Relatório de Sustentabilidade 2011 - versão em inglês
Transcription
Relatório de Sustentabilidade 2011 - versão em inglês
of activities and conquests S u s t a i n a b i l i t y r e p o r t 2 0 1 1 1 2 3 S u s t a i n a b i l i t y 4 r e p o r t 2 0 1 1 5 Message from the Chairman of the Board of Directors pg.8 pg.11 Organization History pg.12 Message from the CEO What we do phaseone With the aim of bringing about the social inclusion of phasetwo Profile and Management people with Intellectual Disabilities and promoting their Profile integral development, APAE SÃO PAULO operates on pg.16 Prevention Where APAE SÃO PAULO is prevention, education, defense of rights, health promotion Units and qualification for work. Its efforts are geared towards pg.16 Reference Service in Neonatal Screening The Newborn Screening Test pg.18 pg.36 Special Kitchen pg.38 Laboratory pg.19 Managing for Sustainability pg.20 Financial Management pg.22 Institutional Development pg.23 Human Resources pg.24 Voluntary Action pg.26 Marketing and Communication pg.28 Corporate Governance enabling people with Intellectual Disabilities to gain autonomy, have fulfilling working and affective lives, be index valued for their talents and develop their full potential. pg.34 phasethree Assistance, Services and Results Ambulatory Care Service pg.42 Stimulation and Skills-building Service Education Service pg.48 Socio-educational Support Service phasefour pg.44 pg.50 Qualification and Professional Inclusion Service Promotion, Protection, Defense and Guarantee of Rights pg.65 Promotion of Public Policies pg.67 Advocacy pg.67 All for the Rights Projects pg.52 pg.56 Aging Support Service pg.59 2011 Achievements phasefive Knowledge Generation and Dissemination The APAE SÃO PAULO INSTITUTE pg.72 phasesix Organizational Structure, Partners and Investors Workforce APAE SÃO PAULO pg.78 pg.91 Financial Report pg.92 Our Contacts 6 7 of activities and conquests Message from the Chairman of the Board of Directors The APAEANO movement acquired such dimensions that it required the emergence of organizational forms more compatible with the Social demarcation turned into national action. Result after 50 years of activity. APAEs, since Social Delimitation is the basic assumption of the movement; in other words, the demands are from the municipalities, while the In the commemorative book we published as one of the marks of the 50 years of foundation of APAE SÃO PAULO, there is a record of the foundation of the National Federation of APAEs, whose mentor and first President was Dr. Antonio dos Santos Clemente Filho, our Dr. Clemente. exercise of the mission of the National Federation of APAEs.The State Federation of APAEs was then created as a necessary result of the logistics necessary for the dissemination of knowledge and the implementation of the policies originating from the National Federation of duty to provide the necessary services is the state’s. APAE’s need to take on those services arises from the state’s inability to provide directly the adequate mechanisms to satisfy those collective demands. NGOs, including APAEs, fulfill that function - a solution accepted by Municipal Mayors, who, in our current public services organization, hold the main responsibility for effectively providing education, health and social assistance and family support to people with disabilities. The aim of that initiative was to assist other municipalities which had and still have the same needs as the São Paulo society for methodologies to develop the autonomy of people with Intellectual Disabilities, within our missions of Prevention, Education, Inclusion, Support for families, and of being both the Guardians of the Scientific Information produced by APAE SÃO PAULO and the facilitators of its dissemination. However, and this is the main reason for this manifestation by APAE SÃO PAULO, it must be pointed out that there is a need for organizational improvement in the Organization of the State Federations of APAEs, which is the Facilitator for the implementation of the mission of the National Federation, managed by the worthy fellow leaders of the more than 2,104 APAE affiliates that make up the National Federation of The reason for the creation of the National Federation of APAEs was the need to carry out the mission of facilitating the dissemination of the APAEs. scientific knowledge that was being produced, and have a nationwide political organization, since the demands being made were hindering São Paulo’s direct actions, which were our primary mission . Mistakenly, some state federation leaders understood that the management should be focused on obtaining financial resources to meet the needs of the APAEs that comprise their area of activity, thus creating the embryo of a state within a state! However, as APAE SÃO PAULO is a non-governmental organization, receiving tax exemptions at all Government levels (municipal, state and federal) as well as voluntary donations, it was essential to organize a way of returning to society what rightfully belongs to it - the Knowledge In the state of São Paulo, those strategic errors, fortunately, have been corrected by the competent action of the current President of the we produce - without damage to the services carried out for the benefit of the São Paulo society. Federation of State APAEs of São Paulo. Nevertheless, new risks of misconceptions have not yet been eliminated. There are 2,104 municipalities today whose communities are modeled on the behavior and the knowledge produced by APAE SÃO PAULO, It is essential that the changes in the statutes of the State Federations of APAES are perfected, and, since the organization of APAEs as including their methodologies for the management of asset and resources, which ultimately belong to the Brazilian society. a nationwide Movement began in APAE SÃO PAULO, we feel that we have to ask for changes that will preserve the high, undisputable principles of corporate governance practices, protected by absolutely safe statutory rules about the municipal principle, which govern and Our corporate governance principles have always been a reference for other municipal associations that have opted for the use of the name delimit the roles of each APAE. APAE due to the seriousness, responsibility and altruism that have marked the management of the services and resources of APAE SÃO PAULO over the last 50 years. 8 In this Sustainability Report we give account to the society that supported us and to those who we think deserve the same support. 9 of activities and conquests We owe everything that has been achieved to the exemplary competence of the Executive Board of APAE SÃO PAULO, its competent and dedicated Functional Body and the work of Voluntary Action, to which I belong. Finally, I want to express our gratitude to the Public Leaders from all areas with whom we have connections and who we supported in the implementation of public social policies in 2011. Message from the CEO 2011. The year of the fiftieth anniversary. We started 2011 with the mission, focus and belief that this year couldn’t go blank, because in April the 50 years of the Foundation of APAE SÃO PAULO would be celebrated. Marco Antônio Fernandes David has a child with the Down syndrome and is Chairman of the Board of Directors of APAE SÃO PAULO. Well, they were celebrated. There was a communication campaign, with advertisements, events and reports, which reiterated our commitment to society and to the understanding of Intellectual Disabilities. We remembered the heroic trajectory of so many parents and friends who, with total unselfishness, opened paths where today we have inclusion avenues, streets of advocacy of rights, roads of research and so many squares, lanes, alleys which insist on reminding us of how tough and continuous the battle is. However, it would be at least simplistic to limit 2011 to this important milestone. We changed our references, dared, and, inspired by the values of the founders, went in search of the future. We structured the new databases of the Institute APAE SÃO PAULO. We inaugurated the new Special Kitchen, capable of meeting 3 to 4 times the demand we have today. We inaugurated our Laundry, important part of the process of inclusion through work. We reevaluated and implanted new operational processes which enable us to achieve greater effectiveness in assisting people and managing the database. We created processes and standards for the area of human resources, with a view to greater effectiveness, talent attraction and retention. We improved our ambulatory care process and dared to reassess our dynamics of inclusion, from stimulation and skills-building up to the defense of rights. In other words, we started to prepare ourselves for the future, and for the great deal of work that still has to be done. We are in the dogged pursuit of effectiveness. However, plagiarizing Che Guevara -” one must harden without ever losing tenderness”. Anyway, 2011 is the year of the 50th anniversary. Let the next 50 come. Cássio dos Santos Clemente Chief Executive Officer of APAE SÃO PAULO 10 11 organization history 50 anos 12 12 of history Disabilities, include them socially and fight prejudice. Moreover, it aimed to promote scientific knowledge and methodologies, nonexistent or rudimentary at the time, geared specifically for people with Intellectual Disabilities. Thus the promotion of changes in social patterns, fighting prejudice and acting positively towards social inclusion, became the indelible Not even the founders of APAE SÃO PAULO could nave predicted that the seed sown 50 years mark of the history of APAE SÃO PAULO. And that spirit was strengthened, a few years after its founding, by the energy, dynamism ago in that small two-storey house on Martiniano Campos street would become the interdisciplinary and vision for the future of the couple Antonio Clemente and Jô, parents of Zequinha, another boy with Down syndrome. complex that the Organization is today, a Brazilian and global reference in Intellectual Disabilities. However, all the principles that would govern the development of APAE SÃO PAULO in the following In the years that followed, APAE SÃO PAULO managed to prove that inclusion was not only possible, but beneficial for society as a decades were already there, based on promotion, inclusion and the fight against prejudice. whole, and that prejudice cannot resist the light of science and the awakening of higher social and human principles. If it was not possible to estimate its size, at least the visionary, vanguard spirit that would mark all the However, no matter how noble the guiding principles of its founding were, the construction of the Organization along those five five decades were already explicit in the inaugural act of the Organization. So much so that its mission, decades would not have been possible if it had not been for the vision of the leaders who ran APAE SÃO PAULO, the technical and recorded in the first statute, remains modern even today. scientific competence of our teams and individual professionals and the invaluable collaboration of the voluntary Corps. Neither would it have happened without the help of society and of the businesses and individuals who not only believed, but actually supported and Added to the consistency of the original principles on which the Organization was founded was the financed structuring the organization. goodwill and selflessness of the original group that gathered around the couple Alda and Olímpio Estrázulas, who were responsible for making real the dream of an organization devoted solely to The achievements and the return that APAE SÃO PAULO has given to society throughout its history are fruits of this conjunction addressing the issue of Intellectual Disabilities. of forces. The pioneer character of the organization is demonstrated by the introduction of the Guthrie test in the country, in scientific research, in the construction of knowledge and the structuring of practices and methodologies applied to serving people It was in the fifties that the Estrázulas couple, belonging to the São Paulo traditional elite and the with Intellectual Disabilities in an integral and interdisciplinary approach that goes from birth to aging. parents of a child with Intellectual Disabilities, began to organize home meetings with other couples who also had children with intellectual disabilities in order to share their experiences and fears. When we see today the size and importance of the Organization, we understand how right were the ideals of those visionary founders who believed in building an inclusive society at a time when prejudice was the norm and the acceptance of differences no more than The union of those people, anxious and worried about the lack of prospects imposed by society on a utopia. But out of respect for its traditions and its past, APAE SÃO PAULO is not satisfied with what it has achieved so far. We have their children, generated the necessary strength for the founding of APAE SÃO PAULO. That at a time plenty more to do, and it is looking to the future that we build our present. when the most expected behavior from those families would be that of resignation, shame, and the concealment of disabled children inside their homes. Instead, proud of their children, they began to build from nothing, except their willpower, an Organization that would promote the physical, intellectual and emotional development of people with Intellectual 13 13 phaseone 14 Profile and management Founded in 1961, APAE SÃO PAULO is a non-profit Organization of the civil society, focused on prevention, social inclusion, empowerment and full development of people with Intellectual Disabilities. 15 Profile and management Profile Founded in 1961, APAE SÃO PAULO is a non-profit Organization of the civil society, focused on prevention, social inclusion, empowerment and full development of people with Intellectual Disabilities. A center for research and dissemination of scientific knowledge, the Organization is a pioneer in the implementation of the Neonatal Screening Test in Brazil. It has become a reference in laboratory exams for Neonatal Screening, and does the follow-up of the newborns and their families after a positive diagnosis. The Organization is present in all stages of life of the person with Intellectual Disabilities, from birth to aging, through a series of services aimed at the social inclusion and the promotion of quality of life. It also works in the defense and guarantee of the rights of people with Intellectual Disabilities and participates in the construction of public policies. Where APAE SÃO PAULO is 16 In recent years, APAE SÃO PAULO is making an effort to decentralize its services in order to be closer to the people it assists and Governments, APAE SÃO PAULO also uses public health equipment in its services, which has significantly expanded the geographic extend its action to the outskirts and the poorest neighborhoods of São Paulo. Through partnerships with Federal, State and Municipal scope of its action. 17 Profile and management Corporate Governance Anhanguera APAE SÃO PAULO keeps all of its main areas professionalized, from internal management to client service, where management Tremembé Pirituba models with clear objectives, set goals and measured results are applied. To ensure the observance of its principles and objectives, the Freguesia do Ó Organization has a Board of Directors and an Audit Committee, an Executive Board and a Superintency. Santana Casa Verde Lapa Itaquera Mooca Pinheiros Campo Limpo Itaim Ermelino \Matarazzo The Board of Directors is responsible for the strategic decisions regarding activities and policies, evaluates the quality of the management Penha Sé Butantã São Miguel Vila Maria and the accounts and makes the Organization’s investment plans. The directors remain in office for 3 years and may be reelected. Guaianazes The Audit Committee verifies the accounts of APAE SÃO PAULO, giving its opinion on the Executive Committee’s accounts annually. Aricanduva Vila Mariana The Executive Board is responsible for putting into practice the guidelines set by the Management Board, for implementing the Cidade Tiradentes Vila Prudente management policies and seeking business efficiency. São Mateus Ipiranga Santo Amaro Finally, the Superintendency is responsible for the monitoring and orientation of the main operation axes, to ensure that the Organization’s Jabaquara actions, services and practices are in line with its strategic objectives and goals. It is responsible for ensuring the quality and excellence of M’Boi Mirim the care offered to people with Intellectual Disabilities and their families and for seeking business efficiency. Cidade Ademar Capela do Socorro Vila Clementino Unit (central) With the aim of professionalizing their management activities and business, APAE SÃO PAULO uses the Enterprise Management Attendance, Stimulation and Enabling Nuclei Model, which, according to the Brazilian Institute of Corporate Governance (IBGC) is defined as “a system by which companies are Itaim Bibi Unit The good governance practices are intended to increase the value of the company, facilitating access to its capital and Specialized Educational Service Center Nucleus contributing to their long-term survival. “ directed and monitored, involving shareholders and investors, Board of Directors, Independent auditors and the Audit Committee. Parelheiros Administrative Council Fiscal Council Units 18 Executive Board 19 Profile and management That system aims to ensure the inclusive Ansociety reliability of the Organization through the establishment of monitoring mechanisms and incentives in the control and decision-making structure. methodology For a nonprofit Organization, the aim of adopting that management model is to seek efficiency in the conduction of its activities and in assessment of results Quality tripod the application of resources and investments, offering transparency so that its partners can see what the organizational structure is like, follow the actions taken and learn how the private social investments are being used. Thus the Organization seeks the benefits of good corporate governance practices, translated into cost reduction, expansion of areas of action, promotion of economic sustainability, continual improvement of performance and the tapping of new funding sources . Direct assistance (disabled person and his/her family) Generation and dissemination of knowledge Defence and guarantee of rights Managing for Sustainability Nine years ago, APAE SÃO PAULO began a thorough restructuring of its management model. During that period, cases were reviewed, services were encouraged and organized by cost centers, and disbursement control mechanisms were established as a All those changes and new paths have been systematized through the Strategic Planning structured in 2010 and effectively implemented way to improve the quality of the expenditure and of investments. in 2011, which brings the strategic goals and the actions planned for the 2011-2013 triennium. As a result of this work, the accounts of APAE SÃO PAULO register a surplus, its investment capacity has increased, and today it Strategic Planning indicates that in the service areas (health, education and social assistance) there is a need for continuous work to has a lean, agile and dynamic structure. In addition, the Organization has adapted and rethought its line of work, going beyond direct improve quality, validating the work methodologies and using tools for the measurement of results. assistance and aggregating new goals such as the generation and dissemination of knowledge and the participation in the construction of public policies. For the areas of generation and dissemination of knowledge, Strategic Planning suggests that the research should be focused on seeking practical results applicable to transforming and improving the quality of life of people with disabilities and their families. In this process of change, the Organization moved towards building a more inclusive society, which means adopting the quality tripod of attending those with Intellectual Disabilities and their families, spreading the concept of inclusion, and In the defense and guarantee of rights, the objective indicated by Strategic Planning is to put the Organization at the forefront of the contributing to the improvement of the social environment in which it is inserted. It also started long term planning to ensure the movement for the construction of public policies, making it a reference in that field. continuity of the process of its activities. To this end, it rethought the axes of its own businesses in order to adapt them to the new 20 challenges raised by the Convention of Rights of People with Disabilities, which has as its main guidelines the promotion, protection Currently, the organization has tools and indicators for monitoring and continuously evaluating the quality and efficiency of the services and the full enjoyment of all human rights by all the people with disabilities. provided by all its main areas. 21 Profile and management 18% Fundraising for research projects promises good results in the future, as well as the management of the use of brand name APAE SÃO PAULO by R evenue 16% 2011 third parties. In recent years, the accounts of APAE SÃO PAULO have registered a Financial Management surplus,reaching in 2011 the sum of R$ 352 ,000. That was the third The financial management aims to ensure the economic sustainability of the Organization by improving business results and sustainability index. 51% 5% 3% 5% 2% consecutive year in which the Organization achieved the 100% self Tests Consultations Fundraising Events Donations Financial Others fundraising,reducing costs without sacrificing the quality of the service, as well as rationalizing and prioritizing investments. Institutional Development Evolution of Cost per Consultation 77 72 2.768 70 2.271 2.249 Evolution of cost per person assisted 211 210 2.252 2.328 201 3.020 The Institutional Development Area was created six years ago with the aim of fostering partnerships with the private sector and the civil society in order to ensure the sustainability of the Organization and the implementation of its projects. This year, the area was responsible for raising R$ 5.5 million. For the next year, the goal is to reach R$ 6.5 million. 2011 5,5 million 2012 6,5 million Partnerships come in a variety of ways. The main one is the participation of companies and individuals in projects supported by FUMCAD – Municipal Fund for the Rights of Children and Adolescents, and the projects that receive the Rouanet Law incentive. 2010 2011 Number of consultations per Month 2012 $ Price per Consultation 2010 2011 Number of people assisted $ 2012 Monthly cost of assistance Another fundraising mechanism which has had a great growth is Cause-related Marketing, whereby APAE SÃO PAULO and some companies unite their brands in favor of the cause, and part of the income goes to the Organization. An example is the Bauducco food In view of the social nature of the work done, some of the services offered are unprofitable and covered financially by others that company ,which, since 2006, uses on the packages of its panettones the seal of APAE SÃO are lucrative, or by private social investors and partners. In order to be monitored and controlled, financial results and the index PAULO - ”partners in the cause of Intellectual Disabilities.” of sustainability are obtained from the main services of the Organization, which have their respective cost centers. To measure the sustainability of services, resources from donations and events are set aside and reinvested in the expansion and improvement of The campaign for the donation of tax receipts, in the São Paulo State Government Tax Receipt Program, was services. another important tool for fundraising in 2011. With that campaign, we involved businesses and their customers, and together we raised R$ 208 thousand. Being a member of the Organization is another form of social 22 The lab remains the largest source of revenue of APAE SÃO PAULO, being responsible for almost half of the resources. Other investment and, in 2011, 3,300 consultations in our ambulatory care clinic were made possible by the services which are self-sustaining are those of Qualification and Inclusion for Work and of Stimulation and Empowerment. contributions of our donors. 23 Profile and management Investing in APAE SÃO PAULO means contributing to the fulfillment of the mission of the Organization, promoting a more equitable and inclusive society. APAE SÃO PAULO is made up of people and ideals. Accordingly, the area of Human Resources selects and invests in the training of talents committed with the prime purpose of the Organization, which is the full development, the quality of life and the social inclusion of people with Intellectual Disabilities. Events In 2011, the fourth Wine Auction of APAE SÃO PAULO was held, raising R$ 1.3 million. The event, sponsored by Banco Bradesco Prime, took place in Terraço Daslu, one of the most sophisticated venues of São Paulo. In 2011, the area of Human Resources initiated a wide-ranging process of restructuring and modernization focused on the development One of the highlights of that event was the auction of a piece of jewelry donated by the designer Jack and retention of talent. The mapping of all offices and functions of the employees was made with the help of a consultancy firm, and Vartanian. that work will be the basis for the personal development projects of the next two years. Another human resources policy is the development of leadership, whose challenge is systematizing and implementing a management style that, throughout its history, has created its own, spontaneous way of generating of leaders. The central idea is that all development initiatives and the training of employees take into account the results shown and the improvement of technical and organizational skills. Human Resources Human Resources 401 380 186 195 Investments in benefits in 2011 (in R$ thousands) Medical Assistance Number of Employees Number of Volunteers 401 188 Transport Vouchers Day care allowance Basic staples packages Meal Vouchers TOTAL 2009 24 2010 465 R$ 213 R$ R$ 34 321 R$ R$ 161 R$ 1.195 2011 25 Profile and management Voluntary Action In the Project “Sponsors of APAE SÃO PAULO”, the psychiatrist and writer Robert Shinyashiki was chosen to be Sponsor of Voluntary Action, generating new opportunities for its development. The work done by Voluntary Action does not end with the year. It is continuous, always in search of volunteers who are engaged and committed to the Mission of APAE SÃO Satisfaction Rating 2009 2010 2011 PAULO in favor of social inclusion and the promotion of a decent, worthy life for people with Intellectual Disabilities. Year Number of volunteers 20092010 2011 186195188 In 2011, the Voluntary Action of APAE SÃO PAULO celebrated 40 years of operation. It is one of the main areas of support of the Organization, acting in its various sectors. Voluntary Action also develops specific projects, such as the Handicrafts Workshop and the record of the History of Voluntary Action. It develops projects in partnership with other institutions, such as the cancer prevention campaign made with Hospital A. C. Camargo. In 2011, 490 people registered in the Action. In its process of motivation, integration and updating, Voluntary Action held the 5th Meeting of Volunteers, the 41st Volunteers Course and external cultural activities. As management tools, satisfaction surveys and performance evaluation of the volunteers are conducted, seeking to better fulfill the Organization’s needs. 26 27 Profile and management Marketing and Communication The changes in the Marketing and Communication area are in compass with the great transformations that APAE SÃO PAULO has been carrying out, seeking to modernize and add new value to its brand. Its goal is to build the Organization’s institutional image through channels of effective communication with stakeholders and with society, and through marketing and communication actions that will ensure visibility and transparency. Marketing strategies take into account the history of the Organization, responsible for the credibility and respect achieved throughout its history, added to which are the new guidelines aimed at the modernization, expansion and excellence of the Organization’s performance. To that effect, the Marketing and Communication area seeks the repositioning of the brand, in line with the cutting-edge work developed by APAE SÃO PAULO. Its actions aim to make the Organization known to the public as a promoter of research and a generator of knowledge, a protagonist in the defence and guarantee of rights and in the construction of public policies, as well as a reference in the attendance and in the provision of services to people with Intellectual Disabilities. In 2009, a survey of public opinion showed the great credibility of the APAE SÃO PAULO brand, but also revealed the little understanding people have of its activities, structure and goals. That survey helps, today, the brand repositioning work, done via advertising campaigns, the Organization’s own vehicles of communication, media relations and other marketing tools. 50-year Campaign EU TAMBÉM NASCI PARA BRILHAR (i was born to shine) Advertising: worth R$ 19.3 million Vehicles: Group 28 29 Profile and management On April 4, 2011, APAE SÃO PAULO completed 50 years .To mark the occasion, Marketing and Communication promoted a large commemorative campaign, whose focus could not have been anything but the people with Intellectual Disabilities. With the slogan “I was born to shine”, the campaign had as its theme the leading roles, autonomy and personal fulfillment of those assisted by the Organization. Social media APAE SÃO PAULO is also a member of the new social media on the Internet, with profiles in Facebook and Twitter, getting amazing results. The aim is to consolidate the Organization’s direct communication with its different kinds of public by means of the electronic media, opening new channels of communication to receive criticism and to disseminate and promote its actions. Two former APAE SÃO PAULO CHILDREN were chosen as “poster-boys”: Sergio Quintanilha, 46 years old, who learned to read, use a computer and swim; and Vinicius Araujo, 25 years old, who works in a laboratory, has studied and can move around on his own. The campaign was made in the major TV networks, magazines and national newspapers through partnerships, besides the social media on the internet. All that advertising would have cost R$ 19.3 million. Form of contact 103% liked the Fan Page / 448 received information posted 515.000 viral reach / 2 million impressions 3.640 followers up to December 2011 Also responsible for the creation and coordination of events, Marketing and Communication promoted the official celebration of the 50 years, which was a big event held at the restaurant The Leopolldo, in São Paulo, attended by the founders, partners and investors, representatives from the government and from other APAES. Public Assistance Service (SAP) 3% Communication Channels Communication for sustainability 65% 1% 54% 45% 32% Type of Contact Phone Face-to-face E-mail/ Suggestions Box Request Information Suggestion/praise/ complaint For 2012, the Marketing and Communications area plans to build a Marketing plan geared towards brand management in order to support the Organization’s business and the generation of revenue, thus contributing to the achievement of sustainability in each APAE SÃO PAULO makes available to the people assisted, their families and other clients its Public Assistance Service (5080 11- service and in the Organization as a whole. That planning will, initially, seek the systematization and consolidation of the policies and 7000), which aims to provide information on the services offered, make appointments for consultations, conduct research, receive procedures of the area. Its goal will be to ensure the visibility and transparency of APAE SÃO PAULO to its public and to society in complaints, suggestions and seek solutions to customer problems and dissatisfaction. We recorded 73,389 interactions with the public general, develop endomarketing projects and contribute to the satisfaction of the disabled assisted and their families. of APAE SÃO PAULO in 2011, divided into requests of different kinds, information, suggestions, complaints and praise. . 30 31 phasetwo 32 prevention APAE SÃO PAULO, a pioneer and national reference in neonatal screening, conducts tests, treats and monitors babies, thus preventing the development of Intellectual Disabilities and other diseases. 33 prevention Reference Service in Neonatal Screening The Newborn Screening Test PBasic ositive Cases 2011 Newborn Screening Test APAE SÃO PAULO, a pioneer and national reference in neonatal screening, conducts tests, treats and monitors babies, thus preventing the development of Intellectual Disabilities and other diseases. The Laboratory Patients with Congenital Hypothyroidism 442 Patients with Phenylketonuria 7 accredited by the Ministry of Health in the State of São Paulo to conduct the Newborn Screening test. Patients with Hemoglobinopathies 195 To this end, it is not enough that the laboratory should have technical excellence in carrying out the tests, but it also has to prove that Patients with Cystic Fibrosis TOTAL 18 662 The laboratory of APAE SÃO PAULO is it can offer the necessary structure to make the Active Search of suspect cases, give orientation to the families, and do the treatment and follow-up of the patients whose tests were positive, which is done by an interdisciplinary team. In 2011, in the city of São Paulo, 80% of the tests of newborns were carried out by APAE SÃO PAULO. History of the Newborn Screening Test Through APAE SÃO PAULO, Dr. Benjamin Schimidt, graduated from the Faculty of Medicine of the University of São Paulo, introduced in Brazil the technique of collecting on filter paper the samples for the Newborn Screening Test, which offered ease of transportation and storage of the collected materials. At first, APAE SÃO PAULO only made the diagnosis of phenylketonuria. From 1980, the screening for congenital hypothyroidism Laboratory Indicators of the Basic Newborn Screening Test 1.700.069 1.519.863 1.246.538 Screening tests carried out Children screened* 313.000 * by APAE SÃO PAULO in the State of São Paulo in Brazil. 34 2009 325.559 2010 346.799 2011 was incorporated. The work developments provided subsidies for the creation of laws regulating the compulsory use of the Newborn Screening Test in the country. Neonatal screening became mandatory on June 6, 2001, through Directive GMMS No. 822 of the National Neonatal Screening Program, and currently the test identifies four pathologies (phenylketonuria, congenital hypothyroidism, sickle cell anemia and other Hemoglobinopathies, and cystic fibrosis). 35 prevention From testing to beginning the treatment Procedure Structure Today, the laboratory of APAE SÃO PAULO is responsible for the Screening Test of 346 thousand children born in the State of São Paulo, which corresponds to about half of all births in the State. Of those tests, 80% are performed in public hospitals Active Search plays a crucial role in bringing in the children whose results showed disorders, using several resources to confirm the results of the tests, treat and monitor patients in time to prevent complications. through the Unified Health System (SUS). Patients with phenylketonuria and congenital hypothyroidism are scheduled to be assisted by The basic tests stipulated by law are used in public hospitals, whereas in private hospitals a range of more detailed tests is offered, among which the MORE Test and the SUPER Test. The Laboratory is able to make the diagnosis of up to SRTN:Attention to Patients. Patients with sickle-cell disease and other Hemoglobinopathies or cystic fibrosis are referred for treatment in specialized reference centers which are partners of APAE SÃO PAULO. 46 pathologies using four Test panels: Basic , MORE , SUPER and Customized. The Tandem Mass Spectrometry (MS/MS) methodology allowed the expansion of those panels and the advancement of Neonatal Screening Tests. SRTN: Patient Assistance 2011 Laboratory 15.206 2010 Of the screened children, 87,5% were tested by the seventh day of life, and the results released, on average, in less than five days. 15.300 The satisfaction survey of the SRTN laboratory shows that 94,6% of the clients (individual or corporate) are satisfied with the service. The Laboratory team of APAE SÃO PAULO, aiming at the improvement and better performance of the professionals involved in the Neonatal Screening Program, trained 3.771 healthcare professionals , reaching the satisfaction index of 97,4%. 36 3.892 2009 Consultations 12.601 Patients assisted Training of professionals to collect material for the Newborn Screening Test: 3.662 2.479 Active Search: In 2011, 662 children had their diagnoses in the Basic Test confirmed in and 100 were assisted in treatment centers. 37 prevention Support and Monitoring Structure The SRTN support and monitoring team is qualified for the full care of children with congenital hypothyroidism and phenylketonuria. In the former, children and families are assisted by an interdisciplinary team consisting of a children’s endocrinologist, a psychologist and a social service professional. In the cases of phenylketonuria, the team is formed by the same professionals mentioned above, as well as a nutritionist. Special Kitchen One of the major investments made by APAE SÃO PAULO in 2011 was the construction of the new Special Kitchen space, focused on the production of low protein foods for people with phenylketonuria. The new kitchen space, Special Kitchen 23.972 30.855 26.183 which already existed in experimental form, was inaugurated on April 26 and The annual average number of patients who consume products and maintain adequate levels of phenylalanine is 73%. serves 320 patients in treatment for phenylketonuria, and 140 from families below the poverty line. The new Special Kitchen has been operating with a production of 3,000 items and 600 kilos per month. All ingredients undergo the aminogram test, which 2009 2010 2011 Items produced shows the profile of aminoacids, to know the exact amount of phenylalanine in .For 2012, the Special Kitchen’s goal is to reach the 100 % index of financial sustainability. In 2011, that index was 88%. Another project for 2012 is the beginning of the production of basic staples packages for patients whose families are in a socially vulnerable situation by attracting sponsors that would finance the project. each type of food produced. The goal is to give people with phenylketonuria adequate but more varied food than usual. To this end, the kitchen produces biscuits, sweets, cakes and pastries, sausages, steaks and vegetables nuggets, among others. The products are sold inside the Organization itself. Phenylketonuria is a disease characterized by the deficiency in the production of an enzyme (phenylalanine hydroxylase), which is responsible for processing the phenylalanine protein. Without this processing, the protein accumulates near the brain (in the bloodbrain barrier), causing Intellectual Impairment. It is a genetic disorder. If it is diagnosed early enough, the child may have a normal development. The treatment consists of an aminoacids formula, provided by the State, and of food restriction. The disease requires strict avoidance of milk and dairy products, meat, eggs, vegetables, cereals (except rice) and diet food. 38 39 39 phasethree 40 assistance, services and results APAE SÃO PAULO works for the integral development of people with Intellectual Disabilities. It offers them services and assistance at all stages of life, from birth to aging. 41 Assistance, services and results The appointments are made via the Public Assistance Service (SAP) or by referral from the Basic Health Units (UBS) of São Paulo. The Much more than direct assistance, the Organization works to enable people with Intellectual Disabilities to exercise their talents and develop their potential, be socially included and have a good quality of life. first appointment is is made with a doctor and a social worker. If the suspicion is strengthened, the patient is referred for consultation and neuropsychological tests to confirm and determine the degree of intellectual disability. In the case of positive tests, patients are referred for further consultation, this time with physicians, neurologists, geneticists, psychiatrists and neuropsychologists who will seek the cause of the disability. Assistance per Service Qualification Educational Stimulation Old age Socio-educational TOTAL 2009 2010 2011 310 300 247 424 230 294 1.727 1.838 2.068 164 140 132 381 242 217 3.006 2.750 2.958 6 % 9% 11% People assisted 15% in 2011 Depending on the result of the diagnosis and the cause of the intellectual disabilities, patients can also be forwarded to consultations with cardiologists and opticians. The interdisciplinary team meets every week for the final diagnoses. Those eligible for the services of APAE SÃO PAULO are referred, and the families start receiving the help of a social worker. 59% Stimulation Educational Professional Qualification Socio-educational Aging That professional is responsible for introducing the families to Ambulatory C are Service 11.953 11.731 the services of APAE SÃO PAULO, explaining what benefits and rights are stipulated by law for people with Intellectual Disabilities and listing the possible social or family problems 10.680 involving the patient. Through this structure, an average of 129 new patients enter the screening process per month. In Ambulatory Care Service The Ambulatory Care Service is responsible for carrying out the diagnoses of intellectual Disability, for screening patients and referring them to the various services offered by APAE SÃO PAULO. The appointments are made by an interdisciplinary team composed of 4.122 3.832 2.104 2011, and 11,731 appointments were made , and 3,832 patients were attended by the Ambulatory Care Service. 2009 2010 Appointments 2011 Patients Assisted geneticists, neurologists, psychiatrists, neuropsychologists, social workers, cardiologists and opticians. It is known that as far as Intellectual Disabilities are concerned, the first obstacle is the lack of specialized services to make the diagnosis; besides, there is a shortage of services to meet the town’s demand, since complementary tests are needed for a final decision on the Intellectual Disabilities etiology. However, the health systems are not yet fully inclusive and accessible to people with disabilities. 42 Final diagnoses of disabilities in the Ambulatory Care Service (2011) Number of Diagnoses - 359 With intellectual disabilities - 276 ( 77% ) 43 Assistance, services and results New screening structure or those with neuropsychomotor developmental delays. This is the service with the highest number of recorded direct assistances. The patient screening service was entirely reformulated in 2011, gaining a new structure and methodology. In June, screening was unified in the Ambulatory Care Service, which was reinforced with the hiring of new professionals to form an interdisciplinary team from the areas of medicine, psychology and social assistance. In 2011, 2.068 children used the service. Early infant stimulation is important because this is a period of neuroplasticity, during which there is an intense brain growth with the creation of synapses. This brain network building capacity and maintenance is directly related to the amount of stimulation received. In addition, with the help of a hired external consultancy firm, new protocols based on international scientific production were created for the evaluation and diagnosis of Intellectual Disabilities. Moreover, routines were established for assistance, appointments and the kind of tests necessary for accurate final diagnoses. It was observed that the interventions performed in infancy (0-3 years and 11 months) enhanced motor abilities in functions such as rolling over, sitting down, crawling and holding objects as well as feeding, while communication and comprehension abilities were less affected. Among 4-7 year old kids, the interventions resulted in a more balanced acquisition of cognitive and social skills. Since Those new protocols will be used in 2012 by the Ministry of Health as a parameter to publish guidelines for the diagnosis of Intellectual this is an age bracket in which most of the children are already being stimulated at school, the intervention is meant to reinforce the acquisition of social and cognitive abilities. Disabilities. With this new structure, the Ambulatory Care Service is responsible for the referral of patients to other areas of APAE SÃO PAULO. To that end, a survey was conducted on the service capacity of each area in order to suit the demand to the assistance capacity of the Organization, according to the criteria of diagnosis and age First Infancy Stimulation and Skills-building Services Children assisted at the stimulation service 1.727 1.838 2009 2010 2.068 The stimulation Service is of outmost importance since its focus is on infancy. The service assists 0-7 year old children and is prepared to to treat both intellectually disabled and/ 44 2011 45 45 Assistance, services and results 19% Some of the activities developed Aqua-stimulation Assisted by Stimulation in aquatic environment to help promote psycho-corporal awakening, 20% complementary to other physiotherapy exercises done out of water. Offered to 0-3 year old children, and to 3-7 year old ones as a preparation for swimming. 34% the Nuclei in Ludotherapy or Playtherapy 2011 Central South Nucleus North Nucleus East Nucleus 27% Therapies using toys and games to improve psychological /emotional conditions in children and the bonds between parent and child.. Educational Support Lectures,clinical discussion of cases and specific courses of action for the assisted, given to the schools or preschools in which the children are enrolled. Family Support News Moment Program The News Moment Program, developed by the Stimulation and Empowerment Service, aims to monitor and give support to parents Through regular meetings,preparation is given to the grandparents from the moment they are informed of a suspicion or a confirmation of an Intellectual Disability or developmental delay. Before leaving and siblings of the assisted , since those people may have to play the maternity or after discharge, parents are accompanied by the Program, whose trained professionals and “support parents” provide an important role in their future life. all the necessary information about Intellectual Disability. In a second moment, the family is accompanied by a “support parent” – someone who has gone through the experience of raising a child with Intellectual Disability – who can, from his/her own experiences, Decentralization clear doubts and raise the families’ awareness of the importance of both the prescribed treatments and of a non-negative view of Following an agreement with the Municipal Health Department, the activities of the Empowerment and Stimulation Services are being decentralized to reach even the farthest regions of São Paulo. The partnership envisages the the disability. use of public space - Basic Health Units - UBS and the supply, by APAE SÃO PAULO, of professionals, materials, methodology and service coordination. Thus, besides the services provided by the Central Unit, there are also those of the Decentralized Stimulation Services in Itaquera, Campo Limpo and Freguesia do Ó. In the first half 2012, the Parelheiros unit is expected to start operating and, in the second half, the “ > location of a second unit will be defined together with the Municipal Health Administration Maria Paes de Souza, mother of Fernando, 3 years old. A study was initiated to assess the impact of these decentralized nuclei in operation on the quality of life of the families. Indicators signaling positive results were obtained from the preliminary data. The impact will be assessed throughout 2012 in partnership with the APAE SÃO PAULO INSTITUTE. 4646 Erica da Silva Alves, mother of Isabele, 3 years old. She brings my family together, makes us live each day fully “ “ Fernando has fans. He captivates people in a unique, true, beautiful way > APAE SÃO PAULO, besides stimulating parents, gives them guidance to continue the treatment at home. > Adriana Nunes Cruz, mother of Samuel, 2 years old. 47 Assistance, services and results Childhood, adolescence and youth Teacher training Education Service The School Inclusion Support Service also contributes to training teachers working in the regular educational network. Over the year, School Inclusion Support Service as curricular flexibilization and the use of assistive technologies for students with Intellectual Disabilities were addressed. seminars called “Dialogues” are held, during which various issues related to the inclusion of pupils are discussed. In 2011, themes such The School Inclusion Support Service is in line with the new educational proposal of the Ministry of Education, committed to supporting a school for all, that is, schools that are open to and capable of dealing with diversity. The inclusion of children with disabilities in the school environment can benefit everybody´s potential for learning and development, besides contributing to eliminating discrimination. Thus, the Inclusion Support Service contributes to the ideal of building an inclusive education system by providing specialized educational services for people with Intellectual Disability. The services include extra activities held after or before mainstream school hours, supervised by a team of educators who have the support of an interdisciplinary team of psychologists, occupational therapists and speech therapists. The study aims to break down the barriers that prevent the cognitive development of students with Intellectual Disabilities, from issues regarding socialization to those of communication and coordination. Therefore, it is not focused on their school subjects but on developing extra-curricular activities. The follow-up is made by a team of educators, who visit the schools where the students are enrolled to check their development, discuss referral options and effective learning strategies with the teachers. Initiation into the Labor Market Short-term courses are designed in modules which are structured to create a routine for students, in order to foster habits and attitudes that enable them to enter the labor market. In 2011, the course “Introduction to the Labor Market” Work” contained a structured information route so that individuals with Intellectual Disabilities could acquire the basic skills for a productive life whether in socialization, communication, autonomy or responsibility. Meetings with the family Once a month, the families of the students who attend the School Inclusion Support Service School have a meeting with the 48 Last year, 80 people attended Module I: Initiation to the Labor Market. At least 30 of them are expected to be referred to the interdisciplinary team to discuss the development of individual students, as well as other general topics related to their learning needs. Professional Qualification Office during 2012. This contact is justified, since a nurturing family environment promotes learning. 49 Assistance, services and results Decentralized Nucleus Besides that, the workshops were geared towards the In 2011, in partnership with the Hedging Griffo Institute and the Municipal Education Administration, a decentralized nucleus of the artistic products that could demonstrate the feasibility of a collective attainment of goals. construction of tangible School Inclusion Support Service started operating in Capela do Socorro, a populous region in the far south of São Paulo. In this nucleus, 120 students are assisted, and the demand is higher than the number of vacancies. Thus, in theatrical activities the aim became the staging basics (setting up a play), in music it was forming a band, in fine arts, the production of paintings and sculptures and so on. The objective for 2012 is to keep this nucleus operating. Decentralization is important to make it easier for people with Intellectual Disability to access the services, since disability affects the poor disproportionately; their limitations and vulnerability must be taken into consideration. An additional innovation of the Socio Support Service in 2011 was the opening of the sports workshops. Soccer, athletics, karate and People Assisted by the Socioeducational Support Service Sports Socioeducational Service tai chi chuan classes began to be offered. The initiative aims to improve not only the quality of life and health of the target group through sports, but also their communication and relationship skills, their self –esteem and their awareness of the need to 381 observe rules. The agenda for 2012 includes the reactivation of the swimming pool and the resumption of swimming lessons. 242 In 2011, the Socio-Educational Support Service underwent a structural 217 The Wings Project change in its focus, beginning to target the development of integrated skills and competencies through art workshops and sports. Between 2010 and 2011, the Socioeducational Support Services implemented the Wings Project, in partnership with Group 25 2009 2010 2011 In 2009 APAE SAO PAULO had the project "São Paulo is a School" in partnership with the City Department of Education. This project was discontinued in 2010. (Counterpart Organization), the Ministry of the Attorney General and the São Paulo Education Secretariat. Through the project, methodologies for inclusive practices were developed, such as the articulation of public and social welfare institutions to make public facilities for leisure, culture and social advancement adequately available to people with Intellectual Disability. The Wings project was originally created to be a driving force for the development of public policies aimed at the inclusion of people with disabilities, taking the school as a reference but opening up other opportunities for integration through the use of public facilities in different areas such as sports, culture, information technology, libraries and job skills 5050 51 Assistance, services and results Youth and Adult Life feel socially included, increase their social links and attain the status of productive citizens acknowledged by the state. Besides, the People Assisted by autonomy obtained with the job sometimes allows them to build a new family. Including people with Intellectual Disabilities is an issue Job Qualification Services that has gained strength from the enactment of law 8213/91, which is known as the Quota Law. Since then, public bodies and private Qualification and Job Inclusion Service 310 300 304 companies have been committed to implementing affirmative action policies as stated by law. Even with the adoption of the inclusive legislation, job access is still a barrier faced by people with disabilities. The Office for Inclusion and Professional Qualification is designed both 2009 for young people from age 16 and adults, regardless of the degree or the cause (etiology) of Intellectual Disability. The most important requirement is the existence of an expressed wish of the assisted to become 2010 2011 Included in the For over thirty years, APAE SÃO PAULO has been a reference in developing professional training and qualification models for people with Intellectual Disability job market 129 qualified for the job market, showing that he/she feels motivated to perform professional activities. The job must also prove to be an actual tool for social inclusion and personal fulfillment 69 Courses and qualification structure 56 The job qualification structure operating in the Vila Clementino Unit (center) serves about 300 people per year. On average, basic training lasts between one and one and a half year, and this flexibility allows treating individual skills and individual needs differently 2009 2010 2011 Experience shows that when professionalization is specially tailored to promote inclusion and citizenship, it can bring significant to foster better assimilation of concepts and work processes. The vocational training courses currently offered cover four segments: restaurants (still restricted to waiter/server, bartender and dishwashing services, since the culinary service courses will be operating in 2012 with the inauguration of the industrial kitchen), benefits for people with Intellectual Disabilities, especially in regard to self-esteem and autonomy. Young people or adults with Intellectual Disabilities who work take on a new role in the family, contribute to the household budget, administrative services, and industrial and laundry services. The courses are designed in accordance with market trends and demands, which requires identifying in companies the areas and activities that are suitable for people with Intellectual Disability. Initially, the courses developed skills in assembling and packaging industrial parts. Due to a marked expansion in the service sectors in recent years, there is now an increased demand for hotel, restaurant and laundry service training courses.. 5252 53 Assistance, services and results Active search for candidates Partnership with companies Since the availability of jobs surpasses the number of people enrolled in training courses, APAE SÃO PAULO develops an active The vocational training courses are held thanks to partnerships made with companies committed to including people with Intellectual search for candidates with Intellectual Disabilities, offering guidance and divulging information about courses and jobs offered. Disability in the job market. Companies, whatever their size or nature, can participate in this process. The orientation service given to the families in the Ambulatory Care Clinic includes all the necessary information about access to the To this end, there exists “Partners for Empowerment”, a project whose aim is to give sustainability to the training courses, divulge the training courses. However, new candidates are constantly being contacted. For two weeks in September 2011, a pilot project meant issue of job inclusion and engage more companies in this cause. to give information about job options for people with Intellectual Disability was conducted in service centers set up at the Sé and Luz The average cost of assistance per person is R$ 6,2m thousand / year. When a company that participates in the project “Partners for Subway Stations. Empowerment” hires a qualified individual, it undertakes the cost of training another. Qualification for all APAE SÃO PAULO is responsible for the service of providing information to partner companies, preparing the other employees for the arrival of a colleague with Intellectual Disabilities, giving guidelines for their relationship, answering questions and discussing myths and prejudice, and so on. As the labor market has been absorbing people with mild disabilities naturally, The process of integration and adaptation of a new professional is also followed for a year after inclusion. the current challenge is to develop and disseminate to companies assistive technologies and work methodologies for Work and family support people with more severe disabilities. People with Intellectual Disabilities need special support from their families to make the entrance in the labor market balanced and One of the most efficient approaches is to treat each case individually, with the supervised assistance of specialists who can suggest productive. additional support whenever needed. For some people with disabilities, including those with significant functional difficulties, assisted job programs can foster the development of skills that make the work done as productive and well-paid as that of other employees. During the It is part of the activities of the professional qualification to guarantee this support and to strengthen families in a process of change in which the assisted will make a transition to the world of labor relations, gradually learning about the new responsibilities and relationships found in the corporate world and gaining autonomy of locomotion. qualification process, whenever it becomes apparent that the candidate will not find personal fulfillment through work, he/she can be referred to other activities, whether educational, athletic or artistic, either in the organization and / or in facilities of the community. In some cases, it is necessary to demonstrate to the parents that the diagnoses made in the past, classifying their children as “incapable”, are actually outdated and untrue. 54 55 Assistance, services and results was on December 12. Throughout the year, 11 employees were assisted by partner companies. This first experiment showed that the training time of eight months can be reduced to six months; therefore, from 2012 on it will be possible to train 40 people a year. Prosegur’s laundry computer system was redesigned to be used in Brazil by people with Intellectual Disabilities, by means of a program that exchanges words for icons. The laundry is equipped with two washing machines and three industrial steam ironers. The capacity is 1200 pieces of clothing per month or 60 pieces a day. Three major companies use the service to have their staff uniforms laundered: GRSA (restaurants), Multipark (parking) and Prosegur (CIT) itself. Partnership with Senac Family members must be aware of the importance of a job for social inclusion and for the development of the In March, APAE SÃO PAULO built a partnership with the National Service for Commercial Learning (Senac) to offer a potential of the person with Intellectual Disabilities. first job preparation course to the young people assisted in the training courses. Information such as personal relationships, expected behavior in the corporate world, the search for a job and CV writing, At this stage, we need to overcome concerns about the exposure of children to the adult world, which often lead to overprotection. Families are also advised on how to monitor the process of acquiring responsibility and autonomy, ranging the dynamics of selection processes in large companies, preparing for an interview, meeting the hiring manager, etc was the main focus of the course. from personal care to commuting issues. The methodology was developed by Senac and adapted by APAE SÃO PAULO for people with Intellectual Disabilities. In 2011, 40 of the assisted attended the course. 2011 Achievements Industrial laundry In partnership with Prosegur, a Spanish safety and security provider company, an industrial laundry with the most modern equipment available for the segment was set up. Prosegur was responsible for supplying the methodology and delivering the The Blue Butterfly Project The Blue Butterfly Project, launched in 2010, was effectively implemented in 2011 to promote the use of outdoor spaces in professional training programs. The methodology was developed by OBB (Outward Bound Brazil) for the improvement equipment. This company maintains an organization with a similar structure in Spain, of professional skills such as aimed at the empowerment of people with Intellectual Disabilities. The first group and teamwork. motivation, autonomy, leadership assisted consisted of 20 students. Classes started in April and the first graduation 56 57 Assistance, services and results The Third Age The project was conducted in the Horto Florestal (Municipal Nursery) of Campos do Jordão, where participants of the training courses were engaged in recreational camping. Since most of those young people had never had the experience of being away from their families, the knowledge acquired was particularly important: they were responsible for feeding and dressing themselves, putting up the tents, tidying up and organizing the space, disposing of garbage according to the rules of the camping site, etc. They also had new experiences in hiking trails and radical sports. The main objective of activities such as these is to awaken in these young people the feeling that they can and should experience challenges. Aging Support Service N umber Assisted in the Aging Service Some interesting experiments 164 140 134 2010 2011 The STATE GROUP, with the project Work for All employs 25 people who attended training courses, and ten out of these are visitors’ guides. Guiding visitors to their areas of interest requires recognizing different sectors and being able to give proper information about the functioning of each area, as well as being welcoming and kind. 2009 In the Delboni laboratory, belonging to the DASA group (Diagnóticos da America), professionals who attended the training courses work in front line client services, delivering results and helping the receptionists, sorting out exams and operating copy machines. APAE SÃO PAULO is a pioneer in providing Big companies have been our partners for many years with great success. The food industry Bauducco has been hiring people with Intellectual Disabilities since 2005 disabilities, undertaking the promotion of their quality of life. In the pharmaceutical industry Libbs, people qualified by APAE SÃO PAULO have been working in The Aging Service Support assists people the production line since 2006. over 35 showing the first signs of senescence 9% 7% 12% and senility which are common in long-lived Gained The MWM has also been a business partner since 1996, employing people who attended courses. 58 services to aging people with intellectual Functional Mapping 84% 82% 81% persons with Intellectual Disabilities. Functional performance 7% 11% 7% Maintained Cognitive abilities Lost Physical abilities 59 Assistance, services and results Comprehensive Geriatric Assessment Since 2010, the Aging Support Office has been adopting a specific methodology to meet the needs of this population. An innovative Comprehensive Geriatric Assessment (CGA) was designed and implemented to assess the cognitive, functional, communicative, emotional, behavioral and social capacities of the aging people assisted, which is used to analyze both their own and their families’ strengths and vulnerabilities. From the data obtained in AGA, a Singular Therapeutic Project (TSP) is developed, identifying individual needs and proposing short, medium or long term interventions. These interventions range from internal service activities and family counseling, or referrals to an external network of suitable equipment. In 2011, the Itaim unit assisted 134 aging adults. The main objective of the Service is the prevention of the impairment and decay related to aging, and the maintenance of the cognitive and functional skills acquired throughout life, favoring the autonomy, independence and social inclusion of aging people with Intellectual Disabilities. The service is provided by a group of different professionals in an interdisciplinary team approach: a geriatrician, an audiologist, a psychologist, a social worker, an occupational therapist, a physical therapist, a workshop instructor, monitors and nursing assistants. The service includes workshops, supervised by experts and focused on health and quality of life. Thus, physical, corporal and artistic activities are offered to enhance cognitive and functional abilities. 60 61 phasefour 62 promotion, protection, defense and guarantee of rights In 2011, APAE SÃO PAULO defined that one of its strategic priorities should be promoting, protecting, defending and guaranteeing the rights of the intellectually disabled. To this end, the Defense and Guarantee of Rights Office started working from real facts and experiences reported by the family to the legal social assistance. 63 Defense and Guarantee of Rights The study demonstrated the need to press for public policies aimed at protecting, promoting and guaranteeing human rights of people with Intellectual Disabilities. Furthermore, it was necessary, not only for society but also for people with Intellectual Disabilities Map of the Regions of the SÃO PAULO State themselves, to have a better awareness and understanding of established rights. Increasing one’s knowledge and changing one’s attitudes are crucial for effective social inclusion. In order to reach the intended goals, the following action programs were developed: Social Law Program The Social Law Program has as its primary goal the protection of people with Intellectual Disabilities and giving their families guidance about their social and civil rights, diffuse and collective.It acts transversely with the people assisted by all the services provided by the Organization, with a team of professional fields of law, social work and psychology. Support Program for People with Intellectual Disabilities experiencing violence. The experience acquired in assisting the mentally disabled and their families, added to the data showing that questions related to The program’s main objective is to prevent and tackle different forms of violence, State of São Paulo and the actors of the System for the Guarantee of Rights should be involved to ensure effective protection of rights. Legal and other instances of violations of the rights of both people with Intellectual Disabilities and their families. The idea of addressing this issue arose in 2008, as 861 a result of demands identified in APAE SÃO PAULO Services, which were clear Assistance 612 479 2010 2011 violence against this group often go unrecognized, resulted in a commitment to addressing this issue. To this end, all the APAEs of the The All for the Rights Project was developed accordingly. evidence of the need to tackle this phenomenon that impairs the quality of life of both the mentally disabled and their families. 2009 Number of families assisted For this purpose, our professionals are trained to become qualified to deal with this issue, using a systematic approach for recognizing and referring suspected cases of violation of rights. Furthermore, renowned professionals, highly specialized in handling cases of violence, participate in the program. 64 It was identified in 2009 and 2010 cases demand of for legal and social orientation of the ban not only attended by APAE SÃO PAULO but similar partner organizations. This work was performed by volunteer lawyers. From 2011, the number of service keeps as expected by the Organization. All for the Rights Project The main objective of the project “All for the Rights” funded by Petrobras is to strengthen the network of assistance to children and adolescents with intellectual disabilities in the state of São Paulo, preventing and meeting the challenges of violence perpetrated against them as well as other associated violations of rights. Starting in January 2011, it reached 46 municipalities in the State of So Paulo. The main proposal was to diagnose , sensitize people and articulate their participation in the issue of Intellectual Disability and in the System of Guarantee of Rights. 65 Defense and Guarantee of Rights In partnership with the APAEs of each municipality, a total of 3163 people became aware of and committed to this issue. Among those were professionals in Education, Health, Social Services and Public Safety, as well as Members of the Tutelary Board, Public Defenders and Prosecutors. In 2012, the project will be developed in six municipalities of the state of São Paulo (Santos, Ribeirão Preto, Campinas, São José do Rio Preto, Presidente Prudente and Bauru). The aim is to train and articulate integrate the agents, to map and implement the form of assistance of this network in preventing violence and in the protection and promotion of the rights of people with intellectual disabilities. All for the Rights 46 seminars held 150 municipalities reached 3,1 thousand trained professionals Family Support Program Self-defenders 2010 - 58 2011 - 69 Over the recent years, APAE SÃO PAULO has been discussing the importance of engaging the family in the fight for the cause of the Intellectually Disabled, improving their participation, mobilization and performance. To achieve this goal, the Family Support Program was created in 2011. It was designed to strengthen and encourage families to become agents of social transformation, stimulating their active participation in APAE and in all the other democratic spaces. Our challenge is not only to get them involved in Forums and Human Rights Councils but also in building, formulating and consolidating public policies for people with Intellectual Disabilities. Promotion of public policies APAE SÃO PAULO has been a protagonist in the construction and implementation of public policies on behalf of the Intellectually Disabled and in the defense of their rights. To this end, it participates in democratic and qualified spaces for political representation of the civil society such as forums, councils and networks of rights, in an attempt to include the issue of Intellectual Disabilities in the Number of families 2009 - 120 2010 - 132 2011 - 243 Self-management and Self-defender Program Since 2010, the Organization has been offering the Self-defender Program, whose aim is to promote spaces for dialogue, critical reflection and articulation of people with disabilities, so that they may become active players in the defense and guarantee of their rights. Participants are stimulated to manage daily activities according to their own individual level of competence and ability. It is important that all the participants have freely chosen to learn how to deal with their individual needs and to broaden their life perspectives. To that effect, they need to get active preparation to enable them to defend their positions and suggest actions and services that will meet their needs and expectations, aiming at improving their participation in all the sectors of society. 66 national agenda. Advocacy The concept of “advocacy” broadly refers to supporting a cause through mobilizing society and raising the awareness of its agents of change, as well as monitoring the actions of the Executive, Legislative and Judiciary Powers. Advocacy has been in operation for three years and its performance cuts across and happens in partnership with all the services of the Organization. The role of the Organization in the construction of public policies was systematized within the structure of Advocacy. This is an important undertaking to be pursued at a time when the legal framework of the defense and guarantee of rights and of the social inclusion of people with Intellectual Disabilities is being implemented in the country. 67 Defense and Guarantee of Rights Regional and Municipal Conferences for the Rights of Children and Adolescents, in which professionals participated National Federation of APAEs (FENAPAES). The Organization was also present at the as elected delegates not only in the regional and municipal conferences but also in the state event. It was the first time that children and adolescents participated as elected delegates. Of paramount importance is the involvement of the Organization in the regional, municipal, state and federal Conferences for the Rights of Children and Adolescents. It is a potentially powerful means of mobilizing the System for the Guarantee of Rights APAE SÃO PAULO highlights and public participation in 2011: and of the general population pressing for the implementation and monitoring of the National Policy and of the Decennial Plan of the Rights of Children and Adolescents. Launch event of the National Plan for the Rights of People with Disabilities – Living without Limits, launched by the federal In 2008, APAE SÃO PAULO, concerned with the stark reality that adults and aging people with Intellectual Disabilities often have Government on November 17, 2011. to face, created the Work Group (WG), composed of government representatives – Municipal and State Secretariats – and the civil Member of the Managing Committee for monitoring the National Health Plan for the Disabled coordinated by the Health Ministry. society. Since then, the WG has been developing articulations to Representation The APAE SÃO PAULO keeps track of the decision-making meetings of the Councils of Rights, forums and discussion networks related to the guarantee the access of people with Intellectual Disabilities to public facilities, and to promote adequate public policies for this segment. Today’s WG consists of eleven Social Organizations and one legal representative of people with with Intellectual Disabilities. It was officially recognized in 2011 by São Paulo’s Mayor as an exemplary initiative to foster transversal public policies aimed at assisting aging disabled people. rights and guarantees of people with Intellectual Disabilities, and there is a permanent APAE SÃO PAULO representative in the State Council for Intellectual Disability Affairs. National Council for the Rights of Children and Adolescents (CONANDA) as a representative of the In 2011, the APAE SÃO PAULO participated in the work of the 68 69 phasefive 70 Knowledge Generation and Dissemination One of the strategic axes of APAE SÃO PAULO is the generation and dissemination of scientific and technical knowledge in relation to the issue of Intellectual Disability. By training people and promoting research and scientific inquiry, the organization is at the forefront of knowledge generation and consolidated as a model institution in dealing with the issue of Intellectual Disability. 71 71 Knowledge Generation and Dissemination Over the past two years, the Institute has undergone an administrative and structural reorganization in order to resume that vocation and ensure the advancement of knowledge. Ongoing research studies on Intellectual Disabilities involve issues such as obesity in people with Down’s syndrome, premature aging, assessment of functional mobility and of increased risk of falls among people with Down syndrome over the age of 35, cognitive decline in adults with the Down syndrome, hemoglobinic profile analysis in preterm infants, studies of congenital adrenal hyperplasia, fragile X syndrome, congenital hypothyroidism, hemoglobinopathies in newborns, carnitine deficiency, habilitation and rehabilitation, evaluation of video-electroencephalography of adults with Down syndrome, clinical, neuroradiological and neurophysiological epilepsy in people with Intellectual Disabilities, as well as studies related to the families and inclusion issues, defense and guarantee of rights, inclusive education and the impact of an interdisciplinary approach on child development. The Institute also invests in The APAE SÃO PAULO INSTITUTE The APAE SÃO PAULO Institute operates in two main areas: the promotion of scientific research on Intellectual Disability and the training of people who have interest in this area. Our goal is to develop and disseminate knowledge and to become a reference in scientific techniques, approaches and theories on Intellectual Disability. The Institute gained momentum in 2009, when Dr. Esper Cavalheiro Abram, a postdoctoral M.D., former president of CNPq and renowned researcher, accepted the invitation to be the new chairman of the Scientific Council. With the reformulation of the Council, the institute’s training activities and research were geared towards a constant update of the major scientific discoveries and state-ofthe-art technologies related to Intellectual Disability. Aging Services, in an attempt to provide the necessary support for the development of children, adolescents and adults with different cognitive abilities and needs. It also works on prevention, an area that demands the development of extensive research, focusing on the causes of Intellectual Disabilities, which in Brazil are markedly associated to alcohol and drug abuse, to mother, infant and young child malnutrition and to pregnancy and delivery problems. An emerging research center Although the research activities were resumed quite recently, they have been gradually progressing as new research questions and projects arise. The idea is to structure research in such a way that it becomes a knowledge exchange resource center where Intellectual Disability researchers across the country can find space to work and share scientific information. For 2012, the prospect is to attract doctors and post-docs to a joint research effort, focused on achieving excellence in our services Research The Institute founders’ ideal was to updating knowledge and practices for Educational, Early Stimulation and and internal training, and contributing to the dissemination of knowledge among scientists and in similar institutions. To this end, create a research center dedicated to the advancement of knowledge of partnership mechanisms that allow interactions with other research institutes are being studied. new tools and methodologies for the prevention of Intellectual Disability and for innovative support approaches. Therefore, the main 72 research lines defined were “Genetics and Molecular Biology”, “Cognition and Development,” “Brain Imaging” and “Neonatology and Since sustainability is a goal, it is expected that the scientific projects proposed will attract research funding. Currently, ongoing Neonatal Screening” - the foundations of an emerging Intellectual Disability research center. research is funded by APAE SÃO PAULO. 73 Knowledge Generation and Dissemination Professional Training Seminars and courses held Seminar on Genetics and the Development of the Nervous System Seminar on Brain and Intellectual Disability (celebrating 50 years of APAE) Workshop on Spectroscopy Courses held in 2011 In-Company: In-House courses: Short duration Courses Held: 8 Medium duration (180 hours) Courses Held: 2 Total: 10 courses Given by a team of researchers from Unicamp (physicians, geneticists, biologists, psychologists) and with the participation of 186 professionals. Held at the Latin America Memorial, with the participation of 447 people, including 258 professionals of APAE SÃO PAULO. Conducted by a team of researchers from Latin American Spectroscopy Center (UNIFESP) and with the participation of 258 professionals of APAE SÃO PAULO. Seminar on Neuroplasticity Given by professionals in neurology and neuroscience at the Autonomous University of Mexico, with the participation of 177 258 professionals of APAE SÃO PAULO Course on Psychopathology Given by the psychiatrist Dr. Ivete Gattas, with the participation of 101 professionals of 258 professionals of APAE SÃO PAULO. The course offered training in neuropsychological assessment tools to professional psychologists. II Seminar on Aging and People with Intellectual Disabilities Third-party courses Courses Held: 22 EAD courses - Employability of the Person with Intellectual Disability and Aging of the Person with Intellectual Disability (with FENAPAES). Courses Held: 3 groups Total: 25 courses Total number of people trained: 735 Total number of courses: 35 Held in association with the institutions belonging to the Study Group on Early Aging in People with Disabilities, with the participation of 102 people. By training teachers and other health and education professionals, the institute tries to spread its knowledge so as to fight prejudice, People trained in the assisted schools 735 In the area of professional training, the Institute uses the practical experience acquired by professionals of APAE SÃO PAULO in the assistance and social inclusion services for The courses for the general public are twofold: people with Intellectal Disabilities. 82 2010 In this area, the Institute focuses on primary and elementary schools and on similar 2011 organizations (especially smaller NGOs), giving technical training to students and practitioners of physical therapy, occupational therapy, social work, speech therapy, education, psychology, physical education and arts,among other areas. The performance of the Institute contributes to inclusive education by training private and public education teachers to deal with the 74 in-house (held in APAE SÃO PAULO) and in-company (held in the companies or organizations that demanded them). Most of the courses are intended for smaller organizations of a similar nature, such 306 2009 destroy myths and guarantee inclusion. as neighborhood associations, often connected to churches or to social movements that are committed to providing some assistance to Intellectually Disabled people. The content of the courses is defined according to the needs of each organization, and questions related to human rights, violence, sexuality, the labor market, behavioral issues are the most common concerns focused on. The courses offered by the Institute have a wide variety of clients, including state and municipal education secretariats, which need them for teacher training in the area of Intellectual Disability. Besides these, there are those numerous professionals working with people with Intellectual Disability who need updating, such as psychologists, speech therapists inclusion of children in mainstream schools and to develop their potential. and teachers of physical education and arts, among others. This undertaking became crucial once special schools were closed in 2009, a decision in Companies that want to have their client/customer service professionals trained to deal with issues such as the accessibility and keeping with the inclusive education policy advocated by APAE SÃO PAULO. inclusion of people with Intellectual Disability have also been seeking APAE SÃO PAULO’s courses. 75 phasesix 76 organizational structure, partners and investors APAE SÃO PAULO is made of transforming efforts and attitudes. It is motivated by those who share the same dream and believe in this reality which, for over 50 years, has been giving opportunities to people with Intellectual Disabilities, thus contributing to creating a more inclusive, fairer and worthier society. 77 WORKFORCE APAE SÃO PAULO Edna V. Tralli Voluntary Action’s Board of Directors Ambassadors Eduardo Camasmie Gabriel Bernadete Destro Brito Machado Gustavo Borges Lifelong Counsellors: Enio Buffolo Cecília do Valle De Zoppa Maria Cândida Alda Moreira Estrázulas (in memoriam) Ernani Buffolo Kátia Villemor Jofily de Lima Antônio dos Santos Clemente Filho (in memoriam) Felipe Clemente Santos Lenita Helena Maciel Linero Sponsors Emirene da Costa Moniz Flávio Strapetti Maria Cristina Lima Kabbach Alessandro Segato Fernando Silva Telles José Diogo Bastos Neto Maria do Carmo L. de Paula Araújo Antônio dos Santos Clemente Filho (in memoriam) Gilberto Penteado da Silva Telles (in memoriam) Leo Braga Furness Filho Olga Auricchio de Souza João Armentano Hermógenes Troyano Liliana Clemente Santos Yoshie Shibata Roberto Kalil Filho Jô Clemente Luiz Carlos Henrique João Leondarides Luiz Fernando Butori Reis Santos Honorary President Joaquim Burin (in memoriam) Marco Antonio Fernandes David Jô Clemente Oscar César Leite (in memoriam) Nelson Bechara Filho Seme Gabriel Oscar Ungarelli Neto Vera Dias Toledo Vicente de Azevedo (in memoriam) Randal Luiz Zanetti Roberto Shinyashiki Executive Group Scientific Counsel and Advisor of APAE SÃO PAULO INSTITUTE Superintendent President Financial Administrative Manager Esper Abrão Cavalheiro Hailton Oliveira Mendes Junior Aracélia Lúcia Costa Raul Manuel Alves Administrative Council President: Marco Antonio Fernandes David Board of Directors Secretary: Randal Luiz Zanetti President: Cássio dos Santos Clemente 1º director vice-president: Cláudio Pacheco do Amaral Counsellors Fiscal Council 2º director vice-president: Felipe Clemente Santos Elza Marcia Yacubian Albino Pereira de Mattos 1º director secretary: Cristiano Frederico Ruschmann José Eduardo Krieger Human Resources Manager Carlos Zaideman Ázar 2º director secretary: Eduardo Camasmie Gabriel José Fernando Perez Maria do Carmo Guardia Nassar Vicente Petrosino Neto (in memoriam) 1º financial director: Raul Manuel Alves Oswaldo Luiz Alves 2º financial director: Leo Braga Furness Filho Elected Councillors 78 APAE SÃO PAULO INSTITUTE Manager Dalci Maria dos Santos Coordinators Honorary Members of the Scientific Counsel Cristiane Valéria Prado Lopes Ana Maria Falzoni Adjunct Directors Aron Diament Fábio Rodrigues Carlos Augusto Gentil Fagundes Carlos Augusto Gentil Fagundes Darcy R. Schussel Leila Regina de Castro Cássio dos Santos Clemente Cláudio Ferreira Fernando José de Nóbrega Maria Aparecida Baptista Soler Cláudio Pacheco do Amaral José Diogo Bastos Neto Hélio Egydio Nogueira Marilena Ardore Cleiton de Castro Marques Luiz Fernando Butori Reis Santos Mina Regen Marília Pinho Ferrari Clóvis Ermírio de Moraes Scripilliti Luiz Cintra do Prado Rosana Cunha Renato Ribeiro dos Santos Cristiano Frederico Ruschmann Maurício Ceschin Seme Gabriel Daniel Souza Campos Miziara May Machado Tuca Munhoz 79 Investor Partners Corporate Strategic Partners Corporate Institutional Corporate Supporters 80 81 Investor Partners Corporate Alvenius Equipamentos Tubulares Ltda Assai Atacadista Atlas Transporte e Logística Banco West LB Cantaloup Casa Santa Luzia Importadora Cesta Maximo CLM Gestão em Saúde Club Transatlântico Colgate-Palmolive DELPIS Com. de Prod. 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Engas S/A Adm Bens Cor Seguros Faculdade Integral Cantareira Formula Ativa Abigail Batista Fuly Abigail Rodrigues Pinto Abrão Adib Dib Adailza França de Oliveira Adão Gomes Adelino Pasqual de Oliveira Ademir Norio Alicawa Aderito Domingos da Conceicao Nunes Adiba Zarzur Zogbi Adilson Nunes Camilo Admilson Mazzuccato Adriana Brolio Panachi Adriana de Cassia Lamberti Adriana Mujakrch Adriana Teixeira de Mello Adriano Mendonça Nishihara Adriano Nuevo Franca Afranio Zucon de A Bueno Agenor Madella Agesipolis Franca Filho Agnaldo Gomes de Souza Agostinho José Alves Filho Aguinaldo Masironi Aida Soares Moura Ailton Sandro de Oliveira Airton Roveran Airton Soares Alberto Augusto de Camargo Melo Alcides Huertas Tello Aldecy Eliana da S Pavan Aldo Neves Godinho Alegra Kosminsky Alessandra Piraino Alessandro Segato Alexandra de Ataliba Temer Alexandre Amado Britez Alexandre José Periscinoto Alexandre Maurano Alexsandro de Moraes Nascimento Alfredo Fernando Vieira Alfredo Ribeiro de Castro Alfredo Rizkallah Alice de Paula Penteado Alice Lallo Alice Suzuki Sato Silva Alice Suzuko Kurihara Alipio Paulino Neto Allan Suzarco Ferraz Alpheu Lazaro Rodrigues Altair Augusto Amaral Altino Valentim Gomes Alvaro G dos Santos Alvaro Peres Alzira dos Prazeres A Ferreira Alzira Loderi Amabilis Pereira Amanda Damasio de Oliveira Amara da Silva Moraca Ana Barbara Bonatelli Ana Beatriz Teixeira Iumatti Ana Bento Ana Bruna Tealdi Almeida Ana Carolina Soares de Almeida Ana Claudia B Mathias Ana Cristina Libório Ana Elisa Strenger Ribeiro Ana Lucia C Bianco Ana Magda Stradioto Casolato Ana Maria Curvelo Borges Ana Maria da Cruz Ana Maria Gervasio Ana Maria Rodrigues Ana Maria Whitaker de S Dias Ana Melo Ana Olimpia D Maia Cardoso Ana Parente Ana Paula de Macedo Reinfederon Ana Rosa Chazaine Ana Sanchez Boix da Silva Anderson Coutinho Ogata Anderson Ricardo Alves Anderson Salles de Almeida Anderson Santos Martins Andre Adam Golebski André Luiz Baraldi André Nogueira de Lima Andre Rosa do Nascimento Andrea Duarte Rodrigues Andréa Maura Bertoline Andrea Teisen Garotti Andreia de Oliveira Dantas Angela Manzini Villela Angela Maria Amaral Vitiello Angela Sueli Roselem Angelina Badosa Oller de Gari Angelo De La Costa Junior Angelo Giro Anna C Moliterno Anna Ciampone de Souza Anna Miguel Attie Anselmo Marino Scuarcialupi Antonia Binhardi Alberto Antonia Mary P. Vitoriano Antonina Vaz G Leme Antonio Alfredo de Lima Antonio Alvaro Rendohl Antônio Alves de Almeida Antonio Annunciato Antonio Batista dos Santos Antonio Branisso Sobrinho Antonio Buonerba Antonio Carlos Andreoli Ciuccie Antonio Carlos Bechtold Antonio Carlos Marchini Junior Antonio Carlos Nunes Abreu Antonio Carlos Possale e Silva Antonio Carlos Sayeg Luisi Antonio Carlos Teixeira Antonio Carneiro Sampaio Antonio Cruz Mendes Antonio da Silva Sobrinho Antonio de Andrade Antônio Eduardo Rocha Alves Antonio Elias Tuma Farah Antonio F de A Cavalcanti Antonio Feliciano Santos Antonio Fernandes da Graca Antonio Gabriel Junqueira F Antonio Garcia Neto Antonio Giroldo Antonio Goncalves Oliveira Antonio Nonato Filho Antonio Nunes Ferreira Antonio Okita Antonio Rivas Gutierrez Antonio Santoro Aparecida Catarina Barbosa Aparecida de Lourdes Mengali Aparecido Cardoso da Silva Aparecido Peres da Silva Aracelis Lopes Affonso Arlei Augusto Piton Arlete Aparecida da Silva Arlinda Rosa dos Santos Arlindo Marques Armando Amorim Klein Arnaldo Lopes Arthur Riedel Arthur Alves Pinto Artur Hiroshi Caldeira Sato Ary de Andrade Atilio Lazari Filho Auglicelia Ricardo de Lima Aurea Nathue Anraku Aurea Silveira de Oliveira Aurice dos Santos Zoppei Aylton Tobias Baltazar Mansano Filho Beatriz Dinapolis Soares Beatriz Penteado Stevenson Beatriz Pereira de Queiroz Beatriz Reale Ferrai Koke Ribeiro Beatriz Tavares Costa Carvalho Belmiro da Costa Pessoa Filho Benedita Marques Gomes Benedito Carlos de Padua Benedito Mario S Siegl Bernard Paulo Premisleaner Bernardino Lavieri Gomes Berta Kasinsky Brasilio de Alcantara Machado Braz Malavazzi Bruna Florian Bruno Massaroppe Cacia Setima Montagni Cacilda Silva Massukado Caio Cortez Evangelista Caio Gomes Mellacci Caio Robledo D C Quaio Camila de Souza Soares Candido de Almeida Neto Carla Cristina T de Oliveira Carla Schultze Carlos Abreu Costa Junior Carlos Alberto Castro Pereira Carlos Alberto dos Santos Carlos Alberto G Vilarinho Carlos Alipio de Araujo Carlos da Silva Leite Carlos Eduardo Ferraz Luz Carlos Eduardo Paes Carlos Eduardo Toledo Ladeira 83 Carlos Henrique Pinto Haddad Carlos Magno Martins Carlos Roberto Borsatto Carlos Roberto Guermandi Carmelita de Carvalho Carmem Castilho Igisca Carmen Ostini Carolina Felix Martins Carolina Norma Vela La Motta Catarine Aparecida V Barbosa Catia Fernandes Pires Cecilia da Rocha Azevedo Cecilia Martins Pinto Cecilia S Francesconi Cecilia Satiko Tanaka Celeste Quintas Ferreira Dias Celestina Bocarossa Cavalier Celia Barbosa de Sa Celia Maria Scholz Cavalini Celia Regina Teixeira de Almeida Celia Tomiko Nagamatsu Celina Creusa da Silva Celis T N Peinado Celso Arruda Marcondes Faria Celso Conde Kneip Celso da Silva Celso Euzebio de Oliveira Celso Gaspar Calia Celso Leite dos Santos Celso Pereira Cosentino Celso Toaldo Cesar Meleiro Pina Cezar Henrique Santos Bueno Chaie Feldman Chantal Perroy Roxo Loureiro Chen Ying Ling Christiano Jorge Christiano Jorge Santos Cibele Russo Cicera Maria Bras Cilania R B Peixoto Cíntia Maria Martins de Luca Clarice L Brito de Luigg Clarisse Mendonca Aun Claudete Maria Grego Claudete Monteiro do Amaral Claudete Valentim Bastos Claudevam Faustino Barros Claudia Bavaresco Tomchinsky Claudia M M Gabrilli Claudia Marques Claudia Marques Lage Claudia Pereira Nora Claudia Ramalho Junqueira Claudio Acquaviva Claudio Fernandes de Mattos Claudio José Giacomelli 84 Claudio Rossi Claudio Sabino Cledson Albino Alves dos Santos Clélia Cristina da Paz Cleonice de M Parreira Cleyton Tadeu Batista Clovis Ferreira Valerio Conceição Aparecida Tavassos Constancia A de Oliveira Cristiane Concilio Saraiva Cristiane Machado Godoy Cristiano de Andrade Altieri Cristina dos Santos Cristina Maria de Matos Moffa Curt Mangold Cybelle Pacheco Vaz Pimentel Dagmar Vaz Mellonio Dalton Luis Bertolini Dalton Pastore Dalva de Assis Carvalho Dalva Dorothy de Lima Mazzilli Dalva Orlandi Robazzi Daniel Chiavarini Altavista Daniel Demattio de Oliveira Simões Daniel Francisco Polato Daniel Souza Campos Miziara Danilo Balarini Danilo Sahione Danilo Volterrini Danusa Schwartz Darby CarlosGomes Beraldo David Marques Dayane Cristina G Antunes Dayane Maria Dayse Almeida Dias Deborah R. Lambach Ferreira da Costa Deborah Regina Baptista Spigariol Delfin Rodriguez Casuso Delfio José Tomazelli Delmo C Arnoni Delvio Steltri Dener Claudino de Lana Denise Gatto Denise Jeronimo Galbiati Denise Rodrigues Rizzo Denise Titoshi Watanabe Dennis Cintra Leite Diego Martins Costa Dieter Mangold Dijalma Martins de Araújo Dionizio Alves Dias Diorante Chiaparini Dirceu Kempter Dirlei Rodolfo Fernandes Diva Bartalini Benatti Diva de F Dupre Marletti Diva Vieira de Faria Domingos Modaffore Donizete Pedroza Dora Tavares Francisco Dorival Vito Teixeira Pinheiro Douglas Hernandez Ventura Seco Douglas Marcel Pereira Dulce Braido Dulcineia Lopes dos Santos Durval Nascimento Freire Durvanil Decio da Silva Duval Moraes Duarte Eden Ferreira Granja Eder Mauricio Barbosa Edgar Tella Edgard Scavone Edilair Rodrigues Silva Edilene de Jesus S. Feitoza Edite Gigliuci dos Santos Edith Celestino Fava Edna Maria Rocha Meirelles Edna Minelvino Edson Alexandre Pereira dos Santos Edson Bueno de Toledo Edson Chiodarelli Edson Souto Ramos Eduardo Antonio André Eduardo Carlos Pereira Eduardo Figueiredo de Moraes Rego Eduardo Gabriel Eduardo Luiz Sophia Eduardo Per Horn Eduardo R Oliveira Eduardo Roberto Martins Edvirges Gorgueira Pedor Egidio Prado Elaine Amorim Elaine da Silva Freire Elaine Regina Ferreira Elcio Meyer Eleonora Cintra P V Roos Eliamar Campos Eliana de Milite Luiz Eliane Zanini Elinor Amatuzzi Oliveira Elisabeth Colon de Oliveira Elivania Vieira de Souza Elizabeth Marques Coni Elizabeth Ortolani Elsie Maria Arruda Penteado de Carvalho Elson Ferreira Granja Elvira Manfredo de Oliveira Elza do Carmo Elza Maria Bosco Encinas Emil Burihan Emil Kosuke Seko Eni Santos Enio Salvador Sanches Enio Shimabukuro Ercilio Sala Eriberto Antonio Paiva Erica Fernanda de Sante Erica Machado Roman Erika Morita Ermelinda de Almeida Ernesto dos Santos Caetano Filho Ervim Hochenberg Estanislau Massahome Uezima Ester Helena Khalil Leanza Esteves Cia Ltda Eugenio Cruz Eunice Carvalho Barros Eunice Visone Euridice Rosso Siqueira Evandro Freitas de Sousa Evelina Ines B Di Benedetto Everton Luis da Silva Fabiana de Oliveira Aoyagui Fabiana Marcondes Fabio Alves de Lima Fabio Antonio G Buffolo Fabio Bruno Parente Fabio Cabral Fabio de Oliveira Ramirez Fabio Ferreira Alvim Fabio Oda Shimada Fabio R M Bellucio Fabio Renato Gama da Silva Fábio Serantes Mota Fabio Tarasautchi Fausto Augusto Fausto Bettiovo Fausto Nicoliello C Vencio Felipe Lopes Zapata Fernanda Araujo Santos Fernanda Minini Lopes Fernanda Pantalena Aliprandi Fernando Barros Barreto Fernando Camargo Mendes Fernando Del Negro Fernando Dias Fernando Dias Oliveira Fernando Fabiani Capano Fernando Gomes Franco Fernando Henrique Coelho Fernando José Bricks Fernando Mauro Neves de Souza Fernando Pioker Gomes da Silva Flavia Jafet Flavia Thereza M Pimentel Flavio Abrahao Nacle Flavio Anjos Rocha Flavio Antonio Moceli Flavio Bulgarão Flavio José de Souza Brando Flavio Riguetto Fleury Pereira Lima Francini Salete Apendino Francisco Gravina Junior Francisco José Macedo Francisco Mariz de Carvalho Francisco Melo de Oliveira Franklin Edgard Moura Campos Frederico Nakashima Geisa Lopes de Araujo Genessy Luiz Vieira Gerd Henrique Stoeber Gesualdo Ramos Getulio de Souza Coelho Giacomina Faldini Gian Paolo Rastelli Gilberto Blanco Jorge Gilberto G Bacchelli Gilberto Grande Polizio Gilberto Kon Gilmar Belluzzo Bolognani Gilson Hochman Gino Benedetti Gislaine dos Reis Stella Givaldo da Silva Lima Gladston Tannous Glaucia Maria Andrade Caldas e Sousa Glaucia Miranda Filio Glória M. Moreira Salles Gofredo da Silva Telles Jr Graca Pires Rocha Guilherme Archer de Castilho Guilherme de Paula Lima Guilherme Farah Guilherme Pimentel Irani Guilhermina O B Ribeiro Guiomar Morsoletto Ferreira Gunther Mangold Gustavo José Lion Guy Jean Roberto Tible Haroldo Rodrigues Hatune Kushitama Haydee Macedolla Rocha Hector Alexis Salinas Olguin Helena C B Muraco Helena Kiyomi Kamei Helena M E Silva Carmo Helena Mamede Polizio Helena Mokarzel Lage Helena Muller Helena Sposito Heloisa de Oliveira Coutinho Henny Nossig Henrique Carlos Soares de Araujo Henrique Bernardo dos Anjos de Jesus Henrique Congo Neto Herculano dos Santos Clemente Hermenegildo Milani Neto Hidehito Tsuramaki Hideo Matsuzaki Hilton Pecorari Baptista Honorio Konno Hygino Carlos Amaral Idelt A Marconi Pereira Ieda C Bernardes Iete Moreira dos Santos Iezo Conte Silva Igor Gomes da Silva Igor Pereira da Silva Ildonei Ribeiro Lutaif Ilza Maria Valentine Iraci Amancio Dosia dos Santos Irany Freitas de Moura Irece O Wargha Vancevicius Irene Cordeiro do Nascimento Irene Scarpiello Villar Irma Carvalho Alvim Irma Conti dos Santos Isabel Cristina Costa Isabel Nones Schahin Isabel Oliveira de Macedo Isabela Simoes de Abreu Schulz Isabella Schout Mazzeo Isaltino Nunes Bibiano Ismenia Isaac Israel Fernando Cardoso da Conceição Ivan Brasil M Bevilaqua Ivan Campos de Sousa Ivana Có Galdino Crivelli Ivete Marly Caetano Moccia Ivete Torres Leite Ivone Dalmazo R Negreiros Ivone Delazari Ivone Fregni Izaura Zanata Rigazzo Izilda Santos Leao Felga Jacqueline Oliveira Lima Jacques Benchetrit Jacques Nigri Jadir Jaco Monteiro Jahir Duarte Jaime Antonio Decarli Jaime Elias Pesce Jamile Serur Zuskin Janaina Nunes Ribeiro da Ponta Janaina Oliveira Lana Martins Janaina Simone Tenório da Silva Jandyra Junqueira Vieira Jane Cristina Vieira Cetra Janet Kimiko Ninomika Janete Novelletto Jano Luiz Benevides Garotti Jaques Clayton Cerutti Jarbas Teixeira Carvalho Jr 85 Jayme Vieira Filho Jeanete Aparecida Shimara Jeannette A Palacio Pereira Jeronimo José Garcia Ruiz Jessica Jeniffer de Oliveira Jhonny David da Cunha Rocha João Adalberto Mariano João Alves de Araujo João Antonio de Moraes Scott João Antonio Setti Braga João Antonio Zogbi João Batista Borgheti João Batista Poiani João Carlos Attarian João Carlos Costa Brega João Davi Sartor João Fernando Lopes de Carvalho João Iumatti João Maccarone Neto João Miguel Jacob Filho João Salgado de Vasconcelos Filho Joaquim Carlos Martins Joaquim de Oliveira Filho Joaquim Fonseca Joaquim Goncalves e Cia Ltda Jones Branco Junior Jorge da Silva Lopes Jorge Mendes Barboza Jorge Murilo Baldim Jorge Rogério Campos Barcelos José Abrahão Netto José Americo Figueiredo Silva José Antonio da C Alcobia José Antonio Ferrara José Aparecido Pagliari Lopes José Arivaldo Alves José Augusto Penteado Aranha José Carlos Batelli Correa José Carlos da Silva Velloso José Carlos de Souza José Carlos de Souza Filho José Carlos Guariento José Carlos Imbriani José Carlos Ramos José Carlos Sampaio José Carlos Tadeu Antonio José Coelho Carneiro Leao José da Costa Siqueira José da Cruz Medeiros José da Cunha José Damião de Souza José Eduardo Lima de Paula Araujo José Enrique Canotilho José Ernesto Succi José Garcia Marin José Gomes Ribeiro José Luis Fernandez Correro 86 José Luiz Antunes Campos José Marmo José Martins da Rocha José Mauro de Lima José Nery Praxedes José Nilvan de Oliveira José Ortali Netto José Rafael Barajas Perez José Ribeiro dos Anjos José Roberto Cruz José Roberto da Silva José Roberto Lorenzi José Roberto P de Mello José Roberto Reffineti Guidi José Rogério Cruz e Tucci José Rufino Teixeira José Silvio Toni Junior José Thomaz Perri José Tulio Alves Barros José Vasconcellos de Oliveira José Vieira de Moraes Josefa Luiz dos Santos Josephina M Pankratz Josue Miranda Juçara P. S. 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