KNR 273 : TR Models Continued Health Protection/Health Promotion Self-Determination and Enjoyment Enhancement

TR Models Leisure Ability Model (Peterson & Stumbo) Health Protection/Health Promotion Model (Austin) Self-Determination and Enjoyment Enhancement: A Psychologically-Based Service Model for Therapeutic Recreation (Dattilo, Kleiber, & Williams)

TR Models (Cont.) TR Service Delivery and TR Outcome Models (Van Andel) Aristotelian Good Life Model: Integration of Values into Therapeutic Recreation Service Delivery (Widmer & Ellis) Optimizing Lifelong Health and Well-Being: A Health Enhancing Model of Therapeutic Recreation (Whilhite, Keller, & Caldwell)

Health Protection/Health Promotion Model 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?

Health Protection/Health Promotion Model Purpose of TR To assist persons to recover following threats to health (health protection) and to achieve as high a level of health as possible (health promotion) Mission of TR To use activity, recreation, and leisure to help people to deal with problems that serve as barriers to health and to assist them to grow toward their highest levels of health and wellness

Health Protection/Health Promotion Model Underlying Concepts Humanistic Perspective Each of us has responsibility for own health Have capacity for making self-directed & wise choices regarding our health Critical to empower people to become involved in decisions regarding health to the fullest extent possible People are active participants in the world Human beings are holistic Each is unique and should be treated accordingly All humans have an inherent drive for health & wellness that can be nurtured by nonjudgmental & caring profs.

Underlying Concepts (Cont.) High-level wellness Goes beyond absence of physical illness Deals with health enhancement vs. treating disease Should strive to not only alleviate illness but to enhance health

Underlying Concepts (Cont.) Stabilization & actualization tendencies 2 motivational forces Stabilizing tendency Maintain steady state of individual Keep stress in manageable range Protects from bio-physical & psychosocial harm (Health Protection) focuses on efforts to move away or avoid negative states of illness and injury Actualizing tendency Directs toward health promotions Movement toward high-level well-being

Underlying Concepts (Cont.) Health Encompasses both coping adaptively and growing and becoming Healthy people can cope with life stressors Ultimate goal is to help clients strive toward health promotion. Based on philosophy that encourages clients to attempt to achieve maximum health, rather than just recover from illness

Components 1. TR is a modality to help people to, first, restore themselves or regain stability following a threat to health (health protection), and second, optimize their potentials in order that they may enjoy as high a quality of health as possible (health promotion) Components Prescriptive activities, recreation, & leisure

Components (Cont.) Prescriptive activities Clients at first withdraw, loss of control, helplessness Activity is necessary prerequisite to health restoration Activity is means to gain control over situation and overcome helplessness & depression TRS provides direction & structure for prescribed activities

Components (Cont.) Recreation Restorative properties which offer opportunity for participant to re-create himself Regain equilibrium disrupted by stressors so they can resume quest for actualization Take part in intrinsically motivated recreation that produces mastery and accomplishment in a supportive environ. Learn they can be successful in the world

Components (Cont.) Leisure Means to self-actualization

Health Protection/Health Promotion Model Any setting in which the goal of TR is holistic health and well-being TR client could be anyone who wishes to improve level of health Typical outcomes Improved physical functioning, improved perceived control, decreased stress, etc.

Health Protection/Health Promotion Summary Assumptions Activity, recreation, and leisure interventions facilitate individuals’ movement towards high levels of health and wellness People are motivated by stabilizing tendencies for managing stress, and actualizing tendencies for seeking growth and health Health is the focus because most professionals work in healthcare settings

Summary (Cont.) Mission: Health Therapy-oriented Outcome is optimal health Leisure & recreation are means only Definition of TR A means, first, to restore oneself or regain stability or equilibrium following a threat to health (health protection), and second, to develop oneself through leisure as a means to self actualization (health promotion)

Summary (Cont.) Service Areas Prescriptive activities Recreation Leisure

Health Protection/Health Promotion Strengths Health is focal point Reality based paradigm that goes well with competitive health care market Opens door for reimbursement Focus on whole person Theoretical foundation

Health Protection/Health Promotion Concerns Doesn’t apply to agencies that do not have health as a major goal Narrow scope of practice Leisure can do more than protect & promote health Health doesn’t address disabling conditions Victim blaming – responsibility for problems & recovery Components are unclear Serves general population Unclear how to facilitate client’s movement in programs or how design programs

Concerns (Cont.) Limited direction for practice Not specify content Leisure theory not included Doesn’t include functional outcomes Not all have drive for health Ross & Ashton- Shaeffer 2001) note more weaknesses than strengths

Self-Determination and Enjoyment Enhancement 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?

Self-Determination & Enjoyment Enhancement Purpose Enjoyment and the creation of environments conducive to enjoyment ultimately contribute to well being and to personal growth Creating conditions that help concentration, effort, and a sense of control and competence while promoting freedom of choice and expression of preference is the “engineering of enjoyment.”

Purpose (Cont.) To support participants in achieving goals of self-determination and enjoyment, and ultimately functional improvement

Model Components Self-Determination Acting as primary causal agent in one’s life and making choices and decisions free from external influence or interference Ability to choose from options Ability to adjust when more than one option is present Self-determination occurs when people take control of their freedom

Components (Cont.) Intrinsic motivation People will seek challenges which are commensurate with their competencies Avoid situations that are too easy or hard Interest, excitement, and relaxation provide reinforcement for activities Intrinsic motivation doesn’t depend on ability level

Components (Cont.) Perception of manageable challenge Flow Merging of action and awareness Investment of attention Goals are clear, challenges and skills are in balance Involves concentration, effort, sense of control

Components (Cont.) Enjoyment Experience derived from investing one’s attention in activities that are intrinsically motivating Functional improvement When participants independently access enjoyment and create environments conducive to enjoyment, functional improvements should result Enjoyment motivates people to do things that push them beyond present ability

Self-Determination & Enjoyment Enhancement Summary Assumptions Promoting self-determination, intrinsic motivation, manageable levels of challenges, and investment of attentions results in the outcomes of enjoyment and functional abilities Increased in the level of enjoyment and functional abilities is associated with the perceptions of self-determination in leisure

Summary (Cont.) Mission: Self-determination & enjoyment Also functional improvement Means/ends model Definition of TR The purpose of TR is to treat physical, social, cognitive, and emotional conditions associated with illness, injury, or chronic disability through a variety of interventions

Summary (Cont.) Service areas Self-determination Intrinsic motivation Perception of manageable challenge Investment of attention Enjoyment Functional improvement

Strengths Tightly connected to existing theories Strong grounding in psychological theory

Concerns Difficult to interpret and apply Definition of TR not go with model Confounded with attachment to functional improvement Focus on DD? Little consensus on the meaning of enjoyment Focus on control Cultural bases of fostering control Focuses on micro- system of the person

Concerns (Cont.) Lack of linkages among components Closed system with each component interdependent No clear entry point, assumed facilitation strategy box in upper left Is material in boxes, process, outcomes, or combo of both

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