Terapia ocupacional e assistência social: os desencontros entre a política, os serviços e as necessidades socioassistenciais da pessoa com deficiência e idosa no contexto fluminense

Abstract

This doctoral thesis, based on the historical-critical framework of Marxist tradition, is theoretically supported by the debate about professional work within the context of social policies in capitalist society, focusing on the work of occupational therapists in the Unified Social Assistance System (SUAS) in the state of Rio de Janeiro, Brazil. The general objective of the study was to understand the inclusion of occupational therapists in SUAS in this state, identifying where they are located and analyzing how these professionals develop their work processes within the context of social assistance policy. Specifically, the study aimed to update the historical series of the profession's inclusion at the national level, identify the characteristics of this inclusion, understand their work processes, and explore the particularities of the Rio de Janeiro context that influence how the profession integrates into social assistance policy. To achieve these objectives, a methodological approach was designed in two interconnected stages. The first stage, a survey, used secondary data from the SUAS Census to update and expand the historical series of occupational therapists' inclusion in SUAS at both the national and state levels. Covering the period from 2011 to 2023, this survey analyzed data on age, gender, employment type, service units, and the populations served by occupational therapists, outlining the characteristics of the profession's inclusion in Rio de Janeiro's social assistance system. The second stage, empirical in nature, involved semi-structured interviews with occupational therapists working in SUAS in Rio de Janeiro, complemented by document analysis of regulations, guidelines, and professional directives. The results highlight a structural mismatch between social assistance policy and the socio-assistance needs of people with disabilities and the elderly, evidenced by contradictions in the work of occupational therapists. These contradictions arise from normative guidelines oscillating between rehabilitation demands and SUAS’s socio-assistance objectives, alongside precarious working conditions and challenges in aligning professional practices with policy guidelines. The survey, based on SUAS Census data (2011–2023), revealed that occupational therapists are predominantly concentrated in services such as Day Centers and Long-Term Care Institutions for the Elderly (ILPIs), operating in a context of precarization and overlapping health and social demands. The interviews and document analysis deepened the understanding of work processes, highlighting how policy fragmentation and disarticulation limit emancipatory practices. However, the thesis does not merely expose this disconnection. It proposes pathways to constructing an encounter understood as an articulation between technical, ethical, and political dimensions capable of transforming professional practices and addressing structural inequalities. This connection requires strengthening multidisciplinary teams, valuing workers, and fostering critical education aligned with SUAS principles. By emphasizing care as a transformative action, the study reaffirms the emancipatory potential of social assistance policy and professional work, projecting possibilities for practices that promote dignity and autonomy for the assisted individuals.