NCTRC-Exam-Study-Guide-1 (7).pdf

1 NCTRC Study Guide - Section One: Foundation Knowledge Part A: Background Human Growth and Development Freud’s Psychosexual Development Theory: Age Name Pleasure Source Conflict 0-2 years old Oral Mouth: sucking, biti...

1 NCTRC Study Guide - Section One: Foundation Knowledge Part A: Background Human Growth and Development Freud’s Psychosexual Development Theory: Age Name Pleasure Source Conflict 0-2 years old Oral Mouth: sucking, biting, Weaning away from mother’s swallowing breast 2-4 years old Anal Anus: defecating or Toilet training retaining feces 4-5 years old Phallic Genitals Oedipus (boys), Electra (girls) 6 puberty Latency Sexual urges sublimated into sports and hobbies. Same- sex friends also help avoid sexual feelings puberty Genital Physical sexual changes Social Rules onwards reawaken repressed needs. Direct sexual feelings towards others lead to sexual gratification. Erikson’s Stages of Psychosocial Development: Stages Developmental Task or Conflict to be Resolved Oral-Sensory Trust vs. mistrust. Babies learn either to trust or to mistrust that (birth to 1 year) other will care for their basic needs including nourishment, sucking, warmth, cleanliness and physical contact. Musculo-anal Autonomy vs. shame and doubt. Children learn either to be self- (1-3 years) sufficient in many activities, including toileting, feeding, walking and talking or to doubt their own abilities. Locomotor-Genital Initiative vs. guilt. Children want to undertake many adult like (3-5 years) activities, sometimes overstepping the limits set by parents and feeling guilty. Latency Industry vs. inferiority. Children busily learn to be competent and (6-11 years) productive or feel inferior and unable to do anything well. Adolescence Identity vs. role confusion. Adolescents try to figure out (12-18 years) “Who Am I?”. They establish sexual, ethnic, and career identities, or are confused about what future roles to play. Young Adulthood Intimacy vs. isolation. Young adults seek companionship and love (19-35 years) with another person or become isolated from others. Adulthood Generativity vs. stagnation. Middle aged adults are productive, (35-50 years) performing meaningful work, and raising a family, or become stagnant and inactive. Maturity Integrity vs. despair. Older adults try to make sense out of their lives, (50+ years) either seeing life as a meaningful whole or despairing at goals never reached and questions never answered. 2 Piaget Theory of Cognitive Development Stage Characterised by Sensory-motor Differentiates self from objects (Birth-2 yrs) Recognises self as agent of action and begins to act intentionally: e.g. pulls a string to set mobile in motion or shakes a rattle to make a noise Achieves object permanence: realises that things continue to exist even when no longer present to the sense (pace Bishop Berkeley) Pre-operational Learns to use language and to represent objects by images and words (2-7 years) Thinking is still egocentric: has difficulty taking the viewpoint of others Classifies objects by a single feature: e.g. groups together all the red blocks regardless of shape or all the square blocks regardless of colour Concrete Can think logically about objects and events operational Achieves conservation of number (age 6), mass (age 7), and weight (age 9) (7-11 years) Classifies objects according to several features and can order them in series along a single dimension such as size. Formal Can think logically about abstract propositions and test hypotheses systematically operational Becomes concerned with the hypothetical, the future, and ideological problems (11 years and up) Havinghurst Theory of Adult Development: Early adulthood = finding a mate, having children, managing a home, getting started in a profession Middle age adulthood = achieving civic and social responsibility, economic standard of living, raising teens, developing leisure activities retirement, reduced income, ties with peers Theories of Human Behaviour/Behavioural Change Stress: Relationship between person and environment that is appraised by the person as taxing or exceeding his or her resources or endangering his or her well-being. A state that results from an actual or perceived imbalance between the demand and the capability of the individual to cope with and/or adapt to that demand that upsets the individual’s short-or-long term homeostasis. When stress is perceived, people engage in a cognitive appraisal process: o Primary - Appraise the risk or threat o Secondary - Appraise options for responding Stress - Coping: The process of dealing with stress and your response to the stress Any effort to master conditions of harm, threat or challenge and bring the person back into equilibrium. Four buffers to help manage stress with recreation/leisure: 1. Sense of competence 2. Nature and extent of exercise 3. Sense of purpose 4. Leisure activity Cognitive and behaviour efforts to manage external and/or internal demands (i.e. stress) Two types of coping: 3  1. Problem-focused 2. Emotion-focused Attribution Model: The casual analysis of behaviour The process by which a person attributes or makes casual inferences “to what I attribute my success and failures”. People formulate explanations for their own and others successes and failures. Involves two dimensions: 1.) Stability (stable/unstable) 2.) Locus of control (internal/external) Involves four determinants of success or failure: o Ability (stable-internal) o Effort (unstable-internal) o Task difficulty (stable-external) o Luck (unstable-external). Learned Helplessness: a perceived lack of control over events no matter how much energy is expended, the situation is futile and you are helpless to change things people learn to be helpless and become dependant behaviours and outcomes are out of one’s control occurs when people are exposed to repeatedly to uncontrollable events and being to learn that responding is futile When people learn that responding does not work they cease to explore other behavioural options. Perceived Freedom: When a person does not feel forced or constrained to participate and does not feel inhibited or limited by the environment Means that the activity or setting is more likely to be viewed as leisure when individuals attribute their reasons for participation to themselves (i.e. actions are freely chosen) rather than determined externally by someone else of by circumstances. The freedom to choose your activity; feeling competent; “I can do this” LAM relies heavily on concepts of perceived freedom and personal choice. Intrinsic Motivation: To do something for yourself Internal desires to do something as a sense of satisfaction Is the impetus to do something for internally or personally rewarding reasons Individuals often are intrinsically motivated toward behaviour in which they can experience competence and self-determination. Locus of Control – Internal: Believe to largely control outcomes Possess the control to change Good self-esteem Typically, individuals with an internal locus of control take responsibility for their decisions and the consequences of their decisions. Obviously, an internal locus of control is important for the individual to feel self-directed or responsible, be motivated to continue to seek challenges, and develop a sense of self-efficacy or self-competence 4 Locus of Control – External: Believe luck, the environment or powerful others are responsible for the outcomes. Low self-esteem Helpless “he made me do it” Self-Efficacy Theory: Is the measure of one's own competence to complete tasks and reach goals Generalizes to other areas Can be influences through: o Performance accomplishments o Vicarious experiences o Persuasion o Physiological arousal Client’s personal evaluations of their abilities directly affect how they cope with their problems. Client’s expectations of themselves largely determine how willing they will be to deal with their problems, how much effort they will be willing to expend, and whether they will make a perseverant effort. Performance Accomplishments: The client preforms the action and derives the desired outcome Strongest influence on self-efficacy beliefs Repeated success builds a sense of competence Practice – with and without support Leisure Efficacy: To meet your own leisure needs, benefits from good circumstances. You need a repertoire of skills to be self-capable. Meet own needs/goals. Experiential Learning Model: The process of making meaning from direct experience. Experiential Learning is learning from experience. The experience can be staged or left open. Staged experiential learning is often called a Dynamic Learning Experience (DLE) Kolb’s model of experiential learning: 5 Neulinger’s Theory of Leisure: A psychological “state of mind” that encompasses freedom of choice and internal motivation Individuals can be said to be in a state of leisure if they simply perceive that they have the freedom to choose activities and are motivated by an activity for its own sake, not just for its consequences Interactions are between: o Perceived freedom o Perceived constraints o Interactions contribute to outcomes Attitude Model: A learned predisposition to respond in consistently favourable and unfavourable manner: o Beliefs o Attitudes o Intention o Behaviour Theory of Reasoned Action (TRA): Derived from the attitude model Can predict actions based on personal attitude and perception of how others will view them Used as a basis for the practices of health education Developed in the 1960’s Tool for observing behaviour and developing interventions based on those observations Person intention is the main factor Intention is a function of attitude and subjective norm: 1. Attitude: concerns a person’s belief that their behaviour will produce a beneficial outcome 2. Subjective norm: whether key people in the person’s life support the behaviour, and whether the subject Is inclined to agree with them Theory of Planned Behaviour (TPB): Developed in the 1980’s A persons intention of doing something is the main factor in determining whether he will actually do it Behaviour attention does not necessarily result in action Builds on TRA by adding a their indicator of a person’s intent: 3. Perceived behavioural control: whether the person believes he can control the conditions necessary for change to occur Health Belief Model (HBM): Health is defined in WHO’s constitution as a state of complete physical, mental and social well-being Not merely the absence of disease or infirmity Recognizes the person with the disability (PWDs) can be healthy Used as a basis for the practices of health education Developed in the 1950’s Take health action to avoid consequences Four key beliefs that make a person more likely to perform a specific behaviour: 1. The person believe that the condition which the behaviour will address is a threat 2. The person is prompted to perform the behaviour, either by people or by messages 3. The person is confident he is able to carry out the behaviour 4. The person believes that the benefits of doing the specified behaviour outweigh the negatives. Transtheorietical Model/Stages of Change: Six stages of behaviour change and advocated various interventions to keep clients motivated: 6  1. Pre-contemplation – client does not feel they have a problem. ▪ Interventions would involve making him/her aware of the problems 2. Contemplation – client admits a problem, but is still not sure if he/she wants to change. ▪ Interventions would include encouraging the subject to make specific plans to change. 3. Preparation/commitment – client realizes a need to change and gathers information. ▪ Interventions would include setting goals; awareness of the positives vs. the negatives of change 4. Action – client follow a plan for change behaviours. ▪ Interventions involve providing feedback and support. 5. Maintenance – client sees the benefits of the new behaviours. ▪ Interventions including helping in case of relapse; continues feedback and support 6. Termination – client can’t imagine ever doing the old behaviour. ▪ Interventions include proving help when needed and continuing to offer support. Social Cognitive Theory (SCT): Grew out of Social Learning Theory (SLT) Introduced in the mid-1980’s Follows the realization that people learn by watching others Behaviour is influenced by three things: 1. The characteristics of the person 2. The characteristics of the behaviour 3. And the environment in which the behaviour would take place The relationship among the three characteristics is called - Reciprocal determinism Changing behaviour is most likely to occur if the person has: o Self-efficacy: confidence in the ability to do something o Behavioural capability: the skills and knowledge to do the specified behaviour o Outcome expectance: a belief that the expected outcome of the new behaviour will be beneficial Diffusion of Innovation Theory (DIT): Explains how new ideas spread and why some ideas never do Gained popularity in the 1960’s Innovation = an idea, practice or object that is perceived as new by a population Diffusion = the process by which an innovation spreads through a social system over time Five key factors influence whether an innovation will diffuse: 1. Characteristics of the target population 2. Environmental context into which the innovation will be introduced 3. Credibility and likeability of the agent promoting to innovation 4. Quantity of information communicated to the population about the innovation 5. Quality of information communicated to the population about the innovation Stage Theory of Adaptation: Based on Kubler-Ross’s theories on acceptance of death Elements of Stage Theory: o Shock o Defensive o Depression or mourning o Personal questioning o Adaptation, change and integration Maslow’s Hierarchy of Needs: Motivation based theories 7  1. Subsistence needs 2. Safety needs 3. Need for love and affection 4. Achievement 5. Self-actualization Family Systems: Members have different roles, so a change in ones behaviour will affect the others Diversity Factors A persons cultural orientation will impact how he/she will react to the assessment and programming process: o Traditional – original culture has been retained o Marginal – an uneasy mixture of original and other cultures o Bicultural – acceptable comfort with original and newly acquired culture o Assimilation – adopting and internalizing values, beliefs, and behaviours of dominant society Stereotyping – making assumptions about an individual based on ideas about a group Prejudice – a negative opinion about someone based simply on that person’s race, gender, or religion Bias – preference for one over another Discrimination – unfair treatment of someone based on personal prejudice Types of Models Medical Model: Focuses on the individual and pathology and includes identification of underlying disorder, interventions, treatment and cures. Assumes that the impairment or condition a person has is the key problem. The response is to “cure” or “care” Health is the opposite end of the continuum from disease, illness and or disability and focuses on functional ability, morbidity and mortality. Believes that is the individual has a disability, he/she is not capable of being healthy. The medical model promotes the view of a disabled person as dependent and needing to be cured or cared for, and it justifies the way in which disabled people have been systematically excluded from society. The disabled person is the problem, not society. Poor health → optimal health Dr. prescribes TR treatment Recreation is treatment – as a means to an end, is more clinical The Public Health Model: Focuses on achieving good health and a sense of well-being Basic human rights Proposes that opportunities (diagnosis/treatment) to achieve health and well-being should be available to all groups Activity Therapy Model: TR is prescribed, similar to medical model “blurring” of different departments including music therapy, art therapy, occupational therapy, dance therapy) Ecological Model: Addresses the environment, what has to change in the environment Looks at the individual needs and environment needs 8  The people around you: community and family Changes can occur encompassing both the promotion of abilities and the elimination and individual barriers. Person-Centered Model: Believes that people have the capacity to be rational thinkers who can assume responsibility for themselves and whose behaviour will be constructive when given freedom to set directions in life. People are seen as motivated by a basic tendency to seek growth and self-enhancement. The role of the helping professional in person-centered therapy is to display unconditional positive regard. The helper never tells the client what to do, is non-judgemental and nondirective. The therapeutic relationship is key. Human Service Models: 1.) Long-term Care model: To maintain one’s functioning, to be divisional To enable individuals whose functional capabilities are chronically impaired to be maintained at the maximum level of health & well-being. 2.) Therapeutic Milieu Model: Where every person & interaction can be therapeutic. Everyone has equal impact. Emotional problems are often the product of unhealthy interactions with one’s environment Staff are organized as a caring community Primary therapist = most effective relationship Educational Training Model: Gain vocational skills Focuses on the acquisition of knowledge and skills that are required to become a contributing member of society Used in sheltered workshops, vocational rehab centers, day-care centers, school Heavy emphasis on classroom-like framework Community Model: Focuses on steps that communities can take to develop preventative programs to effect change Special Recreation: o the provision of recreation programs and services that are provided for people who require special accommodations because of unique needs they have owning to some physical, cognitive, or psychological disability Social Recreation: o Non-clinical approach for disabled in the community o Recreation as an end to itself. Social Model: Impairment is seen as not vitally important The environment attitudes of others, and institutional structures are the problems Prejudice, discrimination, inaccessible building This model was enthusiastically received by the disability movement Rehabilitative Model: Activities of Daily Living: Activities related to personal care These Include: bathing, showering, dressing, getting in and out of bed or a chair, using the toilet, and eating 9  A plan of care must be developed that allows for meeting both the physical and psychosocial needs of the client/patient Two types of goals: 1. Rehabilitative – the goal of restoring independence 2. Habilitative – helping the person function at their highest level The Psychosocial Rehabilitation Model: Focuses on restoring those with mental disorders to the community as functioning society members with a sense of well-being Part B - Diagnostic Groupings: (SEE ICF Notes for more detail) Disability Categories: Cognitive disabilities – i.e. Traumatic Brain Injury, learning disabilities Physical disabilities – i.e. Visual Impairment, Hearing Impairment, Cerebral Palsy o Least amount of prejudice o Longer history of self-identification o Stronger advocacy groups Intellectual disabilities – i.e. Cognitive Impairment (Mental Retardation), Autism Psychiatric disabilities – Mental Illness, Substance abuse o Last to receive government services or benefits Cognitive Impairments: Result of impaired mental perception 1.) Mental Retardation/Developmental Disability: Sub-average intellectual functioning IQto>depressed Schizophrenia: A break from reality, disorder in thinking/reality o Delusional, bizarre behaviors & hallucinations. (thorazine & stalizine) 14  o Hallucinations may occur in any sensory modality (e.g., auditory, visual, olfactory, gustatory, and tactile), but auditory hallucinations are by far the most common and characteristic of Schizophrenia. o Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the person’s own thoughts o Auditory hallucinations, talking to self, “I’m Jesus”, feel others are out to get them, lack of social skills. TR: social skills training, stress management, coping skills 4.) Eating Disorders: Anorexia: Thin - force self to vomit up meals to stay thin, organ damage Bulimia: gorge & perge, onset to young women, poor self-image TR: Leisure Education, social skills, express feelings, values clarification, family groups, meal planning, No physical work. 5.) Chemical Dependency: Drug/Alcohol The leisure education component of TR programming is extremely important for individuals with substance-related disorders. Given the fact that most drug users have passive and sedentary lifestyles TR: Leisure Education, fitness, social skills, provide choice, set limits, have rules, values clarification. 6.) Prison: Sex offenders, murderers etc. TR: health, fitness, social skills, choice, limits. 7.) Organic Brain Syndrome: Acute & chronic; physical changes to brain, memory loss, emotional instability, mood changes, poor judgement, confusion, & disorientation. TR Sensory stimulation, positive reinforcement, reminiscence, pet therapy, cognitive games, walking/exercise, nutrition. Other Diseases 1. Amyotrophic Lateral Sclerosis (ALS) or Lou Gherig Disease: Progressive muscular disease in adults that leads to death. A completely physical disease TR: Exercise 2. Congestive Heart Failure (CHF): Unable to obtain adequate level of output. RT side, legs swelling, Left side fluid in lungs. Hypertension> leads to heart attack Cardiac - Four functional levels: 1) experience no limits; generally exhibit no symptoms with ordinary activity 7.5+ cal 2) Experience slight limitations; comfortable at rest, some symptoms with ordinary activities. up to 7.5 cal. 3) Experience marked limitations, comfortable at rest, ordinary symptoms with less the activity up to 5.0 cal. 4) Experience discomfort with almost any activity, may perform sedentary activities; 2.5 cal. TR: Stress management, relaxation, exercise, awareness of environmental factors. 3. Burns: TR: divert person away from pain. 4. HIV/AIDS Human = because the virus can only infect humans 15  Immunodeficiency = because the effect of the virus is to create a deficiency, a failure to work properly with the body’s immune system Virus = because this organism is a virus which means one of its characteristics is that it is incapable of reproducing by itself TR: stress reduction, socialization, creative arts activities, volunteer opportunities, educational programs and leisure education and counseling. Part C - Theories and Concepts Normalization: Making available to all persons patterns of life and conditions of everyday life that are as close as possible to the routine circumstances and ways of life. Inclusion: Inclusion is the acceptance of all people regardless of their differences. It is about appreciating people for who they are because even though we are all different, we are one. Inclusion allows people to value differences in each other by recognizing that each person has an important contribution to make to our society Inclusion in recreation is more than allowing children with and without disabilities to participate in the same activity. In order for inclusive services to be successful, inclusion must be a value that is shared by all parties involved including: agencies, staff, families, participants, and the greater community. Least Restrictive Equipment: The objective is to use equipment that restricts functional movement the least amount, while offering the maximum safety. Legislation and Guidelines (Federal, State and Regulatory agencies) 1.) Americans with Disability Act: 1990 Goes beyond agencies that receive federal funds Relied heavily of Rehabilitation Act of 1973 “An Act to establish a clear and comprehensive prohibition of discrimination on the basis of disability.” Can be enforced with lawsuits. George Bush was president a) Title IIA. State and Local Government : o all activities, services and programs may not charge extra for accommodations b) Title I. Employment: o Title I of the Americans with Disabilities Act requires employers with 15 or more employees to provide qualified individuals with disabilities an equal opportunity to benefit from the full range of employment-related opportunities available to others. o Covers all aspects from hiring to promoting o Qualified individuals with disabilities c) Title III: Public Accommodations: o Covers the private sector. o It requires that a wide range of public accommodations in the private sector remove physical, communications and procedural barriers to access by people with disabilities. o Covers sales, rental and service establishments, as well as educational institutions, recreation facilities and service centers. o Covers public accommodations, commercial facilities and private entities that offer examinations or courses related to licensing or certification, and transportation provided to 16  the public by private agencies became effective January 26, 1992 and is enforced by the United States Department of Justice. 2.) The Rehabilitation Act, Section 504: 1973 Section 504 is widely recognized as the first civil-rights statute for persons with disabilities. It took effect in May 1977 No otherwise qualified individual with a disability in the United States, as defined in section 705(20) of this title, shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance or under any program or activity conducted by any Executive agency or by the United States Postal Service Its broad anti-discrimination policies ensure that individuals with disabilities receive equal opportunities in programs receiving federal funds Formed architectural and transportation barriers Compliance for PL 90-480 First civil rights law for people with disabilities "Persons with a physical or mental impairment which substantially limits one or more major life activities." Where "Major life activities include caring for one's self, walking, seeing, hearing, speaking, breathing, working, performing manual tasks, and learning." Program Accessibility Act: i. Ramps 8.333% maximum grade ii. Parking space 12.5 x 20.5 iii. Hand rails 32”high iv. Toilet 20” from floor, stall at least 36’ wide 3.) PL 94-142, Education for all Handicapped Children Act: 1975 Free and appropriate public education in a least restrictive environment IEP – Individual Education Plan mandates Education can include recreation 4.) PL 90 – 480 Architectural Barriers Act 1968 Any building built after 1968 with federal funds must be accessible for the physical handicapped. 5.) Individuals with Disabilities Education Act (IDEA) IDEA 2004 – most recent The Individuals with Disabilities Education Act (IDEA) is a United States federal law that governs how states and public agencies provide early intervention, special education, and related services to children with disabilities. It addresses the educational needs of children with disabilities from birth to age 18 or 21 Students must be provided a Free Appropriate Public Education (FAPE) that prepares them for further education, employment and independent living free/appropriate public education, IEP and least restrictive environments 6.) Older Americans Act 1965 To provide assistance in the development of new or improved programs to help older persons through grants to the States for community planning and services and for training, through research, development, or training project grants, and to establish within the Department of 17  Health, Education, and Welfare an operating agency to be designated as the ‘‘Administration on Aging’’. Improved access services The Older Americans Act of 1965 was the first federal level initiative aimed at providing comprehensive services for older adults. 7.) Health Insurance Portability and Accountability Act (HIPPA) 1996 Right to privacy of health information Developed by health and human services (HHS) to protect privacy of personal health information and took effect April 14th, 2003). 8.) 1996 Welfare Reform Transferred welfare programs from federal to states No money provided for job training, job development or childcare 13 million people affected Can only be on welfare for 5 years 9.) Omnibus Budget Reconciliation Act: 1987 Requires clients in a nursing home be engaged in programs Theories of Play Play: Spontaneous, joyful, suspenseful and reality Psycho-Analytic Theory: Engaging in play to reduce anxiety I.e. play therapy – abused child uses doll to master situation. Therapeutic recreation activities provided approved outlets for aggression and other emotions by facilitating sublimation and permitting unconscious conflicts to be expressed. Catharsis Theory: Use of play to release repressed thoughts, feelings, and emotions. An outlet for aggression Diversion Theory: To amuse ourselves Compensation Theory: To play/recreate to fulfill needs not met at work. Surplus Energy: To get rid of excess energy Types of Play Therapy: Perspective Play: used to treat specific symptoms or behavioural problems Filial Therapy: child-centered, includes training parents and then observing and providing feedback Theraplay: aim to improve attachment – increase child’s trust and self-esteem Cognitive Behavioural Play Therapy: make behavioural changes by learning new strategies and receiving support Play in a Hospitalized Child’s Life: Play is the primary means through which the child communicates, copes with stress, learns about the environment and masters new situations. 18  o Provides normalcy o Emotional adjustment and support o Socialization o Independence o Creative expression o Learning and mastery o Diversion Type of Play Activities: Dramatic Play Story-telling Sensory stimulation Music activities Expressive arts Craft activities Medical or preoperative teaching Creative media play Gross motor play Fine motor play Games and activities Creative cooking Community out-trips Play skills education Leisure throughout the Lifespan/Development: Expanders: altered their leisure patterns by the addition of new activities throughout the life course Contractors: learned and became committed to most of their outdoor recreation activities before 21 Activity Theory: asserts that people will be happiest and most fulfilled in direct proportion to how much activity they are able to maintain Disengagement Theory: As the end of life draws near, people will voluntarily disengage from others and from their former activity pattern and society’s withdrawal from then will in turn leave them in peace and happiness. Continuity Theory: Those activities and relationships that have been cultivated and maintained over a long period in peoples lives are most likely to contribute to well-being and a sense of integrity. Leisure lifestyle: Is the day-to-day behavioural expression of one’s leisure related attitudes, awareness and activities revealed within the context and composite of the total life experience Leisure lifestyles implies that an individual has sufficient skills, knowledge, attitudes, and abilities to participate successfully in and be satisfied with leisure and recreation experiences that are incorporated into his or her individual life pattern. NTRS Philosophy statement: Day to day behavioural expression of one’s leisure values, attitudes, awareness and skills in their life experiences Leisure: The main variables of perceived autonomy or freed of choice and intrinsic motivation that reflects behaviours that are enjoyable Money, education, age, ethnicity, etc. 19  Leisure seen as: o Time: a block of time o Activity: social-economic factors -education/money/income/age/ethnicity ▪ determines activity/interests o Holistic: in all aspects of your life Self-determined; can be seen as social instrument Seen as a means to an end 1.) Freedom of choice 2.) Intrinsic motivation 3.) Sense of satisfactions State of Flow: Csikszentmihalyi State of optimal, psychological arousal-when the challenge matches your skill. When the skill level is low and the activity challenge is high, the individual is most likely to be anxious. When the skill level and activity challenge are identical or nearly identical (both low and both high), the individual is most able to achieve a state of concentration and energy expenditure. The matching of skills and challenges is necessary for satisfying experience. Self-Actualization: Also called self-determination Maslow’s hierarchy of needs, to reach your potential A peak experience. physiological needs → safety/security → belonging → self-esteem →self-actualization the central pervasive personal belief that an individual can exercise some control over his or her own functioning and over environmental events to reach some desired end; Foundational to the individual’s sense of competence and control. Individuals with higher self-actualization believe their choices and actions will affect the outcome of a situation Those with lower self-efficacy believe their choices and actions have little relationship to the outcome. NCTRC Study Guide - Section Two: Practice of Therapeutic Recreation Part A: Strategies and Guidelines Concepts of TR Holistic Approach: Looks at the whole person & their needs. Recognizes & integrates multiple factors. Developed from a broad base of information. Integrated from an interdisciplinary frame of reference. Recreational Experience: Everyone has a Right to recreate. Recreation as an end to itself. Treatment Concept: Used as a treatment tool to cure 20  To use Recreation to meet other needs/goals. Special/Adaptive Recreation: In some cases, activities will need to be adapted or modified to accommodate clients with limitations Adaptive equipment may be utilized o i.e. - Bradshaw bowl buggy – w/c designed for bowling o http://www.recreativeresources.com/linkadaptiveequipment.htm Games may be modified by reducing the dimensions of the playing areas, simplifying the rules, etc. The best modification is the least modification. Inclusive Recreation: Inclusive services enable people of varying abilities to participate and interact in life’s activities together with dignity. Services include the concepts of: o right to leisure o quality of life o support o assistance o accommodations o barrier removal In some instances participation in community-based programs is initiated through specific inclusion practices or programs. Successful and full inclusion is dependent on two factors 1.) The individual with the disability must have the activity skills as well as the interaction skills. 2.) The service provider of recreation programs must view the involvement of individuals with limitations as part of their basic service responsibility Inclusion Steps: 1. Address individual needs 2. Identify a source of funds 3. Identify support staff – close to same age 4. Provide training – method of adapting and dealing with behaviours Models of TR Service Delivery TR Service Delivery Model: Nature of service Planned interventions as well as leisure experience dimension Key element of determining whether an activity is an intervention or a leisure experience is not the nature of the activity, but the clients perception of the experience 1.) Leisure Ability Model (Gunn/Peterson): Client-oriented approach to TR The needs of the client determine the nature of programs provided Maximum control by specialist → minimum control by specialist Four Steps: 1. Assessment: ▪ ID Problem, gather data 2. Functional Intervention/Treatment: ▪ Address functional abilities that are prerequisite to leisure involvement and lifestyle. ▪ Domains: physical, mental/cognitive, emotional/affective and social functioning 21  3. Leisure Education: ▪ Focus on the development and acquisition of various leisure-related skills, attitudes, and knowledge. ▪ An appropriate leisure lifestyle appears to be dependent on the acquisition of diverse knowledge and skills. ▪ Utilizes an education model as opposed to a medical model ▪ Four components (see part D – Leisure education) 1) Leisure awareness 2) Social interaction skills 3) Leisure resources 4) Leisure activity skills 4. Recreation Participation/Leisure Lifestyle: ▪ Part of the expression of leisure lifestyle ▪ Examples of recreation participation are activities that: 1) Require many participants and on administrative structure – leagues and tournaments 2) Enjoyed in groups and are facilitated – dramatics, arts and crafts, music 3) Require a specific facility or equipment – fitness and exercise, ceramics 4) Self-initiated and self-directed – park, playground, swimming pool, drop-in center 2.) Heath Improvement/Health Promotion Model (Austin): Purpose of TR is to enable the client to recover following a threat to health (health protection) and to achieve optimal health (health promotion) Use activity, recreation and leisure to help people deal with problems that serve as barriers to health and to assist them grow toward their highest levels of health and wellness. Stability tendency lessons as a client gains optimal health and moves towards actualization. Based on the humanistic assumption that human beings have an overriding drive for health and wellness Three Steps: o Prescribed Activity - CTRS directed: ▪ Health protection is prescriptive and exemplified by the stabilizing tendency that pushes clients to achieve health. ▪ May be necessary in order to engage them so that they are not passive victims of their circumstances but begin to take action to restore their health. o Recreation - Equal participation between client and CTRS: ▪ Through recreation, client begins to regain their equilibrium so they may once again resume their quest for actualization. ▪ In recreation, clients afford opportunities to experience control over their environments within a supportive, non-threatening atmosphere. ▪ Moves away from stability tendencies → towards actualization. o Leisure - Client directed : ▪ Leisure is self-directed by client ▪ Intrinsically motivated, self-determined ▪ Match between abilities and challenges ▪ Can play a critical role in helping clients to actualize and move toward optimal health ▪ Reaches actualization 3.) The Optimizing Lifelong Health through Therapeutic Recreation model Therapeutic recreation specialists work with individuals who have illness, disease, and/or lifelong disability to achieve and maintain leisure lifestyles that will enhance their health and well-being across the life course. Through the elements of 22  o selecting o optimizing o compensating o evaluating 4.) Self-Determination and Enjoyment Enhancement: It is proposed that teaching participants in TR programs to experience enjoyment and to create environments conducive to enjoyment are important goals for TR service which also contribute to participants' functional improvements 4.) Aristotelian Good Life Model: Four major elements 1. Afflictions and oppression 2. Aristotelian goods 3. Freedom 4. Role of CTRS Easy to follow and accommodates a variety of clients and settings Using the Aristotelian Model o What is the end goal/purpose? o Underlying assumptions o Theoretical bases o Direction for research and practice o Could you explain TR with this model o Could you design programs? 4.) Benefits Drive Model: Focuses on what participants will get out of a program Three approaches: a) Quality of life b) Human services c) Marketing Four step process: 1. Identify the problem issue and target goals (assessment) 2. Determine activity components (plan and implement program) 3. Document the benefit outcomes (evaluate) 4. Spread the word about the positive results of the program Mobily’s Summary of Models: Models are useful for: Detection of errors As mechanisms to accommodate new developments As means for improving the profession All seek to reconcile the strict therapeutic outcomes of the clinical setting with the unique modality of recreation activity Theoretical based. Practice Settings Different Therapeutic Recreation Practice Settings: 1. Hospitals 2. Long-term care/extended care 3. Centers – private/public for people with development disabilities 23  4. Correctional facilities – adult and youth detention centers 5. Mental health facilities – outpatient day care, community mental health centers, and public/private psychiatric facilities or units 6. Addiction treatment centers 7. Residential settings – group homes, half-way houses, assisted living and shelters 8. Physical rehab units 9. Hospice – end of life facilities 10. Public, not-for-profit recreation 11. Private, for-profit rehab and vocational centers 12. Schools – inclusionary services 13. Special residential schools – visual impairments, hearing impairments, emotional and behaviours disorders, etc. 14. Community based recreation/special education 15. Year round residential camps – individuals with emotional disturbances Standards of Practice National Therapeutic Recreation Society (NTRS) Standards of Practice: 1.) Scope of Practice Development and implementation Content a) Treatment Services b) Leisure Education Services c) Recreation Services 2.) Mission and Purpose, Goals and Objectives 3.) Individual Treatment/Program Plan 4.) Documentation 5.) Plan of Operation 6.) Personnel Qualifications 7.) Ethical Responsibilities 8.) Evaluations and Research Code of Ethics National Therapeutic Recreation Society (NTRS) Code of Ethics: 1.) The Obligation of Professional Virtue: Professionals possess and practice the virtues of integrity, honesty, fairness, competence, diligence, and self-awareness. Integrity: Professionals act in ways that protect, preserve and promote the soundness and completeness of their commitment to service. Professionals do not forsake nor arbitrarily compromise their principles. They strive for unity, firmness, and consistency of character. Professionals exhibit personal and professional qualities conducive to the highest ideals of human service. Honest: Professionals are truthful. They do not misrepresent themselves, their knowledge, their abilities, or their profession. Their communications are sufficiently complete, accurate, and clear in order for individuals to understand the intent and implications of services. Fairness: Professionals are just. They do not place individuals at unwarranted advantage or disadvantage. They distribute resources and services according to principles of equity. Competence: Professionals function to the best of their knowledge and skill. They only render services and employ techniques of which they are qualified by training and experience. They recognize their limitations, and seek to reduce them by expanding their expertise. Professionals continuously enhance their knowledge and skills through education and by remaining informed of professional and social trends, issues and developments. 24  Diligence: Professionals are earnest and conscientious. Their time, energy, and professional resources are efficiently used to meet the needs of the persons they serve. Awareness: Professionals are aware of how their personal needs, desires, values, and interests may influence their professional actions. They are especially cognizant of where their personal needs may interfere with the needs of the persons they serve. 2.) The Obligation of the Professional to the Individual: Well-Being: Professionals' foremost concern is the well-being of the people they serve. They do everything reasonable in their power and within the scope of professional practice to benefit them. Above all, professionals cause no harm. Loyalty: Professionals' first loyalty is to the well-being of the individual they serve. In instances of multiple loyalties, professionals make the nature and the priority of their loyalties explicit to everyone concerned, especially where they may be in question or in conflict. Respect: Professionals respect the people they serve. They show regard for their intrinsic worth and for their potential to grow and change. The following areas of respect merit special attention: 1. Freedom, Autonomy, and Self-Determination: Professionals respect the ability of people to make, execute, and take responsibility for their own choices. Individuals are given adequate opportunity for self-determination in the least restrictive environment possible. Individuals have the right of informed consent. They may refuse participation in any program except where their welfare is clearly and immediately threatened and where they are unable to make rational decisions on their own due to temporary or permanent incapacity. Professionals promote independence and avoid fostering dependence. In particular, sexual relations and other manipulative behaviors intended to control individuals for the personal needs of the professional are expressly unethical. 2. Privacy: Professionals respect the privacy of individuals. Communications are kept confidential except with the explicit consent of the individual or where the welfare of the individual or others is clearly imperiled. Individuals are informed of the nature and the scope of confidentiality. Professional Practices: Professionals provide quality services based on the highest professional standards. Professionals abide by standards set by the profession, deviating only when justified by the needs of the individual. Care is used in administering tests and other measurement instruments. They are used only for their express purposes. Instruments should conform to accepted psychometric standards. The nature of all practices, including tests and measurements, are explained to individuals. Individuals are also debriefed on the results and the implications of professional practices. All professional practices are conducted with the safety and well-being of the individual in mind. 3.) The Obligation of the Professional to Other Individuals and to Society: General Welfare: Professionals make certain that their actions do not harm others. They also seek to promote the general welfare of society by advocating the importance of leisure, recreation, and play. Fairness: Professionals are fair to other individuals and to the general public. They seek to balance the needs of the individuals they serve with the needs of other persons according to principles of equity. 4.) The Obligation of the Profession to Colleagues: Respect: Professionals show respect for colleagues and their respective professions. They take no action that undermines the integrity of their colleagues. Cooperation and Support: Professionals cooperate with and support their colleagues for the benefit of the persons they serve. Professionals demand the highest professional and moral conduct of each other. They approach and offer help to colleagues who require assistance with an ethical problem. Professionals take appropriate action toward colleagues who behave unethically. 25  5.) The Obligation of the Professional to the Profession: Knowledge: Professionals work to increase and improve the profession's body of knowledge by supporting and/or by conducting research. Research is practiced according to accepted canons and ethics of scientific inquiry. Where subjects are involved, their welfare is paramount. Prior permission is gained from subjects to participate in research. They are informed of the general nature of the research and any specific risks that may be involved. Subjects are debriefed at the conclusion of the research, and are provided with results of the study on request. Respect: Professionals treat the profession with critical respect. They strive to protect, preserve, and promote the integrity of the profession and its commitment to public service. Reform: Professionals are committed to regular and continuous evaluation of the profession. Changes are implemented that improve the profession's ability to serve society. 6.) The Obligation of the Profession to Society: Service: The profession exists to serve society. All of its activities and resource are devoted to the principle of service. Equality: The profession is committed to equality of opportunity. No person shall be refused service because of race, gender, religion, social status, ethnic background, sexual orientation, or inability to pay. The profession neither conducts nor condones discriminatory practices. It actively seeks to correct inequities that unjustly discriminate. Advocacy: The profession advocates for the people it is entrusted to serve. It protects and promotes their health and well-being and their inalienable right to leisure, recreation, and play in clinical and community settings. ATRA Code of Ethics: 1.) Beneficence/No Maleficence: Therapeutic Recreation personnel shall treat persons in an ethical manner not only by respecting their decisions and protecting them from harm but also by actively making efforts to secure their well-being. Personnel strive to maximize possible benefits, and minimize possible harms. This serves as the guiding principle for the profession. The term “persons" includes not only persons served but colleagues, agencies and the profession. 2.) Autonomy: Respect for the individual’s right to choice Therapeutic Recreation personnel have a duty to preserve and protect the right of each individual to make his/her own choices. Each individual is to be given the opportunity to determine his/her own course of action in accordance with a plan freely chosen. 3.) Justice: Access to services must be available to all. There must be fairness in distribution of service based on individual need Therapeutic Recreation personnel are responsible for ensuring that individuals are served fairly and that there is equity in the distribution of services. Individuals receive service without regard to race, color, creed, sex, age, and disability/disease, social and financial status. 4.) Fidelity: Tell the truth, the whole truth and nothing but the truth Therapeutic Recreation personnel have an obligation to be truthful, faithful and meet commitments made to persons receiving services, colleagues, agencies and the profession. 5.) Veracity/Informed Consent: Therapeutic Recreation personnel are responsible for providing each individual receiving service with information regarding the service and the professional's training and credentials; benefits, outcomes, length of treatment, expected activities, risks, limitations. 26  Each individual receiving service has the right to know what is likely to take place during and as a result of professional intervention. Informed consent is obtained when information is provided by the professional. 6.) Confidentiality and Privacy: Always respect people’s privacy and always be confidential with regards to patient care Therapeutic Recreation personnel are responsible for safeguarding information about individuals served. Individuals served have the right to control information about themselves. When a situation arises that requires disclosure of confidential information about an individual to protect the individual's welfare or the interest of others, the Therapeutic Recreation professional has the responsibility/obligation to inform the individual served of the circumstances in which confidentiality was broken. 7.) Competence: Continually take steps to attain, maintain and expand your competence in therapeutic recreation practice Therapeutic Recreation personnel have the responsibility to continually seek to expand one's knowledge base related to Therapeutic Recreation practice. The professional is responsible for keeping a record of participation in training activities. The professional has the responsibility for contributing to changes in the profession through activities such as research, dissemination of information through publications and professional presentations, and through active involvement in professional organizations. 8.) Compliance with Laws and Regulations: Therapeutic Recreation personnel are responsible for complying with local, state and federal laws and ATRA policies governing the profession of Therapeutic Recreation. Part B: Assessment Assessment: Identifying and obtaining data from many sources, data collection and analysis in order to determine problems &/or needs. First step in the therapeutic recreation process. Data collection and analysis in order to determine the status of the client. Aid us to determine client strengths, interests, and expectations and to identify the nature and extent of the problems or concerns. Primary source of info is the client. Secondary sources of info include: medical or education records, results of testing, interviews with family or friends, the social history (social worker), case recordings or progress notes that staff have charted, and conferences and team meetings with other staff. Assessment Purposes: 1.) Identify Client Information: Problems 2.) Initial Baseline Assessment: Treatment Planning/Program Placement 3.) Monitor Progress: Formative Evaluation Methods of Assessment/Assessment Implementation Assessment Implementation Process: 1.) Review assessment protocol 2.) Prepare for assessment 3.) Administer assessment to client 4.) Interviews, observations, self-administered surveys, record reviews 5.) Analyze or score assessment results 6.) Interpret results for placement into programs 27  7.) Norm-referenced, criterion-referenced 8.) Document results of assessment 9.) Reassess clients as necessary/monitor progress Standardized Assessment/Assessment Procedure: The consistent administration and reporting of participant data using formal and informal processes accepted by professionals at the particular agency. Including: MDS, LCM, LDM and agency developed instruments use to identify participants behaviours, abilities, strengths, skills and expectations. Implementation of Assessment: 1.) Multi-disciplinary and a gathering of information: Collect information on leisure interests Do clients value leisure & recreation? Do they value and understand it & what it means in their life? Can they identify their own personal resources, talents, skills, interests, equipment & supplies? Money, family, transportation likes & dislikes? Can these skills be transferred to their present lifestyle? Can they identify leisure partners? Can they describe a healthy leisure lifestyle? Do they have knowledge of leisure resources Do they have the ability to make decisions and take responsibility for their leisure involvement? 2.) Assess how they function in a “normal” environment: Self-initiating? Needs encouragement to participate? Who does client interact with? How do others react to the client? What is the nature of the verbal/no-verbal communications? Error and Confidence: Reducing error All assessments scores have error Want to minimise so scores are accurate Protocols and periodic staff training/retraining Use assessments which produce valid, reliable, and usable results Current TR/Leisure Assessment Instruments 1.) Measuring Attitude Cooperation and Trust Scale (CAT): High cognitive functioning clients Approx. ten mins to administer Usually used in a pretest/posttest protocol Used on adolescents in summer adventure program Purpose: to measure participants perceived level of trust and cooperation Self-report assessment Sample questions: o Having a groups support makes many things easier to do. o Cooperation is more enjoyable then competition in sports and games. o Trusting others is often a mistake 28 Free Time Boredom: Reading level at 4th grade, high cognitive functioning Purpose: to identify the degree to which the participant is bored in the four components that make up boredom which include: 1.) Meaningfulness: the patient has a focus or purpose during their free time 2.) Mental Involvement: the patient has enough to think about and finds these thoughts emotionally satisfying. 3.) Speed of Time: the patient has enough purposeful and satisfying activity to fill their time 4.) Physical Involvement: the patient has enough movement to satisfy them. Sample questions: o During my free time, I do not use a lot of my physical skills o During my free time, it feels that time stands still Idyll Arbour leisure Battery (IALB) Purpose: there are four separate testing tools. Each one measures a specific type of leisure attribute. Has an executive summary that shows interventions based on scores of each of the other assessments Has a summary of participants affect and mannerism during assessment. Includes: 1.) Leisure Interest Measure 2.) Leisure Satisfaction Measure 3.) Leisure Attitude Measurement 4.) Leisure Motivation Scale Leisure Attitude Measurement (LAM): Originally known as Leisure Attitude Scale (LAS) Purpose: to identify attitudes towards leisure High cognitive functioning clients Self-report assessment Originally developed for research Three areas of leisure attitude: 1. Cognitive: general knowledge about leisure, beliefs about leisure, etc. 2. Affective: evaluation of leisure experiences, liking of experiences, feelings toward leisure, etc. 3. Behavioural: Intentions, current and past participation Sample questions: o Engaging in leisure activities is a wise use of my time. o Leisure activities are important. Leisure Interest Measure (LIM): High cognitively functioning clients Purpose: to measure interest in the 8 domains of leisure activities Measures how much interest the client has in the 8 domains of leisure Includes: Physical, Outdoors, Mechanical, Art, Services, Social, Cultural and Reading. Sample questions: o I like to read in my free time o I prefer being outdoors o I like to create artistic designs in my leisure time Leisure Motivation Scale (LMS): High cognitive function clients Purpose: To measure motivation for engaging in leisure activities: Four primary motivators: 1.) Intellectual – extent to which the individuals are motivated to engage in leisure activities. 29  2.) Social – this component measures the need for relationships and being valued by others. 3.) Competence – assesses the extent to which individuals engage in leisure in order to achieve and competence. 4.) Stimulus Avoidance – assesses the need to seek solitude or individual participation. Sample questions: o To learn about myself o To be with others o To expand my leisure interests Life Satisfaction Measure (LSM): Originally known as Leisure Satisfaction Scale (LSS) Used for high cognitive functioning clients Self-report assessment Purpose: to measure degree client perceived general “needs” are being met through leisure Six categories of need: 1) Psychological – sense of freedom, enjoyment, etc. 2) Educational – intellectual stimulation, learning about self and surroundings 3) Social – relationships with others 4) Relaxation – relief from stress 5) Physiological – physical fitness, stay healthy, control weight, etc. 6) Aesthetic – view areas in which they engage in leisure as pleasing, interesting, beautiful, etc. Sample questions o My leisure activities are very interesting to me o My leisure activities help me relax Leisure Diagnostic Battery (LDB): Probably most researched TR assessment Developed originally for in-school use First comprehensive battery of instruments designed to assess an individual’s “leisure functioning” Based on attribution theory, the term ‘leisure functioning” describes how an individual feels about his/her leisure experiences. Measures extent of perceived freedom in leisure & current level of leisure functioning; areas in need of improvement and impact of leisure services. Self-report assessment Long and short forms are available Used for people with and without disabilities The LDB consists of 8 components: o Section 1: Perception of Freedom in leisure: 1) Perceived leisure competency scale 2) Perceived leisure control scale 3) Leisure needs scale 4) Depth of involvement in leisure scale 5) Playfulness scale o Section 2: Barriers to Leisure: 6) Barriers to leisure involvement scale 7) Knowledge of leisure opportunity test 8) Leisure preference inventory Leisurescope Plus and Teen Leisurescope Plus: Purpose: o To identify areas of high leisure interest. 30  o To identify the emotional motivation for participation, o To identify individuals who need higher arousal experiences (risk takers). Used for adults and for adolescents Preferences are divided into 10 categories (game, music & art, adventure, etc.) Clients respond after viewing “collages” (pictures on cards or slides) Which do they like better? Validity & reliability studies reported Life Satisfaction Scale (LSS): Clients with moderate to no cognitive impairment Purpose: to measure perceived satisfaction with life Self-report assessment Sample questions o I feel miserable most of the time o I never dreamed that I could be as lonely as I am now o I haven’t a cent in the world Measurement of Social Empowerment and Trust (SET): Purpose: to measure changes in perception of social attitudes and skills as a result of a treatment program or adventure Adolescents and adults with moderate to no cognitive impairment. Five subscales: 1.) Bonding/Cohesion – see self as connected to group 2.) Empowerment – able to influence people and events around person 3.) Self-awareness – identify own feelings 4.) Self-affirmations – ability to state beliefs and goals 5.) Awareness to others – awareness of trust in others Sample questions: o At present I get along with others o Feel accepted by others o Understand how my actions affect others 2.) Measuring Function Skills: Bus Utilization Skills Assessment (BUS): Clients with cognitive and/or physical impairment Purpose: to determine skills client has in relation to using public transportation. Determine if clients are cognitively and socially competent to use public transportation independently Two Sections: 1.) Evaluations functional skills such as: appearance, getting ready, waiting for the bus, interaction with strangers, pedestrian safety, riding conduct and transfers 2.) Evaluates maladaptive behaviours such as anxiety, depression, hostility, suspiciousness, unusual thought content, hallucinations, disorientation, etc. Uses detailed checklist and observation Comprehensive Evaluation in Recreational Therapy (CERT – Psych/Behavioural, Revised): For psychiatric settings, short term or acute care. Also known as CERT- Psych/R Checklist based on observation Youth and adults with a developmental age of at least ten. Purpose: to identify and evaluate behaviours relevant to successfully integrate into society using 31  appropriate social skills. Three performance areas: 1. General: o Attendance, appearance, attitude toward recreation therapy, posture. 2. Individual Performance: o decision-making ability, judgement ability, ability to form individual relationships, expression of hostility, performance in organized activities, performance in free activities, attention span, frustration tolerance, strength/endurance, etc. 3. Group Performance: o Memory for group activities, response to group structure, leadership ability in groups, group conversation, etc. Comprehensive Evaluation in Recreation therapy (CERT – Physical Disabilities) Adults in rehab/loss of function Purpose to establish baseline for functional skills related to leisure Reassessment of the same client helps to establish skill recovery or loss. Checklist based on observation Eight areas: 1.) Gross motor function: ▪ Neck control, weight bearing, right lower extremity movement, etc. 2.) Fine motor function: ▪ Right manual movement ability, right manual movement endurance, etc. 3.) Locomotion: ▪ Wheelchair maneuverability, transfer ability, ambulatory ability, etc. 4.) Motor Skills: ▪ Fine motor coordinator, gross motor coordination, recreation time, etc. 5.) Sensory: ▪ Ocular pursuit, depth perception, auditory acuity, etc. 6.) Cognitive: ▪ Judgement/decision making ability, attention span, memory, orientation, etc. 7.) Communication: ▪ Verbal expressive skills, verbal receptive skills, written receptive skills, written expressive skills, etc. 8.) Behaviour: ▪ Adjustment to disability, social interaction skills, frustration tolerance level, emotions. FOX: The Activity Therapy Social Skills Baseline Individuals with a primary or secondary diagnosis of dementia, MR/DD, or brain injury Developmental level of approx. 6 months - 4 years. Purpose: to evaluate the clients relative level of skill in the social/affective domain Most of the skills included in this assessment are important building blocks to development of a mature leisure lifestyle. Divided into 12 levels of ability, the lowest being Social Level I. Six areas of abilities Include: o The clients reaction to others o The clients reaction to objects o The clients seeking attention from other to manipulate the environment o The clients interaction with objects o The clients concept of self o The clients interaction with others Functional Assessment of Characteristics for TR (FACTR): 32  Original population was adults in VA hospitals (rehab, psych, geriatric, hospitals, etc.) Can be used as an initial screening for most populations Purpose: to assess basic functional skills, see if client qualifies for services and to identify the area most likely to improve with services. Examines functional skills for leisure involvement Use of chart review and observations Three domains: 1. Physical: 11 areas including: Sight/vision hearing, ambulation, general coordination, etc. 2. Social/emotional: 11 areas including: dyad, small group, competition, conflict/argument, etc. 3. Cognitive: 11 areas including: orientation, receptive language, attending and concentrating, long-term memory, etc. Functional Fitness Assessment for Adults over 60yrs: Seniors with limited disabilities Purpose: to determine the functional capacity of older adults in six areas of function relative to established ego and sex-related norms. Measures six areas including: 1. Body Composition 2. Flexibility 3. Agility/Dynamic Balance 4. Coordination 5. Strength/Endurance 6. Endurance Functional Hiking Techniques: Appropriate for any client group who is ambulatory and has cognitive disabilities. Purpose: to determines ability to demonstrate skills to hike independently. Measures ability to: o Select appropriate attire o Demonstrate pacing patterns o Demonstrate uphill/downhill techniques o Demonstrate techniques to move under obstacles o Demonstrate techniques to move over obstacles General Recreation Screening Tool (GRST): Written for clients with MR/DD Purpose: Measures general developmental level of the client in 18 areas related to leisure. Takes approx. 15 mins to score after observing the patients in two or more activities. Measures 18 areas of leisure including: o gross/fine motor o hand-eye o play behaviour o language use o following directions o problem solving o emotional control o people skills o etc. 33 Idyll Arbour Activity Assessment: Intake assessment form for long-term care/nursing homes Written to meet Omnibus Budget Reconciliation Act (OBRA) regulations Helps complete MDS Purpose: to obtain information to develop a treatment plan Chart review, observation, interview Five sections: 1. Personal and medical history 2. Leisure interests 3. Leisure history 4. Individual performance/social strengths 5. Maladaptive behaviours Inpatients Rehabilitation Facility – Patient Assessment instrument (IRF-PAI) Completed by numerous members of the interdisciplinary treatment team Summary assessment Inpatient rehab unit or hospital including: stoke; brain dysfunction; neurologic conditions; spinal cord dysfunction, Non-Traumatic/Traumatic; amputation; arthritis; pain syndromes; orthopedic disorders; cardiac disorders; pulmonary disorders; burns; DD and medically complex conditions. Purpose: to gather data to determine the payment of each Medicare Part A fee-for-service patients admitted to an impatient rehab unit or hospital Measures what the client with a disability actually does, not what she ought to be able to do. Similar to long-term care Uses FIM in clinical section Leisure and Social/Sexual Assessment (LS/SA) Developed for adolescents and young adult clients who are diagnosed as having MR/DD or other disabilities that cause a person to struggle with appropriate social behaviours and appropriate social interactions. Purpose: to provide the therapist with a tool to assess the breadth and depth of a participants understanding of appropriate social and sexual roles Three sections: 1. Basic personal data 2. Structured interview - Explore understanding of activities/leisure 3. Structured interview - Explore understanding of dating, marriage and sexuality Recreation Early Development Screening tool (REDS): Individuals with severe/profound MR or severe DD who function less than 1 year of age Was designed for adults One of the few TR assessment for clients who are extremely disabled Purpose: to assess developmental level. Tests development levels 0-1 months to 8-12 months Observation Measures five areas: 1. Play 2. Fine motor 3. Gross motor 4. Sensory 5. Social/cognition School Social Behaviour Scale (SSBS): Youth ages 5-18 in school or treatment settings 34  Purpose: to measure social competence and antisocial behaviour Identify students who are behaviourally at-risk and who could benefit from prevention/intervention Measures: 1. Social Competence: ▪ Interpersonal skills, self-management skills and academic skills 2. Antisocial Behaviours: ▪ Hostile-irritable, antisocial-aggression, and disruptive demanding The Social Attributes Checklist – Assessing Young Children’s Social Competence Preschool or elementary school age children, with and without disabilities Purpose: to measure social behaviour related to developmentally appropriate social competence Research show if children do not have minimal social competence by age six they have a high probability of being at risk Observation Three areas: 1. Individual attributes: ▪ Usually in positive mood, usually copes with rebuffs adequately, shows capacity to empathize, etc. 2. Social skills attributes: ▪ Approaches others positively, is not easily intimidated by bullies, takes turns fairly easily, etc. 3. Peer relationship attributes: ▪ Usually accepted versus neglected or rejected by other children, is named by other children as someone they are friends with or like to play and work with, etc. Therapeutic Recreation Activity Assessment (TRAA) Clients with TBI, DD, Psychiatric disabilities, or receiving supported care like residents of a nursing home, group home, adult daycare center, or assisted living facility Best for people who have severe mental illness Purpose: to assess basic functional skills as demonstrated in a group setting Also has a protocol for assessing clients with significant impairments Uses interviews and a series of activities Measures six areas: 1. Find motor skill 2. Gross motor skill 3. Receptive communication 4. Expressive communication 5. Cognitive skills 6. Social behaviours Comprehensive Visual Neglect Assessment (CvNA): Clients with right CVA with left neglect. Purpose: to measure density and scope of visual neglect Uses a dart board 3.) Measuring Participation Patterns Assessment of Leisure and Recreation Involvement (LRI): Individuals with moderate or no cognitive impairments Purpose: to measure perception of involvement and not just participation Self-report assessment Six cognitive/emotional elements that influence actual participation in activity: 35  1.) Importance of activity 2.) Pleasure derived from activity 3.) Interest in activity 4.) Intensity or absorption in activity 5.) Centrality to perception of self 6.) Meaning of activity Sample questions o My favourite activities give me pleasure o My leisure activities give me a sense of value in my life Leisure Assessment Inventory (LAI): Developed for seniors and adults with DD Also appropriate for middle-ages and older adults with moderate to no cognitive disability. Purpose: to measure the leisure behaviour of adults Assess participation Four Subscales including: 1.) Leisure Activity Participation Index (LAP) – measure of activity involvement 2.) L-PRED Index – measure of leisure activities in which the individual would like to increase participation. 3.) Leisure Interest (L-INT) Index – measures degree of unmet leisure involvement 4.) Leisure Constraints (L-CON) Index – assesses the degree of internal/external constraints that inhibit leisure participation. Leisure Step-Up: Assessment and leisure education program Wide variety of populations Most appropriate for psychiatric adults and adolescents in behaviour med. or substance abuse units. Can also be used with physical/developmental disabilities and long-term care homes Built on Nash’s model of hierarchy Uses pictures geared for adults 50 and older Four subscales: 1. Leisure activity participation index – reflect leisure repertoire, measures of involvement 2. Leisure preference index – activities persons would like to [participate in 3. Leisure interest index - unmet involvement 4. Leisure constraints – internal and external constraints Leisure level model steps: 1. Assessment 2. Identify problem 3. Understanding healthy leisure 4. Experience healthy leisure participation 5. Unresolved issues of past and relationship between leisure and what is going on at the time 6. Planning the future 7. Opportunities to observe leisure activities 8. Arts, crafts, music, drama, dance and home activities 9. Exercise, games, sports, physical activities and health 10. Education, cultural, volunteering, collecting and service to others 11. Therapist offers congratulations and states participant is read to participate in own activities of their own choice – discharge State Technical Institute’s leisure Assessment Process (STILAP): Adults with physical disabilities 36  Measures general scope of leisure activity skills in order to provide a basis for program decision making regarding a more balanced & leisure skill repertoire. Fourteen competencies including: physical skill that can be done alone, activity dependent on some aspect of the outdoor environment, etc. Recreation Participation Data Sheet (RPD): Way to monitory the balance of leisure activities offered to clients living in group homes to ensure that staff offer an appropriate mix of activities More a method of documenting participation than an assessment Purpose: to monitor client’s involvement in leisure activities Areas: participation, initiation, independence, physical output, satisfaction, average size of groups and average time spend in activities. Has a supplemental physical activity sheet to monitor physical activity 4.) Community Integration Program Any population that needs to regain the ability to use community resources, including but not limited to patients with physical disabilities, DD, psychiatric disorders, head injuries and youth at risk. Purpose: the give the TRS a standardized tool to measure many different aspects of a patients knowledge and functional skills related to accessing community resources The CIP measures the knowledge and skills required for using resources within the community Each module measures different aspects of knowledge and skills required for integration. The CIP is one of the most powerful tools for the TRS because it provides the therapist with the ability to help the patient and treatment team gauge how well the patient will function after discharge Helps measure the patient’s ability to implement new skills and knowledge gained during treatment Whole manual is 321 pages. Three basic steps 1.) Pretest – walk/talk steps before do 2.) Field Trial – demonstrate skills in community 3.) Posttest 5.) Interdisciplinary Assessments Resident Assessment Instrument (RAI): Interdisciplinary assessment and care planning process Used in long-term care Computerised Used to ass, reimburse and quality assurance Summary assessment Identifies: needs, strengths, preferences, description of functional skills, directs content of care plan Identifies need for further assessment T1a = Recreation Therapy Basic components: 1.) Minimum Data Set (MDS): Mandated by the Omnibus Reconciliation Act (OBRA) of 1987 to ensure that all nursing home residents were assessed, provided with services, and monitored on a regular basis. The MDS has undergone several changes in the past few years, with the last one occurring in the summer of 1998. As of July 1, 1998 the Prospective Payment System began and Section T. was added to the MDS, which requires the reporting of Recreational Therapy treatment services under Section T. 1a. 37  HCFA is currently collecting statistical data on the use of recreation therapy through Section T. 1a. To evaluate for future reimbursement rates. The MDS documents the number of days and total minutes of recreation therapy administered during the past seven days. Recreation Therapy is considered a rehabilitation treatment option, and must be provided by a qualified provider (a certified therapeutic recreation specialist or a certified therapeutic recreation assistant under the supervision of a therapist). The scope of intensity, duration, and service provided must be within the physician or nurse practitioner’s prescription. If recreation therapy is ordered, it is considered medically necessary and appropriate, and therefore, the facilities’ obligation to provide the service for their residents. If the facility does not employ a certified therapeutic recreation specialist, the facility is required to contract for this service. 2.) Triggers: Scores that indicate the need for further assessment in one of more the 18 areas of more in-depth assessment. 3.) Resident assessment Protocols (RAPs): Assessment protocols that provide guidelines for further assessment by the triggers 4.) Resource Utilization Guidelines 5.) Prospective Payment systems 6.) Quality Indicators Impatient Rehabilitation Facility – Patient Assessment Instrument (IRF-PAI): Completed by various members of interdisciplinary team Summary assessment Professionals first assess functional needs using another assessment and then summarized findings on this document Clients in impatient rehabilitation unit or hospital FIM is part of this summary Used to determine payment for Medicaid Functional Independence Measure (FIM): Not a standardized testing tool Included as part of the in-client rehabilitation facility client assessment instrument An 18-item, 7-level ordinal scale. 7 level scale ranging from dependence to independence 126 indicated independence, while a score of 18 indicated full dependence It is the product of an effort to resolve the long-standing problem of lack of uniform measurement and data on disability and rehabilitation outcomes. Areas include: eating, grooming, bathing, dressing, problem solving, etc. Used in rehabilitation Basic indicator of severity of disability Can be administered quickly and to groups Global Assessment of Functioning (GAF): Scale in a managed care environment Behaviours health (psychiatry/substance abuse) Looks at overall functioning Continuum from psychiatric illness to health Scale 1 (sickest) to 100 (healthiest) o 81-90/91-100 = positive mental health 38  o 31-70 = most outpatients o 1-40 = most inpatients Areas include: psychological impairment, social skills, dangerousness, occupational skills, substance abuse Pain Scale: There are a variety of scales In 2001 JCAHO required that all professionals working with clients, including TR need to complete a pain assessment. Other Inventories and Questionnaires Leisure Activity Blank (LAB): Measures past leisure participation & intentionality of future involvement Three point r