Presentation on theme: "Goal Oriented Activities and Outcomes"— Presentation transcript:
1 Goal Oriented Activities and Outcomes Norma J. Stumbo, Ph.D., CTRSPresident, Education Associates
2 Topics Defining Accountability, Intervention, Quality, Outcomes Leisure Ability ModelTherapeutic Recreation Accountability ModelPrinciples of Intervention ProgrammingComponents - Practice
3 Background What is Accountability? How is Quality Defined? What is Intervention (and how does it differ from other services)?What are Client Outcomes?How Does TR Produce Client Outcomes?What Client Outcomes Should be Expected in High- Quality TR Intervention Programs?
4 AccountabilityBeing held responsible for the production and delivery of therapeutic recreation services that best meet client needs and move clients toward predetermined outcomes in the most timely, efficient, and effective manner as possible (Stumbo & Peterson, 2009, p. 73)
5 InterventionA program that is designed and implemented to be intervention has as its outcome some degree of client behavioral change (that is, behavioral change is the purpose of the program) (Stumbo & Peterson, 2009, p. 79) The direct, causal link between the process or delivery of care and the outcomes expected from it (Riley, 1991a)
6 QualityProviding the right patient with the right service [at] the right time in the right setting at the right intensity and for the right duration (Navar, 1991, p. 5) Intervention programs that lead to predictable and measurable client outcomes (Peterson & Stumbo, 2009)
7 QualityAchievement of some pre-established standard or a desired level of service (Stumbo, Pegg, & Carter, in press)Degree to which health services for individual and populations increase the likelihood of desired health outcomes (quality principles), are consistent with current professional knowledge (professional practitioner skills), and meet the expectations of healthcare users (the marketplace) (Buttell, Hendler, & Daley, 2006, p. 62)
8 Client Outcomes - Categories Change in clinical status (effect of tx. on pt. symptoms)Change in functionality (effect of tx. on pt. lifestyle)Change in utilization of medical resources (effect of tx. on using additional health care services)Recidivism (examining patterns of relapse or re-entry into medical system) (Gorski, 1995, p. 33)
9 Client OutcomesObserved changes in a client’s status as a result of our interventions and interactions... Outcomes can be attributed to the process of providing care, and this should enable us to determine if we are doing for our clients that which we purport to do (Shank & Kinney, 1991, p. 76)Need to have relevance and importance to the client’s future lifestyle and are attainable within the time frame of service delivery (Riley, 1987a, 1991a)
10 Client OutcomesObservable changes that result from intervention (Client status, functional status, well-being, care satisfaction, cost/resource utilizationChanges over specified timeClinical resultsResults of performanceDirect effects of serviceDifference between input (assessment baseline) and output (discharge)Both planned and unplannedBoth beneficial and harmfulStraightest line between A and B
11 Client Outcomes Intervention Entry Exit Client characteristics at baseline(assessment)(e.g., health status, functional status, quality of life, etc.)Client characteristics at end of treatment(re-assessment)(e.g., health status, functional status, quality of life, etc.)EntryExitInterventionDifference between Point A/Entry and Point B/Discharge= Outcomes
12 Questions? Accountability? Intervention? Quality? Client Outcomes? Application to Your TR Program?
13 TR Service Models Leisure Ability Model Content ModelTherapeutic Recreation Accountability ModelProcess Model
14 Purpose of TR Service Models Schematic RepresentationsCommunication ToolsExplanation of TR PracticeExpression of Philosophy and TheoryDefines TR PracticeDirects Service Development, Delivery to ClientsDirects Selection of Client OutcomesDirects Program Evaluation & Quality ImprovementFoundation for Research, Public Policy, & FutureTwo TypesContent ModelsProcess ModelsRoss & Ashton-Schaeffer, 2009
16 Current Leisure Ability Model Purpose of Therapeutic Recreation:To aid individuals with physical, intellectual, emotional, and/or social limitations in developing an independent leisure lifestyle aimed at improving their overall health, well- being, and quality of life through the provision of functional intervention, leisure education, and recreation participation services.
17 Current Leisure Ability Model Functional Intervention(formerly Recreation Therapy and Treatment)Leisure EducationRecreation Participation(formerly Special Recreation)
18 Current Leisure Ability Model Functional InterventionAddresses functional abilities that are prerequisite to, or a necessary part of, leisure involvement and lifestyleBaseline abilities that peers without limitations would possessPhysicalEndurance, strength, hand-eye coordinationCognitiveOrientation, ability to follow directionsEmotionalAnger management, emotional expressionSocialRefrain from biting, kicking, etc.
19 Current Leisure Ability Model Leisure EducationBroad category of services that focuses on the development and acquisition of various leisure- related skills, attitudes, and knowledgesLeisure AwarenessSocial SkillsLeisure ResourcesLeisure Skills
20 Current Leisure Ability Model Leisure AwarenessCognitive awareness of leisure and its benefits, a valuing of the leisure phenomenon, and a conscious decision-making process to activate involvementKnowledge of LeisureSelf-AwarenessLeisure and Play AttitudesRelated Participatory and Decision-Making Skills
21 Current Leisure Ability Model Social SkillsDevelopment of social interactionskills through direct instructionCommunication SkillsAssertiveness, Conversation, Active Listening, Information- Seeking, Information-Giving, etc.Relationship-Building SkillsGreeting Skills, Friendship Development, Cooperation, Competition, Negotiation, Compromise, Social NetworksSelf-Presentation SkillsEtiquette & Manners; Hygiene, Health & Grooming Skills; Appropriate Attire, Responsibility for Self-Care2000
22 Current Leisure Ability Model Leisure ResourcesKnowledge and ability to utilize a wide variety of leisure resourcesActivity OpportunitiesPersonal ResourcesFamily and Home ResourcesCommunity ResourcesState and National Resources
23 Current Leisure Ability Model Leisure Activity SkillsActivity skill developmentTraditional Leisure SkillsSports, Dance, Drama, Music, HobbiesNon-Traditional Leisure SkillsSocial Interaction, Community Services, Relaxation, Food Preparation, Living Things Maintenance
24 Current Leisure Ability Model Recreation ParticipationStructured, supervised programs with opportunities to practice skills learned previously, express preferences, display talentsExample:After teaching leisure awareness, social interaction skills, activity opportunities, and decision-making skills, taking clients to an arts performance or sporting event of their choice.
25 LAM: What It IS TR Service Model – Conceptual Content Model Addresses Spectrum of ServicesDisability-, Setting-, & World-InclusiveDefinition of Scope of TR PracticePro-Intervention – Focused on Change of Client Behavior, Skills, KnowledgesDifference Between Entry to and Exit from TR ServicesEvidence, Intervention, Measurement, OutcomesBased on Leisure BehaviorBased on Normalized, Inclusive IdealsBased on Health, Wellness, Well-Being, & QOL
26 * Diversional activities are not within LAM LAM: What It IS NOTA Panacea for All that Ails TRNot Based on Diversional Recreation Provision*Recreation for Recreation’s SakeNot Anti-InterventionNot Loosy-Goosy Excuse to Program PoorlyNot Based on Activity ProvisionIs Based on Evidence-Based, Outcome-Focused Program ProvisionNot Focused on Medical Model – Sick Roles/Pathologies* Diversional activities are not within LAM
28 Therapeutic Recreation Accountability Model Comprehensive & Specific Program DesignActivity Analysis, Selection, ModificationProtocol DevelopmentClient Assessment PlanIntervention ProgramsAssessment ImplementationClient Tracking & DocumentationProgram Outcomes & Client OutcomesQuality Improvement/Efficacy Research
29 Connection Between LAM and TRAM LAM = Content of TR programsScope of practiceTRAM= Process of TR programsSystems approach (whole greater than parts)ResultsExpansion of APIE into programs (instead of activities)Greater accountability for input/process/outputBetter standardization of practice/uniformity of servicesImproved “teach-ability” to students
30 Relationship of TR Models and Evidence-based Interventions and Outcomes Programs Developed ConceptuallyPrograms Drawn from Evidence & ProtocolsPrograms Based on Targeted OutcomesPrograms Provided Based on Systematic PlanProgram & Client Outcomes MeasuredProgram & Client Outcomes Reported
31 Principles of Intervention Programming ConnectionsRelationshipsOutcome-Driven
32 Principles of Intervention Programming Connections between Content and OutcomesComprehensive Program DesignActivity Analysis, Selection, ModificationProtocol DevelopmentAssessment PlanClient DocumentationProgram and Client OutcomesQuality Improvement/Efficacy Research
33 Principles of Intervention Programming Logical, planned, proven connection betweenClient Needs/Deficits Ex: barriers to leisureClient GoalsEx: reduce barriersInterventions Ex: programs to reduce barriersImmediate Client Outcomes (^ Leisure K, S, A) Ex: ability to remove or reduce leisure barriersUltimate Client Outcomes (Life Satisfaction, Wellness, Quality of Life)Ex: independent functioning/invisibility
34 Connections Needs/Barriers Goal Setting Intermediate Outcomes Activities/Programs/InterventionsLong Term/ UltimateOutcomesProblem:lack of energy (Can’t walk 1 block)Goal:Increased energyObjective:Walk 12 blocksProgram:Exercise Program 4x/wk.IntermediateOutcome:Measurable increased energyOutcome: Ability to walk 12 blocksLong-Term Outcome:Sufficient energy for work, leisure, and personal effortsOutcome:Walk 1 mile
35 Typical TR Client Outcomes Functional Intervention Increased ability to manage anger appropriately Increased emotional control and healthy expressionLeisure Education Increase ability to make decisions related to leisure participation Increased knowledge of the importance of leisure in one’s lifeRecreation Participation Improved ability to express self within leisure context Improved ability to select and participate in activity(ies) of one’s choice
36 Guidelines for Outcomes Efficiency and effectiveness of demonstrating client changeReasonable relationship between the services provided and expected outcome(s)Connection between occurrence of outcome and timing of data collectionRelevance to client and societyGoals and intent of the program
37 Guidelines for Outcomes (cont’d) Appropriate level of specification, but not trivial detailIndividual client variation within any given programLong-term and short-term goals and objectivesSocial and home environment to which client will returnBehaviors that are generalizable and transferable to variety of settings and situations
38 Building Goal Oriented Activities and Outcomes Using LAM and TRAM to build programs and activities, based on goals and outcomes
39 Comprehensive and Specific Program Goals Key ConceptWhat program goals/areas will meet the needs of your client group(s)?My example: TR program for individuals with addictions
40 Comprehensive and Specific Program Goals 3.0 Stress Management3.1 Personal Responsibility3.2 Seeking Alternatives3.3 Decision-Making3.4 Social Support Networks1.0 Functional Intervention1.1 Emotional Control2.0 Social Skills2.1 Communication Skills2.2 Relationship-Building Skills2.3 Self-Presentation Skills
41 Comprehensive and Specific Program Goals 5.0 Leisure Resources5.1 Activity Opportunities5.2 Personal Resources5.3 Family and Home Resources5.4 Community Resources5.5 State and National Resources4.0 Leisure Awareness4.1 Knowledge of Leisure4.2 Self-Awareness in Leisure4.3 Leisure and Play Attitudes44 Related Participatory and Decision-making Skills
42 Comprehensive and Specific Program Goals 1.0 To provide programs which teach emotional control…2.0 To provide social skill instruction programs …2.1 To provide programs which directly teach a variety of communication skills, such as compromise, cooperation, negotiation, persuasion, active listening skills, etc.2.2 To provide direct instruction in relationship- building skills, such as self-disclosure and privacy skills, greeting and initiation skills, locating sober leisure partners, building social networks, etc.
43 Comprehensive and Specific Program Goals – Your Turn! 1. Get into small groups of no more than three or four individuals (with common clients) 2. Choose comprehensive program areas based on client needs. EX. Functional abilities, leisure awareness, social skills, leisure skills, leisure resources, recreation participation. 3. Develop comprehensive program goal statements. 4. Develop specific program areas based on client needs. 5. Develop specific program goal statements.
44 Activity Analysis, Selection and Modification Key ConceptWhat activities meet the purpose of the program goals?
45 Activity Analysis, Selection and Modification Programs Related to Goal Areas/Protocols/AssessmentMeet Needs of ClientsLeads to Client Outcomes
46 Activity Analysis, Selection and Modification Your Ideas. . .
47 Protocol Development Key Concept How can you standardize program delivery to clients to ensure outcomes?
48 Protocol Development Problem Definition Defining Characteristics Outcome CriteriaProcess CriteriaRelated factors/Etiologies
59 Quality Improvement/ Efficacy Research Key Concept How effective are your programs at producing targeted outcomes?
60 Quality Improvement/ Efficacy Research Major Aspects of CareIndicators (Outcomes)Criteria/ThresholdsMethods/Data SourcesEvaluate Care
61 Quality Improvement/ Efficacy Research Your Ideas. . .
62 Application to Your Program Comprehensive and Specific GoalsActivity Analysis, Selection and ModificationProtocol DevelopmentAssessment PlanClient DocumentationProgram and Client OutcomesQuality Improvement/Efficacy Research
63 Key Concepts Connections Between Content and Outcomes Comprehensive and Specific GoalsActivity Analysis, Selection and ModificationProtocol DevelopmentAssessment PlanClient DocumentationProgram and Client OutcomesQuality Improvement/Efficacy Research