KNR 273

1. KNR 273 Newer and Older TR Models Health & Human Services Models

2. Newer TR Models(Sylvester, Voelkl, & Ellis, 2001) • Health Protection/Health Promotion Model • Austin, 1991 • Therapeutic Recreation Service Delivery & Outcome Models • Van Andel, 1998 • Self-Determination & Enjoyment Enhancement Model • Dattilo, Kleiber & Williams, 1998 • Optimizing Lifelong Health Through Therapeutic Recreation Model • Wilhite, Keller, & Caldwell, 1999

5. Health & Human Services Models (Carter, Van Andel, & Robb, 2003) • TR is provided in the context of several different health & human services systems or models • Each of these contexts are based on a philosophy of services that impact therapeutic recreation • Some of these have been noted as older TR models

6. Health & Human Services Models (Older) • Medical or clinical • Doctor is primary therapist • Doctor determines what role others play • Assumes client has a disease or illness that needs to be treated, cured, or healed • Treat illness without regard for broader needs of client • Recreation is guided by doctor’s diagnosis and prescription • Settings: Physical med. & rehab; general med/surgical hospitals

7. Health & Human Services Models (Older) • Custodial • Focus is not rehab, but on providing for basic needs • Strong effort to maintain order & keep institutional routines • Activity programs keep residents occupied • Settings: Correctional facilities, nursing homes, state institutions, group homes • Being replaced by Long Term Care Model • Maintain highest level of functioning and QofL

8. Health & Human Services Models (Older) • Milieu therapy (environmental therapy or therapeutic milieu) • Emotional problems are often the product of unhealthy interactions with one’s environment • Staff are organized as a caring community that help client learn to readjust to environment • Primary therapist is whoever has the most effective relationship with the client • Settings: Mental health facilities

9. Health & Human Services Models (Older) • Educational/Training Model • Focus on acquisition of knowledge & skills that are required to become contributing member of society • Heavy emphasis on classroom-like framework • Focus on leisure skills & social skills • Settings: Sheltered workshops, voc rehab centers, day-care centers, schools

10. Health & Human Services Models (Older) • Community or special recreation • Critical aspect of recreation service is the provision of a wide range of leisure opportunities in the community • Provide opportunities to select experiences & acquire skills to participate in inclusive community-based programs • Settings: City recreation departments, SRAs, Easter Seals

11. Health & Human Services Models (Newer) • Psychosocial Rehabilitation Model • MI is continuous and the medical model is not appropriate for people with severe, persistent MI • Foster optimal level of functioning in the community including participating in activities • Equip people with skills in vocation, education, personal adaptation, housing, recreation, and social • Looks at strengths and abilities • Stay in here and now vs. past

12. Health & Human Services Models (Newer) • Recovery Model • Hope and restoration of a meaningful life are possible despite serious mental illnesses • Holistic view that focuses on the person and not the symptoms • Recovery is possible and achievable even though symptoms may reoccur • Person has primary control over decisions about outcomes

13. Health & Human Services Models • Recovery Model • Hope: Belief in self & willingness to preserver • Secure base: Housing, income, healthcare • Supportive relationships: Professionals, friends, family, support groups, and community • Empowerment & inclusion: Importance of social inclusion, recovery of social skills and increased involvement in the community, has power over life & illness • Coping strategies • Coping with loss: Past • Meaning • Medication & treatment: Take least amount possible • Education: Knowledge about illness • Spirituality • Employment or meaningful activity