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Review Article • Cad. Bras. Ter. Ocup. 32 • 2024 • https://doi.org/10.1590/2526-8910.ctoAR395338362 linkcopy

Open-access Occupational therapy actions in the Unified Social Assistance System (Brazilian Welfare System): Brazilian scientific production mapping

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

Abstract

Since the formal inclusion of occupational therapists in the Unified Social Assistance System (SUAS), the number of these professionals working in this sector has grown in Brazil. Based on this context, this article aimed to understand how specific literature in the area of occupational therapy has proposed or discussed the relationship between occupational therapists and SUAS in the country. An integrative literature review was carried out in three indexed national journals. 20 texts were found, 18 of which were published in the Brazilian Journal of Occupational Therapy. Nine articles correspond to experience reports, seven refer to the medium-complexity special protection of SUAS and the adult population at social vulnerability/risk is the most addressed. Social occupational therapy has offered theoretical and methodological support for work in the social assistance sector, being the most present reference in the productions studied, which have been growing in the country. The importance of the professional category in the SUAS services is well known to, together with other professions, face the expressions of social issues. It is hoped that this literature review can contribute to disseminating the profession's practices in SUAS and highlighting its challenges, with a view to strengthening professional performance in this sector.

Keywords:
Occupational Therapy; Social Policy; Social Protection; Systematic Review

Resumo

Desde a inserção formal de terapeutas ocupacionais no Sistema Único de Assistência Social (SUAS), o número desses profissionais trabalhando neste setor tem crescido no Brasil. Com base neste contexto, este artigo objetivou apreender como a literatura específica da área de terapia ocupacional tem proposto ou discutido a relação entre terapeutas ocupacionais e o SUAS no país. Realizou-se uma revisão integrativa de literatura em três periódicos nacionais indexados. Foram encontrados 20 textos, sendo 18 deles publicados nos Cadernos Brasileiros de Terapia Ocupacional. Nove artigos correspondem a relatos de experiências, sete se referem à proteção especial de média complexidade do SUAS e a população adulta em vulnerabilidade/risco social é a mais abordada. A terapia ocupacional social tem ofertado subsídios teóricos e metodológicos para atuação no setor da assistência social, sendo o referencial mais presente nas produções estudadas, as quais vêm crescendo no país. É notória a importância da categoria profissional nos equipamentos do SUAS para, junto às outras profissões, fazer frente às expressões da questão social. Espera-se que essa revisão de literatura possa contribuir para divulgar as práticas da profissão no SUAS e evidenciar os seus desafios, com vistas a fortalecer a atuação profissional neste setor.

Palavras-chave:
Terapia Ocupacional; Política Social; Proteção Social; Revisão Sistemática

Introduction

The Brazilian National Social Assistance Policy

The history of social assistance in Brazil is characterized by donations and assistance provided by philanthropic institutions for people at social risk and vulnerability, in the form of guardianship, kindness and favor (Mestriner, 2001). Only with the Federal Constitution of 1988 was social assistance given the status of public social security policy, alongside health and social security, with the social protection of its citizens being effected by the complementarity of actions between these policies (Campos, 2012). Thus, by affirming human and social rights as a public and state responsibility, the Federal Constitution formally established as a public responsibility needs previously considered personal and individual (Campos, 2012).

The Organic Social Assistance Law (LOAS) came into force five years after the Federal Constitution, in December 1993, and after two unsuccessful attempts to regulate it. This law opened doors for advances in the conception and execution of social assistance as a public policy, mainly with regard to the decentralized political-administrative management model, from the perspective of citizenship (Campos, 2012).

In 2004, the National Social Assistance Policy was promulgated, through the National Secretariat of Social Assistance and the National Social Assistance Council (CNAS). This policy must provide social protection, guaranteeing everyone who needs it, even without prior contribution, the provision of this protection (Brasil, 2004).

Thus, social assistance is responsible for prevention, protection, promotion and social insertion actions, as well as the provision of a set of security measures that cover, reduce or prevent exclusions, risks and social vulnerabilities, as well as meeting the needs arising from personal or social problems. of its users (Brasil, 2004). These guarantees are implemented through the functioning of a basic and special social protection network, that is, through a set of services, programs, projects and benefits. To this end, in 2005, the Unified Social Assistance System (SUAS) was created, which can be understood as a single, decentralized, non-contributory public system that organizes and regulates the National Social Assistance Policy for its implementation in different locations across the country (Brasil, 2004).

Despite the rights guaranteed by law, it is important to highlight that social assistance is functional in strengthening capitalism, as it presents itself as a space for conflicts between the interests of economic profitability, moving within the limits and possibilities that it presents, without its structure is changed (Behring & Boschetti, 2011). Yet, it is also the result of structural resistance to the capitalist mode of production that produces inequality and social injustice (Behring & Boschetti, 2011).

Occupational therapy in the Unified Social Assistance System

The insertion of occupational therapists in services linked to social assistance dates back to the institutionalization of the profession in the country, based on attention to populations traditionally served, such as people with disabilities, mental disorders and the elderly, in the 1970s and 1980s. At the time, assistance was not based on the dimension of social rights, so assistance was linked to philanthropy and took place in institutions such as nursing homes, Pestalozzi societies and the Association of Parents and Friends of the Exceptional (APAEs). Only with the re-democratization of the country, starting in 1988, was there a shift from the perspective of charity to the recognition of rights, increasing the supply of public services and changing the possibilities of professional insertion (Malfitano & Ferreira, 2011).

To understand the spaces where occupational therapists work in Brazil, it is important to highlight that work in social assistance is not recent, with a legislative change having occurred in recent decades, which subsidized an important articulation of the professional category for its regulated entry into the public social assistance policy (Almeida et al., 2012). The mobilization took place with the support of the Brazilian Association of Occupational Therapists (ABRATO), the Federal Council of Physiotherapy and Occupational Therapy (COFFITO) and the Metuia Project, currently Metuia Network – Social Occupational Therapy1 , which were involved in the debates developed at the Regional Meetings, State and at the National Meeting of SUAS Workers (Almeida et al., 2012). The process had repercussions on CNAS Resolution 17, approved in 2011, which recognized occupational therapy as part of the reference team in social assistance services (Brasil, 2011), providing formal inclusion, under current legislation, of the practice of occupational therapists, who it had been improving consistently since the 1970s (Almeida et al., 2012).

Since this legal formalization of the insertion of occupational therapists in social assistance units, the number of these professionals formally working in this sector has grown in Brazil, as highlighted in the study by Oliveira (2020) and Oliveira et al. (2019). In 2011, there were 178 occupational therapists officially registered as working in the different SUAS services, while, in 2022, there were 1.585 (Brasil, 2022). According to Oliveira (2020), the majority of professionals are women, are located in the southeast region and work on equipment of medium complexity at SUAS.

In the context of debate about the actions of occupational therapists in the social assistance sector, this article aims to understand how specific literature in the area has proposed or discussed the relationship between occupational therapists and SUAS in Brazil.

Methodological Course

An integrative literature review was carried out, with a view to producing a synthesis of knowledge and incorporating the applicability of results from significant studies in reflection on professional practice (Souza et al., 2010). This type of review is carried out in six phases: elaboration of the guiding question; literature search or sampling; data collection; critical analysis of included studies; discussion of results; final presentation (Souza et al., 2010).

The main question that guided this research was: “How has specific literature in the area of ​​occupational therapy proposed or discussed the relationship between occupational therapists and SUAS in Brazil?”, therefore, the theme of the review is the interconnection between occupational therapy and SUAS. The searches were carried out in three indexed national journals in the area of ​​occupational therapy: “Revista de Terapia Ocupacional da USP”, “Cadernos Brasileiros de Terapia Ocupacional/Brazilian Journal of Occupational Therapy” (previously named “Cadernos de Terapia Ocupacional da UFSCar”) and “Revista Interinstitucional Brasileira de Terapia Occupational” (REVISBRATO). These journals were chosen as data sources because they are the national vehicles currently in circulation for the dissemination of knowledge production in occupational therapy.

The time frame for the review was 20042 , year of promulgation of the National Social Assistance Policy (Brasil, 2004), until the year 2023, when the review was carried out3 . The search was based on a single inclusion criterion: research articles, reflections or reports of experiences that focused on occupational therapy and SUAS. As exclusion criteria, the following were applied: 1. Documents that corresponded to other types of production, such as editorials; 2. Articles that did not address the review topic.

To choose descriptors for the selection of texts, it was based on those recurrent in National Social Assistance Policy and the publication by Almeida et al. (2012), which describes the process of formalizing occupational therapy at SUAS. Therefore, the following descriptors were selected for the search: “social assistance”, “social service”, “social services”, “social protection” and “Unified Social Assistance System”. The terms were searched individually in quotation marks in the three journals.

After data collection, 88 articled were found. From this total, those that were repeated were excluded4 , reaching a number of 78. These documents were organized in a table, containing the following data: full name of the article, authors and co-authors, periodical and year of publication.

Next, an evaluation of all manuscripts was carried out, based on their titles and abstracts, taking into account the inclusion and exclusion criteria. After this first screening, 72 documents were obtained. Of the six documents that were excluded, four corresponded to editorials, three of them from Cadernos Brasileiros de Terapia Ocupacional/Brazilian Journal of Occupational Therapy and one from REVISBRATO. The two other excluded documents corresponded to the proceedings of a congress and a cover image of the second edition of 2018, both published by REVISBRATO.

All abstracts were read, excluding articles that did not correspond to the focus of the research. When the summary left doubts about the topic, the full document was read. After this stage, 23 articles remained.

Finally, 23 documents were read in full, and records were made for each of them, and in this process, three more articles were eliminated. Such articles, despite mentioning occupational therapy and SUAS, did not focus on the professional category and public policy in question.

Figure 1, below, demonstrates the path taken in the review:

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Figure 1
Search flow and article selection. Source: Own elaboration.

Description of Articles

After the final selection of articles, a matrix was created, with the following data being inserted: title, authorship, types of articles, place and year of publication, to organize the information, as shown in Chart 1.

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Chart 1
Articles gathered and analyzed.

The articles were published in two diferente journals namely: Cadernos Brasileiros de Terapia Ocupacional/ Brazilian Journal of Occupational Therapy 6 (n=18) and Revista Interinstitucional Brasileira de Terapia Ocupacional (n=2). 71 different authors were identified, some of which were present in more than one publication, as shown in Table 1:

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Table 1
Recurring authors in the publication.

Regarding the temporal distribution of articles, publications occurred between 2012 and 2023, as shown in Figure 2. It should be noted that all publications were published after 2011, when the inclusion of occupational therapy in SUAS was regulated (Brasil, 2011), with the first publication found dated 2012, which refers precisely to the process of formalization of the professional category in this sector (Almeida et al., 2012).

thumbnail of Figure 2
Figure 2
Number of articles/year.

Considering the types of articles, nine publications are categorized as “Experience Report” or “Practice Analysis”, seven as “Original Article” and four as “Reflection/Essay Article” or “Reflection Article”.

Topics under Debate

Based on the records, the following themes were chosen for description and discussion: 1. Scenarios for the insertion and professional practice of occupational therapists in SUAS; 2. Theoretical references and/or subsidies for practices; 3. Levels of care, services and populations addressed.

Scenarios for insertion and professional practice of occupational therapists in SUAS

Of the 20 articles analyzed, four have in common the fact that they do not study or reflect on a specific population, a certain service or practical experience to reflect on the role of occupational therapy in SUAS (Almeida et al., 2012; Oliveira et al., 2019; Bezerra & Basso, 2023). Two of them focus on the demands that arise for professional practice in social assistance based on capitalist society, highlighting concepts, organizational and operational guidelines of National Social Assistance Policy and SUAS, in their connections with occupational therapy (Almeida et al., 2012; Bezerra & Basso, 2023). The other two focus on scenarios involving the insertion of occupational therapists in social assistance services at a national level (Oliveira et al., 2019) and in the state of Minas Gerais (Pêgo et al., 2023).

Almeida et al. (2012) and Bezerra & Basso (2023) point to the need for a professional practice that is contextualized to the social policy in which it is inserted, maintaining the ethical-political horizon of professional practice committed to guaranteeing rights. Professional practice is mediated by corporate and professional projects (Bezerra & Basso, 2023). The former can be understood as collective projects that express class intentions for the desired society, based on the defense of certain values ​​(Paulo Netto, 2006). Professional projects are made up of values, define ethical and political principles, theoretical-methodological references for professional practice and establish bases for their relationships with service users, with other professions and with organizations and institutions (Paulo Netto, 2006).

When it comes to work in the social assistance sector, that is, interventions in expressions of social issues – such as poverty, misery, violence, unemployment, destitution, inequalities, lack of social policies, etc. – there is a need for an alignment between societal and professional projects that (re)recognizes the contradictory nature of social assistance policy, which responds to antagonistic interests of the dominant class and the working class (Bezerra & Basso, 2023).

The importance of a professional project critical to the structure and dynamics of capitalist society is highlighted, which continually replaces the expressions of the social issue, and to the conservative tendencies of work in social assistance (Bezerra & Basso, 2023). Such critical sense should be able to break with a technical and supposedly neutral view of the profession and promote freedom and human emancipation as central values ​​in search of the transformation of subjects and their daily lives, inserting professional action into a clear societal project, whose political dimension, with its contradictions, must be subject to analysis (Bezerra & Basso, 2023).

These critical positions can occur in daily work in several ways: in favor of the universalization of rights; against focal criteria, which treat rights as privileges; in favor of the democratization of access to information, which can strengthen individual and collective subjects; against institutional productivism and meeting merely bureaucratic demands; against holding families responsible for difficulties created by capitalist society (Bezerra & Basso, 2023).

In both texts, expertise of occupational therapists is mentioned that meets these critical actions, such as training that recognizes otherness, diversity, culture and plurality as keys to reading social reality; as well as professional skills linked to listening, welcoming and generating and maintaining relationships anchored in the autonomy of the Other; and the ability to operate with group activities that do not have a therapeutic character, but rather the opportunity to reflect and exchange experiences. Furthermore, social occupational therapy is highlighted as a pertinent theoretical-methodological reference to support the practice of occupational therapists in SUAS (Almeida et al., 2012; Bezerra & Basso, 2023).

The work of Oliveira et al. (2019) set out to describe and characterize the insertion of occupational therapists in SUAS, from 2011 to 2016, at a national level. An increase in occupational therapists working in social assistance over the years has been noted. Regarding the distribution of occupational therapists in different units that make up SUAS, it was found that, in absolute numbers, the Day Centers had the highest number of professionals, while the Center Pop (homelessness people) had the lowest (Oliveira et al., 2019).

As in the national survey, the study that focused specifically on the state of Minas Gerais, Brazil found an increase in occupational therapists: from 54 professionals in 2012, to 219 in 2019. The Day Center was also the equipment that covered the majority of professionals of occupational therapy included in SUAS, followed by Welcome Units (Unidades de Acolhimento), Primary Care Assistance (CRAS), Conviviality Center (Centros de Convivência), Specialized Attention (CREAS), Homelessness Center (Centros Pop) and Provisors Family Adoption Program (Família Acolhedora) (Pêgo et al., 2023).

Furthermore, national data bring other contributions to understanding the inclusion of occupational therapists in SUAS: the region with the highest prevalence of these professionals is the Southeast; working hours vary between 20 and 30 hours/week; the gender is, for the most part, feminine; and the role most performed is that of a member of the technical team. It is worth highlighting the variation in employment relationships between the different social assistance units, there is an increase in temporary jobs and those related to the private sector (Oliveira et al., 2019).

In this way, the precariousness of employment relationships in social assistance stands out, which is not a condition that only affects occupational therapists. It can be said that SUAS is made up of public and private non-profit institutions, with work relationships marked by high turnover and fragility, which make organization and political resistance, as well as professional training, difficult. This outsourcing, therefore, can compromise work and assistance to the user, directly interfering with the quality of service for the end user (Pereira & Frota, 2017).

Both articles mention the need to produce materials that help professionals who are occupying social assistance spaces to strengthen their work (Oliveira et al., 2019; Pêgo et al., 2023). There is a need for undergraduate courses in occupational therapy to offer appropriate training for professional work in SUAS, including content related to occupational therapy in social contexts and social occupational therapy in their curricula, which are sometimes scarce (Pan & Lopes, 2019).

Almeida et al. (2012) also point out the need to train qualified occupational therapists to operate critically with concepts, instruments, resources and challenges present in SUAS, with it being urgent, during the period of publication, to deepen reflections on the professional skills required for work in the sector under the perspective of universalization of rights. Therefore, the challenge is to improve professional interventions on specific problems, in order to respond to the social needs of the population served and strengthen coordination with social assistance workers (Almeida et al., 2012).

Theoretical references and/or subsidies for practices

Theoretical references are scientific sources on which articles rely to weave their reflections, justify practices, supporting knowledge about a given subject. When it comes to the texts selected in this literature review, different references were used, depending, for example, on the population on which the practice, the subject of research or the theme of a reflective text.

National Social Assistance Policy appears, in 13 articles, as a reference to contextualize the emergence of social assistance as a public social policy in the country and to point out its function, its guidelines, its levels of action, as well as its socio-assistance units and their services (Almeida et al., 2012; Melo et al., 2014; Neves & Macedo, 2015; Bezerra et al., 2015; Morais & Malfitano, 2016; Surjus, 2017; Silva et al., 2017; Oliveira et al., 2019; Borba et al., 2017; Thus, for the work in SUAS, National Social Assistance Policy is essential to guide professional performance, which is of great relevance, since the professionals who work in SUAS are the executors of the policy, and their knowledge is necessary to achieve the mission established in legislation.

To understand social phenomena that permeate reflections in the care sector, several references from the area of ​​Human and Social Sciences were used, such as sociologist Robert Castel, who was mentioned in five texts (Bezerra et al., 2015; Neves & Macedo, 2015; Borba et al., 2017; Silva et al., 2018; Minatel & Andrade, 2020), and Paulo Freire, present in two texts (Silva et al., 2018; Minatel & Andrade, 2020). Other authors were also present, such as Loïc Wacquant, István Mészáros, Manuel Jacinto Sarmento, among others.

Regarding work in occupational therapy, six articles refer to social occupational therapy as a subarea that, since the 1970s, has been concerned with manifestations of social issues, such as social inequality, poverty and lack of access for certain groups. population to social rights (Almeida et al., 2012; Perez et al., 2014; Bezerra et al., 2015; Pêgo et al., 2023; Bardi et al., 2023; Bezerra & Basso, 2023).

In this historical journey, Almeida et al. (2012) and Bezerra & Basso (2023) highlight social occupational therapy in the process of formalizing the professional category in SUAS, through a process of activism built by the Metuia Project, today called by Rede Metuia – Social Occupational Therapy, and by ABRATO, aimed at the organized participation of the professional category in the decision-making process of who would be the workers who would make up SUAS (Almeida et al., 2012).

In addition to this process of activism, the theoretical framework of social occupational therapy is justified for social assistance, in Bezerra & Basso (2023) and in Bezerra et al. (2015), when resuming the principles of social occupational therapy (Barros et al., 2002) based on professional action separated from health, discussing the contradictory role of social policies, defending the inseparability of the technical, ethical and political dimensions of professional work. Therefore, a recognition of the inadequacy of health models to inform work on the expressions of social issues is highlighted, since it is essential to avoid interventions that individualize, medicalize and psychologize technical work (Malfitano, 2023).

The 20 articles selected in this review use references from social occupational therapy in the discussions held, especially to justify the paths taken in practical situations in the social assistance sector. In 16 productions, social occupational therapy is explicitly defended as an appropriate theoretical-methodological framework to support practices in social assistance (Almeida et al., 2012; Melo et al., 2014; Perez et al., 2014; Neves & Macedo, 2015; Bezerra et al., 2015; Morais & Malfitano, 2016; Borba et al., 2017; Silva et al., 2018; Oliveira et al., 2019; Minatel & Andrade, 2020; Bardi et al., 2023; Bezerra & Basso, 2023; Pêgo et al., 2023; Gomes et al., 2023; Neves et al., 2023; Vedovello et al., 2023), as can be seen in the examples:

In this way, social occupational therapy is a theoretical-methodological framework that can be adopted in the construction of a critical-transformative professional project for work in social assistance (Bezerra & Basso, 2023, p. 12).

The field of occupational therapy that has been dedicated to supporting the profession's role in social assistance is social, which seeks to expand experiences and sociocultural repertoires for the lives of subjects (Morais & Malfitano, 2016, p. 533).

It is highlighted, through the framework of social occupational therapy, that in order to work in social assistance it is important for the professional to understand that there are two social spheres, one microsocial and the other macrosocial, and the occupational therapist is capable of doing the mediation between both, in a dialectical movement between these dimensions (Perez et al., 2014; Minatel & Andrade, 2020; Bezerra & Basso, 2023; Bardi et al., 2023; Gomes et al., 2023). In the microsocial sphere, strategies can be developed that seek to help the subject to have support for their social insertion and participation, taking into account possibilities and imposed structural limits. In the macrosocial sphere, this is where work connects to social policies for the social recognition of certain needs and population groups, working to expand services that promote access to social rights (Malfitano, 2023).

Furthermore, the importance of a collective worldview for the development of work with social demands was identified in the productions (Bardi et al., 2023; Bezerra & Basso, 2023; Melo et al., 2014; Minatel & Andrade, 2020). In Bardi et al. (2023), reading a collective dimension is considered necessary to incorporate aspects of people's culture and daily lives, so that proposals make sense of the lived reality. In Minatel & Andrade (2020), the collective vision of the professional is pointed to the understanding that the problems experienced in the daily life of a person or family are not individual, they are the result of society and its form of organization, requiring a strategy related to social policies – and not individual – to face problems.

Along this path, some articles discuss, based on social occupational therapy, daily life and territory as important aspects for professional performance in SUAS. In Neves et al. (2023), there is an investigation of the interests and life stories of users monitored in social assistance equipment, revealing everyday trivialities. In Minatel & Andrade (2020), the occupational therapist approaches everyday life as a central element for creating intervention strategies, implying work on personal, social and territorial resources. In Borba et al. (2017), the perspective of territorial action is highlighted, since in SUAS there is a need for physical proximity to the monitored public.

Another dimension, present in nine articles, is the use of resources and technologies referenced from social occupational therapy in practices developed in social assistance (Neves & Macedo, 2015; Borba et al., 2017; Silva et al., 2018; Minatel & Andrade, 2020; Neves et al., 2023), in research (Gomes et al., 2023; Bardi et al., 2023), as well as in reflection articles (Melo et al., 2014; Bezerra & Basso, 2023). Neves et al. (2023) and Bezerra & Basso (2023) describe four social technologies described by social occupational therapy that are mentioned as possibilities for the development of practices in SUAS, namely: 1. workshops of activities, dynamics and projects; 2. singular territorial accompaniments; 3. articulation of resources in the social field; 4. dynamization of care networks (Lopes et al., 2011, 2014).

In Bezerra & Basso (2023), such resources and technologies are highlighted as concerning social assistance policy, and it is therefore recommended that occupational therapists use them in their workspaces. In Bardi et al. (2023), when presenting a community of practices formed by SUAS occupational therapists, such methodologies and technical resources appear as important for professional action. During the process, there was a decrease in the idea held by professionals that there were no references for work in the sector, based on a reflection on the relevance of social occupational therapy references (Bardi et al., 2023).

Still on the occupational therapy references used to support practices in SUAS, Silva et al. (2022) presents a practice based on references from southern occupational therapies and decolonial feminist perspectives. In Acevedo (2021) and Córdoba et al. (2015), references used in the selected article, a critical and decolonial stance is demarcated, in which the root of social suffering is interpreted as located in the capitalist/colonial system, regulating occupations/activities in the dimensions of autonomy, participation and inclusion. The authors highlight the defense of a democratic society based on human rights, which produces new forms of life, recognizing plurality through practices and assuming that neutrality is impossible in a profession that works with human activity (Acevedo, 2021; Córdoba et al., 2015).

In Silva et al. (2018), the practice carried out in a CREAS Pop is based on different concepts about culture, as well as the field of art, with different experiments that contribute to the expanded vision of the work and possibilities for interaction and creative production.

Thus, it is observed that social occupational therapy has massively informed scientific production about the work in social assistance, offering theoretical references that contribute to a reading of reality regarding the expressions of the social issue with which professionals work, as well as offering of methodologies for intervention, which make use of work resources that can be replicated in different contexts of activity in this sector.

Levels of care, services and populations addressed

Of the 20 articles found in this review, nine are experience reports (n=45%), corresponding to the category with the most texts. Of the nine reports, only two refer to the experience of professional practices, that is, texts in which the practices of occupational therapists from a given social assistance unit are described and analyzed (Neves et al., 2023; Vedovello et al., 2023). The other seven texts portray experiences developed in Brazilian Higher Education institutions, concerning the curricular internship and/or practical discipline and the extension project experience.

Regarding the levels of complexity, of the total number of articles, seven refer to the medium complexity of the SUAS special social protection, on CREAS Pop (Perez et al., 2014; Silva et al., 2017, 2018), CREAS (Neves & Macedo, 2015; Morais & Malfitano, 2016; Nunes et al., 2021; Neves et al., 2023) and a non-governmental service referenced to CREAS (Vedovello et al., 2023). The others refer to basic social protection (n=4), high complexity (n=1), with one article referring to medium and high complexity simultaneously, in addition to texts that mention levels of complexity in general, as they do not deal with a specific research/performance or reflection scenario.

In relation to the services covered, of the 20 texts, four concern medium complexity: the Specialized Home Care Service (SEAD)7 (Neves & Macedo, 2015; Neves et al., 2023), the Specialized Service to Homelessness People (Serviço Especializado de Assistência à Pessoa em Situação de Rua) (Perez et al., 2014) and the Assisted Freedom to Young in Conflict with the Law (Serviço de Liberdade Assistida and Prestação de Serviços à Comunidade PSC) (Vedovello et al., 2023). However, the most mentioned service (n=3) is basic social protection: the Coexistence and Strengthening of Bonds Service (Borba et al., 2017; Minatel & Andrade, 2020; Gomes et al., 2023). There are also texts that mention social assistance services in general, as they do not deal with a specific research/action/reflection scenario, or that do not mention a specific service, despite dealing with practices and research carried out in certain social assistance units.

There are several target populations in the texts, eight refer to the adult population and/or young people at vulnerability and/or social risk, with four of them focusing on the homeless population (Perez et al., 2014; Silva et al., 2017, 2018; Bezerra et al., 2015), two related to women (Melo et al., 2014; Gomes et al., 2023; Silva et al., 2022) and one to adults and young people (Borba et al., 2017). The other texts focus on adolescents in conflict with the law, the elderly and/or disabled population and socially vulnerable children and adolescents or are texts that refer in general to population groups monitored by SUAS.

Final Considerations

This literature review was dedicated to gathering articles on occupational therapy and SUAS in Brazilian journals in the area of ​​occupational therapy, 20 texts were selected, and it is important to highlight that, like any literature review, there is a limit to what can be achieved, given the selection of scientific articles published and their access, not including books, chapters and other productions in the area, as well as not covering articles that may have been published in social assistance vehicles, or that did not use the selected descriptors. Recognizing these limits, it is still considered that the results contribute to the understanding of the state of the art on the topic of occupational therapy and SUAS.

It is observed that productions on the subject, as well as the number of occupational therapists at SUAS, have been growing, and in 2023, six articles were identified, while in previous years the production was one, two or three articles annually. Such growth relativizes the discourse found by participants who composed previous studies (Oliveira, 2020) that there is a “scarcity” of materials to support the practice of the professional category in the sector.

As the productions reveal, most of the texts refer to services included in the medium complexity of SUAS, with mention being made of the Specialized Service of Home Care, the Specialized Service to Homelessness People and the Assisted Freedom to Young in Conflict with the Law. In relation to the target populations addressed, the majority are adults and/or young people at vulnerability and/or social risk, especially the homeless population.

According to data from the selected and analyzed articles, social occupational therapy has offered theoretical and methodological support for work in this sector, being the most present reference in productions. Its use is justified, according to different authors, as it allows an analysis beyond the health sector, with articulation between micro and macrosocial aspects, as well as based on a sense of collectivity – essential aspects for work focused on the expressions of the complex Brazilian social issue –, in addition to offering methodologies and social technologies for intervention with the populations monitored by SUAS.

It is considered that this review points out ways for researchers on the subject and contributes to the production of knowledge in occupational therapy at SUAS, with a view to demarcating the relevance of the work of occupational therapists for the construction of a multi-professional policy focused on complex demands and contradictions of Brazilian society.

  • 1
    The Metuia Network is the result of a construction that has brought together academics, professionals and students since the end of the 1990s, which seeks to produce theoretical-methodological references ion the face of demands arising from social issues, always bearing in mind the commitment to produce knowledge in and for occupational therapy (Lopes & Malfitano, 2021). Currently, it is made up of seven centers, in different universities in Brazil, in addition to a nucleus in Mozambique and another in France. In a non-nuclear way, it brings together other social actors.
  • 2
    Although the resolution that mentions the occupational therapist as a possible SUAS worker is from 2011 (Brasil, 2011), the promulgation of the National Social Assistance Policy (Brasil, 2004) is considered as a legislative framework that defines the current parameters for professional practices, including occupational therapists, in this sector.
  • 3
    It is important to highlight, in relation to the time frame, that REVISBRATO has made articles available on its website since 2016, the moment in which it began publishing articles. The other journals used in the search make their articles published in periods prior to 2004, the year this review began, available on their websites.
  • 4
    This repetition occurred because the same article was found using different keywords among those used for the search, individually, in this literature review
  • 5
    The article appears classified as “Dossier”, as, in that volume, it comprised part of the texts dedicated specifically to the special edition on Social Occupational Therapy. To follow the standard of classification and debate proposed in this article, we classified it as a “Reflection Article”, due to the nature of the text.
  • 6
    The current name of the journal will be used, even referring to publications prior to 2017, when it was called Cadernos de Terapia Ocupacional da UFSCar.
  • 7
    In the Brazilian National Classification of Social Assistance Services, this service is dedicated to Handicap People, Older People and their Families (Brasil, 2014).
  • How to cite:
    Bardi, G., & Malfitano, A. P. S. (2024). Occupational therapy actions in the Unified Social Assistance System (Brazilian Welfare System): Brazilian scientific production mapping. Cadernos Brasileiros de Terapia Ocupacional, 32, e3836. https://doi.org/10.1590/2526-8910.ctoAR395338362

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Edited by

  • Section editor
    Profa. Dra. Késia Maria Maximiano de Melo

Publication Dates

  • Publication in this collection
    18 Oct 2024
  • Date of issue
    2024

History

  • Received
    25 Apr 2024
  • Reviewed
    06 May 2024
  • Accepted
    08 July 2024
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