Occupational therapy and adolescent offenders: mapping of productions

Abstract

Introduction

Occupational therapists are professionals who can develop actions aimed at adolescents who have committed infractions; however, this practice is still little known.

Objective

To identify the production in scientific literature, specifically in articles from indexed journals, about occupational therapy and actions with adolescent offenders.

Method

Scope review of the literature, searching in six different databases, as well as directories in four Brazilian occupational therapy journals, using terms related to the profession and related to the theme. After applying the inclusion and exclusion criteria, 13 articles specified relationships between occupational therapy and practices with adolescents who committed infractions.

Results

Three themes emerged for discussion: 1. The different occupational therapies in time and space; 2. Framework and intervention models; 3. Occupational therapy as a health clinic professional or social action. The practice of the occupational therapist in this context is still not widespread, as it uses different reference frameworks and intervention models, mostly under principles used in healthcare, although there are also reports of professional action focused on the macro-social context that involves teenagers.

Conclusion

It is understood that a greater diffusion of reflections and professional practices in this context of practice would contribute significantly to a continuous rethinking about the specificity of the occupational therapist in this area, also strengthening the recognition of the profession as a constituent and a contributor to the area of juvenile justice.

Keywords:
Social Occupational Therapy; Justice Administration System; Professional Practice; Scientific and Technical Publications

Resumo

Introdução

Os terapeutas ocupacionais são profissionais que podem desenvolver ações direcionadas aos adolescentes autores de ato infracional, contudo, esta prática ainda é pouco debatida.

Objetivo

Identificar a produção da literatura científica, especificamente em artigos de periódicos indexados, acerca da terapia ocupacional e ações com adolescentes autores de ato infracional.

Método

Revisão de escopo da literatura, com busca em seis diferentes bases de dados, além de diretórios em quatro revistas brasileiras de terapia ocupacional, utilizando termos referentes à profissão e correlatos à temática. Após aplicação dos critérios de inclusão e exclusão, resultaram 13 artigos que especificavam relações entre a terapia ocupacional e práticas com adolescentes autores de ato infracional.

Resultados

Foram elencadas três temáticas para discussão: 1. As diferentes terapias ocupacionais no tempo e espaço; 2. Marcos de referência e modelos de intervenção; 3. Terapia ocupacional como clínica da saúde ou como ação social. A prática do terapeuta ocupacional neste contexto ainda é pouco difundida, sendo que se utiliza de diferentes marcos de referência e modelos de intervenção, majoritariamente sob princípios utilizados na atenção à saúde, apesar de também haver relatos da ação profissional voltada ao contexto macrossocial que envolve os adolescentes.

Conclusão

Compreende-se que uma maior difusão das reflexões e práticas profissionais junto a adolescentes no sistema de socioeducação contribuiria significativamente para um repensar contínuo acerca da especificidade do terapeuta ocupacional nesta área, fortalecendo também o seu reconhecimento como profissional constituinte e contribuinte para a área da justiça juvenil.

Palavras-chave:
Terapia Ocupacional Social; Sistema de Justiça; Prática Profissional; Publicações Científicas e Técnicas

Introduction

Occupational therapy has developed experiences in different areas with a focus on everyday activities seeking the emancipation and autonomy of individuals so that they can perform the activities they want, and those they need to do, regardless of the context or problems. It is a field of knowledge and intervention in the education, health and social spheres, being able to direct its actions to different population groups (Conselho Regional de Fisioterapia e Terapia Ocupacional da 3ª Região, 2020;Faculdade de Medicina de Ribeirão Preto, 2020). Juvenile justice is one of the occupational therapists' areas of activity, governed by specific legislation in each country.

From the point of view of international consensus, the United Nations (UN) discusses adolescents who commit criminal acts, and its documents guide the laws and regulations of co-signatory countries. The first UN document specifically dealing with care for adolescents linked to the juvenile justice system dates back to 1985, called “Minimum Rules for the Administration of Children's and Youth Justice”, also known as the Beijing Rules (Hamilton, 2011; Zanella & Lara, 2015)¹.

Brazil, as a member of the UN, follows such international regulations. Nationally, care for the adolescent population that commits an infraction is regulated through the 1990 Child and Adolescent Statute (ECA) and the 2012 National Social and Educational Service System (SINASE) (Brasil, 1990, 2012). Interventions aimed at these adolescents are called socio-educational measures and are aimed at disapproving of the offending conduct, holding the adolescent accountable for the consequences of the act committed and the adolescent's social integration, with the guarantee of individual and social rights (Brasil, 2012).

To achieve the socio-educational system, which regulates the execution of socio-educational measures, Brazilian legislation (Brasil, 2012) establishes that the composition of program teams must be interdisciplinary, and must contain professionals from the areas of health, education, and social assistance. Even though the occupational therapist can be inserted in this context, the presence of this professional is still not widespread (Kobi et al., 2020), with little theoretical-methodological delimitation on the specifics of professional performance in the execution of socio-educational measures and juvenile justice practices (Lederer et al., 1985; Morais & Malfitano, 2016; Muñoz & Goycolea, 2015; Shea & Siu, 2016).

Aiming at discussing the role of occupational therapists in the socio-educational system, this bibliographical research was dedicated to mapping what has been produced, considering indexed articles about occupational therapy and attention to adolescents who have committed offenses in Brazil and abroad.

Methodology

As a way to raise data related to occupational therapy and its role in juvenile justice in Brazil and abroad, we decided to carry out a scope review research, whose main objective is to map the main concepts related to an area of specific research, considering the main sources and types of evidence available (Arksey & O’Malley, 2005). Thus, initially, we established the research question: “What has been produced, considering the scientific literature, specifically in articles from indexed journals, about occupational therapy and actions with adolescents who commit criminal acts, in Brazil and abroad?”.

To identify relevant studies, we chose the databases Scopus, Web of Science, Eric, Eric Pro-Quest, Lilacs, and SciELO. This choice was based on multidisciplinary scientific platforms that cover productions in the areas of health sciences, social sciences, education, and humanities, nationally and internationally. Direct searches were also carried out in the archives of Brazilian journals: Revista de Terapia Ocupacional da Universidade de São Paulo, Revista do Centro de Especialidades em Terapia Ocupacional, Revista Interinstitucional Brasileira de Terapia Ocupacional and Cadernos Brasileiros de Terapia Ocupacional, regardless of having indexation in the listed databases or considering their relatively recent link to some of the databases, since such journals are relevant in the dissemination of information about Brazilian practices in occupational therapy. The search was carried out between December 1^st and December 9^th, 2019.

In Brazil, the term used to care for adolescents who commit an offense is “socioeducação” or “atendimento socioeducativo”. This terminology is not uniform internationally, and such term does not have a compatible translation and meaning for other languages. After identifying this initial difficulty, terms related to the theme were delimited, using the search for open truncation. The descriptors were then combined: carcer*, crim*, “correctional facilit*”, “correctional unit*”, delinquen*, detent*, incarcerat*, infraction*, “juvenile justice”, ofender, outllaw, prison*, socialeducat* socioeducat*, “social educat*” e “socio educat*”². We opted for the use of descriptors in English since the databases and the journals consulted individually contain records in the mother tongue of the article as well as in English.

As articles that were specific to the intervention of occupational therapists were searched, we used the Boolean logical search operator “and”, relating the descriptor “occupational therap*” to the other groups of words. The search for descriptors was limited to the fields of “article title”, “abstract” and “keywords”. To manage the localized references, the Endnote®online software was used; for researches that did not allow the direct import to the aforementioned database, a table in Microsoft Excel® was used to store the information and later manually include it in the software. To control the information, we also created a table with information about the search bases and searched terms, indicating the number of documents identified in each base consulted.

In the initial survey, we found 513 records, and we excluded duplicate references, leaving 305. For the selection of texts, we established inclusion and exclusion criteria. As an exclusion criterion, the temporal delimitation was defined, followed by the correspondence of the documents to the studied theme and by the availability of access to the study.

We opted for the exclusion of documents before 1985, as this was the year in which the UN published its first regulation specifically related to juvenile justice, offering international bases for local policies to care for adolescents in situations of the infraction. Therefore, we eliminated 62 articles published before 1985, leaving n=243.

Considering that not all selected articles alluded to the theme of adolescents who committed an infraction, an analysis was carried out by reading the titles, abstracts, and keywords of the publications. At this stage, we eliminated 223 articles that were not directly related to the studied public, dealing with different themes, such as: adult or non-specific prison population, mental health and/or forensic psychiatry, other assisted populations, among other topics. In case of doubt, the article was kept for analysis in the next stage of the research, resulting in n=20.

After a complete reading of the remaining 20 articles, studies that only mentioned the occupational therapist as a team member were disregarded (3), not directing the research to this professional category. Four other references were also excluded: two because they were not found after an attentive search and two because they were abstracts and not complete documents. We obtained 13 articles for a full reading. Figure 1 shows the flow of literature search and article selection.

Figure 1
Flow of search and selection of articles. Source: Own elaboration.

Description of the Articles

After the final selection of the articles, a matrix was created, with data on the authorship of the texts, title, place, and year of publication, to organize the information so that they were easily accessible, as shown in Table 1.

Table 1
Table of documents selected for analysis.

Author(s)	Title	Place of publication	Year
Lederer, J. M., Kielhofner, G., & Watts, J. H.	Values, Personal Causation and Skills Of Delinquents and Nondelinquents	Occupational Therapy in Mental Health	1985
Hardison, J., & Llorens, L. A.	Structured Craft Group Activities for Adolescent Delinquent Girls	Occupational Therapy in Mental Health	1988
Deforest, D., Watts, J. H., & Madigan, M. J.	Resonation in the model of human occupation: A Pilot Study	Occupational Therapy in Mental Health	1991
Farnworth, L.	Time use and leisure occupations of young offenders	American Journal of Occupational Therapy	2000
Almeida, M. M. D.	Working with newspaper and video: a setting ofexpression to youngsters law offenders	Revista de Terapia Ocupacional da Universidade de São Paulo	2004
Santos, D. R. Dos., & Fedeger, A. M.	The occupational therapist in the process of re-socialization of youth offenders deprived of freedom: transformation through occupation	Revista de Terapia Ocupacional da Universidade de São Paulo	2008
Cifuentes, R., Molina, P., Moya, P., & Palacios, M.	The house of dreams: occupation, transgressive activityand identity construction	Revista Chilena de Terapia Ocupacional	2014
Poblete, M. J.	Identificacion offender teenagers: a proposed occupational intervention	Revista Chilena de Terapia Ocupacional	2014
Muñoz, E. I., & Goycolea, M. R.	Challenges of occupational therapy in the social inclusion of young offenders in closed centers in Chile	Revista Chilena de Terapia Ocupacional	2015
Goncalves, M. V.	“I didn’t know I could get in here”: cultural citizenship promotion as identity meaning experience of outlaw youth	Cadernos de Terapia Ocupacional da UFSCar1	2016
Morais, A. C. D., & Malfitano, A. P. S.	Occupational Therapist as socioeducational measures executor in open environment: speechs to practice construction	Cadernos de Terapia Ocupacional da UFSCar	2016
Shea, C. K., & Siu, A. M. H.	Engagement in Play Activities as a Means for Youth in Detention to Acquire Life Skills	Occupational Therapy International	2016
George-Paschal, L., & Bowen, M. R.	Outcomes of a Mentoring Program Based on Occupational Adaptation for Participants in a Juvenile Drug Court Program	Occupational Therapy in Mental Health	2019

• ¹
  This journal was renamed “Cadernos Brasileiros de Terapia Ocupacional” in 2017. However, for this article, we chose to identify the name of the journal according to the publication date of the studied documents, for correspondence similar to those references.
• Source: Own elaboration.

The articles were published in seven different journals: Occupational Therapy in Mental Health (4), Revista Chilena de Terapia Ocupacional (3), Cadernos de Terapia Ocupacional da UFSCar (today is Cadernos Brasileiros de Terapia Ocupacional) (2), Revista de Terapia Ocupacional da Universidade de São Paulo (2), American Journal of Occupational Therapy (1), Occupational Therapy International (1).

The publications were carried out in English (6), Portuguese (4), and Spanish (3). Twenty-six authors were identified, and the publications were divided into single authorship (4), double authorship (6), and three or more authors (3). All documents had occupational therapists as authors. Regarding the temporal distribution of articles, there was a quantitative growth of publications, with only three until the 2000s and ten from that year until 2019.

Considering the research design, we observed that 11 studies were descriptive, four had explanatory characteristics and four were exploratory. Some articles presented more than one characteristic, which justifies a total number higher than the number of articles analyzed. According to Gil (2008), descriptive research has as its primary objective the description of characteristics of a population and/or the establishment of relationships between variables, using mostly standardized data collection techniques. If they present explanatory characteristics, the research seeks to identify determining factors for the occurrence of phenomena, trying to explain the “why” of things. Exploratory researches, on the other hand, aim to present an overview of the subject studied and is commonly used when there is little widespread knowledge about the researched topic.

Considering the target population, the selected studies presented actions aimed at children³ and adolescents (10) and professionals (2), in addition to a literature review. The identified practices were referenced to the realities of the United States (5), Brazil (3), Chile (3), and Australia (1), and they referenced experiences in an institution of closed regime and/or confinement (7), followed by related research to practices in an open environment and/or parole (4). One of the texts was exclusive to actions related to the juvenile drug court, and such experience, being specific, was identified separately.

The articles used 41 keywords, of which three were used in more than one article: Occupational therapy (6), Rehabilitation (2), and Juvenile delinquency (2). The keyword adolescent behavior was also found (Farnworth, 2000), highlighting adolescent behavior; in another study, the social vulnerability was the focus (Santos & Fedeger, 2008). An apparent dichotomy can be observed when considering the keywords social inclusion and social isolation (social inclusion and social isolation) (Almeida, 2004; Muñoz & Goycolea, 2015), which present opposite focuses of the same studied reality.

The search for the correlation of the theme with occupational therapy is notorious with the use of the descriptors Occupational Therapy and Forensic Occupational Therapy (Shea & Siu, 2016), which may occur in response to the evident need for dissemination of productions in the area. As for professional actions, the description of the application of standardized tests and assessments was found in articles referring to 1985 to 1999. The use of interviews and questionnaires was also frequent in research articles. Practices were presented, highlighting the workshops and groups of activities carried out, with handicrafts being the most explored. Such documents expressed a view directed to individuals, focusing on personal characteristics, acquisition, and skills, and focused on the effects of activities performed in institutions (DeForest et al., 1991; Hardison & Llorens, 1988; Shea & Siu, 2016).

Other articles were aimed at understanding different factors that may interfere and corroborate the occurrence of the social phenomenon, such as the understanding of the use of time by adolescents (Farnworth, 2000), the recognition of how this public means the social contexts in which they lived as conductors of their identity (Cifuentes et al., 2014), the use of a mentoring program (George-Paschal & Bowen, 2019)and art and culture as an instrument in promoting citizenship and social inclusion (Almeida, 2004; Gonçalves, 2016)and some remained focused on getting to know professionals and their practices (Morais & Malfitano, 2016; Muñoz & Goycolea, 2015).

Discussion

Based on the reading and analysis of the articles, three themes were listed for discussion: 1. The different occupational therapies in time and space; 2. Framework and intervention models; 3. Occupational therapy as a health clinic professional or social action.

The different occupational therapies in time and space

We carried out an analysis regarding the geographic location of the publications, relating them also to the reflection on the different occupational therapies in the world. Of the 13 articles found, six in English were about practices and studies in the United States and Australia, and seven are South American publications, disseminated in Portuguese and Spanish, reporting practices and reflections considering the Brazilian and Chilean realities.

Historically, the arrival of occupational therapy in South American countries was loaded with knowledge and worldviews from other nations, such as England, France, and the United States, reproducing knowledge about occupation as a means of treatment (Díaz-Leiva, 2018). Initially, the use of the European and North American referential did not consider the historical, local, and regional contexts for thinking about professional practice, and

[…] the dominant and colonial occupational therapist would reproduce some of the typical characteristics of western Euro/ethnocentric culture [...] above all, the pretension of universalizing its rationality in different socio-cultural contexts (Núñez, 2019, p. 676).

However, over time and through professional immersion in multiple practices and local realities, the questioning of the model used as the basis for the profession emerged, initiating the understanding of a new way of thinking about occupational therapy as a field of knowledge (Díaz-Leiva, 2018; Núñez, 2019).

The historical social context experienced in Latin American countries was essential for the redefinition of the work of the occupational therapist, calling into question the centralization of medical knowledge and the ahistorical disciplinary method used until then and directing the focus to practices related to guarantee and full exercise of population rights, outlining the profession's ethical and political commitment. Bezerra & Trindade (2013) identify that, in Brazil, occupational therapy experiences a process of “professional reconfiguration”, incorporating new attributions and appropriating new areas of professional activity, resulting from local social transformations.

Considering, then, the heterogeneous practices and the plural conception of the profession, occupational therapies are admitted, related to the specificities of the historical contexts of different countries and populations. In particular, there is also talk of occupational therapies in the south, where the south is not limited to a geographic location, but rather represents the hegemonic setback and all the existing diversity. For Díaz-Leiva (2018), the recognition of occupational therapies in the south is a reflection of a

[…] process that finally challenges us to think in the plural, in the diverse, in the alternative to the project of modernity and absolute truths, to original and orthodox knowledge (Díaz-Leiva, 2018, p. 29, free translation).

The historical-contextual characteristics were essential to promote this paradigm shift, also influencing the productions about professional practice. The end of the dictatorships experienced in South American countries promoted the possibility of fighting for civil, political, social, and economic rights. Motivated to respond to the demands presented by reality, adapting to the molds of the social and political institutions of each period, the professional performance began to incorporate new actions. Individuals, groups, and communities become the focus of occupational therapy actions, as well as social assistance and the socio-juridical field (Bezerra & Trindade, 2013; Galheigo, 2016).

Although there is recognition of the influence of social and institutional environments on “occupational” involvement, as it is said in Anglo-Saxon language, by some dominant theoretical models, Hammell (2020) points out, in a critique of the productions of the northern hemisphere, that it still there is little focus on addressing social determinants, as well as on practices aimed at guaranteeing conditions in which there is full and fair freedom of access for individuals to opportunities to satisfy their needs, called by the author as “occupational equity”.

In the analyzed South American articles, it is identifiable the description of practices rooted in local realities, which corroborate the diffusion of the idea of occupational therapies in the South. It is also possible to recognize the understanding of actions as collective acts of individuals, as one of the characteristics of occupational therapies in the south (Núñez, 2019). When decontextualized, they have no meaning, but when placed in a context, they are instruments for overcoming oppression, and the understanding of social reality and, consequently, the possibilities of transformation, are only possible through the understanding of social practices, that permeate everyday life (Galheigo, 2016).

Maybe, due to these characteristics of thinking about occupational therapy, the South American registries present this characteristic differently from the others found. Furthermore, the documents that reference this social perspective of occupational therapy were produced from 2004 onwards, through a first Brazilian publication, which represents a very up-to-date reflection.

Framework and intervention models

The professional practices aimed at adolescents who commit criminal acts identified in the articles are contextualized by different political-geographic-temporal spaces, as well as by the references and intervention models adopted by professionals according to the historical-social development of the profession in each location.

Considering that each country establishes its juvenile justice system, the regulations that guide the actions of professionals are different. In Brazil, the policy aimed at adolescents who committed an infraction is called socio-education and is described in the Statute of Children and Adolescents (ECA) (Brasil, 1990) and the National Social and Educational Service System (SINASE) (Brasil, 2012). These laws are based on the understanding of adolescents as subjects of rights, resulting from collective struggles aimed at building social and political rights, struggles in which part of occupational therapists was and remains directly intertwined (Barros et al., 2002; Bezerra & Trindade, 2013; Galheigo, 1997, 2016). The processes that show either advances in the conquest of rights or ruptures, as in the case of policy for adolescents, can also be observed in other Latin American countries, marked by local military dictatorships and, from the 1980s onwards, by neoliberal policy (Silva et al., 2019).

According to Brazilian law, an adolescent is considered to be that aged between 12 and 18 years old, and when the commission of offenses similar to crimes or criminal misdemeanors is identified by this population, socio-educational measures are addressed. The different measures are identified as a warning, obligation to repair the damage, provision of services to the community (PSC), assisted freedom (AF), insertion in a semi-liberty regime, and admission to an educational establishment.

In the United States, another country that had professional practices described in the articles analyzed, criminal proceedings relating to juvenile justice are regulated by the states, with no national standard or rule (Churgin, 2008). The juvenile justice process, although similar to the adult criminal process, has as its main objectives the maintenance of public safety and the development of adolescents' skills, meeting the needs of community reintegration. The sanctions foreseen range from community supervision to measures in which the adolescent remains daily with their private freedom, carried out in juvenile detention centers, shelters, correctional facilities, or reform schools (Office of Justice Programs, 2020).

On the other hand, Chile has a system of responsibilities for adolescents between 14 and 18 years old who violate criminal law. Considering adolescents as subjects of rights, the legislation aims at full protection, guaranteeing access to social reintegration processes together with the promotion of responsibility for the practices committed. Sanctions applied to adolescents can be custodial, executed in a closed and semi-closed regime, non-custodial, and also complementary sanctions, such as treatment for drug use and suspension of the right to drive. Deprivation of liberty sanctions can last up to 10 years, depending on the offense committed (Chile, 2005).

Australian law is also different in each state and territory. In most states, the juvenile justice system directs its actions to the population between 10 and 17 years old. However, depending on the situation and location of the offense, the applicable legislation may refer to the adult court. Among the sanctions, there are fines to restrictions orders, which can reach detention, applied to the most serious cases (Austrália, 2020).

Understanding the differences in each country, the practices described in the articles correspond to different times, as the first publication analyzed dates from 1985 and the last from 2019. In this period of 34 years, the understanding of adolescence and youth and on the infraction practice, suffered different influences, highlighting the neoliberal organization that is reflected in the structuring of different state organizations (Bezerra & Trindade, 2013; Frota, 2007), and the development of occupational therapy in each location, which was dynamically changing.

Politically, both local cultures and international agreements interfere in legislation and practices aimed at the adolescent population. In the identified period, four UN regulations were promulgated that aimed to guide practices for adolescents deprived of liberty, proposing alternatives to incarceration and emphasizing social reinsertion as a priority objective (Zanella & Lara, 2015). In the articles, only the United States has not ratified the International Convention on the Rights of Children and Adolescents (Fundo das Nações Unidas para a Infância, 2020), adopted by the UN on November 20, 1989, and which entered into force in 1990.

On the work models adopted by occupational therapists who work in the context of juvenile justice, they reflect the understanding of the concept of human beings, the world, and society that the professional has, indicating the path of investigation and the type of practice to be adopted (Medeiros, 2010). Turpin & Iwama (2011) point out its relevance by explaining the theoretical principles of the profession, promoting a framework for organizing knowledge, and outlining its processes when addressing relevant aspects of practice in occupational therapy.

Different references were identified in the articles, such as the Human Occupation Model (HOM) (DeForest et al., 1991; Lederer et al., 1985) principles related to engagement and occupational justice (Cifuentes et al., 2014; Farnworth, 2000; Muñoz & Goycolea., 2015; Shea & Siu, 2016), occupational adaptation practices (George-Paschal & Bowen, 2019), as well as discussions based on the principles of social occupational therapy and human rights (Gonçalves, 2016; Morais & Malfitano, 2016; Poblete, 2014; Santos & Fedeger, 2008).

The HOM, developed by Gary Kielhofner, considered the most published model in the English language (Kielhofner et al., 2011; Turpin & Iwama, 2011), focuses on the positive adaptation of individuals and engagement in occupations and is used to model the feelings about themselves, thoughts, ways of doing things and clients' abilities (Kielhofner et al., 2011). The HOM has undergone changes since its original publication, in the mid-1980s, with the incorporation of new concepts (Cruz, 2018; Turpin & Iwama, 2011), and it also started to consider issues involving occupational deprivations, that is, occupations that people are unable to perform as a result of social conditions.

The second frame of reference identified in the articles was related to the concepts of engagement and occupational justice. For the authors, Wilcock & Townsend (2011), proponents of the concepts, people are occupational beings and participate individually and collectively in occupations. This contextual relationship is interdependent, in the sense that each individual influences and is influenced by the other and the context. The concept of occupational justice is identified as the recognition and promotion of occupational needs as part of a just and empowering society (Wilcock & Townsend, 2000). This concept may also be related to interventions that aim to address specific characteristics of a problem or situation (both of the subjects and the populations), or, in social and/or collective approaches, when they relate actions to macro-structural conditions, going beyond propositions circumscribed to the individual (Malfitano et al., 2016).

However, Hammell (2020) points out that such concepts, despite recognizing the influence of social and institutional environments, do little to effectively reach the rights she calls occupational, that is, the right of people to participate in significant occupations that contribute to their well-being and their community. For the author, behaviors and actions are not the results of free and autonomous choices, but of social determinants of occupation, which can be identified as the different social, economic, ethnic/racial, and cultural factors that influence how people engage in occupations.

The Occupational Adaptation Theory, conceived by Sally Schultz and Janette Schkade was a third reference identified in the articles. Such theory assumes the individual's adaptation to internal and external demands as a normative process (Turpin & Iwama, 2011) and identifies that the more adaptive they become, the more functional they will be. It then defines success in occupational performance as a direct consequence of personal adaptability, with sufficient domain to satisfy oneself and others (Schultz, 2011). The model considers the person, the occupational environment, and their interaction as conditions that influence each other, directing professional practice to the therapeutic use of the occupation as a means that aims to promote the individual's adaptation to areas and roles that are important to him. It understands occupational performance as a behavioral result and occupational adaptation as an internal generalization process (Turpin & Iwama, 2011). In the same way, as observed in the HOM, the emphasis is on the individual and intrinsic characteristics of the subjects.

Finally, a group of authors was identified that bases the discussions on the principles of social occupational therapy (Barros et al., 2002), based on social inequalities and considering them as substantially expressive when analyzing the criminal involvement of adolescents. Based on this theoretical-methodological foundation, professional practice is rooted in the understanding of complex social exchanges, turning its attention to social groups in processes of disruption of social support networks, evidencing the professional's technical-ethical-political understanding, with a focus on the search for the guarantee of human and social rights to individuals and communities. These authors propose that the references related to the field of health are insufficient and/or inadequate when socioeconomic relations are presented as the core of the issue, and the reading of reality should not end with individual elements, but rather understand that such elements portray social problems. As Malfitano (2016, p. 126) presents, “there is no sense in carrying out works that focus only on decontextualized individuals. Only, and only, in a collective approach to population groups can we speak of social therapeutic-occupational action”. The social becomes the occupational therapist's intervention context, and its action is disconnected from the functionalist perspective of individual adaptation and is directed towards practice as a social articulator (Barros et al., 2002; Galheigo, 2016). Kobi et al. (2020) emphasize that the performance of Brazilian occupational therapists in the context of implementing socio-educational measures aims at the emancipation and autonomy of the subjects, through actions for the protagonism and citizenship of adolescents, principles of social occupational therapy.

Relating the mentioned references and the countries of origin of the articles, it is identified that the HOM and occupational adaptation were present in North American publications, and occupational justice in Chilean and Australian publications. The discussion on the guarantee of human and social rights and the use of the social occupational therapy framework were identified in Brazilian publications.

We found that different frameworks and intervention models were used by occupational therapists, at different times, in the care of adolescents who committed criminal acts. On the one hand, perspectives were observed that strengthen concepts of individual responsibility, emphasizing the search for individual change or adaptation by adolescents. In this sense, the infraction could be related to individual characteristics and intrinsic to the subjects, justifying interventions such as the search for similarities and differences between groups of “delinquent” and “non-delinquent” adolescents, as proposed by Lederer et al. (1985). On the other hand, perspectives were also identified that pointed to the need for an amplified understanding of the sociopolitical situation that permeates the relations of this population. In this context, interventions are no longer aimed at individual adaptation, being directed to the social context, to promote the adolescent's social integration.

This variety found triggers different ways of thinking about the assistance to adolescents in compliance with a socio-educational measure, which may focus on individual, collective and social interventions, according to professional conceptions. However, it is necessary to keep in mind that each model and theoretical-methodological framework is created in a specific historical-social context, corresponding to the needs presented in that scenario, bringing, at its core, premises, and concepts that ultimately support professional practice. Thus, aspects of its conception remain related to the roots, foundations, and values of an era, even though they are not reproduced in the same way they were originally conceived.

The focus of the intervention: Occupational therapy as a health clinic professional or a social action

During the analysis of the articles, two focuses of intervention in occupational therapy were evidenced in the work with adolescents submitted to juvenile justice. The first correlates occupational therapy with a health clinic, carried out within the services and focused on the rehabilitation of adolescents. The concept of rehabilitation of the analyzed texts is related to “becoming able to” and “capable of”, implicitly referring to actions related to individuals, making efforts to enable the promotion or change of individual performance components.

Historically, the attention of occupational therapy was focused on rehabilitative practices. Based on a biomedical paradigm (Camargo Junior, 2005), the definition is used when, in the health clinic, it is related to concepts such as performance, prevention of dysfunction, maintenance and improvement of functional capacity, aiming at maximum capacity to perform the different roles and tasks (Hardison & Llorens, 1988). With the involvement of different components, such as sensorimotor and cognitive, the use of craft activities was considered by some authors (DeForest et al., 1991; Hardison & Llorens, 1988; Lederer et al., 1985; Shea & Siu, 2016) as an ally in improving the adolescents' self-esteem and enthusiasm, promoting “the chance to grow and develop neuropsychologically, in a way that their behavior would be positively affected”, as reported by Hardison & Llorens (1988, p. 114, free translation). Thus, the logic underlying the work was found in the search for correlations between the infraction practice and possible deficits inherent to the individual, which could be suppressed and even overcome through treatment.

The identification of health-related issues that may also be related to the infraction practice is not uncommon, as observed in the article by Hardison & Llorens (1988) when relating the infraction practice with difficulty in the vestibular brain processing; or in articles, such as by Schneider et al. (2017), which correlates offending practice with drug use, in addition to psychiatric comorbidities. In this context, the analysis of variables, similarities, and differences between adolescents who committed an infraction and adolescents who did not commit them, seeks to establish possible patterns, and professionals can then direct interventions focusing on the components that differ, aiming at rehabilitation and fitness of the individual. Fonseca (2010) reflects on this reality, pointing out concerns about associations between the physiological aspects of individuals and the commission of transgressions, considering that such relationships become stigmatizing and based on determinism, in addition to disregarding the social context in which the individual is registered.

How interventions are carried out and the terminologies used by professionals also refer to clinical practices, commonly applied in offices and spaces where the logic of health and disease is imperative. In this way, the proposal of occupational therapy is directed towards the “treatment” of adolescents. The techniques applied to correspond to an individual clinic, such as the use of pre-test, intervention, and post-test, to measure the gains obtained with the action performed (DeForest et al., 1991; Hardison & Llorens, 1988). Likewise, the use of standardized scales and instruments is common, with a focus on obtaining values that can be compared between different populations and studies (Lederer et al., 1985; Farnworth, 2000; Shea & Siu, 2016; George-Paschal & Bowen, 2019). It is identified that most articles that refer to practices such as health clinics report American experiences.

The second intervention focus identified is related to the practice of occupational therapy as social action. The articles written from this perspective are mostly Brazilian productions, and present a historical-critical approach, considering how social relations are produced and reproduced, also having social occupational therapy and its foundations as a theoretical framework. In this context, it is understood that the existing exclusion processes limit the implementation of human and social rights, and these limitations should be considered as primary to guide the work of the occupational therapist with a population that usually has more than its private freedom. For Poblete (2014, p. 46, free translation):

They are not only in a condition of violation of rights throughout their lives, generated by the existing inequality, but they must also resist stigmatization in axes of “deviation or maladjustment”, where they are considered a source of risk or danger, causing a process of exile cultural, economic, social and political.

The understanding of adolescents subjected to juvenile justice practices as subjects of rights, before any other premise, including the act of infraction, is what drives the occupational therapist's actions in this principle. Acting in the context of the juvenile justice system is based on the understanding that acting in institutions transcends immediate apprehension, and that explanations focused on individuals are not sufficient to respond to demands related to the infraction. Thus, the occupational therapist must consider, among others, macro-social factors and data from different realities (Gonçalves, 2016). It should also value the demands of the subjects, emphasizing transdisciplinary actions, through a social approach, permeated by a critical view of reality and with an understanding of the problems of the assisted population. Therefore, the work of the occupational therapist, through activities, for example, is understood as a mediation of relationships, and can also be seen as a means of seeking emancipation, social participation, and better quality of life (Gonçalves, 2016; Morais & Malfitano, 2016).

In this sense, professionals also become political and social actors, by contributing to the subject by reflecting on how he is existing in the world (Almeida, 2004). As Barros presents:

The action processes in social occupational therapy become social spaces for cultural and relational negotiation, production, or facilitation of the person's participation in collective life, in the elaboration of life projects, and the feeling of belonging, and they cannot be understood through of separations and disjunctions. The occupational therapist's action remains in permanent motion (Barros, 2004, p. 92).

This facilitation of social participation sought through the professional's action brings a change in the role of this category. There is a change in the direction of actions towards the collective instead of keeping them exclusively focused on the individual and their particularities, as well as the change in the centrality of the technician's knowledge to the understanding of plural knowledge (Barros et al., 2002). Furthermore, the action must detach from the so-called therapeutic setting and strengthen in the spaces of daily life, with the role played by the occupational therapist as “adapter” giving way to “social articulator” (Galheigo, 1997).

Conclusion

Through a scoping review, we sought to discuss the professional practice of occupational therapists with the population of adolescents submitted to juvenile justice actions. As observed through the survey, this practice is still not widespread, considering the number of documents located, with a greater volume of publications from the 2000s onwards. The research was limited to the searched databases, with the documents located using the criteria established search terms, understanding the possibility of being other documents related to the themes under study.

Through the 13 selected articles, significant differences could be observed in the theoretical conceptions that guide professional practices, identified through the terminologies used and the conceptual bases on which they were anchored. This diversity expresses the theoretical and methodological non-definition of professional practice in the area of juvenile justice. Some used pre-defined theoretical models, and there is some discussion about their use in contexts different from those that were idealized. Some professionals argue that the models are positive, as they establish a single language to demonstrate the results of the occupational therapists' action. At the same time, there are critical positions on the import of models, under the arguments that they do not respond to local demands, nor to socially complex issues, which do not fit into pre-defined procedures, especially considering countries with such diverse economic and social existences.

We emphasize that the practices identified correspond to different countries and times, which may justify their multiplicity of discussions, considering the existing changes in the understanding of adolescence, the attention paid to adolescents linked to juvenile justice, as well as the very development of occupational therapy and its different sub-areas of action.

The analysis of occupational therapy as a social action in counterpoint to the health clinic is also part of the discussion about its epistemological basis for its performance with those adolescents, whether inside prison units or through monitoring in the territory. Therefore, based on the selected literature, we can say that the practice of occupational therapists with adolescents who committed an infraction is a diverse practice, contextualized in different socio-cultural roots of occupational therapy in the world. Considering the Brazilian reality, what stands out are the practices in social occupational therapy, anchored in the search for guaranteeing the fundamental rights of a population that, as a rule, experiences deprivation even before the practice of the infraction.

We end by pointing out that greater dissemination of professional reflections and practices in this context of work would contribute significantly to a continuous rethinking about this specificity, also strengthening the recognition of the occupational therapist as a constituent and contributing professionally to the area of juvenile justice.

• 1
  There are four UN regulations specifically related to juvenile justice: Minimum Rules for the Administration of Juvenile Justice – Beijing Rules (1985); UN Guiding Principles for the Prevention of Juvenile Delinquency – Riyadh Rules (1990); Rules for the Protection of Youth Deprived of Liberty – Havana Rules (1990); and UN Minimum Rules for the Elaboration of Non-Depriving Measures of Liberty – Tokyo Rules (1990)(Zanella & Lara, 2015).
• 2
  Incarceration, crime, correctional institution, correctional unit, delinquency, detainee, incarcerated, infraction, juvenile justice, offender, outlaw, prison and socio-educational.
• 3
  According to Brazilian law, a child is considered to be a person up to 12 years old incomplete and an adolescent when between 12 and 18 years old, and, if the practice of an offense is found by a child, it is subject to protective measures, and not to socio-educational care (Brasil, 1990). In one of the analyzed studies, a similar intervention applied to individuals aged 10 to 14 years was described, and for this reason, it was categorized as “children and adolescents”.
• How to cite: Oliveira, R. H. D., & Malfitano, A. P. S. (2021). Occupational therapy and adolescent offenders: mapping of productions. Cadernos Brasileiros de Terapia Ocupacional, 29, e2931. https://doi.org/10.1590/2526-8910.ctoAR2218

• Funding source

  Coordenação de Aperfeiçoamento de Pessoa de Nível Superior – CAPES – Código 001.

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Edited by

Section editor

Prof. Dr. Beatriz Prado Pereira

Publication Dates

• Publication in this collection
  16 Aug 2021
• Date of issue
  2021

History

• Received
  03 Jan 2021
• Reviewed
  14 Mar 2021
• Accepted
  01 Apr 2021