Success in Therapeutic Recreation

Developing programs that will grow

By Kelli Anderson

Therapeutic Recreation (TR) has been around for a while, but only in the last decade or so has it emerged from the rehabilitation hospitals and special service agencies and into the mainstream of recreation. Such a transition is no surprise given that the goals of improving the social, emotional and physical abilities of particular disabled clients can be accomplished through virtually any park district program if a quality inclusion plan and process are in place. Today inclusion is the buzzword in developing a successful, growing, TR program.

If you're one of the many recreation and fitness facilities across the country who are jumping on the TR bandwagon or thinking about it, no doubt you are also one of the many who want to

provide programming that will successfully target the needs and desires of the disabled in your community. Knowing how to make people aware of programming choices—whether inclusive or special—and then implementing a process that gets them through the door and into the right environment is key.

IT'S THE LAW

Following closely on the heels of the Americans with Disabilities Act (ADA) in 1990, ramps and railings sprouted across the country with the collective good intention of making facilities ADA-accessible. Special programming also was developed to cater to the needs of the disabled, but these programs and special events were typically the only ones available to those with special needs.

Today, however, inclusive programming, where disabled children and adults can participate in the same programs as everyone else, is enjoying increasing popularity—especially among the youth with 80 percent choosing inclusive TR. Mainstreaming, now the norm within the public schools, has fostered an expectation of inclusion that naturally spills over into the realm of recreation.

Inclusion for TR not only is being applauded by those who enjoy its benefits, but equally important, it is also the law—as many court cases now testify.

"If you create a bunch of special programs," explains Andrew Fernandez, inclusion supervisor for the city parks, recreation and community services of Reno, Nev., "you are still legally obligated to provide an inclusive program. There must be an option, to the best of your ability."

In light of the legal reality, Fernandez recommends putting money first toward inclusion and only then toward special programs.

"I would have been sued," Fernandez says, "if I'd gone the other way around."

JUST SAY YES!

It all begins with a can-do attitude that changes a traditionally "just say no" response to inclusive TR into a response that invites and initiates cooperation.

"You start with having a policy statement that welcomes all people," says John McGovern, executive director of Northern Suburban Special Recreation Association (NSSRA) in Northbrook, Ill. "It might be making sure a mission statement incorporates services for people with disabilities and mentions that you provide services in the most integrated setting."

Among those facilities getting it right is the park district in award-winning St. Petersburg, Fla., recipient of a National Therapeutic Recreation Society's (NTRS) award for excellence in 2000. For St. Petersburg, an inclusive mission statement ultimately is embodied by helpful staff.

"The most important thing is a welcoming attitude of the staff," says Barbara Van Camp, recreational supervisor of therapeutic programming for the city. "You have to be willing to work with anyone who expresses an interest."

A TWO-PRONGED APPROACH

You also need to have an effective plan. According to Fernandez, Reno's mid-sized park district had little special recreation when he was hired almost four years ago and had no resources to start an inclusion department. However, with an investment in Fernandez's professional experience and credentials as a Certified Therapeutic Recreation Specialist (CTRS), the city followed his lead—a processing approach that targeted the answers to two fundamental questions: How do we get people with special needs in our door, and once in, how do we include them?

ASKING THE RIGHT QUESTIONS

Gathering information begins with self-evaluation of staff readiness and ADA compliance. Surveys, focus groups and strategic talking circuits are some of the methods that can provide a picture of the community's needs and interests. Through such research, facilities can learn what patrons want most or which obstacles most prevent disabled patrons from participating—like transportation, for example—so that solutions can be found. Assume nothing and ask everything.


A Little Help from My Friends

Not all disabled adults or children need additional assistance in TR programs, but additional help is often needed during the busiest seasons or for special events. Short of hiring a battalion of Certified Therapeutic Recreation Specialists, there are some more practical and creative solutions (and more affordable) in times of overload.

Part-timers can take up the slack to help problem-solve and generally keep the wheels of process turning smoothly. For areas requiring professional experience, hiring part-time behavioral specialists, experienced educators or persons wielding a psychology degree are perfect recruits.

Hiring part-time companions to assist in programs can come from a wider variety of sources. They often include people changing careers, people with a save-the-world-complex, people with big hearts, as well as therapists.

But for budgets that just won't budge, disabled patrons can use their own privately provided companion or facilities can enlist the help of a community volunteer program or look to agency resources.


MARKETING

Getting the word out that TR programming is available to a community that may have traditionally thought it was excluded from regular programs may take some creative marketing. For the city of St. Petersburg, information about both special and inclusive TR programming choices was done through a wide variety of venues like direct mail, Web sites, brochures placed in rehabilitation hospitals, and networking with schools, children's hospitals and day-care facilities, to name a few.

INCLUDING INCLUSION

Unfortunately for the quick-fix types among us, there is no magic formula, no one-size-fits-all, for instant TR-programming readiness. But there are some tried-and-true principles, policies and processes that will help make any facility equipped to handle each individual's unique needs.

It helps to have inclusion policies that promote a staff-wide inclusive mindset. Just as TR was once limited to the "separate but equal" practice of special-needs programming, so too was the tendency to single out the responsibility of staffers who would deal with the needs of the disabled.

"Inclusion has really been made a part of our whole operation here," NSSRA's McGovern says, explaining that it's not only a subject of regular conversation in their governing board meetings for their 12 park districts, but statements of inclusion are in all of their employees' job descriptions and are part of their performance evaluations. Everyone takes ownership.

THE RIGHT STAFF

Not all recreation facilities have the luxury of affording extra staff or a new department, but when considering the best investment for providing quality TR programming, few choices could be better than hiring a CTRS. CTRSs knows recreation and they know disability—they are equipped to research the community's needs, to design programming changes and to evaluate each disabled patron individually to recommend appropriate accommodations.

Whether hired full time or part time, consulted or even bartered—traded from one facility to another in exchange for the use of something like a pool or equipment—the role of a CTRS is virtually indispensable to developing a quality TR program.

If enlisting the aid of a CTRS is a top priority, then providing existing key staffers with inclusion training runs a close second. Such training, like the annual three-day National Recreation and Parks Association's National Institute on Recreation Inclusion (NIRI) provides the practical "how-to's" of registration processes, assessments of a disability, developing accommodation plans, and learning the ins and outs of planning processes, to name a few.

However, there are growing numbers of private consultants who teach similar materials and even universities that now offer courses on inclusion. Whatever the investment in training or resourcing, looking at what others have done successfully in a community or park district also provides a ready resource (read: free).

WHERE DO I SIGN?

One of the key lessons learned by facilities who do inclusion well is to ensure that there is a place at registration for people to indicate any special needs. This simple feature of registration—which may have language like "Do you need reasonable accommodations to enjoy this program?"—is critical.

"It is really important that the registration process requires the registrar to look at that question and answer," McGovern says, "and then to pass it on to somebody who has the skills to do the assessment of that individual— like a CTRS."


Therapeutic Recreation Resource Guide

For more information on how to provide quality therapeutic recreational programming for your community, contact the following organizations:

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

For court and administrative decisions on inclusion impacting park districts, contact John McGovern at 847-509-9400 or e-mail at jmcgovern@nssra.org


ASSESSMENT

Once through the doors, knowing what should be done to help each person with special needs—most often children—is a one-by-one assessment. Will they need staff assistance? Special incentives? Attention to sensory needs? Physical adaptations? Modifications in teaching technique? A carefully matched companion?

Unfortunately, there is no cookbook answer.

"You have to look at each unique child, the program itself and the other kids," says Robyn Miller, inclusion manager at the NSSRA. "There are so many factors. Sometimes they need no support for a particular program. You want to go with the least restrictive environment."

Assessments should include communication with family, physicians and other service providers as well as on-site observations to get as complete a picture as possible to understand the range of needs. Miller explains that sometimes all that is needed is a trained staff equipped with a behavior modification plan consisting of consequences and rewards. Who doesn't remember jumping through hoops to earn a sticker, for example?

Or, for many children, it's just a challenge to hold it all together for a six- to seven-hour day, and providing gross motor play before a class or circle time can make all the difference in their ability to concentrate and participate later. Little things can get great results, but almost every plan is a tweak-as-you-go process of evaluation and modification to get just the right fit for each person.


That Perfect Match

Nothing is foolproof, which is why it helps to have a plan. Just ask Robyn Miller, inclusion manager at the Northern Suburban Special Recreation Association in Northbrook, Ill. This past summer, Miller's full- and part-time staff oversaw 390 placements, and among them was one placement that stood out.

"There's always one or two that challenge you," Miller recalls. "One particular child came in, and this was his first inclusion experience, and we tried to assess his needs. From the very beginning, we knew he needed support—what kind of staff was really the question. You have to ask, male or female? Experienced? A laid-back personality or concrete? We needed a personality match."

It's not as easy as it may seem.

"With challenging behavior issues, you have to have a strong match, which is hard to do during interviewing," Miller says. "You do a quick match after reference checks and try a first placement. So we went with a guy who was highly recommended and experienced in the school system. It all sounded great, but we read the personality wrong."

What you think will work simply may not.

"It was the child we misread, and it was difficult to make it fit," Miller says. "We wanted to make it work, and it just didn't. We struggled and finally removed him for a great—and I mean great—companion, but he ends up getting sick, and this child doesn't deal with transition well. In the end we found the right personality match, a qualified staff member. It was a matter of looking at what we had and, thankfully, it turned out great. The child was happy and ended up with a positive experience. It was our process that told us where the problem was."

Here's the kind of roadmap that park districts in Miller's area follow to achieve their inclusion success stories:

1. Clients register for the park district or recreation department program of their choice.

2. Clients mark the appropriate "SPECIAL ACCOMMODATIONS" section of the registration form.

3. The inclusion support team is contacted by the park district or recreation department to discuss the type of inclusion support needed to accommodate the client.

4. The client starts the program with the inclusion support(s) in place.

5. A member of inclusion support team periodically observes the program to provide support and answer questions.

6. Communication between the inclusion support team, the recreation staff, the individuals and/or family is continued throughout the cooperative inclusion process.


IT TAKES A TEAM

Having assessment and evaluation procedures in place are essential to identifying when accommodations aren't working.

"You have to start with a process to know when it breaks down," Miller says. "It's guesswork, otherwise." These essential procedures, however, need to be created with the cooperation and input from inclusion professionals and facility staff to avoid an "us and them" mentality. It allows everyone to understand who does what and how.

"Everyone having a say was huge," Miller observes of the cooperative effect in her experience with districts and the inclusion department. "Success is from a continual team process. And as it keeps evolving and shifting, we continue to revisit it."

LISTEN UP

Another way to keep evolving is to listen.

"We have to listen to what families tell us," McGovern says. "They have kids 24-7. We have to try to value the feedback families give us and use an inclusive team approach that includes the family, inclusion staff, school teachers and therapists."

And part of listening also is realizing that there is a time, place and need for special TR programming. Remember, 100-percent inclusion doesn't work 100 percent of the time. For some sports, such as wheelchair basketball, the point is to compete at a high level, not to be mainstreamed into a standup game. For some, such as the senior population, inclusion is a relatively new idea, and they may prefer therapeutic recreation in a more traditionally segregated setting.

Although 80 percent of disabled youth choose inclusive TR, there is the remaining 20 percent that don't. They may prefer to be with others like themselves who share similar interests.

In any case, noting the preferences and providing a choice for inclusive and special TR programming will help ensure that everyone can experience fun and recreation in a way that best meets their needs.


A Crash Course in Inclusion

Next September marks the NRPA's National Institute on Recreation Inclusion (NIRI). At the three-day institute in Palm Springs, Fla., these practical seven steps of the inclusion process will take center stage which, summarized, cover the following:

1. Inviting people with disabilities to register.

2. The registration process.

3. Assessing the needs of the individual.

4. The means of weighing assessment results.

5. The accommodation plan.

6. Training staff to do the accommodation.

7. Evaluating the accommodation results.

For more information, visit www.nrpa.org/content/default.aspx?documentid=881.




© Copyright 2019 Recreation Management. All rights reserved.