The TR Process Flashcards
TR process
without the 4 stages, it is not considered therapeutic .
it
it is systematic process — planed
Leisure and recreation is the modality to affect change
change indicate a purpose
targeted towards a specific population.
the TR process is goal oriented , person- centered and a framework to provide services .
the 4 phases
Assessment - Planning - Implementation - Evaluation
( you are always evaluating and assessing . sometimes you go back and move forward is is not a straight line rather than a circular motion
Why is it important ?
Provides a problem-solving structure to accomplish delivery of effective, customized care
•Involves sequential step-by-step actions directed to achieve stated goals
•Promotes customized care by providing a system to meet specific, unique client needs
•Tailors interventions addressed to the individual’s needs (and not the disease/disability)
•Increases client participation in care (client/therapist collaboration)
it shows that we are not giving recreation just for fun and games.
Person-centered, systematic approach
•Allows delivery of care that is organized, continuous, and systematic
•Goal-directed approach and measurable outcomes
•Accountability through evaluation
•Interrelationship among and between phases—ensures all parts work together •Offers means to interpret/communicate to others how TR contributes to client care
Assessments
gathering and analyzing data . it identifies strength problems needs leisure interests .
What data we choose to gather and how we use data is influenced by conceptual TR model of practice
Clinical reasoning
use own judgement when collecting data to determine what you should get
you should not determine the activity before assessing! ( based on your client’s needs
•Avoiding pre-packaged programs!
• Individualization and person-centered approach • Agency requirements
method of assessment
•Observations
◦ Specific goal observations
◦ Time-Interval Observations( every two hour ) ◦ Standardized observations( checklist )
•Interviews
• Can range from highly structured to very informal
• Some agencies use inventories during interview process
•Secondary sources
• Family members, friends, staff/interdisciplinary team • Medical records/charts
• Social histories
• Other professional assessments/tests
• Progress notes
what info to gather
General Information ( name age ect. ) •International Classification of Function, Disability and Health (ICF) outcome domains • Emphasizes function (rehabilitation) look in psychological , cognitive and spiritual functioning • Body structure/function, participation, environment interests , abilities •Other areas suggested in TR Literature • Biological functioning • Psychological functioning • Socialfunctioning • Spiritual functioning •Strengths Assessment :characteristics, social support and recreational ability • Important—most clients need help in identifying strengths discovery of means
Planning
- Setting Priorities
◦ Identifying needs & professional help required to meet those needs (follows analysis of data
gathered in the assessment phase) - Formulating Goals and Objectives (TPOs, EOs, PMs)
◦ Goals > Flow directly from needs; describe client outcomes (intended results). Stated in BROAD
i want to be healthier
terms
◦ Objectives> Specify clients behaviors related to reaching the goal; break down goals into
measurable behaviours
◦ SMARTGoals
◦ Specific>States one behavior or criteria
◦ Measurable> How to measure the behavior/criteria
◦ Attainable > Realistic
◦ Relevant > Relevant to individuals needs
◦ Time-bound> Objectives are to reach a specific deadline
i want to run 3 times a week by now and the end of april. - Determining strategies or Actions to Meet the Goals
◦ Program is selected (this is the intervention!) online or not
◦ Ideally along with the client
◦ Evidence-Based Practice (EBP): A problem-solving approach that integrates the best evidence
from well-designed studies with a clinician’s expertise and a patient’s preferences and values
◦Considers research findings when developing the intervention plan - Selecting methods to assess progress made towards goals
◦ IMPORTANT: What evaluation procedure(s) will you use? This selection happens in the planning phase, and NOT in the evaluation phase!!
you need to re- assess here
collect data
to make changes
is it successful ?
Implementation
•“Action” Phase
•Skills Required:
◦ Interpersonal
◦ Observational
◦ Decision-making
• Technical skills
Characteristics of Therapeutic Activities
1. Goal Directed
2. Require participants to actively participate
3. Have meaning and value to the client
4. Offer potential for pleasure and satisfaction
5. Are selected with the guidance of the recreational therapist
with client
needs an goal interest and strengths
Evaluation
•Same methods as initial assessment
• Re-assessment
•Review Progress Notes
•Interview Clients
•Meet with interdisciplinary team to discuss the client
to evaluate wether or not the activity was successful
Documentation
If it’s not documented, it didn’t happen!
◦ Means of communication
◦ Determining quality of services
◦ Accountability/transparency
clients can request it
Clinical vs Community
◦ Client chart, progress notes, discharge summaries etc.
◦ Log books, report cards, certificates, etc.
•Form of documentation
• Agency requirements
• SOAP(E), DARE, charting by exception…
therapeutic relationship is
it is essential
What it is : Does not involve resolving problems for clients
•Assisting clients to assume responsibility to cope with their problems and develop competence
to meet future challenges
•The general goal is enhanced wellness, including improved functioning and well-being
•A safe environment for the client to express their thoughts and feelings
•Goal-directed outcome focused on client needs
•Empathetic understanding, a genuine approach and nonjudgmental acceptance of clients
what therapeutic relationship is not
•Client becoming dependent on the practitioner
•The helper does not take power and responsibility away from the client
• A relationship that involves the dominance of one over another leads to a power struggle and
negative ramifications
• Helper having power = client being helpless, healing and growth will not transpire, and a true therapeutic relationship will not exist.
confident what we do and do not overstep boundaries of both.
BOUNDARIES !
TIGHTTROPE
Being a Helper presents challenges such as
◦ Clients’ over-identification with the therapist
◦ Therapist’s own motivations and behaviors that are affected by self-esteem, status, and intimacy
needs
•Must walk the tightrope between being an effective educator, facilitator, expert, and cheerleader, and potentially finding one’s self in an unhealthy relationship with a client
BOUNDARIES !
Do not overstep
ethical dilemmas
60 percent when the balance is not there.
Warning signs:
• Therapist’s over-identification with client
• Need to be needed and appreciated by client
• Spending an inordinate amount of time with one client including off-duty time • Keeping secrets the client shared
• Withholding information from the rest of the treatment team
•The above not only violate ethical practice but can lead to potential for exploitation and manipulation and undermine the potential for meaningful change through TR Process
