KNR 273

Newer and Older TR Models

Health & Human Services Models

Newer TR Models(Sylvester, Voelkl, & Ellis, 2001)

Health Protection/Health Promotion Model Austin, 1991

Therapeutic Recreation Service Delivery & Outcome Models

Van Andel, 1998

Self-Determination & Enjoyment Enhancement Model

Dattilo, Kleiber & Williams, 1998

Optimizing Lifelong Health Through Therapeutic Recreation Model

Wilhite, Keller, & Caldwell, 1999

Health & Human Services Models (Carter, Van Andel, & Robb, 2003)

TR is provided in the context of several different health & human services systems or models

Each of these contexts are based on a philosophy of services that impact therapeutic recreation

Some of these have been noted as older TR models

Health & Human Services Models (Older)

Medical or clinical Doctor is primary therapist Doctor determines what role others play Assumes client has a disease or illness that

needs to be treated, cured, or healed Treat illness without regard for broader needs of

client Recreation is guided by doctor’s diagnosis and

prescription Settings: Physical med. & rehab; general

med/surgical hospitals

Health & Human Services Models (Older)

Custodial Focus is not rehab, but on providing for basic

needs Strong effort to maintain order & keep institutional

routines Activity programs keep residents occupied Settings: Correctional facilities, nursing homes,

state institutions, group homes Being replaced by Long Term Care Model

Maintain highest level of functioning and QofL

Health & Human Services Models (Older)

Milieu therapy (environmental therapy or therapeutic milieu) Emotional problems are often the product of

unhealthy interactions with one’s environment Staff are organized as a caring community that

help client learn to readjust to environment Primary therapist is whoever has the most

effective relationship with the client Settings: Mental health facilities

Health & Human Services Models (Older)

Educational/Training Model Focus on acquisition of knowledge & skills that

are required to become contributing member of society

Heavy emphasis on classroom-like framework Focus on leisure skills & social skills Settings: Sheltered workshops, voc rehab

centers, day-care centers, schools

Health & Human Services Models (Older)

Community or special recreation Critical aspect of recreation service is the

provision of a wide range of leisure opportunities in the community

Provide opportunities to select experiences & acquire skills to participate in inclusive community-based programs

Settings: City recreation departments, SRAs, Easter Seals

Health & Human Services Models (Newer)

Psychosocial Rehabilitation Model MI is continuous and the medical model is not

appropriate for people with severe, persistent MI Foster optimal level of functioning in the

community including participating in activities Equip people with skills in vocation, education,

personal adaptation, housing, recreation, and social

Looks at strengths and abilities Stay in here and now vs. past

Health & Human Services Models (Newer)

Recovery Model Hope and restoration of a meaningful life are

possible despite serious mental illnesses Holistic view that focuses on the person and not

the symptoms Recovery is possible and achievable even though

symptoms may reoccur Person has primary control over decisions about

outcomes

Health & Human Services Models Recovery Model

Hope: Belief in self & willingness to preserver Secure base: Housing, income, healthcare Supportive relationships: Professionals, friends, family, support groups, and

community Empowerment & inclusion: Importance of social inclusion, recovery of social

skills and increased involvement in the community, has power over life & illness

Coping strategies Coping with loss: Past Meaning Medication & treatment: Take least amount possible Education: Knowledge about illness Spirituality Employment or meaningful activity