Play For All

Therapeutic Recreation Embraces All Abilities

By Dana Carman

Activity has never seemed more important. With obesity a national healthcare crisis, it's obvious that both children and adults aren't utilizing the great outdoors or recreational opportunities. Once upon a time, everyone went outside to "play"—build forts and imagine the characters in them, ride bicycles, draw stick figures on the cement in chalk, enjoy a game of baseball or kickball, run around playing tag—and it was considered critical to growing up to do so. That much hasn't changed, and the importance of recreation to development has gained increasing recognition, particularly in the area of therapeutic recreation, which uses recreation to produce positive benefits for people with disabling conditions.

Use a form of the word "therapy," and most people assume it takes place in clinical settings, like hospitals or rehab facilities. While therapeutic recreation can take place in clinical settings and is sometimes incorporated into a rehabilitative plan for a patient, which may also include occupational therapy, physical therapy or speech therapy, therapeutic recreation also takes place in the community setting, such as through local parks and recreation programs.

As recreation specialists know, recreational programming isn't just about being physically active, though that is a part of these programs. It's also about social interaction, mental stimulation and engaging creativity. This is why it's critical when creating programming that all populations are considered, including those with disabilities.


A Day at the Beach

The City of San Diego Park and Recreation Therapeutic Recreation Services offers a motorized wheelchair program, which provides access to the sand at Mission Beach. These state-of-the art chairs make it possible for those with a mobility impairment to propel independently on the sand. According to Kathy Aceves, District Manager with the City of San Diego Park and Recreation Therapeutic Recreation Services, the chairs are such a bit hit with tourists that some come back each year because they know they're available.



What is therapeutic recreation?

According to the American Therapeutic Recreation Association (ATRA), "therapeutic recreation is 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 recreation 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."

More simply put, recreational therapy is often defined as the healthcare service while therapeutic recreation is a broader term, which can encompass both the treatment services, which are physician-ordered, and the recreation services provided by local communities. While rehabilitation may be part of why a person utilizes therapeutic recreation in a community setting after his or her discharge, therapeutic recreation also helps those with disabilities with social interaction, life skills, self-esteem and self-confidence.

Like ATRA, the National Therapeutic Recreation Society (NTRS) is a membership organization that supports certified therapeutic recreation specialists (CTRS) and therapeutic recreation initiatives. The NTRS is a branch of the National Recreation and Park Association (NRPA) and works toward "advancing the belief that leisure and recreation are basic human rights and are critical to health, quality of life and happiness."

The Americans with Disabilities Act of 1990 (ADA) helps to put these rights in legal terms. Loosely translated, ADA provides individuals with disabilities the right to the same access to parks and recreation facilities and programming that those without disabilities are entitled to.

"Anybody with a disability has a right to attend programming within the community," said Alayne Kazin, service area coordinator for the Cincinnati Recreation Commission, Division of Therapeutic Recreation.

Kathy Aceves, district manager for the City of San Diego Parks and Recreation Division of Therapeutic Recreation Services, pointed out, "All other citizens can take advantage of programs paid for by city dollars. Why shouldn't people with disabilities?"


Talking About Therapeutic Recreation

The NRPA hosts the National Institute on Recreation Inclusion (NIRI), which takes place in October this year in Reston, Va. The NIRI event is for those interested in learning more about the inclusion process through workshops and training, as well as a forum for discussion on inclusion issues, ideas and opportunities.

This year's NIRI includes an off-site workshop visit to Clemyjontri Park, in McLean, Va., which Recreation Management featured in its July 2007 Supplement on recreation and sport surfaces.

Clemyjontri is a playground especially designed for children with disabilities and features many innovative ways to stimulate and engage children with all types of disability and also offers children without disabilities a wonderful place to play and broaden their world. For more information on this special park, visit www.clemypark.com.

The date for the 2008 NIRI has already been set for September 8-11 in Eugene, Ore. More information can be found on the NRPA's Web site at www.nrpa.org.

Similarly, there are organizations and symposiums around the country discussing therapeutic recreation:



Programming with purpose

When discussing therapeutic recreation, two things come into play, literally: specific programming and inclusion services. Specific programming includes programs designed only for those with disabilities. Some examples are adaptive swimming, bowling, wheelchair basketball or tennis, social functions such as dances, or outings to shows or athletic events.

Often these programs are designed by certified therapeutic recreation specialists (CTRS) and led by them as well. Parks and recreation departments that have a dedicated therapeutic recreation division and staff (usually CTRSs are on staff) will meet to go over their community's needs, design programs and assess those programs along with the participants.

Inclusion services are also part of therapeutic recreation and, in recent years, are a very big part of what therapeutic recreation—and the ADA—is all about.

Beyond the fact that it's mandated by law, inclusion services provide those with disabilities the same freedom of choice in opportunities afforded to everyone else, Kazin said. "Inclusion allows that person to determine their own interests and destiny," she explained.

"I believe all people, regardless of ability, should have the opportunity to choose to participate in recreation that is available to the general public," said Linda Heyne, CTRS and associate professor and chair of therapeutic recreation at Ithaca College in Ithaca, N.Y. "The key to therapeutic outcomes in recreation is to build upon people's interests, strengths and preferences. When people have the option to choose their own recreational activities, they are naturally motivated to work on therapeutic goals and outcomes."

While many parks and recreation departments around the country offer specific programming for people with disabilities, some still don't offer it at all. Fewer offer inclusion services.

Many therapeutic recreation specialists agree that regardless of whether a community offers separate programming for the disabled population, they should have inclusion services. And not just for the benefit of those with disabilities.

"As much as people with disabilities benefit from inclusive recreation, I have found that people without disabilities often benefit even more," Heyne said. "As people without disabilities learn to interact with people with disabilities, it is exciting to see them overcome their fear and awkwardness, learn acceptance and even advocate for inclusion. This is where the real social change of acceptance and tolerance occurs."

Kazin agrees. "It's the way the world works," she said. "It's not typical to only see one kind of people."

Aceves said that she sees inclusion most with kids programs. Summer camps are especially popular for all kids and are the area where inclusion is most requested.

It depends on the program, but when a request for inclusion is made, the child or adult's needs are assessed to determine whether or not the child or adult needs an inclusion specialist, also sometimes referred to as an inclusion aid. The inclusion aids are not necessarily CTRSs. While CTRSs will assess the child or adult, inclusion aids are trained staff who may be students studying therapeutic recreation, special education, occupational therapy or physical therapy. They may be interns or people who have had previous experience working with those with disabilities, possibly in a clinical setting.

Other accommodations may also need to be made for inclusion. "We've done things like widen changing benches or added a changing bench in a bathroom," Kazin said. "We've added handrails to both sides of our stair rail."

In Maryland, Montgomery County Recreation Department's Therapeutic Recreation Division requests what it refers to as "mainstreaming companions," who may be other people within the community who work with the department regularly. For example, for a person with a hearing disability, the division contracts with an interpreting company.

"Some of the classes may be harder," Charlie Butler, recreation specialist with Montgomery County's Therapeutic Recreation Division, said of always finding an appropriate mainstreaming companion, "like if someone wanted to do personal training and weight lifting, it may be more difficult to find someone that has the experience to help the instructor, but most of the time we'll try to work out something to be able to mainstream it."


Therapeutic Recreation
Resource Guide

For more information on therapeutic recreational programming for your community:

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

National Therapeutic Recreation Society (NTRS), a branch of the National Recreation and Park Association (NRPA)
703-858-0784
www.nrpa.org

National Council for Therapeutic Recreation Certification (NCTRC)
845-639-1439
www.nctrc.org

Therapeutic Recreation Directory
www.recreationtherapy.com

National Center on Accessibility
812-856-4422
www.ncaonline.org



Breaking down the barriers

As with any type of programming or project, cost is always the number-one factor cited as a reason for not implementing therapeutic recreation programming, whether specific programs or inclusion services.

"All public governmental agencies are under scrutiny to provide the most bang for their buck," Kazin said. "In Cincinnati, even though we've had therapeutic recreation for 40 years, there's always budgetary issues and constraints."

If budget is an issue, go for inclusion services rather than specific programming, say field professionals. Heyne feels that adapting all services to be inclusive is more in the spirit of the ADA.

Partnering with other local agencies and groups or even the local high school can also start you down the path to incorporating therapeutic recreation. For example, Arlington County Parks, Recreation and Cultural Resources partners with the schools to go in and provide activities, which offsets some of the costs and staffing needs. Similarly, Butler said that he's had instructors of "regular" programming want to expand their offerings to those with disabilities and offer those classes in the instructor's studio space, which means Butler and his staff aren't trying to find the space and the staff. If your facility can't accommodate additional programming or certain needs, school facilities or other community centers may be available.

Aceves said her division often collaborates with other agencies to meet needs.

"We can't run Special Olympics," she said, "but there's an agency that does, and we provide the fields and the gym, and get them practice space. Reaching out to agencies in town is a way to start things."

Heyne feels that parks and recreation departments have a lot to gain from partnering with local hospitals, rehabilitation centers and psychiatric facilities to bridge the gap from discharge to enrollment and "assist people in recovery and building healthy lifestyles." Partnerships with healthcare facilities also provide a way to let people know what opportunities exist beyond the clinical setting. When need is established, funding may be less difficult to secure.

This is a point Shaeron King, therapeutic recreation programmer in Arlington County, Va., also noted. "I think some people are not aware of what the needs are and what needs to be offered," she said. "Sometimes you try to be everything to everybody, and you can't. Narrow it down to who is out there and who needs what services." Partnering with schools, private agencies and healthcare facilities can help identify the population.

Consider hiring certified therapeutic recreation specialists as consultants rather than full-time staff. Utilizing their expertise extends beyond designing programs but also can help educate current staff on why therapeutic recreation is important and the many different types of disabilities, including some that people may not be aware of.

Programs may also be eligible for grant support or other public funding. Cincinnati's accessible golf program is run through grant money from the U.S. Golf Association. It has also partnered with the U.S. Tennis Association for its wheelchair tennis program.

The best first step is to learn from others' experience. Reach out to others with successful therapeutic recreation programs and ask what your best next step should be. As King said, "I'm not a big believer in reinventing the wheel. Check in with other organizations."

Type "therapeutic recreation" into Google, and you'll find several parks and recreation departments around the country. As Kazin mentioned, Cincinnati's program has been around for 40 years; Montgomery County started therapeutic recreation services in 1968; and San Diego has been offering therapeutic recreation for more than 35 years.


Positioning Inclusion for Your Programs

The National Recreation and Park Association (NRPA) is committed to "encourage all providers of park, recreation, and leisure services to provide opportunities in settings where people of all abilities can recreate and interact together" through four inclusion concepts and beliefs addressed in the NRPA Position Statement on Inclusion:

RIGHT TO LEISURE

  • The pursuit of leisure is a condition necessary for human dignity and well-being.
  • Leisure is a part of a healthy lifestyle and a productive life.
  • Every individual is entitled to the opportunity to express unique interests and pursue, develop and improve talents and abilities.
  • People are entitled to opportunities and services in the most inclusive setting.
  • The right to choose from the full array of recreation opportunities offered in diverse settings and environments and requiring different levels of competency should be provided.

QUALITY OF LIFE

  • People grow and develop throughout the lifespan.
  • Through leisure an individual gains an enhanced sense of competence and self-direction.
  • A healthy leisure lifestyle can prevent illness and promote wellness.
  • A social connection with one's peers plays a major role in his/her life satisfaction.
  • The opportunity to choose is an important component in one's quality of life; individual choices will be respected.

SUPPORT, ASSISTANCE AND ACCOMMODATIONS

  • Inclusion is most effective when support, assistance and accommodations are provided.
  • Support, assistance and accommodations can and should be responsive to people's needs and preferences.
  • Support, assistance and accommodations should create a safe and fun environment, remove real and artificial barriers to participation, and maximize not only the independence but also the interdependence of the individual. People want to be self-sufficient.
  • Support, assistance and accommodations may often vary and are typically individualized. Types of support, assistance and accommodations include, but are not limited to: qualified staff, adaptive equipment, alternative formats for printed or audio materials, trained volunteers, or flexibility in policies and program rules.

BARRIER REMOVAL

  • Environments should be designed to encourage social interaction, "risk-taking," fun, choices and acceptance that allow for personal accomplishment in a cooperative context.
  • Physical barriers should be eliminated to facilitate full participation by individuals with disabilities.
  • Attitudinal barriers in all existing and future recreation services should be removed or minimized through education and training of personnel (staff, volunteers, students, and/or community at-large).

Source: National Recreation and Park Association, www.nrpa.org



Communication is key

Like most things in life, therapeutic recreation doesn't work without proper communication, and not just to the potential participants.

"The way to start out is to create a climate of acceptance," Kazin said. "We do disability awareness with our staff. We also started doing disability awareness with our community centers so that kids are the first group of people we talk to so that when a child with a disability enrolls in a program, they have awareness and a level of acceptance. The same thing is true of the staff."

As Heyne mentioned, those without disabilities may have a fear of the unknown in interacting with those with disabilities, which can be greatly reduced through inclusion. Programs may be reluctant to offer therapeutic recreation for the same reason. In Arlington County, inclusion is referred to as Access and Inclusion, and as part of that, the staff throughout the departments is educated on different topics relating to disability.

"We're increasing knowledge and comfort levels," King said. "We're making them feel comfortable to ask the questions they need to ask."

But communicating to the community that these services are offered is critical to success as well. It's especially important if you're in an area where these services have not previously existed. If parents of children or adults or guardians are not looking for them, they won't necessarily know to come to you. More, when you go so long without something, you stop looking.

"In six years of inclusion, we've gone from five or six kids to 100," Kazin said.

"If you build it, they will come."


Play nice

The reality is that regardless of disability, we all have abilities and strengths that differ from one another and the important thing is to recognize each other's abilities and not see only the disabilities. Everyone benefits from social interaction and recreation, not to mention physical activity, as obesity also affects the disabled population.

"Whether one has a disability or not, activities such as sports, dance, yoga and fitness workouts have tremendous physical benefit in terms of building strength, flexibility and cardiovascular endurance," Heyne said. "Art, music and theater programming can enhance self-expression, creativity and a sense of the aesthetic. Nature and wilderness programs can develop team-building, self-esteem and spiritual connection to the land. Board games, word puzzles or learning a language can build cognition …It is amazing to see how people with varying abilities grow and thrive in inclusive environments in which acceptance and support prevail."

In other words, recreation is good … for everyone.



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