Social occupational therapy and technical action with the homeless population: recognizing social technologiesAbstract
Social occupational therapy constitutes itself as a field of practice and a theoretical-methodological framework for Brazilian occupational therapy. After years of experience, the area has developed and named different social technologies for working with vulnerable populations. In this sense, the question was posed: which social technologies are used by social occupational therapy to work with the homeless population? The research aimed to identify and name social technologies used in the technical action of social occupational therapy for working with the homeless population. The research was carried out in three phases: 1) bibliographic survey and interviews with the most recurrent authors in the productions; 2) reading and analysis of field diaries developed by the university extension team that works with the homeless population; 3) collective conversations with the extension team. The analysis resulted in two categories: What is found in the references on social occupational therapy and the homeless population? and Analysis in the light of dialogue and practical daily life: dimensions of the work of social occupational therapy. The study systematized the contribution of theoretical frameworks and the critical professional posture as elements that precede technical action; listed strategies and dimensions of social occupational-therapeutic practice that assist in the development of social technologies; and, finally, identified social technologies used with homeless people. It was concluded that the theme of social technologies is of great relevance to social occupational therapy and that there are demands for new studies on technical action with vulnerable populations.
Keywords:
Social Occupational Therapy; Culturally Appropriate Technology; III-Housed Persons; Sense of Community; Sociocultural Territory
Resumo
A terapia ocupacional social constitui-se como uma área de atuação e referencial teórico-metodológico para a terapia ocupacional brasileira. Após anos de experiência, a área desenvolveu e nomeou diferentes tecnologias sociais para o trabalho com populações vulnerabilizadas. Nesse sentido, questionou-se: quais tecnologias sociais são utilizadas pela terapia ocupacional social para o trabalho com a população em situação de rua? A pesquisa traçou como objetivo identificar e nomear tecnologias sociais utilizadas na ação técnica da terapia ocupacional social para o trabalho com a população em situação de rua. Realizou-se a pesquisa em três fases: 1) levantamento bibliográfico e entrevistas com os autores mais recorrentes nas produções; 2) leitura e análise de diários de campo desenvolvidos pela equipe de extensão universitária que atua junto à população em situação de rua; 3) conversas coletivas com a equipe de extensionistas. A análise resultou em duas categorias: O que constam nas referências sobre terapia ocupacional social e população em situação de rua? e Análise à luz do diálogo e do cotidiano prático: dimensões do trabalho da terapia ocupacional social. O estudo sistematizou o aporte dos referenciais teóricos e a postura profissional crítica como elementos que precedem a ação técnica; listou estratégias e dimensões da prática terapêutico-ocupacional social que auxiliam no desenvolvimento das tecnologias sociais; e, por fim, identificou tecnologias sociais utilizadas junto às pessoas em situação de rua. Concluiu-se que a temática das tecnologias sociais é de grande relevância para a terapia ocupacional social e que há demandas para novos estudos sobre ação técnica junto às populações vulnerabilizadas.
Palavras-chave:
Terapia Ocupacional Social; Tecnologia Social; População em Situação de Rua; Senso de Comunidade; Território Sociocultural
Introduction
Social occupational therapy constitutes itself as a field of practice and as a theoretical-methodological framework for the field of Brazilian occupational therapy, that is, it is a framework that presupposes actions contextualized socially, economically, culturally, and politically, developed in a critical way, aimed at populations with difficulties in accessing social rights and/or in situations of vulnerability (Lopes & Malfitano, 2023) and outlined by “an ethical-political commitment to changing a condition, situation or a cause” (Galheigo, 2023, p. 53).
The first discussions and reflections regarding the social area in Brazilian occupational therapy took place in the 1970s, influenced by the social movements of the time and by a paradigm shift, in which the profession began to be called upon to work with groups and populations in situations of social vulnerability. Furthermore, at the time, the predominance of biomedical knowledge in the field and its reductionist perspectives for dealing with issues that broke with the health-disease dichotomy and generated interventions that institutionalized and disciplined issues of a social order were also questioned (Lopes & Malfitano, 2023).
In 1998, the Metuia Project was created: an interinstitutional group of studies, training and actions for the citizenship of populations undergoing the breakdown of social support networks. The main motivation at the time was to bring the debate on the social field back to occupational therapy, after a decline in the discussion in the early 1990s at three important Brazilian universities, by placing tension on training and reflection through studies and practical experiences offered in extension activities (Galheigo, 2023). The project advanced and is currently entitled Metuia Network – Social Occupational Therapy, formed by individuals, collectives, and institutions that carry out teaching, research, and extension activities based on the theoretical-methodological framework of social occupational therapy with individuals, groups, and collectives who experience social, economic, and/or cultural problems that create barriers to social participation and the exercise of citizenship.
The action of social occupational therapy, in this way, provides a specific methodological framework, in which actions are directed toward populations whose demands are centered on socioeconomic fragility, with the awareness/appropriation of rights and the strengthening of social support networks as the foundation of its practice. For this, a decoupling from the health-disease mediation is proposed, through going beyond the health field and confronting social realities. Working within territories and alongside communities is also a basic premise of the area (Barros et al., 2007).
The accumulated experience of the different Metuia Network centers has produced and continues to produce social technologies aimed at methodologically equipping actions in social occupational therapy, fostering new possibilities for practice and articulating actions with macro and micro-social reach (Lopes et al., 2014). According to Lopes et al. (2014, p. 591), social technologies are understood as “products, techniques or replicable methodologies, developed in interaction with the community and which represent alternatives for social transformation.”
In dialogue with the Social Sciences, the notion of social technologies adopted by Lopes et al. (2014) converges with the concept of social technology (ST) described by Almeida (2010, p. 11):
The concept of ST goes beyond focusing on the artifact and embraces the context and concrete reality of the subjects in order to transform. It is a political positioning, insofar as it is a situation in the world of people and their space, their organization, in an independent, autonomous and self-managed way. ST is a pedagogical instrument, through which everyone learns in the construction of solutions.
Therefore, aiming to construct technical, horizontal, and coherent knowledge based on diverse social realities, Lopes et al. (2014) highlight and describe four social technologies: Activity, Dynamics, and Project Workshops; Singular and Territorial Follow-ups; Resource Articulation in the Social Field; and the Activation of the Care Network. Based on the construction of bonds with individuals as the starting point for reflection, learning, and the joint construction of new realities, the Activity, Dynamics, and Project Workshops serve as a form of connection. They use activities not as an end in themselves, but as a means, facilitating the creation of environments and moments of individual and collective exchange. The Singular and Territorial Follow-ups constitute a follow-up and articulation strategy that starts from the subject's micro and singular reality and turns to the weaving of social support networks. This technology represents the immersion of the professional not only in the subject’s life context but also in the different spheres of their daily life and relational network within the territory (Lopes et al., 2014).
The Resource Articulation in the Social Field can be understood as a technology that weaves together problems and possible mechanisms for change, thus being able to “manage practices at different levels of care around common goals and use the possible resources, understood as financial, material, relational, and emotional tools, whether micro or macrosocial, to shape interventions” (Lopes et al., 2014, p. 597). Finally, the Activation of the Care Network is a technology that seeks to mediate, optimize, and guide the informational exchange between services and their levels of care, aiming to elaborate and implement possible coping strategies. It is also dedicated to engaging the individual, population group, and/or their community within their own process, aiming to build autonomy to understand the structure, functioning, and potential of their network (Lopes et al., 2014).
It is important to mention that the aforementioned social technologies do not necessarily follow a specific order or serve as a sequential procedural script for the actions of the social occupational therapist. The intervention and use of social technologies will depend on the context, group, demands, and particularities presented, and it is up to the professional to choose those most suited to the identified needs (Lopes et al., 2014).
Still within the methodological framework of social occupational therapy, in a study on professional practice with adolescents and young people in schools, Pan et al. (2022) describe transversal dimensions of occupational-therapeutic intervention, which are: Dealing with conflicts; Project management; and Production of care.
The dimension Dealing with conflicts indicates technical knowledge that, by dealing with issues involving groups and collectives who daily experience obstacles and barriers to their social participation and exercise of citizenship, helps in understanding and mediating conflicts that may arise in interactions with and among the accompanied public. The Project management dimension indicates the occupational therapist’s intervention potential in the role of promoter, advisor, and manager of projects with these vulnerable groups, whether through services and public policies or through relationships with the community, social movements, and/or universities, aiming to construct responses to the demands of various partners. The other described dimension, Production of care, refers to actions related to ensuring a dignified existence, democratic care, whether micro or macrosocial, seeking to overcome the biomedical bias in understanding care and questioning its role within the organization and functioning of society, thus revealing and reflecting with individuals, groups, or collectives on the various mechanisms of social control (Pan et al., 2022).
Similarly, in a study on territorial-community actions in occupational therapy, Bianchi & Malfitano (2022) name five strategies of territorial-community work which, although not focused solely on the practice of social occupational therapy, are aligned with its methodological propositions and are widely used in the field. These are: engaged action in collective and social relationships; the weaving of formal and informal networks; building bonds through the use of activities; horizontality and availability in relationships; and strategies for dealing with social vulnerability in both micro and macrosocial contexts.
These strategies form the basis for the social occupational therapist's practice because, each in its own way, they help ensure that professional action focuses on the collective and offers an approach contrary to reductionism and biomedical bias, acknowledging the plurality of ways of being and existing. The strategy for dealing with social vulnerabilities in micro and macrosocial contexts reflects on the social context of the capitalist system of production, which is exclusionary and marginalizing. The strategies engaged action in the collective and social relationships and weaving of formal and informal networks highlight the inseparability of the subject from their relational network and context, also understanding that the process of construction and change can often be woven together. The strategy building bonds through the use of activities points to the therapeutic resources used by occupational therapists in their practice. Finally, horizontality and availability in relationships addresses aspects related to a technical and empathetic professional posture, positioned in relation to, rather than in hierarchy over, the subject (Bianchi & Malfitano, 2022).
Homeless population and the university extension “Territory Dynamics”
The university extension project Territory Dynamics: different modes of occupation and belonging to public space in in the Largo do Mercado Area in Santos, SP aims to understand the various relationships, flows, and modes of use of the territory surrounding the Baixada Santista Campus of the Federal University of São Paulo (UNIFESP). From immersion in this context and the building of bonds between extension students and the people and reference groups in the region, the goal is also to reflect with the community on how space is used, articulating the interests of different fronts, actors, and actions.
The extension project adopts the frameworks of social occupational therapy, critical geography, and popular education as theoretical-methodological tools to promote reflections on different ways of using and circulating through the territory, taking into account dimensions such as work, housing, leisure, culture, and socialization. Active since 2020, the project has created spaces for encounters, dialogues, exchanges, and the strengthening of socio-community ties. The work is divided into two fronts, due to the specific needs of each population group: i) activity workshops for children living in tenements, focusing on play in the city and access to cultural and leisure services in the territory; ii) singular and territorial follow-ups with the homeless population, aimed at strengthening social support networks and fostering intersectoral collaboration with social assistance and health services to promote care actions and access to social rights. This study will focus on analyzing the second front.
The actions of the Territory Dynamics extension with the homeless population focus on identifying demands and co-constructing solutions with the people and groups involved. The team makes weekly visits to the territory, which allows for the building and maintenance of bonds with individuals and groups, generating recognition and familiarity with the team's presence and its possibilities for action.
According to Andrade et al. (2014), the history of the homeless population mirrors the development of Brazilian society. Its origins date back to the colonial era, before the abolition of slavery in 1888, when a series of laws began to grant freedom to the enslaved population but failed to ensure opportunities for work, food, and decent housing, keeping them on the margins of the new social order. Later, this group, already denied their right to housing, was joined by some European immigrants who came to Brazil seeking new opportunities but ended up excluded from the available jobs. In general, a defining characteristic from its inception has been that the homeless population has always existed in a state of exclusion from the mechanisms of wealth production and life maintenance.
The city of Santos, SP, began its urbanization process in the area of Largo do Mercado. Until the end of the 19th century, this region was marked by glamour and status, with luxurious mansions where the commercial elite resided. However, wealth and glamour gradually gave way to poverty and abandonment, as the elite migrated to the coastal area. Urban reforms and increasing elite occupation of the coastline triggered a migration from the central regions, leading older neighborhoods like Largo do Mercado to become occupied by the homeless population (Maziviero, 2016).
In light of this, and inspired by Bianchi & Malfitano’s (2022, p. 18) provocation about the need for “ongoing development of theoretical and methodological reflections that discuss and name the various strategies used by occupational therapists in their practice settings, strategies often subsumed within the work process,” this study formulated the following research question: What social technologies are used by social occupational therapy in working with the homeless population?
Considering the importance of understanding and naming technical actions in the various fields of social occupational therapy and of pluralizing reflections and knowledge about existing practices, the research aimed to identify and name social technologies used in the technical action of social occupational therapy in working with the homeless population, having as one of its axes of analysis the actions developed by the university extension Territory Dynamics: different modes of occupation and belonging to public space in in the Largo do Mercado Area in Santos, SP.
Methodological Procedures
This is a qualitative research study conducted over a period of two years. Qualitative research involves the study of relationships, representations, perceptions, opinions, and other products of interpretation derived from the ways in which human beings live, think, and feel. It is capable of capturing subjective aspects and producing significant results regarding the process under analysis (Minayo, 2014). To this end, data production was carried out in three subsequent phases, as follows:
Phase 1: Understanding the productions and practices of social occupational therapy with the homeless population
The initial phase of the research aimed to approach the productions developed by social occupational therapy on the theme of "homeless population," in order to facilitate the interpretation and recognition of the social technologies used in the field.
For this purpose, a bibliographic survey was conducted on the websites of the main Brazilian occupational therapy journals, using the following keywords: social occupational therapy and homeless population. There was no time restriction in the search for materials, which had to meet only the following inclusion criteria: (i) be pieces of work authored by Brazilian researchers; (ii) use theoretical and methodological frameworks of social occupational therapy; (iii) refer to the homeless population.
The following journals were systematically investigated: Cadernos Brasileiros de Terapia Ocupacional (CadBTO), Revista de Terapia Ocupacional da Universidade Federal de São Paulo (RTO), and Revista Interinstitucional Brasileira de Terapia Ocupacional (REVISBRATO). Initially, twelve pieces of work were found. After applying the inclusion criteria, the survey concluded with six articles for review.
After the search and reading of these six materials, the goal was to identify the discussions, experiences, and practices developed in the field of social occupational therapy for and with the homeless population, as well as to recognize the social technologies used in the development of practical actions.
Still pursuing this objective and based on the bibliographic survey, the second part of this phase was carried out: a dialogue with occupational therapists who are references in the field. The initial plan was to talk with the two most frequently published authors found in the survey, those who have most engaged in the investigation, experience, and dissemination of knowledge in this area of professional practice. However, since four out of the five identified authors had published only a single article, the selection of the second participant was based on their Currículo Lattes (Lattes CV), where other publications and research participation related to the topic were identified and quantified.
The invitation to participate in this research was sent via email. The email addresses of the participants were obtained from their Currículo Lattes profiles and from the contact information provided in the selected articles. Two authors agreed to participate. After receiving their consent to participate, the Free and Informed Consent Form (FICF) was also sent by email.
The dialogues were conducted through semi-structured interviews, held virtually due to the impracticality of face-to-face meetings across different regions of Brazil. Each interview lasted approximately 40 minutes, during which we sought information, experience reports, and discussions about the social technologies most commonly used in developing actions with the homeless population. The interviews were audio-recorded and fully transcribed for later analysis.
Phase 2: Identifying social technologies
The second phase consisted of identifying the social technologies used by the Territory Dynamics extension project in its work with the homeless population.
To do this, we chose to read the collective field diaries written by the extension team, covering the eleven-month period from January to December 2022. This material was made available by the project coordinator and describes the trajectory of the extension's actions during almost one year. This period was selected because it was the year with the most records since the project began in 2020.
The goal was to identify the use of social technologies in the day-to-day scope of the extension’s actions by answering the following questions: How was the connection with the homeless population established? What strategies are used to initiate dialogue and individualized follow-up? How are the connections developed with professionals and services of the social assistance network? The aim was to understand the everyday life of that territory, the social reality in question, the experiences, and the technologies used. Authorization for this phase was granted through the signed agreement by the project coordinator.
To analyze the information collected in the previous two phases, we used Content Analysis, based on the thematic analysis technique. The goal was to identify meaning units based on the presence and frequency of certain topics (Minayo, 2014). The process was carried out in three stages: 1) Pre-analysis: selection of the documents to be used and review of the research objectives; 2) Material exploration: classification phase in which meaningful expressions or words from the collected content were categorized; 3) Treatment of the results and interpretation: final stage in which all the classifications were interpreted (Minayo, 2014).
Lastly, the information was analyzed based on the theoretical frameworks incorporated throughout the research process, especially during the initial phase Understanding the productions and practices of social occupational therapy, in which the theoretical foundation on the investigated topic was expanded.
Phase 3: Recognizing theory in practice
The third and final phase was dedicated to presenting and discussing the results of the previous analyses with the participants of the Territory Dynamics extension project. Around eight student extensionists and the project coordinator participated in this stage. Aiming to broaden perspectives and viewpoints regarding the current practice of social occupational therapy with the homeless population, two meetings were held with the team in the format of collective conversations. According to Pereira & Lopes (2016), collective conversations aim to create opportunities and spaces for dialogue so that research participants can express how they perceive and make meaning of their lived reality, allowing for problematization through listening to oneself and others.
The meetings were held in a hybrid format, both in person and online, to include participants who were unable to attend in person. The first meeting aimed to present the research process and its developments, including a description of the data found through the survey, interviews, and reading of the field diaries. The second meeting focused on reading the provisional research report document, with the goal of deepening the discussion and encouraging new insights. During the conversations, active participation of the group was continuously encouraged, with space for comments and questions. Both collective conversations were audio-recorded for later analysis. The analysis of this material contributed to the review and deepening of the research findings.
The identities of the research participants were preserved, and their participation was granted through the signing of the Free and Informed Consent Form (FICF). Furthermore, the research was approved by the Human Research Ethics Committee of Federal University of São Paulo, CAAE n. 64454822.1.0000.5505.
Results and Discussion
The analysis of the three data production phases resulted in two categories: What do the references say about social occupational therapy and the homeless population?, with emphasis on the discussion of the selected articles from the literature review; and Analysis in light of dialogue and practical daily life: dimensions of social occupational therapy work, in which the interviews, field diary, and collective conversation were analyzed.
What do the references say about social occupational therapy and the homeless population?
The first selected article dates from the 2000s (Lopes et al., 2005) and is the only publication on the topic from that period. The other five articles were published in the 2010s, in the years following 2014, showing a slight increase in studies about the homeless population within the field of social occupational therapy.
Table 1 presents reference data and the social technologies identified in each of them:
The first selected work presents an experience report from a social occupational therapy internship and focuses on the discussion of the need for continued development of a theoretical framework to support the professional’s actions with the homeless population. It also addresses the practical intervention repertoire of the professional in building rapport and connections, for example, through writing life stories. According to Lopes et al. (2005), the interns used activities as a facilitating means to approach people and to understand their needs.
The article published in 2014 brings to light the concept of "encounter" as a tool of intervention, based on a collective, dialogical, and horizontal construction, in which both the professional and the users of the featured social assistance service interacted, exchanged, and reworked reflections on their daily needs and life contexts. The article points to the possibility of creating shared spaces that enable this process within specialized social protection services for the homeless population (Silva et al., 2014).
The work of Bezerra et al. (2015) stems from a study conducted with users of a shelter within the public social assistance network in the city of Maceió, AL. The authors delve into key points that lead to life on the streets, illustrated through three themes: the fragility or rupture of ties of belonging as determinants of homelessness, the nuances of life on the streets, and overcoming homelessness as a (im)possibility. Based on these elements, the text qualifies possible actions by the social occupational therapist, indicating the existing social technologies. Furthermore, it highlights the importance of actions in the field of income generation, the development of care projects, and the writing of life stories. It also points to intervention possibilities of the occupational therapist acting as the manager of the shelter service.
Galvani et al. (2016) discuss the use of ethnography as a research tool and its importance in the dialogue between researchers and the participating public. The work continues the development of an ethical, horizontal practice that is engaged not only during the research process but also in the broader performance of the social occupational therapist with the homeless population. The article qualifies the initial contact and approach of the professional with the public and underscores the importance of articulation with social movements.
The 2017 article presents an internship experience report that addresses the implementation of an ambience project carried out at a Specialized Social Assistance Reference Center – Homeless Population (CREAS – POP) in the city of São Carlos, SP. It focuses on the renovation and revitalization of the center’s social space and reflects on how users' bonds and identification with the service influence their sense of belonging, contributing to the continuity of care and follow-up processes (Silva et al., 2017).
The final work, Silva et al. (2018), presents the experience of an extension project working with the homeless population, users of a CREAS – POP in São Carlos, SP. The article describes the occupational therapist’s strategies and uses art and culture as triggering, reflective, and emancipatory elements to counter the logic of reproducing the vulnerabilities experienced by this group. It utilizes the social technology of activity workshops and highlights the importance of writing life stories as a core aspect of the professional’s actions.
In summary, regarding social technologies, the theoretical foundation to support the actions of social occupational therapists with the homeless population was found to be essential. The most frequently mentioned social technology was Workshops of Activities, Dynamics, and Projects, signaling the importance of investing in collectivity, process, and presence, understanding that the joint construction of exchanges and meaningful discussions, mediated by activity, facilitates a better understanding of personal needs and the development of potential strategies for intervention and coping in vulnerable realities.
Another significant aspect was the focus on individuals' life stories and their written narratives. The strategy of reworking the past proved to be powerful, not only as a symbolic and political act of asserting one’s presence in the world but also as a way to redirect future plans and desires. The development of care projects was another frequently reported action in the articles. Finally, the emphasis some articles placed on the initial engagement phase highlighted its fundamental role in building a relationship of trust, serving as the gateway for any subsequent actions. The need for continued theorization based on practice with this population is also evident, as there remains a relatively underexplored repertoire in the literature on this topic.
Analysis in light of dialogue and practical daily life: dimensions of social occupational therapy work
The analysis of interviews, field diaries, and collective conversations revealed core themes organized into three categories: What precedes technical action: theoretical frameworks and professional stance; What supports social technologies: strategies and dimensions; and Technical action through social technologies.
What precedes social technologies: theoretical frameworks and professional stance
The analysis revealed certain positions that form part of social occupational therapy work but precede technical action itself. These can be understood similarly to the notion of "dimension" discussed by Pan et al. (2022), as underlying techniques that permeate and bring social technologies into effect:
In this sense, talking about technical action in social occupational therapy requires understanding the mechanisms that construct the social places of these subjects and the way in which they are assimilated, in order to raise possibilities of movement in the social fabric through the creation of strategies for access to basic rights, for the articulation of resources and for the expansion of life ( Melo & Lopes, 2023 , p. 20).
From this perspective of understanding the singularities and nuances of the daily life of the public being monitored and being able to adapt the technical action, the importance given to understanding the theoretical-methodological references that served as a basis for the emergence of social occupational therapy was identified. Authors such as Franco and Franca Basaglia, Antonio Gramsci, Robert Castel and Jacques Donzelot were mentioned, who supported the formulation and theoretical construction of social occupational therapy. In addition to the mention in the interviews and collective conversations of authors in the field, such as Roseli Esquerdo Lopes, Denise Dias Barros and Sandra Galheigo, who worked on the constitution and consolidation of the area, conceptualizing fundamental elements for the construction of its reflective reasoning. Occupational therapist 1 points out:
There is a horizon, a perspective of social participation, citizenship, rights and above all of recognizing plural knowledge, in this sense, one of the things that, I think [in] all of Denise's [Dias Barros] texts she talks about is resizing the technique (Occupational therapist 1).
The theoretical deepening by the social occupational therapist was presented as support for a professional positioning in the face of inequalities experienced by vulnerable populations, with a perspective not only on the outcomes of the current social organization, but also on its dynamics and origins. It was understood that this moment of theoretical assimilation, which precedes the technical action, was essential to guarantee not only a critical perspective of the occupational therapist in relation to the cause and effect relationships that determine these conditions, but also gave support to the professional to sustain strategies, dimensions, tools and social technologies discussed in the area, for a real effectiveness of the work in social occupational therapy.
Regarding the work with the homeless population, concepts such as: social vulnerability and disaffiliation by Robert Castel; circuit, path and stain by José Guilherme Cantor Magnani; and popular education by Paulo Freire were indicated.
The critical positioning, which also precedes the technical action, contributes to the occupational therapist's understanding of how the profession positions itself and recognizes itself before society, as mentioned by the interviewees and identified in the extension workers' diaries.
Thinking about occupational therapy in a more critical way, which assumes this ethical/political commitment to the transformation of society, but which is also configured based on the changes in that society itself (Occupational Therapist 2).
Theoretical assimilation helps professionals not only understand and support their actions at the beginning, but also throughout the entire work process, contributing to and guiding technical action. During the collective conversations, participants highlighted the importance of constant reflection on theory and practice during supervision. According to them, the successive discussions about the experiences facilitated the analysis and proposal of new actions in response to the demands observed in the territory. Therefore, the dimension What precedes the technical action is not restricted to the set of actions, resources or interventions, but concerns a professional stance in the face of social contradictions, the reflective process between the experiences and theory, and the theoretical references of the area.
What helps social technologies: strategies and dimensions
In this category, actions aimed at implementing and maintaining social technologies were grouped, that is, they are components of the technical action used in professional practice at different moments in the relationship with the public, context and territory. For the analysis, two guidelines used to support the action in social occupational therapy were used: the strategies of territorial-community action (Bianchi & Malfitano, 2022) and the transversal dimensions of therapeutic-occupational intervention (Pan et al., 2022).
The strategy of horizontality and availability in relationships (Bianchi & Malfitano, 2022) appeared recurrently in the materials analyzed. A correlation was identified between this strategy and the social technology of activity workshops, dynamics and projects, being mentioned in moments of attention, listening, care and openness to create bonds.
The strategy was present in the interviews and reports of the extension, being presented not only in moments of rapprochement and bond building, but also as a facilitator for the beginning of singular and territorial monitoring.
To think that one of the technologies has to do with this possibility of encounter, right, and that this encounter requires openness from both parties, dialogues from those who meet (...). The instrument was the relationship, it was being in the daily routine and listening to the demands, that was the instrument (Occupational therapist 1).
I think that listening is, yes, a technical tool, right? In the sense that it is the person living on the streets, I would say, who has the most to teach us, right? Because they are the ones who experience everyday life on the streets. (...) So I think that listening at this moment comes in as a fundamental work tool so that we can think of intervention strategies that are coherent with people's desires and with what has meaning for them, right? (...) And listening, it has to be present there all the time, in this dialogical relationship, which is a basis there, right, of thinking about Social OT, where we think about this care and this attention based on what is meaningful to the other (Occupational therapist 2).
In the work of the Territory Dynamics extension, it was also possible to identify horizontality and availability in relationships. The passages were demonstrated in the field diaries at moments of apprehension of the speeches regarding life stories and strategies for coping with the daily obstacles on the streets. The following excerpt describes the beginning and opening for a moment of listening, which arose after a signal made by one of the people already accompanied by the project:
Talking to Marcelle1 , she pointed to a girl who was sitting nearby and said that I should talk to her because she needed help, the girl responded and so I went over. Her name is Marta, and right from the start she mentioned that her husband [Rogério] had died and that she was having trouble finding shelter. She started to cry (...). I said that, somehow, [I] would try to help her with this and I tried to calm her down, but she kept venting and talking a lot about her husband (Field Diary).
Territorialization, a well-known tool within the Unified Health System and the Unified Social Assistance System, is structured based on the importance of working with the homeless population that seeks to recognize the context determined by the territory in which the action takes place. The action takes place based on circulation in the territory, making it possible to understand the complexities and singularities that permeate the context, also identifying whether and what public policies are available, the coping strategies and the strengths of the territory. It also unfolds in the use of social technologies such as: Singular territorial monitoring, Articulation of resources in the social field and Dynamization of the care network, and can be a facilitating means for the creation and adaptation of public policies.
Occupational therapist 1 mentioned, during her time on a project in the city of São Paulo, that circulation in the territory is a very powerful tool for working with the public.
Making the circuits together, understanding where people are going, what makes sense, what the power is, looking at the street not only as a lack, as an absence of networks, for example, right, as isolation, but what people were able to produce, on the street, in terms of relationships and power that we can talk about (Occupational therapist 1).
In the field journals, it was possible to identify in several passages this understanding of the complexities and singularities that traverse the individual/collective and the territory, given that the main objectives of the extension project, throughout the engagement with the homeless population, were to understand the workings and flows of services, the strategies for coping with the violence experienced on the streets, the power relations present in the territory, and the management of the daily lives of the individuals being accompanied.
It was noted that territorial-community action and the use of its strategies assist the professional in gaining a deeper understanding of the everyday context of this population, for whom the streets are their main space of social interaction and movement. Thus, from this immersion, the professional was able to access and articulate possibilities for overcoming the daily challenges faced by a population that is extremely violated and marginalized in society.
Some cross-cutting dimensions were also identified: dealing with conflicts and project management (Pan et al., 2022). In the field journals, the handling of conflicts was identified in passages where the role of the extension workers, for example, was to mediate conflicting situations between the accompanied individuals and people within their social support networks or public services assisting them. A remarkable entry was when the team, responding to a request from one of the individuals accompanied, mobilized to reestablish contact with his brother, who lived in another state. The man had lost contact with his brother years earlier due to conflicts between them. The extension workers initially tried to obtain the brother’s phone number through the CREAS – POP services and the Family Health Unit. After those efforts were unsuccessful, the group engaged in conversations with several people to mediate a reconciliation, starting with those closest to the accompanied individual, to find a phone contact and establish effective communication between the two.
Pan et al. (2022) describe the important role of the occupational therapist as a promoter, advisor, and project manager in work with vulnerable populations. As an example of the Project Management dimension, not only was the extension project Territory Dynamics identified, but also the involvement of Occupational Therapist 1 in two other projects with the homeless population, highlighting the relevance of occupational therapy in this field of work.
Beyond the previously mentioned strategies and dimensions, two others were identified that contributed to the implementation of social technologies with the homeless population. These were: Writing Life Trajectories and Building Possible Horizons.
Writing Life Trajectories, identified in the literature review, appeared in the extension accounts, related to the recording of life stories of the individuals accompanied. One such record was the field journal itself, prepared by the extension workers. In this document, the extension workers shared narratives about the encounters with the individuals accompanied and recorded each new piece of information collected, facilitating the understanding of their life histories and the continuation of singular and territorial follow-ups.
Furthermore, the moments of writing proved to play a fundamental role in building bonds between students and people experiencing homelessness. In certain passages, attempts at individual writings with some of the individuals accompanied by the project were identified. It is noted that this strategy supports the process of approach and bonding between the accompanied person and the occupational therapist, and it has reflective and emancipatory potential, in which the individual can rework their experiences and express new concerns.
Building Possible Horizons was also cited in all the materials analyzed. The strategy involves the act of questioning, assisting, and co-constructing with the individuals new life projects and the maintenance of their daily lives. It was associated by Occupational Therapist 1 with the use of the social technology territorial singular follow-ups, which can also lead to the activation of the care network or the articulation of resources in the social field.
The field journals revealed that the project already had an established bond and enabled the construction and reflection on desires, plans, and possible horizons for changing (or not) their reality, as well as for organizing and maintaining life, thus strengthening the singular and territorial follow-ups. Moreover, it was identified that one of the roles developed by the extension workers was precisely to reflect together, build, and follow up on life projects with the accompanied individuals.
We started talking by asking how they spent these days when we couldn't be together and why they had changed places – because it was a quieter place and they preferred it. We asked about the plans that Josinaldo said he had for this year in the last conversation we had, to buy a van to sell eggs/vegetables/legumes and to go to São Vicente to get a small room. He said he hadn't given up, but that he realized that things were very expensive, that he wanted a small room first and then sell his things in front of it (Field Diary).
Social technologies for the homeless population
Activity workshops, dynamics and projects were identified in the bibliographic survey and interviews. Occupational therapist 2 emphasized that the idealization of workshops should happen through joint construction with the public, starting from something that makes sense for the subjects' daily lives. In other words, to structure an activity workshop, one must understand the emerging demands and interests, something that can be done through the tools presented previously, such as territorialization and horizontality and availability in relationships.
I think the workshop has the potential to be a space where we can identify collective demands, but also individual ones, to think about, yes, responses also from other technologies (...). But as there is an activity workshop, it is also a space for us... because despite being a group, we can identify individual demands, which can then lead to the need for care... which is a singular territorial monitoring, in short, a dynamization of the network to meet the needs of a specific individual (Occupational therapist 2).
Singular and territorial monitoring, as already mentioned, was the social technology most used by the extension project. Through the presence and constancy of extension workers in the territory, the group built relationships of bonds and trust with people and groups, effectively weaving together social support networks, helping to coordinate with services and develop life projects.
Also, in the analysis of the extension actions, it was possible to identify that many territorial monitoring activities took place collectively. The extension workers linked up with different groups that, seeking protection and creating a support network on the streets, managed survival, work and housing strategies together. Thus, based on the relationship with these groups, the extension workers worked on individual and collective issues in the relationship between them. During phase 3 of the research, the team indicated that the objective of using this social technology was to strengthen collective care and to problematize and reflect, collectively, on violations of and access to social rights.
In the interview, the occupational therapists spoke about the importance of this technology for working with the homeless population, since it allows them to think about issues related to the construction of possible horizons, the articulation of resources in the social field and the dynamization of the care network.
Individual follow-ups too, we produced a lot of individual follow-ups, sometimes in Social Work, people on the outside say “ah, you don’t pay attention to people” (laughs) “and the singularities?”, we did a lot of individual follow-ups and they were very diverse (Occupational Therapist 1).
Singular territorial monitoring, right? It is essential in working with the homeless population. Because it is through this knowledge, of the circulation spaces, where these people can access resources, food, hygiene, in short, to meet their basic needs, we think about how the occupational therapist can also be a facilitator of access to these goods and resources, right, which end up making life on the street a little less difficult, so to speak (Occupational therapist 2).
Regarding social technology for the dynamization of the care network, several moments were identified in which the network was coordinated by extension workers. One point identified in the analysis of the diaries was the use of network dynamization for mediation and tensions in access to social rights and the guarantee of human rights, in episodes such as: active search for services, coordination and direct contact with services and professionals in the network, case discussions and guidance regarding the functioning of services and public policies aimed at the homeless population, contributing to a better flow and implementation of public policies.
The extension worker took a photo of his leg, with his permission, and tried to contact the health services. She sent the image and managed to outline the care he needed with the professional at the port polyclinic. He was taken there and got a place at the shelter (Field diary).
Regarding the last resource and social technology described by Lopes et al. (2014), articulation of resources in the social field, it was identified, with regard to extension activities, articulations that enabled the participation of extension workers and homeless people in the Municipal Social Assistance Conferences, encouraging participation and helping with transportation to the activity.
Social technology also appeared in the conversation with the interviewees, in indications about the articulation with social movements and in strengthening the homeless population in their process of confronting violence.
Then there were the singularities, the people from the social movement, so those who were creating the movement of the homeless population had a demand for support to create the movement. (...) The leadership of the homeless population, the demand was to strengthen the meetings, to help, to publicize the meetings, to help people to get to the meetings, so it was to be able to have this openness as well... what were the projects that were at stake there and how can we there, in this meeting, strengthen these projects (Occupational therapist 1)
The professional's potential to articulate these strategies, to articulate, for example, the construction of groups and articulation with social movements. (...) Identifying collective issues and thinking together with the homeless people themselves, right, a mobilization, an articulation of this group, right, and that's where this dimension of the social movement comes in, to collectively seek solutions to that problem that is collective (Occupational therapist 2)
According to Almeida (2010), social technologies are adaptations and/or reworkings of technologies already developed in the academic world, based on the discussion and validation of their effectiveness directly with the social environment, in the correlation between different knowledge already available and operated in society, and in the refinement of possible action strategies according to the different fields of knowledge. Based on this, with the recognition of the cores of meaning in the analysis of the materials and the understanding that social technologies are a theoretical-practical repertoire for the work of social occupational therapists, the study identified a technical action that can be considered as a social technology: Public policy management.
The Public Policy Management action is based on the recognition of the role of articulator assumed by the social occupational therapist in working with the homeless population and their public policies. According to Cruz et al. (2014, p. 315), occupational therapy professionals have skills that are essential characteristics for work in management, such as “dealing with human activities and the relationships that derive from them; in addition to managing groups, the appreciation of teamwork”. In the interviews, it was mentioned that the social occupational therapist can assist in the dialogue between the homeless population/movements and management, in listening to the public to formulate public policies and in the relevance of the field for coordinating equipment of the Unified Social Assistance System:
There is one thing I forgot to mention, which I also think is fundamental, which also has a little to do with listening, which is the work of the occupational therapist in the management of public policies, (...) this professional who can, right, occupy management and public policy formulation positions, based on listening to this population to think about services and policies that are more coherent with the reality of these people. (...) So there are several issues here, too, of planning, of public policies; which organize services and criteria that are inadequate for this population, which for me has to do with the lack of listening to the social movement of the homeless population itself, right? And the occupational therapist is the professional who can build this bridge, right, between the needs of this subject, listen to these people and build, right, the bridge with the formulation, planning, discussion of public policies so that they meet the singularities, right, of this population in a more effective way, so I think that this is also an important dimension of professional practice (Occupational therapist 2).
Furthermore, it is important to highlight the contributions to the development of university extension projects and scientific research which, as a result of working with the target population, support the effective production of knowledge based on an understanding of the reality and life context of this group, which can aid in the construction and development of more grounded and assertive public policies.
Conclusion
The research identified that the field of social occupational therapy has been committed to and has developed social technologies appropriate for the support of people experiencing homelessness, although there is still limited academic production specifically addressing the topic and population studied.
Given the complexity of working in the social field with the homeless population and aiming to facilitate understanding and guide professional reasoning, the study systematized the contribution of theoretical frameworks and a critical professional stance as elements that precede technical action; it listed strategies and dimensions of occupational therapy action in the social field that support the development of social technologies; and finally, it identified, among the social technologies already named by the field, those used with the homeless population, which are: Territorial and Singular Follow-Ups, Articulation of Resources in the Social Field, Activation of the Care Network, and Workshops of Dynamic Activities and Projects; as well as the action recognized by the study as Public Policy Management, which contributes to the practical repertoire of the profession in working with the homeless population.
Finally, the research brought to light the discussion about the work of social occupational therapy with the homeless population, recognizing the need to strengthen this theme within the field. It is also important to highlight possible gaps and limitations of the study, such as the fact that the scope of the literature review was limited to occupational therapy journals, not including interdisciplinary databases and journals that also publish works from the field; the time constraints for conducting the study; the limitation of methods for data production, among others.
It is pointed out that the theme of social technologies is of great relevance to the field of social occupational therapy, and there are spaces and demands for new studies, such as dialogue with professionals who work directly in services within the Unified Social Assistance System (SUAS). Therefore, it is understood that a continued theoretical development of this theme is necessary, exploring other possibilities and perspectives, with the aim of overcoming the barriers encountered in this study.
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1
The names are fictitious in order to preserve the identity and confidentiality of the participants in the Territory Dynamics extension.
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How to cite:
Souza, G. V. S., Vasters, G. P., & Bianchi, P. C. (2025). Social occupational therapy and technical action with the homeless population: recognizing social technologies. Cadernos Brasileiros de Terapia Ocupacional, 33, e3952. https://doi.org/10.1590/2526-8910.ctoAO404939522
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Funding Source
This work was carried out with the support of the National Council for Scientific and Technological Development - CNPq.
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Edited by
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Section editor
Profa. Dra. Daniela Tavares Gontijo.
Publication Dates
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Publication in this collection
01 Sept 2025 -
Date of issue
2025
History
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Received
24 Sept 2024 -
Reviewed
03 Oct 2024 -
Accepted
08 May 2025
