1. Evidenced Based Practice Providing Effective Recreational Therapy Interventions For Geriatric Clients Jo Lewis, MS/CTRS Megan C. Janke, Ph.D., LRT/CTRS

2. Objectives Upon completion of this session, the participant will be able to:  Identify three evidenced based interventions for Recreational Therapy treatment for older adults.  Verbalize the criteria established by CMS for Recreational Therapy treatment.  Verbalize the steps needed to implement Recreational Therapy treatment.

3. What Is Recreational Therapy?  Recreational Therapy “means a treatment service designed to restore, remediate and rehabilitate a person’s level of functioning and independence in life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restrictions to participation in life situations caused by an illness or disabling condition.” American Therapeutic Recreation Association TR Definition Statement (July 2009)

4. CMS Definition Services that are provided or directly supervised by a qualified recreational therapist who holds a national certification in recreational therapy, also referred to as a “Certified Therapeutic Recreation Specialist.” Recreational therapy includes, but is not limited to, providing treatment services and recreation activities to individuals using a variety of techniques, including arts and crafts, animals, sports, games, dance and movement, drama, music, and community outings. Recreation therapists treat and help maintain the physical, mental, and emotional well-being of their clients by seeking to reduce depression, stress, and anxiety; recover basic motor functioning and reasoning abilities; build confidence; and socialize effectively. Recreational therapists should not be confused with recreation workers, who organize recreational activities primarily for enjoyment. MDS 3.0 RAI Manual, Appendix A

5. Time For A Game!

6. Cognitive Functioning  Short term memory  Long term memory  Following directions  Safety awareness  Communication skills  Word finding ability  Money management  Attention span  Writing skills

7. Physical Functioning  Endurance  Strength  Flexibility  Gait- walking in room or in facility  Locomotion  Balance  Walking balance  Standing balance  Sitting balance  Transfer skills  Bed mobility  Toilet transfer  Toileting  Dressing upper/ lower body  Eating  Grooming/ personal hygiene  Bathing  Fall reduction

8. Emotional/ Psychosocial Well-Being  Apathy/ Passivity  Depressive symptoms  Anxiety  Communication skills  Social skills  Self-Esteem  Coping skills  Motivation  Disturbing behaviors

9. Other Areas To Address  Pain  Decrease pain  Increase functional abilities  Community reintegration  Independence in community setting  Community resources  Weight Loss/ Gain  Caregiver

10. Evidence Based Practice (EBP)  Based on the integration of:  Research  Clinical expertise, and  Client’s preferences, beliefs and values.  Why is it so important?  Why utilize evidence in your practice?

11. Sources of Evidence  RT/TR Journals  Therapeutic Recreation Journal  Annual in Therapeutic Recreation  American Journal of Recreational Therapy  Other Professional Publications  Simple Pleasures  Dementia Practice Guidelines  Other Professional Journals  RT Wise Owls  Recreational Therapy Evidence Based Practice: Strengthening the Profession (Temple University)  http://rtwiseowls.com http://rtwiseowls.com

12. Looking at the Literature…

13. Integrating Research Into Your Practice  Define the problem or area to be addressed.  Review relevant literature.  Internet search with key terms  Try different terms  Analyze the research  Formulate a plan

14. CMS Requirements for RT Treatment  The physician orders the therapy;  The physician’s order includes a statement of frequency, duration, and scope of treatment;  The services must be directly and specifically related to an active written treatment plan that is based on an initial evaluation performed by qualified personnel  The services are required and provided by qualified personnel  The services must be reasonable and necessary for treatment of the resident’s condition CMS MDS3.0 RAI Manual Section O page 19

15. Implementing Recreational Therapy in Your Practice  Educate!!!!  Receive referral defining problem  Obtain Physician’s Order for RT evaluation  Complete the evaluation using a standardized assessment tool  Obtain Physician’s Order for RT treatment  Scope, Frequency, Duration  Develop Plan of Care  Implement plan  Document sessions  Evaluate using same assessment tool  Continue, D/C, or Revise Plan of Care