Abstract

Objective:

To understand the meaning of the experiences of children living in a shelter through therapeutic play.

Method:

Descriptive, qualitative study, carried out in a non-governmental philanthropic shelter located in the city of Santos (SP) - Brazil. The sample was composed of five children between four and 11 years old, who agreed to participate in the study and were also authorized by their legal guardian. Observation during a dramatic therapeutic play session was the strategy used for data collection. Data were analyzed using Bardin’s content analysis technique.

Results:

Six categories emerged from the data, highlighting aspects of the child’s daily life in the shelter and at school, as well as the nostalgia for family and the way they deal with fear in the shelter. It is also worth mentioning the constant attempt to obtain the approval of the adult and the contentment experience while playing with this adult.

Final considerations:

The therapeutic play allowed the children to reflect on their experiences and have moments of catharsis. For the adult, it was possible to understand how it is to live in a shelter and the challenges faced by the children in this context.

Key words:
Orphanages; Play and playthings; Child; Pediatric nursing

Introduction

Child development is strongly influenced by social, cognitive, and affective aspects, which must be in balance for the child development¹1 Diniz IA, Assis MO, Souza MFS. Crianças institucionalizadas: um olhar para o desenvolvimento socioafetivo. Pretextos-Revista da Graduação em Psicologia da PUC Minas 2018; 3(5):261-285. [acessado 2019 Jun 10] Disponível em: http://periodicos.pucminas.br/index.php/pretextos/article/view/15978
http://periodicos.pucminas.br/index.php/... . The family plays a fundamental role in it, helping children to become adults with good self-esteem, prepared to assume responsibilities and face challenges²2 Nogueira F. A formação da personalidade da criança. PSICOBH 2016; [citado 2019 Jun 10]. Disponível em: http://www.psicobh.com.br/index.php/psicoterapia-infantil/a-formacao-da-personalidade-da-crianca
http://www.psicobh.com.br/index.php/psic... .

Some children, however, do not have the opportunity to enjoy a functional family system and, for various reasons, are forced to live in shelters or foster homes. Family history of domestic violence and chemical dependency, abandonment or death of parents, homelessness and poverty are some of the situations that lead children to be referred to support institutions and that, in most cases, do not occur in isolation³3 Freitas J, Oliveira B. A maioria das crianças e adolescentes em abrigos não são órfãos. Puc-Campinas 2016. [acessado 2019 Jun 10]. Disponível em: https://digitaispuccampinas.wordpress.com/2016/05/19/a-maioria-das-criancas-e-adolescentes-em-abrigos-nao-sao-orfaos/
https://digitaispuccampinas.wordpress.co... ^,44 Ferreira FPM. Crianças e adolescentes em abrigos: uma regionalização para Minas Gerais. Serv Soc Soc 2014; (117):142-168. [acessado 2019 Jun 10]. Disponível em: http://www.scielo.br/scielo.php?script=sci_abstract&pid=S0101-66282014000100009&lng=pt&nrm=is&tlng=pt
http://www.scielo.br/scielo.php?script=s... .

However, despite the intention of protecting and safeguarding children’s rights, institutionalization significantly interferes with the child’s life trajectory, compromising their internal organization and their ability to form relationships, social and affectional bonds¹1 Diniz IA, Assis MO, Souza MFS. Crianças institucionalizadas: um olhar para o desenvolvimento socioafetivo. Pretextos-Revista da Graduação em Psicologia da PUC Minas 2018; 3(5):261-285. [acessado 2019 Jun 10] Disponível em: http://periodicos.pucminas.br/index.php/pretextos/article/view/15978
http://periodicos.pucminas.br/index.php/... .

The experience of one of the authors of this study as a collaborator in a shelter institution, participating in visits and adoptions campaigns, motivated her to learn more about the experiences of children in shelters. Then, the following questions arose: How is it like to live in a shelter? How is the interaction with other children and with team professionals? What are the dreams and expectations of these children?

Seeking to understand the meanings of the experiences of these children, the authors conducted this study to investigate how they perceive the shelter situation and what are their feelings in this context of life.

To achieve this objective, it is necessary to use strategies that favor communication with the child, since, before the school age, they have difficulty to verbally express their feelings. Thus, play, especially therapeutic play (TP), is effective in helping children express what they feel and think about the situation they live⁵5 Ribeiro CA, Borba RI, Rezende MA. O brinquedo na assistência à saúde da criança. In: Fujimori E, Ohara CV, organizadores. Enfermagem e a saúde da criança na atenção básica. São Paulo: Manole; 2009. p. 287-327..

TP is a type of structured play, conducted by a trained professional. This technique is based on the principles of play therapy, and it is used to relieve tensions and anxieties caused by the experience of unusual situations⁵5 Ribeiro CA, Borba RI, Rezende MA. O brinquedo na assistência à saúde da criança. In: Fujimori E, Ohara CV, organizadores. Enfermagem e a saúde da criança na atenção básica. São Paulo: Manole; 2009. p. 287-327..

Three types of TP are identified: dramatic or cathartic, which allows children to relive a stressful situation during play, expressing what they feel, think and relieving their tension; instructional, used when it is necessary to explain a situation or procedure to the child; and enabler, which helps children to develop and strengthen their potential in the use of physiological functions, according to their condition⁵5 Ribeiro CA, Borba RI, Rezende MA. O brinquedo na assistência à saúde da criança. In: Fujimori E, Ohara CV, organizadores. Enfermagem e a saúde da criança na atenção básica. São Paulo: Manole; 2009. p. 287-327..

The use of TP is widely disseminated in the literature and it is used in different contexts, with emphasis on situations related to health, disease and hospitalization⁶6 Oliveira CS, Maia EBS, Borba RIH, Ribeiro CA. Therapeutic play in child care: perceptions of nurses in the pediatric units of a teaching hospital. Rev Soc Bras Enferm Ped 2015; 15(1):21-30 [cited 2019 Jun 10] Available from: https://sobep.org.br/revista/images/stories/pdf-revista/vol15-n1/vol_15_n_2-artigo-de-pesquisa-3.pdf
https://sobep.org.br/revista/images/stor...

7 Silva LF, Cabral IE. Rescuing the pleasure of playing of child with cancer in a hospital setting. Rev Bras Enferm 2015; 68(3):337-342. [cited 2019 Jun 10]. Available from: http://www.scielo.br/scielo.php?pid=S0034-71672015000300391&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S003...

8 Lima KYN, Santos VEP. Play as a care strategy for children with cancer. Rev Gaucha Enferm 2015; 36(2):76-81. [cited 2019 Jun 10]. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472015000200076
http://www.scielo.br/scielo.php?script=s...

9 Silva SGT, Santos MA, Floriano CMF, Damião EBC, Campos FV, Rossato LM. Influence of Therapeutic Play on the anxiety of hospitalized school-age children: Clinical trial. Rev Bras Enferm 2017; 70(6):1244-1249. [cited 2019 Jun 10]. Available from: http://www.scielo.br/pdf/reben/v70n6/0034-7167-reben-70-06-1244.pdf
http://www.scielo.br/pdf/reben/v70n6/003...

10 Caleffi CCF, Rocha PK, Anders JC, Souza AIJ, Burciaga VB, Serapiao LS. Contribuição do brinquedo terapêutico estruturado em um modelo de cuidado de enfermagem para crianças hospitalizadas. Rev Gaucha Enferm 2016; 37(2):e58131. [acessado 2019 Jun 10]. Disponível em: https://www.researchgate.net/publication/303530503_Contribuicao_do_brinquedo_terapeutico_estruturado_em_um_modelo_de_cuidado_de_enfermagem_para_criancas_hospitalizadas
https://www.researchgate.net/publication...

11 Pontes JE, Tabet E, Folkmann MA, Cunha ML, Almeida FA. Brinquedo terapêutico: preparando a criança para a vacina. Einstein 2015; 13(2):238-242. [acessado 2019 Jun 10]. Disponível em: http://www.scielo.br/pdf/eins/v13n2/pt_1679-4508-eins-13-2-0238.pdf
http://www.scielo.br/pdf/eins/v13n2/pt_1...

12 La Banca RO, Monteiro OO, Ribeiro CA, Borba RIH. Vivência da criança escolar com diabetes mellitus expressa por meio do brinquedo terapêutico dramático. Rev Enferm UFPE 2015; 9(Supl.7):9009-17. [cited 2019 Jun 10]. Available from: https://pt.scribd.com/document/332449262/A-Vivencia-Da-Crianca-Escolar-Com-Diabetes-Mellitus-Expressa-Por-Meio-Do-Brinquedo-Terapeutico-Dramatico
https://pt.scribd.com/document/332449262...

13 Dantas FA, Nóbrega VM, Pimenta EAG, Collet N. Use of therapeutic play during intravenous drug administration in children: exploratory study. Online Braz J Nurs 2016; 15(3):454-465. [cited 2019 Jun 10]. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/5581
http://www.objnursing.uff.br/index.php/n... ^-1414 Pereira AK, Maia EBS, Borba RIH, Ribeiro CA. O brincar da criança com transtorno de déficit de atenção e hiperatividade. Cienc Cuid Saude 2015; 14(2):1175-1183. [acessado 2019 Jun 10]. Disponível em: http://ojs.uem.br/ojs/index.php/CiencCuidSaude/article/viewFile/25410/pdf_350
http://ojs.uem.br/ojs/index.php/CiencCui... , but also with children who live in shelters¹⁵15 Giacomello KJ, Melo LL. Do faz de conta à realidade: compreendendo o brincar de crianças institucionalizadas vítimas de violência por meio do brinquedo terapêutico. Cien Saude Colet 2011; 16(Supl.1):1571-1580. [acessado 2019 Jun 10]. Disponível em: https://www.scielosp.org/article/csc/2011.v16suppl1/1571-1580/
https://www.scielosp.org/article/csc/201... .

Thus, this study aims to understand the meanings of the experiences of children living in a shelter through therapeutic play.

Method

This is a descriptive qualitative study, developed in a non-governmental philanthropic shelter, located in the city of Santos (SP), Brazil. At the time of the research, the institution had approximately 15 children, from zero to 18 years old.

This institution receives children and adolescents referred by the Child and Youth Court, and they remain there until they are adopted or return to their original home, always following a court order.

The sample was selected intentionally and consisted of three girls and two boys, aged four to 11 years old, who agreed to collaborate with the research. The legal guardians authorized their participation in the study. This age group is the one that most benefits from therapeutic play, especially those in the preschool age, from three to five years, which is the peak of symbolic play¹⁶16 Monroe RA. Promoção da saúde e do pré-escolar e da família. In: Hockenberry MJ, David W, Roger CC, organizadores. Wong fundamentos de enfermagem pediátrica. 10ª ed. Rio de Janeiro: Elsevier; 2018. p. 380-392. Cap. 12..

As this is a qualitative study, the number of participants was defined during the data collection. According to the literature, the inclusion of new participants in a research should be terminated when the data collected is sufficient to understand the phenomenon or situation studied¹⁷17 Minayo MCS, Gomes SFD. Pesquisa Social: teoria método e criatividade. 34ª ed. Petrópolis: Vozes; 2015..

For the reader to know a little more about the children in the study, a brief description of the main characteristics of each of them will be presented below.

Cinderella is ten years old, lives in the shelter with three brothers, two boys and a girl, aged 12, 14 and 17. Her 17-year-old brother returned to their parents’ house by court order and the other two remain in the same shelter. She was referred three times to this institution; the last time, she returned after the neighbors witnessed fights between her parents. Her mother was admitted to a rehabilitation clinic due to constant drug use. She is communicative and very active, but has difficulties to read and write, with suspected attention deficit hyperactivity disorder (ADHD).

Wonder Woman is 11 years old and was transferred from another shelter, where she lived since the age of four with her 13-year-old sister. She is in the new institution by court order. She is a shy girl who speaks quietly and is not very communicative.

Hulk is four years old and lived on the streets with his parents and three brothers, aged two, seven and ten. He started to live in the institution after being referred by the judge of the childhood and youth court. He is a very cheerful boy who likes to play, but has difficulties obeying orders and is aggressive.

Elsa is six years old and lived in a support house that shelters deprived families that are unable to establish a home. She was brought into the shelter by the social worker, as her mother was about to give birth to another child. She is a kind, loving, shy girl and is very attached to her mother and brother. During the TP session, she worried all the time about the absence of her brother in the play.

Spider-Man is eight years old, is the brother of Elsa and came with her to the shelter. He is a very cheerful, affectionate, outgoing boy and loves to play, but has difficulties concentrating and sharing toys with children.

Data were collected in 2017, after approval of the project by the Research Ethics Committee of the Hospital Israelita Albert Einstein (protocol 1905269) and authorization by the person responsible for the institution where data collection was carried out.

The children’s consented to participate in the research through the Consent Term for Minors, elaborated according to the child’s comprehension ability, as recommended by Resolution 466, 2012, of the National Health Council¹⁸18 Brasil. Ministério da Saúde (MS). Resolução nº 466, de 12 de dezembro de 2012. Diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União 2013; 13 jun. [acessado 2019 Jun 10]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html
http://bvsms.saude.gov.br/bvs/saudelegis... .

Data collection occurred during a dramatic TP session, which would initially be conducted individually. However, some children whose siblings were in the same institution resisted to play alone with the researcher, only agreeing to participate in the play together with their brother/sister.

The observations that occurred before and after the TP session were recorded in a field diary to assist in the subsequent analysis of the data. The material used in the TP sessions included: dolls to represent family members, professionals and other children in the shelter; everyday objects used in the house and in the shelter, such as telephones, pots, food, bathtub; modeling clay, assembling toys, pencils and paper⁵5 Ribeiro CA, Borba RI, Rezende MA. O brinquedo na assistência à saúde da criança. In: Fujimori E, Ohara CV, organizadores. Enfermagem e a saúde da criança na atenção básica. São Paulo: Manole; 2009. p. 287-327.^,1919 Ribeiro CA, Almeida FA, Borba RI. A criança e o brinquedo no hospital. In: Almeida FA, Sabatés AL, organizadoras. Enfermagem pediátrica: a criança o adolescente e sua família no hospital. Barueri: Manole; 2008. p. 65-77. Capítulo 8..

The TP session lasted an average of 30 minutes, ranging from 15 to 45 minutes, as recommended by the literature⁵5 Ribeiro CA, Borba RI, Rezende MA. O brinquedo na assistência à saúde da criança. In: Fujimori E, Ohara CV, organizadores. Enfermagem e a saúde da criança na atenção básica. São Paulo: Manole; 2009. p. 287-327.^,1919 Ribeiro CA, Almeida FA, Borba RI. A criança e o brinquedo no hospital. In: Almeida FA, Sabatés AL, organizadoras. Enfermagem pediátrica: a criança o adolescente e sua família no hospital. Barueri: Manole; 2008. p. 65-77. Capítulo 8.. The sessions were recorded in video to enable the transcription of the observations in full. They were conducted by the first researcher, who spent some time interacting with the children before starting the play, to establish a bond of trust with them. The child was invited to play with the following question: “Let’s play a child who lives in a shelter”?

The toys were offered in a bag to the child and the researcher explained that they could play as wished and that before the session ended, they would be notified. All children ended the play before the maximum time allowed.

The data were analyzed using Bardin’s content analysis technique, which is characterized by a set of communication analysis strategies, used to identify what is said about a given theme through systematic and objective procedures²⁰20 Bardin L. Análise de conteúdo. 6ª ed. São Paulo: Edições 70; 2011..

Initially, a comprehensive reading of the transcripts of the TP sessions was carried out, seeking to obtain an initial perception of the content. Then, successive readings were carried out to highlight the significant sentences, which were highlighted in the text²⁰20 Bardin L. Análise de conteúdo. 6ª ed. São Paulo: Edições 70; 2011..

Each excerpt selected received a code in the categorization stage. These excerpts were initially grouped by the thematic differences that emerged and, later, grouped by similarity of content. Then, the synthesis of the speeches was elaborated, based on the interconnection between the theoretical assumptions and the empirical data²⁰20 Bardin L. Análise de conteúdo. 6ª ed. São Paulo: Edições 70; 2011..

Results

Six categories emerged from the data analysis and will be presented below, accompanied by excerpts from the transcription of TP sessions. The letter “C” identifies the child’s verbalizations and the letter “R”, the researcher’s verbalizations.

Reflecting on the daily life in the shelter

The children played out several situations related to their daily life at the shelter, such as preparing meals, taking care of hygiene and appearance, and sleeping.

During play, some children said that they liked the shelter. One of them even expressed that she preferred to live in this institution, as she came from another shelter. Another child, however, remained silent when the researcher asked her if she liked the shelter.

While playing, the children also talked about how they arrived at the shelter and about leaving the institution to visit their families or to stay with other families during the holiday period.

Playing out the school routine during play

Going to school seemed to be a pleasant event, according to the dramatization of some children during play.

One of them compared her current school, which was public, with the private school she had previously attended, due to a scholarship.

She turned to the side and took several dolls. C: They are going to school, but there are no chairs. [...] She explored the toys and took a box with pieces to assemble... C: Now I’m going to make chairs... to make the school, okay? - said while playing with the assembling pieces. She sat the doll on the chair made with the pieces and continued assembling other chairs of different colors. C: Miss, private schools have colorful chairs, right? Mine is public and it doesn’t have - said while placing the chairs already set up beside her. Then, she built tables with the pieces. C: Beeeeep. Look at the sign! School is over! - she made a noise with her mouth simulating the sound signal that indicates the end of classes. Then, she put the dolls on the bed again to rest and took another doll [...]. C: I really like the pool, some schools have one, but mine doesn’t. (Wonder Woman)

Missing family and home routine

As expected, the loss of contact with family is very significant for the children, and sometimes they do not even understand why they were taken to a shelter. One child talks about how much she misses her parents and pets.

Another child also stopped playing, becoming irritated when the researcher referred to the people at the shelter as her current family.

Having to face fear in the shelter

Situations of physical violence experienced by the child with more aggressive children is one of the factors that cause fear, due to the possibility of physical injury.

One child was constantly worried, reserved and did not interact a lot. She was also afraid of the presence of other children; she flinched any time that one of them entered the place or interfered in the game and asked to end the TP session.

Children also seemed to fear being forgotten and sometimes asked the researcher to take pictures or film them. They also asked the adult to come and visit them on other occasions.

One of the children said that she was afraid because she had to sleep away from her sister who was in the same shelter. At home, they slept together, but in the shelter, they had to sleep in separate rooms, due to the age difference between them.

Some children also did not want to be distant from their siblings, showing constant concern for their sibling while playing, as if they feared being separated at any time. It is also worth noting that in the shelters, the objects are shared among the children, so they were always careful so that other children did not take the toys from the TP session.

Sometimes children seemed to be afraid to talk about certain subjects, as if they were keeping secrets.

Seeking approval from the adult

During play, their need to obtain approval became clear, as they asked repeatedly what the adult thought about the way they played and said they liked to play with her. It was also common for the child to ask the researcher to come back to visit at the shelter and to bring a gift.

The children also showed interest in learning more about the researcher and what she was doing at the shelter.

Showing contentment about playing with the adult

Several times, the children showed contentment while playing. They made decisions, gave orders to the adult and mastered the situation in the play.

Discussion

The analysis of the children’s speeches during play made it possible to understand their experiences in the shelter, regarding their daily life routine, such as bathing, eating and sleeping.

The activities at the school were also highlighted. Going to school represented a pleasant moment in the day and an opportunity to leave the institution and walk around the city. One of the children (Hulk) played out this moment, using the cars to symbolize the children and identifying himself as the driver of the school transport vehicle. He was the youngest child in the group, still in the pre-school phase, which explains the strong presence of symbolism in his make-believe games.

A study developed with children in shelters also pointed out the details of daily life in the institution in the reports. The children commented on the rules and routines of the shelter, why they were sheltered and how they interacted to the other children and adults in the institution, whom they called “uncles” and “aunts”¹⁵15 Giacomello KJ, Melo LL. Do faz de conta à realidade: compreendendo o brincar de crianças institucionalizadas vítimas de violência por meio do brinquedo terapêutico. Cien Saude Colet 2011; 16(Supl.1):1571-1580. [acessado 2019 Jun 10]. Disponível em: https://www.scielosp.org/article/csc/2011.v16suppl1/1571-1580/
https://www.scielosp.org/article/csc/201... .

The organization of the environment was also a routine activity in the shelter. One of the children (Wonder Woman) played out the supervision of children by the caregivers, using a plastic dinosaur to take care of the dolls’ room.

The shelter is a new home for children, where they perform routine activities and establish new relationships with the institution’s employees and the other children. The institution represents a new social and affective support network¹1 Diniz IA, Assis MO, Souza MFS. Crianças institucionalizadas: um olhar para o desenvolvimento socioafetivo. Pretextos-Revista da Graduação em Psicologia da PUC Minas 2018; 3(5):261-285. [acessado 2019 Jun 10] Disponível em: http://periodicos.pucminas.br/index.php/pretextos/article/view/15978
http://periodicos.pucminas.br/index.php/... .

A significant aspect that emerged from the data of the present study was the fact that, while in the shelter, the child has to deal with the absence of the family and the nostalgia for the routine at home. One of the most evident themes in the plays was the preparation of meals.

A previously mentioned study, developed with children who were victims of violence and lived in a shelter, also found that the children often played house in TP sessions, with verbalizations and gestures related to domestic chores¹⁵15 Giacomello KJ, Melo LL. Do faz de conta à realidade: compreendendo o brincar de crianças institucionalizadas vítimas de violência por meio do brinquedo terapêutico. Cien Saude Colet 2011; 16(Supl.1):1571-1580. [acessado 2019 Jun 10]. Disponível em: https://www.scielosp.org/article/csc/2011.v16suppl1/1571-1580/
https://www.scielosp.org/article/csc/201... .

Despite the undeniable importance of shelters for vulnerable children, the distance from the family, the loss of affective bonds with the family of origin and the lack of alternative affective bonds in the institution have a significant impact on social and affective development¹1 Diniz IA, Assis MO, Souza MFS. Crianças institucionalizadas: um olhar para o desenvolvimento socioafetivo. Pretextos-Revista da Graduação em Psicologia da PUC Minas 2018; 3(5):261-285. [acessado 2019 Jun 10] Disponível em: http://periodicos.pucminas.br/index.php/pretextos/article/view/15978
http://periodicos.pucminas.br/index.php/... .

Furthermore, despite the comfort, well-being and possibilities of development that a shelter provides for the child, the characteristics of this environment are different from the characteristics of a home¹1 Diniz IA, Assis MO, Souza MFS. Crianças institucionalizadas: um olhar para o desenvolvimento socioafetivo. Pretextos-Revista da Graduação em Psicologia da PUC Minas 2018; 3(5):261-285. [acessado 2019 Jun 10] Disponível em: http://periodicos.pucminas.br/index.php/pretextos/article/view/15978
http://periodicos.pucminas.br/index.php/... . On this fact, the report of one of the children (Elsa) stands out: she got irritated and stopped playing when the researcher referred to the people of the shelter as her family.

The institution where the study was carried out seeks to favor the contact between the children and their family of origin, promoting visits to the families. One of the children (Cinderella) reported during play that she was taken by one of the caregivers to visit her mother. She also talked about the vacation period, when she was received by other families, having the opportunity to receive more individualized care, different from the shelter.

Shelter institutions work to promote the reintegration of the child into their biological or extended family. However, if this is not possible, the children are referred to a foster family, so that, during their stay in the shelter, the child is prepared and encouraged to form and strengthen new family bonds²¹21 Hueb MFD. Acolhimento institucional e adoção: uma interlocução necessária. Rev SPAGESP 2015; 17(1):28-38. [acessado 2019 Jun 10]. Disponível em: http://pepsic.bvsalud.org/scielo.php?script=sci_abstract&pid=S1677-29702016000100004&lng=pt&nrm=iso
http://pepsic.bvsalud.org/scielo.php?scr... .

Another aspect that was revealed in the play was the feeling of fear, associated with the absence of a significant person for the child and with the possibility of being attacked by other children. One girl (Cinderella) said she could not sleep with her older sister, as she used to in her home, and that she felt afraid for not having her company. The sisters could not sleep together because they were in different age groups, and thus were accommodated in separate rooms.

It is observed that in the same way that children in shelters must learn to live with the lack of bonds, they also need to learn to deal with institutional rules and routines¹⁵15 Giacomello KJ, Melo LL. Do faz de conta à realidade: compreendendo o brincar de crianças institucionalizadas vítimas de violência por meio do brinquedo terapêutico. Cien Saude Colet 2011; 16(Supl.1):1571-1580. [acessado 2019 Jun 10]. Disponível em: https://www.scielosp.org/article/csc/2011.v16suppl1/1571-1580/
https://www.scielosp.org/article/csc/201... .

Most of the times, shelters face difficulties and are unable to provide individualized care for the children, either due to the reduced number of caregivers in relation to the number of children, the unpreparedness of these caregivers to deal with them or, also, due to the rotation of employees, which makes it difficult to form emotional bonds¹1 Diniz IA, Assis MO, Souza MFS. Crianças institucionalizadas: um olhar para o desenvolvimento socioafetivo. Pretextos-Revista da Graduação em Psicologia da PUC Minas 2018; 3(5):261-285. [acessado 2019 Jun 10] Disponível em: http://periodicos.pucminas.br/index.php/pretextos/article/view/15978
http://periodicos.pucminas.br/index.php/... .

The fear associated with the violence experienced inside and outside the shelter was also evident in the play, when the children reported that others were aggressive. One of them (Wonder Woman) even asked to end the play as soon as another child approached. Suspicious and very shy, she had recently come from another institution, and was still not adapted.

In this regard, considering the child’s behavior of promptly ending play, it is emphasized that in situations that cause anxiety, the child becomes tense and does not concentrate, being unable to play.

The referral of children and adolescents to shelter institutions has been increasing every day, due to the higher occurrence of abuse of minors. This is an important protection measure; however, it is also a factor of vulnerability since situations of violence can be repeated in this setting²²22 Salomão PR, Wegner W, Canabarro ST. Crianças e adolescentes abrigados vítimas de violência: dilemas e perspectivas da enfermagem Rev Rene 2014; 15(3):391-401. [acessado 2019 Jun 10]. Disponível em: https://www.redalyc.org/html/3240/324031781003/
https://www.redalyc.org/html/3240/324031... .

Playing also showed its cathartic function when a child (Cinderella) talked about how she arrived at the shelter, after a neighbor reported her parents’ fight. Despite living in a situation of violence, she did not want to leave her family, and expressed her anger by throwing toys on the floor.

A study carried out in Vila Velha (ES) with children and adolescents who were in a shelter after living on the streets also pointed out that, despite recognizing the shelter as a place that offers housing and food and ensures the continuity of studies, the majority wanted to return to their family of origin²³23 Ferreira VVF, Littig PMCB, Vescovi RGL. Crianças e adolescentes abrigados: perspectiva de futuro após situação de rua. Psicol Soc 2014; 26(1):165-174. [acessado 2019 Jun 10]. Disponível em: http://www.scielo.br/pdf/psoc/v26n1/18.pdf
http://www.scielo.br/pdf/psoc/v26n1/18.p...

These same findings were also identified in another study that was previously mentioned, which found that children who lived in a shelter after being victims of violence expressed the desire to return to their home, with their family, even if they experience violence¹⁵15 Giacomello KJ, Melo LL. Do faz de conta à realidade: compreendendo o brincar de crianças institucionalizadas vítimas de violência por meio do brinquedo terapêutico. Cien Saude Colet 2011; 16(Supl.1):1571-1580. [acessado 2019 Jun 10]. Disponível em: https://www.scielosp.org/article/csc/2011.v16suppl1/1571-1580/
https://www.scielosp.org/article/csc/201... .

The family has great importance for the child’s life and, even if it is not functional, it is recognized by the child as a support system, where they can get affective and social support²²22 Salomão PR, Wegner W, Canabarro ST. Crianças e adolescentes abrigados vítimas de violência: dilemas e perspectivas da enfermagem Rev Rene 2014; 15(3):391-401. [acessado 2019 Jun 10]. Disponível em: https://www.redalyc.org/html/3240/324031781003/
https://www.redalyc.org/html/3240/324031... ^,2323 Ferreira VVF, Littig PMCB, Vescovi RGL. Crianças e adolescentes abrigados: perspectiva de futuro após situação de rua. Psicol Soc 2014; 26(1):165-174. [acessado 2019 Jun 10]. Disponível em: http://www.scielo.br/pdf/psoc/v26n1/18.pdf
http://www.scielo.br/pdf/psoc/v26n1/18.p... .

Reflecting on the attempt to obtain the adult’s approval during play, the concern to live up to the adult’s expectations is perceived, as if the children were constantly seeking attention and affection. They seem to crave more lasting relationships when they ask the researcher to return to visit.

Regardless of the desire to obtain the approval of the adult, the opportunity to play freely made the moment of the TP session very pleasant, giving children the opportunity to take control of the situation and feel empowered to decide and take initiatives.

The therapeutic play provides a unique feeling of well-being to institutionalized children, as it enables effective communication with the adults around them and gives children the opportunity to express their feelings, fantasies, desires and experiences, as well as criticisms of the environment where they live and their family relationships¹⁵15 Giacomello KJ, Melo LL. Do faz de conta à realidade: compreendendo o brincar de crianças institucionalizadas vítimas de violência por meio do brinquedo terapêutico. Cien Saude Colet 2011; 16(Supl.1):1571-1580. [acessado 2019 Jun 10]. Disponível em: https://www.scielosp.org/article/csc/2011.v16suppl1/1571-1580/
https://www.scielosp.org/article/csc/201... .

The use of play to approach children who are victims of violence is an important strategy, as it helps them to create their spaces, social bonds and, consequently, to feel self-confident and able to seek solutions to their problems²²22 Salomão PR, Wegner W, Canabarro ST. Crianças e adolescentes abrigados vítimas de violência: dilemas e perspectivas da enfermagem Rev Rene 2014; 15(3):391-401. [acessado 2019 Jun 10]. Disponível em: https://www.redalyc.org/html/3240/324031781003/
https://www.redalyc.org/html/3240/324031... .

Although the play seemed to be enjoyable, almost all the children decided to end the TP session, and looked restless, sad, or aggressive at that moment. Sometimes, it was as if the situation played out in the session led the child to relive stressful situations, such as the absence of parents and the loss of pets, or even fear of violence in the shelter, which led them to stop playing.

Children in shelters constantly experience situations of loss or frustrated expectations, such as being taken away from parents and siblings, loss or death of a pet and changes in the social environment, such as leaving home or changing schools²⁴24 Almeida FA, Souza DF. Vivendo em um Abrigo: As Situações de Perda Contadas pela Criança por meio do Brinquedo Terapêutico. Atas CIAIQ 2018; 2:1031-1039. [acessado 2019 Jun 10]. Disponível em: https://proceedings.ciaiq.org/index.php/ciaiq2018/article/view/1876/1826
https://proceedings.ciaiq.org/index.php/... .

Loss is one of the most disorganizing processes in human life, and it is not only associated with the loss people, but also with any process that involves life changes, which are called small deaths²⁵25 Kovács MJ. A Morte em Vida. In: Bromberg MHPF, Kovács MJ, organizadores. Vida e Morte: laços da Existência. São Paulo: Casa do Psicólogo; 2011. p. 11-33.. The losses considered as “small deaths” are symbolic deaths which can cause anguish, fear and loneliness, leading to feelings of pain and sadness²⁶26 Pereira SM, Pires EF. As experiências de perdas e luto na contemporaneidade: um estudo bibliográfico. Educação 2018; 13(1):200-217. [acessado 2019 Jun 10]. Disponível em: http://revistas.ung.br/index.php/educacao/article/view/2837/2499
http://revistas.ung.br/index.php/educaca... .

Although the data from this study made it possible to understand the experience of the children who live in a shelter, conducting research involving other types of shelters can increase the visibility of this context of children’s life. It is worth noting that, as this study was carried out in a philanthropic institution, the care and resources available for the care of these children differ from the reality of most public shelter institutions.

It is also worth mentioning that one of the limitations of the study was the reduced number of children who were in the shelter during the data collection period, as, at the time, some children who met the inclusion criteria had been referred for adoption or returned to their homes.

Final considerations

The possibility of using play as a communication tool was once again proved effective in giving a voice for children in shelters to talk about themselves. This is also a valuable strategy for developing research in the context of institutionalization of children, which still represents an important knowledge gap.

The results of this study showed peculiarities of the experience of the children in the shelter, which otherwise would not be revealed, considering the limited ability to express feeling and thoughts in this period of development.

The daily life in the shelter, the trips to school, the nostalgia for the family and home routine, the insecurity of being in a strange environment, the fear of violence and, especially, the fear of being forgotten by the adult, clearly emerged during play.

Playing proved to be a pleasant experience for the children and, more than that, it gave them the opportunity to benefit from the cathartic function of dramatic TP, leading them to reflect on experiences and freely express feelings.

The routine use of TP with vulnerable children, such as those living in shelters, can be extremely useful. The adults who care for these children must provide the conditions for this practice, assuming the role of facilitator of therapeutic play in this social context.

It is believed that the results obtained in this study will contribute to raise awareness on the real needs of this population among the professionals who work in shelters, who will be able to provide more effective and quality care.

References

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History