Goal-Oriented-Programs-Power-Point-4-2013
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Transcript Goal-Oriented-Programs-Power-Point-4-2013
Norma J. Stumbo, Ph.D., CTRS
President, Education Associates
Defining Accountability,
Intervention, Quality, Outcomes
Leisure Ability Model
Therapeutic Recreation Accountability Model
Principles of Intervention Programming
Components - Practice
What is Accountability?
How is Quality Defined?
What is Intervention (and how does it differ from
other services)?
What are Client Outcomes?
How Does TR Produce Client Outcomes?
What Client Outcomes Should be Expected in HighQuality TR Intervention Programs?
Being held responsible for the production and
delivery of therapeutic recreation services that
best meet client needs and move clients
toward predetermined outcomes in the most
timely, efficient, and effective manner
as possible (Stumbo & Peterson, 2009, p. 73)
A program that is designed and implemented
to be intervention has as its outcome some
degree of client behavioral change (that is,
behavioral change is the purpose of the
program) (Stumbo & Peterson, 2009, p. 79)
The direct, causal link between the process
or delivery of care and the outcomes
expected from it (Riley, 1991a)
Providing the right patient with the right
service [at] the right time in the right setting at
the right intensity and for the right duration
(Navar, 1991, p. 5)
Intervention programs that lead to predictable
and measurable client outcomes (Peterson &
Stumbo, 2009)
Achievement of some pre-established
standard or a desired level of service (Stumbo,
Pegg, & Carter, in press)
Degree to which health services for individual
and populations increase the likelihood of
desired health outcomes (quality principles),
are consistent with current professional
knowledge (professional practitioner skills),
and meet the expectations of healthcare users
(the marketplace) (Buttell, Hendler, & Daley, 2006, p. 62)
Change in clinical status (effect of tx. on pt.
symptoms)
Change in functionality (effect of tx. on pt.
lifestyle)
Change in utilization of medical resources
(effect of tx. on using additional health care
services)
Recidivism (examining patterns of relapse or
re-entry into medical system) (Gorski, 1995, p.
33)
Observed changes in a client’s status as a
result of our interventions and interactions...
Outcomes can be attributed to the process of
providing care, and this should enable us to
determine if we are doing for our clients that
which we purport to do (Shank & Kinney, 1991, p. 76)
Need to have relevance and importance to the
client’s future lifestyle and are attainable within
the time frame of service delivery (Riley, 1987a, 1991a)
•
Observable changes that result from intervention (Client
status, functional status, well-being, care satisfaction,
cost/resource utilization
•
Changes over specified time
•
Clinical results
•
Results of performance
•
Direct effects of service
•
Difference between input (assessment baseline) and output
(discharge)
•
Both planned and unplanned
•
Both beneficial and harmful
•
Straightest line between A and B
Client characteristics at
baseline
Client characteristics at
end of treatment
(assessment)
(re-assessment)
(e.g., health status,
functional status, quality of
life, etc.)
(e.g., health status,
functional status, quality
of life, etc.)
Entry
Exit
Intervention
Difference between Point A/Entry and Point B/Discharge
= Outcomes
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Accountability?
Intervention?
Quality?
Client Outcomes?
Application to Your TR Program?
Leisure Ability Model
◦ Content Model
Therapeutic Recreation Accountability Model
◦ Process Model
13
Schematic Representations
Communication Tools
Defines TR Practice
◦ Explanation of TR Practice
◦ Expression of Philosophy and Theory
◦
◦
◦
◦
Directs Service Development, Delivery to Clients
Directs Selection of Client Outcomes
Directs Program Evaluation & Quality Improvement
Foundation for Research, Public Policy, & Future
Two Types
◦ Content Models
◦ Process Models
Ross & Ashton-Schaeffer, 2009
14
15
Purpose of Therapeutic Recreation:
To aid individuals with physical, intellectual,
emotional, and/or social limitations in
developing an independent leisure lifestyle
aimed at improving their overall health, wellbeing, and quality of life through the provision
of functional intervention, leisure education,
and recreation participation services.
16
Functional Intervention
(formerly Recreation Therapy and Treatment)
Leisure Education
Recreation Participation
(formerly Special Recreation)
17
Functional Intervention
◦ Addresses functional abilities that are prerequisite to, or a
necessary part of, leisure involvement and lifestyle
◦ Baseline abilities that peers without limitations would
possess
◦ Physical
Endurance, strength, hand-eye coordination
◦ Cognitive
Orientation, ability to follow directions
◦ Emotional
Anger management, emotional expression
◦ Social
Refrain from biting, kicking, etc.
18
Leisure Education
Broad category of services that focuses on the
development and acquisition of various leisurerelated skills, attitudes, and knowledges
◦ Leisure Awareness
◦ Social Skills
◦ Leisure Resources
◦ Leisure Skills
19
Leisure Awareness
Cognitive awareness of leisure and its benefits, a
valuing of the leisure phenomenon, and a conscious
decision-making process to activate involvement
◦ Knowledge of Leisure
◦ Self-Awareness
◦ Leisure and Play Attitudes
◦ Related Participatory and Decision-Making Skills
20
Social Skills
Development of social interaction
skills through direct instruction
200
0
◦ Communication Skills
Assertiveness, Conversation, Active Listening, InformationSeeking, Information-Giving, etc.
◦ Relationship-Building Skills
Greeting Skills, Friendship Development, Cooperation,
Competition, Negotiation, Compromise, Social Networks
◦ Self-Presentation Skills
Etiquette & Manners; Hygiene, Health & Grooming Skills;
Appropriate Attire, Responsibility for Self-Care
21
Leisure Resources
◦ Knowledge and ability to utilize a wide variety of
leisure resources
◦ Activity Opportunities
◦ Personal Resources
◦ Family and Home Resources
◦ Community Resources
◦ State and National Resources
22
Leisure Activity Skills
◦ Activity skill development
◦ Traditional Leisure Skills
Sports, Dance, Drama, Music, Hobbies
◦ Non-Traditional Leisure Skills
Social Interaction, Community Services, Relaxation,
Food Preparation, Living Things Maintenance
23
Recreation Participation
◦ Structured, supervised programs with opportunities
to practice skills learned previously, express
preferences, display talents
◦ Example:
After teaching leisure awareness, social interaction
skills, activity opportunities, and decision-making skills,
taking clients to an arts performance or sporting event
of their choice.
24
TR Service Model – Conceptual Content Model
◦ Addresses Spectrum of Services
◦ Disability-, Setting-, & World-Inclusive
Definition of Scope of TR Practice
Pro-Intervention – Focused on Change of Client
Behavior, Skills, Knowledges
Difference Between Entry to and Exit from TR Services
Evidence, Intervention, Measurement, Outcomes
Based on Leisure Behavior
Based on Normalized, Inclusive Ideals
Based on Health, Wellness, Well-Being, & QOL
25
A Panacea for All that Ails TR
Not Based on Diversional Recreation Provision*
◦ Recreation for Recreation’s Sake
Not Anti-Intervention
◦ Not Loosy-Goosy Excuse to Program Poorly
Not Based on Activity Provision
◦ Is Based on Evidence-Based, Outcome-Focused Program
Provision
Not Focused on Medical Model – Sick
Roles/Pathologies
* Diversional activities are not within LAM
26
27
Comprehensive & Specific Program Design
Activity Analysis, Selection, Modification
Protocol Development
Client Assessment Plan
Intervention Programs
◦ Assessment Implementation
◦ Client Tracking & Documentation
Program Outcomes & Client Outcomes
Quality Improvement/Efficacy Research
28
LAM = Content of TR programs
◦ Scope of practice
TRAM= Process of TR programs
◦ Systems approach (whole greater than parts)
Results
◦
◦
◦
◦
Expansion of APIE into programs (instead of activities)
Greater accountability for input/process/output
Better standardization of practice/uniformity of services
Improved “teach-ability” to students
29
Programs Developed Conceptually
Programs Drawn from Evidence & Protocols
Programs Based on Targeted Outcomes
Programs Provided Based on Systematic Plan
Program & Client Outcomes Measured
Program & Client Outcomes Reported
30
Connections
Relationships
Outcome-Driven
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Connections between Content and Outcomes
◦ Comprehensive Program Design
◦ Activity Analysis, Selection, Modification
◦ Protocol Development
◦ Assessment Plan
◦ Client Documentation
◦ Program and Client Outcomes
◦ Quality Improvement/Efficacy Research
Logical, planned, proven connection between
◦ Client Needs/Deficits
Ex: barriers to leisure
◦ Client Goals
Ex: reduce barriers
◦ Interventions
Ex: programs to reduce barriers
◦ Immediate Client Outcomes (^ Leisure K, S, A)
Ex: ability to remove or reduce leisure barriers
◦ Ultimate Client Outcomes (Life Satisfaction,
Wellness,
Quality of Life)
Ex: independent functioning/invisibility
Needs/Barriers
Goal Setting
Problem:
lack of energy
(Can’t walk 1
block)
Goal:
Increased
energy
Objective:
Walk 12 blocks
Activities/Programs/
Interventions
Intermediate
Outcomes
Program:
Intermediate
Exercise
Program
4x/wk.
Outcome:
Measurable
increased energy
Outcome: Ability
to walk 12 blocks
Long Term/
Ultimate
Outcomes
Long-Term
Outcome:
Sufficient energy
for work, leisure,
and personal
efforts
Outcome:
Walk 1 mile
Functional Intervention
Increased ability to manage anger appropriately
Increased emotional control and healthy expression
Leisure Education
Increase ability to make decisions related to leisure
participation
Increased knowledge of the importance of leisure in
one’s life
Recreation Participation
Improved ability to express self within leisure context
Improved ability to select and participate in activity(ies)
of one’s choice
Efficiency and effectiveness of demonstrating client
change
Reasonable relationship between the services provided
and expected outcome(s)
Connection between occurrence of outcome and timing
of data collection
Relevance to client and society
Goals and intent of the program
Appropriate level of specification, but not trivial detail
Individual client variation within any given program
Long-term and short-term goals and objectives
Social and home environment to which client will
return
Behaviors that are generalizable and transferable to
variety of settings and situations
Using LAM and TRAM to build
programs and activities, based on
goals and outcomes
Key Concept
What program goals/areas will meet the needs of your
client group(s)?
My example: TR program for individuals with
addictions
1.0 Functional Intervention
1.1 Emotional Control
2.0 Social Skills
3.0 Stress Management
3.1 Personal Responsibility
3.2 Seeking Alternatives
3.3 Decision-Making
2.1 Communication Skills
3.4 Social Support Networks
2.2 Relationship-Building
Skills
2.3 Self-Presentation Skills
4.0 Leisure Awareness
5.0 Leisure Resources
4.1 Knowledge of Leisure
5.1 Activity Opportunities
4.2 Self-Awareness in
Leisure
5.2 Personal Resources
4.3 Leisure and Play
Attitudes
44 Related Participatory and
Decision-making Skills
5.3 Family and Home
Resources
5.4 Community Resources
5.5 State and National
Resources
1.0 To provide programs which teach emotional
control…
2.0 To provide social skill instruction programs …
2.1 To provide programs which directly teach a
variety of communication skills, such as
compromise, cooperation, negotiation,
persuasion, active listening skills, etc.
2.2 To provide direct instruction in relationshipbuilding skills, such as self-disclosure and privacy
skills, greeting and initiation skills, locating sober
1. Get into small groups of no more than three or four
individuals (with common clients)
2. Choose comprehensive program areas based on
client needs.
EX. Functional abilities, leisure awareness, social
skills, leisure skills, leisure resources, recreation
participation.
3. Develop comprehensive program goal statements.
4. Develop specific program areas based on client
needs.
5. Develop specific program goal statements.
Key Concept
What activities meet the purpose of the program
goals?
Programs Related to Goal
Areas/Protocols/Assessment
Meet Needs of Clients
Leads to Client Outcomes
Your Ideas. . .
Key Concept
How can you standardize program delivery to clients
to ensure outcomes?
Problem
Definition
Defining Characteristics
Outcome Criteria
Process Criteria
Related factors/
Etiologies
Your Ideas. . .
Key Concept
The content of the assessment must match the content
of the programs.
Questions Relate to Goal Areas/Protocols
Simplify the Scoring System
Leads to Program Placement
Your Ideas. . .
Key Concept
Document only that behavior which relates
to program goals/client needs
Assessment Results
Treatment Plans
Progress Notes
Discharge/Referral Summaries
Your Ideas. . .
Key Concept
Only expect as an outcome, what you plan into and
design the program to do
Relates to Program Goals
Relates to Client Goals
Relates to Client Documentation
Achieved through Program Participation
Your Ideas. . .
Key Concept
How effective are your programs at
producing targeted outcomes?
Major Aspects of Care
Indicators (Outcomes)
Criteria/Thresholds
Methods/Data Sources
Evaluate Care
Your Ideas. . .
Comprehensive and Specific Goals
Activity Analysis, Selection and Modification
Protocol Development
Assessment Plan
Client Documentation
Program and Client Outcomes
Quality Improvement/Efficacy Research
Connections Between Content and Outcomes
◦ Comprehensive and Specific Goals
◦ Activity Analysis, Selection and
Modification
◦ Protocol Development
◦ Assessment Plan
◦ Client Documentation
◦ Program and Client Outcomes
◦ Quality Improvement/Efficacy Research
Norma J. Stumbo, Ph.D., CTRS
[email protected]