Mental health matrix support in primary care: an implementation experience

ORIGINAL ARTICLE

NASCIMENTO, Yanna Cristina Moraes Lira ^[1], MOURA, Adriana Tenório Gomes de ^[2], SANTOS, Cristiane Ferreira da Silva ^[3], SANTOS, Israel Braz Nunes dos ^[4], MATOS, Mônica Santos ^[5]

NASCIMENTO, Yanna Cristina Moraes Lira. Et al. Mental health matrix support in primary care: an implementation experience. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year. 07, Ed. 10, Vol. 07, pp. 128-145. October 2022. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/psychology/mental-health-matrix

ABSTRACT

Matrix support in mental health is an instrument that brings specialized care closer to the primary level of health care, in search of better resolution and comprehensiveness of care. In this sense, we sought to answer the following guiding question: What are the professional guidance actions promoted by the MatriciaMENTE extension project and its benefits to the implementation of matrix support in mental health in Maceió/AL? Determining the general objective of the study: to describe the professional guidance actions promoted by the MatriciaMENTE extension project as well as its benefits to the implementation of matrix support in mental health in the city of Maceió, Alagoas. This is a report of good practices that took place in Brazil in a northeastern capital from July 2017 to May 2018, in which 40 facilitators of actions among students, residents, teachers and professionals from the Municipal Health Department participated. More than 200 professionals benefited from continuing education actions through pedagogical meetings and in loco supervision, in the form of conversation circles and workshops aimed at matrix professionals at the Psychosocial Care Centers, the Expanded Family Health and Primary Care Centers. The experience resulted in dialogue, sharing of responsibilities between professionals in matrix services and primary care, elaboration of the Singular Therapeutic Project, clarification of concepts about matrix support as a model that proposes collaborative and interdisciplinary care, in addition to promoting spaces for learning and skill technique in the process of academic training. It is concluded that the MatriciaMENTE project was a practical-methodological tool for the implementation of matrix support in Maceió, highlighting that the dialogue between the University and other public institutions and the persistence of professionals in improving the level of assistance were fundamental factors throughout the process.

Keywords: Mental health, Mental health services, Patient Care Team, Comprehensive health care.

INTRODUCTION

Matrix support, also known as matrix support, has its term derived from the word Matrix, which starts from the idea of ​​a central point towards different directions, in order to be metaphorically understood as a point that articulates several services to enable the construction of a network, or even facilitate their movement with care at the center. In this sense, it becomes understood as a work organization strategy among health teams supported by co-management and specialized technical support (CAMPOS, DOMITTI, 2007; BRASIL, 2011; LIMA; GONÇALVES, 2020), known worldwide as a network integration device , which encourage shared care and collaborative care, as is the case in Australia and Canada (TREICHEL; CAMPOS; CAMPOS, 2019).

In matrix support, care for mental health users becomes integral, collaborative, interdisciplinary and intersectoral, with multidisciplinary dialogical relationships that transform the way of producing health based on pedagogical-therapeutic interventions (ARAUJO et al., 2019; ALMEIDA et al., 2020).

In Brazil, the first experiences in matrix support in mental health emerged in 1989, in the city of Campinas-SP, and later, in 2004, it was incorporated by the Ministry of Health to better articulate mental health equipment and facilitate the direction of the network. The care offered by the Unified Health System (SUS)[6] strengthens the components of the Psychosocial Care Network (RAPS)[7] from 2011, strengthening communication between Basic Health Units (UBS)[8] and Psychosocial Care Centers (CAPS)[9], ratifying that psychiatric reform does not advance if primary care is not incorporated into the process (BRASIL, 2011; SILVA, 2018; ALMEIDA et al., 2020).

To enable this approximation of mental health with primary care, matrix support becomes the effective element in the new way of doing health, based on the Expanded Clinic in favor of better assistance and access to services. This proposal transforms the traditional and little dynamic logic of the biomedical model, which reinforces the fragmentation of care, the bureaucratic effects and the transfer of responsibility, preventing expanded, integrative actions, articulated at different levels of care (BRASIL, 2011; LIMA; GONÇALVES, 2020; IGLESIAS; AVELLAR, 2019).

With matrix support in mental health in primary care, care is now monitored by at least two teams. A reference team that knows the case in more depth (be it individual, family or collective), which reorganizes care and acts with health responsibility, in an integral and territorialized way, like primary care teams; and a specialized matrix support team that enhances care, communication and approximation of services, such as CAPS teams and Expanded Family Health and Primary Care Centers (NASF AB)[10] (BRASIL, 2011; SANTOS et al., 2020 ; IGLESIAS; AVELLAR, 2019).

These support teams are organizational arrangements that act as methodological instruments for the management of health work, operationalized through networks of relationships and exchanges between professionals from various services, ensuring comprehensive care at all levels of care (SILVA, 2018; ALMEIDA et al., 2020).

Among the instruments that can facilitate the realization of matrix support, there are the elaboration of the Singular Therapeutic Project (PTS)[11], interconsultation, home visit, joint consultation, use of genogram and ecomap, construction of communication channels, permanent education in mental health and the creation of groups in primary health care (BRASIL, 2011; ALMEIDA et al., 2020).

It is worth noting that matrix support is not limited to health interventions, interventions can go further and require intersectoral actions, since there are works articulated with other social assistance sectors, such as the Social Assistance Reference Center (CRAS)[12] and the Specialized Reference Center for Social Assistance (CREAS)[13], such as the sectors of justice, education, work, security, sports, culture and leisure (IGLESIAS; AVELLAR, 2019). An analysis of communication in this intersectoral process is important, so that co-responsibility between network equipment occurs in a dynamic and effective way in order to guarantee comprehensive care.

The construction of a network of links, whether between users and services, between professionals and users, or between different services, constitutes the process of matrix support as the main access route that requires movement and monitoring strategies from devices. In this way, expanding (the) matrix actions in the basic network and investing in programs that guide professionals to work with these instruments can constitute the path of greater effectiveness to comprehensive care.

In this sense, we sought to answer the following guiding question: What are the professional guidance actions promoted by the MatriciaMENTE extension project and its benefits to the implementation of matrix support in mental health in Maceió/AL? Determining as the general objective of the study to describe the professional guidance actions promoted by the MatriciaMENTE extension project as well as its benefits to the implementation of matrix support in mental health in the city of Maceió, Alagoas.

METHODOLOGY

This is a report of good practices on the implementation of Matrix support in mental health in the city of Maceió, State of Alagoas. Brazilian municipality with an estimated population of 1,018,948 inhabitants (IBGE, 2019) and which has a limited psychosocial care network, with 03 CAPS type II, 01 CAPS AD III and 01 CAPS for Children and Adolescents, and 2 more CAPS in the process of being qualification. There are also 06 Mental Health Beds in a General Hospital, covered by the Mobile Emergency Care Service (SAMU)[14], and 07 Emergency Care Units (UPA)[15], in addition to 7 Therapeutic Residences, 1 Culture Center, some Psychosocial Rehabilitation initiatives and Solidarity Economy, 2 Psychiatric Hospitals and primary care consisting of 65 Basic Health UBS Units with 86 Family Health Strategy teams, covering approximately 30% of the territory, in addition to 10 NASF and 06 teams from the Street Clinic (CnaR)[16].

Faced with this network and with the need to implement matrix support in mental health in the municipality, the mental health management of the Maceió Health Department (SMS)[17] invited a group of professors involved in mental health issues at the Universidade Federal de Alagoas (UFAL) in 2015, to contribute to the development of a project to implement matrix support in the municipality.

The “MatriciaMENTE Project: stimulating matrix support actions in Maceió” was born, developed by the UFAL School of Nursing, at the invitation of the Maceió SMS in partnership with the Universidade Estadual de Ciências da Saúde de Alagoas  (UNCISAL), through the Nursing residency and Medicine in psychiatry and mental health. Initially, the project was created as a pilot project in two health units that had a Family Health Strategy (ESF)[18], selected by the SMS. After 6 months, it was evaluated, ceasing to be a pilot project and becoming a permanent implementation project.

In this second phase, the MatriciaMENTE Project was incorporated into the “CuidadosàMENTE Program” in the axis of permanent education actions, also elaborated by UFAL, at this moment the focus of the actions was the realization of bimonthly cycles of supervision of the technical team of matrix professionals from the CAPS and NASF, through pedagogical meetings and in loco monitoring, sometimes in the form of conversation circles, sometimes in workshops, reinforcing and strengthening the concepts of matrix support with these teams.

Thus, the present report concerns the execution of the actions of this second phase, which took place from July to December 2017 and from January to May 2018. 40 people participated directly in the project, as facilitators of the actions, including 13 undergraduate students (6 from nursing, 4 from psychology, and 3 from social work), 4 nursing residents in mental health and psychiatry, 7 professors (5 from nursing, 1 from social work and 1 from psychology), and 16 technical professionals from the SMS of different formations. However, in some meetings, the entire team of the selected health unit participated, reaching more than 200 professionals who benefited from the permanent education actions promoted by the project.

The project was configured in 4 cycles, in the first two the actions took place in the CAPS services and in the last two cycles in the UBS referenced by the CAPS. Always following the bimonthly schedule presented in Table 1, distributing activities according to Sanitary Districts (DS)[19].

Table 1 – Bimonthly schedule of Extension Project activities, 2017

Source: The authors.

It is important to point out that in Maceió health care is regionalized, with the municipality divided into eight DSs. Each DS is made up of several neighborhoods with different population averages, ranging from just over 40,000 inhabitants to districts with 270,000 inhabitants, and due to the small number of CAPS services and different population numbers in each district, the municipal management established two districts under reference of a single CAPS service (except CAPSi and CAPSad which are the only ones in Maceió and references for all DS). Although the population contingent is far beyond that recommended by the Ministry of Health, it was the possible mechanism for the reality experienced in the municipality according to Table 2.

Table 2 – Distribution of reference CAPS for each Sanitary District, their respective neighborhoods and population number, 2019

*CAPS still in the process of qualification by the Ministry of Health. Source: SMS, 2019.

The pedagogical meetings lasted from two to three hours, and aiming at not interrupting services, they were strategically held at the health units. In the first two cycles, the objectives of the meetings, in the period of 2017, were to present the theme to mental health professionals, facilitating the understanding of what matrix support is, what are the strategies for achieving it, what is the role of each team in the process, and what is the objective of this new way of producing health.

The objectives of the third and fourth cycle, in the months of 2018, were to put the process into practice and give mental health and primary care professionals the opportunity to discuss mental health cases together and think of solutions for each problematic posed to comprehensive and resolving care. For this, the UBS were asked to survey the complex cases that occurred in that territory, and based on this demand, the case they would like to discuss at the meeting was chosen, so that the PTS could then be built in a collective and multidisciplinary way, sharing care.

There were meetings in which approximately 10 professionals participated, and others with greater adherence with 50 professionals. The UBS that participated in the discussions of the cases were chosen by the managers, being elected those that were reference units in the territory, had a Family Health Strategy and needed more clarification about the matrix support.

All meetings were facilitated by professors from UFAL, with the help of resident nurses from the residency program in Psychiatry and Mental Health at UNCISAL and undergraduate students participating in the project. Thus, the results of this experience will be presented, describing how the meetings took place, the methodology used, the goals reached, the limitations and their benefits.

RESULTS AND DISCUSSION

Actions linked to primary care are fundamental to the evolution of the SUS, which consider the principles of universality, equity and comprehensiveness. In this sense, matrix initiatives are essential for the improvement of RAPS, and the strengthening of psychiatric reform and the anti-asylum struggle (LIMA; GONÇALVES, 2020). Bearing in mind the viability of the principles of completeness and universality of actions, matrix support enables users of the health network to move between existing services in search of resolution and (that) have their needs met according to their specificities. It is a tool that makes it possible to unite professionals from different backgrounds so that there are resolutive responses based on the PTS collectively prepared with primary care, the matrix team, if necessary the assistance team (CRAS and/or CREAS), and other services (OLIVEIRA; WACHS, 2018).

The MatriciaMENTE project promoted many actions to guide the realization of matrix support in Maceió, and at all times it fostered this understanding of shared care. During the two initial cycles that resulted in five meetings of pedagogical meetings in CAPS qualified in Maceió and two planning meetings with the managers of these services, the activities started with a video about the potentialities of teamwork, stimulating the debate between the professionals around collective work and care in RAPS.

Then there was the explanation of the MatriciaMENTE project and the presentation of the professionals present through the dynamic “Building a network”. Afterwards, there was a survey on the theme of matrix support in the perception of professionals and how they could carry it out. After the opinion of all participants, a conversation circle was set up guiding them on the concepts and tools used to carry out the matrix support.

The understanding was aligned that the Matrix support aims to expand the possibilities of carrying out the expanded clinic and dialogical integration between different specialties and professions, in order to enable the necessary assistance and technical-pedagogical support (CAMPOS; DOMITTI, 2007; CHAZAN et al., 2019). It was also discussed that, in order to carry out the matrix support, some collaborative arrangements with interdisciplinary practices aided by instruments such as the PTS should be adopted.

The same questions and dynamics were used in the five meetings held in qualified CAPS in Maceió. And it was noticed that, although many were unaware of the tools used in matrix support, most had the idea of ​​an articulated and integrative work that could offer specialized support. Professionals from all NASF teams in Maceió were incorporated into these meetings, which added a lot of experience during the sharing of experiences in the conversation circles, and because it is a constant practice in their daily work.

Regarding the meetings with the managers, their importance was reinforced throughout the process of guiding their teams to carry out matrix-based actions. Then, space was opened for their experiences, giving voice to the manager. After listening and considering the reports, the next cycle was planned, based on the evaluation of previous meetings.

In this way, the perspective of the MatriciaMENTE extension project was aligned with the assumptions adopted by the Permanent Education Policy, which is to promote the training and development of workers in the SUS, based on everyday problems related to health care and the organization of work in health, encouraging the planning, execution and evaluation of training processes, shared between educational institutions, residency programs in health and health services (BRASIL, 2017; SILVA; SOUZA, 2017). What actually happened in all the meetings when the participants’ suggestions were widely considered in the planning of actions for the next cycle, confirming that personnel qualification processes must be structured from the problematization of their work process, recognizing their practices as learning opportunities (SILVA; SOUZA, 2017).

In this same perspective, there is Paulo Freire’s problematizing approach, where the individuals’ previous knowledge is valued, categorizing them as active agents in the (re)construction of knowledge, having a voice and decision-making power, praising spaces that allow interaction, and the dialogue as transforming mechanisms (VÉRAS et al., 015).

Spaces for dialogue were also guaranteed in the following cycles of the MatriciaMENTE project. In the third and fourth cycles, which resulted in six meetings at the Basic Health Units, and in two meetings with SMS managers, the proposal was for primary care professionals to share their aspirations and desires regarding the performance of specialized care professionals in conversation circles, and be trained in matrix work methods.

Soon after the presentation of the participants and explanation of the extension project in each meeting, the primary care professionals reported the cases that sought mental health care, and from there they began to build a shared care, with the responsibilities of each team being distributed and the goals to be achieved.

With this dynamic adopted in the pedagogical meetings, the conversation circles were configured in workshops as the training of both teams took place. In all workshops, the facilitators stimulated discussion and guided the construction of the PTS, as the Community Health Agents (ACS)[20], nurses and doctors from that particular unit rescued the most complex cases.

Thus, the workshops provided dialogue, favored the sharing of responsibilities among service professionals, encouraging each case to list a reference technician to manage the situation and be the link between service and user, in order to guarantee the protagonism of the subject and validity to the PTS.

In the six meetings that took place in the UBS of the third and fourth cycle, the teams from the CAPS and NASFs that are references for that chosen health unit were always present, in addition to some undergraduate students, residents and a professor from the MatriciaMENTE project. Some CnaR professionals were also present at some meetings when the chosen unit was the territory for these teams.

For most of the participants, the project brought many benefits. The meetings were considered moments of exchange between the teams present, in which they suggested solutions to the cases discussed, better understanding the concepts of matrix support, PTS and network articulation, expanding the understanding of agreeing on interventions with schools, technical courses, CREAS, CRAS, Guardianship Councils and others, since matrix support was a very new subject for everyone.

It was also noticed the need to improve the communication channels between the municipal management and the services, in some meetings for not reaching the UBS in a timely manner that there would be training, the service professionals were not organized in relation to their routine of work, which kept many of them, mainly nurses and doctors, in attendance with low adherence to the suggested training, on the other hand, there was intense participation of community health agents and professionals in the administrative sector. And even with the shortage of graduated professionals, the meeting was very productive and the chosen case had its PTS built, which reinforced the important contribution of mid-level professionals in the process, since in many situations they are the ones who establish the link with users and bring the demands to other professionals, which is why it is so important to consider their protagonism.

In the meetings, it was noticed that the family health strategy teams had misconceptions about matrix support. Their initial perceptions were that during the matrix support, the units would have individualized psychiatric care, many even thought of reserving rooms for the consultations of the medical specialist. As the workshops clarified that the matrix support was far from this conception, and that it would come to help professionals with mental health issues, through joint consultations, group consultations and shared home visits, the professionals showed disappointment and with the understanding that it would be another job. Added to this, the team understood that complex cases were generally more socially vulnerable, which required greater physical and mental strain on the part of the team to solve them.

There was a need for facilitators to intervene, clarifying that the matrix support, contrary to what they were thinking, had as its main objective to share responsibilities between the teams of the different services in the attempt to reduce the stress of the reference professional. It was important to highlight that the joint consultation allows for greater resolution and deepening of professional relationships, that through it any matrix professional, not just the medical specialist, could present the necessary tools for a better performance in mental health, as well as its handling (CHAZAN et al., 2019; TREICHEL et al., 2019).

It is in the matrix support meetings that the ways to carry it out emerge. Each place has its singularities, but without losing what guides them, which is comprehensive, humane and responsible care. The perspective of mental health brings specificities in the conception of care as a social construct, marked by sociocultural and economic aspects (LIMA; GONÇALVES, 2020). And to ensure the integrality of actions, interdisciplinary work is essential.

In this model of producing health, all professionals have essential functions. The matrix nurse will be able to share their experience during prenatal care to prevent complications during pregnancy or in the puerperium, the pharmacist will be able to clarify the therapeutic dimensions that certain drugs can cause, the nutritionist and the physical educator can intervene in raising self-esteem of a person with obesity, the social worker will be able to reduce the impacts of social vulnerability by guaranteeing some rights, the psychiatrist will indicate the medication conduct, in short, all professionals become essential in the care provided.

Another situation observed during the meetings was the resistance of primary care professionals in relation to monitoring users with problems arising from alcohol and drugs. In the rounds of conversations in which these issues were addressed, an attempt was initially made to demystify the theme and jointly outline interventions on the subject, CAPSad’s performance was extremely important, explaining harm reduction strategies that could be implemented in the communities.

The matrix support actions were not limited to those promoted by the MatriciaMENTE Project. At each meeting, the support teams were encouraged to continue carrying out their weekly actions, to map their territories of action and schedule visits to the UBS in search of cases or to publicize the matrix support. In this way, after supervising the extension project, the teams continued to matrix other UBS in their territories, until the supervision of the next cycle took place. That is, each month the constant work of the support teams reached approximately 5 to 10 primary care teams.

However, many elements were reported during supervision that made it difficult to carry out actions. The reduced number of support teams and limited services in the psychosocial network, the wide territory for the performance of a single reference service, among others, were limitations pointed out, not only in this experience, but in several other studies, being categorized as structural, subjective obstacles , cultural, epistemological, political, communication and precariousness of services (TREICHEL et al., 2019). But even with so many limitations, the assumption of promoting comprehensive and resolute care became the motivating element for the teams.

Thus, the actions and perceptions of the implementation of matrix support in the city of Maceió followed. At the end of the fourth cycle, the last meeting was held with the municipal management to evaluate the project and its possible renewal.

At the meeting, after the presentation of all the services, SMS passed on that during the project the incentives for actions generated a record of more than 50 cases matrixed in the network. He also reported that during the experience there was good adherence by the reference teams and specialized teams, despite the limitations of the world of work, there was also a need to maintain permanent education actions that continued to stimulate matrix support, since many still work in the logic of referral in the biological model. Another issue evaluated was the need to unify the CAPS records to better organize matrix actions, an issue that was selected to be the objective of the next stage of the project, its renewal.

For the university to be inserted in the municipality’s matrix process, it has been a privilege that fulfills its mission to exist. For the pedagogical political projects of undergraduate and graduate courses must train critical, reflective, dynamic (and) active professionals, in the face of the demands of the world of work, able to “learn to do and to learn” (EMMEL; KRUL , 2017), and for this, training based on practical experiences becomes essential. Reasons why they demand transformative extensionist actions from the university that allow students to face reality based on the psycho-emotional and technical skills acquired by socializing, making decisions and working in groups (PORTO; BITTENCOURT; SAMPAIO, 2015).

Investing in university extension projects with this profile has a direct impact on training, stimulating learning through practical, integrative, interdisciplinary and intersectoral actions, and in this sense the MatriciaMENTE Project facilitated the understanding of matrix support in the city where the University is located.

Within the proposal, the extension project contributed to professional training, which is a possibility to contextualize and dialogically interact with the community in the construction of new paths for service professionals, residents, students and teachers. The experience brought the resident nurses a partnership in the teaching-learning process of the health teams by providing critical reflection on the work in multidisciplinary spaces, the importance of dialogue and meetings to facilitate the exchange of information and the planning of actions.

The experience reinforced the need for greater dialogue between CAPS and UBS, for paradigm shifts and the improvement of concepts. In addition, it was shown that these actions are fundamental in the training process in mental health residency programs, as they add skill and quality to professional practice.

For undergraduate students, participating in the actions of the MatriciaMENTE project allowed them to be supportive in the process of permanent education of health workers, collaborating with the search for new studies on the subject in the perspective of sensitizing them to the improvement of the services provided. In addition, the learning stimulated by extensionist actions generates a lot of knowledge that during the coming professional act becomes constant practices.

Another benefit pointed out by the students was the access to the methodological instruments of professional practice before the conclusion of the course, when following the constructions of the PTS during the meetings. For the students, improvement, creativity and didactics in conducting the supervision process, from carrying out the planning of the meetings, to the execution of the conversation circles, the dynamics and chosen activities, were considered rich moments of learning and protagonism.

Even the unwanted situations generated during the course of the project were also punctuated as a rich learning process. It was noticed the extreme importance of acquiring the ability to mediate conflicts in the face of acceptance or refusal to change professional conduct, and to motivate workers to transform a biologicist and fragmented look impregnated in the routine of services, to a new “look” based on in the interdisciplinary and shared model of the extended clinic.

In this context, the experience brought benefits to the various participants, from health network professionals directly involved, such as management in the course of implementing matrix support in the municipality, and to professors and students, whether undergraduate or residency programs in their learning processes anchored in the logic of social inclusion of people with mental disorders.

FINAL CONSIDERATIONS

This report reached its proposed question of describing the professional guidance actions promoted by the MatriciaMENTE extension project, as well as its benefits to the implementation of matrix support in mental health in the city of Maceió, Alagoas. The actions collaborated mainly for the adherence of the CAPS and NASF professionals as a supporting team in the viability of the matrix support of mental health to the UBS of the municipality, confirming the MatriciaMENTE project as a practical-methodological tool in the implementation process.

The understanding of professionals in producing health from the perspective of an expanded model was essential for matrix support to become resolving in cases of mental health, unifying knowledge, promoting shared and comprehensive care that would allow looking at the sick person and seeing them beyond your psychic, as someone who has other care needs, whether outpatient, assistance, legal, educational or even social.

Despite the successful reach of extensionist actions in partnership with municipal management, many difficulties were exposed by professionals, such as the high demand for work to which they are submitted and the reduced number of professionals and services, which ratifies greater precariousness of work, which often favor the physical and mental illness of workers. This condition has had an impact on the adherence of professionals to shared actions that require motivation, time for meetings and willingness to listen to their peers in a horizontal posture.

It is important to perceive the act of matrixing as a way of approximation, which transforms hierarchical and bureaucratized mechanisms into ways of producing accessible health, shared in a network, which considers the integrality of the subject and the effectiveness of the clinic through the PTS.

Experience has shown that projects in this direction of interdisciplinarity expand the process of training students, enabling the acquisition of technical skills in the management of complex cases involving mental health. It also showed that the dialogue and partnership between the University and other public institutions, the persistence of professionals in improving the level of assistance and the organization of the creative matrix process have been fundamental factors in the whole process.

It is suggested that many initiatives need to be thought out and put into practice to continue consolidating Matrix support as a transforming tool in care. Investments in permanent education and public policies are essential so that society can be shown that the place of the person with mental illness is in the community and around their family, and that primary care professionals understand the mind as part of a body and of a spirit immersed in a society.

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VÉRAS, Gerlane Cristianne Bertino; SOUZA, Marilena Maria de; TEOTÔNIO, Layse Fernandes; FÉLIX, Talyta Gonçalves da Silva; PEREIRA, Alice Silvana Gagliuffi; SOARES, Francisco Washington Evaristo da; SILVA, Maria Suelânia Queiroga da. Círculos de cultura e qualificação profissional para agentes comunitários de saúde da unidade básica de saúde São José: Relato de experiência. Revista Brasileira de Extensão Universitária. v. 6, n. 1, p. 53-58, 2015. Disponível em: <https://doi.org/10.36661/2358-0399.2015v6i1.1946>. Acesso em 05/06/2020.

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APPENDIX – FOOTNOTE

6. Sistema Único de Saúde (SUS).

7. Rede de Atenção Psicossocial (RAPS).

8. Unidades Básicas de Saúde (UBS).

9. Centros de Atenção Psicossocial (CAPS).

10. Núcleos Ampliados de Saúde da Família e Atenção Básica (NASF AB).

11. Projeto Terapêutico Singular (PTS).

12. Centro de Referência de Assistência Social (CRAS).

13. Centro de Referência Especializado de Assistência Social (CREAS).

14. Serviço de Atendimento Móvel de Urgência (SAMU).

15. Unidades de Pronto Atendimento (UPA).

16. Consultório na Rua (CnaR).

17. Secretaria Municipal de Saúde (SMS).

18. Estratégia Saúde da Família (ESF).

19. Distritos Sanitários (DS).

20. Agentes Comunitários de Saúde (ACS).

^[1] Doctoral student in Social Work at the Universidade Federal de Alagoas (UFAL), Master in Nursing at UFAL, Specialist in Psychiatry and Mental Health at the Universidade Estadual de Ciências da Saúde de Alagoas, Graduate in Nursing at UFAL. ORCID: 0000-0003-3705-1429.

^[2] Specialist in Psychiatry and Mental Health, in Residence Modality, by the State University of Health Sciences of Alagoas – UNCISAL. ORCID: 0000-0003-3705-1429.

^[3] Specialist in Domestic Violence, in the Lato Sensu Modality, by Faculdade da Região Serrana. Degree in Social Work from the Universidade Federal de Alagoas. ORCID: 0000-0003-3705-1429.

^[4] Degree in Social Work from the Universidade Federal de Alagoas. ORCID: 0000-0002-8611-1929.

^[5] Specialist in Psychiatry and Mental Health, in Residence Modality, by the Universidade Estadual de Ciências da Saúde de Alagoas – UNCISAL.

Sent: September, 2022.

Approved: October, 2022.