Competencies and Outcomes in Therapeutic Recreation Chapter 1 HPR 453

Professional Competency / Service Outcomes Questions to ask…. What does the profession do? How do we provide care? Are we a system or a single modality? Why? How? How is it similar to/different from other healthcare professions? Who do we treat? Range of conditions/diagnoses/illnesses/disabilities? How do we measure up to external norms?

What is professional competence? Ability to provide patient-centered care Ability to work in interdisciplinary teams to provide continuous, reliable care Utilize evidence-based practice through best practices, clinical expertise, and patient preferences Ability to incorporate quality assessment and quality improvement Ability to utilize informatics to communicate, manage data and reduce error

Professional Competence defined “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.” Epstein and Hundert (2002) See dimensions of Professional Competence – pg 5 in text

A professional’s competence is closely related to his or her ability to provide high-quality services that help the client achieve desired and meaningful outcomes. “The individual recreation therapist has a considerable impact on outcomes, both in research and in practice settings. Being the best clinician possible is, therefore, important in advancing evidence-based practice.” Buettner and Fitzsimmons (2007) Professional competence must be monitored to prevent putting the client at risk.

What are Client Outcomes? “The documentable changes in client behavior, skills, and/or attitudes that can be attributed to active participation in the therapeutic recreation intervention program” Dunn, Sneegas & Carruthers, 1991, Stumbo and Peterson, 2009; Shank and Kinney, 1991; Stumbo, 1996 The differences in the client from the beginning compared to the end of treatment

Healthcare Outcomes Categories Clinical status – Measured at organ level ie. Blood pressure, temperature, white blood cell count, respiration, fitness Functional status – ability to fulfill social and role functions; successful, productive and satisfying life ie. ADLs; leisure lifestyle, life and self-care skills, safety; stability of living environments; relationship abilities, such as marriage, parenting and sibling interactions; school or employment status; and engagement in at-risk behaviors

Satisfaction – (with services rendered) Well-being or Quality of Life (QoL) – Satisfaction with living conditions, work or school, leisure, finances and whether basic and fundamental needs are met Satisfaction – (with services rendered) Pts opinion on whether care is accessible, affordable, effective and professional Costs and resource consumption – Balance the need to reduce costs with unfavorable impacts on the quality of care

Outcome Measuring Criteria Be widely accepted Be comprehensive Be suitable or meaningful Be sensitive to change Be psychometrically sound Be statistically amenable Be practical or actionable

Evidence-Based Practice The services delivered to clients should be based on the best available scientific evidence of treatment efficacy or effectiveness Designed or delivered using research evidence to implement “best practices” Moving clients toward desired outcomes in the most effective and efficient way possible

Advance quality of care and services RTs provide Have fewer variations in RT practice Have cost savings that flow from appropriate and timely RT intervention use Improve health outcomes in general

Effectiveness – everyday circumstances, routine, real world Efficacy – Ideal, more controlled circumstances, research EBP – provider should feel confident that he or she is providing the best possible care that is known to produce the most desirable, intended, and meaningful outcomes