Community of Practice in Occupational Therapy in the Brazilian Unified Social Assistance System: arranging meetings and promoting debates in social occupational therapy

Abstract

With the growing number of occupational therapists working at the Unified Social Assistance System (SUAS) in Brazil, there has been an increasing need for education processes focusing on the critical development of professional practice in this field. From this education demand, a project was created in October 2020: “Communities of Practice in Occupational Therapy at SUAS: professional planning and construction of strategies” aiming to promote the exchange of knowledge and experiences between occupational therapists working in social assistance. This study aims to present the work possibilities and limits at SUAS from the point of view of occupational therapists who work at its units and who participated in the Community of Practice, analyzing whether and how their professional actions have been related to the social occupational therapy theoretical-methodological framework. To this end, all the recording material produced in the two project cycles from October 2020 to July 2021 was revisited. The collected information was organized in a table that grouped the themes found. Data analysis revealed two main aspects that allow the correlation of the professionals’ actions with the social occupational therapy theoretical-methodological framework, namely, the necessary interpretation of the inseparability between micro- and macro-social factors for the development of work and the professional and political dimensions of the occupational-therapeutic actions. In both debates, the social occupational therapy theoretical-methodological framework has been the guiding thread of the process, enabling a social reading and a greater understanding of technical-professional purposes within the scope of social assistance.

Keywords:
Professional Practice, Social Policy, Social Protection, Education; Continuing, Occupational Therapy

Resumo

Com o crescente número de terapeutas ocupacionais atuantes no Sistema Único de Assistência Social (SUAS), amplia-se a necessidade por processos formativos que desenvolvam criticamente a atuação profissional neste campo. A partir desta demanda formativa foi criado, em outubro de 2020, um projeto de extensão intitulado “Comunidade de práticas em terapia ocupacional no SUAS: articulação profissional e construção de estratégias”, com o intuito de promover trocas de conhecimento e experiências entre terapeutas ocupacionais trabalhadoras em unidades socioassistenciais. Neste artigo se apresentam as possibilidades e os limites do trabalho no SUAS sob o ponto de vista de terapeutas ocupacionais que nele atuam e que foram participantes da Comunidade de Práticas, analisando se e como suas ações profissionais têm se relacionado com a fundamentação teórico-metodológica da terapia ocupacional social. Para isso, foi revisitado todo o material de registro produzido nos dois ciclos do projeto, efetivados de outubro de 2020 a julho de 2021. As informações extraídas das atas foram organizadas em um quadro que agrupou as temáticas encontradas. A análise dos dados revelou dois principais aspectos que possibilitam a correlação das ações das profissionais com a fundamentação teórico-metodológica da terapia ocupacional social, sendo: a necessária leitura acerca da indissociabilidade entre os fatores micro e macrossociais para o desenvolvimento do trabalho e a dimensão técnico-política da atuação terapêutico-ocupacional. Em ambos os debates a fundamentação teórico-metodológica da terapia ocupacional social foi e tem sido o fio condutor do processo, possibilitando uma leitura social e maior apropriação das finalidades técnico-profissionais no âmbito da assistência social.

Palavras-chave:
Prática Profissional; Política Social; Educação Continuada; Terapia Ocupacional

Introduction

Occupational therapists are professionals who, historically, have been working in social assistance units in Brazil (Galheigo, 2016) and were legally recognized as qualified professionals to work at the Unified Social Assistance System (SUAS) in 2011 (Brasil, 2011a; Almeida et al., 2012). Since then, the number of occupational therapists practicing within SUAS has been growing (Oliveira et al., 2019), necessitating reflections on these practices along with proposals for continuing education that critically develop professional action in this sector, as facilitated by the formation of Communities of Practice.

Communities of Practice¹ are strategies for professionals to collaborate, share experiences and learning, and develop joint actions. They can be understood as collective spaces for learning among people with common interests, related to a specific type of work practice (Wenger-Trayner & Wenger-Trayner, 2015). The voluntary organization among participants can lead to the construction of new knowledge that fosters reflection and dialogue, encouraging research, reflections, and assessments that align with the practice in question (Wenger-Trayner & Wenger-Trayner, 2015). Moreover, the value of collaborative learning brings benefits for personal and professional satisfaction and fulfillment. In a discussion on the necessary epistemic reflexivity in the field of occupational therapy, Kinsella & Whiteford (2009) emphasize the importance of valuing the “wisdom of practice” as one of the resources that generates knowledge and enables the construction of new understandings.

According to Wenger-Trayner & Wenger-Trayner (2015), a Community of Practice is based on three essential characteristics. The first is the domain, which refers to the structured identity formed around a common interest that guides its members. The second is the concept of community, which is related to the collective commitment agreed upon by the members, fostering the construction of mutual relationships based on common interests. Finally, there is the actual practice, where professionals or subjects involved in a specific type of practice develop and share experiences, as well as seek solutions to problems.

The idea of forming the “Communities of Practice in Occupational Therapy at SUAS: professional articulation and strategies construction” discussed here arose from the doctoral dissertation of Oliveira (2020). The research mapped the number of occupational therapists working at SUAS and engaged in discussions with these professionals about their practices. The study was based on data from the SUAS Census (Brasil, 2020), which indicated that, in 2019, Brazil had 1,673 occupational therapists working at SUAS units, including Day Centers, Shelters, Social Assistance Reference Centers (CRAS), Community Centers, Specialized Reference Centers for Social Assistance (CREAS), and Specialized Reference Centers for Homeless People (Centro Pop)² . Subsequently, in 2020, within the context of the COVID-19 pandemic, the researcher organized a presentation of the results in an online event titled “Occupational Therapy at the Unified Social Assistance System”. The event had 580 participants, and 90% of them expressed interest in joining projects involving discussions and continuing education to support the work of occupational therapists at SUAS. Based on this, the creation of the Community of Practice was proposed as a university project aiming to coordinate virtual meetings and collective strategies to address the issues raised by the professional action of occupational therapists involved in the implementation of social protection propositions, using the findings identified in the study of Oliveira (2020) as a reference.

In September 2020, a public invitation was made through communication channels such as institutional e-mail addresses, WhatsApp^®, Facebook^®, and Instagram^®, among others, so that interested professionals could apply to join the Community. The participation criteria were as follows: being a graduate in occupational therapy, working at SUAS, and having availability for virtual meetings. A total of 96 applications were received, and 77 of them were approved. With the invitation extended to 77 professionals, the work occurred from October 2020 to July 2021, with an average participation of 47 professionals from different locations in Brazil. During this period, 12 virtual meetings with a mean duration of two hours each were held in two cycles.

In the first cycle, in 2020, the activities were conducted biweekly and facilitated by teachers and professionals from the universities involved in the Community: Federal University of São Carlos (UFSCar), Federal University of Triângulo Mineiro (UFTM), Federal University of Espírito Santo (UFES), and University of São Paulo (USP - São Paulo campus). They were supported by a team of college students who participated as extensionists. In the initial meetings, the thematic areas and strategies for the Community were collectively discussed, and the main theme chosen was the theoretical foundations for professional practice. To address this theme, subsequent meetings focused on discussions about the theoretical principles of social occupational therapy as a framework for occupational-therapeutic practice at SUAS - a proposition developed by the facilitators and accepted by the participants. Strategies such as assigned readings, as well as sharing and discussing narratives about the professional experiences of the participants at different levels of complexity, in programs and projects within SUAS were adopted. Dialogue, knowledge exchange, and uncertainties surrounding practical experiences in the daily work in various socio-occupational spaces of SUAS were predominant in the meetings.

The second cycle emerged from the participants’ interest in continuing the Community’s activities for 2021, which had not been initially planned. Moving towards more participatory meetings led by the participants, the group was divided into two main organizational fronts. The first front focused on organizing meetings for theoretical deepening, based on jointly chosen topics, with everyone participating in the development of thematic seminars for discussion within the group. The second front was dedicated to producing and disseminating content related to occupational therapy practice at SUAS through the creation of the blog “Terapia Ocupacional no Sistema Único de Assistência Social - TO.noSUAS” ((Blog TO.no SUAS, 2023). The work of the second front, which is still active to this day, will be discussed in future texts.

The theoretical-methodological frameworks of social occupational therapy permeated several debates carried out by the professionals, as well as the posts made on the Blog, understanding these materials as one of the possibilities to support the practices of the category at SUAS.

Social occupational therapy

Social occupational therapy has developed in a pioneering way in Brazil since the 1970s, questioning the purpose of technical-professional actions in occupational therapy practice advocating for its direction toward the social question (Lopes & Malfitano, 2016). The centrality of the social question—understood as a result of the contradictions between capital and work—necessarily leads to a reading of society that understands macro-social phenomena and their expression and inseparability in the everyday life of people, who are dialectically individual and collective (Malfitano et al., 2021).

In this perspective, social policies gain centrality in the discussion of the occupational therapy profession as they aim, within the dynamics of capitalist disputes, to create conditions for workers to be included in exchange relationships based on socially recognized needs in each social context (Offe & Lenhardt, 1984). Occupational therapists predominantly work through their professional involvement in social policies, which aligns with the purpose of their practice when focused on promoting the social inclusion and participation of individuals (Malfitano, 2016) in connection with the universality of social rights. Thus, the public arena for discussing social demands, their recognition, and the establishment of actions regarding them form, or should form, the core of their actions.

Among the social policies, it is important to highlight, in this text, the Brazilian National Social Assistance Policy (Brasil, 2004), from the perspective of the normative and conceptual aspects that guide the work at SUAS, as well as from the historical pathways and interests of the capitalist system (Boschetti, 2016). Occupational therapists integrate, amid the contradictions of this mode of production, the principles of composing actions for the social protection of the subjects, groups, and communities they assist within this policy (Almeida & Soares, 2021).

Therefore, in the process of shaping the Community aimed at enhancing the work of occupational therapists at SUAS, we understand and advocate the relevance of the contributions of social occupational therapy to the theoretical and methodological foundations of these professionals’ actions within the social assistance policy. Based on this premise, we bring them into focus and discussion in the light of the concrete realities of the work of social services professionals. We believe that the purpose of professional practice, aimed at seeking mediation through social inclusion and participation of individuals, is possible when guided by an understanding of the social question that always correlates it with a collective perspective of reality. This is achieved through the inseparability between macro- and micro-social dimensions that are directed toward the development of actions in the everyday life of individuals (Malfitano, 2016)—which are always historical and social, i.e., both individual and collective—aimed at social protection.

This study aims to present the possibilities and limits of the work at SUAS from the standpoint of occupational therapists who work there and who participated in the Community of Practices, analyzing whether and how their professional actions have been related to the theoretical-methodological framework of social occupational therapy.

Pathways

Throughout the development of the Community of Practice meetings, the coordinators of the university project began a study³ aimed at systematically learning about the main characteristics of the work of those occupational therapists at SUAS. The actions were listed through the proposal of Communities of Practice, which result from collective reflections on professional intervention strategies, to strengthen the category. To make the research ethically viable, all participants were consulted, via electronic message, if they agreed with the use of all the minutes produced during the Community meetings as the corpus of the study to be carried out. The minutes present verbal reports from the set of participants, as well as some elementary data about the dynamics of each meeting. There was general agreement and the confidentiality of the answers sent to the researchers was ensured.

Participatory proposals such as those of community of practices methodologically approach those of action research (Thiollent, 1985). Thus, although the experience of constituting a community of practice to reflect and find ways to face problems of a practical reality has not gained the contours of action research right from the start, establishing itself as the university extension project “Community of Practices in Occupational Therapy at SUAS: professional articulation and strategies construction”, its development maintained a permanent dialogue with basic aspects of this method.

Action research can be conceived as a method that combines various techniques of social research aiming to solve social and technical problems or, at the very least, gain a better understanding of the phenomenon and its characteristics to support the formulation of appropriate social, educational, technical, and/or policy responses (Thiollent, 1985). Action research begins with a problem or the problematization of something, and its central objective is to explain the phenomena through a process that seeks to raise awareness of the principles that guide action. It is a participatory method in which all involved parties play an active and collaborative role in identifying problems, monitoring, and evaluating the actions undertaken in response to the experienced issues (Thiollent, 1985).

Indeed, the research process described aligns with a historical-dialectical materialistic perspective. This perspective acknowledges the historical and contextual nature of research objects considering cultural, political, and economic determinants (Gomide, 2014). It aims to analyze socially constructed elements and seeks to provide insights for envisioning social transformations (Soares et al., 2013). The integration of scientific knowledge within action research reflects the intention to understand the world and reality in depth with the ultimate goal of facilitating transformative pathways (Frigotto, 2000). The application of historical materialism in occupational therapy has been prevalent since the 1980s, serving as a valuable framework to understand professional practice within various contexts (Barreiro et al., 2020).

The first cycle of the Community, which occurred from October to December 2020, can be understood as an exploratory phase aimed at mutual knowledge and recognition of demands. During this cycle, discussions revolved around practice and professional collaboration and required theoretical deepening. In six biweekly meetings, participants identified the themes of greatest interest and engaged in the discussion of various experiences, with systematic documentation of the process. The following outputs were produced: six records/minutes describing each meeting, 17 scenes depicting occupational therapy practices at SUAS⁴ , two wordclouds representing expectations and evaluations of the experiences, two graphs illustrating the most relevant topics for discussion and work demands in social assistance, one document and one graph listing the major challenges faced by occupational therapists in social assistance and strategies to address them, and five presentations by the organizing/facilitating committee that guided the theoretical discussions, drawing from the insights of social occupational therapy. During the final meeting of this cycle, the Community was assessed collectively. It involved a debate based on 18 responses collected through an evaluation form, as well as the collaborative writing of a text. Based on the evaluation and discussions, it was decided to continue the actions of the Community.

In 2021, the meetings were changed to a monthly format, with theoretical debates held in five synchronous sessions focusing on a specific theme chosen by the participants related to their work at SUAS. The discussions revolved around the contributions offered by social occupational therapy and guided the proposed program, which was collectively developed by the participants. In this cycle, five detailed meeting records were produced, describing each session. The following themes were chosen: 1) National Social Assistance Policy in contemporary times: challenges, barriers, and difficulties in Brazil; 2) SUAS and levels of complexity; 3) Management and teamwork in social assistance services; 4) Resources, methodologies, and tools for occupational therapy practice at SUAS; 5) The role of occupational therapists in communities and territories. Subgroups were organized, responsible for selecting relevant texts for all participants to read on each theme and presenting them in a seminar format. The readings were guided by the production in social occupational therapy aiming to provide input for the discussions, as requested by the participants.

For this article, all the materials used in the meetings produced during the two cycles of the Community were reviewed, with a particular focus on the 12 meeting minutes. The records were carefully read by pairs of authors of this study, who aimed to identify whether and how professional actions related to social occupational therapy. Subsequently, the information extracted from the minutes was organized into a framework grouping the identified themes. Based on this systematic organization, the author pairs proposed categories for discussion, which were later agreed upon by all the authors. Data analysis was conducted from a comprehensive perspective of reality, as proposed by Bourdieu (1996). This approach understands that individuals establish meanings and explanatory theories about the world and social structures in a relational manner, influenced by culture, social context, and symbolism. As researchers, we considered our understanding but also aimed to achieve a collective understanding. It is important to acknowledge that limitations exist in any study, and this analysis represents one among many possible interpretations of the process followed in the Community of Practice.

Therefore, informed by this theoretical and methodological framework, a hypothesis was formulated: the production of discussions and syntheses regarding the role of occupational therapists at SUAS, based on social occupational therapy, can contribute to concrete changes in work professional routine’s within social assistance services aiming to consolidate the constitutional right to social protection established in Brazil.

Results

Sample characterization

The study participants (n=77) were characterized using the information available on the registration forms (excluding those related to personal identification), namely, 1) distribution of professionals by locality, 2) social assistance unit where they work, 3 ) time working in the service, and 4) type of employment.

The distribution of occupational therapists was categorized according to the regions of the country, with a predominant participation of professionals from the Southeast region (54.5%), but with the presence of individuals from all other regions: South (28.8%), Northeast (11.68%), and Midwest (2.6%), and North (2.6%) (Table 1). When associating these results with the distribution of professionals working at SUAS in 2019, similar proportions were observed regarding the regions: Southeast (59%), South (19%), Northeast (15%), Midwest (5%), and North (2%) (Brasil, 2019).

Table 1
Distribution of professionals enrolled in the Community of Practice in Occupational Therapy at SUAS by region of the country (2020)

Region	Professionals
North	2 (2.59%)
Midwest	2 (2.59%)
Northeast	9 (11.68%)
South	22 (28.57%)
Southeast	42 (54.54%)
TOTAL	77 (100%)

• Source: Prepared by the authors. Secondary data - application forms.

Regarding the social assistance units where professionals work, the Social Assistance Reference Centers (CRAS) stood out numerically (28.6%). These are highly relevant to the Social Assistance Services Network, as they are the structuring units of Basic Social Protection (PSB). Following that, the Specialized Reference Centers for Social Assistance (CREAS) (19.5%), Institutional Reception Units (18.2%), and Centros Dia (11.7%) were the units with the largest number of participants (Table 2). The data concerning CREAS show that three professionals work in the Socio-educational System (Socio-educational Measures Service to adolescents who made an infraction law). It is also noted that three of the responses did not allow identification of the working unit and, therefore, were allocated to the category of “Not identified” (High-complexity and Criança Feliz Program, two entries). Regarding the distribution of professionals at the national level, the proportion of occupational therapists, according to official federal data, is more frequent in Centros Dia (57%), Institutional Reception Units (18%), and Community Centers (13%) (Brasil, 2019). Thus, a differentiation can be observed between the predominance of professionals in services, considering their national distribution among social assistance units and the interests to compose a proposal such as the Community of Practice. One possibility for this discrepancy is that the registration for the Community of Practice, conducted through communication networks (institutional e-mails, WhatsApp^®, Facebook^®, and Instagram^®), may not have reached the professionals. Another hypothesis is that the professionals in Centros Dia may not yet recognize themselves as SUAS workers, possibly because they deal with demands associated with disabilities, with practices that are historically known and formalized as belonging to the “health” approaches. The lack of recognition of occupational therapists in Centros Dia as SUAS workers was highlighted in Oliveira (2020). At CRAS, where the implementation of social assistance guidelines as a policy with specificity is more evident, more challenges and doubts can be present for professionals regarding their routine work, thus leading to a larger number of individuals interested in participating in a proposal for a Community of Practices in Social Assistance. However, based on the hypothesis that the professionals who work in Day Centers do not see themselves as part of SUAS, further investigations are needed. It is justified because they are part of the social assistance service and, as such, should effectively provide social protection, differentiating themselves from actions developed in the health field with people with disabilities.

Table 2
Distribution of professionals enrolled in the Community of Practice in occupational therapy at SUAS by the social assistance unit⁵ (2020).

Social assistance unit	Professionals
CRAS	22 (28.6%)
CREAS	15 (19.5%)
Institutional Reception Unit	14 (18.2%)
Centro Dia	9 (11.7%)
Homeless service	5 (6.5%)
Community Center	5 (6.5%)
Management	2 (2.6%)
Entity Representatives (Boards)	2 (2.6%)
Not identified	3 (3.9%)
TOTAL	77 (100%)

• Source: Prepared by the authors. Secondary data - application forms.

Regarding years of experience, most of the registered professionals have been working at SUAS for less than five years: 26% have been working for two months to one year, and 26% for two to three years. Among the registered professionals, 5.2% had over 15 years of experience in the unit⁶ (Tabela 3). Thus, in the specific case of this Community, it is observed that professionals with less experience at SUAS showed greater interest in discussing, reflecting, and making connections with other occupational therapists about their practices.

Table 3
Distribution of professionals enrolled in the Community of Practice in occupational therapy at SUAS by the time working in the service (2020).

Time working in the service	Professionals
From 2 meses to 1 year (and 12 months)	20 (25.97%)
From 2 to 3 years (and 12 months)	20 (25.97%)
From 4 to 5 years (and 12 months)	17 (22.07%)
From 6 to 8 years (and 12 months)	6 (7.79%)
From 9 to 11 years (and 12 months)	7 (9.09%)
From 12 to 14 years (and 12 months)	3 (3.89%)
From 15 to 17 years (and 12 months)	2 (2.59%)
From 18 to 20 years (and 12 months)	2 (2.59%)
TOTAL	77 (100%)

• Source: Prepared by the authors. Secondary data - application forms.

As for the type of employment of the registered professionals, there is a predominance of civil servants (35%) and professionals hired by private organizations (philanthropic) (32.6%) (Table 4). The data contrasts with national information, which indicates that most SUAS workers are hired by private institutions (official employment) (50.4% in 2017) (Brasil, 2017).

Table 4
Distribution of professionals enrolled in the Community of Practice in occupational therapy at SUAS by type of employment (2020).

Type of employment	Professionals
Civil servant	28 (35.06%)
Private philanthropic organization employee	25 (32.46%)
Temporary worker	9 (11.68%)
Official employment (public or private)	3 (3.89%)
Service provider	1 (1.29%)
Federal Civil Servant (teacher or technician)	5 (5.19%)
Other replies7	6 (7.79%)
TOTAL	77 (100%)

• Source: Prepared by the authors. Secondary data - application forms.

It is worth noting that this characterization gathered all the accepted applications. In the First Cycle of activities, there was an average of 47 participants, and in the Second Cycle, 24.

Occupational therapists in their workspaces at SUAS: building bases and actions

The actions carried out by occupational therapists at SUAS were classified by the participants using references called “places” of action, objectives, the target population of the actions, and resources used for that purpose.

The reference “place” of action adopted by professionals primarily focuses on practices that are typically carried out in social assistance. The territory was mentioned as the primary “place” where professionals engage in their work, including community actions, home visits, coordination with other services in the network, and more. In the territory, they seek to work with the everyday life of individuals, families, groups, and communities, following a guideline regarding the specificity of their work. According to the participating professionals, acting within the realms of everyday life is one of their responsibilities to fulfill the social protection guideline of the service they belong.

She emphasized the work of developing users’ formal and informal networks aiming to strengthen community ties. Territorial follow-up: being together in the territory. Activity as a mediating resource and looking at ADLs. The work focuses on users’ territory and everyday life. (Minutes of meeting 3, 10 November 2020).

The most cited object was the everyday life of users, families, and groups as well as the relationships that users establish, interpersonal relationships and with public policies that permeate their everyday lives and those of families and groups.

It was also mentioned, regarding the intervention in everyday life, how much the objects and objectives are shared between the professionals of the same service and how much the specificity can occur through the differentiated look and the construction of occupational therapy practice. (Minutes of meeting 5, 08 December 2020).

Various work objectives were cited, addressing macro-social perspectives and specific daily challenges individuals face. From a macro-social perspective, professionals mentioned the need to recognize individuals as collective beings and discuss social inequalities and their perpetuation in Brazilian society as part of their work. Specifically, the following objectives were mentioned: providing guidance and information about services and policies; promoting cultural, social, and recreational activities; strengthening community interaction and collective participation; fostering the development of bonds; and promoting actions to weave a support network for individuals in both formal and informal contexts.

More specific objectives related to basic protection: recognition as collective beings; discuss, reflect and question the perpetuation of inequalities for the minority population [...]. (Minutes of meeting 5, 08 December 2020).

[...] Objetives

Strengthen and create support networks

Promote social participation

Recognition as collective beings [...]. (Scene of Practice, meeting held on 08 December 2020).

The target populations of the actions developed by the professionals are diverse, demonstrating the variety of groups accessing social assistance services. Participants were working with women victims of violence, adolescent offenders, sheltered children, people with disabilities, older people, socially vulnerable people, and individuals in need of services and actions for social protection.

The resources used by professionals are varied and involve individual, group, and institutional actions. “Individual consultations”⁸ , home visits, workshops, and group activities (such as cooking groups, maternity spaces, etc.) were mentioned. They also mentioned coordination with the service network and participation in councils, forums, and work groups related to that population. The locations where these actions occur vary from the institutional context of the social device to public spaces such as parks and sports courts. There was a focus on working with multidisciplinary teams. In a broader approach, professionals also mentioned participatory territorial mapping, dynamization of care networks, and coordination of resources in the social field, such as organizing thematic campaigns, among other actions. The inspiration to classify the actions carried out by the participants came from discussions on social technologies in social occupational therapy (Lopes et al., 2014).

Scene: Follow-up of adolescents under an open socio-educational measure - Espaço Meninas.Objective:Provide space for exchanges on the female gender and encourage dialogue on situations and violence [...] Occupational therapy resources: Individual socio-educational services in groups, home care for the family group, joint assistance with the intersectoral network, follow-up of adolescents in activities in the territory and services. (Scene of Practice, meeting held on 08 December 2020).

Object: Everyday life of families selected by the Family Social Vulnerability Index (IVSF) and by the situation of extreme poverty - criteria of the Brasil Sem Miséria Program.Generalobjective: Strengthening family and community ties; Social Belonging and Community Support Networks; Coping with Vulnerability.Activities and resources: Participatory territorial mapping, dialogical activities (conversation circles), expressive resources (forum theater), and audiovisual resources (image panels, photographs, music, videos, etc.), prepared based on community demands. (Scene of Practice, meeting held on 08 December 2020).

Object: Everyday life and Women who are in contact with mothering.Objective: Creation, Strengthening, and Production of life.Resources: Groups, Individual Follow-ups [...] The group intends to promote the exchange of experiences between mothers, at different times of their lives, with young children, adolescents, adults, and even with those who are experiencing the gestational process. In the recognition of potential, oscillating and unromanticized motherhood, around the desire or not to become mothers, in the doubt about having children or not, in the processes of ‘becoming a mother’ versus ‘feeling like a mother’. (Scene of Practice, meeting held on 08 December 2020).

Object:Resident [...] supported by the specialized home care service (SEAD/CREAS) since 2015. The reason for follow-up is negligence and family abandonment. [...] has an intellectual disability and epileptic seizures. Objective: Work on relationships of interdependence, and strengthen family and community ties and social exchanges. Plan and develop life projects that involve alternative forms of survival, coexistence, and social participation [...] Resources and Technologies: Individual visits at home and the CREAS space; Individual territorial follow-up: Parks, Schools, Beach, among others; Workshop of activities; Caregivers Group. (Scene of Practice, meeting held on 08 December 2020).

Target Population:Young people from a group of the Service for Coexistence and Strengthening of Bonds.Objectives of action: Bring young people closer to school and strengthen their relationship with education; mediate the conflict with the school management; discuss possibilities of professionalizing dance through education.Resources and Technologies used: [...] visiting the school, together with the young people, when we were able to talk to the school principal about the importance of the group for the young people and discuss with her how these young people could carry out some presentations and rehearsals in the school. [...] The second strategy was to arrange with the Dance Course at the Federal University a visit of young people to the university so that they could broaden their vision about the professionalization of dance, reinforcing the importance of studies to this end. (Scene of Practice, meeting held on 08 December 2020).

Occupational therapists in their workspaces at SUAS: recognizing possibilities and limits

Facilitating and limiting aspects of occupational therapists’ work at SUAS were mentioned by the members of the Community at different moments throughout the meetings in both cycles. These reports encompass aspects that are part of dimensions related to the everyday realities of their work, as well as the macrostructural relationship that connects public policy, the socioeconomic system, and society.

The elements identified as facilitators in the social assistance work processes were organized into three thematic nuclei: “Developments and dialogues with professionals from other fields”, “Education and reflection on practice”, and “Practices aligned with the demands of the assisted population and the policy”.

The “developments and dialogues with professionals from other fields”, specifically referred to as exchanges, dialogues, and partnerships with colleagues in the service, demonstrate that working as a team (or in pairs) can facilitate the work. This suggests that a professional combination could enhance the actions of different categories and/or that occupational therapists find important references to develop the intended activities in this approach.

dialogue with other professionals who work in the same device

partnership with other professionals

exchanges with other professionals from other areas. (Minutes of meeting 2, held on 20 October 2020).

The theme of “education and reflection on practice” unfolds in participation in events related to SUAS, study and apprehension of theoretical-practical productions in the field of social occupational therapy, understanding of content from other areas associated with social assistance, and reflection on practice. The members seem to recognize that working in social assistance can be enhanced through education processes with the intention of discussing and supporting professional action based on frameworks relevant to the context.

seeking to participate in events about SUAS, studying.

learning from studies produced by Brazilian social occupational therapy and reflections developed within the scope of other professional areas, with greater accumulation on work in social assistance. (Minutes of meeting 2, held on 20 November 2020).

In this sense, the rationale seems to express a commitment to “practices aligned with the demands of the assisted population and the policy”. A positive aspect was identified in the discussions: professionals make the necessary distinctions between social assistance practices and healthcare practices to act coherently within the units of the social assistance policy. Additionally, successful practices were highlighted in the relationship with users, such as holding monthly assemblies and fostering attention networks. Everyday life was debated as a central dimension for the work of occupational therapists, and it was mentioned that “the path is made by walking”, referring to the work of Barros (2004), understanding the processual dynamics of work in social assistance.

A strategy to reduce these barriers involves making good use of the knowledge that underlies social occupational therapy, so that practices can be delimited and differentiated in the two fields (health and social assistance), for instance, by making referrals.

One proposal would be to outline the practice with the real demands of the assisted population, focused on SUAS, but without forgetting the objectives of occupational therapy. (Minutes of meeting 3, held on 10 November 2020).

Regarding the work at SUAS, during the meetings, the limiting aspects emerged in a larger number and more often than the facilitating aspects and were grouped into four thematic nuclei: “Gaps in education and scarcity of frameworks”, “Fragility in professional integration and lack of professional recognition", “Barriers to carrying out the work”, and “Macro-social aspects”.

Concerning “gaps in education and scarcity of frameworks”, the professionals mentioned the limited or absent exposure to debates on social assistance policy during their undergraduate education. In addition, the participants pointed out difficulties in finding professional references within the sector (bibliographic production), lack of materials illustrating the specificity of occupational therapy at SUAS, challenges in applying theoretical knowledge to professional practice, and lack of incentives for publication. These aspects were addressed during the theoretical discussions held in both cycles of the Community.

As for “fragility in professional integration and lack of professional recognition”, it was identified that the low number of occupational therapists in services, bureaucratic impositions adopted by municipalities for hiring the profession, and consequent limitations in the inclusion of occupational therapists in reference teams are limiting factors for professional action. The reasons why the incipient professional integration directly reflects as a limitation were not explicitly mentioned, but it can be inferred that one of the factors involved in these statements is the lack of professional recognition for all categories at SUAS.

This aspect was evident in the relationship with the team and management, who had limited knowledge about the potential contributions of occupational therapists to social assistance. Thus, the mistaken perspective that occupational therapists were professionals that work only in the healthcare field was often reported. To illustrate the situation, we refer back to the minutes including the account of a professional:

Based on her work experience at an Institutional Reception Unit, the worker raised conflicts regarding the requirement to carry out practices aimed at the health field in social assistance. Some teams and devices still see occupational therapists only as health professionals. (Minutes of meeting 3, held on 10 November 2020).

In the “barriers to carrying out the work” nucleus, various obstacles discussed by the participants to effectively carry out work at SUAS were grouped, namely, difficulty in maintaining a joint work plan with the team and sustaining the coordination of the service network (limitations in networking for sectors to communicate and roles to be better defined); lack of management incentives for the development of continuous education; internal bureaucracies that restrict actions in the services; religious practices present in certain social assistance institutions; limited coordination with other occupational therapists working at SUAS; multiple demands and service routine that hinder the implementation of territorial actions, which would enable the transition from isolated and sporadic interventions to community-based actions involving families and other resources such as schools; difficulties in implementing what is provided for in the policy, thus overcoming a welfare-oriented approach, particularly in the context associated with the COVID-19 pandemic.

“Macro-social aspects” were increasingly mentioned as a theme throughout the meetings. In the meantime, broader perspectives on social, economic, cultural, and political realities became more prevalent in the later meetings. Discussions on the limits of practice shifted from being less problematized from the specific standpoint of the profession to being more associated with social assistance as a public policy, encompassing social rights and considering, with emphasis, the current context of predominant public disinvestment in the country. Topics such as the organization of SUAS, social inequalities, dismantling of social policies, and the pandemic as a process that has revealed structural social problems, among others, were part of this debate.

Discussion

Considering the records made during the development process of the Community of Practice, as well as the authors’ theoretical position on this participatory process, two central points of discussion have been chosen that, in our view, enable the analysis of the ongoing process in light of the correlation between the professionals’ actions and the theoretical-methodological framework of social occupational therapy: the necessary understanding of the inseparability between micro- and macro-social factors to develop the work, i.e., its foundation, and the technical-political dimension of occupational therapy practice, i.e., professional action.

Inseparability between the micro- and macro-social spheres: the foundation of the work

In the accessed records, the participants of the Community of Practice reported that their actions developed within the SUAS are focused on the sphere of relationships between individuals, families, and communities with their territories and everyday lives. According to Oliveira & Malfitano (2021), these professional practices, in the routine of social assistance units, are implemented in the face of multiple challenges revealed by complex issues that arise from structural and historical inequalities engendered in the economic, political, and social systems. These challenges manifest themselves in the absence or fragility of access to social rights, poverty and destitution, violence, abuse, intolerance, prejudice, and subjugation.

When considering Brazil, it is important to recognize—even though a more comprehensive analysis is not possible here—the particularities of the social question, rooted in its colonial-slavery history as a synonym for contradiction, exploitation, accumulation, and social struggles within capitalist society. This is reflected in the confrontation of indigenous slavery, the expropriation of black people, and more recent struggles for better living and working conditions in industrial settings (Prado Junior, 1996). Therefore, there is an important dimension of racism in our social question, as well as a dimension of patriarchy. The Brazilian reality still carries the traces of a society built on slaveholding relationships, marked by social relations of gender, race, and class, within an arena of ongoing struggles (Saffioti, 2013).

In an analytical perspective on the practices mentioned by the professionals, it is believed that, in the impossibility of breaking away from the harsh interdependence of the macrostructural dimensions of capitalism with the more singular issues of individuals, possibilities are sought in acting alongside individuals toward promoting social protections in possible crevices accessed in everyday life (Oliveira & Malfitano, 2021). To develop these actions, occupational therapists acknowledged the need to recognize individuals as collective beings, in a dialectical understanding that individual lives express collective phenomena. Thus, it is not possible to individualize interpretations of what afflicts the lives of users of social assistance services to structure professional actions. During the discussions that occurred in the meetings held in the Community, this need led the group to reflect on a theoretical-methodological framework that is capable of fostering a social understanding that allows the comprehension of experienced phenomena, notably social inequality, and the life situation of individuals. In this process, the discussions on the inseparability between macro- and micro-social spheres, as proposed by social occupational therapy, were understood as a theoretical-methodological framework that underpins the work in social assistance.

Social occupational therapy proposes actions based on plural knowledge and that consider a collective perspective, even when interventions are developed individually. It is always necessary to incorporate considerations about the specific local culture and the everyday life of individuals, and the use of activities can serve as mediators of relationships and an organizing axis of intervention. Based on these processes, the aim is to engage with diverse social realities (Barros et al., 2002; Lopes, 2016).

It is important to emphasize the insufficiency of individual interpretations to understand and address social issues, which are structural in the capitalist society we live in. This can lead professionals to blame socially vulnerable individuals and families who are the target population of social assistance policies. Linking poverty to the lack of engagement of subjects in improving their living conditions, such as seeking employment, distorts the principles of social protection established by Brazilian legislation, which occupational therapists, as public servants of this policy, should adhere to. However, it should be emphasized that an individualizing interpretation of poverty does not arise randomly in the social imaginary, nor is it limited to certain professional perspectives, but is defined by a structured ideology propagated in society. From this perspective, poverty is understood as a scenario of an absence of capabilities, theoretically and methodologically configuring an individualistic and liberal focus, which is the view propagated by multilateral economic organizations. This ideology is reflected in the assistance offered to the poor populations, who are renamed based on their vulnerabilities, decontextualized, and de-historicized, preventing discussion about access to social rights (Mauriel, 2010).

To counter this view in the field of occupational therapy practices within SUAS, once again, the discussions led to social occupational therapy. As previously mentioned, one of the important pillars that supports the foundation of this professional subarea is the combination of the micro- and macro-social dimensions for intervention in the everyday life of each assisted individual and/or community. In the micro-social sphere, strategies will be developed to assist individuals in gaining support for their social inclusion and participation, considering their desires and possibilities, as well as the structural limitations imposed. In the macro-social sphere, the work connects social policies and action in public spaces to maintain or expand the social recognition of the specific needs of populations, working toward the expansion of services and other spaces that promote access to social rights. In other words, it recognizes that politics is a working resource for occupational therapists (Malfitano, 2016).

Understanding this structural logic is what enables us to not align with strategies of control, individual blame, individual responsibility, and penalization of poor individuals and families. This theoretical framework has permeated the reference of social occupational therapy since its inception, with contributions from authors such as Althusser, Basaglia, Bourdieu, Castel, Foucault, Goffman, Gramsci, Marx, Paulo Freire, and other social scientists who have addressed marginalized populations (Galheigo, 2016), updating itself with the current scenario of essential debates on social markers of difference and their intersectionality (Melo et al., 2020; Balanta-Cobo et al., 2022).

Indeed, given the issues raised and the reflections generated in the context of the Community of Practice, strengthening the social understanding of reality within the daily work of occupational therapists at SUAS appears as a coherent strategy to address the social needs of individuals in social assistance devices and foster network connections to expand the repertoire of responses aimed at achieving social protection (Oliveira, 2020). This perspective is further supported by recognizing social assistance policy as a mechanism to enable social rights (Mauriel, 2010).

The technical-political dimension of occupational-therapeutic practice at SUAS

Throughout the development of the activities in the Community, the problematization of the theoretical-practical correlation in the sphere of practice often revolved around questioning the actual existence of occupational-therapeutic resources to address typical issues in social assistance. It seemed to us that, on the one hand, this questioning represented a certain sense of powerlessness in the face of the complexity of the Brazilian social question, for which resources always seem to be limited and insufficient - thus, feeling professionally powerless is not surprising; on the other hand, we were struck by the participants’ distance from the body of literature in social occupational therapy that constitutes the profession’s efforts toward building an ethically and politically committed professional practice in addressing the social question, encompassing the central themes of social assistance. “We have no references”, the participants constantly said at the beginning of the meetings.

Certainly, it is not just occupational therapists who feel ill-equipped to provide responses that meet the social needs of the service users (Soares, 2021). This feeling increases when we faced with the growing impoverishment of the population that is most affected by the deepening crisis of capitalism, and particularly the sad moment of regression of social rights and dismantling of the social protection system in Brazil (Silveira, 2017; Raichelis et al., 2022), as well the increasing precariousness in the working conditions at SUAS. However, the initial expression of the Community participants was individualized, focused on supposed weaknesses of the occupational therapy field as a body of knowledge and intervention. Many participants brought their doubts and dilemmas about the best resources to address the demands of the diverse population they assist, as previously mentioned, because of the different social devices where they worked.

Thus, initially, the search for the “specificity of occupational therapy resources” to address social demands seemed to be driven by urgency, leading to linear cause-and-effect thinking that blurred a critical, contextualized perspective grounded in the necessary historical and social analysis of reality. Similarly, unifying concepts and pre-formatted intervention steps—already criticized by Barros (2004) and other authors linked to the field of social occupational therapy (Malfitano, 2005; Lopes, 2016; Farias & Lopes, 2020, among others)—supported the expectations expressed by a part of the group.

Possibly, the fact that these professionals are the only ones belonging to the occupational therapy category working in their socio-assistance units has not allowed an elevation of clarity and confidence levels regarding the best resources to be used and the effective professional contributions in those contexts through shared reflection among peers. As Oliveira (2020) showed, being the only professional of the category in a service unit is a prevailing reality among occupational therapists working at SUAS. In this sense, even the questioning of the relevance of using a clinical approach typical of healthcare units and standardized tools suitable for health assessments was brought up within the group, particularly by participants working with people with disabilities and/or older people. However, while this issue may reflect the theoretical and methodological disorientation of workers in the social assistance sphere, it also seemed to be connected to misguided demands from managers and unit administrators where occupational therapists operate, highlighting weaknesses in the management of this system. For some participants in the Community, the lack of understanding from managers and workers from other professional categories about the nature of occupational therapy practice deepens anxieties and confuses directions and decisions related to the technical-operational sphere. In this context, the dependency on a supposed specificity dictated by the application of a resource/tool “exclusive to the profession” seemed to be a desired solution for part of the group.

It is worth noting that on the path toward establishing a Community of Practice in which individual issues become integrated into the collective interests of the group, another group of workers acted actively and collaboratively to elucidate the theoretical and methodological frameworks they use in professional practice in social assistance, combining them with substantive and successful experiences. This contributed to a progressive configuration of the group dynamics, in which the gathering and presentation of intellectual productions in social occupational therapy and/or notions and concepts informing social assistance practices played a key role. This occurred as the Community pointed out pathways to addressing the issues brought up, linking them to aspects and topics studied by authors who have contributed to establishing and consolidating the theoretical-methodological, ethical-political, and technical-operational dimensions of social occupational therapy. This, in turn, reinforced the need for the Community mediators to retrieve and recognize the power of these productions in the dialogue among participants.

In this direction, the recovery of definitions, delimitations, and detailed explanations about social technologies developed and applied in social occupational therapy (Lopes et al., 2011, 2014) became a fundamental component to discuss the participants’ everyday practices. Through processes that involved systematization, presentation, and debate, these discussions facilitated the creation of connections between the challenges faced in practice and the application of these resources. The exploitation of a technical and instrumental repertoire of the profession, based on the contributions of social occupational therapy, contributed to transforming the professional self-image and in the process of building a community that equally recognizes and analyzes its weaknesses and strengths.

Thus, the discussion about territorial actions, the dynamization of the assistance network, the focus on people’s everyday life, the implementation of workshops of activities, dynamics, and projects, as well as individual territorial follow-ups, gradually established connections that explained what is done in social occupational therapy when working at SUAS. As a result, throughout the process, there was a decrease in the assertion of “We have no references” and a reflection on the relevance of references in social occupational therapy, the possibilities of applying established frameworks, as well as their limitations in the face of certain specificities experienced. Alongside the growing debate about “macro-social aspects” and their implications in determining social issues, there was a greater understanding of occupational therapy actions within SUAS.

Conclusion

The ongoing process of Community of Practice in occupational therapy at the Unified Social Assistance System (SUAS) has proven to be a participatory initiative that, although with a small number of participants, has enabled reflections on the role of our professional category in this relevant social policy. It has contributed to processes for understanding the roles of occupational therapy in social assistance, its discussion, and perhaps the implementation of concrete changes in the routine professional work in services toward consolidating the constitutional right to social protection established in Brazil.

It is worth highlighting that the reflections mentioned here, as characteristic of research that approaches a comprehensive perspective of reality, are influenced by the authors’ points of view presented throughout the text. While on the one hand, this can be seen as a limitation; on the other hand, it brings forth effective aspects of a situated participatory experience. Moreover, it is important to acknowledge the limitation regarding the number of participants involved in this experience, which means it cannot be generalized. However, it still describes possibilities to develop participatory actions to reflect on professional practices and implement social policies.

The reflective journey of the Community, as described in these cycles, has shown an increasing interest among participants in deepening their understanding of the interdependence of micro- and macro-structural relationships that encompass different expressions of the social question. These are the areas where professionals are called upon to act in social assistance services, fostering a growing political discussion. Alongside this, there has been a gradual shift from a discourse of “lack” in occupational therapy to a social interpretation and a greater apprehension of the technical-professional purposes within the scope of social assistance. The theoretical-methodological framework of social occupational therapy has served as the guiding thread throughout this process.

It is expected that the reflective experiences and transformative changes in professional practice based on social occupational therapy can occur in the various sectors where occupational therapists work, aiming toward a stronger commitment to social policy, social rights, and the citizenship of the assisted individuals.

Acknowledgements

The authors would like to thank Andressa Oshiro Hainoski, an occupational therapy undergraduate student at the Federal University of Triângulo Mineiro (UFTM), who characterized the members of the Community of Practice in her undergraduate project. We are also grateful to all of the students and the occupational therapists working at SUAS who participated in the Community of Practice for materializing its existence and for the professional exchanges.

• 1
  To refer to the Community of Practices, in the sense of describing this group, as well as its operation in Occupational Therapy at SUAS, we opted for the spelling Community with a capital letter. For other uses, in the general sense of the term community, this word is written in lower case.
• 2
  CRAS (Social Assistance Reference Center) is a local state public unit located in areas of social vulnerability. It provides basic social protection services and organizes and coordinates the network of local social assistance services within the social assistance policy (Brasil, 2004). The Community Center is a unit where activities of the Service for Social Interaction and Strengthening of Bonds are developed within the scope of Basic Social Protection. It is structured according to age groups based on the National Typification of Social Assistance Services (Brasil, 2009). CREAS (Specialized Reference Center for Social Assistance) is a public unit that provides services to individuals and families in situations of personal or social risk due to rights violations or contingencies, requiring specialized interventions in the field of specialized social protection (Brasil, 2011b). The Centro Dia [for people with disabilities] is characterized as a Specialized Unit (Specialized Social Protection) that offers specialized social protection services for people with disabilities and their families (Brasil, 2012). The Centro Pop is a public and state unit specifically aimed at providing specialized assistance to the population in street situations (Brasil, 2011b). Shelters provide specialized services that offer temporary accommodation and protection to individuals and families temporarily separated from their family and/or community nucleus, and who are in situations of abandonment, threat, or rights violation (Brasil, 2015).
• 3
  Regarding ethical aspects, in addition to consulting all participants, the research resulting from the extension project was approved by the Human Research Ethics Committee of UFTM (CAAE 46018721.5.0000.5154).
• 4
  The scenes of occupational therapy practice at SUAS were an activity proposed to occupational therapists participating in the Community of Practice so that they could share scenes of their professional practice in a meeting, detailing their object, objective(s) and occupational therapy resources used.
• 5
  Six occupational therapists who were employed at more than one institution were identified. To compute the data, the first institution/service was considered in their answer. The answers are detailed below: CRAS and Community Center; CRAS and Criança Feliz Program; CRAS, Institutional Reception Unit, and Community Center; CRAS and Institutional Reception Unit; CRAS and Community Center; Institutional Reception Unit and Community Center.
• 6
  We emphasize that, although SUAS was created in 2005 (Brasil, 2005), the presence of occupational therapists working in the field of social assistance predates this date, being reported since the beginning of the profession in Brazil (Lopes, 2016).
• 7
  Responses that did not refer to the type of employment and therefore did not allow a precise identification of the employment bond with the employing institution were allocated to the category of “Other replies”.
• 8
  We understand that the meaning used for the term individual consultation is close to the clinical aspects of the health field. In the social field, based on the guidelines of social occupational therapy, the term individual follow-up has been used with aiming to encompass activities beyond the clinic. However, specifically in this section, the expression “individual consultations”, in quotation marks, is being used respecting the narratives of the occupational therapists of the Community of Practice.
• How to cite: Bardi, G., Oliveira, M. L., Coelho, F. S., Zanoti, L. F., Soares, C. R. S., Malfitano, A. P. S., & Almeida, M. C. (2023). Community of Practice in Occupational Therapy in the Brazilian Unified Social Assistance System: arranging meetings and promoting debates in social occupational therapy. Cadernos Brasileiros de Terapia Ocupacional, 31(spe), e3389. https://doi.org/10.1590/2526-8910.ctoAO260133892

• Funding Source

  This study was funded by the National Council for Scientific and Technological Development (CNPq) - Process No. 403772/2021-4.

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Edited by

Guest editor

Profa. Dra. Gabriela Pereira Vasters

Publication Dates

• Publication in this collection
  10 July 2023
• Date of issue
  2023

History

• Received
  10 Aug 2022
• Reviewed
  19 Aug 2022
• Accepted
  29 Dec 2022