chapter
15
A Global
Perspective of
Therapeutic
Recreation
David Howard, PhD, MSW, CTRS; Rodney Dieser,
PhD; Heewon Yang, PhD, CTRS; Shane Pegg, PhD;
and Julie Lammel, PhD
Learning Outcomes
• Communicate the nature and purpose of the World Health
Organization and the International Classification of Functioning,
Disability, and Health (ICF), and discuss their relevance to
therapeutic recreation
• Recognize the barriers to, benefits of, and strategies for
implementing the ICF into ongoing therapeutic recreation programs
in the United States
• Describe similarities and differences between the historical
development of therapeutic recreation in the United States and other
countries
• Identify political, socioeconomic, and cultural factors that might
affect the nature of therapeutic recreation services in various regions
of the world
• Describe current trends and issues in the therapeutic recreation
profession as they exist in several different countries
• Discuss alternative possibilities regarding the conceptualization,
development, and delivery of therapeutic recreation services in the
United States, as well as other regions
WHO and Therapeutic Recreation
• World Health Organization (WHO) formed by
the United Nations in 1948
• Defined health as “a state of complete
physical, mental and social well-being and
not merely the absence of disease or
infirmity”
• Holistic approach to health
International Classification of Functioning,
Disability, and Health (ICF)
• Aim and goals
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–
–
–
Scientific basis
Common language
Permit comparison
Systematic coding scheme
• Key characteristics (see figure 15.1 for
framework)
• Compatibility with therapeutic recreation
practice: ATRA position statement
(continued)
International Classification of Functioning,
Disability, and Health (ICF) (continued)
• Basic concepts
–
–
–
–
Health condition
Body structures and function
Activity and participation
Contextual factors
• Schematic coding system
– Performance qualifier versus capacity qualifier
– How codes are created
• Procedural Manual and Guide
• ICF considering therapeutic recreation in other
nations
Therapeutic Recreation in Canada
• History of treatment of persons with
disabilities in Canada
• Canada and Canadian Federalism
– Cultural differences across provinces
– Multiculturalism: the core of Canadian federalism
– Great diversity in health and wellness concerns,
programs, population groups, and community
characteristics
– Table 15.1
History of Therapeutic Recreation in
Canada
• Provincial and territorial therapeutic
recreation organizations existed
• Mid 1990s: National Coordinating
Committee (NCC) developed
• August 1996: Canadian Therapeutic
Recreation Association (CTRA)
established
Canadian Federalism and the Development
of Therapeutic Recreation
• Debate on standards of practice
– Mosaic Certification Framework (MCF)
– MCF based on three axioms
• Political ideology
• Collaboration and unity within paradigm of diversity
• Strong multicultural commitment
– Table 15.2
• U.S. National Council for Therapeutic
Recreation Certification (NCTRC)
– MCF compared to NCTRC
– Table 15.3
Historical Origin of Therapeutic
Recreation in South Korea
• 1960: Leisure and Recreation Association of
Korea (LRAK) by O-Joong Kim
• 1960: Recreation as pleasurable experiences to
help increase economic productivity
• 1963: Ewha Women’s University began
recreation as an academic course
• Late 1980s: general public began viewing
recreation as essential to people’s lives
• 1988: South Korea hosted Seoul Paralympics
Therapeutic Recreation Professional
Organizations in South Korea
• Social workers ignited development of therapeutic
recreation in 1990s
• Korean Therapeutic Recreation Association (KTRA)
established in 1993
– Development and provision of therapeutic recreation programs
– Research on effectiveness of therapeutic recreation intervention
– Education and training programs
• Organizations and institutes after KTRA
– Daehan Therapeutic Recreation Association (DTRA)
– 2001 Korean Therapeutic Recreation Research Center (KTRRC)
– Korean Therapeutic Recreation Academic Society (KTRAS) and
the Korean Therapeutic Recreation Journal (KTRJ)
Certification, Education, and Challenges
for Therapeutic Recreation in South Korea
• Certification administered by Korean Council for
Therapeutic Recreation Certification (KCTRC)
– Similar to NCTRC in the U.S.
– Eligibility of applicants for certification exam
• Education and training programs
– No academic institutions offer therapeutic recreation degrees
– Over 30 universities and colleges offer therapeutic recreation
courses
– Several education and training institutes offer instruction
• Challenges for the growth of therapeutic recreation
Therapeutic Recreation in Australia
• Not fully accepted as a treatment
intervention
• Diverse range of therapeutic recreation staff
titles are used
• Provision of services greatly varies
• Profession associated with the Diversional
Therapy Association of Australia
Historical Development of
Therapeutic Recreation in Australia
• WWI: Nurses used recreation to assist in
rehabilitation
• Post WWII: Red Cross used basic crafts and
recreation to aid rehabilitation
• Deinstitutionalization (late 1960s–1970s)
– More diversional activities needed
– Diversional Therapy Association of Australia
• Early 1980s: Empirical research on the
benefits of activity began to emerge
Ongoing Australian National Reform
• Recent federal level reforms have affected
therapeutic recreation services
– Community-based public health services
– National mental health plan
– Aged care reform
• Therapeutic recreation still seen by many as
diversionary activity
• The public does not understand the role of
therapeutic recreation
Working as a CTRS in Switzerland
• Culture of Switzerland
– Four official languages
– Easy access to other countries in Europe
– Diverse culture
• Therapeutic recreation program in Valens
– Rehabilitation facility on eastern side of Switzerland
– Historical development of the program
– Goals of the recreation and sport programs
Language and Therapeutic
Recreation Services in Switzerland
• Communication important in a country of
multiple languages
• Impact of language on efficacy of treatment
• Obstacle of understanding concepts of
recreation and leisure
• Whorfian hypothesis: language transmits
not only thoughts but also culture
Influence of Culture on Therapeutic
Recreation in Switzerland
• Swiss compartmentalize work and
leisure
• Perfectionism, social status, and
conformity
• Need to understand cultural attitudes
toward recreation
Discussion Questions
• Discuss the potential benefits of implementing the ICF across
American and international health care systems.
• How might such a change enhance awareness and acceptance of
therapeutic recreation among other health care professionals, both
nationally and internationally?
• Interview two or three current health care practitioners. Were they
aware of the ICF? If yes, did it affect their daily work? What
possible implications does their level of awareness have for the
potential use of the ICF? Compare your results to those of other
class members. Were certain professional areas of practice more
or less familiar with this system?
• Based on these interviews, your reading, and your own opinion,
what challenges will come with aligning therapeutic recreation
standards of practice with the ICF?
(continued)
Discussion Questions (continued)
• What similarities and differences exist between the
American history and perspective of therapeutic
recreation and those of other countries?
• Recreation and leisure are an inherent part of culture.
What implications does this present in regard to the
purpose and nature of therapeutic recreation? Is it
possible that the American perspective is irrelevant or
unhealthy in other cultures?
• What steps can you take to ensure that you are
competent in your work with people from other
cultures?