Professional competencies in the psychological care of children and adolescents in hospital services and ambulatory care: qualitative analysis of field experiences

INTRODUCTION: Psychological care for children and adolescents depends on the development of specific professional competencies and the correct theoretical and technical adaptation to different contexts, such as hospital services and ambulatory care. OBJECTIVE: The study aims to describe the professional competencies in the psychological care of children and adolescents in hospital services and ambulatory care, through a qualitative analysis of reports of professional training experiences. METHOD: This is a qualitative study using participant observation, documentary consultation and dialogue (with patients and supervisors), which were recorded in a field diary. These narratives were analyzed in categories, defined based on criteria of relevance, exhaustiveness, exclusivity and precision. A data extraction protocol was developed, based on the description of professional skills, containing: a) objective facts (verbal and nonverbal behaviors observed); environmental elements; available instruments; b) clinical impressions of the care (dialogue). RESULTS: In the fundamental competencies, ethical practice and knowledge of child development were mobilized in both contexts, with a special focus on the demands of the childhood-adulthood transition and chronic mental health problems. Interdisciplinary collaboration was rare in the hospital and non-existent in the ambulatory care. In the functional competencies, clinical formulation occurs in a non-systematic manner in both contexts; intervention is guided by a theoretical approach in the ambulatory care and limited to the hospital context. CONCLUSIONS: Despite the limitations of the study, the findings indicate that professional training would benefit from the increase in interdisciplinary collaboration practices, as well as training in adapting techniques to each environment. In professional practice, there is a lack of structuring of intervention strategies that minimize the trajectories of the development of mental health diagnoses, especially for chronic, less debilitating disorders.