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activity engaged in during one's leisure time that involves, in an appropriate setting, social interaction
This diagnoses the behavior between non-problematic use and severely problematic use. Goes from ranges of use, abuse, & dependence.
Leisure ability model
most widely accepted and utilized.
composed of 3 components
1) functional intervention
2) leisure education
3) recreation participation
ultimate goal: a satisfying leisure lifestyle.
a model that represents or describes the relationships between the components of an ecological system
Long term care
provide medical, nursing, dietary, recreation, rehabilitative and social services for residents. Maybe permanent or temporary.
An environment that provides client the opportunity to interact with staff and other clients. It gives the client the opportunity to practice interpersonal skills, provide feedback to peers about behavior, and work together to develop problem-solving skills.
the concept that diseases have physical causes that can be diagnosed, treated, and, in most cases, cured. When applied to psychological disorders, this assumes that these mental illnesses can be diagnosed on the basis of their symptoms and cured through therapy, which may include treatment in a psychiatric hospital.
human service model
A treatment approch that utilizes problems solving to work with clients and their problems within the context of the environment.
A person's explanation of the course of events that occurred in their life. External and internal.
condition in which repeated attempts to control a situation fail, resulting in the belief that the situation is uncontrollable
feeling free to participate in an activity without a nagging sense that you have to or that you should be doing something else
a desire to perform a behavior due to promised rewards or threats of punishment
external locus of control
the perception that chance or outside forces beyond one's personal control determine one's fate
freud: superego and guilt, today: induction empathy based guilt: ok to feel a bit of guilt but not too much/ with superego, fear of guilt, keeps us in check fear of punishment, fear of losing love of parents
5-6 yo moral development done
The idea that children play to displace energy that is usually used for survival is what
high skill + high challenge.
high skill + medium challenge = control (most activities we do)
intrinsic motivation, being in the zone
according to Maslow, the ultimate psychological need that arises after basic physical and psychological needs are met and self-esteem is achieved; the motivation to fulfill one's potential
maslow hierarchy of needs
theory of motivation based on unmet human needs from basic physiological needs to safety, social, and esteem needs to self-actualization needs
deafness is when a person cannot understand speech from hearing alone. ranges from mild to severe, symptoms include speaking too loudly, leaning forwards to hear, cupping hand or turning head, inappropriate responses, asking for repeating words - Nervous system disorder
a sudden loss of consciousness resulting when the rupture or occlusion of a blood vessel leads to oxygen lack in the brain
signs of stroke
severe HA, slurred speech, weakness or paralysis, change in cranial nerves, confusion or disorientation, dizziness or ataxia
a disorder that appears in childhood and is marked by deficient communication, social interaction, and understanding of others' states of mind
a type of schizophrenia characterized by prominent delusions that are persecutory or grandiose
an indirect expression of aggression delievered in a way that allows the sender to maintain a facade of kindness
an anxiety disorder characterized by extreme and irrational fear of simple things or social situations
a personality disorder where the person has no respect for laws or the rights of other human beings
cluster B personality disorder: In a constant state of crisis, promiscuous, unable to tolerate anxiety-causing situations, afraid of being alone, and having intense but brief relationships
post traumatic stress disorder (PTSD)
Phenomenon in which victums of catastrophes experience again the original event in the form of dreams or flash backs.
a condition of general emotional dejection and withdrawal; sadness greater and more prolonged than that warranted by any objective reason.
a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.
conditions in which a person experiences extreme moods, such as depression or mania; also called affective disorder
any of several psychotic disorders characterized by distortions of reality and disturbances of thought and language and withdrawal from social contact
impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to wernicke's area (impairing understanding)
being abnormally tolerant to and dependent on something that is psychologically or physically habit-forming (especially alcohol or narcotic drugs)
A physical and psychological habituation to a mood- or mind-altering drug, such as alcohol or cocaine.
lowering of performance on a given task in the pressence of others - usually a task that is not well rehearsed
organic brain disorder
Condition resulting from neurological disturbance, genetic abnormality, or tumor.
First degree (surface), second degree (epidermis, maybe upper part of dermis), third degree (subcutaneous, if extensive may need grafting)
tramatic brain injury
damage to an individuals brain tissue some time other than birth. males are affected twice as often as females
a general term used to describe any type of mental difficulty or deficiency; more commonly used term is mental retardation; defined by intellectual function; 85% are educable; 10% are trainable
Any physiological disorder or condition, cosmetic disfigurement or anatomical loss affecting one or more of body systems.
A P I E
A - Assess (what is the situation?)(what is the problem?)
P - Plan (how to improve/stabilize the problem)
I - Implement (putting plan into action)
E - Evaluate (did the plan work?)
gathering and evaluating information about the services provided as well as the results achieved and comparing this information with an accepted standard
Total Quality Management
This is an approach that aims to involve all employees in the quality improvement process, a philosophy that involves everyone in an organization in a continual effort to improve quality and achieve customer satisfaction
504 rehabilitation act 1973
expands protection to other areas that receive federal assistance (education)
Individuals with disabilities education act (IDEA)
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 in cases that involve 14 specified categories of disability.
Americans with disabilities act (ADA)
Passed by Congress in 1990, this act banned discrimination against the disabled in employment and mandated easy access to all public and commerical buildings., prohibits employers, discriminating against qualified individuals with disabilities, a law prohibiting discrimination against people with physical or mental disabilities in the workplace, transportation, public accomodations, and telecommunications
the pursuit of influencing outcomes- including public policy and resource allocation decision within political, economic, and social systems and instituations that directly affect people's lives
a record of being qualified to perform certain acts after passing an examination given by an accredited professional organization
the act of granting credit or recognition (especially with respect to educational institution that maintains suitable standards)
A mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors
continuous quality improvement
system of development in the workplace for daily improving performance at every level in every operational process by focusing on meeting or exceeding customer expectations, prevention is emphasized; views limitations and problems proactively as opportunities to increase quality, a philosophy of continual improvement of processes, Search for new ways to improve patient care, prevent errors, and identify and fix problems
helps students regain preceptual processing, communication, behavioral, and social skills that were lost as a result of traumatic brain injury. Traumatic brain injured and stroke patients may receive this as a means of restoring one's mental processes, including memory, problem solving, sensory perception, emotions, and movement.
non verbal communication
communication that uses factors other than words, such as gestures, facial expressions, eye contact, and body language, expressing oneself through body language
Includes touch, sight, taste, smell and hearing. As these needs are fulfilled the individual may respond to the environment. Can produce predictable responses, such as slow rocking to calm a patient with high tone or agitation
Development involving the ways that the enduring characteristics that differentiate one person from another change over the life span, development involving the ways that the enduring characteristics that differentiate one person from another change over the lifespan
an approach to personality development, based largely on the ideas of Sigmund Freud, which holds that much of behaviour is governed by unconscious forces. (a theory), Any theory of behavior that emphasizes internal conflicts, motives, and unconscious forces. Relates personality to the interplay of conflicting forces within the individual, including unconscious ones
normally associated with Maslow and Rogers; any personality theory that emphasizes that people are positively motivated and progress towards higher levels of functioning (more to human existence than dealing with hidden conflicts); stresses people to potential for growth and change as people experience life. An explanation of behavior that emphasizes the entirety of life rather than individual components of behavior and focuses on human dignity, individual choice, and self-worth. The psychological view that human beings possess an innate tendency to improve and to determine their lives through the decisions they make.
client centered therapy
A humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients' growth., An insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy.
empathic process in which the person being spoken to echoes, restates, and clarifies. A feature of Rogers' client-centered therapy.
non verbal behavior
unspoken messages clients send about how they feel or think. Includes body gestures, eye contact, facial expressions, vocal quality
source oriented medical record
Patient information is arranged according to who supplied the data- the patient, doctor, specialist, or someone else. Describes all problems and treatments on the same form in a simple chronological order
problem oriented medical record
When the physician or treatment team creates a master list of patient/client deficits and develops a plan of action focused on these deficits.
Subjective; Objective; Assessment; Plan - many clinicians use this format to document a visit with a patient, progress note that focuses on a single patient problem and includes subjective and objective data, analysis, and planning; most often used in the POMR
Functional Independence Measure (FIM)
test physical, psychological, and social function. evaluates level of assistance needed, functional changes in different environments, Outcome measure used in National Rehabilitation Hospital Study & is most commonly used outcome measure in adult rehab:
occurs during the process of learning when the teacher or the students monitor progress while it is still possible to modify instruction, The process of gathering information and providing feedback that teachers can use to improve their practice.
conducted after program has been implemented in order to assess outcomes. Refers to an evaluation conducted to determine the extent to which trainees have changed as a result of participating in the training program.
a law enacted by the U.S. in 1990. It was signed into law on July 26, 1990, by President George H. W. Bush. The law is a wide-ranging civil rights law that prohibits, under certain circumstances, discrimination based on disability.
the shared expectations group members have regarding each individual's communication behavior in the group and behaviors or duties each member is expected to fulfill; Each member may perform a different role; Roles maybe determined by one's position within the group of their place of leadership. May be determined by specialization or expertise
provides a framework for creating a win/win solution that combined creative contribution from all group members
activities by an interest group designed to affect policy, Includes enrolling new members and providing benefits for them. Listener, harmonizer, trust builder, supporter, tension reliever, Define a groups social atmosphere (giving praise, mediating, keeping the peace).
behaviors that are directly relevant to the group's task and that affect the group's productivity.
Roles in a group that prohibit the group from reaching its goals. Isolator, Dominator, Free Rider, Detractor, Digresser, Airhead, Socializer
a type of learning in which behavior is strengthened if followed by a reinforcer or diminished if followed by a punisher
Increasing behaviors by presenting positive stimuli, such as food. A positive reinforcer is any stimulus that, when presented after a response, strengthens the response.
An operant conditioning procedure in which reinforcers guide behavior toward closer and closer approximations of the desired behavior
using operant conditioning to teach a complex response by linking together less complex skills
a behavioral technique in which desirable behaviors are reinforced with a token, such as a small chip or fake coin, which can be exchanged for privileges
identifying sources of stress and learning how to handle them in ways that promote good mental/emotional health
Techniques that train people how to be appropriately assertive in social situations; often included as part of health behavior modification programs, on the assumption that some poor health habits, such as excessive alcohol consumption or smoking, develop in part to control difficulties in being appropriately assertive., a method of psychotherapy that reinforces you for stating negative and positive feelings directly
real objects, stimulate senses, new motivation for life, pictures, animals, hobbies, group interaction (depression or early stage of disorientation)
Communication technique used to make an older adult more aware of time, place and person with the purpose of restoring a sense of reality, improving the level of awareness, promoting socialization, elevating independent functioning and minimizing confusion, disorientation, and physical regression.
helping people clarify what their lives are for and what is worth working for. Students are encouraged to define their own values and understand others' values.
(psychology) the aggregate of the responses or reactions or movements made by an organism in any situation
the procedure that is varied in order to estimate a variable's effect by comparison with a control condition
The most essential trait; the ability to read your own emotions and gauge your moods acurately, so you know how you are affecting others
social skill development
being accepted by peers, building a network of social relationships and developing friendships are all key in self-esteem; including structured opportunities for social interaction, rehearsal of skills and use of scripts and role-playing can all be beneficial
if you stay involved in cognitively challenging things when you get older you will stay sharper.
The relatively consistent way in which individuals in leadership positions attempt to influence the behaviour of others.
A form of leadership in which the leader makes decisions on his or her own and then announces those decisions to the group.
Behavior that provides guidance, support, and corrective feedback for day-to-day activities.
(Executive Leadership) Responsible for budgeting, organizing, maintaining structure, and having a vision. Ex. Agency Director, Presidents, VP's.
members of the group take a more participative role in the decision-making process.
laissez fair leadership
Style of leadership allowing staff members to make decisions for themselves based on the assumption that employees are motivated by internal forces and do not require management participation
Occurs in four stages: Mutual acceptance, Communication and decision making, motivation and productivity, and control and organization., forming, storming, norming, performing, adjourning
an observable and measurable end result having one or more objectives to be achieved within a more or less fixed timeframe
The process of breaking a complex skill or series of behaviors into smaller, teachable units; also refers to the results of this process.
the "thinking" domain, includes six intellectual abilities and thinking processes beginning with knowing, comprehending, and applying to analysis, synthesis, and evaluation
Activity modification is the first option to achieve maximum participation by simply modifying the type of equipment used or the activity rules.
- However, keep activity as close to the original as possible (i.e. substitute a yarn ball for a birdie for badminton).
the belief that people with disabilities should be physically and socially integrated into the mainstream of society regardless of the degree or type of disability, As a philosophy and a principle, the belief that people with disabilities should, to the maximum extent possible, be physically and socially integrated into the mainstream of society regardless of the degree or type of disability. As an approach to intervention, the use of progressively more typical settings and procedures "to establish and/or maintain personal behaviors which are as culturally normal as possible" (Wolfensberger, 1972, cited in CHH, 2 Ed).
The process of identifying, describing, and evaluating the activities an organization performs.
Terms describing problems related to knowledge, attitude/beliefs, physical environment, access to food, and food safety.
leisure diagnostic battery
Measures an individual's leisure experience, motivational and situational issues that influence leisure.
extent to which a test, instrument, or experimental method does what it is meant to
Refers to the consistency of measurement, specifically, the extent to which repeated measurement of the same event yields the same values.
the process of gathering information about events or processes in a careful, orderly way
a performance-based assessment technique that involves the application of knowledge to real-life activitities
Things a person tells you about that you cannot observe through your senses; symptoms
Recreational activities as used as a form of treatment to assist in the overall rehabilitation of the patient. Recreation as a therapy is used as a means of achieving established treatment goals concomitant with the overall treatment plans for the client.
any recreation that includes activities to help a person's emotional, mental, or physical health.
any traumatic damage to the head resulting from blunt or penetrating trauma of the skull; bleeding, edema, and ischemia may result.
(ADA) any physiological disorder or condition, cosmetic disfigurement, or anatomical loss effecting one or more of the following body systems, neuro, musculoskeletal, special senses, resp, CV, repro, GI, GU, hem/lymph, skin, endocrine
congenital defect in the spinal column characterized by the absence of vertebral arches, often resulting in pouching of spinal membranes or tissue
group of inherited muscle disorders that cause muscle weakness without affecting the nervous system
a major part of the central nervous system which conducts sensory and motor nerve impulses to and from the brain
spinal cord injury
Bruising or severing of the spinal cord from a blow to the vertebral column resulting in muscle paralysis and sensory impairment below the injury level.
A chronic disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech
a condition caused by brain damage around the time of birth and marked by lack of muscle control and paralysis especially in the limbs
a disorder of the central nervous system characterized by loss of consciousness and convulsions
Involves a wide variety of problems in speech, language, and hearing. Includes stuttering, aphasia, dysfluency, voice disorders, cleft lip and/or palate, articulation problems, delays in speech and language, autism, and phonological disorders.
Witt and Ellis Leisure diagnostic battery
Measures an individual's leisure experience, motivational and situational issues that influence leisure.
condition of having an IQ below 70-75 and significant limitations in the skills necessary to daily life
Anyone who has a mental and/or physical impairment, usually from birth, that will probably continue indefinitely. Usually requires life-long or extended care.
When people who experience inescapable traumas become so overwhelmed they simply give up.
primary needs of hospitalized adolescents
to experience independence and some control over their environment
medical or clinical approach to healthcare
highly structured around a physician-directed healthcare model
primary needs of a hospitalized preschooler
to understand how things work and manipulate objects such as the medical equipment used during procedures
cognitive behavioral change theory
theories underlie many RT interventions and would result in a greater connection between feelings and behaviors for a client
dressing properly would deficits in adaptive functioning for a person with mental retardation
RT might observe an autistic child with impaired communication skills
inability to engage in make-believe play
where the individual experiences feelings of hopelessness, pessimism, guilt, worthlessness and a loss of interest
musculoskeletal disorders is a chronic disorder of the skeleton in which areas of bone undergo abnormal turnover, resulting in areas of enlarged and softened bone
musculoskeletal disorder that shows depressive symptoms, perceptions of loss of control, and a feeling of helplessness
musculoskeletal disorder is characterized as a chronic disorder of joint cartilage and surrounding tissues characterized by pain, stiffness and loss of function.
-recreational therapist uses an exercise intervention to enhance stretching, strengthening and postural exercises
According to Mobily and McNeilthe following disorders is consistently associated with depression in the research literature
group of inherited muscle disorders that cause muscle weakness without affecting the nervous system.
-a recreational therapist uses an exercise intervention to prolong ambulation and slow the rate of increased weakness and contractures
disability may develop as a secondary problem. People with musculoskeletal disorders and other orthopedic impairments often experience pain as a common symptom associated with the various disorders.
a disease where the connective tissue in her body is affected and where her own antibodies and cells attack her body's own tissues.
paralysis of both arms and both legs; also known as quadriplegia. suffered a spinal cord injury at the level of C6 and, as a result, he has loss of muscle strength in all four extremities.
decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions
Primary-progressive MS (PPMS)
a form of multiple sclerosis where there has been continual decline in her symptoms and she has had no remissions in the last two years since her diagnosis.
One of the four recognized forms of Multiple Sclerosis named for gradual advance of the disease; there is significant recovery immediately following a relapse, but there is a gradual worsening of symptoms.
25% of ms patients. There are unpredictable relapes during which new symptoms appear or existing symptoms become more severe. this can last for varying periods and there is partial or total remission. the disease may be inactive for months or years. common amoung younger people with the disease.
One of the four recognized forms of Multiple Sclerosis named for gradual advance of the disease; superimposed relapses (new or resurfacing symptoms) and remissions (periods of recovery) may occur, but they tend to tail off over time.
most distinguishes recreational therapy from regular recreation services
the use of activity to bring about change in the client's behavior
to make available to all persons with disabilities the same conditions of everyday living which are as close to possible as the ways of life of their communities
belief that they can exercise control over their own functioning and environmental events in order to recover or adjust to an illness or disability.
Theory of RT practice directs practitioners to provide interventions which include feelings of intense involvement, clarity of goals and feedback, deep concentration and transcendence of self.
individuals take active roles in their own development
the basis of RT interventions and direct the therapist
structure interventions and outcomes so the patient is able to achieve success
ATRA Standards of Practice require the development of this client service to use appropriate intervention strategies to restore, remediate or rehabilitate in order to improve functioning and independence as well as reduce or eliminate the effects of illness or disability.
The Stumbo and Peterson systems approach step in which the RT decides on program components in designing a comprehensive program
According to the TRAM model (Therapeutic Recreation Accountability Model by Stumbo), client needs, interventions and outcomes are related in that outcomes should happen as a direct result
ethical principle requires professionals to be actively involved in their professional organizations
Identify the underlined component of the following performance measure: After thirty minutes of practice shooting free throw, the participant will shoot the ball through the hoop "with fifty percent shooting accuracy making baskets."
In activity analysis, the areas of memory and concentration are examples of what category of requirements?
stability of client condition and length of stay
most affects the variability of client assessment and is most likely to be outside of the influence of RT practice in genera
client assessment is the first step before planning a treatment and usually involves reading the chart, interviewing the client and conducting some preliminary understanding of client problems
recreational therapy assessment instrument is used to assess individuals with developmental disabilities and determines their relative level of skills in the social/affective areas
recreational therapy standardized assessment tool was initially developed for use with older adults, the purpose of this RT assessment indicates it is recommended for all groups with developmental levels over 10 years of age and it helps determine a client's needs related to basic functional skills and behaviors.
Belinda is a CTRS at a pediatric unit in the hospital and she is trying to assess if a four year old child with a spinal cord injury will be able to generalize from the distraction intervention of blowing bubbles during a blood test, to another medical procedure. What domain is she looking at in the client's behavior?
rapid and abrupt changes in emotional feeling tone, unrelated to external stimuli
ex.observed a group of clients in a coping skills intervention and noted that Fred began crying suddenly in group.
Reduction in intensity of feeling of tone which is less severe than blunted affect but clearly reduced
type of reliability measure would you use to determine the consistency of a client assessment test result over time
Multiple Data System (MDS)
interdisciplinary assessments is the only one to include recreational therapy as a therapy supplement for Medicare
Functional Independence Measure
most frequently used in rehabilitation hospitals in the U.S.
Tests physical, psychological and social function; Evaluates level of assistance needed from total assistance to total dependence; Independence with a device is different than complete independence; Evaluates what they can do not what they do in certain environmental situations; Categories assessed: Self-care activities. Bowel and bladder, Functional Mobility, Communication, Cognition, Assess a patient's level of disability and burden of care. A 7 point scale examines 18 areas (self-care, sphincter control, transfers, locomotion, communication, and social cognitive activities). Score of 1-5= a level of dependence, 6-7=independence. Valid and reliable for CVA population
If you were testing a client's coping skills, where would you classify this in the four domains?
data collection methods would be most appropriate if the recreational therapist wants to determine how a client responds to other clients outside of formal treatment intervention sessions
The recreational therapist tests clients with a leisure interest scale and then gives the same clients the Rotter Locus of Control Scale in order to determine this type of validity. The client's scores on the leisure interest scale and the locus of control scale should have a high correlation.
the extent to which a test samples the behavior that is of interest (such as a driving test that samples driving tasks).
The extent to which there is evidence that a test measures a particular hypothetical construct.
While teaching adolescents with mild mental retardation the game of Hearts, the RT found that she unexpectedly needed to repeat directions throughout the game. The RT had inappropriately analyzed and planned the activity in which of the following domains?
Pauline writes the following recreational therapy treatment plan objective for her patient: "At the end of two weeks, Alicia will demonstrate the ability to interact appropriately with peers by initiating conversation with a greeting, and showing courtesy by saying, "please and thank-you" when it is expected as a social norm, as judged by the CTRS." Is this treatment objective complete with a condition, behavior, and criteria? Or, is it incomplete and missing one of these components?
control of illness, symptom, or behavior
"Within 3 treatment sessions, patient will independently utilize proper diaphragmatic breathing for at least 3 minutes x1 prior to perceived painful treatment to improve non-pharmacological self -management of anxiety related to treatment." Which of the following treatment purposes is this functional goal addressing?
You decide to go back and change the note you wrote. Which action should you take?
draw a single line through your narrative, write the correction, sign and date the entry
"Bill will demonstrate the ability to identify three blocks to his leisure behavior with 75% accuracy." Is this treatment objective complete with a condition, behavior, and criteria? Or, is it incomplete and missing one of these components?
example of an assessment statement in a SOAP note
The patient might have broken bones because I found him moaning in pain on the floor and yelling, "Help
documentation notes is an example of a planning statement in a SOAP note
Provide emergency help for the patient, have all shifts insure that the bedrails are up, monitor medication levels that cause disorientation
This plan should be started at the point of patient admission to the treatment facility to provide a summarization of patient/client treatment, responses and functional.
When playing a board game, Joe will demonstrate the ability to wait his turn." Is this treatment objective complete with a condition, behavior, and criteria? Or, is it incomplete and missing one of these components?
characteristic found with new helpers that results in ineffective listening.
responding to facts rather than feelings of the client
a. clarifying the client's response prior to responding
b. concentrating on the themes in the client's responses
c. maintaining an open body position
facilitation techniques to help a client begin to make connections between how they respond in RT treatments and how they respond to everyday life.
the theoretically grounded process that guides the methods/procedures that are applied in the implementation process and that are based on the presenting problems of the client
children in hospital settings, placing mobiles, posters, and collages on the walls in their rooms
purpose of a diversional activity in a treatment program for hospitalized children
provide a "time-out" from the stressful events of medical care
therapy for people with Alzheimer's disease that lets them believe they live in the past or in imaginary circumstances.
social interaction skills
The area of the Leisure Education Content Model that is focusing on having participants experience cooperative rather than competitive activity. You are using the New Games Cooperative Play book to facilitate group initiatives.
Components of Leisure Education Content Model
a. leisure awareness
b. leisure activity skills
c. leisure resources
d. social interaction skills
following RT interventions would be most ideal for both people with musculoskeletal disorders experiencing chronic pain and people with osteoarthritis with decreased joint flexibility
Leisure activity skills
The area of the Leisure Education Content Model Your primary goal is to provide them with a new activity outlet which they may have never tried or learned before.
ex.You are teaching wheelchair square dancing to adult outpatients in your amputee support group in your position as a CTRS on a physical medicine and rehabilitation unit as a leisure education session
The area of the Leisure Education Content Model You are facilitating a leisure education session called Small Change for children with cognitive impairments. They are learning to identify and count, add, and subtract pennies, nickels, dimes, and quarters in order to handle money as a medium of exchange during activities like eating at a fast food restaurant
Why is evidence-based practice such an important issue in health care today?
because health care costs keep rising and it is important to provide more cost-effective care
A surveyor from the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) checks your activity calendar for compliance with a national standardized requirement for 3 group programs per day and mandated programming variety that includes empowerment, family involvement, and functional improvement activities.
types of evaluation
a. external evaluation
b. formative evaluation
c. internal evaluation
d. summative evaluation
e. mandated evaluation
the main source of quality defect problems and the key area that must be understood in order to improve quality in healthcare services
several important principles to improve quality in healthcare
d. staff selection
refers to how a recreational therapy intervention works under controlled circumstances when done in a research setting by experts with randomization to treatment and control groups for intervention involvement
quality management standard
requires recreational therapists to continuously improve client services and outcomes
A year-end, annual report covering descriptive statistics about TR clients and staff, departmental goals accomplished, and a plan for next year's staff training
types of health care reimbursement
b. fee for service
c. prospective payment
d. retrospective payment
type of health care reimbursement offer the incentive to provide more services
written admonishment with corrections documented
second step of progressive discipline in the documented plan of specific steps that will be taken for an employee's repeated infractions of the same work rules
step of progressive discipline in the documented plan of specific steps
verbal or informal reprimand with note in employee record
- written admonishment with corrections documented
-suspension from work without pay
-dismissal or termination
(psychoanalysis) the process whereby emotions are passed on or displaced from one person to another
RT is implementing a new client intervention and evaluates if the clients have the correct entrance criteria for the intervention at the beginning of the implementation
an intervention provided by a senior member to a junior member of the same profession to assist therapist understanding of their influence on the treatment process
Centers for Medicare and Medicaid Services (CMS)
a federal agency that administers over 15 sets of facility and service standards for such agencies as hospitals, nursing homes, and outpatient care
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
the agency responsible for inspecting facilities in timed intervals in order for the facility to maintain "accreditation"
Commission on Accreditation of Rehabilitation Facilities (CARF)
-external accrediting body was the first to focus on outcome measures in medical practice
-accredits free standing rehabilitation facilities, rehabilitative programs of larger hospital system in the areas of behavioral health, employment and community support services and medical rehabilitation,
- responsible for regulating Rehabilitation Facilities/Medical centers
NCTRC National Job Analysis
defining the scope of practice in recreational therapy and what should be included in the recreational therapy process a student learns in an academic internship
Historically and currently, the top client population served by recreational therapy professionals
exam relate to the NCTRC Job Analysis
the exam is composed of the knowledge areas related to the job skills required for the RT job
The pre-professionalization movement of recreational therapy in the U.S. was characterized by two parallel movements. What were they?
group work services and the recreation movement
How many hours of continuing education are required for NCTRC CTRS renewal every five years?
During the nineteenth century, Florence Nightingale changed the entire approach to medical treatment by doing which of the following?
instituting recreation in the medical recovery process
ethical principle requires the Recreational Therapist to provide information regarding the services to be delivered to the client and the professional qualifications of the service provider
following involves the act of pleading for the support of one's self or another individual or concept
the primary role of the National Council for Therapeutic Recreation Certification (NCTRC) in the field of RT
to establish certification and recertification criteria for the credential that recognizes individuals as therapeutic recreation specialists
What is the primary purpose of organizations like the National Therapeutic Recreation Society (NTRS) and the American Therapeutic Recreation Therapy Association (ATRA) to the field of RT
advance the professional growth and development of their respective members
A year-end, annual report covering descriptive statistics about TR clients and staff, departmental goals accomplished, and a plan for next year's staff training
unreasonable lack of skill in professional duties, illegal or immoral conduct, or professional misconduct
relates to the state subcontractors of the Centers for Medicare/Medicaid Services who process claims for services provided at the state level making decisions about what is to be reimbursed for inpatient and outpatient services under Medicare
gaining experience from theoretical and practical knowledge to know what to do, when, with whom and why
health maintenance organization (HMO)
is a prospective payment system that offers prepaid coverage for hospital and physician services within a provider network
is an insurance carrier's cost control method of paying a prearranged amount for a specific service no matter what the actual cost of that service
Why are there universal precautions to prevent transmission of HIV which require all health care workers to use gowns, gloves, or aprons with all patients regardless of diagnosis?
To prevent skin exposure to patients' blood and body fluids
RT practice is based on the judicious use of the current research and best practice to make effective clinical decisions about the treatment of patients to reach outcomes valued by stakeholders
type of health care team, professional roles and responsibilities are clearly and separately delineated and professionals have responsibility for their own client outcomes.
members seek to provide services in a uniform and integrated fashion by conducting joint assessments, sharing information and expertise across discipline boundaries, and selecting goals and interventions that are discipline free
most sharing team works the best
A group of health care professionals and nonprofessional who work together in the care of a patient.
written plan of operation
a management tool for recreational therapy services that is essential to ensuring that RT services achieve the desired goals, outcomes, quality improvement, resource management and program evaluation/research
intervention frequently used with clients who show signs of disorientation, confusion, and memory loss
social skills training
intervention where participants are taught a variety of verbal and nonverbal responses to use during leisure experiences
intervention has been shown to improve physiological functioning while reducing anxiety and stress levels
facilitation skill that enables the helper to communicate a sense of caring and understanding to the client
How does the helper's worldview or cultural context influence the helping relationship?
helpers are more effective when they understand the influence of diversity on selection of interventions
ability to put oneself in the place of another person and see the world through that person's eyes
when feelings or attitudes about previous relationships are shifted or transferred to another person
verbal part of the planned intervention that helps the client make connections and generalizations between insights learned about themselves and their behavior during an RT treatment
An integrated pattern of human behavior that includes communication, rituals, roles, thought, courtesies, relationships, languages, beliefs, practices, manners of interacting, customs, expected behavior of a racial, ethnic religious, social, political, or professional group
an expectation that causes you to act in ways that make that expectation come true.
a technique of relaxation and pain control in which a person conjures up a picture that is held in mind during a painful or stressful experience.
a technique of learning to relax by focusing on relaxing each of the body's muscle groups in turn
Concentrated areas of energy aligned vertically in the body that relate to each other as well as to specific areas of the body, mind , and spirit.
relaxation technique that involves breathing control, focused attention on physical sensations, and mental imagery.
reflection and clarification
mirror what you heard from the client in order to help explain the client's comments
A seven year old pediatric patient with a blood disorder has been referred to the RT for treatment. After assessing the patient, the RT develops the following functional treatment goal: "Within 6 treatment sessions, patient will demonstrate needle-stick procedure for blood draw on sock monkey to demonstrate medical understanding of these procedures." Which of the following areas of assessment does this treatment goal most likely address?
When the treatment team creates organizes information in the narrative portion of the client's medical chart to include data, action and response for each identified client concern
Jane is an RT at a psychiatric hospital where she has just completed a two week intervention program to reduce depression. Jane assesses clients on the Depression Assessment Scale to do which of the following
If the RT goal is to improve physical stamina, which of the following might be a good and measurable objective?
walk 20 minutes without stopping for a rest
. Identify the underlined component of the following performance measure: Upon requesting the participant to answer the question, "When do you have free time?"
-"the participant will verbally identify three time periods, as judged by the CTRS. "
SOAP note, which of the following statements would be classified as "Plan"?
The therapist gave Emily a doll with face masks to demystify the face masks for treatment
CERT-Physical Disabilities (Comprehensive Evaluation in Recreational Therapy-Physical Disabilities)
needs a standardized assessment tool for her patients in a rehabilitation setting. She wants to determine a baseline for clients' functional skills related to leisure and to be able to reassess the same functions in order to determine improvements or losses over the course of treatment.
The recreational therapist assess how often Greg's family visits while he is on a locked Alzheimer's Unit in an effort to look at which domain of functioning?
determine if a client initiates conversation with peers even though this client has been described as non-communicative by the treatment team
To reduce interviewer bias and facilitate objective scoring of a client in assessment
structured interview with fixed alternative questions
was the first standardized assessment tool developed in recreational therapy to identify, define, and evaluate behaviors relevant to a person's ability to integrate into society using their social skills
the professional places value on client attributes to cause change in health or recovery
most likely healthcare professional to conduct the admission work-up and define the preliminary treatment plan
of the theory underlying your RT services and your accuracy in treating specific client problem areas.
A measure of reliability; the degree to which a test yields similar scores across its different parts, such as on odd versus even items.
type of validity in an RT assessment instrument would allow you to generalize the results of an individual assessment to a group of individuals.
If a recreational therapist failed to tell a client about the process, benefits, and outcomes of recreational therapy services, that individual would be in violation of Veracity
Sequencing and structuring the intervention
According to the RT APIE process, when planning the treatment intervention, the RT takes into account the preferences of the client such as learning style, complexity of skills, adaptations needed, and the learning environment. When the therapist looks at these issues which of the following is being done the RT process?
Code of Ethics does for practice and RT practitioners
guides the actions of professionals and provides the public with an expected standard of care
a philosophy of care that empowers the client to make decisions about his/her own healthcare
In the APIE Process, the recreational therapist does this to assure that strengths and supports can be used to best address client needs and to reach the desired outcomes of service. What is it?
Americans with Disabilities Act of 1990
piece of legislation is referred to as the civil rights act for individuals with disabilities
The role of the RT changes as the client becomes more independent
What is a common characteristic found in several of the practice models, particularly the Leisure Ability, Health Protection/Health Promotion, and the Therapeutic Recreation Outcome and Service Delivery models?
Aristotelian Good Life model
based on the concept that high-level wellness and optimal leisure are achieved through therapeutic recreation services when participants reach self-actualization
-incorporates an ethical component and helps the client attain happiness by promoting individual freedom and responsibility
primary outcome of the Leisure Ability Model
improved leisure satisfaction and independent leisure functioning
outcome model of TR/RT represents
a description of the nature and relationship of possible effects for RT services
form of autism where an individual have normal intelligence and no expected regression
a rare disorder found virtually exclusively in girls, is a neurodevelopmental disorder in which the child usually develops normally unitl about 6 to 18 months of age at which characteristics of the syndrome emerge; characteristics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated head growth, and disinterest in play activities
childhood disintegrative disorder
a rare disorder in which the child develops normally for the first 2 years of life but starts regressing developmentally between the ages of 2 and 10; at least 2 of the following areas must be affected: expressive or receptive language, social skills or adaptive behavior, bowel or bladder control, or play and motor skills such as coordination
what two behavioral areas must there be dysfunction for a person to be considered to have mental retardation
-intellectual and adaptive
primary needs of a hospitalized toddler
to learn and master new skills and behaviors that will facilitate the developmental process
disability results from calcium loss, is controlled by exercise, is a primary disability for aging women and a secondary complication with cerebral palsy, spinal cord injuries, or other situations where inactivity is present
autosomal dominant disorder of connective tissue characterized by brittle bones that fracture easily
Which statement identifies a leadership strategy that is used with those with Alzheimer's who experience "sundowning"?
physical activity and exercise reduce restlessness and wandering
What is the primary reason a therapist offers relaxation classes to individuals with eating and substance impairments?
fosters awareness of self-control and self-respect
conductive hearing loss
results from physical obstruction in transmission of sound waves to the inner ear
sensorineural hearing loss
hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; also called nerve deafness
Which factors are most indicative of the potential of clients with visual impairments
age of onset of the impairment and degree of residual vision
prelingual hearing loss
a type of acquired hearing loss that occurs after birth but before a child has developed language
"hallmark" problem for a child who is diagnosed with attention deficit hyperactivity disorder?
How might the recreational therapist detect or notice an individual who is experiencing issues as a result of depression?
the individual reports being saddened by the death of a spouse that occurred 12 months earlier
failure to respond to visual stimulation on the side of the visual field that is opposite a brain lesion
Which characteristic distinguishes a person with spastic cerebral palsy from persons with other forms of cerebral palsy?
increased muscle stiffness and contractions upon stretching
characteristic of an individual with muscular dystrophy
progressive wasting away of functional muscle
the purpose of RT with a person with a newly traumatized spinal cord injury
to support the rehabilitation team's treatment objectives
occurs when diabetes damages the tiny blood vessels in the retina, causing blood to leak into the posterior segment of the eyeball
post-traumatic stress disorder
Tom has been home from his military service in Iraq for about a year but he still experiences problems with drug use, memory, and physical health. What is a likely diagnosis?
patient centered care
key concept in RT and includes seven primary dimensions of working with clients including respect for the patient's values, physical comfort, involvement of family and friends, and the coordination and integration of services
medical or clinical approach to healthcare
highly structured around a physician-directed healthcare model
milieu therapy approach in healthcare
often found in psychiatric hospitals and modeled after a caring, supportive community
primary feature that distinguishes recreational therapy from recreation
whether the intervention is specifically designed to bring about behavioral or attitudinal changes in the client
physical rehabilitation hospital
most likely find recreational therapy practiced under the "medical model"
Functional Independence Measure (FIM) Conceptual basis
measures the functional ability of the patient
The degree of disability (as indexed by FIM score) is an indicator of the "burden of care"
Used in rehabilitation, Can be administered quickly, Can be administered to groups, Discipline free
A basic indicator of the severity of disability
Can be administered quickly with data collected on a large number of patients
Most commonly used assessment in rehab throughout the US
As the severity of disability changes through rehab, the data collected on the FIM can be used to track changes and analyze outcomes of rehab
o 18 items over six areas of function:
7 levels of function (for each item)
The top two levels represent no involvement of a human helper
The other five levels indicate levels of functioning in which progressive degrees of help are required
18 FIM Areas
RT and the FIM
RTs may be certified as FIM Assessors and then woud be responsible for all areas
Usually, RTs focus on:
• Social Interaction
Functional Description: FIM
patient best understood when you -
Talked to the patient
Gestured, wrote or sign language
Did both equally
Unable to assess
Comprehension 7 point FIM Measures
7 = understands complex/abstract multi-step directions and conversations (100% time)
6 = understands complex/abstract directions and conversations with difficulty or additional time
6 = requires hearing aid or communication device, i.e., glasses/contacts
5 = understands directions/conversations ONLY about basic daily needs (toileting, eating, pain) 91%-99% of the time
Comprehension 7 point FIM Measures
4 = understands directions/ conversations ONLY about basic daily needs (toileting, eating, pain) 75%-90% of the time
3 = understands directions/ conversations ONLY about basic daily needs (toileting, eating, pain) 50%-74% of the time
2 = understands only simple questions or statements or understands < half of the time
1 = is unable to understand simple questions or statements or understands < 25% of the time
Functional Description: patient communicated with you by mostly -
Talking with you
Writing, gestures, sign language
Did both equally
Unable to assess
Expression 7 point FIM Measures
7 = expresses complex/abstract ideas clearly and fluently (100% time)
6 = expresses complex/abstract ideas with mild difficulty, additional time, or device
5 = expresses ONLY basic daily needs (toileting, eating, pain) 91%-99% of the time
4 = expresses ONLY basic daily needs (toileting, eating, pain) 75%-90% of the time
3 = expresses ONLY basic daily needs (toileting, eating, pain) 50%-74% of the time
2 = expresses single words, simple phrases or gestures or understands < half of the time
1 = is unable to express simple words or simple phrases or expresses < 25% of the time
Social Interaction 7 point FIM Measures
7 = always interacts appropriately with staff, family and others (100% of the time)
6 = occasionally inappropriate but self-corrects behavior OR requires medication, i.e., anti-depressant, anti-anxiety
5 = needs supervision only under stressful or unfamiliar conditions < 10% of the time
4 = interacts appropriately 75%-90% of the time
3 = interacts appropriately 50%-74% of the time
2 = interacts appropriately 25%-49% of the time
1 = interacts appropriately less than 25% of the time
Social Interaction 7 point FIM Measures
Observations of inappropriate behavior:
Loud, foul abusive language
Excessive laughing or crying
Very withdrawn or non-interactive
Needs restraints for safety
Conclusions on FIM
The standard measures such as the FIM enable assessment/re-evaluation of improvement over time: from admission to discharge; discharge to follow up etc..
The standard measures enable predictive criteria of practical interest:
How much home help will a person need?
How much life satisfaction is to be expected
Inpatient Rehabilitation Facility-Patient Assessment Instrument
Used in conjunction with FIM
Mandated for use in rehabilitation facilities by the Center for Medicare and Medicaid Services (CMS) in 2002 for every patient receiving federal funds through Medicare or Medicaid.
The IRF-PAI is used to determine the payment for each Medicare Part A fee for service for rehab patients
Created in 1935 as a social insurance program designed to pay retired workers age 65 or older a continuing income
Major social welfare law of the U.S. passed after the great depression
Social Security Disability Insurance (SSDI
pays benefits to people with disabilities provided that they have been in the work force for a set amount of time and paid Social Security taxes.
Supplemental Security Income (SSI)
pays benefits based on financial need. SSI disability benefits are payable to adults or children who are disabled or blind, have limited income and resources, meet the living arrangement requirements, and are otherwise eligible.
passed in 1964 (almost 30 years after Social Security)
Medicare is a federal insurance program. Medical bills are paid from trust funds which those covered have paid into.
Serves people over 65, whatever their income; and younger people with disabilities.
Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage.
Younger people with disabilities are eligible after 24 months of SSDI eligibility.
- originally passed in 1965 and revised later laws
Medical assistance program for low-income people of every age.
Available to most SSI recipients.
Medical bills are paid from federal, state and local tax funds.
Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required.
Rehabilitation Act of 1973
Authorizes formula grant programs of vocational rehabilitation, supported employment, independent living, and client assistance.
Also authorizes a variety of training and service discretionary grants administered by the Rehabilitation Services Administration. Recreation in community funded as discretionary grants.
Section 504 is one of the nation's first laws barring discrimination base on disability. Simply made it illegal for recipients of federal funds to discriminate on the basis of disability. Modeled on Title VI of Civil Rights Act of 1964.
Also set up the first accessibility rules and the Architectural and Transportation Barriers Compliance Board (ATBCB) which regulates architectural and transportation accessibility compliance
Individuals with Disabilities Education Act (IDEA) - 1975
Part B - State grants, evaluations, eligibility, IEPs and procedural safeguards
Part C - Comprehensive program for Infants and Toddlers
Part D - Personnel prep, research, technical assistance, Parent Training Info Centers
First US Law to mention Therapeutic Recreation as a related service along with PT, OT, and Speech
Individuals with Disabilities Education Act (IDEA) - 1975
Important concepts in the Law:
"free and appropriate public education"
Based on "an individualized education plan" (IEP)
Covers children from 0-21 years of age
Includes related services - transportation and other health related services in public education
Therapeutic Recreation is considered a Related Service of the Individuals with Disabilities Education Act (IDEA),
If Therapeutic Recreation as a related service is part of the child's Individual Education Program (IEP),
IDEA - Related Services
IDEA - Related Services
Includes services that may be required to assist a child with a disability to benefit from special education
speech-language pathology and audiology services,
physical and occupational therapy,
recreation, including therapeutic recreation,
social work services, counseling services, including rehabilitation counseling, orientation and mobility services, and
medical services, except that such medical services shall be for diagnostic and evaluation purposes only)
1982 Tax Equity & Fiscal Responsibility Act (TEFRA)
Limits on increase in operating costs based on previous year and limits on ancillary service costs
1983 DRGs (Diagnostic Related Groups
Looked at inpatient hospital services & made payments by diagnosis
This is the beginning of prospective payment and cost containment in healthcare (will only reimbursed capped total on diagnostic treatment—no more individual reimbursements for individual treatments)
1987 Omnibus Budget Reconciliation Act (OBRA) of 1987 i
Statutory & Regulatory Basis for the RAI (Resident Assessment Instrument) and the MDS
To provide a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capabilities
1997 Balanced Budget Act
Shifted nursing homes to prospective payment system (PPS) which is similar to hospital DRGs
Resource Utilization Groups (RUGS)
Reimbursement based on responses to Minimum Data Set (MDS).
Section T: Defines RT beyond activity program based on Physician orders. Provided only by CTRS or CTRA under direction of CTRS; active treatment
Americans with Disabilities Act (ADA) - 1990
A person with a disability is defined by Rehab Act and ADA as a person who :
has a physical or mental impairment that substantially limits one or more major life activities,
has a record of such an impairment, or
is regarded as having such an impairment (even if no impairment in fact exists, e.g. HIV positive)
ADA has 5 parts
• Title I - Employment
• Title II - State and Local Governments
• Title III - Public Accommodations
• Title IV - Telecommunications
• Title V - Miscellaneous Provisions
Title I ADA - Employment
Prohibits discrimination on the basis of disability in employment.
Title I 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.
Prohibits discrimination in recruitment, hiring, promotions, training, pay, social activities.
Restricts questions that can be asked about an applicant's disability before a job offer is made,
Requires that employers make reasonable accommodation to the known physical or mental limitations
Title II ADA- State and local governments
Must provide equal opportunity to benefit from programs, services, and activities (e.g. public education, employment, transportation, recreation, health care, social services, courts, voting, and town meetings).
Must follow specific architectural standards in the new construction and alteration of buildings.
Relocate programs or otherwise provide access in inaccessible older buildings, and communicate effectively with people who have hearing, vision, or speech disabilities.
Public entities are not required to take actions that would result in undue financial and administrative burdens.
They are required to make reasonable modifications to policies, practices, and procedures where necessary to avoid discrimination, unless they can demonstrate that doing so would fundamentally alter the nature of the service, program, or activity being provided.
Title III - Public accommodations
Must comply with basic nondiscrimination requirements that prohibit exclusion, segregation, and unequal treatment.
must comply with specific requirements related to architectural standards for new and altered buildings;
reasonable modifications to policies, practices, and procedures;
effective communication with people with hearing, vision, or speech disabilities; and
public accommodations must remove barriers in existing buildings where it is easy to do so without much difficulty or expense, given the public accommodation's resources.
Courses and examinations related to professional, educational, or trade-related applications, licensing, certifications, or credentialing must be accessible.
Rancho Los Amigos Scale
I. No Response: Patient appears to be in a deep sleep and is unresponsive to stimuli.
II. Generalized Response: Patient reacts inconsistently and nonpurposefully to stimuli in a nonspecific manner. Reflexes are limited and often the same, regardless of stimuli presented.
III. Localized Response: Patient responses are specific but inconsistent, and are directly related to the type of stimulus presented, such as turning head toward a sound or focusing on a presented object. He may follow simple commands in an inconsistent and delayed manner.
IV. Confused-Agitated: Pt in heightened state of activity and severely confused, disoriented, and unaware of present events. Behavior frequently bizarre and inappropriate to immediate environment. Unable to perform self-care. If not physically disabled, may perform automatic motor activities such as sitting, reaching and walking as part of agitated state, but not necessarily as a purposeful act.
V. Confused-Inappropriate, Non-Agitated: Pt appears alert and responds to simple commands. More complex commands, however, produce responses that are non-purposeful and random. Pt may show some agitated behavior in response to external stimuli rather than internal confusion. Pt is highly distractible and generally has difficulty in learning new information. Can manage self-care activities with assistance. Memory is impaired and verbalization is often inappropriate.
VI. Confused-Appropriate: Pt shows goal-directed behavior, but relies on cueing for direction. Can relearn old skills such as activities of daily living, but memory problems interfere with new learning. Has beginning awareness of self and others.
VII. Automatic-Appropriate: Pt goes through daily routine automatically, but is robot-like with appropriate behavior and minimal confusion. Has shallow recall of activities, and superficial awareness of, but lack of insight to, condition. Requires at least minimal supervision because judgment, problem solving, and planning skills are impaired.
VIII. Purposeful-Appropriate: Pt alert and oriented, and is able to recall and integrate past and recent events. Can learn new activities and continue in home and living skills, though deficits in stress tolerance, judgment, abstract reasoning, social, emotional, and intellectual capacities may persist.
Professional Roles and Responsibilities
1. Establish and maintain therapeutic relationship with person served
2. Create and maintain a safe and therapeutic envi-ronment
3. Maintain CTRS credential
4. Participate in in-service training and staff develop-ment
5. Maintain knowledge of current TR/RT trends, techniques, methods, issues, and professional and legal standards
6. Enhance professional competence through addi-tional credentials and/or contribution to TR/RT field (e.g., professional presentations, research, at-tending conferences)
7. Adhere to professional standards of practice and code of ethics
8. Participate in quality improvement process (e.g., exit interviews, customer service satisfaction, peer reviews)
9. Participate in agency/professional committees
10. Request and secure referrals from professionals or other sources
11. Obtain and review pertinent information about person served (e.g., records or charts, staff, support system)
12. Select and/or develop assessment methods based on needs of the person served and setting (e.g., in-terview, observation, task performance, established instruments)
13. Conduct assessments using selected methods to determine physical, social, affective, cognitive, lei-sure, and/or lifestyle functioning
14. Analyze and interpret results from assessments
15. Integrate, record, and disseminate results gathered to appropriate individuals (e.g., person served, treatment team)
Planning Interventions and/or Programs
Discuss results of assessment and involve the per-son served or appropriate others (e.g., parent or le-
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gal guardian, support system, treatment team, ser-vice providers) in the design of individualized inter-vention plan
17. Develop and document individualized intervention plan with goals, objectives, evaluation criteria, and discharge/transition plan
18. Develop and/or select interventions and ap-proaches to achieve individual and/or group goals
19. Develop and/or select protocols for individual or group session
20. Utilize activity and/or task analysis prior to inter-ventions/programs
21. Select adaptations, modifications and/or assistive technology
Implementing Interventions and/or Programs
22. Explain the purpose and outcomes of the interven-tion/program and steps to be followed to the per-son served
23. Implement individual and/or group sessions, pro-tocols, and/or programs
24. Use leadership and facilitation techniques to maxi-mize therapeutic benefit (e.g., role-modeling, reflec-tive listening)
25. Monitor and address safety concerns throughout the intervention/program
26. Observe person served for response to interven-tion/program and note important data (e.g., inter-action with others, group, or therapist)
27. Monitor effectiveness of individual and/or group intervention/program plans and make modifica-tions as needed
Evaluate Outcomes of the Interventions and/or Programs
28. Evaluate changes in functioning of the person served
29. Determine effectiveness of individual intervention plan and adjust as needed
30. Revise individualized intervention plan as necessary with input from the person served and appropriate others (e.g., parent or legal guardian, support sys-tem, treatment team, service providers)
31. Evaluate individual's need for additional, alternative or termination of services
32. Determine effectiveness of protocols, modalities, and/or programs for targeted groups
Documenting Intervention Services
33. Record behavioral observations, progress, function-ing, and intervention outcomes of the person served
34. Document unusual occurrences, accidents and inci-dents relating to risk management
35. Document protocols, modalities and/or program effectiveness
Working with Treatment and/or Service Teams
36. Provide information to team members concerning the range of available TR/RT services
37. Communicate information regarding person served to team members in a timely and appropriate man-ner (e.g., behavioral changes, functional status)
38. Coordinate or integrate intervention plan with other service providers for the person served (e.g., care planning)
39. Develop and provide collaborative services with other team members as necessary (e.g., co-treatment)
40. Maintain equipment and supply inventory
41. Plan and coordinate support services (e.g., transpor-tation, housekeeping, dietary)
42. Maintain program budget and expense records
43. Develop and distribute schedules (e.g., programs, special events, programming changes)
Managing TR/RT Services
44. Comply with standards and regulations (e.g., gov-ernment, credentialing, agency, professional)
45. Conduct an initial and/or on-going organizational needs assessment for TR/RT service delivery (e.g., populations served, internal and external resources)
46. Prepare and update comprehensive TR/RT written plan of operation (e.g., programs, risk management, policies and procedures)
47. Confirm that programs are consistent with agency mission and TR/RT Service philosophy and goals
48. Recruit, train, educate, supervise, and evaluate pro-fessionals, paraprofessionals and/or volunteers (e.g., plan in-service training, develop staffing schedules)
49. Provide staff development and mentorship
50. Develop, implement and/or maintain TR/RT in-ternship program in accordance with legal require-ments and professional guidelines
51. Prepare, implement, evaluate, and monitor TR/RT service annual budget
52. Support research programs or projects
53. Prepare and report quality improvement data
54. Write summary reports of TR/RT Services
Public Awareness and Advocacy
55. Establish and maintain network with organizations and advocates (e.g., community agencies, universi-ties, allied health professions)
56. Advocate for rights for persons served (e.g., access, inclusion, independence, transportation)
57. Provide education to the community (e.g., explana-tions of purpose of program/interventions; initiat-ing opportunities to expand community awareness of value of TR/RT; organization of TR/RT ser-vice)
58. Promote the agency, TR/RT services and the pro-fession through marketing and public relations
the traditional approach to the diagnosis and treatment of illness as practiced by physicians in the Western world since the time of Koch and Pasteur. The physician focuses on the defect, or dysfunction, within the patient, using a problem-solving approach. The medical history, physical examination, and diagnostic tests provide the basis for the identification and treatment of a specific illness. The medical model is thus focused on the physical and biologic aspects of specific diseases and conditions.
psychosocial rehabilitation model
the process of restoration of community functioning and well-being of an individual who has a psychiatric disability
-seeks to effect changes in a person's environment and in a person's ability to deal with his/her environment, so as to facilitate improvement in symptoms or personal distress
-These services often "combine pharmacologic treatment, independent living and social skills training, psychological support to clients and their families, housing, vocational rehabilitation, social support and network enhancement, and access to leisure activities."
Inter-national Classification of Functioning
The ICF is WHO's framework for measuring health and disability at both individual and population levels.
-a classification of health and health-related domains. These domains are classified from body, individual and societal perspectives by means of two lists: a list of body functions and structure, and a list of domains of activity and participation. Since an individual's functioning and disability occurs in a context, the ICF also includes a list of environmental factors.
provides the conditions for a growth-promoting climate, a relationship that enables people to discover the capacity to use the relationship for growth and change. The facilitative ingredients referred to that must be present in order for a climate to be growth-promoting, whether the relationship be that of leader and team, business partnership, humanitarian and community, teacher and student, therapist and client, parent and child, any relationship in which growth is a goal are:
-Congruence (Authenticity & Realness)
-Unconditional Positive Regard (Non-judgmental Respect & Acceptance)
- Empathy (process of understanding)
Authenticity & Realness
A fundamental basis for communication. What is being 'experienced' is present in 'awareness' and that awareness is present in 'communication' and can be lived in the relationship.
Unconditional Positive Regard
Non-judgmental Respect & Acceptance
Freedom from any kind of moral or diagnostic evaluation. The ability to step outside of one's own frame of reference and lay aside one's own view and values in order to perceive the perspectives of others without prejudice. A non-possessive behavior that enables in a total rather than conditional way, without attempt to mold individuals to produce a desired result.
Process of Understanding
To perceive the internal frame of reference of another with accuracy and with the emotional components and meanings associated 'as if' one were the person, but without ever losing the 'as if' condition. Active listening with a real understanding of the personal meanings the individual is experiencing.
a slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes
Cognition and related impairments
dementia, traumatic brain injury, developmental/learning dis-abilities
and least restrictive envi-ronment
that a student who has a disability should have the opportunity to be educated with non-disabled peers, to the greatest extent appropriate.
Any architectural feature of a facility which makes it difficult or impossible for a person with disabilities to use
Older Americans Act
committed the government to providing elderly Americans with adequate income and medical care
Individuals with Disabilities Education Act
(IDEA) ensures rights of nondiscriminatory treatment in all aspect of disabled individuals lives; fair and appropriate education, appropriate evaluation, individualized education program, least restrictive environment, parent and student participation in decision making, procedural safeguards
experiential learning model
"the process where knowledge is developed through the transformation of the learner's experience"; requires that students take responsibility for deriving meaning from their experiences; Factors: 1) reality of experience or relevence to the student, 2) level of risk and uncertainty (meaningfullness to student), 3) student reflection; characterized by adventerous learning- Zainuddin p. 129
the study of a whole culture completely. observe human behavior and interview members of soc. Goal- to study the broad range of human beliefs and behaviors to discover what it means to be human.
provide participants with the opportunity to develop new skills, enhance awareness of their community and natural environment, build self-confidence, and recognize personal potential.
Adaptive Recreation Services offers recreational opportunities for people with a variety of disabilities including, but not limited to: cerebral palsy, head injury, stroke, multiple sclerosis, wheelchair users, mental and or emotional illness, alcoholism and drug addiction, visual impairments, spina bifida, mental retardation, and autism.
Concepts of leisure ability model
•Learned helplessness • Intrinsic motivation and focus of control • Choice • Optimal experience, decrease boredom • Intent its to embed leisure model • premise is that not all but most work disabilities experience barriers to leisure
Discrepency Evaluation Model
evaluation, outcomes or measureable objective. serve as the stand for client success -summative evaluation, do clients measure up to criteria -actual outcomes are componants to desired outcomes and discrepancy is examined. -discrepancy is used for revising program plan to address discrepancies
Leisure Ability Model
• Functional intervention
• Leisure Education
• Recreation participation
Most widely used model in field, Its focus is to develop a healthy leisure lifestyle
Functional intervention model
Its purpose is to improve function -treatment its needed before one can be involved in leisure + Improper people to take control + Minimize Disability appropriate for some cases
Its purpose is to teach things related to leisure for health participation and break down leisure barriers
• Self-awareness its leisure attitude towards leisure, knowledge about leisure + social skills • Communication •small group and large • Relationship building • Self-presentation (i.e grooming) + Leisure skills • Traditional(i.e sports, art) • Non-traditional ( riding bus, saving money) + Decrease stress through leisure
• Recreation opportunities • Personal resources (i.e ability to save money) • Family and home resources (i.e, transportation) -state and national resources (i.e parks, rehab, services)
+Mutually driven not therapy driven+ TR serves as facilitator and educator rather than therapist, educate client/participate rather than treat • Acknowledge range of abilities and needs • Range of interaction from independence to dependence TRS its prescriber
Health Promotion/Health protection Model
•Purpose is to facilitate recovery and functional improvement • Uses a humanistic perspective • Health occurs when physical, psychological and environment areas lead to self-actualization. • Health is dynamic and relationship between leisure and health is focus. • Therapeutic recreation is different from recreation participation and is not part of model; model reflects purposeful nature of TR • Designed to stop at hospital/Rehab center/ • Works better in outcome oriented agencies ATRA embraces this philosophy
Leisure Ability Model
Leisure ability model philosophy (ntrs 1987) -assumptions: leisure is a basic him man right and that many people encounter barriers to enjoyable leisure experiences •Functional Intervention • Leisure education • Most widely used model in field • Focus is to develop a healthy leisure lifestyle
recover filtering threats to health and to achieve as high a level of health that is possible. • Humanistic perspective, capable of change • Prescriptive activities: stabilizing force + re-engage in activities but not ready for rec or leisure. •Rec: allow client tip learn new skills, values and ways of thinking. • Leisure: greatest amount of choice and control + primary outcome of TR services
TR service delivery + Outcome model
TR=specialized application of recreation and experimental activities or interventions that assist in maintaining or improving the health status, functional capabilities and ultimately the quality of life of persons with special needs.
Delivery: 1. diagnosis or assessment of need: -formal assessment of evaluation of client strength and limitations. 2. treatment -ameliorate the primary or secondary effects of a disease our injury 3. education -provide information that effects a clients knowledge, attitude and behavior. 4. prevention/health promotion -promote health lifestyle
Health status quo: interrelationship between physical, emotional, cognitive, social, and spiritual health.
Self Determination/Enjoyment enhancement model
• Occurs when an individual is the primary causel agent in ones life making choices and decisions free from external influences or interest. • Enjoyment: level of psychological absorption one had in an activity Enjoyment and functional outcomes = objectives of the model
Selects: activities Optimizes: goals Compensate: impaired abilities Evaluates: effectiveness -design and implements programs to deal with clients awareness, skills, and knowledge
Recreational Therapy personnel shall treat persons served in an ethical manner by actively making efforts to provide for their well-being by maximizing possible benefits and relieving, lessening, or minimizing possible harm.
Recreational Therapy personnel have an obligation to use their knowledge, skills, abilities, and judgment to help persons while respecting their decisions and protecting them from harm.
Recreational Therapy personnel have an obligation to use their knowledge, skills, abilities, and judgment to help persons while respecting their decisions and protecting them from harm.
Recreational Therapy personnel are responsible for ensuring that individuals are served fairly and that there is equity in the distribution of services. Individuals should receive services without regard to race, color, creed, gender, sexual orientation, age, disability/disease, social and financial status.
Recreational Therapy personnel have an obligation, first and foremost, to be loyal, faithful, and meet commitments made to persons receiving services. In addition, Recreational Therapy personnel have a secondary obligation to colleagues, agencies, and the profession.
Recreational Therapy personnel should provide services characterized by mutual respect and shared decision making. These personnel are responsible for providing each individual receiving service with information regarding the services, benefits, outcomes, length of treatment, expected activities, risk and limitations, including the professional's training and credentials. Informed consent is obtained when information needed to make a reasoned decision is provided by the professional to competent persons seeking services who then decide whether or not to accept the treatment.
Confidentiality and Privacy
Recreational Therapy personnel have a duty to disclose all relevant information to persons seeking services: they also have a corresponding duty not to disclose private information to third parties. If a situation arises that requires disclosure of confidential information about an individual (i.e.: to protect the individual's welfare or the interest of others) the professional has the responsibility to inform the individual served of the circumstances.
Recreational Therapy personnel have the responsibility to maintain and improve their knowledge related to the profession and demonstrate current, competent practice to persons served. In addition, personnel have an obligation to maintain their credential.
Compliance with Laws and Regulations
Recreational Therapy personnel are responsible for complying with local, state and federal laws, regulations and ATRA policies governing the profession of Recreational Therapy.
Individualized Intervention Plan
an individualized plan of care or intervention for a person served by a qualified TR/RT professional (CTRS) based on assessed strengths and needs, and includes goals, objectives and intervention strategies aimed at fostering desirable and necessary outcomes.
also referred to as "intervention team", and "multidisciplinary, interdisciplinary,
transdisciplinary team". A treatment team is a group of qualified profession
Standards of Practice:
statements of professional expectations for service delivery in order to assure systematic provision of recreation therapy services. Such statements are set by the organizations representing
the specific profession
planning process in which individuals with disabilities have the opportunity to participate fully in all community activities offered to people without disabilities. Inclusion requires providing the necessary framework for adaptations, accommodations and supports so that individuals can benefit equally from an experience.
observed changes in an individual's health status and functional abilities as a result of services. Out-comes must be measurable, achievable, documented, meaningful, and linked to professional intervention.
Management and treatment of such functions and skills as arousal, perception, discrimination, orientation, organization, thinking, recall, and memory for persons with open or closed head injuries
"Road maps" for the provision of multidisciplinary clinical services. They are plans that identify interventions and sequence them along a timeline. Their purpose is providing the most effective and efficient way to approach a diagnosis.
Idea from psychoanalysis in which the therapist unconsciously responds to the client as though he or she was a significant other from the therapist's past
Disorder of the exocrine glands that causes those glands to produce abnormally thick secretions of mucus. The glands most affected are the respiratory, pancreatic, and sweat glands
Analysis following an activity which permits clients to think about their participation, to examine their feelings, and to discuss how they may use insights gained from the activity
Change in mental health care from traditional, institutional care to the provision of community based services
Diagnostic Related Groups
Classification representing 23 major diagnostic categories that aggregate patients into case types based on diagnosis, age, sex, treatment procedures, and discharge status, predicting use of hospital resources and length of stay. It has been used as a basis for system of prospective payment under Medicare
Defense mechanism in which emotions are transferred from the original person or object to a less formidable, or safer, target
Behavior of persons who are not classifiable as antisocial personalities, but who are predatory and follow criminal pursuits. Formerly termed sociopathic personalities
Active processes that can be used in any interpersonal transaction. It involves four major skills: attending, paraphrasing, clarifying, and perception checking
Group whose major goals are awareness and genuineness. Concern is not so much with the transfer of learning but with the encounters among members. Sessions tend to be emotionally charged, dealing with feelings of love and aggression
Screening tool used to determine a client's needs realted to basic functional skills and behaviors. Measures 11 areas in 3 domains: cognitive, physical, and social/emotional
Type of psychotherapy developed by Frederic Perls that focuses on sensory awareness and here and now experiences.
Global Assessment of Functioning Scale
Scale used to determine the highest social, occupational, or educational level of functioning of a person in the 12 months preceeding the current evaluation.
Perceives people as being self-aware, able to accept or reject environmental influences, and generally capable of being in conscious control of their own destiny. It emphasizes the development of unique potentials.
View that percieves the delivery of human services as a human enterprise in which the dignity and rights of clients are fully recognized. People are seen as stiving to realize their individual potentials, yet capable of growing beyond themselves in order to care about others.
Hereditary progressive central nervous system disease characterized by jerking motions and progressive mental deterioration. Onset in adult life.
Ideas of reference
Symptoms in which a person (who usually is paranoid) ascribes special importance to irrelevant events and believe they are related to himself or herself.
Diagram of the interpersonal behavior of individuals that reveals the degree of openness with which they meet other people and their level of awareness of themselves
intrinsically motivated, self-determined experience allowing for a chosen level of mastery and competence that leads to feelings of self-efficacy, empowerment, excitement or enjoyment; having freedom to become
Leisure Ability Model
Practice model for TR originally developed by Carol Peterson and Scott Gunn that has as its goal developing the client's leisure abilities
Leisure Competence Measure
8-leisure domain, 7-level point scale designed to document leisure functioning and to measure recreational therapy outcomes
Type of learning in which responses are modified by their consequences. Reinforcement increases the likelihood of future occurences of the reinforced response.
Organic Mental Syndrome
Abnormality associated with transient or permanent dysfunction of the brain of unknown or unspecified etiology, characterized by disorientation and signs of psychosis such as halluciantions, delusions, impaired judgement, and poor impulse control
Currently perceived to be a clinical syndrom and not a specific disease. It usually begins with a tremor in one of the upper limbs accompanied by pill rolling movements of the thumb and fingers, a masklike appearance to the face, and slowed speech. Balance and ambulation may be affected, as well as cognitive processes. It usually affects older persons and is slowly progressive.
peripheral nervous system
Network of nerve fibers that transmit messages between the central nervous ystem and the skin, skeletal muscles, and internal organs. It has two parts: the somatic and autonomic.
Somatic nervous system
the division of the peripheral nervous system that controls the body's skeletal muscles
autonomic nervous system
The part of the peripheral nervous system that controls the glands and the muscles of the internal organs (such as the heart). Its sympathetic division arouses; its parasympathetic division calms.
an approach to therapy that assumes all individuals have a tendency toward growth and that this growth can be facilitated by acceptance and genuine reactions from the therapist
Genetic disorder resulting in the buildup of concentrations of chemicals that interfere with brain development, leading to severe mental retardation; detectable by a simple test administered shortly after birth and treatable by diet when detected early
according to psychoanalytic theory, the basic human tendency to avoid pain and seek pleasure
acute communicable systemic viral disease affecting the central nervous system with variable severity ranging from subclinical infection to paralytic disease, to possible death
type of reinforcement in which a more preferred behavior by the individual is contingent on the successful completion of a less preferred behavior
therapy based on Freudian constructs wich attempts to explore the unconscious by bringing it to the surface of consciousness
psychological theory developed by Freud. A conflict model involving three systems of personality (id, ego, and superego) and two instinctual drives (sex and aggression)
process whereby the quality of healthcare is evaluated in terms of predefined standards
enjoyable, restorative activity in which individuals exercise choice and control; often associated with leisure time
real objects, stimulate senses, new motivation for life, pictures, animals, hobbies, group interaction (depression or early stage of disorientation)
phenomenon studied by psychologists that people in groups behave with greater risk that those not in a group
social facilitation theory
social psychology theory centered on the effect of the presence of others on behavior, particularly performance and learning
criteria in standards of practice that describe service delivery in terms of environment, resources, organizational purpose and mission, legal authority, facilities, qualifications of providers, and standards of licensing, regulatory, or accreditation agencies
defense mechanism in which energy associated with unacceptable impulses is diverted into acceptable channels
in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).
is a form of physical therapy designed to treat a wide variety of balance disorders, the majority of which are caused by problems in the inner ear and vestibular nerve
play to release repressed thoughts, feelings, and emotions. An outlet for aggression.
to mainatin one's functioning, to be diversional. To enable individuals whose functional capabilities are chronically impaured to be maintained at the maximum level of health and well being
Amiotropic Lateral Sclerosis
Lou Gherig Disease. Progressive muscular disease in adults that leads to death. Completely physcial.
Leisure Activity Blank
Measures past leisure participation and intentionality of future involvement through a three point rating scale
for those with high cognitive functioning. Identify emotional motivation for participation. Client responds after looking at pictures - which do they like better?
experiential learning model
"the process where knowledge is developed through the transformation of the learner's experience"; requires that students take responsibility for deriving meaning from their experiences; Factors: 1) reality of experience or relevence to the student, 2) level of risk and uncertainty (meaningfullness to student), 3) student reflection; characterized by adventerous learning
One of the four behavioral domains. Focuses on body position, edurance, cardiovascular fitness, etc.
One of the four behavioral domains. Focuses on emotions, self-esteem, expression, etc.
One of the four behavior domains. Focuses on cooperation, competition, individual vs. group, leadership needed, etc.
One of the four behavioral domains. Focuses on concentration needed, age appropriateness, memory, time, etc.
NTRS Code of Ethics
1.The obligation of professional virtue
2.The obligation of the professional to the individual
3.The obligation of the professional to other individuals and to society
4.The obligation of the professional to colleagues
5.The obligation of the professional to the profession
6.The obligation of the professional to society
NTRS Standards of Practice
1.Scope of Service
2.Mission and Purpose/Goals and Objectives
3.Individual Treatment/Program Plan
5.Plan of Operation
8.Evaluation and Research
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