;  Felitti  VJ  et al:  Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the Adverse Childhood Experiences Study.  American Journal of Psychiatry 160:1453–1460, 2003
[CrossRef] | [PubMed]
Penna  LHG;  Santos  NC;  Souza  ER:  The scientific literature on domestic violence in the area of public health [in Portuguese].  Revista Enfermagem UERJ 12:192–198, 2004
Galehouse  P;  Herrick  C;  Raphel  S:  On foster care: International Society of Psychiatric–Mental Health Nurses.  Journal of Child and Adolescent Psychiatric Nursing 23:36–39, 2010
[CrossRef] | [PubMed]
Kaufman  J;  Birmaher  B;  Brent  D  et al:  Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL): initial reliability and validity data.  Journal of the American Academy of Child and Adolescent Psychiatry 36:980–988, 1997
[CrossRef] | [PubMed]
Scivoletto  S;  da Silva  TF;  Rosenheck  RA:  Child psychiatry takes to the streets: a developmental partnership between a university institute and children and adolescents from the streets of São Paulo, Brazil.  Child Abuse and Neglect 35:89–95, 2011
[CrossRef] | [PubMed]
Shaffer  D;  Gould  MS;  Brasic  J  et al:  A Children’s Global Assessment Scale (CGAS).  Archives of General Psychiatry 40:1228–1231, 1983
[CrossRef] | [PubMed]
Stefanovics  E;  Medeiros Filho  MV;  Rosenheck  RA  et al:  Functional outcomes of maltreated children and adolescents in a community-based rehabilitation program in Brazil: six-month improvement and predictors.  Child Abuse and Neglect , in press
References Container

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 31.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 61.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 44.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 44.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 64.  >
Topic Collections
Psychiatric News