1. The following presentation is a repeat of the presentation given at the 17 th Annual CTRA conference. BCTRA Teleconference December 4 th 2013

2. TR à la carte : INNOVATION, ADAPTATION, INSPIRATION 17th Annual CTRA Conference May 17th, 2013 Montreal, Quebec Canada Presented by : Jane Crawford CTRS

3. Disclosure Employee of Alberta Health Services – Living Well Program Calgary Zone Recipient of the Alberta Therapeutic Recreation Calgary Chapter Scholarship program I have no relevant financially or non financial relationships to disclose.

4. Session Objectives Two Self Care Management Models Recreation Therapy and Self Care Management Potential challenges building TR into a very established program

5. Psychology review Humanistic Psychology Positive Psychology

6. Chronic Disease/Chronic Illness Disease Chronic disease is an illness that is prolonged, do not resolve spontaneously and are rarely cured completely. Both communicable and non communicable http://www.cfp.ca/content/53/12/2086.full Illness Chronic illness refers to the lived experience of long- term bodily or health disturbance, It is experience of intrusive bodily or mental unwelcome pleasant sensations

7. HEALTH SYSTEM MODEL CHARACTERISTIC CHRONIC CARE MODEL FAMILY MEDICINE AS MEDICAL SPECIALTY MULTIDISCIPLINARY PRIMARY CARE NEW ORIENTATIONS OF PRIMARY HEALTH CARE View of health Absence; control of disease; quality of life Absence; control of disease Absence; control of disease; quality of life Positive well-being Locus of control Health system managers, self- management Medical practitionersHealth professionals Communities, families, and individuals Main focus Health systems Patient self-management Providers Individuals Cradle-to-grave disease prevention and control through medical interventions Practice-based Cradle-to-grave disease prevention, management, and care through provider interventions Population- and community-based Improve individual’s family and community, healthy living, and equity Health care providers Multidisciplinary systems, including physicians, intersectoral and community collaboration Family physicians with other health care providers Family physicians as part of multidisciplinary teams Multidisciplinary networks include FPs and intersectoral collaboration Strategies for health Disease prevention and management systems across health sectors Self-management, care coordination, evidence, and community involvement Medical interventions and systems Acute care paradigm between secondary and tertiary care; evidence- based guidelines First-level health system Prevention, chronic disease management; structured and planned care; self-management with professional, peer, and family support Population health systems Health promotion, prevention, self-care, and illness support; address inequalities and determinants; community empowerment; accountability

8. Provincially for Self Management Every province is doing something. Often falls under health promotion/prevention portfolios Evidence informed practice Strong part of the work that occurs in the primary or family doctors office. Introduction of the allied health care professional in family doctors office Education opportunities make up the bulk of the programs offered

9. What is Self Management? “the tasks that an individual must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management, and emotional management of their conditions.” http://www.healthcouncilcanada.ca/tree/HCC_SelfMa nagementReport_FA.pdf page 7 http://www.healthcouncilcanada.ca/tree/HCC_SelfMa nagementReport_FA.pdf

10. Other definitions of Self Management Centre for Advancement of Health: 'involves (the person with the chronic disease) engaging in activities that protect and promote health, monitoring and managing the symptoms and signs of illness, managing the impact of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes.' http://www.cfah.org/ Stanford Definition: 'participants to make informed choices, to adapt new perspectives and generic skills that can be applied to new problems as they arise, to practise new health behaviours, and to maintain or regain emotional stability.' Lorig, K; et.al. Living with a Healthy Life with Chronic Conditions. Bull Publishing Company 2000

11. Wagner’s Model of Chronic Care

12. Flinders Self Care Model

13. Stanford Model Programs are designed to help people gain self- confidence in their ability to control their symptoms and how their health problems affect their lives Small-group workshops are given in community settings and on the Internet Facilitated by two leaders/moderators with health problems of their own Workshops are highly interactive, focusing on building skills, sharing experiences, and support

14. Self Management Tasks To take care of the illness To carry out normal activities To manage emotional changes

15. Tool Box for Self Management Pain Management Fatigue Management Breathing Techniques Relaxing and managing emotions Nutrition Exercise Medication Community Resources. Communication with professionals

16. Tool Box for Diabetes Medication taking Diet Physical activity/exercise Blood Glucose Monitoring Managing high/low blood sugars Medical monitoring/ doctor visits Managing distress/depression Foot care Eye care

17. Roots of Recreation Therapy The professions roots can be found in Humanistic and Positive psychology Recreation Therapy applies interventions to change behaviours that promote growth and positive feelings Strength based interventions

18. National Philosophy Therapeutic Recreation is directed toward functional interventions, leisure education and participation opportunities. These processes support the goal of assisting the individual to maximize the independence in leisure, optimal health and the highest possible quality of life. www.canadian-tr.org/About

19. Alberta Official Definition Therapeutic Recreation/Recreation Therapy is a health profession which acknowledges the significance of leisure and recreation as integral components of optimal health and well-being of individuals with illnesses and disabling conditions. http://www.alberta-tr.org/

20. Evolution of RT Conceptual Models Early days there were general impressions provided but not truly conceptual models (e.g., “recreation for the ill and handicapped” or “recreation as a treatment tool.”). 1970s/1980s RT worked frantically to define itself (Leisure Ability Model was embraced). 1980s saw dissatisfaction with the Leisure Ability Model (Hamilton & Austin, 1992). Health Protection/Health Promotion Model presented in 1991 -- as an alternative to the Leisure Ability Model. Additional RT conceptual models have followed. Reformulated HP/HP Model in 2011. Slide taken from Dr. Austin’s presentation “The Reformulated Health Protection/Health Promotion Model”

21. Leisure Ability Model

22. Health Protection/Health Promotion Model

23. Skills of the Recreation Therapist Integration Encouraging independence Accentuating the positive Providing active listening Exploring new lifestyle options Setting appropriate goals.

24. Skills for the Clinician of Self Managed Client Motivational Interviewing Open ended inquiry Reflective Listening Has skills to bring about change Can measure conviction and confidence http://www.healthcouncilcanada.ca/tree/HCC_S elfManagementReport_FA.pdf page 9 http://www.healthcouncilcanada.ca/tree/HCC_S elfManagementReport_FA.pdf

25. Therapeutic Recreation and Self Management Client is an active participant in the process Client has a clear understanding of the end goal in both styles of programs Client can identify the symptoms and/or barriers and make the necessary changes when they encounter a health change Client can maintain a level of independence pursuing an activity that brings health improvements Client develops self efficacy and confidence in ones own environment and community

27. Living Well Program A support program for people with diabetes, high blood pressure, heart disease, chronic lung disease, chronic pain and other long term illnesses. There are three pillars to this program: supervised exercise classes education classes self management workshop (Better Choices, Better Health™).Better Choices, Better Health

28. Calgary Experience So why add Recreation Therapy 10 years after the program had started.

29. Community Partnership Building Understanding the core competencies of your program What will a client know when they leave Understanding the partners goals and missions What can the partner offer in their mandate

30. Professional Challenges Defining Recreation Therapy Language barriers – (definitions such as community integration) Isolation as the lone Recreation Therapist program. Learning curve

31. Future of TR in Living Well Program Strong community integration piece within the exercise pillar Group and 1/1 Recreation Therapy support as assessed in accessing community programs Development of TR role in the education pillar. Access to Recreation Therapy in the rural sites in 2014

32. Session Objectives Completed Can you name a Chronic Disease Model? What are the similarities of self management and recreation therapy models? What are some of the challenges a CTRS might face moving into an established Self Care Model?

33. Resources Health Council of Canada. Self –management support for Canadians with Chronic health conditions. A focus for primary health care. May 2012: http://www.healthcouncilcanada.ca/tree/HCC_SelfManagementRepor t_FA.pdf http://www.healthcouncilcanada.ca/tree/HCC_SelfManagementRepor t_FA.pdf Stanford Program Self Management: http://patienteducation.stanford.edu/programs/ http://patienteducation.stanford.edu/programs/ College of Family Physicians: http://www.cfp.ca/content/53/12/2086.full http://www.cfp.ca/content/53/12/2086.full Centre for Advancing Health: http://www.cfah.org/http://www.cfah.org/ Alberta Health Living Well Calgary Program: http://www.albertahealthservices.ca/services.asp?pid=service&rid=100 5671 http://www.albertahealthservices.ca/services.asp?pid=service&rid=100 5671

34. Reference List Alberta Health Services. Integrated Community Base Chronic Disease Management Program. A proposed Model for Alberta. Presented by: Community &Rural, Primary Care & Chronic Disease Management Anderson, L. & Heyne, L. “Flourishing through Leisure: An Ecological Extension of the Leisure and Well Being Model in Therapeutic Recreation Strengths- Based Practice. Therapeutic Recreation Journal Vol. XLVI No 2 pp 129-152. 2012 Austin, D. Lessons Learned An Open Letter to Recreational Therapy Students and Practitioners, Sagmore Publishing 2011

35. Reference List continued Austin D. Therapeutic Recreation Processes and Techniques 5 th Ed. Sagmore Publishing 2004 Austin, D. Reformulation of the Health Protection/Health Promotion Model American Journal of Recreation Therapy Volume 10 Number 3 pages 19-26 Austin, McCormick & Van Puymbroeck, Positive Psychology: A theoretical foundation for Recreation Therapy. American Journal of Recreation Therapy Vol.9 No. 3

36. Reference List continued Choices and Changes: Clinician Influence and Patient Action Workshop, Institute for Healthcare Communication. January 2013 Chronic Disease Prevention and Management Conference. Calgary 2007 Dieser, R. A Cross Cultural Critique of Newer Therapeutic Recreation Models: The Self Determination & Enjoyment Enhancement Model, Aristotelian Good Life Model, & the Optimizing Lifelong Health Through Recreation Model. Therapeutic Recreation Journal 4 th Quarter 2002 p 352-368

37. Reference List Continued Hood & Carruthers. Enhancing Leisure Experience and Developing Resources: The Leisure and Well Being Model Part I. Therapeutic Recreation Journal Vol 41 No 4 276 -297. 2007 Hood & Carruthers. Enhancing Leisure Experience and Developing Resources: The Leisure and Well Being Model, Part II. Therapeutic Recreation Journal Vol. 41, No. 4. 298-325 2007 Keogh Hoss & Kensinger, Medical Home: Is there a place for recreational therapy? American Journal of Recreation Therapy, Vol. 9 N0. 2

38. Reference List Continued Lee and McCormick: 2002 Sense Making Process in Defining health for People with Chronic Illnesses and Disabilities. Therapeutic Recreation Journal 3 rd Quarter Vol 36. No 3 235- 246 Loitz et al, Sociodemographic Patterns of Leisure-Time Physical Activity of Albertans 2000 to 2011. Health and Fitness Journal of Canada Vol. 5 No.1 Lorig, K; et.al. Living with a Healthy Life with Chronic Conditions. Bull Publishing Company 2000 Mobilily, K. Role of Exercise and Physical Activity in Therapeutic Recreation Services. Therapeutic Recreation Journal Vol. XLIII, No 2 pp 9-26, 2009

39. Reference List Continued Mobily & MacNeil, Therapeutic Recreation and the Nature of Disabilities Venture Publishing 2002. Parker, V. & Carmack, R. A Critique of Van Andels’s TR Service Delivery and TR Outcome Models. Therapeutic Recreation Journal 3 rd Quarter 1998 Porter & Burlingame. Recreational Therapy Handbook of Practice, ICF-Based Diagnosis and Treatment Idyll Arbour 2006 Shank & Coyle. Therapeutic Recreation in Health Promotion and Rehabilitation, Venture Publishing 2002

40. Reference List Continued Sylvester, C. Therapeutic Recreation, the international Classification of Function, Disability and Health, and the Capability Approach. Therapeutic Recreation Journal Vol., XLV, No 2 pp. 85-104 2011. Wilhite, B. et al. Optimizing Lifelong health and Well Being: A Health Enhancing Model of Therapeutic Recreation. Therapeutic Recreation Journal. 2 nd Quarter 1999 p98-108

41. Thank you – BCTRA Contact information: jane.crawford@albertahealthservices.ca