Avaliação de políticas a prevenção terciária da violência sexual contra crianças e adolescentes no Norte do Brasil

Abstract

Sexual violence against children and adolescents is a multifactorial issue that challenges the effectiveness of public policies and the responsiveness of specialized services in Brazil. In the Northern region, characterized by vast territorial expanse, deep socioeconomic inequalities, and limited access to protection services, addressing this issue requires integrated solutions and actions to enhance tertiary public policy prevention and intervention. This dissertation is part of the project “Quality of Bonds and Intrafamilial Violence in Brazil: Epidemiological Mapping, Risk and Protection Factors, and Professional Training Strategies,” funded by the CAPES Families and Public Policies program and coordinated by Prof. Dr. Luísa Fernanda Habigzang from the Pontifical Catholic University of Rio Grande do Sul (PUCRS). The study is organized into two complementary axes aimed at investigating gaps in social assistance and mental health services, analyzing the effectiveness of public policies, and assessing disparities between notifications and service provision. The first study analyzed the coverage of Specialized Social Assistance Reference Centers (CREAS) and Child and Adolescent Psychosocial Care Centers (CAPSi) in the Northern region, using data from the 2021 SUAS Census and the National Registry of Health Establishments (CNES). A total of 289 specialized facilities were identified, of which 278 belong to the Unified Social Assistance System (SUAS) and 11 to the Psychosocial Care Network (RAPS). The results revealed insufficient coverage, particularly in small municipalities, and unequal distribution, which negatively impacts the continuity of care. The second study examined the disparities between notifications of child and adolescent sexual violence and the services provided by the Specialized Service Program for Families and Individuals (PAEFI) in the state of Amazonas. This analysis was based on data from the Notifiable Diseases Information System (SINAN) and the Monthly Service Report (RMA) from 2018 to 2022. The findings highlighted significant disparities, attributed to inadequate infrastructure, geographic and cultural barriers, and poor communication between services. However, municipalities with greater network integration showed better service outcomes, emphasizing the importance of intersectoral collaboration. Overall, the results underscore the urgent need for investments in infrastructure, continuous professional training, strengthening protection networks, and awareness campaigns focused on tertiary prevention. Additionally, the findings suggest the necessity of multisectoral approaches to overcome barriers that hinder the effectiveness of public policies in the region. Therefore, this dissertation contributes significantly to understanding the gaps in public policies addressing sexual violence against children and adolescents, providing essential insights for more effective and integrated interventions.