KNR 273: Leisure Ability Model Stumbo & Peterson, 2009

Overview Significance of a professional philosophy Leisure Ability Model Means/end debate Framework for evaluating models Will be looking at several TR models Will need to know Leisure Ability Model inside and outside Be able to draw, describe, and label parts Mark chapter 1 and 2 and memorize

Why is a professional philosophy important? It guides practice Tells you and others why you do what you do Regardless of philosophy or model, will use APIE Professional philosophies are often represented in models Tell how programs are designed Guides assessment

What is a model? Representative of something Provides an image or picture Practice models must do more Should direct practitioners in intervening with clients Should be based on theory Austin, 1999 Ross & Ashton-Shaeffer in Stumbo (2001) 1st step to quality services = selection of model 2nd = operationalize the model & design programs with outcomes First TR models = late 1960s & early 1970s Were continuums & leisure oriented Ball 1970; Frye & Peters 1972

Leisure Ability Model (Adopted by NTRS in 1982) Originally by Peterson & Gunn, 1984 Modified by Peterson & Stumbo, 2000 Services should be based on client needs or deficits Focus on needs related to leisure makes TR unique Leisure is vital to overall quality of life and life satisfaction Also know as TR Service Model, formulated by Gunn & Peterson in 1978 One of the most widely used models Needs are based on analysis of clients served by agency. Nature of agency and mandate for service is also considered. (Clustered needs) Clients are assessed individually

Listen to this!!!! “This exclusive discipline focus on leisure behavior within the umbrella of health promotion makes the field of therapeutic recreation different and unique from all other health and human services. Therapeutic recreation has much to offer clients regarding their overall health and rehabilitation goals, and its specific contribution lies in the area of leisure functioning and leisure behavior.” p. 28

Rationale for TR Services Every human being needs, wants, and deserves leisure Many, if not most, individuals experience barriers to full and satisfying leisure Many PWD may experience more frequent, severe or lasting barriers than people without disabilities Rationale/assumptions They may experience those barriers simply due to the presence of their disability or illness. For some these barriers are so limiting that it ultimately effects their quality of life, health, and overall happiness. Barriers include (BRAINSTORM): Attitude that leisure is not important Lack of skills Inability to make decisions Lack of motivations Inappropriate social skills See Page 16

Rationale for TR Services (Cont.) Many individuals with disabilities will need the help of CTRS to eliminate, reduce, overcome, or compensate for their barriers The reduction of barriers allows the individuals to participate in leisure experiences of choice

Ultimate Outcome of TR Services “is the improved ability of the individual to engage in a successful, appropriate, and meaningful independent leisure lifestyle that, in turn, leads to improved health, quality of life, and well-being. When the individual can independently and successfully engage in leisure of his or her own choice, the individual has the chance to receive psychological, physical, and social benefits as well as the more global benefits of improved health, wellness, and quality of life.” p. 29

Clients Any individual with a physical, mental, social, or emotional condition that limits leisure functioning Individuals with illnesses, disabilities, or conditions acknowledged by health and human services classification systems Medical & psychiatric classification schemes DSM IV WHO, ICF Healthy People 2010 Also includes legal offenders, at-risk youth Deviation from social norms & become recipients of specialized services

Clients (Major groups) Psychiatric and mental health services 35% Geriatrics 30% Physical medication services 18.4% Developmental disabilities 13.6% Riley & Connolly, 2007 May well be other groups in the future

Settings Any agency or center that serves the clients we discussed Clinical, residential, community Page 31-32

Settings (Major settings) Hospitals 38.6% Skilled nursing facilities 19.3% Residential & transitional settings 15.0% Community settings 14.4% Partial/outpatient facilities 3.9% Day care/day treatment 3.6% Schools 1.9% Correctional centers 1.4% Riley & Connolly, 2007

Process Selection, development, implementation, and evaluation of goal oriented services Functional intervention Leisure education Recreation participation

Purpose of TR Is to facilitate the development, maintenance, and expression of an appropriate leisure lifestyle p. 33 Have you read this before? 1982 NTRS Definition/Philosophy Who was president of NTRS at the adoption of this philosophy? Peterson

Leisure Lifestyle Is the day-to-day behavioral expression of one’s leisure-related attitudes, awareness, and activities revealed in the context and composite of the total life experience p. 14 Routinely engaged in as part of daily existence Cannot be viewed independently of all other parts of life Influenced by collective and accumulated life experiences. Express lifestyle through the daily & lifetime choices they make about clothes, activities, living arrangements & environments, religious or spiritual beliefs, health practices, social behaviors, etc. What is your leisure life style like? What about someone in LTC? Substance abuse?

Leisure Lifestyle (cont.) Implies that an individual has sufficient skills, knowledge, attitudes, and abilities to participate successfully in and be satisfied with leisure and recreation experiences that are incorporated into his or her individual life pattern. (Peterson & Stumbo, 2000, p. 7)

Leisure Lifestyle as an Outcome Means Client … Has reduced functional limitations that prohibit leisure involvement (or has learned how to overcome these barriers) Understands and values the importance of leisure Incorporates leisure into daily life Is competent in a variety of leisure activities Has adequate social skills for involvement with others

Leisure Lifestyle as an Outcome Means Client … Is able to choose between several leisure options and make decisions for leisure participation Is able to locate and use leisure resources Has increased perceptions of choice, responsibility, and independence with regard to leisure p. 70

In other words…. TR is helping individuals with disabilities and/or illnesses develop and more freely express their leisure choices AND The outcome of TR services is the improved ability of the individual to make and act on choices for leisure that are rewarding and successful

Psycho-Social Theories of Leisure Behavior Perceived freedom & personal choice Intrinsic motivation Self-efficacy, locus of control, & causal attribution Optimal experiences (flow) Remember I said models/philosophies must be based on theory Has been some controversy because when Leisure Ability was originally formulated, there was no mentioned theory. Theory was added in 1999 TRJ article and 2000 text. I really don’t like learned helplessness Learned helplessness= events in life are outside of control and person stops trying to make changes (psychological barrier) Try to decrease learned helplessness & increase control, choice, and motivation Latest edition removed learned helplessness

Leisure Ability Model 3 major categories of service See p. 34 Functional Intervention Leisure Education Recreation Participation See p. 34 Functional intervention used to be treatment, but changes because all areas c/b goal oriented and treatment Agency will provide services in more than one category.

Functional Intervention Focus is on improving functional behaviors which are prerequisites to, or necessary part of, leisure involvement Baseline abilities that are prerequisite to typical leisure behavior 4 domains Physical Mental/cognitive Emotional/affective Social Look at functional areas which might keep client from participating in leisure If on treatment team, may work on functional areas the team is working on Baseline Physical (coordination, endurance, mobility, strength, eye-hand coordination, balance) Cognitive (memory, orientation, attention span, reading ability, ability to follow directions) Emotional (anger management, emotional control, emotional expression) Social (minimal social expectations….behaviors that are inappropriate for any individual under any circumstance, refrain from biting, kicking & hitting others, from screaming, spitting, caressing strangers, appropriate public behavior, staying dressed, not being agressive)

Sample Functional Behaviors Addressed by TR Intervention Depression: decreased energy level; inability to express emotions appropriately, decreased stamina Dementia: minimal orientation; limited attention span Intellectual disability: delayed motor and social development; limited attention span Spinal Cord Injury: minimal strength; endurance; depression Many of the areas we discussed with the disability review. Not usually address pathology, but limitation from pathology or secondary disabilities (when a disability imposes other limitations) Functional problems may not be the client’s major area of need. Sometimes functional behaviors can be changed, sometimes they can not. Use activities that are selected to address areas (activity analysis)

Functional Intervention Role of CTRS Therapist Degree of Control Intervention mostly controlled by therapist Degree of Freedom in Participation Obligatory behavior, constrained, prescribed, dependent, extrinsically rewarded Control. Client does have control and choice in becoming actively involved in the treatment process. The client may help select treatment goals. Can be part of interdisciplinary team by contributing to general treatment goals & addressing specific leisure-related goals

Leisure Education Focus on the development and acquisition of various leisure-related skills, attitudes, and knowledge 4 components Leisure Awareness Social Interaction Skills Leisure Activity Skills Leisure Resources See p. 43 In many ways the leisure education component may be the most important program for many clients. Uses an educational model…behavior can change when people learn new knowledge & skills Illness or disability is not primary concern, behavioral grown and change are sought

Leisure Awareness Cognitive appreciation of leisure Content includes, but not limited to: Knowledge of leisure Self-awareness in relation to leisure Leisure and play attitudes Related leisure participatory and decision-making skills Can be separate or combined programs See page 45-48 Provide examples Knowledge of leisure: benefits, barriers, difference between leisure and other behaviors like work, leisure as a context to meet people and experience new things, concept of leisure lifestyle, balance between leisure, work and other obligations, personal responsibility in leisure Self-awareness: actual & perceived abilities or limitations, effects of disability on leisure, past & current leisure patterns and activities, satisfaction with current leisure, effects of family & friends on leisure development Attitudes: Origins of beliefs about leisure, relationship between attitudes and behavior, appropriateness of former leisure attitudes with current lifestyle Participatory: Decision-making skills, leisure planning skills, long-term coping and adaptation strategies, reducing and managing stress thru planning and decision-making, asking appropriate questions about accessibility, asking for assistance

Social Interaction Skills Communication skills Assertiveness, active listening, empathy Relationship-building skills Friendship development, cooperation, competition Self-presentation skills Manners, hygiene, grooming, appropriate attire See page 49-52 Much of leisure is social. Need to be able to apply a variety of social skills in a diversity of settings. Past focus included large & small groups Communication: negotiation, disagreements, conflict, & compromise; conversational skills, expressing feelings & thoughts, information seeking skills Relationship: greeting & initiation, locating leisure partners, self-disclosure & privacy issues, developing & maintaining social networks, reciprocal social support Self-presentation: Politeness, sharing, turn taking

Leisure Activity Skills Develop a repertoire of diverse leisure skills Two categories Traditional Nontraditional See page 52-56 Traditional: Sports, dance, aquatics, drama, music, arts & craft, games, hobbies Nontraditional: Social interaction, spectating, fitness, relaxation & meditation, eating, food preparation, intimacy & dating, shopping, home improvement, pets & plants, computer & Internet activities, travel, home decorating & maintenance, email conversations

Leisure Resources Activity opportunities Personal resources Family and home resources Community resources State and national resources Knowledge Utilization See pages 57-60 ATM, How use telephone book, etc. Both knowledge and utilization Activity opport.: Vast number of acts. that are available How to use phone book to locate information How to use an ATM Could be separate program or part of leisure skills Volunteer opportunities

Leisure Education Role of CTRS Degree of Control Instructor, advisor, counselor BUT cautions about use of term counselor Degree of Control Responsibility shared between CTRS & client

Recreation Participation Focus on providing an opportunities for fun, enjoyment, and self-expression within organized delivery systems Leagues, tournaments Special Events Activities requiring specialized equipment Opportunities for self-initiated activity Allow client to practice newly acquired skills and/or experience enjoyment and self-expression May be part of leisure lifestyle Assume have activity skills and participatory abilities

Recreation Participation Goals Increase ability to assume responsibility for personal leisure participation Increase ability to make and follow through on decisions, regarding leisure involvement Increase competence in leisure skills through practice and involvement Increase sense of mastery through attainment and performance of skills 1. May not have as specified goals as functional intervention or leisure education

Recreation Participation Roles Practice and application of skills Inclusionary program Normalization of institutional routine Focus on “well” aspects of client Expression of leisure lifestyle Diversion or palliative purposes Fun & belonging Adjust to routine in hospital. Allows degree of normalcy Distraction, alleviation from boredom, release of emotions, doing things other than watching TV while in treatment. Can strongly justify rec. part. prgs. Hutchinson, LeBlanc, & Booth, 2006 argue for the value of RP & should not be underemphasized.

Recreation Participation Role of CTRS Leader, facilitator, supervisor Degree of Control Opportunity for participation provided for client Degree of Freedom Independent, self-regulated, intrinsically rewarding This is traditional definition of leisure This is area that has caused a lot of debate Remember the vote to decide on what philosophy in 1982? Treatment Recreation Continuum

Leisure Ability Model Programs/interventions based on individual client need that is related to leisure All populations All settings May need services in 1, 2, or all 3 areas Apply to settings and populations, including community based (NH, SRA, substance abuse, etc……show how this model works in those settings. Think back to APIE presentations Class brainstorm strengths & weaknesses of model

Leisure Ability Summary Assumptions (Rationale): Leisure is a need & right of all individuals Many individuals experience constraints & barriers to leisure TR services are designed to facilitate individuals’ independence in leisure functioning Mission: Leisure Leisure is end product or outcome Sylvester, Voelkl & Ellis, 2001 Ross & Ashton-Schaeffer in Stumbo, 2001 ( ) = Peterson & Stumbo’s terms

Summary (Cont.) Definition of TR (Purpose) Service Areas To facilitate the development, maintenance, and expression of an appropriate leisure lifestyle for individuals with physical, mental, emotional or social limitations Service Areas Functional Intervention Leisure Education Recreation Participation 1. Service areas were added by SK

Leisure Ability Strengths Extensive use in field (most widely used) Acceptability & utilization in field Flexibility (settings & population) Services based on client needs Stood test of time Oldest Fostered consistency in practice Brought profession together Most recognized Recognizes importance of recreation participation Stumbo & Peterson, 1998 (TRJ) Bullock, 1998 (TRJ) Researcher response Yaffee, 1998 (TRJ) Practitioner response A. Rec Part. (respite from other tx., experience enjoyment & self expression)

Strengths (Cont.) Referenced in NCTRC & accreditation Common sense approach to TR High degree of merit Tied to leisure theory Graphics clear, concise & comprehensive Good clarity of terms Good for program design (1-1 or group) Austin (1999) Sylverster, Voelkl & Ellis, 2001 Ross & Ashton-Shaeffer in Stumbo, 2001

Leisure Ability Concerns Based on nondisabled adult leisure behavior Some terms ill defined (leisure lifestyle) Focuses on leisure instead of therapy Too broad More empirical research is needed Widely debated Problems with conceptual/theory Recreation participation is not reimbursable service Problems with theory (Bullock, 1998, TRJ, Researcher Response) Not until 1998 stated Missing theoretical constructs from disability literature Disability literature is questioning independence vs. interdependence Questions about learned helplessness Questions little on choice and flow as ultimate goal Lacks strong tightly woven theoretical base Recommends Normalization, Social Role Valorization, Self-Determination, Interdependence & Inclusion Yaffe problems : Maslow s/b included

Concerns (Cont.) Recreation participation as role of CTRS Lack of attention to health & independent functioning outside of leisure Programs designed for 1 outcome Linear conceptualization Not in concert with current health cares’ focus on functional outcomes Include Austin, 1999 here In regard to theory: Lack of theoretical underpinnings, descriptive theory which is an OK first step, 1998 theory applied & those are too limited & not integrated Sylvester, Voelkl, & Ellis 2001 1 outcome may not be necessary or practical They however, think role assumed by CTRS in recreation participation may be necessary Linear conceptualization (functional before others) SK not sure that applies. Ross & Ashton-Shaeffer in Stumbo 2001 Notes problems with theoretical bases Based on adults without disabilities; doesn’t necessarily apply to adults with disabilities, children, diverse ethnic & cultural backgrounds, or different lifestyles.

Is Therapeutic Recreation a means to an end or an end in itself?

Means means… Instrumental Tool to produce some other outcome (eg. Improve health, decrease depression) Recreation as an agent (means) of change Means is anything that contributes to the attainment of an end. It receives it value in proportions to its utility for yielding an end. A means, therefore, is subordinate to an end and has no value unless directed toward one. Ross & Ashton-Schaeffer in Stumbo 2001 Last quote was from Mobily 1985

Means (Cont.) Means orientation indicates change or improvement of functional behaviors as the desired end. Draws from a medical, psychiatric, psychological and human development body of knowledge 1. Peterson, 1989 as quoted in Ross & Ashton-Schaeffer in Stumbo 2001

End means… Intrinsic Leisure or recreation is the outcome that TR services aim to produce End is anything that is valuable in its own right and is done for its own sake. An end is good for its own sake

Ends (Cont.) Implies that the ultimate outcome is related to leisure behavior Draws on the body of knowledge related to leisure Some models regard leisure as both a means & an end Both a tool and a product of TR services 1. Peterson 1989

Can TR be both at the same time? Does the Leisure Ability Model emphasize one over the other? Which? How? Mobily, Weissinger, & Hunnicutt, 1987 Historical piece Your reading

Criteria to Evaluate TR Practice Models Easy to follow (graphic depiction, clarity of terms & concepts) Accommodates a variety of clients & settings Flexibility in types of services What is the end goal? Purposes Underlying assumptions Theoretical bases Direction for research & practice Could you explain TR with this model? Could you design programs? Have students brainstorm before show slide Give copies to use to evaluate the models they will read NOTE CHANGES FROM WHAT I HANDED OUT BEFORE

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