About 5000 children in Georgia live and work on the street (Save the Children 2004). They represent a vulnerable social group with a very specific background and needs. Street children encounter particular barriers and problems, which are mostly related to the lack of basic essentials, educational and vocational opportunities. These deficits detrimentally affect their quality of life and exclude them from social participation. Holistic rehabilitation programmes for street children are based upon egalitarian principles and are vital to increasing their participation in community life (see Ch. 21).

Governmental and non-governmental organizations acknowledge the importance of resolving this issue at micro, meso and macro levels. The holistic approach derives from a wide understanding of health promotion. It aims for a better understanding of existing programmes and services, and especially of children’s needs within an overall context. The occupational therapy perspective may introduce a client-centred approach (within the psychosocial frame of reference) in the needs assessment of street children and three-level analysis (i.e. macro, meso and micro) of their context (see chapter 1 and chapter 2). At all levels, a genuinely child-centred approach is needed if children are to be taken seriously and involved in research, programme design and implementation (Van Beers 1996).

The small pilot project was carried out through the collaboration of three occupational therapy students (MK, MD, NS) and the Children’s Social Adaptation Centre, a government organization working with street children. The project was realized in September–October 2005, in connection with an education module coordinated by the European Network of Occupational Therapy in Higher Education: ‘Occupational Therapy with Street Children and Refugees’. It was an initial step in the process of exploring the occupational therapy role with street children in Georgia. Hence, the programme recognized the importance of the participatory strategies used in community-based rehabilitation and their applications in local contexts (Kronenberg 2003).

Social vulnerability is a significant indicator of service provision quality levels. Programmes are often directed towards poverty reduction and establishing basic socioeconomic responsibilities but lack adaptive strategies for the inclusion, facilitation and education of relevant actors. Therefore the project had to demonstrate its ability to accommodate these issues through cycles of participatory action research, including the identification of issues, initial planning and cycles of action, reflection and modification. An understanding of the political dimension of everyday practice is very important both for professional development and in determining the relevance of occupational therapy in promoting social change.

Two main directions in needs assessment were developed in parallel with the progress of the project: 1) negotiations within the interdisciplinary team and 2) the facilitation of the children’s group by incorporating elements of expressive therapy, forum (and interactive) theatre techniques and communication skills training.