KNR 273: TR Models Continued

KNR 273: TR Models Continued

TR Service Delivery and TR Outcome Models

The Aristotelian Good Life ModelOptimizing Lifelong Health and Well-Being

Model


Easy to follow (graphic depiction, clarity of terms & concepts)

Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice

Could you explain TR with this model? Could you design programs?


2 interrelated TR models TR Service Delivery Model provides an

overview of the nature of service delivery TR Outcome Model focuses on service

outcomes The Outcome Model should be viewed as an

extension of the Delivery Model

TR Service Delivery Model

Describes the scope of TR services, nature of TR services, and relationship between TRS and client

Scope of service Activities and strategies that contribute to

diagnosis or assessment, treatment or rehabilitation, client education, and health promotion/prevention


Diagnosis/needs assessment Use of standardized tests, field observations, or

other techniques to determine client’s strengths and abilities or

their potential limitations in achieving habilitation or rehabilitation goals


Treatment/rehabilitation Providing assistance in restoring or stabilizing

health or abilities of an individual who has experienced loss or

limitations in those abilitiesE.g. Aquatic therapy might be used to maintain

muscle tone and flexibility in a client who has MS


Education Develop the attitudes, values, and skills needed to function more effectively in society to improve overall health and/or to achieve a higher quality of life

E.g. Assertiveness training, leisure education, cognitive retraining, reality orientation, social skills training


Prevention/health promotion Protect or promote healthy lifestyles

Several components may function at the same time

Swimming may be treatment/rehabilitation to a person recovering from a stroke, and serve as an opportunity to learn a new leisure skill (education), and prevent further physical losses and promote a healthier lifestyle (prevention/health promotion)


Nature of service Involves an element of planned intervention, as

well as a leisure experience dimension Some settings may emphasize intervention while

others focus on leisure experiences Key element of determining whether an activity

is an intervention or a leisure experience is not the nature of the activity, but the client’s perception of the experience


Gray band describes the optimal area of interaction for CTRS and client

Diagnosis/needs assessment and treatment/rehabilitation tend to be more structured and goal directed which are less likely to facilitate the leisure experience

Last 2 lend themselves to greater personal freedom and greater opportunities for leisure


Nature of TRS & client interaction Informed consent, independence and self-

determination


Theoretical foundations Attempt to show that recreation therapy and

leisure experience philosophy may co-exist Neulinger’s theory of leisure

State of mind, choice, internal motivation, freedomAll interactions are interactions between perceived

freedom and perceived constraint Interactions contribute to outcomes

TR Outcome Model

A leisure experience will always affect the participant’s quality of life and may also contribute to some improvement in functional capacity and/or health status

Wellness/health status Quality of life


Functional capacity/potential Cognitive Physical Psychological/emotional Spiritual (ability to find meaning & purpose in

life) Social Leisure


Goal is to assist the client in achieving the highest possible level of health and well-being through leisure and nonleisure experiences

Theoretical foundations Human development (becoming) Rehabilitation science empirical research

Summary

Assumptions The focus of interventions differ in their degree

of focus on intervention and leisure The outcomes of TR services are

multidimensional in nature (e.g., health status, quality of life, functional capabilities)

Mission: Quality of life Means/end model

Summary (Cont.)

Definitions of TR The specialized application of recreation and experiential

activates or interventions that assist in maintaining or improving the health status, functional abilities, and ultimately the quality of life of persons with special needs

TR Service Delivery areas Scope of TR service, nature of service, nature of

TRS/client interaction

Summary (Cont.)

TR Outcomes areas Functional capacity/potential Wellness/health status Quality of life

Strengths

Reflects current TR practice Provides consumers, employers,

practitioners, legislators, etc. with a clear understanding of the scope and outcome of TR services

Doesn’t just focus on “fixing broken parts” Can be used in wide variety of settings

Strengths (Cont.)

Attempt at providing a model that unifies TR

Contains content from NTRS & ATRA definitions

Endorsed notion that leisure experiences and quality of life can be legitimate goals in healthcare

One activity may simultaneously address several service components

Concerns

Some terms are not clearly defined Is this an improvement on existing models? Distinction between areas is not clear (e.g..

Treatment/rehabilitation and education) Failure to show interrelationship between the 2

models Theory on helping relationships and client change

is missing





The Aristotelian Good Life Model





TR Defined TR comprises sets of services directed at increasing

client freedom and responsibility in order to facilitate attainment of human happiness (the

“good life”) This is accomplished by empowering clients to overcome

constraints that arise from illness, disability, oppression, wrong desires, challenges in following the principle of enough, and focus on apparent goods that lack potential to become real goods.


Model is founded on concept of happiness Recreation & leisure are viewed as necessary

components of a happy life Eudaemonism is Greek for happiness, human

flourishing, or well being Used to describe Aristotle’s conception of the good

life Puts happiness in the realm of ethics


Attainment of the good life is based on the premise that 2 conditions are met The individual has access to sufficient wealth to meet

basic biological needs The society provides basic human freedoms and rights

3 principles of good life Ethics of enough Real and apparent good Wrong and right desires


Ethics of enough Too little or too much of most things leads to

problems Rational and prudent people can reach agreement

on what is enough There can be variation between people Some goods like wisdom and knowledge are

limitless good --- one can never have too much


Real and apparent goods Real goods led to good life Apparent goods were those sought for the sake of

happiness, but did not realize that desire Apparent goods seem good at one time, but later lack

their appeal --- we usually regret having received apparent goods

Attainment of real goods lead to an enriched life with continued grown and development


Wrong desires Pleasure, money, fame, and power are wrong

desires Pleasure is a real good, but cannot by itself lead

to a good life so it becomes a partial good Pleasure may be desired if it is not sought as the

only good, it is desired in accordance with the ethics of enough, and if it does not cause injury to other people


Right desires The good life is achieved by developing the habit of right

desires The crowning virtue of eudaemonism or summum

bonum is leisure Leisure is the highest good and is intimately connected

with health and well-being Highest leisure is engaging in intellectual virtues of art,

learning, and creating


4 major elements Afflictions and oppression Aristotelian goods Freedom Role of TRS


Afflictions and oppression Scope of challenges that might lead someone to

need TR services Failure to follow the principle of enough Disadvantaged people Focus on apparent goods that don’t contribute to

the good life (e.g. Substance abuse, smoking)


Aristotelian goods Statement of the target outcomes of TR service Elements needed for the good life Primary goods (e.g. Biological needs, functional

skills, etc.) Secondary goods (e.g. Learning, creating,

meaningful relationships) Approaching summum bonum (leisure)


Freedom and responsibility As individuals overcome afflictions and

oppression, freedom increases and primary goods give way to secondary goods and, ultimately and ideally, to eudaemonia

Greater freedom comes with progression through treatment

Implies greater responsibility to self, family ,and community


Role of TRS Therapist Educator Facilitator Resource Advocate

Strengths

Grounded in a philosophical theory of happiness

Helpful in defining value laden goals like an appropriate leisure lifestyle

Could be used with a variety of clients Brings a dose of social conscience to our

understanding of leisure

Concerns

Reflects political and economic state of Greeks Freedom was for the ruling class and made available by

slaves Hard to use for programming Few TRS have exposure to ethics or Aristotle’s

work Assumes high cognitive functioning of clients (so

not appropriate for DD, dementia, poverty) Never designed as replacement model





Optimizing Lifelong Health Through Therapeutic

Recreation Model Easy to follow (graphic depiction, clarity of terms &

concepts) Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice


Optimizing Lifelong Health

Assumption TR service is based on the assumed need for intervention

with the intent of influencing the individual’s personal and/or leisure functioning

Purpose was to incorporate health enhancement concepts into TR practice

Propose a non-linear model of TR that is grounded in life course perspective

Merges health enhancement and self-care approaches


Health enhancement Variety of behaviors individuals may use to

prevent health risks, maintain or promote health, and facilitate functional interdependence

These behaviors are often undertaken with assistance and support of othersFormer service providers Informal (e.g.. Family and friends)


Health Enhancement Continued Clients, networks, and environmental factors or

situational contexts facilitate or impede health enhancement efforts

Healthy People 2000Directed health care providers to consider

disease/illness prevention, health education, and health promotion as central directions for clients


Leisure participation may influence health and well-being by helping to facilitate coping behaviors in response to the changes and transitions that individuals experience over the life course

When people engage in healthy leisure lifestyles, they actively participate in their own well-being


Theory Baltes and Baltes (1990) developmental theory

of human aging/adaptation Process where people become active agents in

their own well being Health enhancement strategies are client initiated

and reflect self-determined decision-making processes


3 basic principles Engagement in a healthy leisure lifestyle reduces

the probability of pathology or secondary consequences of disability across the life course

Strengthening optimal health and well-being can be achieved by individualizing resources and opportunities


3 principles continued Individuals must be prepared to alter leisure choices or

find substitutes, when necessitated, by changing personal and environmental characteristics across the life course

Central task of CTRS is to help facilitate adjustments while allowing for maximum client choice, control, and preservation of selfhood

Mission: Health Enhancement (Means)


Elements Selecting

Client selects activities that match interest, abilities, & resources. Also identifies goals

Optimizing Compensating Evaluating (added by Wilhite et al)


Role of CTRS Is derived from an educational and facilitative

perspective Education focus is on opportunities for acquiring

awareness, knowledge, and understanding of various leisure options

Facilitative focus is on opportunities for clients to apply the learning to enable leisure to occur and to advocate on the client’s behalf


Independent leisure functioning (with minimal support from CTRS, other caregivers, friends, family) is not always possible or desirable Interdependent leisure might be ideal Interacting cooperatively with others in a self-

determined manner enables goal attainment


Systems theory provides framework Apply APIE

Strengths

Understands effects of environment CTRS interventions emphasize personal

responsibility and empowerment for health and well-being

Compatibility with community-based with reliance on education and facilitation instead of therapy approaches

Strengths (Cont.)

Could be used with a wide diversity of clients

Concerns

Good start but needs development Terms such as health, health enhancement, and

healthy leisure lifestyle were discussed without presenting meanings

Educator and facilitator not well developed Model is individualistic Questions adaptation and accommodations as

indicators of health (resistance)

Optimizing Lifelong Health Through Therapeutic

Recreation Model Easy to follow (graphic depiction, clarity of terms &

concepts) Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice


One Minute Paper

Clear Muddy General Comments

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KNR 273: TR Models Continued