Mental Health of At-Risk Youth
Child and adolescent victimization is a global public health problem. The United Nations estimates that there are 100 million children living in the streets around the world. Many of them suffer from severe socioeconomic problems and early emotional stress (EES) caused by factors like physical and sexual abuse.1 There is very strong evidence that adversity in children’s home lives negatively impacts their mental health, for example:
- Children with a history of maltreatment who have been separated from their parents are more susceptible to developing mental disorders2
- An estimated 30% to 85% of youth in out-of-home placements or living in group shelters have mental health problems3
- The rate of serious psychiatric disorders is approximately four times higher among these youth than among children who remain with their own families3
- Early exposure to domestic violence increases the risk for both internalizing and externalizing psychiatric problems4
- Exposure to domestic violence also hinders capacity for attachment, increasing vulnerability to repeated victimization5
The Need for Services in Brazil
In Brazil, around 28 million children and adolescents are victims of EES, and corporal punishment is highly prevalent (10.1%).6 Models from high-resource settings for promoting mental health among at-risk youth may not be appropriate for middle-income countries like Brazil, which experiences high levels of urban crime, violence, and the impact of the organized drug trade. Further, the existing services for children on the streets of in group shelters are frequently “inadequate, fragmented and poorly coordinated”,7 for a variety of reasons:
- There is little interaction between the social and health systems
- Social support is precarious
- Health care follow-up is impeded by frequent changes in client residence and the impracticability of assertive community outreach due to a lack of safety for community workers8
Long-term follow-up, from the street to the point of family reintegration, is essential to countering further family disaffection. However, in São Paulo it is difficult to maintain the bonds that sustain the confidence and trust of children and adolescents in these situations.
The Equilibrium Program
The Equilibrium Program was created to promote the social and family reintegration of maltreated children and adolescents through an interdisciplinary intervention program that provides multi-dimensional biopsychosocial treatment integrated with the diverse services needed to meet the unique demands of this population (e.g. general health care assistance, schools, social services, child welfare programs and the criminal justice system). Program development was guided by principles that emphasize acceptability to consumers, flexibility in addressing diverse client needs, and meeting the needs of high-risk sub-populations within a safe and accessible setting.
The Equilibrium Program offers comprehensive mental and physical health care along with social services in a Community Sports Center where participants receive specialized services and support for school attendance while participating in social and recreational activities with their peers. The center is near many of the shelters in the vicinity of downtown São Paulo and is open to the local community, facilitating the social reintegration process among children and their families in a safe and secure environment. The ultimate goal is to follow maltreated children and adolescents from the streets or group shelters throughout the process of community and family reintegration.