ESTRATEGIAS PARA HACER FRENTE A LA VIOLENCIA CONTRA NIÑOS, ADOLESCENTES Y MUJERES EN EL CONTEXTO DEL AISLAMIENTO SOCIAL DEBIDO AL COVID-19: REVISIÓN DE ALCANCE

Lettiere-Viana, Angelina; Baraldi, Nayara Girardi; Carlos, Diene Monique; Fumincelli, Laís; Costa, Luiza Cesar Riani; Castro, Paola Cristina de

doi:10.1590/1980-265X-TCE-2020-0443

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Special Section COVID-19 • Texto contexto - enferm. 30 • 2021 • https://doi.org/10.1590/1980-265X-TCE-2020-0443 linkcopiar

ESTRATEGIAS PARA HACER FRENTE A LA VIOLENCIA CONTRA NIÑOS, ADOLESCENTES Y MUJERES EN EL CONTEXTO DEL AISLAMIENTO SOCIAL DEBIDO AL COVID-19: REVISIÓN DE ALCANCE

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo: mapear las recomendaciones de las estrategias para hacer frente a la violencia contra niños, adolescentes y mujeres en el contexto del aislamiento social debido al Covid-19.

Método: revisión de alcance de conformidad con el Joanna Briggs Institute, por medio de una estrategia de investigación realizada en la literatura gris en el Portal CAPES y en las siguientes bases de datos: SCIELO, LILACS, PubMed, CINAHL, Web of Science, Repositorio Institucional para Intercambio de Información de la Organización Panamericana de la Salud. El análisis del material identificado estuvo a cargo de tres revisores independientes. Los datos extraídos fueron analizados y sintetizados de forma narrativa.

Resultados: de los 526 estudios encontrados, 59 se mantuvieron para la revisión y su contenido se sintetizó en seis categorías: 1) prevención; 2) identificación e intervención; 3) atención continua; 4) atención a la seguridad y la salud mental de los profesionales; 5) intersectorialidad/interdisciplinaridad; y 6) atención especial a poblaciones vulnerables.

Conclusión: los servicios de salud deben garantizar atención continua, intersectorial y segura, en especial en el ámbito de la salud mental, al igual que debe promoverse la concientización comunitaria. Los profesionales de la salud deben permanecer sensibles y alerta a señales de violencia, interviniendo de forma inmediata y conectados a la red de protección.

DESCRIPTORES:
Exposición a la violencia; Violencia doméstica; Infecciones por coronavirus; Aislamiento social; Violencia de pareja; Maltrato infantil; Revisión

Conceptual categories of recommendations	Studies
Prevention
To improve the mental health services, promoting psychosocial care to parents, caregivers and intimate partners, remotely or in person;	⁴ ^, ¹³ ^, ²⁹ ^, ³² ^, ³⁷ ^, ³⁹
To increase the teams that work in the prevention of violence;	²⁸
To provide support and guidance to parents and caregivers on: positive parenting (responsive care, family dialog, reading, positive coping strategies, early education, stimulation and protection against taboos and violence, not using force and cohesion), social support and self-care (stress management, physical exercise, relaxation, sleep and eating routine, and the prevention of useless coping strategies, such as the use of tobacco, alcohol or drugs);	⁴ ^, ⁹ ^- ¹¹ ^, ¹⁴ ^- ¹⁵ ^, ³⁰ ^, ⁴⁰ ^- ⁴¹
To stay alert in relation to parents using beverages or psychoactive substances and on the increase of intra-family stress, providing treatment by telemedicine or in person;	⁴ ^, ²⁹ ^, ³⁷
To conduct state campaigns to reduce the consumption of alcohol and other drugs during the period of social isolation;	⁴
To guide women to keep in touch with friends and family through text messages, video and voice calls so that there is a support network;	¹⁴ ^, ²⁸ ^, ³³
To inform and guide older adult women who have caregivers to recognize situations of violence and seek help via phone, messages and e-mail in a safe manner;	³⁹
To disclose to the population, through radio, television, notices in supermarkets, pharmacies, social networks and urgency and emergency services, information about the increase in violence, signs for its identification; reproductive health; support to the victims and locally available services (helplines/hotlines, shelters, counseling services). To produce accessible materials in Braille and Libras;	⁴ ^, ⁸ ^, ¹⁴ ^, ¹⁶ ^- ¹⁸ ^, ³³ ^, ⁴⁸ ^, ⁵⁴ ^- ⁵⁸
To create and implement laws against domestic violence and policies that guarantee employment and autonomy for women.	¹⁶
Identification and intervention
To keep professionals, especially in health and education, alert and sensitive, enabling them to identify warning signs;	⁵ ^, ¹⁹ ^- ²¹ ^, ³⁶ ^, ⁵⁴ ^, ⁵⁹ ^- ⁶⁰
To review protocols for the identification and support of situations of violence, considering the peculiarities of each region of the country;	²⁰ ^, ²⁸ ^, ⁴⁸ ^, ⁶¹
To provide care with respect, sympathy and confidentiality, and care with a person-centered approach, validating experiences and feelings;	¹⁰ ^, ¹⁴ ^, ²²
To provide standard admission forms for the evaluation of women subjected to IPV or sexual assault in units, clinics and community screenings devoted to responding to Covid-19, with individual approaches for those who are unable to respond privately;	²³ ^, ²⁹ ^, ⁵⁴ ^, ⁴²
To immediately refer children with suspected injuries derived from violence, if necessary hospitalization to clarify and ensure the child's protection;	¹⁵ ^, ⁶²
To connect people in situations of violence to protection and continuous care services, facilitating safe access.	¹⁴ ^, ³² ^, ³⁶
Continued care
Not to neglect care related to health and violence against children, adolescents and women;	³ ^, ¹¹ ^, ¹³ ^, ³¹ ^- ³⁵
To classify violence assistance, protection and prevention services as essential;	⁴ ^, ⁴⁸ ^, ¹⁴ ^, ³³ ^, ⁴¹ ^, ⁴³ ^- ⁴⁴ ^, ⁵⁸ ^, ⁶¹ ^, ⁶³
To adopt strategies that ensure the continued care and safety of children, adolescents and women, whether in person or remotely (development of new digital platforms that enable contact and health care; friendly and accessible platforms; leveraging existing platforms; training and support for the health professionals to work on digital platforms);	⁴ ^- ⁵ ^, ⁸ ^- ¹⁰ ^, ¹⁵ ^- ¹⁶ ^, ²⁴ ^, ³⁰ ^, ³⁸ ^, ⁴¹ ^, ⁴⁴ ^, ⁴⁶ ^, ⁵⁵ ^, ⁵⁸ ^, ⁶¹ ^, ⁶⁴ ^- ⁶⁵
To promote medical and social assistance services in the nature of telemedicine and virtual counseling 7 days a week, 24 hours a day;	⁴⁶
To implement legal support in a virtual manner;	⁸ ^, ⁴⁶
To provide free telephone lines and hotlines for reporting violence;	¹⁰ ^, ¹⁴ ^, ²² ^, ³⁸ ^, ⁴¹
To identify ways online or over the phone to maintain services for perpetrators of violence;	⁴
To enable access to reproductive and sexual health services (special attention to prenatal care, reproductive planning, abortion medications if legalized, and actions against rape) in person or remotely;	⁴ ^, ⁴³ ^- ⁴⁴ ^, ⁵⁵ ^- ⁵⁶ ^, ⁶¹
To ensure safety and reduce exposure in remote care (standardize the question form; explain that these questions are asked to everyone; ask questions that can be answered with "yes" or "no"; evaluate non-verbal expressions; provide a field to which the woman can access, at a time that the aggressor is not close, and which, after filling in, the health server is warned/alerted of the situation of violence; providing services with safety mechanisms for quickly exiting the page and history of navigation that make aggressor control unfeasible);	⁸ ^, ⁴² ^, ⁵⁴ ^, ⁵⁸ ^, ⁶⁶
To provide updated information on the paths and places that are available to promote assistance, safe ways to seek help and collaborate in identifying family members, friends or neighbors who may be a source of support and contact for the victims. To include opening hours, contact details and whether the services can be offered remotely;	⁴ ^, ⁹ ^, ¹⁴ ^, ²² ^, ²⁹ ^, ⁵⁴
To keep service providers and community leaders informed about changes in the reference routes of care for violence;	¹⁰
Governments must finance assistance, protection and violence prevention services so that they are accessible, free, without time restrictions and that new services are created where they are not available;	¹⁴ ^, ²⁶ ^, ⁴⁴ ^, ⁵⁴ ^, ⁶¹ ^, ⁶⁴ ^, ⁶⁷
Governments must promote the funding of hotels, inns, housings, as well as using drug abuse treatment sites to become places of emergency shelter and distancing from the aggressor;	¹⁵ ^, ⁴¹ ^, ⁴⁶ ^, ⁶⁸
To keep frequent contact with the woman and the family after the end of social isolation by protection services.	³⁸
Care for the safety and mental health of the professionals
To assess physically and mentally, and ensure care and emotional support to the health professionals and the community involved in the care and coping with violence during the pandemic, with the care of pregnancy and motherhood, and respondents on the front lines;	¹⁰ ^, ⁴¹ ^, ⁵⁴ ^, ⁶⁹
To prioritize long-term care for these professionals;	³⁹
To promote self-care plans and encourage professionals to meet in regular support groups;	⁴¹
To increase support for family caregivers. To increase surveillance and monitoring of these families and health professionals in the long term;	³⁹
To reduce professional stress - rotation between functions; association of experienced and non-experienced workers; implement flexible hours, in particular, for workers directly affected or who have a family member affected by a stressful event;	⁴ ^, ⁴¹
To promote and continuously train professionals;	¹⁰ ^, ²⁸ ^, ⁴⁸ ^, ⁶¹
To ensure personal protective equipment for the health professionals, the community, lawyers and specialists in violence;	⁴¹
The managers must implement plans to deal with the safety and health of the workers;	¹⁴
The managers must show appreciation to the team for their commitment and ability to continue to provide the required level of service.	⁸
Intersectoriality/Interdisciplinarity
To carry out actions aimed at the care and prevention of violence in interdisciplinary teams. To think about intersectoral care, uniting sectors such as health, education, justice, media and non-governmental organizations;	⁴ ^, ¹³ ^, ⁴⁶ ^, ⁷⁰
Special care for vulnerable populations
To keep special attention and care for children and adolescents with disabilities, chronic problems and in situations of poverty, discrimination or conflict, marginalized during and after the pandemic;	⁴⁵
To minimize risks with policies that guarantee employment, health care and economic support for disadvantaged families;	⁴ ^, ¹⁵ ^- ¹⁶ ^, ⁴⁰ ^, ⁵⁴
To waive service fees for those disadvantaged women and provide high-speed Internet access.	⁴ ^- ⁵ ^, ¹⁶ ^, ³⁹ ^, ⁴⁴ ^, ⁵⁸ ^, ⁶¹ ^, ⁶⁴ ^, ⁷¹

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