Introduction to Therapeutic Recreation and its Importance

1. chapter10 Therapeutic Recreation Francis Stavola Daly and Robin Kunstler

2. Introduction to Therapeutic Recreation • People with illness, disability, or special needs have the same right to healthy and satisfying recreation participation as anyone else. • Disability may impose barriers on people’s ability to engage in recreation as they would choose. • People with disabilities participate in recreation programs in all types of settings. • Knowledge of how to support successful participation is significant for all recreation majors.

3. Disability Statistics • 44 million Americans (approximately 1 out of every 6) have at least one disability. • The proportion of Canadians with a disability is considered to be the same (Bullock & Mahon, 2000). • Only half of the people with a disability consider themselves impaired in some aspect of their functioning.

4. Common Threads of Therapeutic Recreation • Purposeful use of recreation activities to reach a goal or outcome • Enhancement of functioning through participation • Focus on whole person or client in the context of his or her own environment (known as an ecological perspective), including supports and resources provided by the community • Long-term improvements in health, well-being, and quality of life as core concerns (Bullock & Mahon, 2000)

5. Definition of Therapeutic Recreation Engaging people in planned recreation and related experiences in order to improve functioning, health, well-being, and quality of life; focusing on the whole person and the needed changes in the optimal living environment.

6. Range of Intervention or Treatment • Traditional recreation activities • Nontraditional activities • Therapeutic interventions • Complementary and alternative medicine (CAM), such as relaxation, yoga, and aromatherapy • Advocating for resources and support for clients’ family, environment, or community

7. Philosophy • Based on a system of beliefs about human nature, needs, and behaviors and the meaning and purpose of leisure, recreation, and play in human lives . • Roots in humanistic philosophy: People are capable of growth and change, they strive to meet their needs and goals, they are autonomous, and they are inherently altruistic.

8. Benefits of Therapeutic Recreation • Enables clients to reach desired goals. • Clients make choices during the planning process. • May feel a sense of control over decisions affecting their care and treatment. • Participation has physical, cognitive, psychosocial, emotional, and spiritual benefits for individuals as well as values for the health care system and society as a whole (Coyle et al., 1991).

9. History of Therapeutic Recreation • In the early 19th century in the United States, hospitals served people with mental illness. • Florence Nightingale, founder of modern nursing practice, believed that wounded soldiers should be in beautiful environments or “recreation huts,” listen to music, and have visits from family and pets to comfort them and speed their recovery. • Dorothea Dix advocated for better treatment of people with disabilities and illnesses in asylums and prisons in the United States. (continued)

10. History of Therapeutic Recreation (continued) • Settlement houses and community centers were established in North America in the 19th century to provide social services and recreation to immigrants, the poor and ill, and to people with disabilities. • American Red Cross promoted recreation services to soldiers during and after wartime. • In the 1920s, research conducted in Illinois demonstrated the value of recreation for people with mental retardation. (continued)

11. History of Therapeutic Recreation (continued) • Dr. Karl Menninger, psychiatrist, recognized the vital role of recreation in the treatment of psychiatric patients. • Post World War II saw the birth of wheelchair sports. • The Special Olympics began in the 1960s. • In the 1970s, deinstitutionalization moved people with mental illness and cognitive disabilities from large institutions to community-based living.

12. Legislation in the United States • PL 90-480 Architectural Barriers Act, 1968 • Section 504 of the Rehabilitation Act, 1973 • PL 94-142 Education for All Handicapped Children Act, 1975 • PL 101-476 Individuals with Disabilities Education Act, 1990 • PL 101-336 Americans with Disabilities Act, 1990

13. Legislation in Canada • Vocational Rehabilitation for Disabled Persons Act, 1962 • Canadian Charter of Rights and Freedoms, 1982 • In Unison: A Canadian Approach to Disability Issues (government report, not a law), 1998

14. Inclusion Defined Empowering people with disabilities to become valued and active members of their communities through involvement in socially valued life activities. Community offers support, friendship, and resources to facilitate equal participation in everyday life by all its members.

15. New Century Direction • Cultural diversity in North America • Aging population • Impact of ADA in the United States and 1998 Report of Canadian governments • Personal responsibility for health • Relationship of leisure to health • Complementary and alternative medicine • Cost of health care in relation to obesity and declining levels of physical activity and fitness • Technological innovations and increased reliance • Growth of populations served and settings

16. Leisure Ability Model • TR is provided along a continuum encompassing three types of services: • Functional intervention (previously known as treatment) • Leisure education • Recreation participation • The recipient moves along a continuum of services, gaining more control over decision-making ability and choices while learning new skills, becomes more independent, and participates in a repertoire of healthy recreation activities. (Stumbo & Peterson, 2004)

17. Health Protection/Health Promotion Model • 3 components of services include the following: • Prescriptive activity • Recreation • Leisure • Emphasis is on TR’s role in health care as a treatment modality and recreation activities as interventions to address specific health problems as part of the work of the treatment team. (Austin, 1999)

18. TR Services Model • TR has a role in these 4 types of services: • Diagnosis • Rehabilitation • Education • Health promotion • Services along a continuum are based on client’s needs, interests, level of functioning, degree of control, and type of setting (Carter, Van Andel, & Robb, 1996).

19. TR Outcome Model • As functioning and health status improve with the help of therapeutic recreation, so does the quality of life. • This model places the emphasis on the whole person when providing services, not just on one aspect of functioning or health status (Carter, Van Andel, & Robb, 1996).

20. Applying a Model to Clients and Settings • “How do I know which model is right for me, my clients, or my setting?” • Choosing is based on several factors: • Agency philosophy, mission, and goals • Needs of the clients • Regulations of accrediting bodies and government oversight agencies • Own professional philosophy

21. Canada’s Preferred Model • The primary model is the leisure ability model: • Reflects longstanding commitment to integration of people with disabilities into all aspects of society. • Recognizes that recreation is a part of the vision of full citizenship for all Canadians.

22. United States’ Preferred Model • Practitioners follow the leisure ability model. • The health protection/health promotion model is becoming more widely used in clinical settings.

23. Acute treatment in the hospital setting Residential facilities In-home TR services Nursing homes Hospice programs Rehabilitation centers Prisons Assisted living facilities Adult day care Partial hospitalization Outpatient programs Drug treatment programs Homeless shelters Group homes Schools Community recreation centers Camps and people’s own homes Settings for TR Services

24. Job Duties and Responsibilities • Conducts individual assessments • Develops treatment plans • Plans a schedule of TR programming • Observes and documents participation and progress • Engages in discharge planning, as appropriate • Attends treatment team meetings and in-service training • Maintains equipment and supplies • Supervises volunteers and interns • Provides support to family members • Organizes special events and community outings • Undertakes management responsibilities

25. TR Process Four steps, APIE, help fulfill the purposes of TR: • Assessment • Planning • Implementation • Evaluation The TR process can be applied in any setting where recreation is used with therapeutic intent to help a person achieve specific outcomes.

26. Do I Have What It Takes to Be a TRS? • No one personality type is best suited to being a TRS. Attributes include the following: • Self-awareness and a desire to learn new things • Ability to communicate and take initiative • Flexibility, ability to adapt to change, and compassion • Creative ideas, energy, and enthusiasm • Focus on helping clients achieve their goals • Obtain an education and possess credentials of profession. • Adhere to a code of ethical behavior. • Provide services based on professional standards of practice. • Update professional knowledge through research. • Be an active member of professional organizations.

27. Credentialing A process whereby a profession or government establishes minimum standards of competency required for practice by a professional in order to protect consumers as they receive services. • Registration is a voluntary listing of people who practice in a profession and meet criteria. • Certification is meeting a set of criteria and taking a written examination. • Licensure is a process by which the state mandates qualifications for practice and administers a licensing program.

28. Standards of Practice • Define the scope of services provided and state a minimal, acceptable level of service delivery. • Ensure consistent practice across service settings and help establish credibility of the profession. • Core practices include assessment, treatment planning, documentation, and management.

29. Code of Ethics • Describes the established duties and obligations of the professional in order to protect the human rights of service recipients. • 4 major bioethical principles are as follows: • Autonomy • Beneficence • Nonmaleficence • Justice • Both U.S. and Canadian TR professional associations have issued codes of ethics.

30. Ethical Concerns • ConfidentialityClient’s right to control access to information about himself or herself and know who will have access to that information • Maintaining a professional relationshipMaintaining boundaries between friendships or personal relationships • Cultural competence Understanding and respecting diverse beliefs and values and how they influence client’s behaviors

31. Shift from the institution to the community as the primary residential setting Retirement planning Early intervention Family leisure counseling Community reintegration Adaptations for people with disabilities Quality of services Changes in health care Economic pressures Social trends Demographic characteristics Technological advances Focus on health promotion Independent functioning Quality of life Future Challenges

32. Professional Opportunities • Community inclusion specialists • Accessibility consultants • Trainers in leadership techniques