knr 273: tr models continued
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KNR 273: TR Models Continued
TR Service Delivery and TR Outcome Models
The Aristotelian Good Life ModelOptimizing Lifelong Health and Well-Being
Model
TR Service Delivery and TR Outcome Models
Easy to follow (graphic depiction, clarity of terms & concepts)
Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice
Could you explain TR with this model? Could you design programs?
TR Service Delivery and TR Outcome Models
2 interrelated TR models TR Service Delivery Model provides an
overview of the nature of service delivery TR Outcome Model focuses on service
outcomes The Outcome Model should be viewed as an
extension of the Delivery Model
TR Service Delivery Model
Describes the scope of TR services, nature of TR services, and relationship between TRS and client
Scope of service Activities and strategies that contribute to
diagnosis or assessment, treatment or rehabilitation, client education, and health promotion/prevention
TR Service Delivery Model
Diagnosis/needs assessment Use of standardized tests, field observations, or
other techniques to determine client’s strengths and abilities or
their potential limitations in achieving habilitation or rehabilitation goals
TR Service Delivery Model
Treatment/rehabilitation Providing assistance in restoring or stabilizing
health or abilities of an individual who has experienced loss or
limitations in those abilitiesE.g. Aquatic therapy might be used to maintain
muscle tone and flexibility in a client who has MS
TR Service Delivery Model
Education Develop the attitudes, values, and skills needed to function more effectively in society to improve overall health and/or to achieve a higher quality of life
E.g. Assertiveness training, leisure education, cognitive retraining, reality orientation, social skills training
TR Service Delivery Model
Prevention/health promotion Protect or promote healthy lifestyles
Several components may function at the same time
Swimming may be treatment/rehabilitation to a person recovering from a stroke, and serve as an opportunity to learn a new leisure skill (education), and prevent further physical losses and promote a healthier lifestyle (prevention/health promotion)
TR Service Delivery Model
Nature of service Involves an element of planned intervention, as
well as a leisure experience dimension Some settings may emphasize intervention while
others focus on leisure experiences Key element of determining whether an activity
is an intervention or a leisure experience is not the nature of the activity, but the client’s perception of the experience
TR Service Delivery Model
Gray band describes the optimal area of interaction for CTRS and client
Diagnosis/needs assessment and treatment/rehabilitation tend to be more structured and goal directed which are less likely to facilitate the leisure experience
Last 2 lend themselves to greater personal freedom and greater opportunities for leisure
TR Service Delivery Model
Nature of TRS & client interaction Informed consent, independence and self-
determination
TR Service Delivery Model
Theoretical foundations Attempt to show that recreation therapy and
leisure experience philosophy may co-exist Neulinger’s theory of leisure
State of mind, choice, internal motivation, freedomAll interactions are interactions between perceived
freedom and perceived constraint Interactions contribute to outcomes
TR Outcome Model
A leisure experience will always affect the participant’s quality of life and may also contribute to some improvement in functional capacity and/or health status
Wellness/health status Quality of life
TR Service Delivery Model
Functional capacity/potential Cognitive Physical Psychological/emotional Spiritual (ability to find meaning & purpose in
life) Social Leisure
TR Service Delivery Model
Goal is to assist the client in achieving the highest possible level of health and well-being through leisure and nonleisure experiences
Theoretical foundations Human development (becoming) Rehabilitation science empirical research
Summary
Assumptions The focus of interventions differ in their degree
of focus on intervention and leisure The outcomes of TR services are
multidimensional in nature (e.g., health status, quality of life, functional capabilities)
Mission: Quality of life Means/end model
Summary (Cont.)
Definitions of TR The specialized application of recreation and experiential
activates or interventions that assist in maintaining or improving the health status, functional abilities, and ultimately the quality of life of persons with special needs
TR Service Delivery areas Scope of TR service, nature of service, nature of
TRS/client interaction
Summary (Cont.)
TR Outcomes areas Functional capacity/potential Wellness/health status Quality of life
Strengths
Reflects current TR practice Provides consumers, employers,
practitioners, legislators, etc. with a clear understanding of the scope and outcome of TR services
Doesn’t just focus on “fixing broken parts” Can be used in wide variety of settings
Strengths (Cont.)
Attempt at providing a model that unifies TR
Contains content from NTRS & ATRA definitions
Endorsed notion that leisure experiences and quality of life can be legitimate goals in healthcare
One activity may simultaneously address several service components
Concerns
Some terms are not clearly defined Is this an improvement on existing models? Distinction between areas is not clear (e.g..
Treatment/rehabilitation and education) Failure to show interrelationship between the 2
models Theory on helping relationships and client change
is missing
TR Service Delivery and TR Outcome Models
Easy to follow (graphic depiction, clarity of terms & concepts)
Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice
Could you explain TR with this model? Could you design programs?
The Aristotelian Good Life Model
Easy to follow (graphic depiction, clarity of terms & concepts)
Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice
Could you explain TR with this model? Could you design programs?
The Aristotelian Good Life Model
TR Defined TR comprises sets of services directed at increasing
client freedom and responsibility in order to facilitate attainment of human happiness (the
“good life”) This is accomplished by empowering clients to overcome
constraints that arise from illness, disability, oppression, wrong desires, challenges in following the principle of enough, and focus on apparent goods that lack potential to become real goods.
The Aristotelian Good Life Model
Model is founded on concept of happiness Recreation & leisure are viewed as necessary
components of a happy life Eudaemonism is Greek for happiness, human
flourishing, or well being Used to describe Aristotle’s conception of the good
life Puts happiness in the realm of ethics
The Aristotelian Good Life Model
Attainment of the good life is based on the premise that 2 conditions are met The individual has access to sufficient wealth to meet
basic biological needs The society provides basic human freedoms and rights
3 principles of good life Ethics of enough Real and apparent good Wrong and right desires
The Aristotelian Good Life Model
Ethics of enough Too little or too much of most things leads to
problems Rational and prudent people can reach agreement
on what is enough There can be variation between people Some goods like wisdom and knowledge are
limitless good --- one can never have too much
The Aristotelian Good Life Model
Real and apparent goods Real goods led to good life Apparent goods were those sought for the sake of
happiness, but did not realize that desire Apparent goods seem good at one time, but later lack
their appeal --- we usually regret having received apparent goods
Attainment of real goods lead to an enriched life with continued grown and development
The Aristotelian Good Life Model
Wrong desires Pleasure, money, fame, and power are wrong
desires Pleasure is a real good, but cannot by itself lead
to a good life so it becomes a partial good Pleasure may be desired if it is not sought as the
only good, it is desired in accordance with the ethics of enough, and if it does not cause injury to other people
The Aristotelian Good Life Model
Right desires The good life is achieved by developing the habit of right
desires The crowning virtue of eudaemonism or summum
bonum is leisure Leisure is the highest good and is intimately connected
with health and well-being Highest leisure is engaging in intellectual virtues of art,
learning, and creating
The Aristotelian Good Life Model
4 major elements Afflictions and oppression Aristotelian goods Freedom Role of TRS
The Aristotelian Good Life Model
Afflictions and oppression Scope of challenges that might lead someone to
need TR services Failure to follow the principle of enough Disadvantaged people Focus on apparent goods that don’t contribute to
the good life (e.g. Substance abuse, smoking)
The Aristotelian Good Life Model
Aristotelian goods Statement of the target outcomes of TR service Elements needed for the good life Primary goods (e.g. Biological needs, functional
skills, etc.) Secondary goods (e.g. Learning, creating,
meaningful relationships) Approaching summum bonum (leisure)
The Aristotelian Good Life Model
Freedom and responsibility As individuals overcome afflictions and
oppression, freedom increases and primary goods give way to secondary goods and, ultimately and ideally, to eudaemonia
Greater freedom comes with progression through treatment
Implies greater responsibility to self, family ,and community
The Aristotelian Good Life Model
Role of TRS Therapist Educator Facilitator Resource Advocate
Strengths
Grounded in a philosophical theory of happiness
Helpful in defining value laden goals like an appropriate leisure lifestyle
Could be used with a variety of clients Brings a dose of social conscience to our
understanding of leisure
Concerns
Reflects political and economic state of Greeks Freedom was for the ruling class and made available by
slaves Hard to use for programming Few TRS have exposure to ethics or Aristotle’s
work Assumes high cognitive functioning of clients (so
not appropriate for DD, dementia, poverty) Never designed as replacement model
The Aristotelian Good Life Model
Easy to follow (graphic depiction, clarity of terms & concepts)
Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice
Could you explain TR with this model? Could you design programs?
Optimizing Lifelong Health Through Therapeutic
Recreation Model Easy to follow (graphic depiction, clarity of terms &
concepts) Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice
Could you explain TR with this model? Could you design programs?
Optimizing Lifelong Health
Assumption TR service is based on the assumed need for intervention
with the intent of influencing the individual’s personal and/or leisure functioning
Purpose was to incorporate health enhancement concepts into TR practice
Propose a non-linear model of TR that is grounded in life course perspective
Merges health enhancement and self-care approaches
Optimizing Lifelong Health
Health enhancement Variety of behaviors individuals may use to
prevent health risks, maintain or promote health, and facilitate functional interdependence
These behaviors are often undertaken with assistance and support of othersFormer service providers Informal (e.g.. Family and friends)
Optimizing Lifelong Health
Health Enhancement Continued Clients, networks, and environmental factors or
situational contexts facilitate or impede health enhancement efforts
Healthy People 2000Directed health care providers to consider
disease/illness prevention, health education, and health promotion as central directions for clients
Optimizing Lifelong Health
Leisure participation may influence health and well-being by helping to facilitate coping behaviors in response to the changes and transitions that individuals experience over the life course
When people engage in healthy leisure lifestyles, they actively participate in their own well-being
Optimizing Lifelong Health
Theory Baltes and Baltes (1990) developmental theory
of human aging/adaptation Process where people become active agents in
their own well being Health enhancement strategies are client initiated
and reflect self-determined decision-making processes
Optimizing Lifelong Health
3 basic principles Engagement in a healthy leisure lifestyle reduces
the probability of pathology or secondary consequences of disability across the life course
Strengthening optimal health and well-being can be achieved by individualizing resources and opportunities
Optimizing Lifelong Health
3 principles continued Individuals must be prepared to alter leisure choices or
find substitutes, when necessitated, by changing personal and environmental characteristics across the life course
Central task of CTRS is to help facilitate adjustments while allowing for maximum client choice, control, and preservation of selfhood
Mission: Health Enhancement (Means)
Optimizing Lifelong Health
Elements Selecting
Client selects activities that match interest, abilities, & resources. Also identifies goals
Optimizing Compensating Evaluating (added by Wilhite et al)
Optimizing Lifelong Health
Role of CTRS Is derived from an educational and facilitative
perspective Education focus is on opportunities for acquiring
awareness, knowledge, and understanding of various leisure options
Facilitative focus is on opportunities for clients to apply the learning to enable leisure to occur and to advocate on the client’s behalf
Optimizing Lifelong Health
Independent leisure functioning (with minimal support from CTRS, other caregivers, friends, family) is not always possible or desirable Interdependent leisure might be ideal Interacting cooperatively with others in a self-
determined manner enables goal attainment
Optimizing Lifelong Health
Systems theory provides framework Apply APIE
Strengths
Understands effects of environment CTRS interventions emphasize personal
responsibility and empowerment for health and well-being
Compatibility with community-based with reliance on education and facilitation instead of therapy approaches
Strengths (Cont.)
Could be used with a wide diversity of clients
Concerns
Good start but needs development Terms such as health, health enhancement, and
healthy leisure lifestyle were discussed without presenting meanings
Educator and facilitator not well developed Model is individualistic Questions adaptation and accommodations as
indicators of health (resistance)
Optimizing Lifelong Health Through Therapeutic
Recreation Model Easy to follow (graphic depiction, clarity of terms &
concepts) Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice
Could you explain TR with this model? Could you design programs?
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