Chapter 14
HPR 453
THERAPEUTIC RECREATION
PRACTICE MODELS
QUESTIONS YOU ARE AND WILL BE ASKED…
What is TR?
 What are anticipated outcomes of TR?
 What strategies or interventions are used to
bring about the outcomes?
 What is the profession’s scope of practice?
 What is unique about TR?
 How does TR fit into health and human service
delivery systems?

PRACTICE MODELS ARE PHILOSOPHIES
They guide therapists
 Foundation for public policy
 Foundation for research
 Foundation for further development of the
profession
 2 Types of Practice Models

 Content
Models
 Practice Models
CONTENT AND PROCESS MODELS
Content Models identify the “what” or
substance of TR services
 Process models identify the “how” or means
(procedures for design and delivery)
 There are numerous Models and selection
should be made carefully – It guides everything
done in practice to produce outcomes for
clients

DIFFERING PHILOSOPHIES RESULT IN
DIFFERENT CONCEPTS OF LEISURE
End vs. Means to End
 Leisure Orientation – Outcomes related to
leisure behavior body of knowledge
 Therapy Orientation – Outcomes related to
change or improvement in functional behaviors
(medical, psychiatric, psychological, and human
development) body of knowledge

Currently TR delivered primarily in healthcare
arena
 Models must be congruent with medical model,
nonmedical models, public policy, professional
association, accrediting bodies (JC and CARF),
societal trends
 Limitations – Models are static diagrams –
practice is multifaceted

MODELS
1978 – Gunn and Peterson - TR Service Model
(Leisurability Model)
 Late 70s & early 80s – Philosophical views
continued to be discussed (Recreation vs.
Treatment vs. both vs. Leisurability)
 Mid to late 80s shift from leisure to healthcare
models

 Therapy
oriented (means) vs. Leisure oriented
(outcomes)
SHIFT FROM MEDICAL MODEL TO WELLNESS
Pew Health Commission (1995)
 Paradigm shift from illness, cures, and
separation of mind and body to…
 Holistic Health (mind and body), wellness and
prevention
 WHO defines health as …”a state of complete
physical, mental, and social well-being and not
merely the absence of disease or infirmity.”


Coding Systems
 ICD-10
is mainly used to classify causes of death
 ICF classifies health – based on psychosocial
model
ICF mainstreams the experience of disability
and classifies it as one dimension of a person
 Treatment has shifted from “process” to
“outcomes”

HEALTHY PEOPLE 2010
USDHHS, 2000

2 GOALS FOR NATION’S HEALTH AGENDA
INCREASE QUALITY AND YEARS OF HEALTHY LIFE
 ELIMINATE HEALTH DISPARITIES


“Quality of life reflects a general sense of
happiness and satisfaction with our lives and
environment. General quality of life encompasses
all aspects of life including health, recreation,
culture, rights, values, beliefs, and aspirations,
and the condition of a life which contains these
elements”
TR PRACTICE MODELS

Leisure Outcome Models
 Leisurability
Model – anticipated outcome is a
satisfying leisure lifestyle – independent
functioning of an individual in leisure experiences
and activities of their choice – This leads to
improved health, quality of life and well-being
Supposes that TRSs assist person’s with illness
and/or disabilities to overcome leisure barriers
 Continuum Model

HEALTH AND WELLNESS OUTCOMES MODELS

Health Protection/Health Promotion Model
(Austin, 1991 and continually updated)
 The
goal of TR is for clients to achieve the highest
level of health
 The purpose of TR is identified as enabling a client
to recover from a threat to health (health
protection) and to achieve optimal health (health
promotion)
 Prescriptive
activity, recreation and leisure
TR SERVICE DELIVERY MODEL AND TR
OUTCOME MODEL (CARTER, VAN ANDEL AND ROBB, 1995)
Meant to be used together – Outcome Model is
an extension of TR Service Delivery Model
 The purpose of TR is the maintenance or
improvement of the health status, quality of life
an/or functional capacities of clients through
the use of specially designed recreation or
experiential activities and processes”
 Overall outcome is QoL – Health status is
intermediate outcome

TR OUTCOME MODEL

Primary Components
 Functional
capacities/potential
 Health status/wellness
 Quality of life
Leisure function represents a complex
interaction of all the domains working together
 QoL is interrelated to functional capacities and
wellness

TR SERVICE DELIVERY MODEL

Goal – Empower the client to achieve her or his
desired goals and optimally experience a sense
of fulfillment, satisfaction, mastery and wellbeing
 Diagnosis/Needs
Assessment
 Treatment/Rehab
 Education
 Prevention/Health
Promotion