The following presentation is a repeat of the presentation given
at the 17th Annual CTRA conference.
BCTRA Teleconference
December 4th 2013
TR à la carte : INNOVATION, ADAPTATION, INSPIRATION
17th Annual CTRA Conference
May 17th, 2013 Montreal, Quebec Canada
Presented by : Jane Crawford CTRS
Disclosure
 Employee of Alberta Health Services – Living Well Program
Calgary Zone
 Recipient of the Alberta Therapeutic Recreation Calgary
Chapter Scholarship program
 I have no relevant financially or non financial relationships to
disclose.
Session Objectives
 Two Self Care Management
Models
 Recreation Therapy and
Self Care Management
 Potential challenges building
TR into a very established
program
Psychology review
 Humanistic Psychology
 Positive Psychology
Chronic Disease/Chronic Illness
Disease
Illness
 Chronic disease is an illness
 Chronic illness refers to the
that is prolonged, do not
resolve spontaneously and
are rarely cured completely.
 Both communicable and non
communicable
lived experience of longterm bodily or health
disturbance,
 It is experience of intrusive
bodily or mental
unwelcome pleasant
sensations

http://www.cfp.ca/content/53/12/2086.full
HEALTH SYSTEM MODEL
CHARACTERISTIC
CHRONIC CARE MODEL
FAMILY MEDICINE AS
MEDICAL SPECIALTY
MULTIDISCIPLINARY
PRIMARY CARE
NEW ORIENTATIONS OF
PRIMARY HEALTH CARE
View of health
Absence; control of
disease; quality of life
Absence; control of
disease
Absence; control of
disease; quality of life
Positive well-being
Locus of control
Health system
managers, selfmanagement
Medical practitioners
Health professionals
Communities, families,
and individuals
Main focus
Individuals
Health systems Patient Cradle-to-grave
self-management
disease prevention and
control through
Providers
medical interventions
Practice-based
Cradle-to-grave
disease prevention,
management, and care
through provider
interventions
Population- and
community-based
Improve individual’s
family and community,
healthy living, and
equity
Health care providers
Multidisciplinary
systems, including
physicians,
intersectoral and
community
collaboration
Strategies for health
First-level health
Disease prevention and
Medical interventions system
management systems
and systems
Prevention, chronic
across health sectors
Acute care paradigm
disease management;
Self-management, care
between secondary and structured and planned
coordination, evidence,
tertiary care; evidence- care; self-management
and community
with professional, peer,
based guidelines
involvement
and family support
Multidisciplinary
Family physicians with Family physicians as
networks include FPs
other health care
part of
and intersectoral
providers
multidisciplinary teams
collaboration
Population health
systems
Health promotion,
prevention, self-care,
and illness support;
address inequalities
and determinants;
community
empowerment;
accountability
Provincially for Self Management
 Every province is doing something.
 Often falls under health promotion/prevention portfolios
 Evidence informed practice
 Strong part of the work that occurs in the primary or
family doctors office. Introduction of the allied health
care professional in family doctors office
 Education opportunities make up the bulk of the
programs offered
What is Self Management?
 “the tasks that an individual
must undertake to live well
with one or more chronic
conditions. These tasks
include having the
confidence to deal with
medical management, role
management, and
emotional management of
their conditions.”

http://www.healthcouncilcanada.ca/tree/HCC_SelfMa
nagementReport_FA.pdf page 7
Other definitions of Self Management
 Centre for Advancement of Health:
 'involves (the person with the chronic disease) engaging in activities
that protect and promote health, monitoring and managing the
symptoms and signs of illness, managing the impact of illness on
functioning, emotions and interpersonal relationships and adhering to
treatment regimes.' http://www.cfah.org/
 Stanford Definition:
 'participants to make informed choices, to adapt new perspectives and
generic skills that can be applied to new problems as they arise, to
practise new health behaviours, and to maintain or regain emotional
stability.' Lorig, K; et.al. Living with a Healthy Life with Chronic
Conditions. Bull Publishing Company 2000
Wagner’s Model of Chronic Care
Flinders Self Care Model
Stanford Model
 Programs are designed to help people gain self-
confidence in their ability to control their symptoms and
how their health problems affect their lives
 Small-group workshops are given in community settings
and on the Internet
 Facilitated by two leaders/moderators with health
problems of their own
 Workshops are highly interactive, focusing on building
skills, sharing experiences, and support
Self Management Tasks
 To take care of the
illness
 To carry out normal
activities
 To manage emotional
changes
Tool Box for Self Management
 Pain Management
 Fatigue Management
 Breathing Techniques
 Relaxing and managing





emotions
Nutrition
Exercise
Medication
Community Resources.
Communication with
professionals
Tool Box for Diabetes
 Medication taking
 Diet
 Physical activity/exercise
 Blood Glucose Monitoring
 Managing high/low blood




sugars
Medical monitoring/ doctor
visits
Managing
distress/depression
Foot care
Eye care
Roots of Recreation Therapy
 The professions roots can
be found in Humanistic and
Positive psychology
 Recreation Therapy applies
interventions to change
behaviours that promote
growth and positive feelings
 Strength based
interventions
National Philosophy
 Therapeutic Recreation is
directed toward functional
interventions, leisure
education and participation
opportunities. These
processes support the goal
of assisting the individual to
maximize the independence
in leisure, optimal health
and the highest possible
quality of life.
 www.canadian-tr.org/About
Alberta Official Definition
 Therapeutic
Recreation/Recreation
Therapy is a health
profession which
acknowledges the
significance of leisure and
recreation as integral
components of optimal
health and well-being of
individuals with illnesses and
disabling conditions.
 http://www.alberta-tr.org/
Evolution of RT Conceptual Models
• Early days there were general impressions provided but not truly
•
•
•
•
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conceptual models (e.g., “recreation for the ill and handicapped” or
“recreation as a treatment tool.”).
1970s/1980s RT worked frantically to define itself (Leisure Ability
Model was embraced).
1980s saw dissatisfaction with the Leisure Ability Model (Hamilton &
Austin, 1992).
Health Protection/Health Promotion Model presented in 1991 -- as an
alternative to the Leisure Ability Model.
Additional RT conceptual models have followed.
Reformulated HP/HP Model in 2011.
•
Slide taken from Dr. Austin’s presentation “The Reformulated
Health Protection/Health Promotion Model”
Leisure Ability Model
Health Protection/Health Promotion Model
Skills of the Recreation Therapist
 Integration
 Encouraging
independence
 Accentuating the
positive
 Providing active
listening
 Exploring new lifestyle
options
 Setting appropriate
goals.
Skills for the Clinician of Self Managed Client
 Motivational Interviewing
 Open ended inquiry
 Reflective Listening
 Has skills to bring about
change
 Can measure conviction
and confidence

http://www.healthcouncilcanada.ca/tree/HCC_S
elfManagementReport_FA.pdf page 9
Therapeutic Recreation and Self Management
 Client is an active participant in the process
 Client has a clear understanding of the end goal in both
styles of programs
 Client can identify the symptoms and/or barriers and
make the necessary changes when they encounter a
health change
 Client can maintain a level of independence pursuing an
activity that brings health improvements
 Client develops self efficacy and confidence in ones own
environment and community
Living Well Program
 A support program for people
with diabetes, high blood
pressure, heart disease, chronic
lung disease, chronic pain and
other long term illnesses.
 There are three pillars to this
program:
 supervised exercise classes
 education classes
 self management workshop
(Better Choices, Better
Health™).
Calgary Experience
 So why add Recreation
Therapy 10 years after the
program had started.
Community Partnership Building
 Understanding the core
competencies of your
program
 What will a client know
when they leave
 Understanding the
partners goals and
missions
 What can the partner
offer in their mandate
Professional Challenges
 Defining Recreation Therapy
 Language barriers –
(definitions such as
community integration)
 Isolation as the lone
Recreation Therapist
program.
 Learning curve
Future of TR in Living Well Program
 Strong community integration piece within the
exercise pillar
 Group and 1/1 Recreation Therapy support as
assessed in accessing community programs
 Development of TR role in the education pillar.
 Access to Recreation Therapy in the rural sites in
2014
Session Objectives Completed
 Can you name a Chronic
Disease Model?
 What are the similarities of
self management and
recreation therapy models?
 What are some of the
challenges a CTRS might
face moving into an
established Self Care
Model?
Resources
 Health Council of Canada. Self –management support for Canadians




with Chronic health conditions. A focus for primary health care. May
2012:
http://www.healthcouncilcanada.ca/tree/HCC_SelfManagementRepor
t_FA.pdf
Stanford Program Self Management:
http://patienteducation.stanford.edu/programs/
College of Family Physicians:
http://www.cfp.ca/content/53/12/2086.full
Centre for Advancing Health: http://www.cfah.org/
Alberta Health Living Well Calgary Program:
http://www.albertahealthservices.ca/services.asp?pid=service&rid=100
5671
Reference List
 Alberta Health Services. Integrated Community Base Chronic
Disease Management Program. A proposed Model for
Alberta. Presented by: Community &Rural, Primary Care &
Chronic Disease Management
 Anderson, L. & Heyne, L. “Flourishing through Leisure: An
Ecological Extension of the Leisure and Well Being Model in
Therapeutic Recreation Strengths- Based Practice.
Therapeutic Recreation Journal Vol. XLVI No 2 pp 129-152.
2012
 Austin, D. Lessons Learned An Open Letter to Recreational
Therapy Students and Practitioners, Sagmore Publishing 2011
Reference List continued
 Austin D. Therapeutic Recreation Processes and Techniques
5th Ed. Sagmore Publishing 2004
 Austin, D. Reformulation of the Health Protection/Health
Promotion Model American Journal of Recreation Therapy
Volume 10 Number 3 pages 19-26
 Austin, McCormick & Van Puymbroeck, Positive Psychology: A
theoretical foundation for Recreation Therapy. American
Journal of Recreation Therapy Vol.9 No. 3
Reference List continued
 Choices and Changes: Clinician Influence and Patient Action
Workshop, Institute for Healthcare Communication. January
2013
 Chronic Disease Prevention and Management Conference.
Calgary 2007
 Dieser, R. A Cross Cultural Critique of Newer Therapeutic
Recreation Models: The Self Determination & Enjoyment
Enhancement Model, Aristotelian Good Life Model, & the
Optimizing Lifelong Health Through Recreation Model.
Therapeutic Recreation Journal 4th Quarter 2002 p 352-368
Reference List Continued
 Hood & Carruthers. Enhancing Leisure Experience and
Developing Resources: The Leisure and Well Being Model Part
I. Therapeutic Recreation Journal Vol 41 No 4 276 -297. 2007
 Hood & Carruthers. Enhancing Leisure Experience and
Developing Resources: The Leisure and Well Being Model, Part
II. Therapeutic Recreation Journal Vol. 41, No. 4. 298-325 2007
 Keogh Hoss & Kensinger, Medical Home: Is there a place for
recreational therapy? American Journal of Recreation
Therapy, Vol. 9 N0. 2
Reference List Continued
 Lee and McCormick: 2002 Sense Making Process in Defining
health for People with Chronic Illnesses and Disabilities.
Therapeutic Recreation Journal 3rd Quarter Vol 36. No 3 235246
 Loitz et al, Sociodemographic Patterns of Leisure-Time Physical
Activity of Albertans 2000 to 2011. Health and Fitness Journal
of Canada Vol. 5 No.1
 Lorig, K; et.al. Living with a Healthy Life with Chronic
Conditions. Bull Publishing Company 2000
 Mobilily, K. Role of Exercise and Physical Activity in
Therapeutic Recreation Services. Therapeutic Recreation
Journal Vol. XLIII, No 2 pp 9-26, 2009
Reference List Continued
 Mobily & MacNeil, Therapeutic Recreation and the Nature of
Disabilities Venture Publishing 2002.
 Parker, V. & Carmack, R. A Critique of Van Andels’s TR Service
Delivery and TR Outcome Models. Therapeutic Recreation
Journal 3rd Quarter 1998
 Porter & Burlingame. Recreational Therapy Handbook of
Practice, ICF-Based Diagnosis and Treatment Idyll Arbour 2006
 Shank & Coyle. Therapeutic Recreation in Health Promotion
and Rehabilitation, Venture Publishing 2002
Reference List Continued
 Sylvester, C. Therapeutic Recreation, the international
Classification of Function, Disability and Health, and the
Capability Approach. Therapeutic Recreation Journal Vol., XLV,
No 2 pp. 85-104 2011.
 Wilhite, B. et al. Optimizing Lifelong health and Well Being: A
Health Enhancing Model of Therapeutic Recreation.
Therapeutic Recreation Journal. 2nd Quarter 1999 p98-108
Thank you – BCTRA
 Contact information:
jane.crawford@albertahealthservices.ca