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,
- 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
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
- 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
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
basic functions that are prerequisites to participation in leisure activities,
coordination, endurance, mobility, strength
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
2. Service motive- dedicated to improvement of society first. A focus on serving
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
5. Autonomy of judgement responsibility to practice accordingly to standards of
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
- 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,
- 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
- 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
- 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
- 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
- Unconditional positive regard
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
- 6. Carefully selected by the TR specialist (be tailored to the client’s needs, use your
- 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
- 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
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