Abstract

INTRODUCTION

Violence has always been part of the human experience, but it currently stands out in the political agenda and in national and international organizations which are in charge of initiatives and proposals addressed to prevention, intervention and defense of the human rights¹1. Baierl LF. Medo socia: da violência visível ao invisível da violência. São Paulo: Cortez; 2004.. Recognizing juvenile violence as a social problem has led to the need for discussion, as well as political and social mobilization worldwide. The magnitude of this phenomenon in different contexts and countries has shown how important it is to involve several segments and social sectors in the implementation of programs and actions, as well as cognitive aspects, development and social integration of the juvenile population.

International documents such as the Declaration of Human Rights (1948) and of the rights of the Child (1959) had repercussions in Brazil, however, only in the 1980s, with the Constitution, and in the 1990s, with the formulation of the Statute of the Child and Adolescent (ECA), the violation of the rights in this population group stood out in the national scenario²2. Gonçalves HS, Ferreira AL. A notificação da violência intrafamiliar contra crianças e adolescentes por profissionais de saúde. Cad Saúde Pública 2002; 18(1): 315-9.. ECA is a social instrument, as well as an tool used by the public power to transform the reality of victims with regard to the different manifestations of violence, be it social violence, negligence, physical violence, sexual exploration, among other forms of human rights violation¹1. Baierl LF. Medo socia: da violência visível ao invisível da violência. São Paulo: Cortez; 2004.^,33. Brasil. Ministério da Saúde. Secretaria de Assistência à Saúde. Notificação de maus-tatos contra crianças e adolescentes pelos profissionais de saúde: um passo a mais na cidadania em saúde. Brasília: Ministério da Saúde; 2002..

Integrating the Unified Health System (SUS), emergency units are one of the important sectors of care, being part of a privileged organization that analyzes the dimension of violence, once, in these services, the phenomenon gains visibility, and becomes part of the work process and of the interaction between professionals and clients⁴4. Moura ATMS, Moraes CL, Reichenheim ME. Detecção de maus-tratos contra criança: oportunidades perdidas em serviços de emergência na cidade do Rio de Janeiro, Brasil. Cad Saúde Pública 2008; 24(12): 2926-36.. By considering emergency units as protective services, the professionals of these units must be able to identify and conduct procedures and referrals related to cases of violence, especially with regard to notifying the Accident and Violence Surveillance System (VIVA), from the Ministry of Health. This system aims at knowing the dimension and the profile of the assisted external causes, thus allowing an approximation with the real situation, especially in cases of less severe injuries, which did not lead to death or hospitalization, considering the strong impact of these events on health, as well as the high demand of these cases in emergency units⁵5. Gawryszewski VP, Silva MMA, Malta DC, Mascarenhas MDM, Costa VC, Matos SG, et al. A proposta da rede de serviços sentinela como estratégia da vigilância de violências e acidentes. Ciênc Saúde Coletiva 2007; 11(Suppl 0): 1269-78..

It is valid to mention that the VIVA system was implemented in the different regions of Brazil, in 2006, assuming the responsibility of monitoring non-fatal violent events and victims, in the different population segments and courses of life, assisted by SUS⁶6. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Viva: vigilância de violências e acidentes, 2006 e 2007. Brasília: Ministério da Saúde; 2009..

The identification and notification of violence to the competent authorities is decisive to fight it, as well as the insertion of health professionals in this process, which becomes essential due to their privileged position in terms of caring for the most evident consequences⁷7. Malta DC, Lemos MSA, Silva MMA, Rodrigues EMS, Gazal-Carvalho C, Morais Neto OL. Iniciativas de vigilância e prevenção de acidentes e violências no contexto do Sistema Único de Saúde (SUS). Epidemiol Serv Saúde 2007; 16(1): 45-55.. These professionals are presented as protective agents, responsible for activating the support of the multidisciplinary staff through groups of surveillance and care, as well as for enabling the process of notification and referral of suspected or confirmed cases²2. Gonçalves HS, Ferreira AL. A notificação da violência intrafamiliar contra crianças e adolescentes por profissionais de saúde. Cad Saúde Pública 2002; 18(1): 315-9..

This study aims at analyzing the work of professionals in emergency units in the process of notification of juvenile violence cases, considering sociodemographic characteristics, professional category and main difficulties.

METHODOLOGY

This is a cross-sectional study conducted with a sample of health professionals who integrate the emergency units of Feira de Santana, Bahia. The study included the units that provide this type of care in the city, accounting for a total of 7, distributed in 1 regional general hospital of the state (Clériston Andrade), with 523 professionals and 6 polyclinics, with 238 professionals, distributed in the following units: Tomba (57), George Américo (43), Parque Ipê (38), Rua Nova (44), Feira X (40) and Distrito de Humildes (18), which were represented by categories of physicians, nurses, nursing technicians, physical therapists, dental surgeons and social workers.

The sample calculation was simple and casual, by considering a total of 523 technicians. Estimated prevalence was 20%, standard error, 5%, and 95% confidence interval, resulting in a sample size of 200. This study included those who had been employed for more than one year, the ones who were part of the staff and were performing their activities during the data collection period.

A standardized questionnaire was developed to study the action of the professionals towards the cases, and the study variables were selected based on literature⁸8. Lima MCC. Conhecimento e atuação dos profissionais da Atenção Básica de Saúde de Feira de Santana-BA frente à violência contra crianças e adolescentes [dissertação de mestrado]. Feira de Santana: Universidade Estadual de Feira de Santana; 2008.^,99. Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, et al. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saúde Mater Infant 2005; 5(1): 103-8.. The outcome variable was the notification of cases, suspected or confirmed, to the competent parties, considering medical appointments in the past six months (to prevent memory bias). The descriptive variables of the outcome were the ones with possible influence on the notification: (1) sociodemographic variables: gender, age group, marital status, presence of children; (2) professional characteristics: professional category, expertise, length of experience in the category and in the emergency service, type of professional contract; (3) assisted cases of violence: physical, sexual, negligence/abandonment; (4) professional decision in cases of violence: requesting the opinion of another professional, talking with the family, questioning the child, notifying competent parties, filling out the form from the VIVA system; referrals: child protective services, police, Public Prosecutor's Office; credibility towards reference institutions: confirmation/identification, accusation, referral/follow-up of cases; (5) education on the theme: offered by the unit and interest in learning about the theme; (6) difficulties with notification: fear of getting involved with justice; fear of separating the child from the family, retaliations from the aggressor, lack of professional education and family negligence.

The access to emergency units for data collection was documented and authorized by the Secretariat of Health (Sector of Permanent Education). The Informed Consent Form was signed by the professionals, after learning about the objectives of the study, and they were ensured of anonymity, confidentiality and the volunteer aspect of the participation. The questionnaire was answered individually and in secrecy. Afterwards, it received a numerical code and was stored in a sealed envelope. Collection was executed from October to December, 2010. The software SPSS, version 12.0, was used to process the data. Data were analyzed by descriptive statistics, bivariate analysis, and measurement of the association prevalence ratio (PR) and respective 95% confidence intervals (95%CI), with the Pearson's chi-squared test (χ²2. Gonçalves HS, Ferreira AL. A notificação da violência intrafamiliar contra crianças e adolescentes por profissionais de saúde. Cad Saúde Pública 2002; 18(1): 315-9.) with p ≤ 0.05.

This study was approved by the Research Ethics Committee of Universidade Estadual de Feira de Santana, protocol n. 057/2010, CAAE 0055.0.059.000-10. It is important to mention that this article constitutes the result of an original study of the authors, and there is no conflict of interests.

RESULTS

Two hundred professionals were analyzed, from the universe of professionals (n = 523), considering possible losses during the data collection process.

Among the analyzed sociodemographic characteristics (Table 1), the results showed most participants were women (82.5%), aged between 20 and 40 years old (75.5%), married or in a consensual relationship (61.0%), and with children (60.0%). As to professional characteristics: 52.5% were nursing technicians, 22.5% were nurses, 17% were physicians, 54% had specialization courses; 48% had up to 5 years of professional experience, and most of them (71.0%) worked in emergency units with a temporary work contract (69.0%).

In the past 6 months, 35.7% of the professionals informed having worked with at least one case of juvenile violence. In this group, types of violence were: physical (63.4%), sexual (43.7%) and negligence/abandonment (33.8%). Among the procedures adopted for the cases, asking the opinion of another professional stands out (60.0%), as well as talking with the family (54.0%), and notifying to competent parties (69.5%). However, only 42.9% (n = 56) of the professionals filled out the notification form of the VIVA system. Most of them reported referring the cases to child protective services (95.0%), and 41.5% called the police (41.5%). With regard to the credibility of reference institutions, most professionals claimed to trust them, especially in terms of referring and following-up the cases (65.0%).

Education to work on cases of violence and on the process of notification was reported by only 30.5% of the professionals, and 82.0% of them claimed to work differently after taking courses about this theme; 95.5% were interested in taking up courses about this subject. Among the difficulties to notify the competent parties, family negligence was mentioned (91.5%), as well as the fear of professional involvement with the judicial system (63.5%) and the lack of professional skills facing the procedures to be adopted in cases of violence (47.0%).

In the analysis of the associations between the notification of the case and the variables related to professional characteristics, education on the subject, referrals and credibility in reference institutions (Table 2), it was possible to observe a significant result (p ≤ 0.05): with regard to professional category (p ≤ 0.001); having taken a course in the work unit (p = 0.041); referring cases to the police (p = 0.001); having credibility towards the institutions regarding the confirmation/identification of cases (p = 0.049).

In relation to work, according to professional category (Table 3), it was possible to observe statistical significance, with positive associations for some aspects of work: in the category of physicians, regarding the fact of not asking the opinion of another professional (PR = 1.90; 95%CI 1.02 - 3.51); not being afraid of juridical involvement (PR = 2.20; 95%CI 1.19 - 4.06) and not lacking professional skills on the theme (PR = 2.46; 95%CI 1.21 - 5.00). Among nursing technicians, there was statistical significance for notifying competent parties (PR = 1.64; 95%CI 1.28 - 2.09) and filling out the notification form of the VIVA system (PR = 2.81; 95%CI 1.06 - 7.40). It was also possible to observe that the categories of physician and nurses showed statistical results with negative associations related to notification (PR = 0.39; 95%CI 0.16 - 0.96) and (PR = 0.39; 95%CI 0.16 - 0.96), respectively; for nurses, with regard to filing out the notification of the VIVA system (PR = 0.51; 95%CI 0.29 - 0.89). The same results were verified among nursing technicians, as to the fear of juridical involvement (PR = 0.72; 95%CI 0.53 - 0.98) and lack of professional education (PR = 0.71; 95%CI 0.55 - 0.93).

DISCUSSION

Facing the violence cases and from the perspective of the sentinel services, the emergency unit represents one of the "entrance doors" of the Health System, working as an opportunity to reveal the case. Therefore, this sector is strategic to analyze indicators of violence, its different manifestations and consequences⁴4. Moura ATMS, Moraes CL, Reichenheim ME. Detecção de maus-tratos contra criança: oportunidades perdidas em serviços de emergência na cidade do Rio de Janeiro, Brasil. Cad Saúde Pública 2008; 24(12): 2926-36.. It is worth to mention that Basic Care, represented by the Family Health Strategy (ESF), also provides access to the system, and has the same responsibility in terms of identifying and notifying cases of violence, especially due to the characteristics of the work process regarding the approach to families, household visits, care and connection¹⁰10. Deslandes SF. O atendimento às vítimas de violência na emergência: "prevenção numa hora dessas?" Ciênc Saúde Coletiva 1999; 4(1): 81-94.^,1111. Rocha PM, Uchoa AC, Rocha NSPD, Souza ECF, Rocha ML, Pinheiro TXA. Avaliação do Programa Saúde da Família em municípios do Nordeste brasileiro: velhos e novos desafios. Cad Saúde Pública 2008; 24(Suppl 1): S69-S78..

The notification of juvenile violence in emergency units allows characterizing the limits and difficulties faced by professionals, especially the excessive number of visits, the lack of privacy, the absence of resources, as well as scarce professional training¹²12. Arpini DM, Soares ACOE, Bertê L, Dal Forno C. A revelação e a notificação das situações de violência contra a infância e a adolescência. Psicol Rev 2008; 14(2): 95-112.. The invisibility of the phenomenon is accompanied by the disbelief in the responsibilization of competent parties and the maintenance of the cycle of violation by the approximation of the victim and the aggressor⁹9. Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, et al. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saúde Mater Infant 2005; 5(1): 103-8.^,1313. Russel M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and response. Br J Community Nurs 2004; 9(8): 332-8.. This evidence compromises the efficiency of the care network, tends to trivialize and postpone protective measurements, reinforcing the need to sensitize and educate professionals as to the importance of identifying and notifying cases in the work routine.

Among the difficulties pointed out in this study, the fear of judicial involvement, reported by many professionals, corroborates the findings of other researchers who observed this characteristic, attributed to the lack of or insufficient institutional support, as well as to the lack of influence of the professionals in terms of conflicting social relationships that are part of domestic violence¹⁴14. Saliba O, Garbin CAS, Garbin AJI, Dossi AP. Responsabilidade do profissional de saúde sobre a notificação de casos de violência doméstica. Rev Saúde Pública 2007; 41(3): 472-7.. The creation of institutional responsibility dynamics to notify cases and preserve the life and the dignity of the victim is essential for the success of actions against violence in emergency services. In this process, for the respective emergency units, the identification of attributions must be specific for each professional category, immediate management and board (social services, health professionals and board of the institutions), with regard to filling out the forms referring to the notification. By understanding that the notification is a responsibility (both ethical and legal) of the health professional, the institution must guarantee this practice, protecting the individual from all pressures and sharing the responsibility for the case¹⁰10. Deslandes SF. O atendimento às vítimas de violência na emergência: "prevenção numa hora dessas?" Ciênc Saúde Coletiva 1999; 4(1): 81-94..

In the mentioned study, even though most professionals denied having specific education in the field, about 70% of them confirmed having notified cases to reference institutions (child protective services), with significant results for the notification in the following categories: physician, nurses and nursing technicians. These findings can suggest the possibility of articulation between the Health System and the System of Guarantee of Rights (SGDCA), which is essential to strengthen the Network of Care and Protection to children and adolescents who are victims of violence. Studies suggest that the establishment of an intrinsic and cohesive relationship between these systems is based on aspects such as the feedback/display of information concerning the notification for the professional, in order to strengthen the process of notification in the services¹⁵15. Assis SG, Avanci JQ, Pesce RP, Pires TO, Gomes DL. Notificações de violência doméstica, sexual e outras violências contra crianças no Brasil. Ciênc Saúde Coletiva 2012; 17(9): 2305-17..

The approach of domestic violence cases requires a social and committed professional practice. Literature recommends that technicians (professionals) and institutions should clarify the obligatoriness and the content of notifications for the families²2. Gonçalves HS, Ferreira AL. A notificação da violência intrafamiliar contra crianças e adolescentes por profissionais de saúde. Cad Saúde Pública 2002; 18(1): 315-9.^,33. Brasil. Ministério da Saúde. Secretaria de Assistência à Saúde. Notificação de maus-tatos contra crianças e adolescentes pelos profissionais de saúde: um passo a mais na cidadania em saúde. Brasília: Ministério da Saúde; 2002..

In this negotiation, the notification should be presented as a mean to access institutions and services, being necessary for prevention and intervention, thus reducing the effects and factors that favor violence¹⁴14. Saliba O, Garbin CAS, Garbin AJI, Dossi AP. Responsabilidade do profissional de saúde sobre a notificação de casos de violência doméstica. Rev Saúde Pública 2007; 41(3): 472-7..

Studies indicate the positive influence of education, access to courses and sensitization in the field addressed to the attitude of health professionals by notifying cases of juvenile violence¹⁶16. Vulliamy AP, Sullivan R. Reporting child abuse: pediatricians' experiences with child protection system. Child Abuse Negl 2000; 24(11): 1461-70.^,1717. Gomes R, Junqueira MFPS, Silva CO, Junger WL. A abordagem dos maus-tratos contra a criança e o adolescente em uma unidade pública de saúde. Ciênc Saúde Coletiva 2002; 7(2): 275-83.. The findings in this study showed that, even though most of the participants had not attended specific courses on the subject, the notification of violence cases was reported by 69.5% of the professionals, suggesting that the practice of approximation and the listening process contribute with the understanding of several aspects related to violence in health services.

Researchers recommend that courses should be seen as opportunities to work the main difficulties found by health professionals when assisting victims that go to the service, as well as the main procedures involving notification, considering the importance of education in the field¹⁸18. Jaramillo DEV, Uribe TMJ. Rol de lpersonal de salud em laatención a lãs mujeres maltratadas. Inv Educ Enferm 2001; 19(1): 38-45.. Studies show that these gaps are present in the disciplines taught by graduation courses in the health field, which do not approach the multiple aspects related to violence¹⁹19. Finkelhor D, Zellman GL. Flexibe reporting options for skilled child abuse professionals. Child Abuse Negl 2000; 15(4) :335-41..

The findings in this study, which verify that about 70% of the professionals did not attend courses in this field, corroborate other studies conducted in the same city, in which only 30.5% of the health professionals from basic care (ESF and Basic Health units) were skilled to work in the process of identification and notification of violence cases⁸8. Lima MCC. Conhecimento e atuação dos profissionais da Atenção Básica de Saúde de Feira de Santana-BA frente à violência contra crianças e adolescentes [dissertação de mestrado]. Feira de Santana: Universidade Estadual de Feira de Santana; 2008.^,1818. Jaramillo DEV, Uribe TMJ. Rol de lpersonal de salud em laatención a lãs mujeres maltratadas. Inv Educ Enferm 2001; 19(1): 38-45.

19. Finkelhor D, Zellman GL. Flexibe reporting options for skilled child abuse professionals. Child Abuse Negl 2000; 15(4) :335-41.^-2020. Goldman J, Salus MK, Wolcott D, Kennedy KY. A coordinated response to child abuse and neglect: The foundation for practice. Child abuse and neglet user manual series. Washington: Department of Health and Human Services; 2003.. With regard to the credibility in SGDCA, evidence shows that this conduct can have a positive or negative influence on the notification process²¹21. Melton GB. Mandated reporting: a policy without reason. Child Abuse Negl 2005; 29(1): 9-18.^,2222. Noguchi MS, Assis SG, Santos NC. Entre quatro paredes: atendimento fonoaudiológico a crianças e adolescentes vítimas de violência. Ciênc Saúde Coletiva 2004; 9(4): 963-73.. In this study, it was possible to observe a positive and significant association between the notification and the credibility in the institutions, with regard to the identification and confirmation of cases, thus suggesting the articulation between the practices of professionals from different sectors involved in care, defense and protection. With regard to referrals, child protective services, which is a permanent, autonomous and non-jurisdictional party, is reference in terms of guaranteeing the rights, by embracing and checking the accusations³3. Brasil. Ministério da Saúde. Secretaria de Assistência à Saúde. Notificação de maus-tatos contra crianças e adolescentes pelos profissionais de saúde: um passo a mais na cidadania em saúde. Brasília: Ministério da Saúde; 2002.^,2323. Brasil. Estatuto da Criança e do Adolescente: Lei nº 8.069, de 13 de julho de 1990. Brasília: Ministério da Justiça; 1990.. The results presented in this study show that most professionals referred the cases to child protective services, even though a considerable proportion of them have referred cases to the police sector, whose attributions are different. From the perspective of Whole Care provided to children and adolescents who are victims of violence, the police sector (Public Safety) is not part of the group of institutions addressed to care and referral of the victims, even though it is part of a network of institutions that provide civil protection facing violent social events²⁴24. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas. Linha de Cuidado para a Atenção Integral à Saúde de Crianças, Adolescentes e suas Famílias em Situação de Violência. Brasília: Ministério da Saúde; 2010.. In this context, while most professionals referred the cases properly, part of them considers that juvenile violence is a problem involving Public Safety. The results in this study corroborate the findings of other analyses, which showed the inadequate conduct and referral for violence victims, thus contributing with the perpetuation of the cycle of victimization⁸8. Lima MCC. Conhecimento e atuação dos profissionais da Atenção Básica de Saúde de Feira de Santana-BA frente à violência contra crianças e adolescentes [dissertação de mestrado]. Feira de Santana: Universidade Estadual de Feira de Santana; 2008.^,2525. Sanders T, Cobley C. Identifying non-accidental injury in children presenting to A & E departaments: an overview of the literature. Accid Emerg Nurs 2005; 13(2): 130-6..

The fear of confrontation with the aggressor and the impact of these threats upon family members, are some of the difficulties mentioned by professionals to justify the non-notification of violence cases²⁶26. Ferreira AL, Gonçalves HS, Marques MJV, Moraes SRS. A prevenção da violência contra criança na experiência do Ambulatório de Atendimento à Família: entraves e possibilidades de atuação. Ciênc Saúde Coletiva 1999 4(1): 123-30.. The closeness with the aggressor makes revelation more difficult, thus increasing the risk of recurrence. It also compromises the family core, which is often aware of the victimization. In this study, professionals reported this difficulty, among others, thus corroborating possible associations between the notification and factors related to aggressors and the family environment²⁷27. Scott L. Child protection: the role of communication. Nurs Times 2002; 98(18): 34-6.

28. Vetere A, Cooper J. Setting up a domestic violence service. Child Adolesc Mental Health 2003; 8(2): 61-7.^-2929. Keshavarz R, Kawashima R, Low C. Child abuse and neglect presentations to a pediatric emergency department. J Emerg Med 2002; 23(4): 341-5..

In the study from Feira de Santana, Bahia, it is important to mention the significant association between the notification in the VIVA system by the category of nursing technicians, which suggests the importance of professional education in all categories and levels of care in the health sector⁵5. Gawryszewski VP, Silva MMA, Malta DC, Mascarenhas MDM, Costa VC, Matos SG, et al. A proposta da rede de serviços sentinela como estratégia da vigilância de violências e acidentes. Ciênc Saúde Coletiva 2007; 11(Suppl 0): 1269-78.^,66. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Viva: vigilância de violências e acidentes, 2006 e 2007. Brasília: Ministério da Saúde; 2009.^,3030. Lima JS, Deslandes SF. A notificação compulsória do abuso sexual contra crianças e adolescentes: uma comparação entre os dispositivos americanos e brasileiros. Interface (Botucatu) 2011; 15(38): 819-32..

The complexity of the notification of violence cases in the health network has been an object of study in other countries (the United States and Australia), where barriers begin by the lack of record standardization, whose indicators show that the notified cases are not confirmed, and most of them do not receive any other type of care or referral, thus demonstrating the importance of strengthening and structuring the protective network for the victims³⁰30. Lima JS, Deslandes SF. A notificação compulsória do abuso sexual contra crianças e adolescentes: uma comparação entre os dispositivos americanos e brasileiros. Interface (Botucatu) 2011; 15(38): 819-32..

The result of this study was significant in the category of physicians regarding the fact that they do not require the opinion of another professional. These results can possibly be a consequence of the dynamics from the emergency service, which requires immediate action, after fast evaluations. Therefore, it is more difficult to conduct more extensive discussions in possible cases of violence, together with the staff¹⁰10. Deslandes SF. O atendimento às vítimas de violência na emergência: "prevenção numa hora dessas?" Ciênc Saúde Coletiva 1999; 4(1): 81-94..

On the other hand, the results in the same study that pointed out significant results for the notification and filling out of the notification form in the VIVA SYSTEM, by nursing technicians, can be related to the longer length of care, which promotes more closeness and connection between victims and family members.

FINAL CONSIDERATIONS

Even though the health sector has been working for the institutional strengthening and the articulation with the Network of Prevention, Care and Guarantee of Rights/SGDCA, the violence scenario from the perspective of care and notification of health services is more complex than the lack of preparation in professional education addressed to care. This reality suggests the need to invest in actions and multidisciplinary education programs in the field.

The inadequacy of the biomedical model in the formation of professionals requires new alternatives to fill the gaps of education. From this perspective, the health sector is faced with the challenge to improve and extend its infrastructure by using skilled teams, with efficient routines and management for the institutionalization of the notification process, in order to care for victims and families¹⁵15. Assis SG, Avanci JQ, Pesce RP, Pires TO, Gomes DL. Notificações de violência doméstica, sexual e outras violências contra crianças no Brasil. Ciênc Saúde Coletiva 2012; 17(9): 2305-17..

It is recommended that the gaps of the results presented here should be further analyzed, and the matter of juvenile violence notification should be amplified, with more complex analyses of interaction models with longer activities in emergency units, in order to understand how the investigated context works.

References

Publication Dates

History