The work of occupational therapists in the Unified Social Assistance System (Brazilian Welfare System - SUAS): perceptions of professionals in the fieldABSTRACT
The Unified Social Assistance System (SUAS) is structured through a network of social assistance services that provide two levels of social protection: basic protection and special protection, at medium and high complexity. Occupational therapists work at both levels. Based on semistructured interviews conducted with 12 occupational therapists participating in a Community of Practice in Occupational Therapy within SUAS, this study sought to identify and discuss their perceptions of their work, focusing on their actions. The analysis of the interviews identified a set of perceptions discussed around the following thematic axes: a) Welcoming practices, qualified listening, and horizontal dialogue: otherness as a guide; b) Transformative doing: challenges and potentialities of activity use by occupational therapists in social assistance; c) Network articulation in SUAS work; d) Fragilities and needs perceived by the therapists. The diversity of professional insertion among participants in the system revealed that, from their perspectives, the work includes transversal elements across different services and levels of protection in social assistance, as well as elements that are more specific to occupational therapy, considering the particularities of the populations assisted and the institutional objectives. The study also identified the relevance of creating and maintaining spaces for debate and professional development for occupational therapists working in SUAS, such as Communities of Practice, which support articulation among professionals.
Keywords:
Occupational Therapy; Professional Practice; Social Support; Public Policy
Resumo
O Sistema Único de Assistência Social (SUAS) é estruturado por meio de uma rede de serviços socioassistenciais que ofertam dois níveis de proteção social: básica e especial, de média e de alta complexidades. Há terapeutas ocupacionais atuando em ambos os níveis. Por meio de entrevistas com roteiros semiestruturados realizadas com 12 terapeutas ocupacionais participantes de uma Comunidade de Práticas em Terapia Ocupacional no SUAS, buscou-se identificar e discutir as percepções dessas profissionais sobre o trabalho desenvolvido, dialogando sobre suas ações. A análise das entrevistas identificou um conjunto de percepções reunido e discutido em torno dos seguintes eixos temáticos: a) Acolhimento, escuta qualificada e diálogo horizontal: a alteridade como guia; b) O fazer que transforma: desafios e potências do uso das atividades por terapeutas ocupacionais na assistência social; c) Articulação em rede no trabalho no SUAS; d) Fragilidades e necessidades percebidas pelas profissionais. A diversidade de inserção profissional das participantes no sistema revelou que, conforme suas percepções, o trabalho apresenta elementos transversais aos diferentes serviços e níveis de proteção na assistência social, bem como elementos mais específicos da terapia ocupacional, considerando as particularidades dos públicos e dos objetivos institucionais. Também foi constatada a relevância da criação e manutenção de espaços de debate e de formação profissional para terapeutas ocupacionais atuantes no SUAS, como as Comunidades de Práticas, que favorecem articulações entre profissionais.
Palavras-chave:
Terapia Ocupacional; Prática Profissional; Assistência Social; Política Social
Introduction
Since 2005, the Unified Social Assistance System (SUAS) has offered social assistance services, programs, projects, and benefits, implementing actions grounded in the perspective of universal rights and promoting advances in the conceptual, organizational, and management dimensions of social assistance in Brazil. SUAS is structured through a social assistance network organized into levels of complexity for the provision of Basic and Special Social Protection. Basic Social Protection focuses on preventing risk situations and strengthening family and community bonds, whereas Special Social Protection is divided into Medium and High Complexity and provides specialized support to personally and socially vulnerable individuals and families, as well as to those who have experienced violations of rights (Brasil, 2005).
The guidelines of SUAS recommend differentiation between preventive actions that address vulnerabilities and social risks, which must occur within Basic Social Protection, and those that address violations of rights, which must be offered in Special Social Protection services (Brasil, 2005). However, the repercussions of the socioeconomic context on the singular dynamics of everyday life produce intersections between problems of varying degrees of intensity. These problems appear across the different service levels of the system, requiring professionals to maintain a constant, “focused, and knowledgeable reading of social and subjective reality” (Lopes et al., 2014, p. 600) and to adjust their professional actions to the complexity of users’ demands. As discussed by Jannuzzi et al. (2023), when examining the development of the National Social Assistance Policy (PNAS) from the standpoint of the expansion of the State’s political, institutional, and administrative capacities over recent decades, the workforce constitutes a strategic factor when the objective is to achieve outcomes in social policies. These authors argue that if frontline professionals are crucial in most social policies, their centrality is even more evident in social assistance, since these workers implement the principles, norms, intentions, and objectives of the policy in the reality of services whose users are mostly individuals with limited resources to confront violations of rights or the conditions of social vulnerability they experience. Thus, whether in policy formulation or implementation, these workers are considered the true assets capable of producing the desired results, especially within the limits imposed by the neoliberal context and by processes of precarization that create obstacles for the operationalization of social work.
Regarding occupational therapy, its formal recognition as a professional category qualified to join reference teams and/or service management within SUAS, according to local, regional, and territorial demands and specificities, established through Resolution no. 17 of the National Council for Social Assistance (CNAS) in 2011 (Brasil, 2011), supported the growing presence of professionals in diverse services across the different levels of social protection (Oliveira et al., 2019). As a result, the work with different populations and demands within SUAS increased occupational therapists’ interest in theoretical and methodological frameworks capable of coherently informing their practice in social assistance and their interpretation of users’ social demands. Academic production also advanced in this direction.
A mapping of publications on occupational therapy and social assistance conducted by Bardi & Malfitano (2024) identified a growing body of work on various themes. These themes range from the historical trajectory of the profession—which highlights the work of occupational therapists in connection with the development of social policies in the country, particularly in social assistance (Almeida & Soares, 2023)—to practical experiences across different services, with varied populations and at the levels of protection established by SUAS. Together, these studies demonstrate the diversity of ongoing experiences. In this mapping, social occupational therapy emerged as the most widely used theoretical-methodological framework. These publications represent a collective effort to ground and strengthen a professional field that, as identified by Oliveira (2020), has a continued need for spaces of knowledge exchange to support professional practice.
Based on this understanding, in 2020 and 2021, faculty members and occupational therapists from three Brazilian universities: Federal University of Espírito Santo (UFES), Federal University of São Carlos (UFSCar), and University de São Paulo (USP), formed a Community of Practice (Wenger-Trayner & Wenger-Trayner, 2015), inviting occupational therapists working within SUAS. The Community was initially established through a university outreach project whose purpose was to combine collective strategies to address issues relevant to professional practice in SUAS (Bardi et al., 2023). Its creation was chosen at that time because it constituted a collaborative space that brings together professionals with shared interests to exchange and produce knowledge, share experiences, and develop joint actions, aimed at improving professional dynamics (Wenger-Trayner & Wenger-Trayner, 2015). The project coordinators, researchers from the participating universities, are members of the Metuia Network – Social Occupational Therapy, and although they have individual academic trajectories in each institution, they have been dedicated, for many years, to teaching, research, and outreach activities in social assistance, grounded in the theoretical-methodological framework of social occupational therapy.
The activities of the “Community of Practice in Occupational Therapy in SUAS: professional articulation and strategy development” involved 47 occupational therapists from different regions of Brazil, mostly women, and occurred in two cycles of regular online meetings: the first from October to December 2020 and the second from February to July 2021 (Bardi et al., 2023). In 2021, the Community expanded its activities by creating the blog “TO.noSUAS” (Comunidade de Práticas em Terapia Ocupacional no SUAS, 2021) and an Instagram account (@tonosuas), both maintained by Community participants who regularly produced content on occupational therapy in social assistance until early 2023 (Bardi et al., 2024). In 2022, the Community organized an online event titled “TO.noSUAS: Contemporary Dialogues,” which emphasized the need for continuous professional development for occupational therapists as a central strategy to strengthen and improve the work conducted in SUAS.
From the beginning, participants viewed the meetings as opportunities for knowledge exchange and production, based on the demands brought by occupational therapists concerning the need for theoretical and methodological refinement and for work resources and tools for their practice in SUAS (Bardi et al., 2023). Throughout the process, participants reiterated their interest in engaging with colleagues working at the same level of social protection and, when possible, in the same types of units and/or services, emphasizing the differences and specificities they perceived between work developed in Basic and Special Social Protection. Because they were often the only professional of their category in a SUAS unit, they reported the need to create conceptual and practical alignments with other colleagues in the profession.
Based on the observation that the Community brought together a wide variety of work experiences across different services and levels of social protection, and that participants’ relationships had strengthened over time, the coordinators proposed the study whose results are presented here. Its objective was to identify and discuss perceptions of the work conducted by occupational therapists in SUAS, focusing on the actions conducted across the different levels of social protection. The decision to dialogue with professionals capable of contributing to the composition of a broad picture of practice across levels was guided by the hypothesis that specific actions are required in each level, as suggested by the workers themselves during the Community’s activities.
Method
Interviews were chosen to produce descriptive data and to value the professional experience of the workers, considering their perspectives regarding professional practice (Lüdke & André, 2014).
The semistructured interview format was selected to generate information that could contribute to understanding the perceptions of occupational therapists working in SUAS concerning their practices in a singularized manner. According to Marconi & Lakatos (2003, p. 195), the interview “is a meeting between two people, intended for one of them to obtain information about a given topic through a conversation of a professional nature.” As for semistructured interviews, Dicicco-Bloom & Crabtree (2006, p. 315) state that they are commonly “organized around a set of predetermined open-ended questions, with other questions emerging from the dialogue between interviewer and interviewee.” In line with the objective of this study, the script encompassed aspects of the daily work of occupational therapists in social assistance services (including the description of a workday and the report of a case under their responsibility), the social resources/technologies employed in occupational-therapeutic practice, the participants’ perceptions of how the work team viewed occupational therapy in these services, and possible strategies for articulation, qualification, and strengthening of the professional category in the field of social assistance1.
The initial inclusion criteria were as follows: a) having a degree in occupational therapy; b) having, or having had, an employment relationship with social assistance units; c) having registered for the project “Community of Practice in Occupational Therapy in SUAS.” Twelve occupational therapists from the Community were selected, four linked to Basic Social Protection and eight to Special Social Protection, of whom four worked in Medium Complexity services and four in High Complexity services.
For participant selection, a Microsoft Excel® spreadsheet was created with the list of the 77 individuals registered in the Community, grouped by work unit and corresponding level of social protection, together with their percentage of attendance in meetings. A descending ranking was then conducted according to participation percentage, which enabled the invitation of those with the highest attendance first. In cases of unavailability, the next professional on the list was invited, until the predefined number was reached. The interviews were conducted entirely by the Community coordinators through Google Meet®, on previously scheduled dates and times between January and March 2023. All interviews were recorded and later transcribed by a student supported by a research scholarship. The transcribed material was sent to participants for review and confirmation, which occurred in all cases.
The information from the transcripts was initially analyzed through thematic identification and discussion, in a descriptive manner, which resulted in four categories: a) Welcoming practices, qualified listening, and horizontal dialogue: otherness as a guide; b) Transformative doing: challenges and potentialities of activity use by occupational therapists in social assistance; c) Network articulation in SUAS work; d) Fragilities and needs perceived by the therapists. After this first phase, the authors held successive meetings to collectively discuss and deepen the interpretations of the data, achieve consensus and analytical refinement, and consolidate the final discussion categories.
Results and Discussion
The 12 transcribed interviews generated a total of 96 pages, which were read repeatedly to identify the main findings according to the objectives of the study. The results were organized to first present the characterization of the participants’ professional insertion, considering the nature of the service, the length of time working in that context, the corresponding level of social protection, and the geographic location of the unit by state. The discussion of the data is then presented, focusing on the proposed analytical axes.
Characterization of participants’ professional insertion
The presentation of results begins with Table 1, which lists the occupational therapists who contributed to the study.
Characteristics of participants’ professional insertion by level of protection, length of work in the unit, unit/service, and geographic location by state.
All participants had worked for at least one year in their respective unit or service, despite variation in length of work. Of the 12 interviewees, five had between 1 and 4 years of experience in SUAS, and seven had between 7 and 21 years in the field. The extended period of work, especially among those with more than seven years of experience, indicates that the profile of the interviewees is not characterized by high turnover in social assistance because of salary precarization and employment instability (Pereira et al., 2017). Instead, it reflects the presence of occupational therapists who remain in this field for a considerable period. This finding may be associated with the specific characteristics of the group invited to participate in the study.
Regarding the services, the research design sought to ensure representation across all levels of social protection, including occupational therapists working at different levels of the system. Concerning the geographic distribution of the services in which participants work, most are in the state of São Paulo (8), followed by Espírito Santo (2), Distrito Federal (1), and Paraná (1). Except for the last two, all participants work in the Southeast region of the country. This distribution, with greater concentration in the Southeast, corresponds to the fact that a large portion of the Community’s members were from that region (Bardi et al., 2023), which also contains the largest number of occupational therapists working in SUAS (Oliveira et al., 2019; Oliveira, 2020).
Welcoming practices, qualified listening, and horizontal dialogue: otherness as a guide
When asked about the actions and resources employed in their daily work as occupational therapists, the professionals repeatedly mentioned components that do not pertain to their core body of professional knowledge and practice (Malfitano, 2005). In other words, they emphasized actions that are not carried out from the specific foundations of the field of occupational therapy. In almost all interviews, welcoming practices2 and qualified listening were mentioned. These elements are considered essential components of the social work developed in social assistance services and are not attributed to professionals of a specific disciplinary identity (Brasil, 2014). According to the interviewees:
We request that people come for the initial reception. It is a moment when I listen to the population’s demands, explain the CRAS services, the social assistance rights… In short, it truly functions as the point of entry. (TO 1)
We manage to place ourselves in that position… I believe that occupational therapy can contribute significantly in this regard. We learn to do this, this exercise of otherness, which is also ethical, grounded in listening, perception, understanding the person’s experience and the place from which the user speaks. (TO 9)
The mention of these actions seems to reflect the occupational therapists’ recognition of the importance of their integration into the dynamics of interdisciplinary work within social assistance, contributing collaboratively to the technical teams of the services in which they work and strengthening collective efforts toward the expected social work.
From another perspective, however, one may consider that the interviewees also revealed in their responses what Bezerra & Trindade (2024, p. 144) describe as the “lack of differentiation of professional duties and competencies in social assistance.” They characterize this process as a factor that may intensify the precarization of work in SUAS, since it is ideologically used to reduce the number and diversity of professionals in service teams. According to these authors, such lack of differentiation originates in processes that contribute to the production of a “fetish” surrounding interdisciplinary work, that is, processes that attribute to it, without critical examination, beneficial qualities supposedly inherent to its nature or superior possibilities that it does not, in fact, possess.
For Bezerra & Trindade (2024), these processes are linked to three broader social vectors that are not related to the internal dynamics of the professions: the institutional definitions and characteristics of social assistance policy, the intensification of precarization in public social services within the current context, and the forms of organizing team-based work in SUAS. Once fetishized, interdisciplinary work ceases to be an object of reflection and new elaborations in the daily work of professionals, preventing the team from seeking higher levels of qualification in social work based on the singular contributions of each profession. This lack of debate regarding the different professional categories in the construction of everyday practice also appears to emerge in the way occupational therapists perceive how they are viewed by other team members. One of the interviewees states that:
In social assistance, occupational therapy is still not recognized. Its theoretical foundations and the place it occupies within social contexts are not understood. When there is no recognition or understanding, practices and interventions do not advance, and the presence of its resources is not defended. (TO 8)
Another professional presents a similar perspective regarding the lack of differentiation between professions:
The work of the occupational therapist is very fluid, with many dimensions. I did not understand that I had an occupational therapist’s role there. You are part of the technical team, you have your knowledge, and you contribute to the processes and to the team, but you do not provide specific care within your area. (TO 11)
Considering these statements, the interviews indicate that important issues require discussion within the reality of team-based work in SUAS. The potential of a team composed of professionals who bring different possibilities of intervention in relation to social problems appears to be a topic that deserves further development. In this context, it is necessary to examine whether the absence of professional specificities in SUAS services has contributed to overcoming the undesirable fragmentation of knowledge and practices or whether it has intensified the exploitation of workers in a period marked by neoliberal adjustments.
Because interviewees were encouraged to describe the actions they undertake in their workplaces, they described support and follow-up processes based on an interpretation of the needs and potentialities of the individuals, families, communities, and territories in which the work occurs.
[Conducting] an interpretation of the context, history, and territory, and the use of strategies such as activity groups. (TO 8)
From my specific area, I mobilize resources based on the demand that is presented and not in advance. What concretely emerges as presented demand. What you can identify as demand based on a critical interpretation of reality, that is, of the context. (TO 9)
Their descriptions often highlighted the connections between these needs, potentialities, and the objectives guiding the follow-up processes. However, the actions and resources employed to pursue these objectives were not always detailed with the same clarity.
These accounts also reveal that the participants believe they must understand and act upon the singularities of the individual and collective realities with which they engage, although all these realities are strongly marked by common precarities, typical of socially vulnenable groups.
According to the interviewees, work in SUAS services requires constant inventiveness and an ongoing search for new strategies and resources. This indicates a commitment to the quality of their actions.
Everyone, each family is very singular; I would emphasize the territory. When we talk about territories, some have characteristics that prevent me from doing certain things that I could do in others; this is very evident to me—even the approach differs. (TO 6)
Our resources are very broad and very cyclical. At certain moments, activities related to music appear frequently because they match adolescents’ profiles; at other times, graffiti because it connects with the identity of certain groups; at another moment, sports appear. These are different forms of expression that we must have as part of the range of possibilities in our work. (TO 7)
However, although this appreciation suggests an active posture by the professionals interviewed, since they do not remain passively bound to actions with limited effectiveness, it may also indicate that they do not always find appropriate conditions to perform their work.
As for the follow-up process with the population, the formation of bonds with individuals and communities was frequently highlighted as an essential component. The importance attributed to bond formation appears to relate to the professionals’ ethical-political commitment to creating relationships in which the user is viewed as a subject of rights; as someone who must be seen, heard, and understood. This perspective asserts the need for conduct that opposes assistentialist, charitable practices marked by the subordination of those who seek the service. In this sense, bond formation is understood as inseparable from dialogical and horizontal relationships, as well as from a mode of listening that enables recognition of the “other” in their otherness, as a being who must be identified and respected within their reality and context, based on references of their culture (Barros et al., 2007).
In some interviews, the relational dimension also appeared as a technical-operational function, grounded in the idea that the individual must not only receive support but also recognize themself as a subject of rights. For example, TO 8 describes part of a follow-up process in which she mediated actions intended to change the social position of a woman experiencing gender-based violence:
We managed to help her understand that she was a victim and that she did not need to remain in that position, but also that she did not need to become an offender; she could occupy another place. (TO 8)
Thus, follow-up processes must promote conditions in which the continuous affirmation and exercise of these rights, sustained by relationships that confirm them, constitute a central strategy, as discussed in social occupational therapy (Lopes, 2023). It was also observed that the professionals described their work by alternating between terminology adopted in the sector to express actions shared by the team and notions grounded in the theoretical-methodological foundations of occupational therapy. One may ask whether these forms of presenting their work—by articulating what is common to the sector and what is specific to the profession—may serve as resources for producing meanings that help anchor their practices within SUAS services.
Transformative doing: challenges and potentialities of activity use by occupational therapists in social assistance
For the occupational therapists interviewed, activities play a central role in their work within social assistance services and are present in different forms of follow-up. Here, activity use is understood as the set of resources employed in their practices. The professionals reported that the actions undertaken may be individual, group-based (such as activity groups or reflection groups, workshops, and lectures), or territorial when they occur in schools, sectoral and intersectoral network services, households, and community environments, including public squares, cinemas, and other cultural spaces.
The activities involved in follow-up are diverse, including craft-based, artistic, physical, cultural, leisure, and play activities. They are strongly associated with the demands and the social, demographic, and cultural profile of the population assisted and are shaped by the specificities of the contexts in which they occur. However, the terminology used to designate these activities is not homogeneous among the professionals, resulting in different names for similar practices.
In relation specifically to collective or group-based activities, terminological variations were observed. They were often referred to as activity groups, activity workshops, or collective methodology, with no explicit distinction between these terms. These activities share an orientation around a specific action—cultural, playful, craft-based, among others—and promote active participation, expression of knowledge and opinions, identity formation, interaction, and reflection, as described by one of the participants:
We have activity workshops, but today we characterize them as a group because of terminology. Yet what we structure are meaningful encounters through human doing. We also use activity as a mediating resource in relationships. (TO 6)
The absence of terminological consensus may relate to the different norms and practices present across the levels of social protection and fields of practice, such as the terminological differences between the socioeducational sphere and institutional sheltering. In addition, it may reflect an effort by professionals to align themselves with other actors and sectors that influence work management in SUAS, including managers, monitoring and inspection bodies, and the influence of terminology used in other sectoral policies in which the occupational therapists previously worked.
In the narratives of the workers, activities, especially in group formats, extend beyond their role as mediators of communication or triggers of reflection. They function as central elements for creating physical and symbolic spaces of active participation, in which those being supported can express themselves without judgment, share opinions and identities, interact, and, above all, experience decision-making.
We try to be very creative, according to the abilities and experiences that the adolescent brings and wishes to develop. In terms of work technology, I believe that these different forms of expression constitute our central resource. Artistic forms, music, and other modes of expression make it possible for the adolescent to recognize themself through the activity. We construct with the adolescent to guarantee their participation, to give this adolescent a voice, and from that process we build the activities. For this reason, we have many resources, both activities and partnerships, that we use to reach the adolescent and promote meaningful experiences and activities. (TO 7)
In the discourse of some interviewees, one observes the concept of activity developed in social occupational therapy, in which activity is understood as a construct that mediates multiple relationships situated within a specific cultural and historical context, as discussed by Barros et al. (2002). From this perspective, activity has an unfinished nature and is continuously constructed through movement and communication, which manifests in various forms, such as verbal, gestural, auditory, iconic, and symbolic languages. Activity takes place in lived experience and concrete situations. It has a materiality that provides meaning to it but also sets conditions and limits for its interpretation. It is shaped by the history, social practices, and cultural values of the individuals and groups who experience it. Thus, activity may take on singular and collective forms and may promote emancipation or alienation. Its role is defined by the intentionality that guides its use and the processes adopted in its construction.
To promote emancipation, it is essential that activity be part of processes directed toward the expansion of autonomy, citizenship, and social participation (Godoy-Vieira et al., 2024; Farias & Lopes, 2022). In this text, emancipatory practices refer to those that allow reflection on the social origins of the problems faced by individuals in society, recognizing that this perspective depends on professional intentionality rather than on the activity itself (Godoy-Vieira et al., 2024, p. 3).
From this perspective, occupational therapists described territorial and community-based actions through activities as one of the most important strategies in their professional practices within social assistance, considering themselves specialists in activity use. Neves et al. (2023) identified contributions and specificities of occupational therapy practice in social assistance, characterized by activity use in collective spaces and by an approach centered on the everyday lives of individuals.
Network articulation in SUAS work
Network articulation was mentioned by most of the professionals interviewed as a technical action developed in the daily work of social assistance units across the different levels of complexity in SUAS. These references were present mainly in responses describing a workday, reporting a case followed in their service, and identifying the resources and methodologies used in their work.
In the daily routine of services, network articulation emerged as one of the actions, among many others, intended to achieve the objectives of social protection:
Individual assistance, collective assistance, territorial actions, referrals and articulation with the network, initial reception, a moment in which I listen to some of the population’s demands, and referrals related to social assistance rights. (TO 1, emphasis added)
Articulation with other social assistance services and with other sectors, such as health and culture, was mentioned repeatedly. The occupational therapists understand that the social assistance policy alone is not sufficient to address the complexity of users’ demands. In this sense, they consider that their work includes mapping services and establishing referrals to other sectors with the aim of ensuring rights and citizenship for those they support.
It is important to highlight that the identification of occupational therapists with actions developed through network-based work is recurrent in different subfields of the profession linked to social policies. Avelar & Malfitano (2022), discussing this theme with professionals working in different policies, found this recurrence but concluded that it cannot be understood as a specific or exclusive professional action. This aligns with the legislative principle of social protection, which defines integration among policies as essential for the effective implementation of social protection, a point Rezende et al. (2015) identify as a legacy of the Brazilian social protection system.
There is, therefore, a territorial dimension embedded in this work, since such mapping extends beyond the concrete boundaries of a social assistance unit. This territorial dimension and network articulation are themes present in social assistance documents, such as the PNAS (Brasil, 2004, p. 44):
Thus, the operationalization of social assistance policy through a network, based on the territory, is one of the pathways to overcome fragmentation in the practice of this policy. Working through a network, in this territorial conception, means going beyond simple adherence, because it requires the rupture with old paradigms in which practices were historically built on segmentation, fragmentation, targeting, and observing reality while considering the new challenges posed by the dimension of everyday life, which presents itself in multiple configurations and requires integrated and combined engagement.
Articulation between the network, services, and sectors appears in the literature as the formal social support network of individuals. According to Pizzinato et al. (2018), the support network may be divided into the formal system and the informal system. The formal system includes public institutions and services that provide assistance, care, and support to individuals and society, such as health services, social assistance services, child protection councils, courts, schools, social security (INSS), housing departments, among others. The informal system consists of family, friends, neighbors, and civil society institutions that provide some form of social support (Pizzinato et al., 2018).
Sociologist Robert Castel defines primary sociability as the processes that connect community members through belonging to close networks, such as family, work, and neighbors, in relationships of interdependence. Secondary sociability, in turn, refers to specialized institutions with specific technical characteristics. Both constitute alternatives for promoting and maintaining social balance and are directly related to social cohesion (Castel, 2015).
Beyond mentioning articulation with network services, the professionals also emphasized articulation with the informal network as an important part of work conducted in close proximity to individuals’ everyday lives:
The work, understood as participation in territorial activities, dialogues with the network and the family, made it possible to strengthen bonds, including a closer relationship (marriage), and the outcome occurred through the overcoming of the violation of the rights. (TO 6)
In another situation, reported by TO 3, concerning a case of domestic violence against an adult with a disability who was kept at home without basic health conditions, without contact with services, and without a support network, professional practice centered primarily on the (re)construction of personal bonds and the restoration of family relationships.
Another professional described articulation with the informal network when discussing the case of a young person with intense involvement in drug trafficking (as a work environment) who was living on the streets and received a temporary custodial socioeducational measure. The work took place through family articulations, especially with the mother, while also considering the bond the young person had with a dog that lived with him on the streets. The occupational therapist emphasized the young person’s everyday life as the specific locus of her professional practice:
The bond established by the adolescent is not necessarily a bond only with people. It may be a bond with institutions, with services, with animals. This broader understanding is very connected to the profession of occupational therapy. (TO 8)
By developing practices directed toward articulating formal and informal networks, occupational therapists produce actions aimed at ensuring access to social rights and strengthening support networks. The examples mentioned can be linked to Castel’s contributions, since his grounding of the concept of social cohesion in the pillars of labor and relational bonds highlights paths for interventions within the scope of the social question. These interventions mobilize the social support networks of individuals experiencing vulnerability and/or social disaffiliation (Castel, 2015). In this sense, beyond the vulnerabilities resulting from scarce material resources, there is the fragility of the relational fabric (Castel, 1994, p. 23), which contributes to the marginalization of groups.
Thus, interventions by occupational therapists directed toward everyday life contribute to sustaining the expansion of sociability (primary and secondary), as defined by Castel. They support the expansion and/or strengthening of the social support networks of individuals and their families. The accounts show that the complexity of everyday life requires occupational therapists to create multiple articulations, guided essentially by users’ demands and by their professional commitment. A critical analysis of social realities, aligned with a sensitive engagement with people’s lives, their potentialities, and their difficulties, appears to shape the work of articulating formal and informal networks according to their availability and possibilities of interconnection. The execution of these articulations constitutes the foundation for integral action, which is crucial for expanding and/or strengthening individuals’ social support networks (Oliveira & Malfitano, 2021).
Occupational therapists have demonstrated competence in performing this type of technical action, as described by Oliveira (2020), since undergraduate education enables engagement across different sectors and services, expanding the possibilities for understanding and interacting with multiple social actors. In this sense, they identify ease in communicating with professionals from other fields and are, at times, responsible for coordinating network-related processes.
I perceive this with great potential; I believe we have a differentiated perspective, a complete macro and micro view of situations, of the territory, and of families, and we can engage in dialogue with these sectors. (TO 6)
Moreover, there is recognition that network articulation is a technical action conducted by occupational therapists, even though it is not an exclusive responsibility of the profession. In the theoretical-methodological framework of social occupational therapy, which guides most occupational therapy practice and research within SUAS (Bardi & Malfitano, 2024), the dynamization of the care network is understood as an action aimed at mapping programs, projects, and actions involving population groups and/or communities. The objective is to foster integration among them, articulating different sectors and levels and enabling the direction of intervention strategies (Lopes et al., 2014). Throughout the interviews, one of the professionals mentioned network dynamization as an essential element of her work in SUAS.
And we also consider, as social technologies, the issue of network dynamization, mapping the network, articulating these services; we must know our territory. (TO 10)
According to Bezerra (2023), occupational therapy, when compared to psychology and social work, is the professional category that most emphasizes the technical-operational aspects of work in social assistance, to make explicit how practice is conducted and which resources and strategies compose teamwork within SUAS. This author argues that the emphasis on the everyday life of individuals and on activities is recognized by other professionals as a characteristic specific to occupational therapists (Bezerra, 2023).
Based on these considerations, the professionals who participated in the Community of Practice and in this study, regardless of the level of complexity in which they work in SUAS, regard the articulation of formal and informal networks as a relevant technical action for the development of work within social assistance.
Fragilities and needs perceived by the therapists
The work of occupational therapists in social assistance may also be understood through the difficulties and fragilities reported by the professionals. Difficulties are observed particularly when, during the interview, they comment on how they perceive the value and/or recognition of their work by the technical team, by professionals in the unit, or by the municipal management of the system. They reported difficulties in having their work understood and/or valued, indicating different forms of relationship between these two aspects. In some interviews, the lack of understanding of the profession was associated with discredit or with the lower value attributed to these actions when compared to others performed in the same professional environment. This seems to occur particularly among professionals working in PSB. Those working in services at other levels of social protection reported perceiving changes in the value attributed to their work over time, associated with the specific contributions of the profession in the social assistance context. TO 11 noted that the team had begun to perceive what differentiated her from other professionals. TO 8 expressed a similar perspective, stating that the role of occupational therapy had become consolidated in the team of the unit where she works because of a historical process that granted it unequivocal legitimacy. Another interviewee, TO 5, considered that there is a wide variety of situations regarding the insertion of occupational therapy in social assistance services. She stated that she had already experienced more positive perceptions of the profession’s growth in social assistance but also what she regarded as resistance from the team toward its presence.
From the participants’ perspective, initiatives aimed at strengthening and articulating the professional category would be significant. The professionals mentioned the need to occupy representative spaces as a path toward strengthening. They emphasized that, with greater political engagement, they could participate more actively in entities such as the regional and federal councils of the profession.
Another strategy suggested by the occupational therapists was the implementation of welcoming spaces to expand articulation with colleagues in the field, foster dialogue, publish and conduct actions related to the social field, and thus strengthen bonds.
Well, beginning with the Community of Practice, for instance, I believe that having spaces for dialogue that bring forward the challenges, debates, and diversities of the work is important. We need these spaces; there must be ongoing funding, and we must conduct all the necessary discussions. (TO 7)
My perception is that there should be more movements like those of the Community of Practice to truly create strength, to prevent us from feeling alone. It seems that nothing else exists. I do not know if this is because I was very confined in my own context, but I never saw another project like the one you organized. (TO 4)
The Community of Practice was emphasized as a strategy for professional articulation. In general, it was presented in the interviews as an opportunity to connect with professionals from other states and service contexts. Through this exchange, it allowed a national-level understanding of the political recognition of occupational therapy within SUAS, revealing experiences that range from the absence of social assistance content in undergraduate education to the limited availability of specialization outside the São Paulo–Rio de Janeiro axis.
I feel represented by this collective because I do not feel alone, since I am the only occupational therapist working in SUAS in my municipality, and there are so few of us. I believe it is important to feel part of a collective, and we seek to produce. (TO 1)
The provision of professional development for occupational therapists in SUAS emerged as one of the main needs identified as a pathway toward strengthening the profession, as illustrated in the following examples:
I believe there must be more courses, more specialization programs in the SUAS field, specialization in Social Assistance, postgraduate education, and training courses. This education is very much needed. (TO 6)
I miss specialization courses; I miss having a postgraduate program that is accessible. I am speaking about accessibility because everything related to the social field today requires traveling to São Paulo, which is not my reality. So extension courses, postgraduate programs, the Community of Practice, I believe this is a very feasible strategy. The production of books organized by service areas, more structured in terms of the duties and competencies of occupational therapists, capable of making these aspects more concrete. I also believe that more visibility is needed in collective spaces, such as cultural centers, and sometimes meetings at the state level. (TO 5)
The participants emphasized the need for postgraduate programs to support professional practice in SUAS, an issue also identified during the Community of Practice meetings (Bardi et al., 2023). This need emerges in a context in which undergraduate occupational therapy programs in Brazil offer limited access to content related to the social field, as indicated by Pan & Lopes (2014).
They also highlighted the demand for education opportunities outside the Southeast region, noting that many programs remain concentrated in the principal centers of theoretical production in the field. The professionals referred to the need for forums, workshops, and congresses in social occupational therapy, as well as accessible forms of communication to discuss everyday work and increase the visibility and understanding of the profession within the field.
The production of books and materials addressing the work of the profession in social assistance was also identified as an important strategy to support professional practice. However, it is worth highlighting that there is extensive material addressing practices and research in social occupational therapy, a theoretical-methodological framework relevant for supporting action in the field (Bardi & Malfitano, 2024).
Another perspective on professional development was raised by one participant:
SUAS professionals receive extensive training; there is the permanent education program, and many companies provide training for these professionals. Therefore, I believe we should also participate in these education spaces, to present our knowledge, and I believe that this dialogue between theory and practice, including content capable of addressing possible occupational therapy actions in social assistance and the existing practices, would be important. (TO 1)
This participant’s observation approaches professional development from another angle: it is not limited to the provision of specific education for occupational therapists working in SUAS but also includes the participation of these professionals in the general training programs offered by social assistance departments. In these spaces, they may present their analyses and work methodologies, demonstrating their contribution to the field.
Final Considerations
The accounts of the interviewees enabled the description of the actions that compose the daily work of occupational therapists who participated in the Community of Practice in occupational therapy within SUAS. In addressing the question regarding the actions undertaken by occupational therapists across the different levels of social protection in SUAS, the interviews revealed that a portion of the work in social assistance is transversal, meaning that it expresses areas of articulation that do not present distinctions among the different types of services, units, or levels of complexity in which they operate. No differences were identified among the levels of protection that shape professional practice, although these practices were consistent with the characteristics of the context and of the populations followed up in each unit.
Conversely, certain accounts revealed specificities, given the varied nature of the services that compose each level of social protection and the placement of the professionals in different types of units and services. In other words, the interviewees differentiated their actions and perceptions based on the particularities of the services, which frequently involve specific target populations and objectives, even when situated within the same level of social protection.
Among the possible threads of debate, the main resources used by the professionals were emphasized, with activities standing out as mediators of relationships in work within SUAS. Network articulation was reaffirmed as a characteristic of the work, both because of its frequent mention and of its relevance for social work in the sector. In this regard, it appears as a resource widely used by occupational therapists which, although not specific to the profession, is frequently employed in the effort to support access to rights and to social protection. Articulation of the informal network, conducted through interventions in the everyday lives of subjects and groups, adding elements derived from the apprehension of sensitive daily processes to macrostructural analyses, constitutes a specific technical action of these professionals.
Thus, the actions developed by the participants in social assistance employ diverse activities intended to be transformative and emancipatory, and articulation of social support networks, both formal and informal, forms part of their strategies. Their accounts provide examples of social technologies in social occupational therapy being developed within social assistance.
These results are situated within the context of the Community of Practice, created to discuss professional work. This context may reflect professional perceptions shaped by ongoing reflection on their own practices, as well as by the intention to exchange experiences and by their availability for dialogue. It is also observed that part of the interviewees were occupational therapists with prolonged work experience in the sector.
It should be noted that the selection of these participants did not consider the national proportionality of units that concentrate the largest share of occupational therapists in social assistance. According to the SUAS Census, these would be the services of Special Social Protection of Medium and High Complexity, respectively, the Day Centers and the Institutional Care Units. For this study, four professionals from each level of complexity were invited to ensure a balanced set of narratives across settings. Within the Community of Practice, participants worked mainly in the units of Special Social Protection of Medium Complexity.
Another result of this study, in its specific context of a Community of Practice, was the recognition of the relevance of creating and maintaining spaces for debate and professional development for occupational therapists. These spaces enable articulation among professionals, as occurred in this experience. Therefore, welcoming and listening to the interests and needs of professionals in this context, and not only in it, may guide strategies capable of supporting the development of actions that, in a more collective manner, weave connections that strengthen the complex social work of understanding and, perhaps, moving and transforming the lives and everyday realities we encounter.
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1
Regarding ethical aspects, the guidelines and norms of Resolution no. 510/2016, which regulates research in the Human and Social Sciences, were respected. The study was approved by the Research Ethics Committee for Human Subjects at the Federal University of Triângulo Mineiro (UFTM), under opinion no. 4.759.709 (CAAE: 46018721.5.0000.5154), and all interviewees signed an Informed Consent Form.
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2
The term acolhimento [welcoming practices or supportive reception], as used by the occupational therapists, does not appear in the Social Assistance regulations. Its meaning is approximately represented by the term acolhida [initial reception or reception process], which conveys the idea of offering careful attention to the needs, interests, and possibilities expressed by service users.
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How to cite:
Oliveira, M. L., Almeida, M. C., Santos, J. F. D., Santamaria, L. M., Soares, C. R. S., Bardi, G., & Malfitano, A. P. S. (2025). The work of occupational therapists in the Unified Social Assistance System (Brazilian Welfare System - SUAS): perceptions of professionals in the field. Cadernos Brasileiros de Terapia Ocupacional, 33, e4112. https://doi.org/10.1590/2526-8910.cto417041122
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Data Availability
The data supporting the results of this study are available from the corresponding author upon request.
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Funding Source
National Council for Scientific and Technological Development (CNPq), Process no. 403772/2021-4 and e Internal Undergraduate Research Scholarship Program (PIBIC/CNPq/UFSCar).
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Edited by
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Section editor
Profa. Dra. Beatriz Prado Pereira
The data supporting the results of this study are available from the corresponding author upon request.
