chapter 15

1. chapter15 A Global Perspective of Therapeutic Recreation David Howard, PhD, MSW, CTRS; Rodney Dieser, PhD; Heewon Yang, PhD, CTRS; Shane Pegg, PhD; and Julie Lammel, PhD

2. Learning Outcomes • Communicate the nature and purpose of the World Health Organization and the International Classification of Functioning, Disability, and Health (ICF), and discuss their relevance to therapeutic recreation • Recognize the barriers to, benefits of, and strategies for implementing the ICF into ongoing therapeutic recreation programs in the United States • Describe similarities and differences between the historical development of therapeutic recreation in the United States and other countries • Identify political, socioeconomic, and cultural factors that might affect the nature of therapeutic recreation services in various regions of the world • Describe current trends and issues in the therapeutic recreation profession as they exist in several different countries • Discuss alternative possibilities regarding the conceptualization, development, and delivery of therapeutic recreation services in the United States, as well as other regions

3. WHO and Therapeutic Recreation • World Health Organization (WHO) formed by the United Nations in 1948 • Defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” • Holistic approach to health

4. International Classification of Functioning, Disability, and Health(ICF) • Aim and goals • Scientific basis • Common language • Permit comparison • Systematic coding scheme • Key characteristics (see figure 15.1 for framework) • Compatibility with therapeutic recreation practice: ATRA position statement (continued)

5. International Classification of Functioning, Disability, and Health(ICF)(continued) • Basic concepts • Health condition • Body structures and function • Activity and participation • Contextual factors • Schematic coding system • Performance qualifier versus capacity qualifier • How codes are created • Procedural Manual and Guide • ICF considering therapeutic recreation in other nations

6. Therapeutic Recreation in Canada • History of treatment of persons with disabilities in Canada • Canada and Canadian Federalism • Cultural differences across provinces • Multiculturalism: the core of Canadian federalism • Great diversity in health and wellness concerns, programs, population groups, and community characteristics • Table 15.1

7. History of Therapeutic Recreation in Canada • Provincial and territorial therapeutic recreation organizations existed • Mid 1990s: National Coordinating Committee (NCC) developed • August 1996: Canadian Therapeutic Recreation Association (CTRA) established

8. Canadian Federalism and the Development of Therapeutic Recreation • Debate on standards of practice • Mosaic Certification Framework (MCF) • MCF based on three axioms • Political ideology • Collaboration and unity within paradigm of diversity • Strong multicultural commitment • Table 15.2 • U.S. National Council for Therapeutic Recreation Certification (NCTRC) • MCF compared to NCTRC • Table 15.3

9. Historical Origin of Therapeutic Recreation in South Korea • 1960: Leisure and Recreation Association of Korea (LRAK) by O-Joong Kim • 1960: Recreation as pleasurable experiences to help increase economic productivity • 1963: Ewha Women’s University began recreation as an academic course • Late 1980s: general public began viewing recreation as essential to people’s lives • 1988: South Korea hosted Seoul Paralympics

10. Therapeutic Recreation Professional Organizations in South Korea • Social workers ignited development of therapeutic recreation in 1990s • Korean Therapeutic Recreation Association (KTRA) established in 1993 • Development and provision of therapeutic recreation programs • Research on effectiveness of therapeutic recreation intervention • Education and training programs • Organizations and institutes after KTRA • Daehan Therapeutic Recreation Association (DTRA) • 2001 Korean Therapeutic Recreation Research Center (KTRRC) • Korean Therapeutic Recreation Academic Society (KTRAS) and the Korean Therapeutic Recreation Journal (KTRJ)

11. Certification, Education, and Challenges for Therapeutic Recreation in South Korea • Certification administered by Korean Council for Therapeutic Recreation Certification (KCTRC) • Similar to NCTRC in the U.S. • Eligibility of applicants for certification exam • Education and training programs • No academic institutions offer therapeutic recreation degrees • Over 30 universities and colleges offer therapeutic recreation courses • Several education and training institutes offer instruction • Challenges for the growth of therapeutic recreation

12. Therapeutic Recreation in Australia • Not fully accepted as a treatment intervention • Diverse range of therapeutic recreation staff titles are used • Provision of services greatly varies • Profession associated with the Diversional Therapy Association of Australia

13. Historical Development of Therapeutic Recreation in Australia • WWI: Nurses used recreation to assist in rehabilitation • Post WWII: Red Cross used basic crafts and recreation to aid rehabilitation • Deinstitutionalization (late 1960s–1970s) • More diversional activities needed • Diversional Therapy Association of Australia • Early 1980s: Empirical research on the benefits of activity began to emerge

14. Ongoing Australian National Reform • Recent federal level reforms have affected therapeutic recreation services • Community-based public health services • National mental health plan • Aged care reform • Therapeutic recreation still seen by many as diversionary activity • The public does not understand the role of therapeutic recreation

15. Working as a CTRS in Switzerland • Culture of Switzerland • Four official languages • Easy access to other countries in Europe • Diverse culture • Therapeutic recreation program in Valens • Rehabilitation facility on eastern side of Switzerland • Historical development of the program • Goals of the recreation and sport programs

16. Language and TherapeuticRecreation Services in Switzerland • Communication important in a country of multiple languages • Impact of language on efficacy of treatment • Obstacle of understanding concepts of recreation and leisure • Whorfian hypothesis: language transmits not only thoughts but also culture

17. Influence of Culture on Therapeutic Recreation in Switzerland • Swiss compartmentalize work and leisure • Perfectionism, social status, and conformity • Need to understand cultural attitudes toward recreation

18. Discussion Questions • Discuss the potential benefits of implementing the ICF across American and international health care systems. • How might such a change enhance awareness and acceptance of therapeutic recreation among other health care professionals, both nationally and internationally? • Interview two or three current health care practitioners. Were they aware of the ICF? If yes, did it affect their daily work? What possible implications does their level of awareness have for the potential use of the ICF? Compare your results to those of other class members. Were certain professional areas of practice more or less familiar with this system? • Based on these interviews, your reading, and your own opinion, what challenges will come with aligning therapeutic recreation standards of practice with the ICF? (continued)

19. Discussion Questions (continued) • What similarities and differences exist between the American history and perspective of therapeutic recreation and those of other countries? • Recreation and leisure are an inherent part of culture. What implications does this present in regard to the purpose and nature of therapeutic recreation? Is it possible that the American perspective is irrelevant or unhealthy in other cultures? • What steps can you take to ensure that you are competent in your work with people from other cultures?