Recently 23 instructional videos produced by the Recreation Therapy Video (RTV) Project directed by Professor David R. Austin, Ph.D., CTRS, of Indiana University have been posted at the Indiana University web site.

Topics of the RTV videos range from an introduction to recreation therapy, provided by “To Serve a Purpose,” to developing such skills as engaging in therapeutic communications, making client observations, completing documentation, giving and receiving clinical supervision, and understanding models of practice. Three separate videos extensively cover the history of recreation therapy and another presents pioneers in recreation therapy.

The list of videos available are:

1. Adaptive equipment
2. Case studies
3. Clinical supervision
4. Computer use in therapeutic recreation
5. Documentation and behavioral observation
6. Effective listening
7. Feedback in learning and performance situations
8. History of therapeutic recreation parts I, II, III
9. Individual program planning
10. Interactions with people who have disabilities
11. Models of practice : health protection/health promotion model
12. Models of practice : leisure ability model
13. Nonverbal communication
14. Portraits of pioneers in therapeutic recreation
15. Professional ethics
16. Professionalism in therapeutic recreation
17. Quality of life
18. Safe transportation : safely transporting clients
19. Therapeutic communication
20. Therapeutic recreation history : the formative years
21. Therapeutic recreation history: the modern era
22. To serve a purpose
23. Transfer techniques

Over the course of this past several months I have heard from about six employees that they are having a difficult time finding someone to take their recreation therapist or activity director job opening.  They say that they have posted job openings at the Therapeutic Recreation Directory, Monster.com, local newspapers, etc and was not able to find a suitable candidate and/or very few people applied for the job.

There is a state psych hospital near where I work that has had extreme difficulty in finding a TR for their rec therapy position for several years!

I don’t know what the real answer is.  I can only speculate… can it be that the position is in a very rural area and no one wants to relocate to such a setting?  Can it be that people are “picky” with the types of jobs or places they are willing to work?  Are people not willing to “pay the dues” and work in lower paying or less desirable jobs?  Are the pay scale too low?  With more colleges dropping TR programs are there not enough TRs out there?

I also hear from others having gone through many interviews and not being selected.

What are your thoughts?  I envite you to post your comments and experiences with your job searches.

Charlie Dixon

The following information regarding recreation is recommended and derived from the Epilepsy Foundation:

Leading an active life is good medicine for most children with epilepsy. Yet, getting overheated or physically tired may triggers seizures. Children may want to avoid exercising when it’s very hot and take breaks.

Most children with seizures, find that exercise is good in a number of ways. It makes them feel good and fights depression. It keeps their weight at reasonable levels so they look their best, and it builds self-confidence and self-esteem.

For all these reasons, the Epilepsy Foundation encourages people with epilepsy to engage in sports and recreation activities as part of a positive approach to an active life.

However, precautions are necessary for some activities.

Swimming and other water sports: Swimming is a wonderful exercise. However water can be a hazard for anyone, and especially people with epilepsy. If one becomes unconscious while in the water, or if a seizure causes him or her to fall into water, one could drown. Even taking a bath in a tub with a few inches of water can be dangerous for people with epilepsy.

It is therefore advisable to review one’s seizure control with the doctor to see whether water sports of any kind are appropriate for you at this point in your treatment. If one is still having seizures, he or she should not swim unless a lifeguard or a friend who is a good swimmer is there to provide help if need be. No one, whether or not he or she has epilepsy, should swim alone. Life jackets are a good idea for all watercraft activities and when swimming in oceans, rivers and lakes where water may not be as clear as it is in a swimming pool.

Mountain climbing: Heights are also a potential hazard to anyone who has epilepsy. It’s not only the risk of falling if you have a seizure, the reduced oxygen and atmospheric changes at the kind of elevations encountered in some kinds of mountain climbing may increase seizure risk, too.

This is not to say that someone with excellent seizure control should not go mountain climbing. But in doing so, take a long, considered look at the safety precautions and at any risks to one’s own well-being and that of other members of the party.

Contact sports: If a teenager wants to participate in contact sports like tackle football, he or she needs to consider the risks of a blow to the head. If playing contact sports is important, discuss it with a doctor or other health professional and/or with the team physician.

Other special activities: Similar considerations obviously apply to sky diving, water skiing, hang gliding, scuba diving, or any sports activity that would be hazardous if you were suddenly to lose consciousness or be unable to control your movements. Participation in these activities should be decided individually, in consultation with a doctor, and after careful consideration of the risks involved.

Ultimately, maintaining a good quality of life is paramount. Children with epilepsy are often misunderstood by peers. It is my sincere hope that recreation professionals can facilitate the process of providing free choice recreation for all children with epilepsy.

Civil Rights for the Disabled include the right to recreate and or pursue a leisure lifestyle. Those who receive nursing care at home are often denied access to leisure activities because private insurance companies refuse to pay home health aides to travel out of the home. They cann assist the patient open bathroom doors, reach ticket windows, cut up foods, assist on shopping trips or attend picnics in a park. Rather, the home health aide is restricted to travel except for medical appointments.

Being a spastic-quad presents many interesting challenges. Access to leisure is extremely important to me, the patient, who led an active leisure lifestyle. Less than ten years ago I skied to the top of NY’s highest mountain. Post my diagnosis of MS, I paddled a canoe in the Vermont wilderness, camped outside in the Catskills and attended many outdoor events including baseball games. Using a motorized wheelchair did not stop me.

For the home heath care agency that provides my care, I am a difficult patient because I refuse to stay in bed. My home is equipped with a remote controlled powered Hoyer lift system, roll-in shower, accessible gardens and all the modern technology for multi-media TV/DVD/CD/MP3 music experiences. Still, I need to experience Broadway shows, concerts, lectures and other opportunities for leisure. My home health aide can make this happen. I am not dead. I need nursing help for getting out of bed, for my ADLs and for other needs like locking the door behind me.

A “nursing home without walls” is my private home. It cost the government less than being in a nursing home. Yet, Recreation is not provided outside the home if nursing care is needed. Something is wrong with this system. As a former RT professional, I am stunned.
Recreation outside the home improves the quality of life.
Charles Sourby MS Ed, HTR

As of late there has been an increase in the number of TR/RT groups at www.facebook.com. As of yesterday there are now nearly 40 TR/RT groups at Facebook. Facebook provides a great way to interact with fellow TRs. However, having so many TR/RT groups means that to stay in touch with everyone you would have to join all of the groups.

Having one consolidated group would make sense to me. ATRA recently started a group at Facebook. You may want to consider joining this group as it represents the largest group of TR/RTs.

Charlie

It is very important to revisit all created standard documentations, that capture resident’s/client’s detailed, profile and functions. Today there are changes occurring on the MDS coding that impact the reimbursement dollars of each resident and client. This is an opportunity for Recreaton Therapists to re-visit all documentations pertaining to their client’s care  and examine the interventions . Why is it important? Well lets’ take for example, all  the physical activities and examine how each beneficial captured documented movement can help the rehab department.By adding points to the codes that may increase the reimbursement dollars. i.e. adapted sports, exercise, etc. The MDS has broken down all aspect of care per client, leaving the surveyors to examine the level of assistance and services rendered . This is really important to know because it affects the codes that pay for services, which may be much less from  just a couple of months ago. What this all balls down to is the possibility of less money per client. Some  years ago I created an activities assessment  tool that sub-dividied all the recreational activities within  the five domains including: cognitive,social,emotional. physical and spiritual activities. This tool was the beginning of revisiting an existing documentation process that included the assessment tool in making sure that the recreational services met the expected domain  and detailed other areas that collaborated with other discipline’s goals of service.  This is what is needed today especially in Nursing Homes where cuts are expected and a need for collaboration within other departments is necessary for the existence of organization. I urge all to revisit all TR to revisit  all of the forms to examine their purpose and delivery of service. it should also be designed to credit the recreational services rendered that has a true impact to each individual.

I plan to speak the NYSTRA Conference on March 31 st at Saratoga Springs to address this concern more clearer with my colleague Rehab Director who has collaborated with the recreation department due to the respect and acknowledgement of our contribution in the continuum of rehab and restorative care service we otherwise don’t get credit for. I also plan to introduce New York’s very first Virtual Rehab service we use at CNR Center for Nursing and Rehabilitation  Nursing Home located in   Brooklyn New York.  

Assessments are crucially important now and should  capture information within the  areas expected for reimbursements. So Yes, we all have to re-visit our assessments and all other documentation forms that impact  our professional recreational services provided  that contribute to the authentic healing of our clients and assist in the contribution to the continuum of care and services of our clients. Especially in our  collaborating effort with  our interdisciplinary team.  

Brenda Torres CTRS Technohealer

www.technohealer.com

Should recreation therapist become licensed professionals?Recreation therapists in  North Carolina, New Hampshire and Utah are now licensed. New York State and other states are pursuing licensure.  In New York State we decided to pursue licensure because some regualtory agencies will only permit licensed professionals to facilitate core/essential groups. This mandate limits the scope of practice for recreation therapists in New York. We also beginning to notice that restrictions on what recreation therapists can do are spreading to other settings such as hospitals and day treatment centers.  I really feel that becoming licensed as a professional will only strengthen the integrity of the profession and what we do in our RT practice.

What do you think about licensure?

A recent poll at the Therapeutic Recreation Directory in showed that 255 (out of 290 votes) respondents are facing some type of cut backs in their work place.  Despite these cut backs it appears that the health care industry is doing quite well.  Since 2001, the health care industry has added 1.7 million jobs .  How are you doing at your place of employment? Are you facing cut backs?  Do you feel that your job is in jeopardy?  You are invitd to share your responses here.

Charlie Dixon

Assistive technology has the potential to enhance many aspects of an individual’s life. For example, augmentative and alternative communication (AAC) systems ranging from simple communication boards and wallets to sophisticated electronic communication devices enable people to communicate more effectively with care givers and peers.

Universal design enables everybody—not just people with disabilities—to navigate, manipulate, and appreciate our world.” Curb cuts, non-slip flooring, grab bars and automatic doors make life easier for everybody. Universal design has developed over the past 14 years but, is not exactly universal. Universal Design can eliminate the need for special accommodations.

Imagine being an individual who must plan his or her leisure pursuits only to places that offer Universal Design. People with disabilities are finding more choices to share with families and friends. This session explores how a former TR professional uses Assistive Technology and Universal Design to overcome the devastating effects of Multiple Sclerosis in maintaining an active leisure lifestyle.

USEFUL WEBSITES:

www.tubcutter.com/
www.NMSSLI.org

CHARLES SOURBY

Assessment tools in oncology are developed by the TR department, conducted within 72 hours of admission, are an initial assessment document and do not repeat information found elsewhere in the chart.

Willetts and Sperling (1983), list the goals and objectives of therapeutic recreation in serving the cancer patient this way: (1)to educate or re-educate patients in the constructive use of their leisure time, during hospitalization and/or after discharge; (2)to eliminate boredom and as a result, to help alleviate stress and anxiety; (3)to provide a variety of unique recreation and cultural opportunities to patients; (4)to help patients regain or reinforce their self esteem through recreation experiences; (5)to provide emotional and psycho-social support to patients and their families; (6)to adapt leisure activities for patients, based on their physical and emotional needs; and (7)to continue, as much as possible, the patient’s normal leisure activities during hospitalization.

The recreation therapist plays many roles in an oncology setting; assessing the patient’s functioning, establishing goals and objectives, designing an appropriate treatment plan, evaluating each patient’s progress and enhancing the patient’s personal capacity to cope with the disease process (Willetts & Sperling, 1983).

Stensrud (1993) writes: “The therapeutic recreation professional has a responsibility to address death in order to help people live fully until they die. It is our responsibility as professional recreation therapists to address the sensitive subject of death awareness because we often have the best opportunities to do so. We are frequently called upon to be the confident of our clients. We connect with their expressive domains and encourage cathartic release of emotions through re-creative activities. We are present at some of the most powerful occasions, when, for example, the magic of the leisure experience can open a person to poignant insights.” (Stensrud, 1993, p.36)

This can occur in small groups or at bedside through activities that address life and death issues through symbolism, interaction, and reflection. Indeed, experiences and insights are difficult to measure but, as therapists, we are called upon to facilitate the process, and, hope to be a catalyst in helping patients achieve goals and receive the benefits of therapeutic recreation, including an intinsic sense of hope.

REFERENCES

Stensrud, C. (1993) Quality of living until death: A fusion of death awareness into therapeutic recreation-leisure education, Loss, Grief, & Care, New York: 6(4) 33-37.

Willetts, H. C. & Sperling, A. (1983) The role of therapeutic recreationist in assisting the oncology patient to cope, New York, Futura Publications.

Charlie Nature