1. KNR 273 Newer and Older TR Models Health & Human Services Models

2. Newer TR Models (Sylvester, Voelkl, & Ellis, 2001) Health Protection/Health Promotion Model  Austin, 1991 Therapeutic Recreation Service Delivery & Outcome Models  Van Andel, 1998 Self-Determination & Enjoyment Enhancement Model  Dattilo, Kleiber & Williams, 1998 Optimizing Lifelong Health Through Therapeutic Recreation Model  Wilhite, Keller, & Caldwell, 1999

5. Health & Human Services Models (Carter, Van Andel, & Robb, 2003) TR is provided in the context of several different health & human services systems or models Each of these contexts are based on a philosophy of services that impact therapeutic recreation Some of these have been noted as older TR models

6. Health & Human Services Models (Older) Medical or clinical Doctor is primary therapist Doctor determines what role others play Assumes client has a disease or illness that needs to be treated, cured, or healed Treat illness without regard for broader needs of client Recreation is guided by doctor’s diagnosis and prescription Settings: Physical med. & rehab; general med/surgical hospitals

7. Health & Human Services Models (Older) Custodial Focus is not rehab, but on providing for basic needs Strong effort to maintain order & keep institutional routines Activity programs keep residents occupied Settings: Correctional facilities, nursing homes, state institutions, group homes Being replaced by Long Term Care Model Maintain highest level of functioning and QofL

8. Health & Human Services Models (Older) Milieu therapy (environmental therapy or therapeutic milieu) Emotional problems are often the product of unhealthy interactions with one’s environment Staff are organized as a caring community that help client learn to readjust to environment Primary therapist is whoever has the most effective relationship with the client Settings: Mental health facilities

9. Health & Human Services Models (Older) Educational/Training Model Focus on acquisition of knowledge & skills that are required to become contributing member of society Heavy emphasis on classroom-like framework Focus on leisure skills & social skills Settings: Sheltered workshops, voc rehab centers, day-care centers, schools

10. Health & Human Services Models (Older) Community or special recreation Critical aspect of recreation service is the provision of a wide range of leisure opportunities in the community Provide opportunities to select experiences & acquire skills to participate in inclusive community-based programs Settings: City recreation departments, SRAs, Easter Seals

11. Health & Human Services Models (Newer) Psychosocial Rehabilitation Model MI is continuous and the medical model is not appropriate for people with severe, persistent MI Foster optimal level of functioning in the community including participating in activities Equip people with skills in vocation, education, personal adaptation, housing, recreation, and social Looks at strengths and abilities Stay in here and now vs. past

12. Health & Human Services Models (Newer) Recovery Model Hope and restoration of a meaningful life are possible despite serious mental illnesses Holistic view that focuses on the person and not the symptoms Recovery is possible and achievable even though symptoms may reoccur Person has primary control over decisions about outcomes

13. Health & Human Services Models Recovery Model Hope: Belief in self & willingness to preserver Secure base: Housing, income, healthcare Supportive relationships: Professionals, friends, family, support groups, and community Empowerment & inclusion: Importance of social inclusion, recovery of social skills and increased involvement in the community, has power over life & illness Coping strategies Coping with loss: Past Meaning Medication & treatment: Take least amount possible Education: Knowledge about illness Spirituality Employment or meaningful activity