The path of social occupational therapy in a Higher Education institution: trajectory in teaching, research, and extension

Abstract

In the 1980s, during the social occupational therapy construction process in Brazil, there was a shift from the centrality of health and illness to social phenomena resulting from social and cultural inequalities. It is worth noting that social occupational therapy has gained notoriety both in Brazil and internationally. Despite the advances in this area, the literature points out that the main bottlenecks for the formation of social occupational therapy have been the insufficiency of human resources and the almost exclusive emphasis of the curricular guidelines of occupational therapy courses on the health area. In this scenario, it becomes relevant to deepen the analysis of how social occupational therapy has been constituted in other courses in the country, in addition to the state of São Paulo, the cradle of its emergence. This experience report aims to discuss the constitution of social occupational therapy, based on the historical process that enabled its emergence, its advances and setbacks in the UFMG undergraduate course. It is verified that social occupational therapy is gradually being consolidated in the course at UFMG, legitimizing the space for the education of occupational therapists. It is evident that the configuration of this area occurs in a field of active forces, as it advances, retreats and/or maintains itself. The power of its expansion lies in the combination of the dimensions of teaching, research, extension, public policies, and service practices.

Keywords:
Occupational Therapy; Professional Education; Teaching; Socioeconomic Factors

Resumo

No processo de construção da terapia ocupacional social no Brasil nos anos de 1980, observa-se um deslocamento da centralidade do binômio saúde e doença para os fenômenos sociais decorrentes das desigualdades sociais e culturais. Vale destacar que a terapia ocupacional social ganhou notoriedade tanto no Brasil quanto internacionalmente. Não obstante os avanços dessa área, a literatura aponta que os principais gargalos para a formação da terapia ocupacional social têm sido a insuficiência de recursos humanos e a ênfase quase exclusiva das diretrizes curriculares dos cursos de terapia ocupacional voltadas à área da saúde. Diante desse cenário, torna-se relevante aprofundar a análise de como a terapia ocupacional social tem se constituído em outros cursos no país, além do estado de São Paulo, berço do surgimento da área. Este relato de experiência objetiva discutir a constituição da terapia ocupacional social, a partir do processo histórico que viabilizou a sua emergência, seus avanços e recuos no curso de graduação da Universidade Federal de Minas Gerais (UFMG). Verifica-se que, gradativamente, a terapia ocupacional social vai se consolidando no curso na UFMG, legitimando o espaço de formação do terapeuta ocupacional. Torna-se evidente que a configuração da área se dá em campo de forças atuantes, fazendo-a avançar, recuar, manter-se. Uma potência da expansão está na articulação entre as dimensões de ensino, pesquisa, extensão, políticas públicas e práticas em serviços.

Palavras-chave:
Terapia Ocupacional; Formação Profissional; Ensino; Fatores Socieconômicos

Introduction

The first movements toward the construction of social occupational therapy emerged in the 1980s from political and theoretical positions assumed by professionals who engaged in debates about latent social problems in Brazil (Barros et al., 1999). The beginning of this decade was marked by an effervescence of social movements contrary to the then-current political system, in defense of a political agenda that included guidelines for democratization, social inclusion, and expansion of social rights that were later expressed in the Federal Constitution of 1988 (Barros et al., 1999; Barros, 2004; Costa, 2016; Galheigo, 2016; Malfitano et al., 2014). There was also an intensification of this debate around the need to shift the centrality from the health-disease binomial to social phenomena resulting from social and cultural inequalities when working with various socially vulnerable groups that were experiencing fraying or disruption of social bonds (Barros et al., 2007; Costa, 2016; Galheigo, 2016; Malfitano et al., 2014; Malfitano, 2016). Thus, as a result of a broader political reading of the effects of these inequalities and sub-citizenship on the everyday life of populations assisted by occupational therapy, a critique emerges among occupational therapists about the restriction of their professional action to the functionalist biomedical model (Lopes, 2016; Galheigo, 2016). In this dynamic scenario, Brazilian social occupational therapy has historically gained national and international notoriety (Galheigo, 2016; Lopes, 2016; Malfitano et al., 2014).

Universities have been one of the main materiality loci in this subarea amid setbacks and advances resulting from disputes between different fields of knowledge. In the late 1970s, disciplines in the social field were created to compose the curricula of the Federal University of São Carlos (UFSCar) and the Pontifical Catholic University of Campinas (PUC-Campinas), namely, social occupational therapy and occupational therapy applied to social conditions, respectively (Galheigo, 2016). Later, in some of the courses in the country, these disciplines were excluded because they were considered redundant, with the argument that the social dimension was cross-sectional to occupational therapy in general (Galheigo, 2016; Pan, 2014). In the late 1990s, mainly after the establishment of the Metuia Project, currently called Metuia Network¹ , the debate about the social field is resumed in the academic scenario through the development of teaching, research, and extension projects, which resulted in scientific productions that consolidated social occupational therapy (Galheigo, 2016).

Notwithstanding the advances in social occupational therapy, a study that compared three occupational therapy undergraduate courses at universities in the state of São Paulo found important differences in the operationality of education in this field: non-uniformity of the contents offered; contradictions and divergences regarding the concepts of this field; variations in the distribution of specific class hours, in the availability of disciplines, and in the intended profile for the education of these professionals (Pan & Lopes, 2014). Moreover, another survey that assessed fifteen courses in the country also reported a minority inclusion of content related to this subarea in their curricula (Pan, 2014). One of the main bottlenecks identified in that study was a lack of human resources, which implied the lack of conceptual and practical uniformity in social occupational therapy. This scenario was also evidenced by the almost exclusive emphasis on the National Curriculum Guidelines (DNCs) of 2002, and because the DNCs had a focus on health, the social area remained linked to this perspective in some courses² (Pan & Lopes, 2014; Pan, 2014).

As for the process that regulates occupational therapy in the social field, in 2009, Brazil’s Federal Council of Physical Therapy and Occupational Therapy (Brasil, 2009) created and regulated the occupational therapy specialty in social contexts, formalizing the role of occupational therapists in social assistance, socioenvironmental, socioeconomic, and cultural development policies. In 2011, the National Council for Social Assistance recognized occupational therapists as one of the professionals who can compose the teams in social assistance services of the Unified Social Assistance System (SUAS) (Almeida et al., 2012).

In this context, it is relevant to analyze more comprehensively how social occupational therapy has been constituted in other courses in the country in addition to those in the state of São Paulo, where this sub-area was created (Reis, 2008). This experience report aims to discuss the constitution of social occupational therapy from the historical process that enabled its emergence, setbacks, and advances in the occupational therapy undergraduate course of the Federal University of Minas Gerais (UFMG). This report was built from the perspectives of its authors as participants in the historical process of building this subarea at UFMG - the third federal public university to implement an occupational therapy course in Brazil. It is worth emphasizing that a singular experience can reflect the regularities of the constitution of this field in the different courses in the country, as well as elucidate differences that can indicate which paths should be followed.

The Construction of Social Occupational Therapy at UFMG: Teaching on the Agenda

The Occupational Therapy Course at UFMG began in 1979 based on Brazil's first minimum curriculum of undergraduate occupational therapy courses, which was instituted in 1963 and approved in 1964 (Drummond, 1999; Universidade Federal de Minas Gerais, 2008). At the time, the education of occupational therapists in Brazil was limited to the need for technical qualifications to work in the field of rehabilitation. During this period, an effort was made to define the parameters and basic requirements of the profession’s specificities that would reflect on professional education (Lopes, 1990). In this process, in search for technical and scientific competence, the profession in Brazil was anchored mainly in the North American concepts of occupation, having been influenced by foreign professionals who worked in the construction of occupational therapy courses in Brazil (Reis & Lopes, 2018).

As previously mentioned, in the early 1980s, the political and social situation in Brazil led to a review of professional postulates of occupational therapists in the face of the debate about the responsibilities of technicians in the formation of social values and the political role associated with professional practices (Barros, 2004). The social dimension began to be incorporated into professional discourse, mainly in the context of the struggle to ensure and expand social rights, the Sanitary Reform and Psychiatric Reform movements, and the rights of children and adolescents (Almeida et al., 2012; Soares, 1991).

Amid this reality, which would soon be followed by the re-democratization process in Brazil, in 1982-83, the second minimum curriculum of occupational therapy was instituted³ , guided mainly by the need to provide technical, social, and political education, and a critical role of occupational therapists in line with the real health problems of the Brazilian population (Lopes, 1990; Palhares, 1991).

At UFMG, the first class of occupational therapists graduated in 1982, when the faculty had no accumulated teaching experience and there was no consolidated analysis of professional practices. Even so, in 1985, only six years after the creation of the course, UFMG took on the task of reformulating its curriculum to adapt it to the new minimum curriculum in force at the time (Drummond, 1999; Palhares, 1991; Universidade Federal de Minas Gerais, 2008).

The UFMG curriculum, implemented in 1985, included the discipline occupational therapy applied to social conditions and its respective internship fields (Drummond, 1999). In 1989, a public contest was held to hire a teacher to work in this area. The term “applied”, to describe this new “area”, reproduced the perspective of other disciplines marked by the perspective of disease, announcing the risk of pathologizing the social field. Within the scope of intervention, the circulation of occupational therapists in institutionalized segregation and marginalization spaces, such as prisons, the State Foundation for the Well-being of Minors (FEBEMs), and nursing homes, highlighted problems arising from serious social inequalities in the country. However, at UFMG, as well as at other institutions in Brazil, given the fragility of the action proposals taken from a disciplinary, clinical, and interventionist health framework and, above all, the lack of apprehension of theoretical scopes to enhance the production of knowledge and practices, at the time, the course chose not to invest in practices in the social field and reduced the number of class hours of the only discipline. Thus, the professor who had been hired in 1989 to work in the social field ended up migrating to another area of occupational therapy.

In the 1990s, the only discipline in the social field remained isolated in the education of occupational therapists at UFMG despite the consistent discussions about the processes of social exclusion/inclusion of socially vulnerable people and the choice of theoretical frameworks from a historical materialism perspective. At that time, there was no collective discussion in the course to sustain the cohesion of a field of knowledge that could overcome the hegemony of the functionalist biomedical model. The history of occupational therapy at UFMG clearly portrays the dynamic of the institutional environment and of relationships that did not provide for the upsurge of the area.

In the late 1990s, the course began another process of curricular reform brought about, among many aspects, by the need to invest in changing the biomedical model, which culminated in the proposition of specific occupational therapy contents in the social field. This process, which was also pervaded by the necessity to adapt to the DCNs of the undergraduate occupational therapy course approved in 2002, resulted in the new pedagogical project of 2008 and, consequently, in the replacement of the previous compulsory discipline by others that addressed the theoretical contents of the social field (Table 1) (Universidade Federal de Minas Gerais, 2008).

Table 1
Disciplines related to the social field.

Discipline	Semester	Type	Number of hours
Cultural anthropology*	1st	Theoretical, compulsory, correlated to social occupational therapy	60
Sociology*	1st		60
Social inclusion processes**	2nd		30
Interventions in occupational therapy II**	5th	Theoretical, compulsory, specific to social occupational therapy	60
Clinical practice in occupational therapy II**	5th	Practical, compulsory (1 or 2 classes specific to the social area, with six vacancies for each class each semester)	45
Child and adolescent occupational therapy clinic **	7th	Compulsory curricular internship (2 to 6 specific vacancies in the social area each semester)	390
Occupational therapy: young people and social vulnerability**	Variable	Elective	30
Social Occupational Therapy**			30
Total number of course hours = 3,210
Compulsory number of hours of social occupational therapy = 60
Elective number of hours of social occupational therapy (practices and internship) = 435 (45+390)
Elective number of hours of social occupational therapy = 60

• ^*
  Offered by the College of Philosophy and Human Sciences (UFMG). **Offered by the Department of Occupational Therapy (UFMG).

Thus, in 2009, the new curriculum began at UFMG, and, in 2011, a specific public contest was opened for the social field, and an occupational therapist with a postgraduate degree in the area of social sciences was hired, demonstrating the investment of the course to develop this sub-area. Formally, it was the second public contest for the area, considering that the first had occurred in the late 1980s. An important difference from that relatively late moment, when investment in the social area was resumed, refers to the accumulation of knowledge production in this field in Brazil, which favored the internal support of the area even considering that education in the UFMG course was clearly referenced by American and Canadian models of performance and functionality (Barros et al., 1999; Barros, 2004; Barros et al., 2007; Reis, 2008; Universidade Federal de Minas Gerais, 2008). In 2015, occupational therapy in the social field was strengthened with the admission of another professor with recent postdoctoral education in social occupational therapy at the Department of Occupational Therapy at UFSCar.

Thus, since 2012, the UFMG occupational therapy graduation has contemplated themes related to the social field in compulsory and elective disciplines, both theoretical and practical, revealing its constitution and expansion. Therefore, even with a reduced number of teachers, the configuration of this area⁴ , currently known as social occupational therapy, has ceased to be an isolated investment and has become a process of combining the contents and practices that underlie it. Although the social content is foreseen in the pedagogical project to be developed in the 5th semester, themes related to the social field have been developed combined with the disciplines offered in the 1st and 2nd semesters; regarding compulsory practices and internships, it has been possible to offer experience in the social field to some students in disciplines of the 5th and 7th semesters (Table 1).

The theoretical support of social occupational therapy education at UFMG has occurred, since the first semesters, from the compulsory disciplines that bring the interdisciplinary perspective of the social field linked to the compulsory discipline of the 5th semester, which has a specific number of hours on social occupational therapy. Additionally, the two elective disciplines, systematically offered, increase the number of hours dedicated to this education. The disciplines seek to combine structural social dimensions (from the concepts of class, State, public policy, social inequality, social justice, gender, race, and citizenship) with micro-social perspectives (portrayed in the concepts of social cohesion, socialization, social capital, belonging, territory, everyday life, social bonds, among others). The aim is to understand, from these theoretical frameworks, the multidimensionality of social phenomena intertwined in the practical everyday experiences of poor and socially vulnerable populations. Corroborating Luz (2008), instead of searching for totalizing models or theories, it is essential to build social occupational therapy corpus from an interdisciplinary perspective based on different disciplinary or pluridisciplinary fields, especially those of the social sciences and humanities. Social occupational therapy must be understood not only through the multidimensionality of its object of study, but above all through the dynamism of social transformations, and this demands a certain multidisciplinarity and ventilation of knowledge and practices in which science and life cannot be separated in the construction of their explanations (Barros et al., 1999; Barros, 2004; Barros et al., 2007; Costa, 2016; Galheigo, 2016; Malfitano et al., 2014; Malfitano, 2016).

Regarding the practical disciplines, in 2012, negotiations with the Secretary for Social Development of the State of Minas Gerais (SUASE-MG) were initiated to enable teaching practices in juvenile detention centers (called Socio-educational Units in Brazil) where socio-educational measures were carried out under the regime of deprivation of liberty (Closed and/or Semi-closed Environments), which culminated in the formalization of a partnership with this public body in 2013. Thus, over the past ten years, students of the practical discipline of the 5th semester and in the internships of the 6th semester have been inserted in Socio-educational Units, where occupational therapists play the role of preceptors. In 2018, a new partnership was established with the Secretary for Social Assistance aiming to expand the practical fields of social occupational therapy teaching at SUAS with action at a Reference Center for Social Assistance (CRAS) where teachers play the role of preceptors because of the absence of occupational therapists in this center. It is worth highlighting the importance of these partnerships, which have expanded formal job openings for occupational therapists in the state of Minas Gerais, mainly in socio-educational services, for which more than 20 newly graduated students have been hired since then.

Furthermore, if these agreements with state and municipal departments, on the one hand, have generated recognition and legitimacy of social occupational therapy actions with the population assisted by these policies; on the other hand, they have revealed several challenges to be faced to strengthen this area. In the case of the socio-educational system, although the context of action is the public security policy for young offenders, which refers to discussions on eminently social issues related to the offense, young people, and social inequalities, according to a guiding document of the functions of the professionals in the units managed by SUASE-MG, the focus of professional action is on occupational performance and development of occupational skills - terms used by the American Occupational Therapy Association (AOTA)⁵ (Minas Gerais, 2012; Universidade Federal de Minas Gerais, 2008). This reflects gaps in the education of occupational therapists who joined the socio-educational system in the state of Minas Gerais in the first decade of the 2000s. These professionals probably did not have a technical-methodological framework in the social field, which explains the use of other references, such as psychosocial rehabilitation, mental health, and AOTA, in their practice. Continuing education—formal or informal—carried out through personal initiatives or in the services, also led to the construction of the role of occupational therapists in this policy. This situation began to change, partially, with the development of social occupational therapy at UFMG and the entry of newly graduated students into the socio-educational system.

Another challenge faced refers to the fragility of the inclusion of occupational therapists at SUAS in Belo Horizonte, which has occurred in special protection services, with an emphasis on people with disabilities and older people (Pêgo, 2021), that is, although these professionals are inserted in the context of the social assistance policy, their practices have been required from health demands.

Thus, in a context of limits but also of possibilities, based on the frameworks of the humanities and social sciences, theoretical discussions were leveraged to substantiate the practices of social occupational therapy at UFMG, in a reading contrary to the understanding of the object of the profession as exclusively centered on the individual, functionality, and occupations. The apprehension of the sociological and anthropological reading to understand the impact of social inequalities and discrimination in the everyday life of subjects, supported by a relational and structural view, provided advances in the production of knowledge and practices that have been added to the corpus of this subarea at UFMG. This scenario shows that, despite the advances from 2012 with the curriculum reform and the insertion of teachers in this area, the space of education is still incipient compared with the total number of hours in the course. However, this situation does not differ from that of most occupational therapy courses in Brazil (Pan, 2014), or even from that of courses in the state of São Paulo, which reveal challenges to expand the field and professional education in social occupational therapy (Pan & Lopes, 2014). The contents provided in the curricula of undergraduate courses are still unrepresentative regarding the number of hours for social occupational therapy education (Pan & Lopes, 2014; Macedo et al., 2018), a situation that is expected to change after the final approval of the new occupational therapy DCNs (Brasil, 2020).

In the UFMG course, a strategy to increase the volume of compulsory content addressing this specific area has been the provision of complementary education spaces linked to university extension projects. A similar movement has characterized strategies to expand the social field in other Brazilian universities, as demonstrated byMacedo et al. (2018), Lopes (2016), and Pan (2014).

Combining Extension and Research Actions at UFMG

One of the powerful strategies used to expand social occupational therapy in the occupational therapy course at UFMG has been the development of extension activities, especially those associated with social policies of socio-educational measures and social assistance. Currently, there are two projects linked to an “Extension in social occupational therapy education” program at UFMG: one started in 2018 in the socio-educational system that follows up young people in Socio-educational Units and another started in 2019 at CRAS that follows up socially vulnerable young people. Several students—grant holders and volunteers—have participated in both projects. Considering the particularities of these young people, the actions have been directed toward everyday activities based on the concepts of youth, social protagonism, citizenship, law, and justice. One of the focuses of this extension education program is the qualification of occupational therapy education to assist populations with needs and demands resulting from social problems through educational meetings jointly directed to extension students and occupational therapists.

As of the second decade of the 2000s, there has been a greater investment in social occupational therapy research at UFMG mobilized by undergraduate research projects, capstone projects, and, more recently, postgraduate projects. With the opening, in 2019, of the Master’s Degree Course in Occupation Studies (CPGEO) - a stricto sensu program of the Department of Occupational Therapy at UFMG that includes the line of research “Occupation, public policies, and social inclusion”, research in this area is expected to enhance. The ascending movement of construction of this field—combining teaching, research, and extension and seeking associations with other courses in Brazil and the world—can be verified by the partnership of the CPGEO in the IV Social Occupational Therapy International Symposium held at UFMG (Escola de Educação Física, Fisioterapia e Terapia Ocupacional, 2020). Moreover, research has been enhanced by the increased interest of undergraduate and master’s degree students in themes related to social occupational therapy, such as studies addressing socially vulnerable populations, the socio-educational system, ethnic and racial aspects in the everyday life of low-income black women, etc. Within the scope of activities at the CPGEO, there has been a growing need to combine with other theoretical perspectives related to the study of occupations, such as occupational justice and related concepts and other critical perspectives (Townsend & Wilcock, 2004; Gerlach et al., 2018). Despite these research initiatives, there is still much to be done to consolidate a space for knowledge production that can effectively contribute to the theoretical support of this field.

Final Remarks

Social occupational therapy has gradually been consolidated at UFMG, legitimizing the space of occupational therapy education in a historical process that does not occur linearly. The teaching activities—experienced in the compulsory, correlated, and elective disciplines, together with the possibility of practices in the socio-educational system and CRAS, research in the undergraduate course and the CPGEO, thus achieving the triple objective of the university by combining the teaching, research, and extension activities—have been an assertive commitment toward advancing education in the area. Along the way, it has become evident that one of the strengths of this expansion lies in the combination of these dimensions with public policies and practices in services, as it has occurred in other higher education institutions. In addition, considering the current goals of including extension in the curriculum of undergraduate courses (Brasil, 2018), the ongoing university extension projects will constitute another space for education within the compulsory number of hours of these courses .

The option of associating with public authorities to open combined spaces for education has enabled practical learning and provided social occupational therapy with greater visibility. Considering the current political and economic context, there are several specific challenges to the consolidation of this field that involve disputes and conflicts both in the scenarios of practices to insert professionals in social policies and the dynamic of the scientific field, singularized in internal disputes in occupational therapy.

Finally, the increase in the theoretical-practical foundation in education has gradually formed a profile of professionals who work in social occupational therapy, designing it as a core of knowledge and singularities, showing paths that can be followed to sustain their knowledge and practices. Amid ruptures and discontinuities, the subarea of social occupational therapy has been notoriously strengthened at UFMG from the perspective of university teaching, research, and extension, mainly with the admission of teachers specifically for this area.

• 1
  The Metuia Project was created in 1998 by occupational therapy teachers at USP, UFSCar, and PUC-Campinas. Currently, the Metuia Network is composed of five centers: USP, UFSCar, UNIFESP, UFES, UnB, and UFPA/UNCISAL (Laboratório Metuia, 2020).
• 2
  The proposal of the Occupational Therapy DCNs approved by the National Health Council in 2020, which is being processed by the Ministry of Education (MEC), defined that the profession can act in the fields of health, education, social assistance, social security, sports, leisure, justice, work, culture, and environment (Reneto, 2020).
• 3
  This new curriculum emerged from the proposal—presented by UFMG course coordinators—approved at the meeting of physical therapy and occupational therapy course coordinators held in São Paulo in 1983 (Lopes, 1990).
• 4
  In this article, the terms “field” and “area” are mentioned to portray different historical moments in the epistemological trajectory of social occupational therapy. The term social field appears at the moment of emergence of the debate on social issues as phenomena that should be embraced by the profession, even if a previously constituted methodological theoretical framework that delimited a specific area of knowledge was not yet available; whereas the term area or subarea of social occupational therapy is used when an epistemological maturation, which advances in the delimitation of the object of study and in the methodological procedures recognized and shared by peers, is verified. There is also a taxonomic approach of the terms “social field” and “social occupational therapy” to the definitions of areas of knowledge and fields of knowledge that govern the guidelines and regulations of higher education institutions (CAPES).
• 5
  The AOTA document is not proposed as a theoretical occupational therapy model, although it is used as such by Brazilian occupational therapists (Cruz, 2018).
• How to cite: Costa, L. A., Souza, R. G. M., & Drummond, A. F. (2023). The path of social occupational therapy in a Higher Education institution: trajectory in teaching, research, and extension. Cadernos Brasileiros de Terapia Ocupacional, 31(spe), e3371. https://doi.org/10.1590/2526-8910.ctoRE258033712

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Edited by

Guest Editor

Prof. Dr. Marina Leandrini de Oliveira

Publication Dates

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

History

• Received
  13 July 2022
• Reviewed
  02 Aug 2022
• Reviewed
  03 Jan 2023
• Accepted
  07 Mar 2023