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Recreation and Leisure Studies
REC 252
Leeann Ferries

THERAPEUTIC RECREATION MIDTERM CHAPTER 1: INTRODUCTION 1. TR MODELS OF PRACTICE - LEISURE ABILITY MODEL - Envisions the major TR mission to be “a satisfying leisure lifestyle, that is, the independent functioning of a client in leisure experiences of his or her choice” - 1. Functional Intervention: improving functional ability. Responsible for the content of the intervention and is primarily in the hands of the TR Specialist. - 2. Leisure Education: focuses on client gaining leisure related attitudes, skills, knowledge. - 3. Recreation Participation: structured activities that give the client the opportunity to practice new skills and enjoy a new recreation experience. EXAMPLE: CLIENT WITH DEPRESSION 1. Functional Intervention: aquatics program that addresses the loss of energy and frequent fatigue 2. Leisure Education: indentifying leisure barriers, learning social skills, learning new leisure skills that include physical exercise and stress management 3. Recreation Participation: providing leisure activities that provide a sense of competency, mastery, control choice etc. HEALTH PROTECTION/HEALTH PROMOTION MODEL - TR assists people to recover following threats to health, achieve high level of health possible. - usually when clients encounter an illness or disorder they become self absorbed, withdraw from usual life activities and experience a loss of control over their lives. - 3 main components: 1. Prescriptive Activities- directs the activities with the goal of treatment being stabilization 2. Recreation – as stability increases and client assumes more control in their life, they learn more skills, values, ways of thinking etc. 3. Leisure- means of self actualization. Leisure experiences feature self determination, intrinsic motivation, mastery, competence leading to maximum health. 2. BEHAVIOURAL DOMAINS - C.A.P.S. - C- Cognitive  memory, orientation, attention span, reading ability, following directions - A- Affective  anger management, emotional control, emotional expression -P- Physical basic functions that are prerequisites to participation in leisure activities, coordination, endurance, mobility, strength -S- Social  targeting inappropriate behaviours that are based on social expectations, refrain from biting, kicking, hitting etc. CHAPTER 2: INTRODUCTION TO THE PROFESSION 1. CRITERIA FOR DEFINING A SCIENTIFIC PROFESSION - SIX Criteria 1. Professional organizations/associations (TR ONTARIO, CANADIAN TR ASSOCIATION) 2. Service motive- dedicated to improvement of society first. A focus on serving others 3. Scientific basis- based on a body of knowledge, best practices, journals, books etc 4. Extended preparation of personnel- lots of training through uniform training standards 5. Autonomy of judgement responsibility to practice accordingly to standards of practice 6. Code of ethics 2. INTERPROFESSIONAL EDUCATION - Two or more professions learn with, from and about eachother to improve collaboration and the quality of care. - More than just common learning, takes into account respective roles and responsibilities, skills and knowledge, powers, duties, value systems, codes of conduct. - Cultivates mutual trust and respect, acknowledging differences dispelling prejudice and rivalry, confronting misconceptions and stereotypes, grounded in mutual respect. - Frequently explaining the role of a recreation therapist particularly to our colleagues. - Each profession has a better understanding of practice and the process of collaboration (learning and practising skills and behaviours that facilitate effective teamwork. Understanding how to complement the work of other professions to improve client care and mutual support amongst disciplines/professions. CHAPTER 3: THERAPEUTIC RECREATION PROCESS 1. FOUR PHASES- APIE (ASSESSMENT, PLANNING, IMPLEMENTATION, EVALUATION) - Systematic problem-solving procedure used by specialists to improve their levels of health by meeting identified needs - 1. Assess client health status, needs and strengths - Client centered, importance of developing rapport and maintaining confidentiality, content of assessment must match content of program. Look beyond what the client is saying. - Methods of assessment:  Observation: natural, specific goal observations, standardized observations  Interviews: leisure inventories and open ended questions  Checklists and questionnaires  Standardized assessment instruments (Leisure Motivation Scale, Leisure Satisfaction Measure, Leisure Attitude Measure) - Questions related to leisure functioning: How do clients spend their free time? What leisure skills do they have currently? What resources do clients have available that can be used for leisure?  Do clients appreciate the value of meaningful leisure experience? - 2. Create a plan of action to meet goals and objections Consideration of needs and strengths, setting priorities Formulate goals and performance measures / objectives, outcome measures specify programs, strategies, approaches to meet goals - Goals may include: - to increase social interaction - to live independently in a transitional program - to improve time management skills - to increase leisure awareness - to develop a discharge plan short term: identify accessible community leisure programs  long term: to participate in community outings with significant others discharge goal: to live independently in a transitional program - Performance Measures - performance, condition, criteria - performance is action verbs, measurable things such as “attend, perform, complete, write, repeat, stay seated” - condition “on request, on exam, without assistance” - criteria- acceptable levels of achievement such as “three out of four times, level of accuracy, within one week, %of time” - When writing performance measures use this model: [insert CONDITION under which performance/behaviour will be judged] participants will [insert BEHAVIOUR you want them to perform] [insert CRITERIA by which participants will be judged].  ie: goal: expand knowledge of available community leisure resources. “Given a local telephone book, client will be able to list a minimum of five community leisure resources within a one week time frame.” Ie: goal: to improve cardio fitness “Attending the walking women program twice a week, client will walk mile within 15 minutes”. - Overt: doing words, concise and specific Covert: being words, not to be used alone, open to interpretation, ie. Understanding, feeling, knowing, enjoy - 3. Implement the plan - execute the plan! Need for interpersonal, observational, decision making and technical skills. - Must know the process and intended outcome when implementing the plan - Nintendo wii is popular now with assessment or outcome based programs. (motivation, increased movement, enjoyment, core strength etc) - 4. Evaluate the plan, was it successful? - review the progress note, goals, performance measures - an interview allows the client to reflect on the plan. If the goals look like they have been attained then we can discharge. *Termination is the final step, but not really 2. THREE ASPECTS THAT FACILITATE THERAPEUTIC RELATIONSHIPS ARE - Genuineness - Unconditional positive regard - Empathy 3. THERAPEUTIC ACTIVITIES - 1. Are goal directed - 2. Require active participation by clients (must be active in both choosing the activities and affecting the outcome of the activities) - 3. Have meaning and value to the client (learn to approach the activity not as a requirement but as an opportunity to achieve an end) - 4. Offer potential for pleasure and satisfaction - 5. Provide opportunity for mastery (competence= enjoyment, heightened interest. Don’t encourage clients to participate in activities where they’re likely to fail or be embarrassed) - 6. Carefully selected by the TR specialist (be tailored to the client’s needs, use your skills!) 4. DOCUMENTATION - Therapist records data throughout the whole process beginning with assessment findings, to a discharge note. Subjective and objective data collected through observation, interview, standardized assessment tools, group involvement etc. - Depending on the agency you’re working in, need to know which types of documentation are required. - Assessment Phase: communicating assessment findings, information about the plan - Planning Phase: goals, performance measures and the client plan are included. - Implementation Phase: progress notes written according to the format adopted by the agency. - Evaluation or Termination Phase: Recreation therapist creates a discharge summaryreflecting the client’s response to the interventions, condition upon discharge and remaining plans, instructions or referrals. CHAPTER 4: PSYCHIATRY AND MENTAL HEALTH 1. ONTARIO AND MENTAL HEALTH ACT FORMS - Governs how people are admitted to a psychiatric facility as a voluntary or involuntary patient, the rights of patients in facilities, how client records can be accessed, guidelines for issuing, renewing or terminating community treatment orders and identifies which hospitals in Ontario are psychiatric facilities. - Main purpose is regulating involuntary admissions - If a person is a danger to himself, others or unable to properly care for self the act allows the physician by completing FORM 1 to require a psychiatric assessment whereby the individual is held in a facility for up to 72 hours. Doctor must determine if client is capable of consenting to treatment in a facility. Consent is still needed for treatment or medication unless its an emergency. A substitute decision maker can be appointed if necessary. - A Justice of the Peace can order an examination based on sworn evidence (that the person shows signs of a mental illness) for police to apprehend the client to determine if the individual meets the criteria for a Form 1 (usually done at hospital emergency department). - A judge can order an examination for someone who appears in court and is charged with or convicted of an offense, but seems to have a mental disorder (Form 6). - A judge can require that such a person be admitted to a psychiatric facility for up to 2 months (Form 8). - A police officer can take someone to a hospital (usually emergency department) for an examination if the officer has reasonable and probable ground to believe a person has acted in a “disorderly manner” – danger to self or others or is unable to care for self. The physician will determine if the individual meets the criteria for a Form 1. - If someone is held under form 1, they must be given form 42 ASAP telling them why they’ve been detained and that they have a right to see a lawyer. - Upon completion of the assessment, the patient must either be released, or admitted as an involuntary patient, a voluntary patient or an informal patient (under 16). - Form 3 is completed before the Form 1 expires indicating that the individual is an involuntary patient – not permitted to leave the hospital or psychiatric facility. FORM 3- CERTIFICATE OF INVOLUNTARY ADMISSION- for 14 calendar days (if within 72 hours the doctor thinks more hospitalization is necessary) FORM 4- CERTIFICATE OF RENEWAL, 1 MONTH- at the end of 14 days doctor reviews case and still thinks more hospitalization is necessary FORM 5- CHANGE FROM INVOLUNTARY TO VOLUNTARY STATUS- whenever appropriate FORM 45- COMMUNITY TREATMENT ORDER- Individuals who suffer from serious mental disorders and who have a history of repeated hospitalizations and who meet the committal criteria for the completion of an application by a physician for a psychiatric assessment in the Mental Health Act; and Involuntary psychiatric patients who agree to a treatment/supervision plan as a condition of their release from a psychiatric facility to the community BILL68- BRIANS LAW, changed community treatment orders. Ensure serious illnesses get treatment they need in a community based system FORM 28- REQUEST TO EXAMINE OR COPY CLINICAL RECORD  A competent patient may review or request a copy of The clinical record (Form 28). If a physician objects to the patient seeing his/her clinical record, the physician can apply (within 7 days) to the Consent and Capacity Board, which can withhold the file or part of the file. This happens only if disclosure will likely result in serious harm to the treatment or recovery of the patient w
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