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chapter
10
Therapeutic
Recreation
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.
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.
Common Threads
of Therapeutic Recreation
1. Purposeful use of recreation activities to reach a
goal or outcome
2. Enhancement of functioning through participation
3. 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
4. Long-term improvements in health, well-being, and
quality of life as core concerns
(Bullock & Mahon, 2000)
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.
Range of Intervention or Treatment
1.
2.
3.
4.
Traditional recreation activities
Nontraditional activities
Therapeutic interventions
Complementary and alternative medicine
(CAM), such as relaxation, yoga, and
aromatherapy
5. Advocating for resources and support for
clients’ family, environment, or community
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.
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).
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)
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)
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.
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
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
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.
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
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 decisionmaking ability and choices while learning new
skills, becomes more independent, and
participates in a repertoire of healthy recreation
activities.
(Stumbo & Peterson, 2004)
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)
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).
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).
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
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.
United States’ Preferred Model
• Practitioners follow the leisure ability
model.
• The health protection/health promotion
model is becoming more widely used in
clinical settings.
Settings for TR Services
• 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
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
TR Process
Four steps, APIE, help fulfill the purposes
of TR:
1.
2.
3.
4.
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.
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.
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.
Standards of Practice
1. Define the scope of services provided and
state a minimal, acceptable level of service
delivery.
2. Ensure consistent practice across service
settings and help establish credibility of
the profession.
3. Core practices include assessment,
treatment planning, documentation, and
management.
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.
Ethical Concerns
• Confidentiality
Client’s right to control access to information
about himself or herself and know who will
have access to that information
• Maintaining a professional relationship
Maintaining boundaries between friendships or
personal relationships
• Cultural competence
Understanding and respecting diverse beliefs
and values and how they influence client’s
behaviors
Future Challenges
• 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
•
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Changes in health care
Economic pressures
Social trends
Demographic
characteristics
Technological advances
Focus on health promotion
Independent functioning
Quality of life
Professional Opportunities
• Community inclusion specialists
• Accessibility consultants
• Trainers in leadership techniques