Recreational Therapy: An IntroductionChapter 3: The Recreational Therapy Process

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Recreational Therapy Process: The Framework for Providing RT

“Recreational therapy (RT) is a purposeful intervention designed to help clients relieve, or adaptively cope with, health problems and concerns and experience the highest levels of wellness possible for them through participation in recreation and leisure activities. The intervention occurs through a collaborative interaction between a credentialed recreational therapist and a client, who use the recreational therapy process (often referred to as the RT process) as a framework for providing services” (Austin et al., 2015, p. 43).

The RT Process is:

The systematic process employed in recreational therapy to provide purposeful interventions.

The cornerstone for the delivery of recreational therapy.

Is the base from which all RT actions proceed.

Brief explanation of the RT Process

Assessment Phase: The RT collects data and analyzes them to determine the client’s problems or concerns and strengths and needs.

Planning Phase: The RT makes a plan to meet the client’s problems or concerns.

Implementation Phase: The RT puts the plan into action.

Evaluation Phase: The RT conducts an assessment to determine the validity of the plan and the effectiveness of the interventions.

Clinical Reasoning

Assessment involves much more than data collection.

The RT must use clinical reasoning to determine what constitutes the client’s problem, determining the client’s needs, and identifying strengths and resources that may be employed as means to helping the client to reach optimal health.

In short, clinical reasoning during assessment allows the RT to identify client problems, needs, and strengths.

How theory affects assessment & clinical reasoning:

Helps to define which assessment data to collect and analyze.

Outlines actual and potential problems for consideration.

Assists in analyzing and understanding health situations.

Guides formulation of RT diagnosis.

Clarifies goals and objectives.

Specifies interventions that may be provided.

Examples of theory defining which assessment data to collect…

Under the Reformulated Health Protection/Health Promotion Model, the emphasis would be on health problems and concerns.

Under the Leisure Ability Model, data collection would focus on problems or concerns related to leisure functioning rather than health.

Common methods of RT assessment:

Observation

Interviewing

Use of secondary sources

Types of observations

Naturalistic observations

Specific goal observations

Time-interval observations

Standardized observations Norm-referenced tests Criterion-referenced tests

Checklists and questionnaires

Interviews

The interview is a time to gather information about the client, clarify items not understood, and observe the client’s condition and behavior.

RTs typically ask clients about past leisure habits, activities in which they participate, with whom they usually participate, and recreation interests they may wish to pursue in the future.

Possible Secondary Sources

Family members and friends

Client medical records

Social histories

Progress notes

Interdisciplinary teams

Visits to the client’s home and community

Possible areas of RT assessment (Shank & Coyle)

Biological functioning, including physical functioning and health status (e.g., mobility, muscle strength and endurance, flexibility).

Psychological functioning, including cognitive and emotional functioning (e.g., memory, orientation, attention, enjoyment, coping).

Social functioning (e.g., behaviors during interactions with others).

Spiritual functioning (e.g., formal religion, as well as one’s personal belief system or philosophical values).

Possible areas of RT assessment (Austin)

Client’s general perceptions about their present health status, how they are dealing with their health problems or concerns, and how their health problems/concerns may impact regular recreation and leisure patterns.

Sensory and motor impairments, cognitive deficits, limitations in activities of daily living, and any precautions (e.g., heart problems).

Leisure values, interests, and pursuits are explored, along with client attitudes toward participation in RT programs.

The developmental level of the client is appraised to determine developmental tasks or issues with which the client may be dealing.

Problems or concerns are explored in order to reveal needs (e.g., need to belong, for self-esteem) in order to establish a needs list.

Strengths (e.g., abilities, virtues, support from family and friends) to build a strengths list.

Client expectations and goals are identified.

The Planning Phase

After identifying and analyzing the client’s needs and strengths during the assessment phase, the RT and client are ready to move to the second stage of the RT Process: the planning phase.

During planning: priorities are set; goals are formulated; objectives are developed; programs, strategies, and approaches are specified; and means of evaluation are determined.

The client’s intervention plan: A blueprint for action elements found in intervention plans

An indication of the client’s problems and needs, in order to formulate a needs list (Problems represent obstacles to meeting needs. Therefore, the identification of problems leads to needs.).

An identification of client strengths (e.g., abilities, virtues, family support) to formulate a strengths list.

A prioritized goals set appropriate to guide the delivery of RT services.

A listing of specific objectives for each goals.

A plan of interventions or programs indicated for participation by the client, approaches to be utilized by staff, and the proper environment in which to facilitate change.

A brief description of procedures by which client progress will be evaluated.

Skills needed by RTs during implementation:

Interpersonal skills (i.e., relationship skills).

Observational skills (e.g., observing and charting client behaviors).

Decision-making skills (e.g., deciding to modify the goals and objectives or the approach to achieving them if they are not being reached).

Technical skills (e.g., clinical reasoning, charting progress notes, activity analysis, organizing and conducting activities, offering feedback, completing group processing (debriefing).

The Evaluation Phase

In this phase, the client’s goals and objectives are appraised. The primary questions is: How did the client respond to the interventions?

Evaluation reveals whether the plan has been effective or requires modification.

Similar methods to those employed in the initial assessment may be used in the evaluation phase.

Common means of evaluating are to conduct a review of progress notes, interview clients so they may respond retrospectively after participation in the intervention plan, and hold discussions during interdisciplinary team meetings.