Efeitos de uma intervenção preventiva nas competências emocionais e sociais de crianças em ambiente escolar

Abstract

In the last couple of years, the prevalence of mental disorders in children and adolescents have increased. Literature indicates that Anxiety Disorders and Depressive Disorder are highly prevalent in an isolated form or in comorbidity in this population. The presence of psychiatric symptoms in children and adolescents is a risk factor that may lead to developmental losses. Consequences include academic and relationship issues, increased involvement with violence, drugs and risky behavior, and the evolution of mental disorders in adult life. From this perspective, considering the high prevalence and severity of the effects of symptoms, it is important to prevent or reduce the impact of symptoms and promote mental health in children and adolescents. The school environment has been pointed as a favorable space for the development of mental health through the implementation of programs that aim to promote resources and prevent problems. School can contribute to the healthy growth by integrating academic, social and emotional learning and contributing to increase quality in student education. In face of what was exposed, it can be thought that early interventions focusing on the development of socio-emotional skills can help prevent behavioral problems and promote mental health. The Terapia de Regulação Infantil (TRI) has a preventive modality known as Terapia de Regulação Infantil Preventiva (TRI-P) or Trabalho de Regulação Infantil. The preventive mode of TRI is intended to the universal population with the aim of developing socio-emotional skills, working on techniques of emotional regulation and social skills, which are considered protective factors for the non-development of problems related to mental disorders. This dissertation aims to evaluate the effects of the preventive protocol of the Terapia de Regulação Infantil (TRI-P) on the socio-emotional skills of children from 7 to 9 years of age, in schools of a city in the interior of Rio Grande do Sul. This study is part of a larger project aimed to evaluate the effectiveness of Terapia de Regulação Infantil, which was approved by the Comitê de Ética da PUCRS (CAAE: 40658214.6.0000.5336). Initially, a theoretical section is presented with theoretical basis on the theme of the dissertation, exposing the prevalence and the consequences of the presence of symptoms of mental disorders in children and adolescents, the implementation of preventive programs in the school environment, the development of socio-emotional skills and researches with preventive programs. This section also presents the first study entitled: “Intervention based on a protocol of Cognitive-Behavioral Therapy: An experience report with children in school environment”, which aims to report the experience of applying the preventive protocol of Terapia de Regulação Infantil with a group of seventeen children in a private school in the interior of Rio Grande do Sul. The objectives and activities of each protocol meeting are described in details. It is suggested that TRI-P may have helped in strengthening skills acquired during the intervention through the use of accessible language and concrete materials. Stands out that the high number of participants may have hampered greater learning and participation of all during the activities. It is inferred that there was high adherence because no child dropped out of the program and there were positive feedbacks from those responsible. It was concluded that this report presented a possibility of intervention at school for the development of skills that are protective factors for the healthy development of children. The empirical section of the dissertation is divided into two empirical studies. The first study in this section concerns the pilot study conducted with the TRI-P and was entitled "Preventive Protocol of Terapia de Regulação Infantil: Pilot Study in the School Environment". This study aims to evaluate the effects of TRI-P on socio-emotional skills in children from 7 to 9 years of age. A quasi-experimental baseline study was performed comparing the experimental group (n=17) with a waiting list control group (n=11) before and after the intervention. The division of the groups was non-randomly. The scales used were the Social Skills Rating System (SSRS-BR) to evaluate social skills and behavior problems, and the Emotional Regulation Checklist (ERC) to evaluate emotional regulation and mood lability. Both scales were filled by those responsible. The period between pre and post evaluation was approximately 3 months. The research was conducted in a private school in the interior of Rio Grande do Sul. Results after intervention indicate significant decrease in behavior problem levels [Pre: 30,2±20,0 vs. Post: 22,4±15,8; p=0,018] and mood lability [Pre: 22,2±3,7 vs. Post: 19,9±3,2; p=0,036], in the experimental group. There was an increase, but not significant, in the emotional regulation and social skills scores in the experimental group. There was a significant difference between the groups in the subscale that assesses mood lability in the pre and post intervention evaluations (Pre: p=0,055; Post: p=0,006). The results point that the implementation of the TRI-P was effective to reduce behavior problems and mood lability levels of the sample and may be a promising option given the importance of mental health care in the school environment. The second empirical study entitled “Effects of an intervention to promote mental health and prevent children's behavior problems in school environment” aims to evaluate the effects of TRI-P on socio-emotional skills and symptoms of anxiety and depression in aged children. between 7 and 9 years of age. A quasiexperimental base outline was performed. 39 children participated in the study, who were non-randomly assigned to the experimental group and the waiting list. Those responsible completed the Social Skills Rating System (SSRS-BR) - Parents Version and the Emotional Regulation Checklist (ERC). On the other hand, children completed the Social Skills Rating System (SSRS-BR) - Children Version, Screen for Child Anxiety Related Emotional Disorders (SCARED) and Children Depression Inventory (CDI). The research was conducted in two schools, one private and one public, in a city in the interior of Rio Grande do Sul. The experimental group (n=22), which received the intervention of the protocol TRI-P, was compared to the waiting list control group (n=17), regarding to social skills levels, behavior problems, mood lability and emotional regulation, as well as the scores of symptoms of Anxiety Disorders and Depressive Disorder, before and after the intervention. The period between pre and post evaluation was approximately 3 months. There were no significant differences regarding the comparison of participant's demographic data between groups. Significant reduction in behavioral problem levels was noticed [Pre: 55,22±30,52 vs. Post: 37,09±30,15; p=0,013] and mood lability [Pre: 27,73±4,98 vs. Post: 24,04±5,10; p=0,006], as well as anxiety levels [Pre: 38,86±8,87 vs. Post: 28,00±8,02; p= 0,000] and depression [Pre: 11,18±6,48 vs. Pos: 6,68±3,82; p= 0,000], in the experimental group. Also a significant increase in levels of emotional regulation was noticed [Pre: 31,27±3,41 vs. Post: 34,09±3,23, p=0,000] and in social skills based on the self-evaluation of the child [Pre: 35,59±30,61 vs. Post: 59,00±29,29; p=0,002] and in the evaluation of the parents [Pre: 43,31±25,61 vs. Post: 58,27±24,87; p=0,001]. In the control group there was no significant increase or decrease. However, unlike the experimental group, in the control group there was a significant decrease in social skills levels in the self-assessment of children (p=0,019). There were statistically significant differences between the groups in the initial self-assessment of children in relation to social skills (p=0,044), in the final self-evaluation (p=0,010) and in the final emotional regulation evaluation (p=0,011). This research presents satisfactory results with the application of the TRI-P, since it decreased the levels of behavior problems and mood lability and increased the emotional regulation scores and social skills in the children undergoing the intervention. Thus, it was presented as an effective proposal to prevent emotional behavior problems of children in the school environment.