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Friday, October 9, 2009

Ed., Economics, and Emplyment in RT

Picture: Missy Armstrong and Marry Ann Keogh-Hoss.

A review of “Education, Economics, and Employment in Recreational Therapy” by Missy Armstrong and Mary Ann Keogh-Hoss


Armstrong, M., & Keogh-Hoss, MaryAnn. (2009, Oct. 3rd) Education, economics, & employment in recreational therapy. Poster session presented at annual conference of the American Therapeutic Recreation Association, Minneapolis, MN.

The purpose of this session was to explore the impact of education, economics, and employment on the practice of recreational therapy. Both the structural and attitudinal attributes of professionnalization were discussed during this session.

Four self-awareness questions were asked at the start of this session:

a.) What is your most significant learning opportunity that changed something you’ve done (an example) safety process.
b.) What is your least professional moment?
c.) Moment you realized you were being treated like a professional?
d.) What is your Recreational Therapy (RT) elevator speech?

Here are some current health trends:

Customer satisfaction is a measurement of quality care and a hospital’s public rating.
Consumers expect quality care by qualified professionals
Regulatory (rules and laws) are designed to keep the public safe. These laws could include the required registration, certification, or licensure of a professional.

Hospitals have voluntary standards, including Joint Commision, CARF, NCQA.

Recreational therapist have professional standards set by the American Therapeutic Recreation Association (ATRA) and the National Council for Therapeutic Recreation Certification (NCTRC). If you’ve not done so already, I [Danny Pettry] highly recommend for you to get a copy of the Standards of Practice (2000) published by ATRA. It is a self-assessment guide.

Here are some Joint Commission standards:
Age/ culture
Methods of assessment
Scope of practice
Applicable supportive services
Available necessary competent staff
Services meets the need

A very important point was made during this session. Recreational therapists need to represent themselves at a higher level of professionalism.

One of the speakers said these were the “4-no-Bs:”
Butts, backs, bellys, or boobs. Later, an individual in the audience added a 5th “b” beer.

Naturally, we, recreational therapists are professionals providing a professional service.

Here is a quick example from my personal experience. I provide recreational therapy services for a children’s residential program. All of these children have been abused in some way including physical, emotional, and/ or sexual. These children have learned to “act-out” the same abusive behaviors on others.

I have many nursing students sit in on recreational therapy group interventions during the autumn “back-to-school” season. In the past, I’ve had to ask nursing students to leave because their shirts were to low-cut, or because they were using profanity during an intervention. During one session, a boy could not stop starring/ gazing at the female nursing student with the low cut shirt. During one “social skills building” two females nursing students who were good friends attended. We were using some type of card game as the vehicle to get the children to use appropriate social skills, including: talking nicely, taking turns, being considerate. One nursing student nearly slipped out a curse word when her female nursing student got her card or something.

In this case, I had to be the professional and set the boundaries and limits with the student, their instructor, and the nurses. We, recreational therapists could appear to be only “fun and games” from an outsider prospective, however, we are professionals who are trained to provide a service.

Competencies are important. Naturally, a recreational therapist with no training in a certain intervention would not attempt to provide the intervention because it could be harmful to the patient. A recreational therapist should continuing her (or his) knowledge and development in the profession to gain more competences and to provide better services.

Missy Armstrong talks about an article called, “Big Red Dog.” It said that the recreational therapist had her father to sit down in a group circle to listen to the children’s story “big red dog.” Her father had had a stroke and would never be able to fly an airplane again. I’m not sure if this “big red dog story” was time-filler or what the purpose of the story was in this case. However, an article was published. The key point here is to never infantile a consumer.

Be aware, that we, recreational therapists are part of the treatment team.

We must prove ourselves that we’re a necessity vs. something nice to have.

The 3Bs vs. the 3Os were presented.

The 3 Bs include: bingo, bible, and birthday. These are nice activities to have.

The 3 Os include: options, opportunities, and outcomes. These are better.

Remember that documentation lasts forever. Here are some key points:

Remember why we’re doing what we’re doing.

Example of not-so-good documentation:
“patient participated in bingo. She smiled and expressed pleasure with the activity.” That is wonderful and nice, but it is not treatment focused. It is not goal-oriented. Anyone could lead a bingo game for people. The recreational therapist is striving to help the patient to gain functional outcomes as a result of the intervention.

Here is an example of better documentation for the same type of intervention:
“Patient demonstrated fine motor skills and cognitive functioning.” I [Danny Pettry] would add “as evidenced by.”

Here are some ideas for clinical standards:
Evidenced based practice
Clinical language
Analysis of need
Safe practice/ diagnostic specific
Team member
Competent practice

Evidenced based practice, includes:
Relevant need to consumer
Date driven

Why do we do an activity? The purpose is to meet the patient need. What is relevant to the patients inpatient care?

Tips for Costumer Service

Have standard treatment meetings with the patient. Danny P.: We have ours once per month for the children in our residential treatment program.
Recreational Therapy supports treatment team goals for the patient

Important Reminder: Healthcare services are being cut across the board. Danny P.: I had read an interesting idea. Someone said, “wear a band-aid.” When people ask about it, say, “cuts hurt.” I wouldn’t really do that. However, it does make a good point.

Try to always market recreational therapy.
Promote service with your team, family members, and others.

Competent Practice

The National Council for Therapeutic Recreation Certification (NCTRC) is considering developing divisional competencies, including: neuro, geri, pediatrics, psyh, etc.

Read various journals, not only in recreational therapy, but physical therapy, occupational therapy, or journals related to the population which you serve.

Physical therapy has a lot of evidenced based practice.

A lot of money is being spent on healthcare. Naturally, the consumer should be getting outcomes.

Recreational therapists could be helping with several areas of rising cost in Medicare, including: obesity, mental disorder, heart disease, arthritis, cancer.

Primary care physicians are often overwhelmed with seeing some patients. Recreational therapists could be the perfect discipline for helping in a Medical Home setting. The recreational therapist could assure that people are doing well, assess, educate, help people to be functional in their home and community, and make sure the patient only sees a primary care physician when needed. We could help physicians to understand our services. Recreational therapy is a service that is designed to be physician recommended. It starts with educating the primary care physicians with what we can do. They would love us recreational therapists for taking care of patients with chronic diseases when there is nothing else a physician can do for them. The recreational therapist could help the patient to maintain functioning. This could help an individual with chronic disease to have a life (and not one in an institution.) Do a quick google search and some research for “Medical Homes” in your own state.

No one else is going to promote our profession for us. It is the responsibility for each of us, recreational therapists.

Here are some questions to consider:

How are recreational therapists valued?
What value do our services bring to the organization?
What do services cost the organization?
What is the return/ gain of service to the organization?

These are vital questions that every recreational therapist should be able to answer.

Helpful Idea

Survey your co-workers to determine their understanding of a recreational therapist’s competencies. Educate staff after the survey. Measure the difference 6-months after an in-service educational training.

Talk about the evidence and document the evidence well.

To be cont. soon.

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