Utilizing the Therapeutic Recreation Process in Community Settings: THE CASE OF SUE.

Delivering therapeutic recreation services in community settings has been particularly successful when the therapeutic recreation process is applied. In this article, the authors show us that it is not the setting that determines the use of the therapeutic recreation process, but the needs of the clients/participants.

Sue is a forty-year-old woman with a moderate developmental disability. She is interested in participating in a dance program with other adults with developmental disabilities but has difficulty with socialization skills. In addition, she has only one friend and would like to make more friends. Using a system called the therapeutic recreation process, therapeutic recreation staff can help people like Sue to learn the necessary skills to engage in recreation activities.

The therapeutic recreation process is a systematic method of planning and providing services for individuals with disabilities. The process is based on a systems theory approach meaning that parts or components are interrelated (Peterson & Stumbo, 2000). According to Peterson and Stumbo, the systems design is a guide for "a well-defined, goal-oriented purpose to the activity or program being provided". It involves the application of four phases: assessment, planning, implementation, and evaluation. Use of the therapeutic recreation process is not dependent on location, but on systematic and consistent use of assessing, planning, implementing, and evaluating services for people with disabilities (Luken & Rios, 1998). While this process is applied widely in settings like hospitals and long-term care facilities, it is also useful in leisure education and recreation participation settings, such as park and recreation agencies and schools.

During the past five years, greater numbers of individuals with disabilities are seeking access to community recreation services (Devine & Kotowski, 1999). Some speculate that the rise in the demand for community recreation services by people with disabilities is a result of reduced hospital stays, increased awareness of rights to access services, and longer life expectancies. It also appears that demand for community recreation services will continue to rise (Sylvester, 1996; Wilhite, Devine, & Goldenberg, 1999).

If therapeutic recreation specialists are to positively influence the quality of life for individuals with disabilities, we must maximize their specialized and inclusive community recreation options. Using the therapeutic recreation process allows the therapeutic recreation specialist to individualize within recreation programs designed specifically for people with disabilities and to systematically develop support plans for inclusive recreation programs. This article discusses how the therapeutic recreation process is used in community recreation settings, identifies issues that affect utilization of the process in these environments, and highlights the importance of the therapeutic recreation process to successful community (specialized and inclusive) programming. The case of "Sue," a fictitious participant, will be used to illustrate the therapeutic process.

Assessment

Prior to Sue's participation in a community recreation program, the therapeutic recreation specialist conducts an assessment to identify her abilities and limitations by asking her a series of questions related to her social skills and observing her interactions with her peers. Information is gathered not only from Sue, but also from her caregiver, social worker, and vocational counselor to provide thorough information prior to her participation so that her needs may be addressed. An assessment is a systematic process of gathering specific information about an individual (Howe-Murphy & Charboneau, 1987), and the purpose is to determine the needs of the individual in relation to his or her independent functioning in recreation engagement or pursuits (Howe-Murphy & Charboneau, 1987; Peterson & Stumbo, 2000). Assessing individuals in community recreation settings typically begins with a program registration. Registration materials include questions designed to determine an individual's needs related to independent recreation participation. Program descriptions that clarify activity content, participation requirements, possible risks, and intended outcomes also are helpful in determining these needs. Hallmarks of community recreation programs are voluntary participation and initiation of participation from the individual. Thorough and accurate information about the individual is necessary, even when participation is self-initiated and voluntary. Without accurate information, the quality of an assessment is compromised.

Although programs and activities may be pre-planned, assessments enable the therapeutic recreation specialist to individualize interventions, accommodations, and teaching strategies within group activities. For example, the leisure education program in which Sue is registered may have a group goal to improve socialization skills through participation in group activities, but Sue will have a goal more specific to her needs, such as "Sue will use socially appropriate means to initiate social interaction with others." The key to a community recreation assessment is to identify areas that may be deficits for the individual's independent functioning in a recreation program or activity. Thus, community recreation assessments may be designed to identify deficits in specific activity skills (e.g., sports), as well as general skills (e.g., social skills). In addition, assessments for an individual participating in a specialized recreation program may differ from an assessment used with someone who is interested in participating in an inclusive recreation program. Assessments applied to those wishing to participate in separate programs often ask for more detail about the person's level of functioning than an assessment used to analyze participation in inclusive recreation would. A unique aspect of a community recreation assessment is that it can be a life-long process. Unlike treatment settings, such as hospitals where a therapeutic recreation specialist may only work with an individual for a brief period of time (e.g., 3-5 days), people with disabilities who participate in community recreation programs often remain involved in programs for many years. For example, after Sue has participated in community programs for several years, it may be necessary to conduct a reassessment to determine her current needs and leisure interests.

Conducting assessments of individuals with disabilities in order to analyze their participation in inclusive recreation programs is often done using a different approach. Participation in separate or specialized programs designed for people with disabilities often has more of a therapeutic intent in that the purpose may be to improve functioning or teach leisure components (e.g., leisure resource utilization). Inclusive recreation participation is geared more toward successful engagement and independent leisure functioning. An individual with a disability in an inclusive setting may require a greater level of support, as their skills may not be compatible with those of their peers without disabilities. The assessment process must take into account the "fixed" factors of the inclusive setting and the staff's inability to control some environmental issues. The identification of immediate, short-term goals is frequently necessary to maintain participation. For example, specific objectives are designed to address areas of concern, such as disruptive behaviors. Although it may be necessary for the general recreation staff to have information about the participant's objectives and limitations to address them, the utmost care is taken to assure confidentiality of participant information. Specifically, particular information about a participant's disability is only provided on an "as needed" basis to recreation staff and then only with the participant's or caregiver's permission.

Planning

From the assessment of Sue's social skills, the therapeutic recreation specialist discovered that although she was friendly and pleasant, Sue had trouble initiating and sustaining conversations. For example, Sue would stand by herself and watch her peers rather than joining in conversations. When her peers would include her in conversations, Sue would walk away after a brief period of time and while her companion was in mid-sentence. The therapeutic recreation specialist found that Sue often feels like she doesn't know what to say to others. The planning phase of the therapeutic recreation process can guide a therapeutic recreation specialist in developing individualized goals and objectives for Sue and then selecting recreation activities to meet the goals and objectives (Peterson & Stumbo, 2000). The planning component is particularly helpful for identifying activities to meet goals and objectives that promote independent recreation functioning. Some activities have the potential for improvement of functioning (e.g., warm water aquatics) in treatment and rehabilitation settings; however, the majority of activities used in community settings are geared toward promoting leisure education, health, and independent participation.

The therapeutic recreation specialist selects a 12-week leisure education program that includes social skills training and dance components to meet the objectives outlined for Sue. Leisure education focuses on the development and acquisition of leisure-related skills, attitudes, and knowledge so a person can express him/herself through leisure (Peterson & Gunn, 1984). Community therapeutic recreation programs provide an ideal environment to apply leisure education goals by teaching how to access and utilize community recreation resources, as well as how to develop skills related to independent recreation functioning. The therapeutic recreation specialist forms goals, develops objectives, specifies activities (e.g., social skills training and dance), and determines a means of evaluation.

A unique aspect of applying the planning component of the therapeutic recreation process in community therapeutic recreation settings involves collaborating and coordinating service delivery details with many different entities to ensure a thorough, practical, affordable, and realistic plan for the individual. In the case of Sue, the therapeutic recreation specialist makes efforts to coordinate goals and objectives with her other individualized plans, like her vocational rehabilitation plan. Individual education plans (IEP) in the school system, individual habilitation plans from sheltered work environments, and outpatient rehabilitation plans from hospitals are excellent starting points for examining current individualized plans for consistency purposes. Planning participation in inclusive recreation programs involves a great deal of collaboration between therapeutic recreation specialist/inclusion support staff and general recreation staff. The therapeutic recreation specialist/inclusion support staff's ability to promote participant objectives is dependent on their ability to gain support from general staff, parents, and participants without disabilities.

Implementation

According to Austin and Crawford (1996), the implementation phase of the therapeutic recreation process is the action phase and involves carrying-out the individual or group program plan. The therapeutic recreation specialist carries out the social skills and dance program, focusing on group and individual goals. For example, the group will be taught how to appropriately ask someone to dance, and Sue will be taught ways to initiate conversations with her dance partner. The implementation phase involves coordinating and executing recreation activities proposed in the plan, as well as documenting information about the individual (e.g., his or her responses), the program (e.g., time of day, duration), and the activities (e.g., competitive vs. learning).

The application of the therapeutic recreation process in community recreation settings is advantageous because it sets the stage for systematically administering activities. Implementation of the individual plan in a community setting is affected by several factors that may differ from a clinical setting. First, due to the number of individuals to be served, community agencies often employ part-time staff to provide direct services. These staff members may or may not be trained in therapeutic recreation. Success of the implementation phase of the therapeutic recreation process requires that these employees be trained to understand the value of the therapeutic recreation process and execute the recreation activity as planned. Sue's therapeutic recreation specialist trained her instructors to look for behaviors that indicate Sue was initiating and maintaining conversations. Second, staff should be educated on the importance and techniques of documentation. The therapeutic recreation specialist can ensure that documentation tools take into account that part-time program leaders may have little education or experience in carrying out individualized plans; identifying behaviors, criteria, or conditions that meet objectives; or evaluating outcomes. The therapeutic recreation staff in Sue's program developed documentation forms that are very "user friendly," allowing staff to identify specific behaviors, without asking them to make diagnostic decisions. Therapeutic recreation staff must closely monitor the entire implementation phase of the therapeutic recreation process, even though they may not be actually conducting the recreation activity.

Implementation of the individual plan in the inclusive recreation setting

requires attention to social (i.e., attitudinal), programmatic (i.e., adaptations) and environmental (i.e, accessibility) issues. For example, general recreation programs in which people with disabilities can be included may not be structured to accommodate people with a variety of disabilities. The therapeutic recreation specialist/inclusion support staff may have to be prepared to implement numerous adaptations or accommodations according to the individual's disability and must have the knowledge and skills to make these adaptations to facilitate participation. Therapeutic recreation staff may find it useful to train general recreation staff in planning and structuring activities for the benefit of all participants so that implementation is successful and coincides with each person's plan. Other issues that could affect the implementation of the individual plan include inconsistent attendance of a participant with a disability, unanticipated facility/environmental issues, lack of support from family/caregivers, inconsistency of general recreation staff, and inappropriate program placement.

Evaluation

Sue's therapeutic recreation specialist conducts evaluations on her social skills at the end of the 12-week program by asking the same series of questions asked in the assessment phase and conducting an observation. The purpose of the evaluation phase is to assess Sue's response to the planned program and the plan's effectiveness and determine whether revisions are necessary. While conducting the evaluation, the therapeutic recreation specialist can interview the participant, speak with family members or caregivers, review documentation, administer questionnaires, confer with part-time and general recreation staff, and observe the participant while engaged in the activity. Although the therapeutic recreation specialist didn't conduct a mid-term evaluation on Sue's progress, it is often helpful to do this so that necessary adjustments to a person's program plan can be made.

Typically in community therapeutic recreation settings, programs are evaluated quarterly in terms of successful promotion of participant objectives, value to the individual and community, and cost and practical effectiveness. For example, a comprehensive program evaluation was conducted at the conclusion of the leisure education program in which Sue participated. The purpose was to evaluate all aspects of the program and make recommendations for next season. In addition, an evaluation was conducted to compare Sue's progress to the needs identified in the assessment, determine if the objectives had been met, and make recommendations for her future participation. Inclusion support plans are a means of documenting information about those who participate in inclusive services. During the evaluation phase, input from participants, family/caregivers, and general recreation staff are included.

Thorough and accurate documentation is a critical component of the evaluation process. An important concern with evaluative documentation in community settings is that this information is made available to others and is ultimately utilized. For example, at the conclusion of the leisure education program, Sue may choose to enroll in a new program with different general or therapeutic recreation staff. Assessment and evaluation information should be passed on to the staff of Sue's new program to ensure continuity of goals and objectives.

Applying the evaluation phase of the therapeutic recreation process in community therapeutic recreation settings can be advantageous in that information tracking can be done over a long period of time, enabling in-depth, longitudinal evaluations. However, a limitation of conducting the evaluation phase of the therapeutic recreation process in community settings is that pieces of information gathered at different points in time may become fragmented and not unified in one location. The therapeutic recreation staff's role is to compile the various evaluative elements into a comprehensive evaluation document to be used across specialized and inclusive contexts over time.

Conclusion

An advantage of applying the therapeutic recreation process with leisure education and recreation participation services is that, though individuals may not participate daily, they may participate throughout the course of several years enabling long-term progress evaluation. Applying the therapeutic recreation process can ensure continuity between settings and move the individual toward independent leisure functioning. Individuals participating in inclusive programs also can benefit by having the therapeutic recreation process applied to these services, promoting continuity of strategies and recommendations for accommodations.

Resources

Austin, D. R., & Crawford, M. E. (1996). Therapeutic recreation: An introduction. (2nd ed.). Boston: Allyn and Bacon.

Howe-Murphy, R., & Charboneau, B. (1987). Therapeutic recreation intervention: An ecological perspective. Englewood Cliffs, NJ: Prentice Hall, Inc.

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

Peterson, C. A., & Stumbo, N. J. (2000). Therapeutic recreation program design: Principles and procedures. (3rd ed.). Boston: Allyn and Bacon.

Sylvester, C. (Ed.). (1996). Philosophy of therapeutic recreation: Issues and ideas. Volume II. Ashburn, VA: National Therapeutic Recreation Society.

Wilhite, B., Devine, M. A., & Goldenberg, L. (1999). Self-perceptions of youth with and without disabilities: Implications for leisure programs and services. Therapeutic Recreation Journal, 33, 15-28.

In "Utilizing the Therapeutic Recreation Process in Community Settings: The Case of Sue," authors Steve LeConey, M.S., CTRS, supervisor of the Division of Therapeutic Recreation for the Cincinnati Recreation Commission, Dr. Mary Ann Devine, CTRS, assistant professor at Kent State University, and Heidi Bunker, CTRS, and Stephanie Montgomery, M.S., CTRS, program coordinators for the Division of Therapeutic Recreation for the Cincinnati Recreation Commission, discuss how the therapeutic recreation process can be used in leisure education and recreation participation programs. Devine says, "It is not the setting that determines the use of the therapeutic recreation process, but the needs of the clients/ participants."