THERAPEUTIC RECREATION PRACTICE MODELS

Chapter 14HPR 453

QUESTIONS YOU ARE AND WILL BE ASKED…

What is TR? What are anticipated outcomes of TR? What strategies or interventions are

used to bring about the outcomes? What is the profession’s scope of

practice? What is unique about TR? How does TR fit into health and human

service delivery systems?

PRACTICE MODELS ARE PHILOSOPHIES They guide therapists Foundation for public policy Foundation for research Foundation for further development of

the profession 2 Types of Practice Models

Content Models Practice Models

CONTENT AND PROCESS MODELS

Content Models identify the “what” or substance of TR services

Process models identify the “how” or means (procedures for design and delivery)

There are numerous Models and selection should be made carefully – It guides everything done in practice to produce outcomes for clients

DIFFERING PHILOSOPHIES RESULT IN DIFFERENT CONCEPTS OF LEISURE

End vs. Means to End Leisure Orientation – Outcomes related

to leisure behavior body of knowledge Therapy Orientation – Outcomes

related to change or improvement in functional behaviors (medical, psychiatric, psychological, and human development) body of knowledge

Currently TR delivered primarily in healthcare arena

Models must be congruent with medical model, nonmedical models, public policy, professional association, accrediting bodies (JC and CARF), societal trends

Limitations – Models are static diagrams – practice is multifaceted

MODELS

1978 – Gunn and Peterson - TR Service Model (Leisurability Model)

Late 70s & early 80s – Philosophical views continued to be discussed (Recreation vs. Treatment vs. both vs. Leisurability)

Mid to late 80s shift from leisure to healthcare models Therapy oriented (means) vs. Leisure oriented

(outcomes)

SHIFT FROM MEDICAL MODEL TO WELLNESS

Pew Health Commission (1995) Paradigm shift from illness, cures, and

separation of mind and body to… Holistic Health (mind and body),

wellness and prevention WHO defines health as …”a state of

complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

Coding Systems ICD-10 is mainly used to classify causes of

death ICF classifies health – based on

psychosocial model ICF mainstreams the experience of

disability and classifies it as one dimension of a person

Treatment has shifted from “process” to “outcomes”

HEALTHY PEOPLE 2010USDHHS, 2000

2 GOALS FOR NATION’S HEALTH AGENDA INCREASE QUALITY AND YEARS OF HEALTHY LIFE ELIMINATE HEALTH DISPARITIES

“Quality of life reflects a general sense of happiness and satisfaction with our lives and environment. General quality of life encompasses all aspects of life including health, recreation, culture, rights, values, beliefs, and aspirations, and the condition of a life which contains these elements”

TR PRACTICE MODELS

Leisure Outcome Models Leisurability Model – anticipated outcome

is a satisfying leisure lifestyle – independent functioning of an individual in leisure experiences and activities of their choice – This leads to improved health, quality of life and well-being

Supposes that TRSs assist person’s with illness and/or disabilities to overcome leisure barriers

Continuum Model

HEALTH AND WELLNESS OUTCOMES MODELS

Health Protection/Health Promotion Model (Austin, 1991 and continually updated) The goal of TR is for clients to achieve the

highest level of health The purpose of TR is identified as enabling

a client to recover from a threat to health (health protection) and to achieve optimal health (health promotion)

Prescriptive activity, recreation and leisure

TR SERVICE DELIVERY MODEL AND TR OUTCOME MODEL (CARTER, VAN ANDEL AND ROBB, 1995)

Meant to be used together – Outcome Model is an extension of TR Service Delivery Model

The purpose of TR is the maintenance or improvement of the health status, quality of life an/or functional capacities of clients through the use of specially designed recreation or experiential activities and processes”

Overall outcome is QoL – Health status is intermediate outcome

TR OUTCOME MODEL

Primary Components Functional capacities/potential Health status/wellness Quality of life

Leisure function represents a complex interaction of all the domains working together

QoL is interrelated to functional capacities and wellness

TR SERVICE DELIVERY MODEL

Goal – Empower the client to achieve her or his desired goals and optimally experience a sense of fulfillment, satisfaction, mastery and well-being Diagnosis/Needs Assessment Treatment/Rehab Education Prevention/Health Promotion