Inclusion in the aquatic environment.

Imagine a hot July day and how refreshing a swim at the local beach would feel, but you use a wheelchair and the beach is not accessible. Imagine that all your friends are going to the local water theme park for the day and have invited you to join them, but you use a guide dog and this park has a policy prohibiting animals in its facility. Imagine that you want to take a swim class at the local public pool, but you have mental retardation, and the swim instructors do not know how to adapt their instructions to accommodate you.

These scenarios are not fiction but barriers to aquatic programs, contributing to the exclusion of people with disabilities in community life. The purpose of this article is to offer ways to create and maintain the inclusion of people with disabilities in aquatic environments. Information offered will be supported by findings from a 1997 survey of park and recreation agencies on the inclusion of people with disabilities in leisure services.

Edgington et al. (1998) noted that swimming is one of the most popular community leisure activities pursued by people. Over the past decade, the inclusion of people with disabilities in community leisure programs has increased, with a growing interest in aquatic activities (Devine, 1997; Beaudouin & Keller, 1994; Peterson, 1996). Increased interest in water activities may be associated with the freedom of movement inherent to water environments, resulting in physiological benefits -- improved circulation, mobility, strength, coordination, cardiovascular endurance -- and psychological benefits -- enhanced self-esteem, body image, and mood (Beaudouin & Keller, 1994; Broach & Dattilo, 1996). Despite the growing interest in and benefits of aquatic activities, a number of people with disabilities experience barriers to inclusion in these types of pursuits.

To examine barriers to inclusion in leisure services, a joint committee between the American Park and Recreation Society (APRS) and National Therapeutic Recreation Society (NTRS) was formed. The goal of the committee was to explore the "state of inclusion" in park and recreation agencies across the United States and to assist with strategies and resources needed to provide leisure services to people with disabilities in an efficient, useful, and cost-effective manner. This committee surveyed park and recreation agencies across the country regarding services provided, problems encountered, and training needed for inclusive leisure services. Findings from this survey have been discussed and applied to aquatic environments.

Barriers to Inclusion

According to Schleien and colleagues (1997), common barriers to the inclusion of people with disabilities in leisure programs include administrative, physical, and attitudinal obstacles. Administrative barriers are procedural difficulties that pose participation obstacles to people with disabilities and include financial constraints, policy restrictions, program limitations, and lack of qualified staff. The APRS-NTRS Joint Committee survey found that while park and recreation agencies had reviewed and revised some policies and procedures, conducted some staff training on inclusion, and modified some programs, they needed to proceed further.

Physical barriers are those environmental and architectural obstacles that inhibit inclusion. Some examples of physical barriers include lockers that are mounted too high, steps or lips at the threshold of a shower, narrow seating in shower stalls, narrow dressing stalls, lack of family dressing areas, lack of access to pool entry, and lack of raised lettering or Braille signage. Survey findings revealed that park and recreation agencies had retrofitted some areas, buildings, and facilities and purchased some adaptive equipment but needed to do more to meet accessibility needs.

Negative societal responses or attitudinal barriers to people with disabilities have been identified as the greatest obstacle to inclusive leisure services for people with disabilities (Shank et al., 1996). According to Devine (1997), this barrier is salient because it relates to societal limitations experienced by people with disabilities. Attitudinal barriers experienced by people with disabilities in leisure settings can take the form of stigmas, stereotypes, unequal treatment, lack of social acceptance, and lower expectations of abilities (Bedini & Henderson, 1994; Devine, 1997; West, 1984). A woman with multiple sclerosis who registered to participate in an aquatic exercise course at a public pool illustrated an example of an attitudinal barrier. Because of her disability, she needed assistance standing in the water and had to wear a catheter bag to prevent urinary incontinence. According to the aquatic director, other participants had expressed a concern about her catheter bag posing a water-quality/health hazard. Instead of educating the aquatic staff and other participants regarding the catheter bag to resolve concerns, the aquatic director instead attempted to prevent this woman's participation in the course and referred this woman to another aquatic facility. This woman was so discouraged by the attitude of the aquatic director, she chose not to participate in any aquatic program. On the APRS-NTRS Joint Committee survey, park and recreation agencies identified poor attitudes toward people with disabilities by staff and the general public as problems encountered when implementing inclusive leisure programs.

Creating Inclusion

Studies have shown that mere physical placement of people with and without disabilities together in leisure programs does not lead to successful inclusive leisure experiences. The notion of creating inclusion requires the examination and design or redesign of the administrative, physical, and attitudinal components of leisure programs. Aquatic professionals are encouraged to create inclusion to increase the possibility of a successful leisure experience for all participants. Creating inclusion involves elimination of internal (characteristics of disability) and external (policy barriers) constraints in all areas of the aquatic environment.

As identified in the APRS-NTRS Joint Committee survey, park and recreation agencies indicated the need for more policy and procedure review and revision, staff training, and program modifications. Applying these findings to aquatic settings, an examination of these administrative components would be a good starting point for creating inclusion. Specifically, leisure professionals could examine policies and procedures of pools or beaches to determine whether a barrier may exist. Staff training needs can also be examined to determine if lifeguards, swim coaches, or facility managers have adequate information and skills to include people with disabilities in programs or services. Program modifications needed to include an individual with a disability in an aquatic program can vary from individual to individual. Examining the availability of general program modification guidelines and strategies may be helpful to the aquatic leisure professional to create inclusion. For example, does the agency have a therapeutic recreation specialist on staff who serves as the inclusion specialist to assist with program modifications and strategies? Does the aquatic facility have a file or database of effective program modifications or strategies that may serve as a starting point for adapting an aquatic program? Has information been obtained from individuals with disabilities or family members regarding effective modifications for that person?

Creating inclusion involves examining and making changes to improve physical accessibility. The survey conducted by the joint committee found that while park and recreation agencies had retrofitted some areas and purchased some adaptive equipment, they needed to do more to meet physical accessibility needs. In an aquatic setting, it is important to assess accessible routes of travel, locker rooms, pool decks, outdoor showers, water fountains, first-aid areas, signage, entrances to the pool, and recreational features within a water area.

Another consideration for making aquatic settings physically accessible is the temperature of the water. When considering the ideal water temperature to accommodate a variety of needs, consideration of factors such as age, activity level, and disability can also play a part in maintaining a safe and comfortable body temperature in the water (Broach & Dattilo, 1996; Clayton & Thomas, 1989). For example, a pool designed for competition could be kept from 78-82 [degrees] F, one for instruction and young children could be kept from 84-87 [degrees] F, and another for individuals unable to tolerate colder water temperatures (infants, preschoolers, older adults, people with certain disabilities) could be kept at 86-92 [degrees] F (Broach et al, in press). Purchasing some basic adapted aquatic equipment (pool lifts, flotation devices) is an important aspect of physical accessibility. For example, the provision

of pool lifts was identified by park and recreation agencies in the APRS-NTRS Joint Committee survey as the number one accommodation provided to people with disabilities. In addition to pool lifts, making adaptive flotation devices and transfer mats available to consumers with disabilities is also a way of creating inclusion.

The APRS-NTRS Joint Committee survey also found that negative attitudes toward people with disabilities were primary obstacles to providing services. Thus, conducting in-service training with aquatic staff may be needed to address negative attitudes toward people with disabilities. For example, to create inclusion, management in aquatic settings can assess staff and volunteer training needs to determine if sensitivity, awareness, program planning and implementation, or disability-information training is needed. An assessment may find problems with how staff views people with disabilities. Therefore, viewing people with disabilities as participants and entitling them to the same respect and attention given to people without disabilities should be considered in training on attitudinal barriers and creating inclusion (Bedini & Henderson, 1994; Devine, 1997). Training in the appropriate terminology to be used by staff is another way to reduce attitudinal barriers and contribute toward creating inclusion. Specifically, using "person-first terminology" (for example, people with hearing impairments versus the hearing impaired when referring to an individual with a disability demonstrates respect and dignity (Dattilo & Smith, 1990). Creating an atmosphere of social acceptance between participants with and without disabilities can also be used to create inclusion. Devine (1997) noted that leisure settings may be a context where social acceptance between people with and without disabilities becomes obvious. Aquatic professionals could design programs that focus on common rather than individual goals and personal rather than casual interactions to foster social acceptance between people with and without disabilities.

Maintaining Inclusion

The idea behind maintaining inclusion in aquatic environments is to evaluate all inclusion efforts, revise those that are not effective, and continue those that are effective. Administratively, several methods can be applied to maintain inclusion. First, all levels of the agency's staff must treat inclusion as a priority in the delivery of services. Treating inclusion as a service-delivery priority involves making it part of the agency's aquatic mission, goals, and objectives. Another way in which maintaining inclusion can be accomplished from an administrative perspective is to monitor the type and extent of services offered to people with disabilities. For example, what separate and inclusive aquatic opportunities are available for people with disabilities? Continuous evaluation and examination of aquatic services offered to people with disabilities increases both the likelihood that programs are not offered based on stereotypes and the diversity and flexibility of aquatic options (Schleien et al. 1997). Language and descriptions of aquatic programs should be inclusive and generic to all potential participants. In addition, monitoring the fee structure of inclusive and separate aquatic programs to determine the affordability for consumers may be an important aspect of maintaining inclusion.

Finally, seeking input from all participants, including people with disabilities as well as family members, can contribute to maintaining inclusion. Input on issues such as making accommodations, assessing aquatic abilities, or marketing to community members with disabilities can be sought as part of an evaluation process or as part of a community-needs assessment. Inclusion of people with disabilities on advisory, swim-team, or planning boards can serve as a way to gain input, as well.

The Americans with Disabilities Act (ADA) requires that agencies maintain a structure's accessible features. Therefore, to maintain inclusion, physically accessible features in an aquatic structure should be inspected periodically for damage, soundness, and usability. Repairs to accessible features should be made immediately; not doing so not only violates the ADA but also places the safety of all participants in jeopardy. Seeking input from consumers with disabilities regarding their needs for adaptive aquatic equipment is another way to maintain inclusion. Lastly, sustaining an adequate supply of alternative forms of information (large-print or Brailled materials) can also serve to maintain inclusion.

It is essential to continuously monitor staff attitudes toward people with disabilities to maintain inclusion in aquatic services. Since attitudinal barriers were identified by park and recreation departments in the APRS-NTRS survey as among the greatest barriers to inclusion, it is recommended that attention be given to sustaining positive attitudes toward the inclusion of people with disabilities in aquatic environments. Specifically, aquatic leisure professionals can strive to nurture social interaction between people with and without disabilities by giving attention to how aquatic programs are designed and implemented. Social acceptance toward people with disabilities has been found to correlate with satisfaction when participating in inclusive leisure activities (Devine, 1997). By focusing on the abilities and value of all participants when implementing aquatic programs, aquatic leisure professionals can contribute to fostering social acceptance between people with and without disabilities. At times, it is the social rather than the skill aspect of a leisure activity that draws people to participate (Peterson & Gunn, 1984). Social aspects of a leisure activity may contribute to developing friendships, a sense of belonging, and a connection to our community (Dumazedier, 1974; Kaplan, 1960; Wilhite, Devine & Goldenberg, in press). People with disabilities typically have less of a sense of belonging to a group or community and fewer friendships than do people without disabilities (Schleien et al., 1997). Devine (1997) noted that by nurturing social acceptance between people with and without disabilities, commonalities can be explored, and a sense of belonging -- as well as friendships -- may form. Finally, in addition to encouraging a positive attitude toward people with disabilities during service delivery, aquatic leisure professionals can monitor their attitudes toward people with disabilities to maintain inclusion. For example, the provision of periodic in-service training for aquatic staff on sensitivity and attitudes toward people with disabilities may assist in maintaining a positive attitude toward their inclusion in aquatic environments.

Conclusion

Creating and maintaining inclusion of people with disabilities in aquatic environments can be easily accomplished if attention is given to administrative, physical, and attitudinal components of aquatic services. Using information, such as survey results from the APRS-NTRS Joint Committee, aquatic leisure agencies can monitor their progress toward creating and maintaining inclusion. Scenarios of inclusion may then replace those of exclusion.

References

Beaudouin, N. M. & Keller, M. J. (1994). Aquatic-solutions: A continuum of services for individuals with physical disabilities in the community. Therapeutic Recreation Journal, 28, 193-202.

Bedini, L. A., & Henderson, K. (1994). Women with disabilities and the challenges to leisure service providers. Journal of Park and Recreation Administration, 12(1), 17-34.

Broach, M. E. & Dattilo, J. (1996). Aquatic therapy: A viable option. Therapeutic Recreation Journal, 30, 213-229.

Broach, M. E., Groff, D., Dattilo, J., Yaffe, R., & Gast, D. (In press). The effect of aquatic therapy on individuals with multiple sclerosis. Annual in Therapeutic Recreation.

Clayton, R. D. & Thomas, D. G. (1989). Professional aquatic management Champaign, IL: Human Kinetic Books.

Dattilo, J., & Smith, R. W. (1990). Communicating positive attitudes toward people with disabilities through sensitive terminology. Therapeutic Recreation Journal, 24,(1), 8-17.

Devine, M. A. (1997). The relationship between social acceptance and the leisure lifestyle of people with disabilities. Unpublished doctoral dissertation. University of Georgia: Athens, GA.

Dumazedier, J. (1974). Sociology of leisure. New York: Elsevier.

Edgington, C. R., Hanson, C. J., Edginton, S. R., & Hudson, S. D. (1998). Leisure programming: A service-centered and benefits approach. (3rd ed.). Boston: McGraw-Hill.

Kaplan, M. (1960). Leisure in America. New York: John Wiley & Sons Inc.

Peterson, C. A. (1996). Aquatic programming for seniors. Parks and Recreation, 13,(7), 16.

Peterson, C. A. & Gunn, S. L. (1984). Therapeutic recreation program design: Principles and procedures. (2nd ed.). Englewood Cliffs, NJ: Prentice Hall.

Schleien, S. J., Ray, M. T., & Green F. P. (1997). Community recreation and people with disabilities: Strategies for inclusion. (2nd ed.). Baltimore: Paul Brookes.

Shank, J. W., Coyle, C. P, Boyd, R., & Kinney, W. B. (1996). A classification scheme for therapeutic recreation research grounded in the rehabilitative sciences. Therapeutic Recreation Journal, 30, 179-196.

West, P. C. (1984). Social stigma and community recreation participation by the mentally and physically handicapped. Therapeutic Recreation Journal, 18,(1), 40-49.

Wilhite, B., Devine, M. A., & Goldenberg, L. (In press). Perceptions of youth with and without disabilities: Implications for leisure programs and services. Therapeutic Recreation Journal.

Resources for Creating and Maintaining Inclusion in Aquatic Environments

Publications

Association of Swimming Therapy (1992). Swimming for people with disabilities. London: Bedford Row.

Campion, M. R. (1985). Hydrotherapy in pediatrics. Oxford: Heinemann Medical Books.

Stova, R. (1996). Backhab: The water way to mobility and pain-free living. Port Washington, WI: DSL, Ltd.

Stova, R. (1992). Aquatics: The complete reference guide for aquatic fitness professionals. Boston: Jones and Bartlett.

Adaptive Aquatic Equipment

Adolph Kiefer and Associates [phone]

AquaSource International [phone]

Aquatic Access [phone]

Aquatic Therapy Innovations [phone]

Aquatic Therapeutic Worldwide [phone]

Arjo, Inc. [phone]

Flaghouse [phone]

Recreational Supply Co. [phone]

Sprint Rothhammer International [phone]

Organizations and Other Resources

APRS-NTRS Joint Committee

John McGovern, Co-Chair (NTRS) Executive Director, NSSRA P.O. Box 8437, Northfield, IL 60093 [phone]

Linda Kotowski, Co-Chair (APRS) Superintendent of Recreation Boulder Parks and Recreation Department P.O. Box 791, Boulder, CO 80376 [phone] E-mail: [e-mail]

ADA and Inclusion

Dr. Mary Ann Devine Kent State University School of Exercise, Leisure & Sport P.O. Box 5190, Kent, OH 44221 [phone] E-mail: [e-mail]

NTRS Aquatics Committee

Dr. Fran Coffey Stanat, Co-Chair University of Wisconsin-Milwaukee 409 W. Willow Terrace Milwaukee, WI 53217 [phone] E-mail: [e-mail]

Ellen Broach, Co-Chair University of Georgia Department of Recreation and Leisure Studies 300 River Road Athens, GA 30602 [phone] E-mail: [e-mail]

RELATED ARTICLE: Creating an atmosphere of social acceptance between participants with and without disabilities can also be used to create inclusion.

(Approved by the NTRS Board of Directors, October 29, 1997)

Diversity is a cornerstone of our society and culture and thus should be celebrated. Including people with disabilities in the fabric of society strengthens the community and its individual members. The value of inclusive leisure experiences in enhancing the quality of life for all people, with and without disabilities, cannot be overstated. As we broaden our understanding and acceptance of differences among people through shared leisure experiences, we empower future generations to build a better place for all live and thrive.

Inclusive leisure experiences encourage and enhance opportunities for people of varying abilities to participate and interact in life's activities together with dignity. It also provides an environment that promotes and fosters physical, social and psychological inclusion of people with diverse experiences and skill levels. Inclusion enhances individuals' potential for full and active participation in leisure activities and experiences. Additionally, the benefits of this participation may include:

* providing positive recreational experiences which contribute to the physical, mental, social, emotional, and spiritual growth and development of every individual;

* fostering peer and intergenerational relationships that allow one to share affection, support, companionship and assistance; and

* developing community support and encouraging attitudinal changes to reflect dignity, self-respect and involvement within the community.

PURPOSE

The purpose of the National Therapeutic Recreation Society's (NTRS) Position Statement on Inclusion is to encourage all providers of park, recreation, and leisure services to provide opportunities in settings where people of all abilities can recreate and interact together.

This document articulates a commitment to the leisure process and the desire outcomes. Accordingly, the NTRS Position Statement on Inclusion encompasses these broad concepts and beliefs:

Rights to Leisure

* The pursuit of leisure is a condition necessary for human dignity and well-being.

* Leisure is a part of a healthy lifestyle and a productive life.

* Every individual is entitled to the opportunity to express unique interests and pursue, develop and improve talents and abilities.

* People are entitled to opportunities and services in the most inclusive setting.

* The right to choose from the full array of recreation opportunities offered in diverse settings and environments and requiring different levels of competency should be provided.

Quality of life

* People grow and develop throughout the life span.

* Through leisure an individual gains an enhanced sense of competence and self-direction.

* A healthy leisure lifestyle can prevent illness and promote wellness.

* The social connection with one's peers plays a major role in his/her life satisfaction.

* The opportunity to choose is an important component in one's quality of life; individual choices will be respected.

Support, Assistance and Accommodations

* Inclusion is most effective when support, assistance and accommodations are provided.

* Support, assistance and accommodations can and should be responsive to people's needs and preferences.

* Support, assistance and accommodations should create a safe and fun environment, remove real and artificial barriers to participation, and maximize not only the independence but also the interdependence of the individual. People want to be self-sufficient.

* Support, assistance and accommodations may often vary and are typically individualized. Types of support, assistance and accommodations include, but are not limited to: qualified staff, adaptive equipment, alternative formats for printed or audio materials, trained volunteers, or flexibility in policies and program rules.

Barrier Removal

* Environments should be designed to encourage social interaction, "risk-taking," fun, choices and acceptance that allow for personal accomplishment in a cooperative context.

* Physical barriers should be eliminated to facilitate full participation by individuals with disabilities.

* Attitudinal barriers in all existing and future recreation services should be removed or minimized through education and training of personnel (staff, volunteers, students, and/or community at-large).

The National Therapeutic Recreation Society is dedicated to the four inclusion concepts of:

* Right to Leisure (for all individuals)

* Qualify of Life (enhancements through leisure experiences)

* Support, Assistance and Accommodations

* Barrier Removal

in all park, recreation and leisure services. Properly fostered, inclusion will happen naturally. Over time, inclusion will occur with little effort and with the priceless reward of an enlightened community. Encouraged in the right way, inclusion is the right thing to plan for, implement and celebrate.

The National Therapeutic Recreation Society is a branch of the National Recreation and Park Association, 22377 Belmont Ridge Road, Ashburn, VA 20148. Phone [phone]; fax [phone]; e-mail NTRS [e-mail]; Web: http://www.nrpa.org/