Practice of Therapeutic Recreation/Recreation Therapy Flashcards
Holistic Health Model
The treatment of the whole person. Ex.- Patient is referred to therapeutic recreation for a stroke, the therapist is concerned not only with the patient’s physical and cognitive well-being but also his/her emotional, social and spiritual well-being. The therapist is concerned with the patient’s deficits and strengths, what changes might help him/her when he/she goes home and what adaptive assistance he/she might need when returning to the community in order to participate in his/her former activities.
Value of the Recreation Experience
For all people, recreation experiences can provide relaxation, stimulate the mind, allow adventure, enable socialization, etc. Clients need to learn the impact their choice of recreation experiences can have on their quality of life.
Special/Adaptive Recreation
Special recreation is the provision of programs and opportunities for individuals with disabilities to develop, maintain, and express a self-directed, personally satisfying lifestyle that actively involves leisure. Very often special recreation refers to segregated programming for people w/ disabilities when inclusive programming is not possible. Adaptive Recreation- Inclusive recreation, also known as adaptive or accessible recreation, is a concept whereby people with disabilities are given the opportunity to participate in recreational activities. Through the use of activity modifications and assistive technology, athletes or participants in sports or other recreational pursuits are able to play alongside their non-disabled peers.
Inclusive Recreation
The full acceptance and integration of persons with disabilities into the recreation mainstream. It reflects free and equal access to recreation participation by persons w/ disabilities. All community recreation programs should be offering inclusive programming due to the Americans w/ Disabilities Act.
Using Recreation As A Treatment Modality
Different from both special recreation and inclusive recreation. It is recreation used for purposeful interventions using prescribed activities or experiences to bring about a physical, social, emotional, cognitive or spiritual change in a person. It is not to say that it could not be used in a community, school or health care setting, it is NOT setting specific but PROCESS SPECIFIC.
Leisure Ability Model
Defines and gives direction to the development and delivery of service to a wide variety of clients in diverse settings. One of the oldest models and seems to be the most widely accepted and utilized model. It is composed of the 3 following components: 1) functional intervention 2) leisure education 3) recreation participation. Each of these 3 service areas is based on distinct client needs and has specific purposes, expected behavior of clients, roles of the TRS and targeted client outcomes. Role in functional intervention is therapist and TRS intervention is mostly controlled by TRS. Role in leisure education is instructor, advisor, counselor and responsibility is shared between the TRS and client. Role in recreation participation is leader, facilitator or supervisor and it is an opportunity for participation provided by the TRS w/ client. Purpose of functional intervention is to improve functional ability. Purpose of leisure education is to acquire leisure knowledge and skills. Purpose of recreation participation is to engage in organized participation opportunities. The ultimate goal of this model is a satisfying leisure lifestyle, the independent functioning of a client in leisure experiences and activities of his/her choice. The TRS assesses the client’s need, provides the necessary functional intervention, leisure education and recreation participation services and evaluates the degree to which the client met the desired outcomes.
Health Protection/Health Promotion model
Has 2 components: 1) helping a patient recover from threats to health (health protection) 2) helping a client achieve optimal health (health promotion) through the use of prescriptive activities, recreation and leisure. Mission of therapeutic recreation is to assist persons to move toward an optimal state of health. Prescriptive activities- TR is outer directed and is structured, TRS directed. TRS is active and client choice is limited when client is in poor health in an unfavorable environment. Recreation-mutual participation. Stability tendency declines, TRS role narrows. Client’s actualization tendency grows, client role enlarges. Leisure- self-direction, client directed, client has freedom of choice and in optimal health in a favorable environment. 4 Basic Underlying Concepts of the Health Protection/Health Promotion Model: a humanistic perspective, high-level wellness, stabilization and actualization tendencies and health.
TR Service Delivery Model
Adopted concepts from both the Health Protection/Health Promotion Model and Leisure Ability Model. Mission of this model is to produce outcomes relating to functional capacities, to health status and ultimately to the enhancement in quality of life. The scope of services involved in therapeutic recreation. The 4 components include: 1) Diagnosis/Needs Assessment 2) Treatment/Rehabilitation of a problem or need 3) Educational Services 4) Prevention/ Health Promotion activities. The model is intended to represent a continuum of service delivery-from the more intense, acute care approach involving diagnosis and treatment found in hospitals or rehabilitation centers to the community-based focus on outpatient, day treatment or home health care services that generally emphasize education and health promotion activities. Like in the Health Protection/Health Promotion Model, the potential for a leisure experience enlarges as the client becomes more and more autonomous.
Therapeutic Recreation Outcome Model
An extension of the Service Delivery Model. This model looks at the products (outcomes) of the delivery of therapeutic recreation services. It takes into account changes in functional capacities and health status that, according to the model, will ultimately impact quality of life.
Common Themes of the TR Practice Models
A continuum of growth and intervention, a belief in the strengths and abilities of the individual, increasing freedom and self-determination, decreasing TRS “control” and increasing involvement and participation in the “natural” community or inclusion.
Types of TR Practice Settings
hospital (40%), skilled nursing facility (18.2%, but increasing), residential/ transitional (12.1%), parks/recreation organization (6.9%), outpatient/day treatment (5.8%), academic (3.7%), disability support organization (3.2%), school (2.9%), day care setting (2.5%), private practice (2.1%), correctional institution (1.8%), professional organization (0.7%), community recreation, physical rehabilitation centers, psychiatric hospitals, outpatient clinics, day treatment programs, long-term care facilities.
Much of TR is transitioning from the clinical setting to being more community based. The process of TR—assess, plan, implement and evaluate is constant no matter where TR is being practiced. TR is a PROCESS and NOT SETTING DEPENDENT.
Standards of Practice Definition
Used to “define a profession’s scope of service and to measure quality of services delivery.” Includes a variety of self-assessment tools for program and administration practices. Standards 1-7 are for the direct practice of TR. Standards 8-12 are the management of TR. Understanding and knowing the Standards of Practice is very important for the entry-level professional; it is these standards that must guide process. Standards were developed by a committee of the American Therapeutic Recreation Association (ATRA).
12 ATRA Standards of Practice
- Standard 1: The TRS conducts an individualized assessment to collect systematic, comprehensive and accurate data necessary to determine a course of action and subsequent individualized treatment plan. Gather accurate date from client assessment and determine an individualized treatment plan. TRS’s responsibility- determine a course of action, form relationship w/ client, include client in assessment, find out their leisure interests, cultural practices and preferences. Need correct information and prepare to share information.
- Standard 2: The TRS plans and develops the individualized treatment plan that identifies goals, objectives and treatment intervention strategies. Treatment planning, identifies goals, objectives and treatment intervention strategies. Important because it’s the foundation for successful treatment. TRS’s responsibility- our goals should be in line w/ client’s goals. Client should know their goal and be involved. Know considerations for client- diagnosis, precautions, activities that would NOT work for the client.
- Standard 3: The TRS implements the individualized treatment plan using appropriate intervention strategies to restore, remediate or rehabilitate in order to improve functioning and independence as well as reduce or eliminate the effects of illness or disability. Implementation of the treatment plan by the TRS is consistent w/ the overall patient/client treatment program. Plan implementation- HOW you will meet the client’s goals to improve his/her functioning and independence. TRS’s responsibility- TRS is consistent w/ overall client treatment program. Facilitate competency and know your stuff! Appropriate client/staff ratios for activity and appropriate for needs of program. Documentation, tracking if patient is participating/progressing/ responses, adverse reactions, outcomes.
- Standard 4: The TRS systematically evaluates and compares the client’s response to the individualized treatment plan. The treatment plan is revised based upon changes in the interventions, diagnosis and patient/client responses. Re-assessment & Evaluation. Systematically evaluates and compares client’s response to the individualized treatment plan. Important because it sees if the intervention is meeting goals and objectives. Formative & summative evaluations can re-advise treatment as necessary. TRS’s responsibility- Patient’s feedback, getting good observations, actual data (%) and communicate results to other in treatment plan/treatment team.
- Standard 5: The TRS develops a discharge plan in collaboration with patient/client, family and other treatment team members in order to continue treatment, as appropriate. Discharge & Transition planning- important because we want to create lifestyle changes, continue treatment-continuum of care. TRS’s responsibility- locating resources, passing info on to other facilities, do not want client to stop treatment, discharge paper work done on time, referrals to other agencies and follow ups if appropriate.
- Standard 6: Recreation opportunities are available to patients/clients to promote or improve their general health and well-being. Recreation Services- TRS’s responsibility- providing activities in accordance w/ organization’s procedures to improve pt.’s well-being. Re-assess patient’s interests, positive outcomes for patients→5 Domains, independence, control, adjustment to physical procedure, changes in lifestyle and social interactions.
- Standard 7: The TRS adheres to the ATRA Codes of Ethics. Ethical Conduct- Important because as a discipline we need to follow them. Need to report if others are violating the Codes of Ethics. Ensures each client is treated in a human and professional way.
- Standard 8: The therapeutic recreation department is governed by a written plan of operation that is based upon ATRA Standards of Practice of Therapeutic Recreation and standards of other accrediting/regulatory agencies, as appropriate. Written Plan of Operation (WPO)-Important because its how TR is governed in agency, guidance for management of staff, program evaluations and quality improvement. TRS’s responsibility- Need to comply w/ agency standards, WPO controls how TR department runs.
- Standard 9: The therapeutic recreation department has established provisions for assuring that therapeutic recreation staff maintain appropriate credentials and have opportunities for professional development. Staff Qualifications & Competency Assessment- Important because aspects of the field are always changing and need appropriate credentials. TRS’s responsibility- maintain credentials, go to conferences in TR or other areas, CEUs.
- Standard 10: Within the therapeutic recreation department, there exists an objective and systematic quality improvement program for the purposes of monitoring and evaluating the quality and appropriateness of care, and to identify and resolve problems in order to improve therapeutic recreation services. Quality Management- Important because we should always be improving the quality of care for clients, appropriateness of care and resolve problems to TR services.
- Standard 11: Therapeutic recreation services are provided in an effective and efficient manner that reflects the reasonable and appropriate use of resources. Resource Management- Important because TR department tries to get the most of their $$. Cost effective and accountable w/ resources for effective client treatment. TRS’s responsibility- adhere to the established budget and work within the budget, be savvy w/ budget and do not go over or under the budget.
- Standard 12: The therapeutic recreation department engages in routine, systematic program evaluation and research for the purpose of determining appropriateness and efficacy. Program Evaluation & Research- Evaluating department as a whole for its worth. Important because the TR staff should routinely do research, review outside research and participate in research. TRS’s responsibility- contributes to the advancement of TR and shares ideas w/ others.
Code of Ethics Definition
Guides professional behavior. Code of ethics is a standard of behavior that is expected of all professionals. Codes of ethics are self-regulatory but are developed to govern behavior. Used as a guide for promoting and maintaining the highest standards of ethical behavior. Applies to all TR personnel.
Code of Ethics Principles (8)
- Principle 1: Beneficence/Non-Maleficence- DO GOOD/ DO NO HARM. Therapeutic Recreation personnel shall treat persons in an ethical manner not only by respecting their decisions and protecting them from harm but also by actively making efforts to secure their well-being. Personnel strive to maximize possible benefits, and minimize possible harms. This serves as the guiding principles for the professional. The term “persons” includes, not only persons served but colleagues, agencies and the profession. Activities meet clients’ goals.
- Principle 2: Autonomy- CHOICE. Therapeutic Recreation personnel have a duty to preserve and protect the right of each individual to make his/her own choices. Each individual is to be given the opportunity to determine his/her own course of action in accordance w/ a plan freely chosen. Being part of the assessment and planning goals.
- Principle 3: Justice- ACCESS/FAIRNESS. Therapeutic Recreation personnel are responsible for ensuring that individuals are served fairly and that there is equity in the distribution of services. Individuals receive services without regard to race, color, creed, gender, sexual orientation, age, disability/disease, social and financial status. Treating people equally and time and efforts are spread equally with clients.
- Principle 4: Fidelity- TRUTH. Therapeutic Recreation personnel have an obligation to be loyal, faithful and meet commitments made to persons receiving services, colleagues, agencies and the profession. Ex.- timeliness of assessments.
- Principle 5: Veracity/Informed Consent- TRUTH/INFORMATION. Therapeutic Recreation personnel shall be truthful and honest. Therapeutic Recreation personnel are responsible for providing each individual receiving services with information regarding the service and the professional’s training and credentials; benefits, outcomes, length of treatment, expected activities, risks, limitations. Each individual receiving service has the right to know what is likely to take place during and as a result of professional intervention. Informed consent is obtained when information is provided by the professional. Clients should be informed of what you are doing with them and what and why you are doing the activity.
- Principle 6: Confidentiality and Privacy- Therapeutic Recreation personnel are responsible for safeguarding information about individuals served. Individuals served have the right to control information about themselves. When a situation arises that requires disclosure of confidential information about an individual to protect the individual’s welfare or the interest of others, the Therapeutic Recreation professional has the responsibility/ obligation to inform the individual served of the circumstances in which confidentiality was broken. Ex.- Standard 1- do assessment in a private area.
- Principle 7: Competence- Therapeutic Recreation personnel have the responsibility to continually seek to expand one’s knowledge base related to Therapeutic Recreation practice. The professional is responsible for keeping a record participation in training activities. The professional has the responsibility for contributing to advancement of the profession through activities such as research, dissemination (spreading) of information through publications and professional presentations and through active involvement in professional organizations. Continue to attain, maintain and expand competence. Go to conferences, CPR. Culturally competent.
- Principle 8: Compliance With Laws & Regulations- Therapeutic Recreation personnel are responsible for complying w/ local, state and federal laws and ATRA policies governing the profession of Therapeutic Recreation. Know the laws governing the profession and populations served.
Assessment
When assessing a patient, TRS must be able to sift through all the information the client may give and determine what is most important, dependent, on the needs of the patient and the type of program (functional intervention, leisure education) that the TR department offers. TRS use a variety of assessments and procedures in order to determine the needs of our patients. Many TR departments use their own agency-specific assessment, there are a variety of published TR/leisure assessments ranging from functional to leisure based. As a TRS it is important to be familiar w/ a variety of assessment instruments to determine what is best for the population and setting where you are working. When assessing a patient the TRS needs to utilize background information to effectively understand/ use some of the information obtained. TRS needs some basic understanding about patients (age, education level, diagnosis, family, etc.). Important to gain an understanding of the patient’s past medical history. Multicultural considerations such as the patient’s cultural belief system are also important to keep in mind when assessing a patient. A TRS needs to “develop cultural self-awareness, use interpreters/translators and involve the family network” to fully understand the implications of the assessment.
Definition of Assessment
identifying and obtaining data from many sources, data collection and analysis in order to determine problems &/or needs.
Types of Functional Assessments
Comprehensive Evaluation in Recreation Therapy-Psych (CERT-Psych), BANDI-RT assessment and the Functional Assessment of Characteristics for Therapeutic Recreation (FACTR).
Comprehensive Evaluation in Recreation Therapy-Psych (CERT-Psych)
identifies, defines and evaluates behaviors relevant to a person’s ability to successfully integrate into society using social interaction skills. One of the most widely used assessments in the field of recreational therapy, this 25-question test takes just 5 minutes to score after observing a patient in a group activity. Each assessment sheet can be used up to 10 times with a single patient. Interrater reliability tested. Agreement between therapists for 38 clients ranged from 67% to 100% and averaged 91%. For psychiatric settings, short term acute care. 3 areas of observation; 1) general; 2) individual performance; 3) group performance
Buettner Assessment of Needs, Diagnoses and Interests for Recreation Therapy in Long-Term Care (BANDI-RT) Assessment
This assessment is designed to follow the MDS 3.0 and to help the practicing RT review all relevant areas of function and design a RT Care Plan. The minutes and days of RT should be documented in Section O for eligible residents.
Functional Assessment of Characteristics for Therapeutic Recreation (FACTR)
Examines functional skills for leisure involvement: 1) Physical; 2) Social/emotional and 3) Cognitive. a screening tool used to determine a client’s needs related to his/her basic functional skills and behaviors. The FACTR measures eleven areas in each of three domains: Physical, Cognitive, and Social/Emotional. It usually takes less than 20 minutes per client to administer and score. This tool helps prioritize treatment interventions and is useful for non-credentialed staff and new therapists who lack extensive clinical experience.
Types of Leisure Assessments & Checklists
Leisure Diagnostic Battery (LDB), Leisure Competence Measure (LCM), and the Leisurescope Plus.
Leisure Diagnostic Battery (LDB)
Measures leisure attitudes, control & playfulness. Measures extent of perceived freedom in leisure & current level of leisure functioning; areas in need of improvement and impact of leisure services. Section 1: perception of leisure; Section 2: barriers to leisure. 5 components: 1) perception of freedom in leisure; 2) perceived leisure control; 3) leisure needs; 4) depth of involvement and 5) playfulness. Consists of 2 forms: Long form and Short form. Within the long and short form, there are 2 versions, one for adolescents and one for adults. Long form consists of 8 scales- A=Perceived leisure competence Scale, B= Perceived leisure control scale, C= Leisure needs scale, D= Depth in involvement in leisure scale, E= playfulness scale, F= Barriers to leisure involvement scale, G=leisure preferences inventory and H=Knowledge of leisure opportunities test.
Leisure Competence Measure (LCM)
Intended to measure functional skills, knowledge and behavior related to leisure functioning. 7 scales used to measure leisure competence include: leisure awareness, leisure attitudes, leisure skills, social appropriateness, group interaction skills, social contact and community-based participation. Scales were created to align w/ the Functional Independence Measure, a tool widely used in physical medicine. The LCM is a standardized instrument designed to measure outcomes in recreational therapy. It consists of eight subscales: leisure awareness, leisure attitude, leisure skills, cultural/social behaviors, interpersonal skills, community integration skills, social contact, and community participation. It works for both screening and full client evaluation. The LCM will objectively measure change in client functioning over time; provide a basis for evidence-based decision making; guide client-centered goal setting and recreational therapy intervention; provide a mechanism for program evaluation; help ensure compliance with CARF, JCAHO, and CCHSA standards; and provide accountability data to funding sources, administrators, and inter-disciplinary teams.
Leisurescope Plus
The Leisurescope Plus testing kit helps the therapist quickly identify: 1. Areas of high interest; 2. Emotional motivation for participation and 3. A patient’s need for high arousal experiences. For adults; Teenscope for adolescents. Preferences are divided into 9 categories (game, music, art). Clients respond after viewing “collages” (pictures on cars or slides) Which do they like better? Validity & reliability studies reported.
Leisure Activity Blank (LAB)
Measures past leisure participation & intentionality of future involvement through a three (3) point rating scale. Leisure participation categories include Mechanics, Sports. Past involvement = 6 categories; future = 8 categories. Manual includes instructions, validity & reliability information.
Leisure Barriers Inventories (LBI)
Examines leisure barriers in 8 categories (time, money, transportation, partners, etc. client responds to 48 items on 3 point scale (agree, don’t know, disagree)
Recreation Behavior Inventory (RBI)
to assess clients cognitive, sensory and perceptual motor skills as prerequisite to leisure participation. 87 behaviors to be observed during 20 activities, rated on a 3 point scale. Intended for children but, reportedly used in psychiatric and long term care settings.
State Technical Institute Assessment Process (STIAP)
Adults with physical disabilities, measures general scope of leisure activity skills in order to provide a basis for program decision making regarding a more balanced & leisure skill repertoire.
Leisure Motivation Scale (LMS)
measure motivation in leisure skills: 1. Intellectual; 2. Social; 3. Competency/mastery and 4. Stimulus/avoidance.
Life Satisfaction Scale (LSS)
to measure the participant’s perceived life satisfaction. 5 Dimensions of Satisfaction:1) pleasure vs. apathy; 2) determination; 3) difference between desired and achieved goals; 4) mood at time of assessment and 5) self concept.
Other Types of Assessments
Functional Independence Measure (FIM), American Spinal Injury Association Scale (ASIA) and the Children’s Coma Scale, which are used primarily in rehabilitation units and hospitals.
Functional Independence Measure (FIM)
Measures the level of a patient’s disability and indicates how much assistance is required for the individual to carry out activities of daily living. The Functional Independence Measure (FIM) scale assesses physical and cognitive disability. This scale focuses on the burden of care – that is, the level of disability indicating the burden of caring for them. Items are scored on the level of assistance required for an individual to perform activities of daily living. The scale includes 18 items, of which 13 items are physical domains based on the Barthel Index and 5 items are cognition items. Each item is scored from 1 to 7 based on level of independence, where 1 represents total dependence and 7 indicates complete independence. The scale can be administered by a physician, nurse, therapist or layperson. Possible scores range from 18 to 126, with higher scores indicating more independence. Alternatively, 13 physical items could be scored separately from 5 cognitive items. Dimensions assessed include: grooming, eating, bathing, upper and lower body dressing, toileting, bladder management, bowel management, bed to chair transfer, toilet transfer, shower transfer, locomotion (ambulatory or wheelchair level), stairs, cognitive comprehension, expression, social interaction, problem solving and memory. FIM Scoring Criteria- NO HELPER REQUIRED: Score 7- complete independence, Score 6- modified independence (patient requires use of a device, but no physical assistance),HELPER (MODIFIED DEPENDENCE) Score 5- supervision or setup, Score 4-minimal contact assistance (patient can perform75% or more of the task), Score 3-moderate assistance (patient can perform 50% to 74% of the task). HELPER (COMPLETE DEPENDENCE) Score 2- maximal assistance (patient can perform 25% to 49% of tasks). Score 1- Total assistance (patient can perform less than 25% of the task or requires more than 1 person assist). Score 0- activity does not occur.
American Spinal Injury Association Scale (ASIA)
The ASIA is a multi-dimensional approach to categorize motor and sensory impairment in individuals with SCI. It identifies sensory and motor levels indicative of the most rostral spinal levels demonstrating “unimpaired” function currently on its 6th edition. 5 point ordinal scale, based on the Frankel scale, classifies individuals from A” (complete SCI) to “E” (normal sensory and motor function): A: complete. No sensory or motor function is preserved in the sacral segments S4-S5. B: sensory incomplete. Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5 (light touch, pin prick at S4-S5 or deep anal pressure), AND no motor function is preserved more than three levels below the motor level on either side of the body. C: motor incomplete. Motor function is preserved below the neurological level and more than half of key muscle functions below the single neurological level of injury (NLI) have a muscle grade less than 3.
D: motor incomplete. Motor function is preserved below the neurological level and at least half of key muscle functions below the NLI have a muscle grade of 3 or greater. E: normal. If sensation and motor function as tested with the ISNCSCI are graded as normal in all segments, and the patient had prior deficits, then the AIS grade is E. Someone without an initial SCI does not receive an AIS grade. Twenty-eight dermatomes are assessed bilaterally using pinprick and light touch sensation and 10 key muscles are assessed bilaterally with manual muscle testing. The results are summed to produce overall sensory and motor scores and are used in combination with evaluation of anal sensory and motor function as a basis for the determination of AIS classification. AIS scores are considered essential when classifying persons with SCI as to their neurological status. AIS scores are routinely collected in administrative databases such the Model Systems and CIHI National Rehabilitation Reporting System.
Children’s Coma Scale
One of the components of the Glasgow coma scale is the best verbal response which cannot be assessed in nonverbal small children. A modification of the original Glasgow coma scale was created for children too young to talk. Parameters: (1) eyes opening (2) best verbal or nonverbal response (depending on development status) (3) best motor response. Eye opening scores- Spontaneously=4, To verbal stimuli=3, To pain=2 and Never=1. Nonverbal children/Best verbal response- Smiles oriented to sound follows objects interacts=5, Consolable when crying and interacts inappropriately=4, Inconsistently consolable and moans; makes vocal sounds=3, Inconsolable irritable and restless; cries=2, No response=1. Verbal children/Best verbal response (as in Glasgow scale)- Oriented and converses=5, Disoriented and converses=4, Inappropriate words=3, incomprehensible sounds=2, No response=1. Best motor response- Obeys commands=6, Localizes pain=5, Flexion withdrawal=4, Abnormal flexion (decorticate rigidity)=3, Extension (decerebrate rigidity)=2, No response=1. Children’s coma scale = (score for eye opening) + (score for best nonverbal or verbal response) + (score for best motor response). Interpretation: minimum score is 3 which has the worst prognosis, maximum score is 15 which has the best prognosis, Scores of 7 or above have a good chance for recovery and Scores of 3-5 are potentially fatal especially if accompanied by fixed pupils or absent oculovestibular responses or elevated intracranial pressure. Normal children under 5 years may have lower scores than adults because of reduced best verbal and motor responses.
In order to receive Medicare reimbursement, inpatient physical rehabilitation hospitals and units are required to use the…
Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI). The Functional Independence Measure (FIM) also is imbedded within the IRF-PAI. Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI).
Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)
assessment data collected on all Medicare Part A fee-for-service patients who receive services under Part A from an inpatient rehabilitation facility (IRF) at admission and upon discharge. IRF-PAI items address the physical, cognitive, functional, and psychosocial status of the IRF patients. The data collected for IRF-PAI is used for quality of care purposes and items were developed primarily for IRF prospective payment system (PPS).
In many long-term care facilities, professionals may use these types of assessment tools…
Global Deterioration Scale (GDS), Mini-Mental State Examination and for Medicare reimbursement they must use the Minimum Data Set for Resident Assessment and Care Screening (MDS).
Global Deterioration Scale (GDS)
A psychiatric tool charting stages of dementia. The scale sets out seven (7) stages: 1) Normal; 2) Objectively normal but complaints of mild memory loss; 3) Mild cognitive impairment; 4) Early dementia; 5) Moderate dementia, 6) Moderately severe dementia; and 7) Severe dementia. According to the GDS, the ability to, live independently is compromised as of the 4th stage. “Complex care” is the usual care for those in stages 6 or 7. The Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg, provides caregivers an overview of the stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer’s disease. It is broken down into 7 different stages. Stages 1-3 are the pre-dementia stages. Stages 4-7 are the dementia stages. Beginning in stage 5, an individual can no longer survive without assistance. Within the GDS, each stage is numbered (1-7), given a short title (i.e., Forgetfulness, Early Confusional, etc. followed by a brief listing of the characteristics for that stage. Caregivers can get a rough idea of where an individual is at in the disease process by observing that individual’s behavioral characteristics and comparing them to the GDS. Level 1= No cognitive decline- No subjective complaints of memory deficit. No memory deficit evident on clinical interview. Level 2= Very mild cognitive decline (Age Associated Memory Impairment)- Subjective complaints of memory deficit, most frequently in following areas: (a) forgetting where one has placed familiar objects; (b) forgetting names one formerly knew well. No objective evidence of memory deficit on clinical interview. No objective deficits in employment or social situations. Appropriate concern with respect to symptomatology. Level 3= Mild cognitive decline (Mild Cognitive Impairment)- Earliest clear-cut deficits. Manifestations in more than one of the following areas: patient may get lost traveling to an unfamiliar location, coworkers become aware of person’s relatively poor performance, word and name finding deficit becomes evident to intimates; patient may read a passage or a book and retain relatively little material; patient may demonstrate decreased facility in remembering names upon introduction to new people, patient may have lost or misplaced an object of value, concentration deficit may be evident on clinical testing. Objective evidence of memory deficit obtained only with an intensive interview. Decreased performance in demanding employment and social settings. Denial begins to become manifest in patient. Mild to moderate anxiety accompanies symptoms. Level 4= Moderate cognitive decline (Mild Dementia)- Clear-cut deficit on careful clinical interview. Deficit manifest in following areas: (a) decreased knowledge of current and recent events; (b) may exhibit some deficit in memory of ones personal history; (c) concentration deficit elicited on serial subtractions; (d) decreased ability to travel, handle finances, etc. Frequently no deficit in following areas: (a) orientation to time and place; (b) recognition of familiar persons and faces; (c) ability to travel to familiar locations. Inability to perform complex tasks. Denial is dominant defense mechanism. Flattening of affect and withdrawal from challenging situations frequently occur. Level 5= Moderately severe cognitive decline (Moderate Dementia)- Patient can no longer survive without some assistance. Patient is unable during interview to recall a major relevant aspect of their current lives, e.g., an address or telephone number of many years, the names of close family members (such as grandchildren), the name of the high school or college from which they graduated. Frequently some disorientation to time (date, day of week, season, etc.) or to place. An educated person may have difficulty counting back from 40 by 4s or from 20 by 2s. Persons at this stage retain knowledge of many major facts regarding themselves and others. They invariably know their own names and generally know their spouses’ and children’s names. They require no assistance with toileting and eating, but may have some difficulty choosing the proper clothing to wear. Level 6= Severe cognitive decline (Moderately Severe Dementia)- May occasionally forget the name of the spouse upon whom they are entirely dependent for survival. Will be largely unaware of all recent events and experiences in their lives. Retain some knowledge of their past lives but this is very sketchy. Generally unaware of their surroundings, the year, the season, etc. May have difficulty counting from 10, both backward and, sometimes, forward. Will require some assistance with activities of daily living, e.g., may become incontinent, will require travel assistance but occasionally will be able to travel to familiar locations. Diurnal rhythm frequently disturbed. Almost always recall their own name. Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment. Personality and emotional changes occur. These are quite variable and include: (a) delusional behavior, e.g., patients may accuse their spouse of being an impostor, may talk to imaginary figures in the environment, or to their own reflection in the mirror; (b) obsessive symptoms, e.g., person may continually repeat simple cleaning activities; (c) anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur; (d) cognitive abulla, i.e., loss of willpower because an individual cannot carry a thought long enough to determine a purposeful course of action. Level 7= Very severe cognitive decline (Severe Dementia)- All verbal abilities are lost over the course of this stage. Frequently there is no speech at all -only unintelligible utterances and rare emergence of seemingly forgotten words and phrases. Incontinent of urine, requires assistance toileting and feeding. Basic psychomotor skills, e.g., ability to walk, are lost with the progression of this stage. The brain appears to no longer be able to tell the body what to do. Generalized rigidity and developmental neurologic reflexes are frequently present.
Mini-Mental State Examination (MMSE)
A brief psychologic test designed to differentiate among dementia, psychosis, and affective disorders. It may include ability to count backward by7s from 100, to identify common objects such as a pencil and a watch, to write a sentence, to spell simple words backward, and to demonstrate orientation by identifying the day, month, and year, as well as town and country. The Mini Mental State Examination (MMSE) is the most commonly used test for complaints of memory problems. It can be used by clinicians to help diagnose dementia and to help assess its progression and severity. The MMSE is a series of questions and tests, each of which scores points if answered correctly. If every answer is correct, a maximum score of 30 points is possible. The MMSE tests a number of different mental abilities, including a person’s memory, attention and language. The MMSE is a tool that is used by clinicians such as a GP or a neuropsychologist (a psychologist who specializes in the brain and its function) to help them diagnose and assess dementia. It is only one part of these processes and clinicians will often consider a person’s MMSE score alongside the results of other tests. In general, scores of 27 or above (out of 30) are considered normal. However, getting a score below this does not always mean that a person has dementia - their mental abilities might be impaired for another reason or they may have a physical problem such as difficulty hearing, which makes it harder for them to take the test. The MMSE can also be used to assess changes in a person who has already been diagnosed with dementia. It can help to give an indication of how severe a person’s symptoms are and how quickly their dementia is progressing. On average, people with Alzheimer’s disease who are not receiving treatment lose two to four MMSE points each year. The MMSE is made up of a range of different questions and tests. Below are four sample questions that give an indication of the style of the MMSE.1 Orientation to time-‘What is the date? 2 Registration- ‘Listen carefully. I am going to say three words. You say them back after I stop. Ready? Here they are… apple [pause], penny [pause], table [pause]. Now repeat those words back to me.’[Repeat up to 5 times, but score only the first trial.] 3 Naming-‘What is this?’ [Point to a pencil or pen.] 4 Reading- ‘Please read this and do what it says.’ [Show examinee the following words on the stimulus form: Close your eyes.]
Minimum Data Set (MDS)
Recording format for a standardized assessment tool required by the federal government in long-term care facilities. The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive assessment for all residents in a Medicare and/or Medicaid-certified long-term care facility. The MDS contains items that measure physical, psychological and psychosocial functioning. The items in the MDS give a multidimensional view of the patient’s functional capacities and helps staff to identify health problems. Part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident’s functional capabilities and helps nursing home staff identify health problems.
In psychiatric settings, the TRS needs to understand these assessments…
Multiaxial Assessment System, specifically the Global Assessment of Functioning (GAF).
Multiaxial Assessment System
AXIS 1-5-DSMIV: Axis I Clinical Disorders/ Other Conditions That May Be a Focus of Clinical Attention: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence (excluding Mental Retardation, which is diagnosed on Axis II), Delirium, Dementia, and Amnestic and Other Cognitive Disorders, Mental Disorders Due to a General Medical Condition, Substance-Related Disorders, Schizophrenia and Other Psychotic Disorders, Mood Disorders, Anxiety Disorders, Somatoform Disorders, Factitious Disorders, Dissociative Disorders, Sexual and Gender Identity Disorders, Eating Disorders, Sleep Disorders, Impulse-Control Disorders Not Elsewhere Classified, Adjustment Disorders. Axis II Personality Disorders Mental Retardation: Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder, Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder, Avoidant Personality Disorder, Dependent Personality Disorder, Obsessive-Compulsive Personality Disorder, Personality Disorder Not Otherwise Specified and Mental Retardation. Axis III General Medical Conditions: Infectious and Parasitic Diseases, Neoplasms, Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders, Diseases of the Blood and Blood-Forming Organs, Diseases of the Nervous System and Sense Organs, Diseases of the Circulatory System, Diseases of the Respiratory System, Diseases of the Digestive System, Diseases of the Genitourinary System, Complications of Pregnancy, Childbirth, and the Puerperium, Diseases of the Skin and Subcutaneous Tissue, Diseases of the Musculoskeletal System and Connective Tissue, Congenital Anomalies, Certain Conditions Originating in the Perinatal Period, Symptoms, Signs, and Ill-Defined Conditions and Injury and Poisoning. Axis IV Psycho-social and Environmental Problems: Problems with primary support group, Problems related to the social environment, Educational problems, Occupational problems, Housing problems, Economic problems, Problems with access to health care services, Problems related to interaction with the legal system/crime and other psychosocial and environmental problems. Axis V Global Assessment of Functioning: Global Assessment of Functioning (GAF) Code: 91-100-Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms. 81-90-Absent or minimal symptoms (e.g. mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members). 71-80-If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). 61-70- Some mild symptoms (e.g. Depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. 51-60- Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g. few friends, conflicts with peers or co-workers). 41-50- Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). 31-40- Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgement, thinking, or mood (e.g. depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). 21-30- Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g. sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends). 11-20- Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute). 1-10- Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear-cut expectation of death. 0- Inadequate information. DSM-5 combines the first three axes into one that contains all mental and other medical diagnoses. Doing so removes artificial distinctions among conditions, benefitting both clinical practice and research use. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has dropped the multiaxial diagnostic system and moved to a dimensional system of diagnostic classification. This change means that there is no longer a separate Axis V or specific diagnostic category for assessment of functioning. In addition, the Global Assessment of Functioning Scale (GAF), the previously endorsed numerical rating scale used for assessment of functioning and reported on Axis V, has been eliminated.
Global Assessment of Functioning (GAF)
a numeric scale (1 through 100) used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living.
Other sources of assessment data
Ex.- records or charts, staff, support system
•Sometimes it is not possible for the patient to provide all the necessary information for a complete assessment. *Important as an entry-level TRS you know to use other sources of assessment information, such as medical records, educational records, interviews w/ family and friends, and other members of the treatment team.
Criteria for selection and/or development of assessment
purpose, reliability, validity, usability, and practicability.
•In order to select the most appropriate assessment tool, you need to have an understanding of reliability, validity, usability, and practicability.
•Reliability- Refers to the estimate of the consistency of measurement.
•Validity- Refers to the extent to which the assessment meets its intended purpose. Does the assessment measure what is necessary to place the patient in the appropriate program and has it been tested on the population in the agency for which it is intended?
•Usability & Practicability- Involves whether the assessment is “doable” as far as time constraints, ease of use, cost, availability, and staff knowledge and ability.
Implementation of assessment
•When implementing the assessment, it is important that the therapist completely understands the assessment tool and is able to administer it with ease following the directions that were given to ensure test reliability. TRS needs to easily use strategies of interviews, observations, self-administered questionnaires and record reviews depending on the information desired.
7 Step Process For The Assessment Implementation Process
1) Reviewing the assessment protocol.
2) Preparing for the assessment.
3) Administering assessment to the patient.
4) Analyzing or Scoring the assessment.
5) Interpreting results for placement into programs.
6) Documenting results of assessment.
7) Reassessing the patient as necessary/monitoring progress.
Competencies under assessment procedures, observation, interviewing and functional skills testing are important knowledge items in this category. Observation, interviewing and functional skills testing are 3 of the most important tools an entry-level TRS can have.
Methods of Assessment
Observation: Casual; engage in on a daily basis.
Skilled: knowing what to look for & what to expect, learn to disregard irrelevant information.
Naturalistic: no attempt to manipulate or change natural environment, personal appearance, posture & movement, manner, facial/expressions.
Specific goal observation: assess a well defined behavior. Standardized observation: Reliability: produces stable results over time and Validity: measures what it is designed to measure. What to look for (observations)- 1) general appearance, 2) motor activity, 3) interpersonal interaction, 4) body language.
Subjective Data: what “client” tells you.
Objective Data: anything else you or others observe. ASSESSMENT: Always ask open-ended questions during assessment. (1) Multi-disciplinary and a gathering of information; collect information on leisure interests, do clients value leisure & recreation? Do they value and understand it & what it means in their life? Can they identify their own personal resources, talents, skills, interests, equipment & supplies? Money, family, transportation, likes & dislikes? Can these skills be transferred to their present lifestyle? Can they identify leisure partners? Can they describe a healthy leisure lifestyle? Do they have knowledge of leisure resources? Do they have the ability to make decisions and take responsibility for their leisure involvement? who does client interact with? how do others react to the client? what is the nature of the verbal/no-verbal communications?
Systematic observation (behavorial observation)
the most frequently used type of observation in the field today. It standardizes the procedures used including identifying the targeted behavior, developing specific recording techniques for the observation of the targeted behavior and scoring and interpreting the observation.
Different Types of Recording Methods/Techniques In TR
Checklists, rating scales, anecdotal records (a description of behavior; a reporting of observed behavioral incidents) along with frequency or tally methods (An exact count of how many times a specific behavior occurs) and duration (measuring time), interval and instantaneous time sampling (used to gather quantitative data regarding how many times ADHD behaviors are recorded during a 10-minute time period (frequency) techniques.
frequency or tally methods
An exact count of how many times a specific behavior occurs
duration observation
measuring time
interval and instantaneous time sampling
used to gather quantitative data regarding how many times ADHD behaviors are recorded during a 10-minute time period (frequency) techniques.
Interview techniques for assessment
Entry-level TRS needs to understand and use interview skills, keeping in mind the purpose of the assessment interviews, which is to gather information about a client.
Most TRSs use the directive approach to interviewing, which involves a series of questions targeted for a specific end result. Different types of questions can be asked in the interview, ranging from close-ended questions (ex., “What is your favorite leisure activity?” to open-ended questions (ex., “Tell me what you like to do for fun”.).
•A rule of thumb for interview questions is that they should directly relate to the purpose of the interview/assessment.
•Every interview should have an opening, a body of the interview and a closing.
•All TR departments should have developed an interview protocol to use in assessment to ensure everyone is collecting the necessary information in the same way.
Functional skills testing for assessment
- For functional skills testing, the TRS needs to be able to use mechanical measurement tools, (ex.- stop-watches, measuring tapes, or other objects) that will provide standardized information.
- Functional abilities should be considered baseline abilities that are a prerequisite to typical leisure behavior that most individuals without disabilities would possess. Functional skills include, cognitive ability, social skills, communication skills, behavior skills, motor skills) related to independent leisure functioning and community reintegration as well as the assessment of leisure behavior (e.g., interest, satisfaction, values, attitudes, motivation).
Sensory assessment
Ex.- vision, hearing, tactile
Sensory domain is a patient’s ability to see and hear. Can he/she see to read? Is it functional sight, or is the patient essentially blind? Can the person hear? How much can he/she hear? Is it better to sit to one side of the patient when working with him/her because his or her hearing is better on one side? Also, how is the person in relationship w/ tactile abilities? Are they tactile defensive?
Cognitive assessment
Ex.- memory, problem solving, attention span, orientation, safety awareness)
When considering a patients’/clients’ cognitive domain it is important to look at his/her functional abilities. In general, a TRS is concerned with a patient’s memory, both long and short term, his/her ability to solve problems and his/her attention span. Also concerned with our patient’s orientation, is he/she oriented to person, place and time? Another big concern is safety awareness. Is the patient aware of danger and can he/she take care of him/herself in public? All of these are examples of functional skills that can be assessed in the cognitive domain.
•Cognitive examples of functional abilities include memory, orientation, attention span, reading ability, ability to follow directions and other mental functions that are a prerequisite for leisure behavior.
Social assessment
Ex.- communication/interactive skills, relationships
A unique assessment. TRS is concerned with whether the patients have good communication/ interactive skills. Can they initiate a conversation, maintain a conversation and respond appropriately to questions? Are they able to maintain friendships and can they develop a support network? All of these are examples of functional skills in the social domain.
•Social functional abilities include such targets as those fundamental behaviors that meet minimal social expectations. Baseline social skills need to be taught to some client groups of TR services prior to attempting higher level social skills, such as relationship building, taught within the leisure education component.
Physical assessment
Ex.- fitness, motor skills function
In the physical domain the behaviors are more explicit. TRS assess a person’s fitness, gross motor and fine motor skills. Assess patient’s eye-hand coordination and other physical functional skills.
Physical functional abilities include coordination, endurance, mobility, strength, hand-eye coordination, fine and gross motor sills and other basic functions that are a prerequisite to participation in leisure activities.
Gross motor skills
the ability to use large muscle groups that coordinate body movements involved in activities such as walking, running, jumping, throwing, and maintaining balance.
Fine motor skills
the use of precise coordinated movements in such activities as writing, buttoning, cutting, tracing, or visual tracking.
Affective assessment
Ex.- attitude toward self, expression
•Affective domain is a little more difficult to assess.
•When assessing emotional skills, a TRS wants to know what the patient’s attitude is toward self. How does he/she express emotions? Can he/she express anger appropriately? These are considered functional skills in the affective/emotional domain.
•Emotional or affective functional abilities include anger management, emotional control and emotional expression.
Examples of Disabilities or Impairments and Potential Deficits that Result from Each Condition
- Child w/ Behavior Disorder- Social skills deficits (hitting, kicking, scratching, biting) to the degree that s/he cannot participate w/ others in a socially appropriate manner. Until these disruptive behaviors are minimized or replaced by appropriate social behaviors, the child will not be very successful in learning about or experiencing leisure. These deficits need to be reduced, at least to an acceptable minimal level, prior to the client’s involvement with others.
- Teen who is At-risk- Emotional and/or affective skill deficits (lack of impulse control and risk assessment, decreased empathy and perspective-taking skills, inability to predict consequences of actions). Attention to these emotional and affective limitations may greatly enhance the individual’s ability to interact more appropriately w/ others, problem solve and make healthy, life-affirming decisions. These are important skills for maintaining social relationships and getting involved in leisure activities.
- Young Adult w/ Brain Injury- Cognitive skill deficits (attention span, sequencing, memory) to the extent the s/he has difficulty w/ age-appropriate activities. Until this person’s cognitive skill deficits can be improved or compensated for, it will be difficult for the person to learn or relearn recreation activities, especially those that involve, rules, strategies and specific modes of play.
- Middle-Aged Adult w/ Depression- Physical skill deficits (lack of energy and activity tolerance, decreased stamina and cardiovascular capacity, muscle atrophy) that need to be addressed before the individual can actively participate in leisure or other life activities.
4 Behavioral Domains
Cognitive: intellectual processes of learning or knowing learning capability; decision making; follows directions, short term memory, problem solving, concentration/attention span, attention to details. Psycho/Social: psychological & social functioning; Independence, ability to form relationships, frustration tolerance, self concept, evaluate and value oneself. Engagement : 1st phase of social interaction. Affect: outward expression of feeling. Social appropriateness: manners, etiquette, hygiene, & dress. Social anxiety: confidence, competent, appear to be anxious, tense. Physical: Physical functioning in the environment. Overall coordination: functioning of sensory system & body parts. Activity level: intensity of sensory system & body parts. Strength: capacity for exertion, flexibility, bending/stretching Balance> Endurance> Physical Health: Ability to right self>Withstand exertion over time>mobility> & overall state of wellness. Affective: facial expression, body gesture, self-esteem.
Leisure Assessment
Ex.- barriers, interests, values, patterns/skills, knowledge
Necessary that a TRS assess a patient’s leisure functioning. What leisure barriers does the person have? What are his/her leisure interests? What are his/her leisure attitudes? What leisure skills does the person have, and is he/she well rounded? What does the person know about leisure and is he/she able to get his/ her leisure needs met? Some of the areas to be assessed in leisure domain.
Typical Leisure Barriers to Adult Leisure Behavior
Attitude that leisure is not important, lack of planning time or skills devoted to leisure, inability to make leisure-related decisions, fear of entering new situations or facilities, lack of leisure and recreation skills, lack of motivation to seek new alternatives, lack of lifelong leisure skills, negative feelings associated with playing instead of working, too tired to play, lack of sense of competence in relation to leisure, lack of spontaneity; over planning, decrease in time (real or perceived) available for leisure and limited physical ability. Inappropriate social skills, lack of internal locus of control, concepts of “acceptable” age-related adult leisure behavior, lack of knowledge of recreation facilities and events, lack of experience in seeking leisure information, refusal to take responsibility for personal leisure, perceived inability to effect personal change, lack of financial means, limited knowledge of leisure opportunities, lack of reliable transportation, lack of ability to establish leisure as a priority, inability to control anger, fear of rejection, lack of personal hygiene skills, inability to appropriately manage emotions, inability to plan for leisure expenses, inability to manage time, lack of knowledge of transportation options, inability to attend to a task, lack of physical coordination, decreased mobility due to disability or distance, lack of awareness of personal disabilities and strengths, lack of leisure partners and inability to manage stress.
Typical Benefits or Outcomes of TR Services
Increased emotional control, improved physical condition, decreased disruptive behavior in group situations, improved short and long term memory, decreased confusion and disorientation, decreased symptoms of anxiety and depression, improved mobility in community environments and situations, improved health indicators such as bone density, heart rate and joint mobility, improved coping and adaptation skills, increased awareness of barriers to leisure, improved ability to prevent, manage, and cope w/ stress, improved adjustment to disability and illness, improved understanding of importance of leisure to a balanced lifestyle, improved communication among family members, improved intrinsic motivation to participate in meaningful leisure activities, increased ability to use assertiveness skills in a variety of social situations, improved ability for planning, making choices, and taking responsibility, improved ability to locate leisure partners for activity involvement, improved knowledge of agencies and facilities that provide recreation services, greater belief in ability to produce positive outcomes in leisure, improved knowledge of leisure opportunities in community, increased life and leisure satisfaction and increased ability to develop and maintain social support networks.
Leisure Patterns/Skills
A child’s leisure experiences, particularly in their early years, are often a direct reflection of the values and preferences of the parents and other family members, as well as teachers and friends. We all know or at least can reasonably guess at the amount of peer pressure that will be exerted on your child when he or she becomes a teenager! If you are concerned about your child’s leisure future, you are not alone. The expression “it takes a community to raise a child” is especially true when talking about the leisure future of children - all children. Technology has a huge impact on the type of recreation pursued by children today. Now information about anything in the world can be accessed over the internet instantly. Telephones smaller than a child’s fist, which are wireless, take pictures and videos, play games, and allow instant communication anytime of day. Video games, so realistic that you can almost touch the figures on the TV monitor replace board games, comic books, and Saturday morning cartoons.
Leisure Education
A broad category of services that focus on leisure-related skills, attitudes & knowledge. For leisure to add to one’s well-being and not just take up time. Affirms what you know & what you can do. Five Target Areas: 1) Self Awareness: more knowledgeable about yourself; understanding one’s own attitude toward leisure. 2) Decision Making: requires knowledge of opportunities; what would be the result of consequence of a decision. 3) Leisure Skill Development: ability to do alone or with another person indoors, outdoors. a person should have the skills that they value & society values. 4) Resource Awareness & Utilization: Need to process the ability to access and gain information & resources. 5) Social Skills Development: a) initiation skills: greeting someone, exchange information, offer inclusion into group b) maintenance skills: effective communication; to give positive attention and approval. c) conflict resolution skills: to negotiate, to be a “good sport;” to use persuasion, to compromise. Program Structures: One to one, group, instructional classes, competition, specific events, mass activities, open facility, drop-in.
