1-Time line of historical events
2600 BC Chinese taught that disease was caused by organic inactivity and thus used physical training for the promotion of health.
1000 BC Ancient Persians realized the beneficial effects of physical training and utilized it to fit their youth for military duty.
420 BC The Greeks described diversion and recreation as a means of treating the sick.
477-900 The Dark Ages, the mental and physical influences of play were regarded by the Church to be evil.
1454-1605 The Renaissance, the mental and physical influences of play are again recognized after Arabic texts are translated into German
1786 Phillip Pinel introduced work treatment in the Bicetre Asylum for the Insane near Paris
1803 Johann Christian Reil suggested the use of exercise and a special hospital gymnasium along with patient participation in his book "Rhapsodies on the psychic treatment of the insane." This is evidence of one of the first uses of psychodrama in the treatment of the insane.
1816 Samuel Tuke, an English Quaker, established a Retreat Asylum for the Insane at York, England. He used work or occupation therapy as Pinel did but placed special emphasis on humane treatment or treating of patients as rational beings who have the capability of self-restraint. He called it "moral treatment." "....every effort should be made to divert the mind of melancholias by bodily exercise, walks, conversations, reading, and other recreations."
1844 Amariah Brigham, superintendent of the Utica State Hospital in New York advocates the therapeutic value of occupying patients. The idea that only the therapeutic value should be considered in selecting the activity was a new and important advance toward a more scientific use of occupation as therapy.
1854 Florence Nightengale provides recreation to casualties of the Crimean War dubbing her the Mother of Hospital Recreation.
1906 National Recreation Association founded
1906 Hall received a $1,000 grant from Harvard to "assist in the study of the treatment of neurasthenia by progressive and graded manual occupation." He established a workshop in Marblehead, MA, where he used, as a treatment, the crafts of hand weaving, woodcarving, metalwork, and pottery "because of their universal appeal and the normalizing effect of suitable manual work."
1909 Recreation therapy - a type of psychotherapy - plays an important role in the management of functional neuroses. It is not enough to tell a patient to take a daily walk or to go to the theater. Ascertain what he enjoys. Fortunate is the psychopath who enjoys hunting or fishing; or, still better, the ocean or the mountains. The ceaseless lashing of the sea has a wonderfully calming effect upon the emotions; the inspiring grandeur of the mountains is also quieting and lifts one to higher mental levels. Journal of the Indiana State Medical Association - 1909, The Psychic Element in the Causation and Cure of Disease, By Frank B. Wynn, MD, Indianapolis, December 15, 1909, page 520
1911 After studying Tracy's book on invalid occupations, Dunton taught a series of classes on "occupation and recreation" for nurses at SEPA
1918 First National Recreation Congress is held.
1920 Vocational Rehabilitation Act of 2 JUN 1920 (PL113)
1926 Recreation Act of 1926-43ss 869-869-3
1926 Potts Memorial Hospital, Livingston, NY uses recreational therapy
1934 In order to meet growing demands in the professional field and because increased opportunities were available through the cooperation of Washington University, courses in recreation and group work were included in the curricular requirements. The name of the school was changed to the St. Louis School of Occupational and Recreational Therapy.
1935 Davis publishes "Recreational Therapy, Play and Mental Health."
1936 Davis and Dunton collaborate to publish "Principles and Practice of Recreational Therapy" the forward is written by Adolf Meyer, May 3, 1933. Recreational therapy is defined as "any free, voluntary and expressive activity; motor, sensory or mental, vitalized by the expansive play spirit, sustained by deep-rooted pleasurable attitudes and evoked by wholesome emotional release; prescribed by medical authority as an adjuvant in treatment."
1942 American Recreation Society, "recreation worker"
1943 Federal Vocational Rehabilitation Act of 6 JUL. 1943 (PL 190)
funds physical and vocational restoration, amendment to Vocational Rehabilitation Act of 1920 (PL113) "remunerative occupation"
funds physical and vocational restoration, amendment to Vocational Rehabilitation Act of 1920 (PL113) "remunerative occupation"
1945 VA Recreation Service established. The objectives are: "to assist the doctor in getting his patients well, and to make life as satisfying and meaningful as possible for those patients who must remain in the hospital."
1948 American Recreation Society, Hospital Recreation Section
1950 The National Association for Music Therapy is founded
1952 Davis writes book "Clinical Applications of Recreational Therapy"
1953 Sacramento State College offers B.A. in Recreational Therapy
San Francisco State College develops a Hospital Recreation program
New York University starts a Hospital Recreation Graduate program
San Francisco State College develops a Hospital Recreation program
New York University starts a Hospital Recreation Graduate program
1955 CAHR publishes the first hospital recreation personnel standards, separating registration into three sections: Hospital Recreation Director, Hospital Recreation Leader, and Hospital Recreation Aide.
1966 The NRA and ARS merge into the National Recreation and Parks Association (NRPA)
1972 Draft of the first NTRS Code of Ethics was completed...Legislative Action Committee was developed...Competencies for therapeutic recreation specialists were developed.
1973 PL 93-113 Rehabilitation Act of 1973, Section 504
1974 PL 94-142 Education for All Handicapped
1975 Utah Recreation Therapy Licensure Rule goes in effect
1982 NTRS Philosophical Position Statement
1984 The American Therapeutic Recreation Association (ATRA)
1985 "ATRA Annual" ATRA
1990 Revised Standards for Internship in Therapeutic Recreation published
1995 I was born
1995 Western Carolina University is the first institution of higher education to offer B.S. in Recreational Therapy, offering a clinical perspective of recreation, rather than just a therapeutic bent to a recreation degree
1996
NTRS became a National Organization Patron of the 1996 Atlanta Paralympic Games
NTRS became a National Organization Patron of the 1996 Atlanta Paralympic Games
2014 I join the Recreation Therapy program at BYU
2-Requirements /competencies of the field
Level 1, Beneficence (Do No Harm): Basic and general competencies that a Certified Therapeutic Recreation Specialist (CTRS) can do in any type of setting after a basic orientation to the specific unit and setting assuming successful completion of the facility’s orientation (e.g., fire and safety, hazards, etc.). Supervision is easily attainable (readily available) within the treatment setting whenever the therapist has questions or is in of supervision. Level 1 does not qualify the professional to take clients off of the facility’s campus without supervision. At the Level 1 the therapist is able to provide basic supervision for recreational therapy support personnel (e.g., volunteers, aides).
Level 2, Mastery Level: The therapist successfully demonstrates competencies contained within Level 1. The therapist demonstrates the ability to perform all aspects of the job including knowing when to refer to specialists or to seek assistance. Demonstrates independent clinical judgment to perform all aspects of job. Level 2 indicates that the therapist has demonstrated the competencies required to take clients off of the facility’s campus without supervision.
Level 3, Teacher: Demonstrates specialized skills related to teaching and supervision of others. An individual at Level 3 must be able to successfully demonstrate all competencies from Levels 1 and 2 and must have a minimum of two years experience within the environment or disability group for which s/he will supervise a student intern.
Workshop/Inservice Attendance: Therapists attends a workshop or inservice whose content is equal to or greater than the knowledge and skill base required. This level of measurement is assuming a great deal: that the therapist was actively listening and participating, and that the content provided the knowledge and skill base adequately and accurately and that the therapist was able to translate the material into knowledge and skills needed for practice.
Self-Education with Written Test: The therapist successfully completes an independent study whose content is equal to or greater than the knowledge and skill base required and whose content has been developed and accepted by a recognized group. Successful completion is defined as having passed a test on the content of the material. "Recognized group" could include professional organizations, institutions of higher education or other recognized groups of professionals, including a facility’s clinical competency or staff education committee.
Verbalize Knowledge Base: The therapist is able to verbally (or otherwise communicate) the content required in adequate detail to demonstrate a clear understanding. The content of the knowledge base may be determined to be meeting standards if it: 1. demonstrates enough understanding for beneficence, 2. contains content with a scope and detail considered adequate when compared to professional literature and standards and 3. satisfies requirements for job performance.
Demonstrated Skill: The therapist is able to demonstrate the skill required with adequate technique to show a clear ability. The level of skill may be determined to meet standards if it: (1)shows enough technique for beneficence, (2)displays proficiency with a scope and detail considered adequate when compared to professional literature and standards and (3) satisfies requirements for job performance.
Credentialing: The therapist holds proof of competence through a recognized credentialing agency achieved through a process of demonstrated knowledge and skill. Recognized credentialing agencies include (but are not limited to) the National Council for Therapeutic Recreation Certification, the American Red Cross, state and federal agencies.
Competency
|
Comments and/or Not Applicable
|
| Demonstrate skill related to leadership skills | group dynamics, leadership styles, and how to direct, lead, instruct and guide people and processes toward desired outcomes |
| Holds basic knowledge of life stages | stages as outlined by Erikson, Kohlberg, Piaget; preparing clients for medical procedures based on developmental level; and other important milestones presented in literature; death, dying and grieving process |
| Knowledge of common side effects of general medication groups | common side effects and precautions related to the following medication groups: antibiotics, neuroleptic/antipsychotic; antianxiety/anxiolytic drugs; antidepressant drugs; anti-mania/mood stabilizer drugs |
| Working knowledge of common diagnosis including ability to define physical and emotional ramifications of .. | anxiety disorders, birth defects, burns, CD/substance abuse, CVA, dementia, MR/DD, mood disorders, neuro-progressive, neuro-trauma, orthopedic, personality disorders, SCI, TBI, thought disorders; schizophrenia |
| Holds basic knowledge of other disciplines | basic scope of practice to facilitate appropriate referrals and teamwork |
| Holds basic knowledge of ethics related to practice and can demonstrate understanding in his/her day-to-day practice | working knowledge of categories (and their scope) of ethical practice as outlined by national organization(s) |
| Holds fundamental knowledge of types of legal status and using this knowledge can support the facility’s policies for implementation relating to legal status | guardianships; emergency involuntary, temporary involuntary, extended involuntary, voluntary; competency (of fiscal/contractual affairs and of physical person or body/consent for treatment); facility policies related to levels of autonomy within the program |
| Demonstrates a working knowledge of standards of practice (JCAHO, HCFA, CARF, NCQA, ATRA/NTRS, etc.) | scope of each standard setting groups’ standards; key requirements (timing of assessments, level of documentation, standards for quality of treatment, etc.); where to locate standards documents when more information is needed |
| Knowledge of treatment outcomes | a basic knowledge of the types of interventions which have been demonstrated to positively impact the patient’s health status |
| Knowledge of cognition | attention, memory, orientation, reasoning, problem solving, executive function, motor planning and visual spatial, decision making processes |
| Knowledge of how the neuromuscular system works and impacts function |
| Knowledge of the cardiovascular system works and impacts function | |
| Knowledge and ability to avoid dual relationships | dual relationships of internship supervisor as counselor/intimate significant other to student; patient as friend/intimate other to therapist; supervisor as intimate other to supervisee |
| Demonstrates basic knowledge and skills related to assisting patient movement including transfers, bed mobility and | (list transfers, list bed mobility areas) |
| Maintains appropriate credentials | CTRS; First Aid; CPR |
| Holds basic knowledge of common dietary orders and restrictions | (list diets including diabetic precautions) |
| Verbalized knowledge of how to access community resources and how to access scope of continuity of care available | |
| Verbalizes techniques/therapist behaviors required to implement close observation orders | |
| Demonstrates understanding of commonly used scales | including FIM, ASIA, min/mod/max assist/ weight bearing levels, contact guard, supervision, |
| Demonstrates ability to accurately measure vital signs | |
| Demonstrates ability to use task analysis techniques to analyze individual activity consistent with diagnosis, precautions and contraindications | include task analysis for specific physical skills listed for L&I |
| Demonstrated skill Chart Review | |
| Demonstrated skill interview | |
| Knowledge of standardized assessments in recreational therapy | Some examples of standardized testing tools include the LDB, CERT Psych/R, CIP and TRAA. |
| Knowledge of how to chose, administer and interpret assessment to develop a treatment plan | |
| Knowledge related to the assessment and determination of barriers | Barriers refers to architectural, attitudinal, cognitive, social and other types of barriers to successful involvement in activity. |
| Knowledge base adequate to know when and what type of referrals need to be made. | This includes knowing when inter-facility or out-of-facility referrals may be clinically indicated. This does not include the knowledge base (to whom the referral should be made) and skills (agency procedures) required to actually make the referral. |
| Knowledge base adequate to assess when contraindications related to activity exist and to know when to anticipate common contraindications based on diagnosis. | An example of anticipating a contraindication based on diagnosis would be the contraindication of sitting for extended periods of time on insensate skin without a pressure release. |
Competency
|
Comments and/or Not Applicable
|
| Demonstrates ability to incorporate information from assessment (from both the recreational therapy assessment as well as from the other team members) | |
| Demonstrates basic clinical judgment in establishing the frequency, intensity and duration of treatment interventions | |
| Demonstrates a working knowledge related to diversity issues to organize and implement therapeutic interventions to meet the patient’s unique needs | age, attitude, cultural, educational, financial, geographic, language, social, spiritual |
| Verbalizes knowledge of how to match patient’s needs with the available resources | |
| Demonstrates the abilities and attitudes necessary to collaboratively develop the patient treatment plan |
| Demonstrates the ability to use a variety of interventions/programs to improve physical, cognitive, social, emotional and behavioral abilities and independence in life activities and leisure functioning. | |
| Demonstrates basic skills and knowledge to use the following interventions/teach the following techniques | (we need to work on this list) advanced activities of daily living, anger management techniques, basic health/fitness, community integration, exercise group, functional skills, leisure counseling, leisure education, pre-community integration skills, relaxation techniques, remotivation, sensory stimulation, social skills, stress management, stress management, time management, validation, value clarification |
| Demonstrates ability to blend patients with different impairments in a group setting and maintain milieu, appropriateness and safety | |
| Demonstrates ability to use/adapt existing supplies and facilities to better meet patient needs |
| Ability to demonstrate skills and knowledge to establish and maintain a safe workplace for staff, patients & the public | body mechanics; infection control (universal precautions, hand washing procedure, MRSA); appropriate access and safe use of equipment; violence in the workplace |
| Is familiar with the basic principles of guarding the public’s, patient’s and staff’s safety related to confidentiality and right to know | including working knowledge of confidentiality and Tarasoff I and II; requirements to report abuse |
| Demonstrates appropriate body mechanics for transferring patients, lifting objects and other back safety techniques | |
| Demonstrates techniques used to protect a patient during a seizure | |
| Identifies observable behaviors which may indicate that a patient is considering suicide, elopement or assault | |
| Demonstrates ability to identify tools/supplies which may be used as a weapon or harm a patient and how to manage this inventory | including sharps, potential weapons, patient judgment |
| Verbally explains pressure lease techniques and states primary causes/situations which lead to skin breakdown | power tilt, dependent tilt back, (we need to list the ones we want)(list causes and situations) |
| Verbalizes basic knowledge related to understanding and monitoring orthopedic precautions | (list specific precautions we want them to know) |
| Verbalizes how to maintain a safe, clean environment | including water temperature, unnecessary obstacles, how to clean supplies, supply inventory, appropriate levels of stimulation |
| Verbalizes primary concerns/behaviors to monitor with patients on a chemical treatment program |
| Demonstrates basic skills related to documenting aspects of patient care | |
| Demonstrates understanding of documenting units of time including filling out timecards; noting units for purposes of billing or contact hours, | |
| Understands basic components of and basic principles related to documentation for critical pathways | |
| Demonstrates basic understanding of how to document using forms including check lists, participation records, billing sheets, time cards | |
| Demonstrates ability to write measurable objectives | |
| Understands basic standards/techniques related to updating precautions and coverage information in a timely basis | |
| Documentation reflects appropriate grammar, spelling and readability. Documentation also includes only approved abbreviations. |
| Able to perform de-escalation techniques while maintaining a safe and therapeutic environment | |
| Understands the purposes of different categories of restrains and is able to state negative consequences of each | medications., soft, hard |
| Verbalize techniques/skills used for behavior modification | (including token systems, …) |
| Basic skill in use of safety belts and restraint systems including proper applications and contraindications. | |
| Basic skill in use of communication equipment including pagers, phones, two-way radios, call lights. PA systems. | |
| Basic computer skills including the use of word processing equipment; loading and deleting information from disks, e-mail and documents already in files on the system; and knowledge related to the use of a computer. | |
| Basic Internet skills including receiving and sending e-mail, using the web for obtaining information and knowledge about netiquette. | |
| Fitness equipment | |
| Pool equipment | |
| sports equipment | |
| personal hygiene equipment | |
| emergency equipment | |
| kitchen and craft equipment including microwaves, etc. | |
| basic skills associated with patient equipment | The group said basic knowledge of how to operate a motor vehicle & strap in w/c but level 1 can’t go out |
| Knowledge of/recognizes and maintains precautions for adaptive devices | (including knowing when s/he is not familiar with a piece of equipment and asking for instruction prior to taking responsibility for the patient using that equipment |
| Ability to analyze and evaluate data to modify the individualized treatment/program plan, the intervention/programs or to recommend discharge plans/aftercare | |
| Verbalizes basic principles and concepts of performance improvement |
| Demonstrates ability to communicate with others (staff, patients, others) in a clear, concise, professional and timely manner. |
3-Listing and definitions of related fields
- an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals,
- customized intervention to improve the person’s ability to perform daily activities and reach the goals, and
- an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.
Cognitive Behavioral Therapy: Cognitive and behavioral therapies usually are short-term treatments (i.e., often between 6-20 sessions) that focus on teaching clients specific skills. CBT is different from many other therapy approaches by focusing on the ways that a person's cognition (i.e., thoughts), emotions, and behaviors are connected and affect one another. Because emotions, thoughts, and behaviors are all linked, CBT approaches allow for therapists to intervene at different points in the cycle.
Recreation Workers: Conduct recreation activities with groups in public, private, or volunteer agencies or recreation facilities. Organize and promote activities, such as arts and crafts, sports, games, music, dramatics, social recreation, camping, and hobbies, taking into account the needs and interests of individual members.
Recreation Workers: Conduct recreation activities with groups in public, private, or volunteer agencies or recreation facilities. Organize and promote activities, such as arts and crafts, sports, games, music, dramatics, social recreation, camping, and hobbies, taking into account the needs and interests of individual members.
4-Glossary of terminology used in TR
https://scholarworks.iu.edu/dspace/bitstream/handle/2022/6474/Austin_Glossary.pdf?sequence=1&isAllowed=y
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