Logical model and matrix of criteria for assessing care to people with mental disorders in conflict with the law

Oliveira, Lannuzya Veríssimo e; Coelho, Ardigleusa Alves; Uchôa, Severina Alice da Costa; Salvador, Pétala Tuani Cândido de Oliveira; Freitas, Cláudia Helena Soares de Morais

doi:10.1590/1413-812320212611.28562020

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FREE THEMES • Ciênc. saúde coletiva 26 (11) • Nov 2021 • https://doi.org/10.1590/1413-812320212611.28562020 copy

Logical model and matrix of criteria for assessing care to people with mental disorders in conflict with the law

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

We aim to describe the construction and validation of the logical model and the matrix of criteria for assessing care to people with mental disorders in conflict with the law. This is a methodological research, carried out from February to December 2019, following three procedures: 1) theoretical - composed of an evaluability study performed from documentary research and interviews with key informants; 2) empirical - construction of the collection instrument and selection of experts for the validation process of the proposed evaluation instrument; and 3) analytical - performing two Delphi steps. The evaluability study resulted in the elaboration and agreement of the logical model; the analysis and comparison between the reality of the policy and the logical model; and the elaboration of the matrix of criteria. The criteria matrix content adequacy was assessed by 16 experts in the Delphi 1 step and 12 experts in the Delphi 2 step, whose content was validated with a Content Validity Coefficient of 0.93. The logical model and the matrix of criteria proposed in this study are expected to direct health professionals, researchers, workers, and other social actors to assess this clientele’s care.

Key words:
Evaluation of health programs and projects; Evaluation of research programs and tools; Validation study; Mental disorders; Inmates

Fehring (1994)	Points	Adapted criteria	Adapted points
Master in Nursing	4	Master (Mandatory criteria)	0
Master in Nursing - dissertation with relevant content from the clinical area	1	Master with a dissertation on Mental or Prison Health	2
Research (with publication) in diagnostics	2	Research in the field of Mental or Prison Health	3
Paper published in the field of diagnostics in a reference journal	2	Paper published in the area of Mental or Prison Health	2
Doctorate in diagnosis	2	Doctor with a thesis on Mental or Prison Health	4
Clinical practice of at least one year in medical clinic Nursing	1	Professional experience in Mental or Prison Health	2
Certified in the clinical medical field with proven clinical practice	2	Mental Health specialization certificate	1
Maximum score	14	Maximum score	14

Logical Model Component	Reality
Structure	“The ordinances are very lean, leaving many things without details, to be interpreted [...], but the big issue is that adherence to the ordinance is optional for the municipality. So, who is responsible? Will the state do everything? Will it be hybrid? Funding is impaired without municipalities’ adherence” (Informant 1) “There is no physical structure, no equipment to place the deinstitutionalization teams, or physical space. In fact, there is no implanted EAP, we are still trying to implement it” (Informant 1) “We are starting to articulate with the state conducting group, there is an ordinance, but it is not yet effective at work” (Informant 2)
Process	“The great difficulty is intersectoriality. It is still very truncated, with a certain dispute between Justice and Health, although the ordinances are joint. There is not much dialogue between SUS, SEAP, and SUAS” (Informant 1) “Health education actions are very specific and do not address problems from a macro perspective” (Informant 1) “Intersectoriality is the big issue because the ‘crazy-offender’ is nobody’s responsibility. Who wants to take on that role? Who wants to talk about it?” (Informant 3) “Another problem is that the professionals working in the Psychiatric Unit of Custody and Treatment are not effective in the service. It operates on occasional on-duty, so it harms a little the PTS issue” (Informant 4)
Results	“One good thing is that some CAPS have signed a partnership to work with disinternation, but other CAPS are not very prepared to receive these interns” (Informant 1) “We have a certain difficulty in releasing inmates; psychiatrists do not feel the support to suggest disinternation” (Informant 2) “Now that the deinstitutionalization team has a psychologist, it has somehow improved the monitoring and implementation of the therapeutic measure, because the psychiatrist is safer. However, there are still many difficulties, and changes are slow” (Informant 4)

Delphi 1 Step
Likert scale
Item	Adequate		Partially adequate		Inadequate		CVC
Item	n	%	N	%	n	%
Item 1	11	68.8	4	25	1	6.3	0.9
Item 2	11	68.8	4	25	1	6.3	0.9
Item 3	12	75	2	12.5	2	13	0.9
Item 4	11	68.8	4	25	1	6.3	0.9
Item 5	9	56.3	7	43.8	-	-	0.9
Item 6	14	87.5	2	12.5	-	-	1
Item 7	13	81.3	3	18.8	-	-	0.9
Item 8	8	50	8	50	-	-	0.8
Item 9	12	75	4	25	-	-	0.9
Item 10	14	87.5	2	12.5	-	-	1
Item 11	16	100	-	-	-	-	1
Item 12	11	68.8	5	31.3	-	-	0.9
Item 13	13	81.3	3	18.8	-	-	0.9
Item 14	7	43.8	8	50	1	6.3	0.8
Item 15	12	75	4	25	-	-	0.9
Item 16	13	81.3	3	18.8	-	-	0.9
Item 17	13	81.3	3	18.8	-	-	0.9
Item 18	11	68.8	5	31.3	-	-	0.9
Item 19	12	75	4	25	-	-	0.9
Item 20	11	68.8	5	31.3	-	-	0.9
Delphi 2 Step
Likert scale
Item	Adequate		Partially adequate		Inadequate		CVC
Item	n	%	N	%	n	%
Item 1	10	83.3	1	8.33	1	8.3	0.9
Item 2	10	83.3	2	16.6	-	-	0.9
Item 4	11	91.7	-	-	1	8.3	0.9
Item 5	9	75	3	25	-	-	0.9
Item 8	10	83.3	1	8.33	1	8.3	0.9
Item 12	11	91.7	1	8.33	-	-	1
Item 14	9	75	3	25	-	-	0.9
Item 18	10	83.3	1	8.33	1	8.3	0.9
Item 20	11	91.7	1	8.33	-	-	1

Component	Subcomponent	Analysis dimension	Indicators	Data and information collection technique
	Intersectoral management		Implementation of the State Conducting Group/Labor Commission (with community participation)
			Elaboration of a state deinstitutionalization strategy
			Implementation of a state deinstitutionalization strategy
		Structure	Adherence of municipalities in compliance with the Ordinances 94, 95, 142 of 2014	Document analysis/Interview with managers/Consulting with SIOPS
Political-managerial	Funding		Carrying out the monthly transfer for the cost of the service for the Evaluation and Monitoring of Therapeutic Measures applicable to People with Mental Disorders in Conflict with the Law
Tactical-operational	Comprehensive care		Implementation of EAPs	Interview with professionals and managers/field diary with a thematic roadmap
Tactical-operational	Comprehensive care		Human and material resources
	Intersectoral management		Articulation and communication between the SUS and SUAS	Interview with professionals and managers/field diary/consulting with SIOPS
	Intersectoral management		Articulation with the RAPS
Political-managerial	Funding	Process	Continuing education strategies for SUS, SUAS, and Justice professionals.
Tactical-operational	Comprehensive care		Shared service	Document analysis (medical records/Interview with users
Tactical-operational	Comprehensive care		Emphasis on the PTS	Document analysis (medical records/Interview with users
Tactical-operational	Comprehensive care	Results	Realization of the multidisciplinary support	Interview with professionals and managers and document analysis (medical records)/Interview with users
Tactical-operational	Comprehensive care	Results	Monitoring the implementation of the therapeutic measure

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[1] Collaborations

LV Oliveira worked on the conception of the study, in the collection and analysis of the data and in the final writing of the manuscript. AA Coelho worked on the conception of the study, in the analysis of the data and in the approval of the version to be published. SAC Uchôa worked on data analysis and approval of the final version to be published. PTCO Salvador worked on the critical review of the article and the approval of the version to be published and. CHSM Freitas worked on the conception of the study, the critical review of the article and the approval of the version to be published.