Diferença e diversidade: Perspectivas transfeministas na compreensão da categoria “gênero” / Difference and Diversity: Transfeminist perspectives on understanding the category "gender”

Gênero não é sexo. Este é o ponto de partida para iniciar o debate. Teresa de Lauretis discute sobre gênero tomando como ponto de partida a diferenciação em relação ao pensamento foucaultiano e colocando em questão as “diferenças sexuais”. Neste artigo, a proposta é de ampliar o debate de Lauretis, considerando a cisheteronorma na discussão sobre gênero a partir de teorias transfeministas. Thiffany Odara, Viviane Vergueiro Simakawa e Sofia Favero são algumas das autoras que trazem contribuições sobre essa temática, repensando normas e definições, por meio de um olhar atento à diversidade

Cohort profile : demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe

Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. Findings to date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. Future plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared. Trial registration number: NCT03013595

"Somos viantes, construimos vias" : não binariedade, configurações subjetivas e identidade

Orientadora: Profª Dr ª Norma da Luz FerrariniDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Humanas, Programa de Pós-Graduação em Psicologia. Defesa : Curitiba, 06/06/2022Inclui referências: p. 215-219Resumo: A não binariedade é um assunto que tem se popularizado e promovido debates principalmente no movimento LGBTI+ e, mais especificamente, no movimento trans. No âmbito acadêmico dos estudos de diversidade de gênero e sexualidade são recentes as produções que abarcam a temática de forma central. Tendo em vista os pressupostos da Teoria da Subjetividade de González Rey, esta pesquisa teve como objetivo geral compreender as configurações subjetivas da não binariedade de pessoas que se autoidentificam como não binárias, por meio da Metodologia Construtivo-interpretativa, apoiada nos princípios da Epistemologia Qualitativa, que se referem à singularidade com status epistemológico e à pesquisa com caráter construtivo-interpretativo, singular e dialógico. Participaram desta pesquisa cinco pessoas que se autoidentificam como não binárias e participam de um coletivo artístico trans. Foram realizadas duas dinâmicas conversacionais individuais e uma dinâmica conversacional em grupo. A partir de conceitos da Teoria da Subjetividade e sua relação com sexualidade; Apresentação de diferentes concepções de identidade e análise de suas aproximações e distanciamentos da concepção de identidade proposta pela Teoria da Subjetividade; Diálogo com diferentes concepções de gênero, foi possível ampliar compreensões sobre não binariedade, juntamente às vivências não binárias apresentadas. Algumas vias nas diferentes experiências de vida não binárias são compartilhadas: O não lugar; A nomeação - não binária ou outra - como identidade e lugar político; A língua e a linguagem com possibilidades de experimentação - linguagem neutra, poesia, literatura, arte, corporeidade -, como escoamento de sofrimentos e angústias e como potente via de conexões e contatos; Processos de transição de gênero que transcendem uma ideia de ponto de partida e chegada, mas dizem respeito a um processo contraditório, entre emoções e tensionamentos diversos, para além de nomenclaturas biomédicas e patologizações. É proposta, portanto, uma concepção de metamorfoses de gênero, que transcende a simples mudança de forma ou de essência. Esta metamorfose de gênero se expressa de forma singular nas pessoas participantes. Nos posicionamentos de gênero enquanto uma identidade que lhes localiza Metamorfose como movimento cuidadoso de identidade. Metamorfose como alquimia de si, como criação, estudo e aprofundamento das possibilidades de vivenciar gênero, para além de algo categórico, socialmente determinado ou construído e constituído. Metamorfose pela comunicação, espontaneidade e acolhimento às diferenças. Metamorfose produzindo vias, sendo "viantes" em busca de um mundo possível e plural em suas mais diversas singularidades. O que une a diversidade também é a própria diferença. Por fim, esta pesquisa não se conclui. Expande-se.Abstract: The non-binary gender identity is a subject that has become popular and promoted debates mainly in the LGBTI+ community and, more specifically, in the trans community. In the academic field of gender and sexuality diversity studies, the productions that address the theme in a central way are recent. Considering the assumptions of González Rey's Theory of Subjectivity, this research had the general objective of understanding the subjective configurations of non-binarity of people who self-identify as non-binary, through the Constructive-Interpretative Methodology, supported by the principles of Qualitative Epistemology, which refer to the singularity with epistemological status and the research with constructive-interpretative, singular and dialogical character. Five people who self-identify as non-binary and participate in a trans art collective took part in this research. Two individual conversational dynamics and one group conversational dynamic were carried out. From concepts of Subjectivity Theory and its relation with sexuality; Presentation of different conceptions of identity and analysis of their proximity with the conception of identity proposed by Subjectivity Theory; Dialog with different conceptions of gender, it was possible to broaden understandings about non-binarity, along with the non-binary experiences presented. Some pathways in the different non-binary life experiences are shared: The non-place; The naming - non-binary or other - as identity and political place; Language with possibilities of experimentation - neutral language, poetry, literature, art, corporeality - , as an outlet for suffering and anguish and as a potent way of connections and contacts; Gender transition processes that transcend an idea of starting and ending point, but concern a contradictory process, among diverse emotions and tensions, beyond biomedical nomenclatures and pathologizations. Therefore, a conception of gender metamorphosis is proposed, which transcends the simple change of form or essence. This gender metamorphosis is expressed in unique ways in the participants. In the positioning of gender as an identity that locates it Metamorphosis as a careful movement of identity. Metamorphosis as alchemy of self, as creation, study and deepening of the possibilities of experiencing gender, beyond something categorical, socially determined or constructed and constituted. Metamorphosis through communication, spontaneity, and welcoming differences. Metamorphosis producing ways, being a pathway (viantes) in search of a possible and plural world in its most diverse singularities. What unites diversity is also difference itself. Finally, this research does not conclude itself. It expands

Transition as a topic in psychiatry training throughout Europe: trainees' perspectives

The majority of adolescents with mental health problems do not experience continuity of care when they reach the transition boundary of their child and adolescent mental health service. One of the obstacles for a smooth transition to adult mental health services concerns the lack of training for health-care professionals involved in the transition process. This study aims to seek psychiatric trainees' opinions regarding training on transition and the knowledge and skills required for managing transition. A survey was distributed to trainees residing in European countries. Trainees from 36 countries completed the questionnaire, of which 63% reported that they came into contact with youth and young adults (16-26 years) during their clinical practice. Twenty-seven percent of trainees stated they have good to very good knowledge about the transition process. Theoretical training about transition was reported in only 17% of the countries, and practical training in 28% of the countries. Ninety-four percent of trainees indicated that further training about transition is necessary. The content of subsequent transition-related training can be guided by the findings of the MILESTONE project.status: publishe

Leaving child and adolescent mental health services in the MILESTONE cohort : a longitudinal cohort study on young people's mental health indicators, care pathways, and outcomes in Europe

Background The configuration of having separate mental health services by age, namely child and adolescent mental health services (CAMHS) and adult mental health services (AMHS), might be a barrier to continuity of care that adversely affects young people's mental health. However, no studies have investigated whether discontinuity of care in the transition period affects mental health. We aimed to discern the type of care young people receive after reaching the upper age limit of their CAMHS and examine differences in outcomes at 24-month follow-up between young people receiving different types of care. Methods To assess mental health in young people from 39 CAMHS in eight European countries (Belgium, Croatia, France, Germany, Italy, Ireland, the Netherlands, and the UK), we did a longitudinal cohort study. Eligible young people were CAMHS users up to 1 year younger than the upper age limit of their CAMHS or up to 3 months older, if they were still in CAMHS. Information on mental health service use, mental health problems (ie, using the Health of the Nation Outcome Scale for Children and Adolescents, Youth Self-Report and Adult Self-Report, DSM-5, and ICD-10), and sociodemographic characteristics were collected using self-reported, parent-reported, and clinician-reported interviews and questionnaires. Mixed models were applied to assess relationships between baseline characteristics, mental health service use, and outcomes. Findings The MILESTONE cohort included 763 young people. The participants were 60·0% female (n=458) and 40·0% male (n=305), 90·3% White (n=578), and had a mean age of 17·5 years (range 15·2–19·6 years). Over the 24-month follow-up period, 48 young people (6·3%) actively withdrew from the study. For young people, the higher their scores on the Health of the Nation Outcome Scale for Children and Adolescents (p=0·0009) and Youth Self-Report and Adult Self-Report (p=0·046), and who had a clinical classification of severe mental illness (p=0·0033), had suicidal thoughts or behaviours or self-harm (p=0·034), used psychotropic medication (p=0·0014), and had a self-reported or parent-reported need for continued treatment (p<0·0001) at baseline, were more likely to transition to AMHS or stay in CAMHS than to have care end. Overall, over the 24-month follow-up period, the mental health of young people improved, but 24·4% of young people reported an increase in problems calculated using the reliable change index, of whom 5·3% had a clinically relevant increase in problems. At 24-month follow-up, no differences in change in mental health problems since baseline were found between young people who used different types of care (CAMHS, AMHS, or no care). Interpretation Although approximately half of young people reaching the upper age limit of their CAMHS stop using mental health services, this was not associated with a deterioration in their mental health. Young people with the most severe mental health problems are more likely to receive continued care. If replicated, our findings suggest investments in improving transitional care for all CAMHS users might not be cost-effective in times of rising health-care costs, but might be better targeted at a subgroup of young people with increasing mental health problems who do not receive continued treatment

Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

International audiencePurpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services