Policy framework

Portugal has a set of documents in different fields and under the jurisdiction of a diverse group of institutional actors that promote anticipatory healthcare for young people facing health risks:

National Programme for Children and Youth Health (PNSIJ)

The PNSIJ came into force in 2013 and arose after the positive impact of the model Programme of Action in Child and Youth Health, which was in force from 1992 to 2005.  This, through a programme of health monitoring, promoted a more equal access to health services and quality care that allowed, among others, a substantial reduction of the youth mortality rate.

The PNSIJ has introduced some changes, including:

• change in the chronology of appointments regarding key ages of surveillance;
• adoption of the growth curves of the World Health Organisation (WHO);
• a new approach to child development, considering the part of emotional and behaviour disorders, and ill-treatment.

The new PNSIJ values ​​the importance of anticipatory care as a factor of health promotion and disease prevention. Thus, the primary health care is fundamental to the initial detection of symptoms and in the secondary or targeted prevention, which operates to identify young people at a higher health risk. 

At the level of mental health, an investment was made in the prevention of emotional and behaviour disorders.

Under the PNSIJ, there is a set of services that are offered to young people, including:

- Children and Youth Health Appointments. It is a monitoring appointment, promoting health and prevention of diseases for children and young people under the age of 18, according to the National Health Plan.

- Support Centres for Children and Youth at Risk. A network of support Centres of primary health and hospital care available in health centres and hospitals.

Cross-reference with  Chapter 4 - Social Inclusion - 4.6 Access to Quality Services (3. Healthcare)

National Mental Health Programme

Under the National Mental Health Programme, the National Plan for Suicide Prevention 2013-2017 also provides for a group of preventive Strategies for specific populations, in particular teenagers.

This plan promotes the development of a set of initiatives for the prevention and early detection of signs of self-harm behaviour in teenagers, such as:

• intervention in the school space;
• school programmes to raise awareness of suicide, with training of teachers and educational agents to identify the warning signs, risk groups and referral; as well as the peers.

Stakeholders

PNSIJ identifies the shortcomings and imbalances in the professional distribution in Primary Healthcare (CSP). They act on human resources diversity suggesting, among other measures, home visitation as a way to monitor and promote health in cases of children/young people and families identified as at risk.

It also establishes the importance of team work through the involvement of a diverse group of actors that are part of the child/young person's life, particularly at the level of services that give support to the child and teenager: school or day care, spots or associative communities, social security services, local authorities, etc.

In addition, it also aims to give health professionals the role of training parents and caregivers with knowledge that promote early identification in the health area, in the role of first carers.  

The early and anticipatory intervention of young people at health risk is thus ensured by the concerted action of a wide range of actors that develop synergies amongst themselves in order to ensure and optimize an adequate monitoring of the health of children and young people

Guidance to stakeholders

The Directorate-General of Health offers a set of tools and documents that promote an early and anticipatory intervention to be more effective and capable.

Abuse of Children and Young People

DGS and the Division of Communication and Promotion of Health in the Cycle of Life elaborated a practical guide to approach, diagnose and prevent - Abuse in Children and Young People - Practical Guide to approach, diagnose and intervene - targeted at professionals of different levels of care of children and young people at risk.  The guide aims to raise the awareness and motivate health professionals about their role in the prevention and intervention of abuse, clarify and standardize the most important basics about abuse, and facilitate the processes of identification and intervention.

Within the same context, the National Commission for the Promotion of Children and Young People's Rights and Protection (CNPDPCJ) developed Guidelines for approaching abuse situations or other dangerous situations, targeted at professionals in the field of education, social work, security forces and health. 

Cross-reference with Chapter 4 - Social Inclusion - 4.6 Access to Quality Services (3. Healthcare)

The Reproductive Health portal (from the General Directorate for Health) also offers information material targeted at health professionals on female genital mutilation, family planning/contraception and domestic and sexual abuse.

Target groups

The National Programme for Children and Young People Health (PNSIJ) prioritizes the detection and support for children with special needs, at risk or especially vulnerable, and the reduction of inequalities in the access to health services.

In the case of detecting a situation of abuse or special health needs, the PNSIJ is supposed to promote strategies of flagging, referral and intervention in articulation with the "Health Action for Children and Young People at Risk" (ASCJR). The goal is to create a structured response from the National Health Service to the phenomenon of Abuse, through the development of a "National Network of Support Centres for Children and Young People at Risk", both at the level of Primary Health Care and at the level of Hospital with Paediatric care.

At the national level, the ASCJR is coordinated by the Directorate-General of Health, through a monitoring commission, and, regionally, by the regional health administrations.

Abuse in Children and Young People is framed in a typology that provides for a multiplicity of situations that represent the practice of abuse. These can present different clinical forms, but any of them puts the child/young person at a greater health risk, physically, emotionally or psychologically: - Negligence (includes abandonment and begging); Physical Abuse; Psychological/Emotional Abuse; Sexual Abuse; Munchausen syndrome by Proxy.

The intervention strategy in cases of abuse must also create synergies with the National School Health Programme and the National Early Intervention in Childhood System, among others.

In the case of children/young people with a disability or at a severe risk of development delay, families can benefit from an early intervention programme, through the National Early Intervention in Childhood System (SNIPI).

Funding

The set of strategies, recommendations and proposals referred both in the National Health Plan and Priority Health Programmes are funded by the Directorate-General of Health, through the Ministry of Health and framed in the National Health Service.