Serving a Brave New World.

The year 2000 is upon us, and a number of trends have created a world vastly different from nearly a half century ago, when the field of therapeutic recreation began as a professional practice.

As a consequence of dynamic forces impinging on the practice of therapeutic recreation, the 21st century presents opportunities and challenges that will propel the profession toward greater degrees of sophistication and acceptance as an essential piece in health and human services.

In the new millennium, we must reposition therapeutic recreation as a significant and essential contributor to the functional status, health, and well-being of people with illnesses, disabilities, or other conditions. Crafting a vision of an essential piece of the health and human services puzzle in the next century requires documentation of the benefits gained from purposefully designed experiences impacting quality of life.

In the late 1960s the National Therapeutic Recreation Society, a branch of the National Recreation and Park Association, emerged from an amalgamation of the first professional organizations representing therapeutic recreation. The environment, pace, and focus of the agencies in which therapeutic recreation is being practiced has changed and will continue to change (Coyle, Boyd, Kinney & Shank, 1998). The nature of health and human services today will not be the final structure/organization in the 21st century (Roth, 1997).

A number of trends are affecting the nature of services, the location of service delivery, the roles of practitioners, and the individuals who benefit from therapeutic recreation experiences. The humanistic approach and promotion of health and the prevention of illness and disease are resulting in services designed to maximize functioning and wellness. The health care continuum will stretch from the cradle to the grave, from hospitals to community centers and into private homes.

In a variety of settings, therapeutic recreation specialists will plan, implement, and evaluate programs and services that facilitate lifestyle changes and health enhancement throughout the life course. Consumers, caregivers, and environmental factors will be assessed and incorporated into programs and services. Maximum functioning and optimal health will be primary goals of all leisure professionals.

Within local park and recreation agencies and other leisure service entities, therapeutic recreation professionals will provide leadership on nurturing and understanding the principles of inclusion. Outside of the family, play is the first place that a person with an illness, disability, or other condition can feel -- and be -- included. Therapeutic recreation educators, researchers, practitioners, managers, and consumers are the orchestrators for inclusion. Inclusive leisure experiences encourage and enhance opportunities for people of varying abilities to participate and interact in life's activities together with dignity (NTRS, 1997). Inclusion at play leads to inclusion in the classroom, in the place of worship, in the workplace, and in the neighborhood.

Medical progress and cost containment have resulted in reduced hospital stays, increased outpatient services, and home health care practices (Riley & Skalko, 1998). The outcome of these shifts has been the development of integrated service delivery systems organized to provide medical care in the community (Gilmartin, 1998). Integrated describes the nature of the services provided as well as the procedures used to manage and deliver programs. Moralities such as social work and rehabilitation will be packaged alongside leisure professionals. Brief interventions, during lunch or before work, will occur at clinics and drop-in centers in local park and recreation agencies.

Teams of multiskilled and credentialed practitioners will deliver services in public agencies and private residences. A single plan will follow consumers via electronic transport from one setting to another. Documentation will be streamlined by means of software programs and tied directly to reimbursement and fees and charges. The efficacy of therapeutic recreation specialists and their multiskilled partners will be measured by the degree to which consumers' benefits have been realized.

The changing nature of health care financing and management has transformed the settings in which services are provided as well as the roles and responsibilities of professionals. Therapeutic recreation practitioners have predominantly practiced in hospitals, most conspicuously in mental health and behavioral health settings. The therapeutic recreation process is now and will continue to be applied across a full spectrum of service settings, including intensive inpatient care, in-home health care, adult day and assisted-living services, and early intervention with youth.

Therapeutic recreation professionals are uniquely adapted to support the needs of youth. The international research of the Search Institute on Youth Asset Development (Search Institute, 1996) identified 40 assets critical to the success of our nation's young people. Many of these assets can be strengthened or constructed through leisure experiences.

Young people serve useful roles in their school, family, and community.

Young people volunteer one hour or more per week to help others.

Young people are involved in music, theater, or other arts for at least three hours each week.

Young people are involved in sports, clubs, or organizations for at least three hours per week.

Young people balance their time among family, structured activities, and hanging out with friends.

Services provided will meet consumer needs in a most effective and timely manner. Consequently, each experience will be expected to offer multiple benefits. Because the practice addresses holistically the means of living and the purpose of life, therapeutic recreation specialists are naturally suited to provide a broad service perspective. Therapeutic recreation specialists address diverse consumer needs that emanate directly from physical limitations, as well as secondary outcomes of illness and disability, such as low self-esteem, which threaten control freedom, self-efficacy, and happiness.

Pet, aquatic, horticulture, and aroma therapies; adventure training; and outdoor recreation will be joined by newly emerging experiential-based practices. An overriding concern for the environment will continue to facilitate the use of natural and synthetic resources to create barrier-free experiences in relevant settings.

Diversity describes a number of variables affecting the roles and responsibilities of therapeutic recreation specialists. Population dynamics and changes are creating larger groups of seniors and young people. There is also more social, cultural, and economic diversity within the general population.

Advances in medicine are enabling individuals with chronic disabilities to live longer, fuller lives. Therapeutic recreation specialists will work side by side with other leisure and social service providers to facilitate opportunities, offer information, and provide access to resources.

Leisure education will become a primary job responsibility, while referral, transition planning, and community re-entry will develop new perspectives. Because therapeutic recreation specialists are outcome-oriented, they will train leisure professionals to design programs that target specific results. As changes continue, social service providers will assume responsibilities once associated with the family.

As a result of the changing nature of therapeutic recreation practice, which was triggered by changes in the larger health and human services system, therapeutic recreation is undergoing a repositioning and rededication that will bring it into the 21st century with a new look. Early writings relate recreation to health: Recreation purposefully and effectively promotes ... growth in health.... Fun is the sign, health is the goal (Haun, 1966). We have espoused the need for effective research, while reporting the benefits that accrue to consumers (Coyle, Kinney, Riley & Shank, 1991).

Twenty-first-century practice will find cross-discipline professionals developing programs that explicitly tie experiences to definitive outcomes through diagnostic needs. Collaborative relationships will bring practitioners, educators, and researchers together to conduct research that will document the significant and essential nature of leisure behavior in health and well-being. Therapeutic recreation professionals will validate specific experiences that simultaneously promote the integration of body, mind, and spirit and alleviate the primary and secondary consequences of illness and disability.

Higher-education reforms continue to demand "leaner and meaner" academic programs that emphasize relevant preparation of entry-level professionals. A Pew Health Professions Commission report has called for a restructuring of education to incorporate cross-discipline training with a psychosocial-behavioral perspective and increased use of field-based instruction sites (1995).

Curricula have shifted from primarily being housed in departments of health, physical education, and recreation to departments of parks and recreation, health and human services, allied health, or social and behavioral sciences. Administrative location of curricula influences course requirements. The future will see the transition toward "human service" professions continue with increased course work incorporating helping skills, technology competencies, sciences, and experiential interventions.

The rate and intensity of change itself is perhaps one of the most professionally challenging trends. The new millennium offers opportunities to reshape the practice and propel the profession into central roles and positions among health and human services. Leisure is a right, not a privilege. The right to leisure is grounded in the notion that the individual is entitled to the opportunity to express unique interests and pursue, develop, and improve talents and abilities because of his/her potential (NTRS, 1996). By proactively embracing change, assuming advocacy roles, cooperating and coordinating, and promoting the benefits of therapeutic recreation in the health care puzzle, therapeutic recreation is virtually guaranteed to remain a vital component of consumers' well-being in the new millennium.

The right to leisure is a condition necessary for human dignity and well-being (NTRS, 1996). Why not go out on a limb? After all, that's where the fruit is. Perhaps therapeutic recreation professionals can point the way to the ripest morsel.

References

Coyle, C., R. Boyd, W. Kinney, and J. Shank. 1998. "The Changing Nature of Therapeutic Recreation: Maintaining Consistency in the Face of Change. Parks & Recreation 33 (5): 56-63.

Coyle, C., W. Kinney, B. Riley, and J. Shank. 1991. Benefits of Therapeutic Recreation: A Consensus View. Philadelphia, PA: Temple University.

Gilmartin, M.J. 1998. "The Nursing Organization and the Transformation of Health Care Delivery for the 21st Century." Nursing Administration Quarterly 22 (2):70-86.

Haun, P. 1966. Recreation: A Medical Viewpoint. New York: N.Y. Teachers College, Columbia University.

NTRS. 1996. "Philosophical Position Statement." Arlington, Va.: Carter, M.

NTRS. 1997. "Position Statement on Inclusion." Arlington, Va.: Carter, M.

Pew Health Professions Commission. 1995. "Critical Challenges: Revitalizing the Health Professions for the 21st Century" (The third report of the Pew Health

Professions Commission). San Francisco: Center for the Health Professions, University of California at San Francisco.

Riley, B., and T.K. Skalko. 1998. "The Evolution of Therapeutic Recreation." Parks & Recreation 33 (5): 64-71.

Roth, B.E. 1997. "The Current Health Care Environment and Stages of Market

Development." Gastroenterology Clinics of North America 26 (4): 75-724.

Search Institute. 1996. Minneapolis. www.searchinstitute.org

RELATED ARTICLE: Therapeutic Recreation Rides into the future

The National Sports Center for the Disabled, based in Winter Park, Colo., is one of the largest providers of adaptive recreation in the world, offering nearly 28,000 lessons annually in a variety of sports. The center is no longer alone in providing recreation; all across the country people with disabilities are sailing, scuba diving, golfing, cycling, mountain climbing, and snowboarding.

This wasn't always the case, however. In the 1970s, most recreation therapists worked in clinical settings -- hospitals and nursing homes. These are the settings in which people with disabilities found most of their recreation opportunities. Today, therapists and people with disabilities have more options and are turning to community resources, such as park and recreation departments or private programs, to provide recreation for individuals with disabilities.

As managed care began to change rehabilitation, other institutions that served people with disabilities were also changing. Specialized schools for children with disabilities were becoming smaller as some children were mainstreamed into classes with their able-bodied peers. Mental health hospitals began sending patients into group homes. As perceptions of people with disabilities began to change, people with special needs were turning more and more frequently to their communities to provide services once sought from institutions:

Today's professionals are going beyond specialized programs for those with disabilities, realizing that a sense of accomplishment in recreation can help people with disabilities generalize success to other areas of their lives, such as work, school, or parenthood.

As the trend of providing community-based recreation for people with disabilities continues to grow, the private sector is beginning to realize the significance of a market of 52 million Americans. The Americans with Disabilities Act and other legislation have required facilities and programs to become more accessible to all users. Nonprofit organizations are popping up across the country, providing resources for everything from archery and baseball to windsurfing and skydiving.

"Adaptive equipment is changing, too," says NSCD program director Hal O'Leary. "Outriggers, a device used by three-track, or amputee, skiers, have become lighter, safer, and easier to use. Hand cycles are more advanced. Adaptive sports equipment is becoming like computer equipment -- always changing, updating, and getting better."

One reason for this trend is consumer demand. Athletes of all abilities want to be included in general programming, to participate in recreation activities relating to their personal interest, not their perceived physical limits.

An example of how this demand is being met is the three-step inclusion program developed by NSCD and the children's center ski school at Winter Park Resort. First, students with disabilities receive an initial assessment with the NSCD and in most cases several one-on-one lessons with an instructor. Then, while the student is integrated into a class taught by a Winter Park children's center instructor, he or she has the assistance of an instructor from the specialized sports center. In the final step of the program, the child participates in the regular ski school class without the assistance of the sports center, but assistance is always available.

Inclusive recreation offers multiple benefits because it allows individuals with disabilities to recreate with their peers, family members, and friends in a safe, successful environment.

-- Gigi Dominguez, CTRS, and Sharon Roth, CTRS

Marcia Jean Carter, CTRS, CLP, is president of the National Therapeutic Recreation Society.