Play With a Purpose

Understanding therapeutic recreation and how it can work for you

By Elisa Kronish

From late April through mid-October, Baltimore's Inner Harbor is abuzz with budding and seasoned sailors who depart from the Downtown Sailing Center. Gazing at the scenic vista, you wouldn't realize that some of the sailboat occupants are people with disabilities.

It was the Sailing Center's Access-Ability program that interested Katrina Johnson, executive director of the Camping and Therapeutic Recreation Program of the League for People With Disabilities at Camp Greentop. In spring 2003, Johnson approached the Sailing Center to help her host an event for people with disabilities and their friends and family.

"It was a rainy day, but almost 40 people showed up," says Johnson, whose aptly titled Sailing Saturday Spectacular was so successful that it exploded into two full sessions of sailing classes in fall 2003 and will probably lead to additional sessions in 2004.

The growing interest in such programs isn't surprising. After all, according to the 2000 U.S. Census, nearly 20 percent of the population 5 years old and up are regarded as having a disability. With people living longer, that number is predicted to rise, which, in turn, will likely generate more need and appeal for recreational therapists and therapeutic recreation, like accessible sailing.

THERAPEUTIC RECREATION: GOALS AND DISTINCTIONS

Two national organizations represent and support recreational therapists: the American Therapeutic Recreation Association (ATRA) and the National Therapeutic Recreation Society (NTRS), along with a separate certifying agency, the National Council for Therapeutic Recreation Certification, which awards the credential of Certified Therapeutic Recreation Specialist (CTRS). Although there is some hair-splitting over the difference between the expressions "special recreation," "therapeutic recreation" and "recreational therapy," the common use seems to favor therapeutic recreation (TR), meaning basically, recreation with a purpose.

"Our role in therapeutic recreation is to assist individuals with disabilities in maximizing their self-sufficiency and independence through recreational activities," says Evan Braff, division supervisor of the Therapeutic Recreation and Teen Services at the Fairfax County Department of Community and Recreation Services in Fairfax, Va. With its more than 35 programs for people with disabilities 3 years old and up, Fairfax County covers a lot of ground.

"If somebody has a need, we provide recreation for them," Braff says.

Recreation doesn't operate alone in the rehab field, though. Therapeutic recreation has historically been used in combination with other therapies, such as occupational and physical therapy. But TR includes that play component that other therapies just can't match.

"It's more fun, and you're focusing on something other than one foot in front of the other," Johnson says.

David R. Austin, professor at Indiana University and co-author of the textbook Therapeutic Recreation: an Introduction, describes the differences among common treatments this way: "Physical therapists have become mobility therapists; occupational therapists have become upper-body specialists; and therapeutic recreation is more holistic, more psycho-educational or psycho-social. It deals with the whole person and uses that person's strengths in interventions."

Whether individuals have a long-term or temporary disability, a physical, emotional or cognitive disability, therapeutic recreation can provide a goal-oriented, engaging way to achieve rehabilitation or to improve their lifestyle.

Therapeutic recreation often follows the more clinically based therapy, and each treatment can play an important role in a person's well-being.

"It could be appropriate for a patient to see a physical therapist first for an acute injury," explains Ann D. Huston, executive director of ATRA. "But TR would follow closely."

A friend of Huston's, now an ATRA lobbyist, became a double amputee at the age of 10 after a traumatic car accident. He spent plenty of time in the clinical rehab setting but eventually got outside for a little TR.

"He became a downhill skier as a result of a recreational therapist forcing him to get active," Huston says. Though she regards therapeutic recreation as complementary to other therapies, Huston also stresses a key advantage to TR.

"We work with the individual for life," she says. TR also takes people out of the medical setting and allows them to—and shows them it's possible to—participate in enjoyable activities with their families and friends.

Even the simple scheduling of TR sessions seems to win points over other therapies.

"Therapeutic recreation is available evenings and weekends, whereas the other kinds of therapies might not be," notes Gerald Hitzhusen, associate professor at the University of Missouri-Columbia and coordinator of the International and Midwest Symposiums on Therapeutic Recreation.

Austin adds humorously: "Occupational therapists and physical therapists seem to do things that people hate," while people actually have fun with TR.


A DEFINITION — OR THREE

Although therapeutic recreation has varying definitions, each with varying nuances, two of the clearest and most concise come from the two national organizations devoted to the field. For good measure, we've also included a textbook definition, literally.

American Therapeutic Recreation Association:

"The provision of treatment services and the provision of recreation services to persons with illnesses or disabling conditions. The primary purposes of treatment services, which are often referred to as recreational therapy, are to restore, remediate or rehabilitate in order to improve functioning and independence as well as reduce or eliminate the effects of illness or disability. The primary purposes of recreational services are to provide recreational resources and opportunities in order to improve health and well being. Therapeutic recreation is provided by professionals who are trained and certified, registered and/or licensed to provide therapeutic recreation."

National Therapeutic Recreation Society:

"Therapeutic recreation uses treatment, education and recreation services to help people with illnesses, disabilities and other conditions to develop and use their leisure in ways that enhance their health, functional abilities, independence and quality of life."

Therapeutic Recreation, an Introduction by David R. Austin, Michael E. Crawford (Prentice Hall 1991):

"The purposeful use of recreation/leisure activities and experiences as a means of producing positive benefits for recipients of TR services," and, "the clinical application of recreation and leisure"


GETTING IN ON THE ACTION

While the Americans with Disabilities Act mandates a certain level of accessibility and carries a kind of "I have to do this" connotation, therapeutic recreation takes accessibility into a different realm and evokes more of a "I want to do this" attitude. And besides the depth and breadth of benefits for participants of therapeutic recreation, there are plenty of positive outcomes for your facility as well. To help you get over some of the hurdles to developing a solid and successful TR program at your facility, here are some common concerns (read: obstacles, objections, gripes, etc.) and the solutions to making it all work.

Concern #1: It's too much trouble.

Solution: When considering adding or enhancing a TR program at your facility, the key is to form partnerships. If you have the resources but lack staff and participants, try expanding your view beyond your own front doors, and you'll likely find what you need. In one instance, the Fairfax County Department of Community and Recreation Services wanted to offer an adaptive aquatics program for people with disabilities, but they don't manage their own pool. So every week, they borrow other facility pools—three in fact.

"We have no standalone facility of our own, so we run programs wherever we can find space," says Sara Mumford, branch manager for the Fairfax County Therapeutic Recreation Services. "We're savvy at finding resources, so our costs are pretty low."

Another Fairfax TR program takes advantage of summer vacation at area schools. The county runs four different types of summer camps for people with disabilities and uses nine different schools to do it.

Getting the school principal on board to accommodate the campers for a summer can sometimes be a challenge, Mumford says. "But after they've had us there once, they always invite us back," she says.

Recreational therapists who work out of a clinic often need a place to bring their clients, and you can provide it.

"Anyone working in a medical setting needs to be clued into the recreational opportunities in the community," says Laurie Jake, ATRA communications coordinator and past president. "These folks running incredible [TR programs] need to have these people referred to them."

Your budget might flinch when you consider the cost of hiring a specialist, but you don't always have to hire a full-time staff member.

"You might just need to work with a CTRS in your area on a consulting basis to simply help show you how to adapt your programs," Jake says. Also, depending on the type of facility and program you run, a little research and some determination might just earn you some government or private foundation funding to help mitigate your financial outlay.

"It helps to have a partner like us, unless the facility can have a full-time staff member," says Johnson, whose partnership with Baltimore's Downtown Sailing Center brought more clients to a facility that already owned accessible boats. "The sailing center doesn't have the bigger picture in terms of knowing what each individual needs. But the sailing center is good at what they do in providing the facility and sailing staff."

Johnson knows the therapy, and the Downtown Sailing Center knows recreation. Merging the two made perfect sense—and a lot of happy campers.


THE WINNING SCORE

Trouncing therapeutic recreation naysayers, a national research project sponsored by the National Institute on Disability and Rehabilitation Research published a document entitled "The Benefits of Therapeutic Recreation: A Consensus View." The American Therapeutic Recreation Association sums up the findings in four key points.

1. Recreational therapy services are an effective means for improving physical, cognitive, social and emotional functioning.

2. Recreational therapy services develop the skills needed to enhance functional independence for community living and to promote a higher quality of life for the individual and their family.

3. Recreational therapy services provide individuals with disabilities mechanisms to prevent declines in physical, cognitive and psychosocial functioning and as a result reduce the need for health care service.

4. Recreational therapy services reduce secondary disability and associated higher health costs.


Concern #2: You lack proper equipment and experience.

Solution: Before assuming the worst, evaluate your facility's present accessibility situation. Indeed, you might not have every latest and greatest piece of adaptive equipment, but you might discover there's a lot of potential for TR programming. Once you've determined that potential, then you can assess community interest in a program that takes advantage of your facility's adaptive assets. You could survey nearby hospitals, rehab centers, clinics and residential healthcare facilities. Another, quick way to measure interest might simply be to host a trial run.

"Hold an activity, a one-day thing—swimming, basketball, an adaptive sports relay—and see how many people show up," Johnson suggests. That way, you'll have an idea of the interest level before diving into the deep end.

You'll also get a clue about the gaps in your experience and staffing. If you think you have the potential to run a kayaking program that integrates people with disabilities, and you've got a kayak instructor, then contract a recreational therapist on a short-term basis who can help you adapt it properly. Certified TR specialists know the tricks of the trade that allow people to participate in activities that you might not consider. For example, it might seem impossible for a person with hearing difficulties to take an aerobics class, but a TR specialist knows any activity can be adapted.

"Face the speaker toward the floor and turn up the bass, so they can really feel the beat," Jake offers as an example.

"After an individual [with disabilities] is acclimated to the program, the recreational therapist can even train other staff to run the program," Huston suggests. Once the participants with disabilities are up to speed to participate at their level, then you can have one of your own recreation specialists take it from there.

Concern #3: There's a negative attitude among your staff and community.

Solution: "It's a matter of education," says Austin, who feels that the vast majority of leisure providers haven't seen themselves as providers of recreation for people with disabilities. Interestingly, some of Austin's studies have shown that facility managers' intentions toward serving people with disabilities are generally positive, but attitudes toward people with disabilities are less so. This mind-set may lead to some assumptions of what a people with disabilities can or cannot do.

"Where they experienced difficulty was they didn't feel they had the training or background to know what to do," Austin says.

Braff encourages facility managers to put their staff through training to handle any situation with any type of guest. Proper training gives staff confidence to run programs for people with disabilities. Sara Mumford puts Fairfax County recreation staff through crisis prevention and intervention training; some staff members are also trained in certain medical procedures. Staff training also includes etiquette training. Even something as simple as a staff greeting can be welcoming or intimidating.

"[A person who's visually impaired] might be able to get in the door, but if no one comes forward to help, then the person can't really gain access," Austin points out.


TR TO GROW ON

Therapeutic recreation programs can take many forms, and with any of them, it helps to create some consistency. The Therapeutic Recreation and Teen Services program of the Fairfax County Department of Community and Recreation Services in Fairfax, Va., has developed a wise model that's worth sharing with TR novices. Division Supervisor Evan Braff calls it a "continuum of care." It works for any activity, and it takes participants from start to finish and back again.

Here's how it goes:


1. First phase— Foundation This is where people start when they're not quite ready for integrated activity.

"It focuses on skill developments one-on-one," Braff explains.


2. Second phase— Transitional When participants have mastered the basic skills of a sport or activity, this phase allows them to go out and just do it, but with a little support from staff.


3. Third phase— Integrational This is the stage of independence. "Total mainstreaming inclusion with minimal support," Braff says.


"What's unique about this model is it moves up and down," Braff notes. For example, an individual with a disability who wants to take a karate class might start out with a staff member showing him some moves and how he might adapt them appropriately. As he progresses, the staff person hangs back a bit and then fades out completely.

"But then they want to take up a new hobby, and they go back down to the transitional phase," Braff explains. With more than 35 programs for people with disabilities, Fairfax County's model provides organization, control and a welcoming approach for people who want to try something new.


Concern #4: The whole thing will be a waste of effort and money.

Solution: Get your staff and community involved in creating TR programming and attracting people with disabilities.

"In the first place, you have to be able to do some community and consensus building," says Braff, who recently developed a strategic plan for Fairfax County, Va., recreation services. His first step was inviting people from the community—both those being served by county programs and some who weren't—to answer questions about what they thought of existing services and what was missing.

"Get people around the table to come up with a common goal, a mission and an action plan," Braff says. He also urges people to look for grants and funding, work with county and officials, and research what's been done and what has worked. "They shouldn't feel like they're reinventing the wheel," he says.

Austin points to research by the National Center for Accessibility at Indiana University that took on the argument by some golf facilities owners and players that it would take too long for a person with disabilities to complete a round of golf. In fact, when researchers timed players with disabilities, it turned out they played at about the same pace as non-disabled players.

Next, be open to new ideas from anywhere and anyone, Braff advises.

"Everybody has a voice from the part-time staff to the division supervisor; all are empowered to be part of the decision-making process," he says of his department. "A certain energy comes with that."

Involving staff allows people to take ownership of decisions that might affect their jobs. Involving community members opens you up to some potentially rewarding ideas.

For example, in 1998, a woman in the Fairfax, Va., area received a grant for a program she called Project Success, which teams up teenagers with and without disabilities to participate in community service together.

"Since then, the grant has gone, but there's been other money to keep it going," Braff says. The rewards were experienced on all sides. Not only have the teens put in 80,000 hours of community service, but their work has demonstrated to the community that they accept and value individuals with disabilities, Braff says.

"One of the benefits I didn't even realize is that the program has turned into an employee training ground for us," he says.

Besides the benefits of TR programming for people with disabilities, as well as the positive feelings you, your staff and the community can gain from it, your facility's bottom line is bound to get a boost.

"There's a lot of business out there for facilities that want to serve more people," Johnson says. The demand for TR programming is growing, and the effort toward implementation is minimal. Consider ways it can work for your facility, and soon enough you'll be smooth sailing beyond just accessibility and toward a truly inclusive facility.


RESOURCE GUIDE

There are plenty of experts and advocates who can answer questions, offer suggestions and support your mission to develop or increase therapeutic recreation services at your facility.

Here are just a few of those resources:

  • American Therapeutic Recreation Association (ATRA), 703-683-9420 or visit www.atra-tr.org

  • National Therapeutic Recreation Society (NTRS), a branch of the National Recreation and Park Association, 703-858-0784 or visit www.nrpa.org (click on "Branches")

  • National Council for Therapeutic Recreation Certification (NCTRC), 845-639-1439 or visit www.nctrc.org Therapeutic Recreation Directory, www.recreationtherapy.com

  • National Center on Accessibility, 812-856-4422 or visit www.ncaonline.org

  • Midwest Symposium on Therapeutic Recreation (April 19 to 21, 2004), 573-882-4038 or visit www.muconf.missouri.edu/midwest_symposium


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