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Sunday, November 8, 2009

Standards of practice in rec therapy

Marcia Smith, M.A., CTRS, H/FI and Jim Barrett, M.S., TRS/CTRS presented on the American Therapeutic Recreation Association’s Standards of Practice: Getting It Off The Shelf on Sunday, October 4th, 2009 at the annual conference in Minneapolis, Minnesota.

I had the privilege to attend this session.

All recreational therapists should have a copy of “Standards for the Practice of Therapeutic Recreation & Self-Assessment Guide.” It is published by the American Therapeutic Recreation Association. If you don’t have this book already then you’ll need to get a copy of it as soon as possible.

Get a copy of it here:

Objectives for this training session included:

a.) Develop knowledge of the standards of practice
b.) Develop skills needed to use the standards of practice self-assessment guide
c.) Develop understanding of how the standards of practice can improve services
d.) Develop an understanding of the relationship between the ATRA – standards of practice and other accreditation standards, including: the Joint Commission, and CARF.

Here, I’ll explain a little about each of the objectives.

Standards of Practice (SOP) developed by the American Therapeutic Recreation Association (ATRA) include the following: Note that I’ve re-worded these standards based on my own understanding of them.

Standard # 1: Assess the patient to determine strengths and areas of needed improvement

Standard # 2: Development of a treatment plan with goals and objectives

Standard # 3: Implementing the treatment plan (using interventions) to restore, remediate, or rehabilitate in order to improve functioning independence and eliminate effects of illness or disability.

Standard # 4: Evaluate patient/ client’s response to treatment

Standard # 5: Develops a discharge plan with patient, family, and treatment team members.

Standard # 6 Provide opportunities for recreation to help promote or improve health and well-being.

Standard 7: Follow the Code of Ethics

Standard 8: Have a written plan of operation for the TR department that is in alignment with the ATRA standards of practice

Standard 9: TR department has provisions for assuring that TR staff maintain their credentials and have opportunities for professional development.

Standard 10: TR department to have quality improvement plan in place to help resolve problems and improve TR services

Standard 11: Services be provided in an effective and efficient manner with reasonable and appropriate use of resources

Standard 12: TR department engages in routine, systematic program evaluation and research for the purpose of determining appropriateness and efficacy.

Self-Assessment Guide:

The self-assessment guide is like a grade-card. A department manager could use it to determine the effectiveness of recreational therapists and the overall department. It is very individualized. Each section can be scored to determine if standard is being met. It can’t be assumed that the standard is being met. An evaluator can’t say, “Yeah, we do that, and check it off.” That is not good enough.

I think it would be better to have an outsider to come in and do the evaluation. Here is an example: the recreational therapists at private psychiatric hospital could evaluate the program at state psychiatric hospital. The recreational therapists at state psychiatric hospital would naturally, return the favor and evaluate the services at private psychiatric hospital. This could help to improve services for both hospitals. Of course, I understand this would be tough to do because of confidentiality, hospital politics, and possible conflicts of interests. An outsider is more objectives. They won’t be able to say, “yeah, they’re meeting that.” The outside will need to see evidence and proof.

There are several ways to evaluate the standards. These include chart audits, hospital policy audits, outcomes audit, etc.

How do Standards of Practice Improve Services?

Naturally, as a profession, we want to assure the public that we’re providing quality care. There are certain standards that must be met in order to meet minimum standards. All professions have standards. Even fast-food places, like McDonalds have standards that their employees must adhere to. If, we, recreational therapists are not meeting and/ or exceeding the basic standards then we’re not providing the best quality services to our patients. We’re not just providing fun, games, and activities. We’re providing quality healthcare services. Healthcare is expensive and people want outcomes. Naturally, we must follow standards to assure the patient/ client/ consumer is getting the best quality services.

The standards of practice also help to keep services consistent. I’ll use McDonalds again for consistency. You can go to a McDonalds here in my home state of West Virginia or to a McDonalds across the border in Ohio or Kentucky and you’ll get the same experience. The food is going to be the same. The menu is going to be the same (for the most part). McDonalds is consistent.

Therapeutic Recreation standards help make our services consistent, too. Two people have a stroke. One receives rehabilitation services in California and one receives rehabilitation services in Ohio. Are they both going to get the same consistent Therapeutic Recreation services? I understand that we are a diverse profession and that we provide a variety of interventions. Let’s say that one of the two individuals receive services that are grounded in research and evidenced-based practice. The department meets all of the standards of practice with at least 4 out of 5 on the self-assessment guide. The other individual die receive services from a TR department that doesn’t even know about the standards of practice, nor do they know if the interventions they’re providing have been proven to bring about outcomes. Which patient do you think is going to receive the better quality of service?

Standards equal quality service.

Standards are always increasing. An example is that several states are requiring their recreational therapists to have a license to practice. This standard assures that the provider has met minimum standards needed to practice. Currently, four states require a license to practice in the field: Utah, New Hampshire, North Carolina, and Oklahoma. Two states have a registration: Washington (state) and California. Of course, I want us to be consistent. I’d like to see the licensure in all 50 states, the District of Columbia, and Puerto Rico.

Here is an important standard that should be met, but it is not listed in the ATRA – standards of practice.

New Standard and policy should be that TR services (a.k.a.) recreational therapy services must be physician ordered. In fact, providing therapy without a physician order is a big liability. Physician could recommend services, including: community reintegration, biofeedback, animal-assisted therapy, etc. based on the patient’s needs. Of course, the physician order could be as simple as “Recreational therapist evaluate and treat patient.”

Of course, the recreational therapist should always get additional training and qualifications to provide sessions. A recreational therapist should just assume that she (or he) is qualified to provide the service.

I believe that recreational therapists in North Carolina must have proof that they have skills needed to provide various treatment interventions. In example, if the recreational therapist does not have competence in providing self-esteem interventions, the she (or he) can’t provide them. (I’m not certain on this fact), but I do believe it is that way in N.C. or at certain hospitals in the state.

Why are the standards important?

Healthcare is serious business. It is vital that we’re proving effective services. Funding for healthcare is limited. Third-party payers, insurance companies, and even private payers don’t’ want to pay for services that are not needed or not effective.

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