KNR 273: TR Models Continued

KNR 273: TR Models Continued TR Service Delivery and TR Outcome Models The Aristotelian Good Life Model Optimizing Lifelong Health and Well-Being Model

TR Service Delivery and TR Outcome Models • Easy to follow (graphic depiction, clarity of terms & concepts) • Accommodates a variety of clients & settings • Flexibility in types of services • What is the end goal? Purposes • Underlying assumptions • Theoretical bases • Direction for research & practice • Could you explain TR with this model? • Could you design programs?

TR Service Delivery and TR Outcome Models • 2 interrelated TR models • TR Service Delivery Model provides an overview of the nature of service delivery • TR Outcome Model focuses on service outcomes • The Outcome Model should be viewed as an extension of the Delivery Model

TR Service Delivery Model • Describes the scope of TR services, nature of TR services, and relationship between TRS and client • Scope of service • Activities and strategies that contribute to diagnosis or assessment, treatment or rehabilitation, client education, and health promotion/prevention

TR Service Delivery Model • Diagnosis/needs assessment • Use of standardized tests, field observations, or other techniques • to determine client’s strengths and abilities or their potential limitations • in achieving habilitation or rehabilitation goals

TR Service Delivery Model • Treatment/rehabilitation • Providing assistance in restoring or stabilizing health or abilities • of an individual who has experienced loss or limitations in those abilities • E.g. Aquatic therapy might be used to maintain muscle tone and flexibility in a client who has MS

TR Service Delivery Model • Education • Develop the attitudes, values, and skills • needed to function more effectively in society • to improve overall health • and/or to achieve a higher quality of life • E.g. Assertiveness training, leisure education, cognitive retraining, reality orientation, social skills training

TR Service Delivery Model • Prevention/health promotion • Protect or promote healthy lifestyles • Several components may function at the same time • Swimming may be treatment/rehabilitation to a person recovering from a stroke, and serve as an opportunity to learn a new leisure skill (education), and prevent further physical losses and promote a healthier lifestyle (prevention/health promotion)

TR Service Delivery Model • Nature of service • Involves an element of planned intervention, as well as a leisure experience dimension • Some settings may emphasize intervention while others focus on leisure experiences • Key element of determining whether an activity is an intervention or a leisure experience is not the nature of the activity, but the client’s perception of the experience

TR Service Delivery Model • Gray band describes the optimal area of interaction for CTRS and client • Diagnosis/needs assessment and treatment/rehabilitation tend to be more structured and goal directed which are less likely to facilitate the leisure experience • Last 2 lend themselves to greater personal freedom and greater opportunities for leisure

TR Service Delivery Model • Nature of TRS & client interaction • Informed consent, independence and self-determination

TR Service Delivery Model • Theoretical foundations • Attempt to show that recreation therapy and leisure experience philosophy may co-exist • Neulinger’s theory of leisure • State of mind, choice, internal motivation, freedom • All interactions are interactions between perceived freedom and perceived constraint • Interactions contribute to outcomes

TR Outcome Model • A leisure experience will always affect the participant’s quality of life and may also contribute to some improvement in functional capacity and/or health status • Wellness/health status • Quality of life

TR Service Delivery Model • Functional capacity/potential • Cognitive • Physical • Psychological/emotional • Spiritual (ability to find meaning & purpose in life) • Social • Leisure

TR Service Delivery Model • Goal is to assist the client in achieving the highest possible level of health and well-being through leisure and nonleisure experiences • Theoretical foundations • Human development (becoming) • Rehabilitation science empirical research

Summary • Assumptions • The focus of interventions differ in their degree of focus on intervention and leisure • The outcomes of TR services are multidimensional in nature (e.g., health status, quality of life, functional capabilities) • Mission: Quality of life • Means/end model

Summary (Cont.) • Definitions of TR • The specialized application of recreation and experiential activates or interventions that assist in maintaining or improving the health status, functional abilities, and ultimately the quality of life of persons with special needs • TR Service Delivery areas • Scope of TR service, nature of service, nature of TRS/client interaction

Summary (Cont.) • TR Outcomes areas • Functional capacity/potential • Wellness/health status • Quality of life

Strengths • Reflects current TR practice • Provides consumers, employers, practitioners, legislators, etc. with a clear understanding of the scope and outcome of TR services • Doesn’t just focus on “fixing broken parts” • Can be used in wide variety of settings

Attempt at providing a model that unifies TR Contains content from NTRS & ATRA definitions Endorsed notion that leisure experiences and quality of life can be legitimate goals in healthcare One activity may simultaneously address several service components Strengths (Cont.)

Concerns • Some terms are not clearly defined • Is this an improvement on existing models? • Distinction between areas is not clear (e.g.. Treatment/rehabilitation and education) • Failure to show interrelationship between the 2 models • Theory on helping relationships and client change is missing

TR Service Delivery and TR Outcome Models • Easy to follow (graphic depiction, clarity of terms & concepts) • Accommodates a variety of clients & settings • Flexibility in types of services • What is the end goal? Purposes • Underlying assumptions • Theoretical bases • Direction for research & practice • Could you explain TR with this model? • Could you design programs?

The Aristotelian Good Life Model • Easy to follow (graphic depiction, clarity of terms & concepts) • Accommodates a variety of clients & settings • Flexibility in types of services • What is the end goal? Purposes • Underlying assumptions • Theoretical bases • Direction for research & practice • Could you explain TR with this model? • Could you design programs?

The Aristotelian Good Life Model • TR Defined • TR comprises sets of services directed at increasing client freedom and responsibility • in order to facilitate attainment of human happiness (the “good life”) • This is accomplished by empowering clients to overcome constraints that arise from illness, disability, oppression, wrong desires, challenges in following the principle of enough, and focus on apparent goods that lack potential to become real goods.

The Aristotelian Good Life Model • Model is founded on concept of happiness • Recreation & leisure are viewed as necessary components of a happy life • Eudaemonism is Greek for happiness, human flourishing, or well being • Used to describe Aristotle’s conception of the good life • Puts happiness in the realm of ethics

The Aristotelian Good Life Model • Attainment of the good life is based on the premise that 2 conditions are met • The individual has access to sufficient wealth to meet basic biological needs • The society provides basic human freedoms and rights • 3 principles of good life • Ethics of enough • Real and apparent good • Wrong and right desires

The Aristotelian Good Life Model • Ethics of enough • Too little or too much of most things leads to problems • Rational and prudent people can reach agreement on what is enough • There can be variation between people • Some goods like wisdom and knowledge are limitless good --- one can never have too much

The Aristotelian Good Life Model • Real and apparent goods • Real goods led to good life • Apparent goods were those sought for the sake of happiness, but did not realize that desire • Apparent goods seem good at one time, but later lack their appeal --- we usually regret having received apparent goods • Attainment of real goods lead to an enriched life with continued grown and development

The Aristotelian Good Life Model • Wrong desires • Pleasure, money, fame, and power are wrong desires • Pleasure is a real good, but cannot by itself lead to a good life so it becomes a partial good • Pleasure may be desired if it is not sought as the only good, it is desired in accordance with the ethics of enough, and if it does not cause injury to other people

The Aristotelian Good Life Model • Right desires • The good life is achieved by developing the habit of right desires • The crowning virtue of eudaemonism or summum bonum is leisure • Leisure is the highest good and is intimately connected with health and well-being • Highest leisure is engaging in intellectual virtues of art, learning, and creating

The Aristotelian Good Life Model • 4 major elements • Afflictions and oppression • Aristotelian goods • Freedom • Role of TRS

The Aristotelian Good Life Model • Afflictions and oppression • Scope of challenges that might lead someone to need TR services • Failure to follow the principle of enough • Disadvantaged people • Focus on apparent goods that don’t contribute to the good life (e.g. Substance abuse, smoking)

The Aristotelian Good Life Model • Aristotelian goods • Statement of the target outcomes of TR service • Elements needed for the good life • Primary goods (e.g. Biological needs, functional skills, etc.) • Secondary goods (e.g. Learning, creating, meaningful relationships) • Approaching summum bonum (leisure)

The Aristotelian Good Life Model • Freedom and responsibility • As individuals overcome afflictions and oppression, freedom increases and primary goods give way to secondary goods and, ultimately and ideally, to eudaemonia • Greater freedom comes with progression through treatment • Implies greater responsibility to self, family ,and community

The Aristotelian Good Life Model • Role of TRS • Therapist • Educator • Facilitator • Resource • Advocate

Strengths • Grounded in a philosophical theory of happiness • Helpful in defining value laden goals like an appropriate leisure lifestyle • Could be used with a variety of clients • Brings a dose of social conscience to our understanding of leisure

Concerns • Reflects political and economic state of Greeks • Freedom was for the ruling class and made available by slaves • Hard to use for programming • Few TRS have exposure to ethics or Aristotle’s work • Assumes high cognitive functioning of clients (so not appropriate for DD, dementia, poverty) • Never designed as replacement model

The Aristotelian Good Life Model • Easy to follow (graphic depiction, clarity of terms & concepts) • Accommodates a variety of clients & settings • Flexibility in types of services • What is the end goal? Purposes • Underlying assumptions • Theoretical bases • Direction for research & practice • Could you explain TR with this model? • Could you design programs?

Optimizing Lifelong Health Through Therapeutic Recreation Model • Easy to follow (graphic depiction, clarity of terms & concepts) • Accommodates a variety of clients & settings • Flexibility in types of services • What is the end goal? Purposes • Underlying assumptions • Theoretical bases • Direction for research & practice • Could you explain TR with this model? • Could you design programs?

Optimizing Lifelong Health • Assumption • TR service is based on the assumed need for intervention with the intent of influencing the individual’s personal and/or leisure functioning • Purpose was to incorporate health enhancement concepts into TR practice • Propose a non-linear model of TR that is grounded in life course perspective • Merges health enhancement and self-care approaches

Optimizing Lifelong Health • Health enhancement • Variety of behaviors individuals may use to prevent health risks, maintain or promote health, and facilitate functional interdependence • These behaviors are often undertaken with assistance and support of others • Former service providers • Informal (e.g.. Family and friends)

Optimizing Lifelong Health • Health Enhancement Continued • Clients, networks, and environmental factors or situational contexts facilitate or impede health enhancement efforts • Healthy People 2000 • Directed health care providers to consider disease/illness prevention, health education, and health promotion as central directions for clients

Optimizing Lifelong Health • Leisure participation may influence health and well-being by helping to facilitate coping behaviors in response to the changes and transitions that individuals experience over the life course • When people engage in healthy leisure lifestyles, they actively participate in their own well-being

Optimizing Lifelong Health • Theory • Baltes and Baltes (1990) developmental theory of human aging/adaptation • Process where people become active agents in their own well being • Health enhancement strategies are client initiated and reflect self-determined decision-making processes

Optimizing Lifelong Health • 3 basic principles • Engagement in a healthy leisure lifestyle reduces the probability of pathology or secondary consequences of disability across the life course • Strengthening optimal health and well-being can be achieved by individualizing resources and opportunities

Optimizing Lifelong Health • 3 principles continued • Individuals must be prepared to alter leisure choices or find substitutes, when necessitated, by changing personal and environmental characteristics across the life course • Central task of CTRS is to help facilitate adjustments while allowing for maximum client choice, control, and preservation of selfhood • Mission: Health Enhancement (Means)

Optimizing Lifelong Health • Elements • Selecting • Client selects activities that match interest, abilities, & resources. Also identifies goals • Optimizing • Compensating • Evaluating (added by Wilhite et al)

Optimizing Lifelong Health • Role of CTRS • Is derived from an educational and facilitative perspective • Education focus is on opportunities for acquiring awareness, knowledge, and understanding of various leisure options • Facilitative focus is on opportunities for clients to apply the learning to enable leisure to occur and to advocate on the client’s behalf

Optimizing Lifelong Health • Independent leisure functioning (with minimal support from CTRS, other caregivers, friends, family) is not always possible or desirable • Interdependent leisure might be ideal • Interacting cooperatively with others in a self-determined manner enables goal attainment

Optimizing Lifelong Health • Systems theory provides framework • Apply APIE

KNR 273: TR Models Continued