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Therapeutic recreation tools of the trade

This is an excerpt from Therapeutic Recreation Leadership and Programming-2nd Edition by Robin Kunstler,Frances Stavola Daly.

The therapeutic recreation specialist or recreational therapist (TRS/RT) plans and implements therapeutic recreation or recreational therapy (TR/RT) programs to address clients’ needs, help them reach their goals, and reinforce their strengths. The TRS/RT selects from a range of recreation activities that, when combined with the TRS/RT’s interactions and communication skills, become TR/RT programs or experiences (also known as therapeutic recreation or recreational therapy interventions) that help the clients achieve functional and existential outcomes. Recreation and experiential activities are the bread and butter of TR/RT services, the fundamental methods used to achieve the goals of TR/RT. “Enjoyable, freely entered into, and health promoting, these activities recreate a positive sense of the inner self” (O’Keefe, 2005, p. 81). Recreation activities can be powerful vehicles for learning new skills, adapting existing abilities to new circumstances, developing new behaviors to function in one’s chosen environment, and maintaining functioning to minimize decline (Bullock & Mahon, 2017) as well as for personal fulfillment and overall quality of life. The TRS/RT selects “activities that will possess characteristics suitable to use the client’s strengths and meet the client’s needs” (D. Austin, 2020, p. 59). It is TRS/RTs’ ethical responsibility to develop knowledge and competence in a wide variety of activities so they can select the most appropriate ones for their client. Almost any recreation activity can be used as a TR/RT intervention for therapeutic purposes with careful application of leadership strategies. The TRS/RT’s ethical obligation is to do good for clients, to respect their personal values and beliefs in providing programs, to be competent in TR/RT programming, and to treat everyone fairly. American Therapeutic Recreation Association (ATRA) Standards 3: Plan Implementation and 12: Program Evaluation and Research apply to the use of the TR toolkit.

The Therapeutic Recreation Toolkit

The therapeutic recreation toolkit is a collection of information, resources, and activities that TRS/RTs use in their work. This chapter focuses on the activities included in the toolkit. Although there are as many different TR/RT activities as there are recreation activities, a fairly standard group of TR/RT program offerings are used in many settings and with all types of clients. These programs can be loosely grouped into five areas: arts-related programs, cognitively oriented programs, health-related programs, nature-oriented programs, and social activities. These are the activities in each area:

• Arts-related programs: arts and crafts and the arts (fine or visual arts, performing arts, and technological or new arts)
• Cognitively oriented programs: discussion groups, leisure education (including values clarification, assertiveness training, and social skills training), intellectual and literary activities, and games
• Health-related programs: cooking and food preparation, physical activity (exercise, fitness, sports, aquatics), relaxation and stress management, hobbies, and humor
• Nature-oriented programs: outdoor recreation, horticulture and gardening, and animal-assisted programming (AAP)
• Social activities and special events

Looking over this list, we can see that all TRS/RTs have had experience in their own lives as participants in specific activities in each program area. Given their training and their experiences with these activities, all TRS/RTs should be able to lead programs in each of these areas appropriate to the client population they are serving. For example, although TRS/RTs do not have to know how to play every single type of game, they should know at least several that can be used or adapted for their clients. Initially, TRS/RTs need to be comfortable and secure with the basics of the activity. Over time, they can add to their knowledge and repertoire to deliver imaginative and motivating activities that maximize the benefits to clients. In addition to activities, the TR toolkit contains resources such as tablets loaded with exercise programs, games, and music; audiobooks, books, and magazines; craft supplies, board games, and cards; puzzles; and materials that stimulate the senses. Fulfilling the blended role of TR leadership entails being a role model, enjoying and actively engaging in the recreation experience, and displaying enthusiasm and energy that are contagious and motivating to clients.

Activity Selection

Knowing which TR/RT activity to select for a particular client or group of clients is part of the TRS/RT’s professional expertise and judgment. TRS/RTs should carefully select a TR program to meet the interests, needs, and abilities of their clients and not their own interests. Their personal preferences should not dictate the choice of programming. “Far too often, programs are offered because of tradition, precedent, popularity, demand, or other reasons” (Sylvester et al., 2001, p. 253). In addition, TR/RT programs should be designed and selected in accordance with research findings from a thorough search of the professional literature. This is a form of evidence-based practice that strengthens the rationale for providing that program. Most research articles include a section on practical implications of the findings for implementing TR/RT interventions. Reviewing the literature in professional journals provides the TRS/RT with concrete evidence of the effectiveness of an activity or intervention. When TRS/RTs combine the educated opinions and insights of experts and their own first-hand knowledge, clients are more likely to succeed in the activity and meet their goals. Evidence-based practice is specified in Standard 3: Plan Implementation (ATRA, 2015).

In health and human service agencies, all professionals utilize the interventions and strategies of their own discipline to produce desired outcomes. These interventions may be high tech, with state-of-the-art equipment or supplies, or as basic as a card game. Just as a doctor may either prescribe a sophisticated antibiotic for a particular illness or recommend only bed rest and plenty of fluids, a physical therapist may utilize either elaborate equipment such as an electrotherapy muscle stimulator or simple walking. So too, the TRS/RT may choose an active video game or a table game such as Scrabble. All the TR/RT program areas described in this chapter are supported by evidence of their effectiveness and guidelines for implementation with different client groups. The TRS/RT should select TR/RT programs based on the evidence and the client’s assessed strengths, needs, preferences, and future goals. Activity selection is influenced by

• the mission of the agency;
• regulations of government agencies and accrediting bodies;
• the TR/RT practice model followed by the TR/RT department;
• the available budget;
• the physical environment;
• staffing; and
• strengths, preferences, and goals of participants.

For activities to be considered therapeutic, certain characteristics should be present (D. Austin & Cooke, 2019). Activities should

• be goal directed, done for a purpose, with an intended outcome;
• require participants to actively engage in choosing and participating in activities to increase their feelings of self-efficacy and competence;
• have meaning and value to the client as a means of achieving therapeutic benefits;
• offer potential for pleasure and satisfaction that is motivating and encourages ongoing participation; and
• be selected with the guidance of the therapist so they meet clients’ needs and utilize their strengths.

As in our personal recreation pursuits, all activities should be enjoyable and fun for the participant. “Recreation services are purely for enjoyment, while therapeutic recreation/recreation therapy services are enjoyable but intentionally more goal directed and treatment oriented” (Bullock & Mahon, 2017, p. ix).

Creativity and ingenuity on the part of the TRS/RT can maximize the experience for clients and enhance the benefits. “Creativity is the ability to see things in a new way, to recognize what is significant; to relate meaningful observations, and to pull them together into some new whole” (Streitfeld, 1993, p. 120). Being creative is exciting for the TRS/RT and helps keep programming fresh.

More Excerpts From Therapeutic Recreation Leadership and Programming-2nd Edition

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