Practice of TR/RT

Question 1

Concepts or TR

Answer 1

Treatment of the “whole person” which also fits into the holistic health model - treating the whole person and all their well-being, as well as picking rec experiences that can attribute to their QofL.
TR includes special Rec and inclusive Rec. (because of ADA all comm rec programming should be offering inclusive).
As a TRS we use recreation as a Tx modality, used for purposeful interventions, by using prescribed activities/experiences for a physical, social, emotional, cognitive, or spiritual change.
Can be used in comm, school, or health care setting.
Process specific, not setting!

Question 2

Models of TR

Answer 2

Leisure Ability Model: oldest, most widely utilized. Functional Intervention, Leisure Ed., and Recreation Participation. Ultimate goal is satisfying leisure lifestyle, or the independent functioning of cl in leisure of their choice. TR assess need, provides necessary intervention/leisure ed./or rec. participation, and then evaluates the degree to which the cl met the outcomes.

Health Protection/Health Promotion: a)helps cl recover from threats to health and b)helps cl achieve optimal health - all through the use of actvities, rec, and leisure. This model includes 4 concepts: humanistic perspective, high level wellness, stabilization and actualization tendencies, and health.

Service Delivery Model: scope of services involved in TR are 4 fold: diagnosis/needs assessment, tx/rehab of problem or need, educational services, and prevention or health promotion activities. Hopefully this shows continuum of service delivery allllll over.

TR Outcome Model: (extension of service delivery model) looking at products, or outcomes, of the delivery of the TR services.

Question 3

Practice Settings

Answer 3

Variety! community recreation, physical rehabilitation centers, psychiatric hospitals, outpatient clinics, day treatment programs, long term care facilities, etc.
TR Process - APIE (D) - Assess, Plan, Intervention, Evaluation, (Discharge). While TR might be trying to transition from clinical to more comm, keep in mind its process, not setting specific!

Question 4

Standards of Practice for TR Profession

Answer 4

Our standards guide our practice.
American Therapeutic Recreation Association (ATRA) gives us stdrds that define TR’s scope of service and helps us measure quality of service delivery.

Question 5

Code of Ethics in TR

Answer 5

Essentially this is a strd of behavior that is expected for all professionals, these are self-regulatory but developed to govern our professional behavior.

Question 6

Current TR Leisure Assessment Instruments

Answer 6

There are lots of published TR and leisure assessment tools out there to be used, while many dprtmts use an agency specific assessment. Range from functional assessments (CERT-Psych) to the leisure checklists (LDB).

Question 7

Other Inventories, Questionnaires, and sources of Assessment

Answer 7

All could be used and would then mean that the TRS should know how to implement them, how to read them, and overall how to use them in regard to cl and tx.

FIM - Functional Independence Measure
ASIA - American Spinal Injury Association Scale
Rancho Los Amigos Scale of Cog Functioning
Glascow Coma Scale
Children’s Coma Scale
IRF-PAI - Inpatient Rehab Facility-Patient Assessment Instrument (used in inpatient physical rehab units)
GDS - Global Deterioration Scale (long term care)
MDS - Minimum Dada Set for Resident Assessment and Care Screening (for medicare in long term care)
GAF - Global Assessment of Functioning (psychiatric settings)

Could also use medical records, interviews w/ family and or friends, and or other members of tx team as sources for more information if its not always possible to get it from cl.

Question 8

Criteria for Selection andor Development of Assessment

Answer 8

most appropriate means the TRS understands
Reliability - consistency of the measurement
Validity - how does assessment meet it’s intended purpose
Usability
Practicability
(is it “doable” meaning it’s use, cost, availability, staff knowledge and ability, etc. all line up as well)

Question 9

Implementation of Assessment

Answer 9

Means we know it and we know how to give it. TRS uses knowledge, tools of observation, interviewing, and functional skills testing to help too.

7 step process:

• review assessment protocol
• prepare for assessment
• administer assessment to cl
• analyze or score the assessment’s results
• interpret results for placement into programs
• document results
• reassess cl as neccessary or monitor progress

Question 10

Behavioral Observation Related to Assessment

Answer 10

Systematic observation is used most frequently. It includes identifying the targeted behavior, developing recording techniques, and scoring and interpreting that behavior.

Others use checklists, rating scales, anecdotal records w/ frequency or tally methods, duration, and interval and instantaneous time sampling techniques.

Question 11

Interview Techniques for Assessment

Answer 11

The purpose here is for the TRS to really understand and use their different interviewing skills with assessment in their minds (gathering more info on cl.).
Directive approach - Q’s for a specific end result
Closed-ended Q’s - which is your fav?
Open-ended Q’s - what do u like to do?
Each Q though, should directly relate to the purpose of the interview or assessment.
Interviews need opening, body, and closing.

Question 12

Functional Skills Testing for Assessment

Answer 12

The TRS using mechanical tools (stop watches, measuring tapes, etc. )
Also see social, physical, cognitive, and emotional domains of assessment for this.

Question 13

Sensory, Cognitive, Social, Physical, Affective, and Leisure Assessments

Answer 13

Sensory - cl’s ability to see and hear and how well

Cognitive - functional abilities, long term and short term memory, problem solving abilities, attention span, orientation to people places or time, etc, and safety awareness and public safety.

Social - communication and interactive skills, does cl initiate and or maintain convos, make friends, respond appropriately to Q’s, etc. support networks, so on.

Physical - cl’s physical fitness, gross and fine motor skills, eye hand coordination, etc.

Affective - emotional domain. cl’s attitude toward self, how they express emotions, anger, etc.

Leisure - leisure functioning of cl, if they have barriers, their attitudes to leisure, interests, etc. are they well rounded or are their needs met through leisure.

Question 14

Impact of Impairment and or Treatment on Cl

Answer 14

TRS needs to recognize the whole picture. Something affecting cl may be affecting whole family, etc. Any secondary conditions or other areas that may be affected too.

Question 15

Interpretation of Assessment and Record of Cl

Answer 15

Interpret the assessment correctly, after it has been administered! Follow models or instruments if necessary. Scores need to be interpreted through norm-referenced criterion if published assessments were used.

Question 16

Documentation of Assessment, Progress, Functional Status, Discharge andor Transition Plan, of Cl

Answer 16

After assessing cl, document it! (tx plan or medical chart). To document, the TRS summarizes necessary facts, include cl’s strengths, weaknesses, process used to collect info, and mutually agreed goals for tx. - Do this is terms of measurable terminology - facts! write in pen and in black, single line dash through mistakes, no venting to others, sign and date every entry, document incidents, write clear!

Documenting could be Narrative (paragraph format), Problem-Oriented Medical Records, POMR (lists), or charting by exception, CBE (charting only changes in functioning and health)- and figure out where to put this TR info. Technology and computers can make differences in how we chart info. Electronic Health Record, EHR, is cl’s computerized health record for easy access to TRS.

Progress notes, periodic updates of cl, progress toward them meeting their tx goals, the frequency, etc.

SOAP, SOAPIE, SOAPIER (usually hospital settings) (progress notes form example)
Subjective: direct quotes from cl
Objective: data gathered by observation
Analysis: interpretation by TRS from SandO
Plan: plan recommended based on S,O,A by TRS
Intervention: specific intervention that was used
Evaluation: how cl responded to that intervention
Revision: changes made in original tx plan

World Health Organization (WHO) made 2 classification systems for TRS.
ICD-10: International Classification of Diseases 10th Ed: used to classify disease and written as code, used for health stats or to compile reports, etc.
ICF:International Classification of Functioning: focuses on classifying by cl’s health and functioning rather than disability, disease, or disorder. uses Likert scale of codes for classifying. (mild-moderate-severe).

Plan for discharge the day the cl arrives! Patient needs to be involved, usually happens when goals are met.

Question 17

Methods of Writing Measurable Goals and Behavioral Objectives

Answer 17

Goals and Objs are written based on cl’s strengths and weaknesses as determined by the assessment. Our job to make them measurable.

Usually we use Blooms taxonomy, a 7 level system. 
Knowledge (lowest level)
comprehension
application
analysis
synthesis
evaluation (highest level)
(Cl's know something, then understand it, then apply it). 

Krathwohl Taxonomy typically used for affective or emotional domain. 5 level :
Receiving
responding
valuing
organization
characterization by value set (highest level)
(Ordered according to principle of internalization (cl’s affect toward object moves from general awareness to internalized affect, where they guide or control behavior)).

Goals flow from cl’s needs and can reflect what they will be able to do at completion of tx plan.

Behavioral objs written based on goal statement. Objs are indicators that goal has been achieved. Sometimes called outcome measures. Must have 3 components:
-conditions that state when or where behavior should occur
-action verb describing expected behavior
-criteria describing how well or often cl should do that behavior.
(shortcuts sometimes used, but not universally accepted)

Question 18

Nature and Diversity of Recreation and Leisure Activities

Answer 18

Range of activities from outdoor to board games to spectator sports to more and more give TR more depth and therefor more knowledge for more diverse programming for cls.
Activities must have direct relationship to cl goal.
Functional Interventions should focus on ability of activity to help cl reach goals, rather than activity for activity’s sake.
Functional Interventions and leisure Eds should be related to problem, skills, or knowledge being addressed
Activity characteristics important for successful implementations of programming.
Cls should be able to place activity in a context order so they can see it’s use and make it applicable over time.
Types of activities for cl’s engagement should be considered.
Programming should be geared toward cl’s outcomes and priorities.
Cl involvement in activities should be enjoyable.

Question 19

Selection of Programs, Activities, and Interventions to Achieve Assessed Needs of Cl

Answer 19

TRS needs to understand their cls, activity-based interventions, and themselves in general.
3 factors influence selection and implementation:
- activity content and process
- cl characteristics
- resource factors
TRS can determine appropriate activities based on cl goals or can use cl goals to pick good activities.
Activity picking could also depend on agencies and their philosophies, space, resources, $, etc.

Question 20

Activity Analysis

Answer 20

TRS should pick activity most appropriate given circumstances of cl population and programming. Using program’s purpose and use is the activity analysis.

This helps us analyze and examine the activity’s physical, social, emotional, and cognitive requirements in order to determine the skills, equipment, and materials necessary to successfully participate in the activity.

Is it best for cl? Will it help them reach their goals?
etc. Activities can also be modified, different assistive techniques, etc.

Question 21

Assistive Techniques and Adaptive Technologies

Answer 21

The TRS can make modifications and determine any necessary assistive techniques or use equipment. Activities are usually modified for either individual participation or to enhance the tx benefit.

Question 22

Modalities and Intervention Techniques

Answer 22

There are many interventions used in TR.
Leisure skill development can help cl’s develop leisure skills through non and traditional activities.
Assertive skills can help cl’s in everyday life and for ppl who have problems expressing their needs or feels. They learn the difference between emotions and how to show them in interactions.
Managing stress is huge bc stress can be a factor in everyone’s life. Relaxation techniques can help here too, these include deep breathing, visualization, stretching, etc.
Coping strategies are also important here, this would be a deliberate process to deal with stressors. Social suport systems are also key.
Re-motivation is used with older adults which encourages the cl to re-establish contact with the outside world through interests, activities, verbal and cognitive skills, etc. This uses a climate of acceptance, a bridge to reality, sharing the world, appreciating the work of the world, and a climate of appreciation.
Reality orientation is used with older adults as well when they are confused, disoriented, or have memory loss. This can use basic facts like time or place to the cl and it can also be in group settings using facts on a board, etc.
Cognitive or Retraining rehabilitation is used for cl’s who have had a traumatic brain injury or a CVA, which could help them regain some cognitive processes like memories or sequences.
Sensory training and stimulation is used to bombard the senses with variety of stimulants. Could be used w/ older adults w/ dementia, or with children with developmental deficits. Basically this uses sensory cues to relate familiar life activities.
Validation intervention can be used w/ older adults who have dementia bc it tries to get the cl to accept their feelings and resolve unfinished business or conflicts. This uses good listening and communication skills in order for it to be successful, allowing the cl. to express their feelings.
Social skills used all over and help the cl when using techniques like modeling, role playing, reinforcement, or even homework to practice real-life situations.
Community reintegration is used all over too by resuming roles and utilizing decision making in the community.

Question 23

Facilitation Techniques and Approaches

Answer 23

Lots of these techniques exist and can include behavior modification and coping skills.
The TRS wants to get the cl. to be better and most successful. If managing behaviors can help the cl, then the TRS should use techniques like positive reinforcement, punishment, modeling, token economies, etc.
Counseling techniques or communication skills are always important; listening as well as all non-verbal behaviors and body language are key here.
Values Clarification techniques can be used in leisure ed and usually involve, choosing, cherishing, and acting on values. The TRS should have cl’s clarify their response, have a group discussion, or use value sheets.

Question 24

Leisure Education

Answer 24

This assist cl’s in fulfilling or re-gaining a whole leisure lifestyle or understanding importance of leisure or learning new leisure skills. This helps in cl’s down time where time is not so managed. They can pick leisure, develop styles, expand knowledge, utilize resources, etc!