Client Outcomes in Therapeutic Recreation Services - eBook

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ISBN/ISSN: 978-1-952815-71-3

Author(s): Norma J. Stumbo

Copyright year: 2003

Edition: 1st

pages: 274

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Therapeutic Recreation (TR) is in the midst of exciting and challenging changes in health and human services. One of the toughest challenges is creating, planning, implementing, and evaluating TR intervention programs that are based on “best practice” and provide maximum accountability to invested persons and parties. These services are designed and delivered to produce outcomes that are valued by, meaningful to, and important to the consumer as well as other service providers. This book represents a synergistic, collective effort to bring the newest information on outcomes, accountability, and evidence-based practice to the field of therapeutic recreation. It does so with a specific focus on the process of designing, delivering, and evaluating comprehensive and specific programs (as opposed to specific groups of clients). The actions and decisions described in these chapters apply to all population groups with which therapeutic recreation specialists work.

The book begins with three chapters on background information on outcomes and accountability from national and international perspectives, within and external to the profession of therapeutic recreation. In the next three chapters, past, present, and future directions for outcomes research in therapeutic recreation are highlighted. The next seven chapters address the process of theory selection, program design, assessment, implementation, evaluation, performance improvement, and marketing. The last chapter provides a brief state-of-the-art of outcomes and evidence-based practice in therapeutic recreation. Collectively, these chapters are intended to upgrade and update the outcomes literature within the field and spur professionals into providing higher quality and more meaningful services to all clients.

These tasks are not without effort; we are not implying that creating evidence-based practice is easy—but we are saying it is desirable, necessary, and must be taken seriously by every student and professional. Today is the day to start, if even with a small step. We welcome you to open this book, open your mind, and determine how you can best contribute to the outcomes movement within therapeutic recreation. The field and our clients are depending on you.

Chapter 1

Outcomes, Accountability, and Therapeutic Recreation

Norma J. Stumbo

Why Have Outcomes Gained Importance?

What Are Outcomes?

  • Important Terminology Related to Outcomes
  • Important Outcomes in Healthcare and Therapeutic Recreation
  • Typical TR Outcomes
  • Important Characteristics of Outcomes

What Is Outcome Measurement?

  • Important Characteristics of Outcome Measures

Methods of Defining and Measuring Outcomes in Healthcare

The Relationship Between Outcomes, Outcomes Research, and Evidence-Based Practice


Discussion Questions


Chapter 2

The Importance of Evidence-Based Practice in Therapeutic Recreation

Norma J. Stumbo

What Is Evidence-Based Practice?

Evidence-Based Practice Requires Paradigm Shift

Steps for Evidence-Based Practice

  • Step 1: Formulate a clear clinical question from a patient’s proble
  • Step 2: Search databases for relevant clinical evidence
  • Step 4: Implement and use findings in practice
  • Step 5: Evaluate the impact of change in practice

Problems and Concerns With Evidence-Based Practice

  • Production of Evidence Through Research and Scientific Review
  • Production and Dissemination of Evidence-Based Clinical Guidelines
  • Implementation of Evidence-Based, Cost-Effective Practice Through Education and Management of Change
  • Evaluation of Compliance With Agreed Practice Guidance and Patient Outcomes


Discussion Questions


Chapter 3

Outcomes From a National and Worldwide Perspective

John M. Jacobson

Definitions of Outcomes

Evolution of Outcomes

The Importance of Outcomes

Who Looks at Outcomes?

Current and Emerging Issues With Global Outcomes

Conclusion: National and World Outcomes Issues and Therapeutic Recreation

Discussion Questions


Chapter 4

Basing Outcomes on Theory: Theories of Intervention and Explanation

Linda L. Caldwell

Evidence-Based Intervention

Interplay of Theory and Practice

Applying Theory

  • Theory of Intervention
  • Theory of Explanation

Relationship of Theory and Outcomes

  • Drug Prevention Example



Discussion Questions


Chapter 5

Other Voices, Other Rooms: Consumers’ and Healthcare Professionals’ Perspectives on Valued Client Outcomes in Therapeutic Recreation

Barbara Wilhite, Jan S. Hodges, and Mason Peebles

Involving Consumers

Moving Beyond Single Discipline Research

Revisiting a Research Agenda for Therapeutic Recreation

A Selected Review of Outcome-Based Literature

  • Outcome-Based Literature Related to Functional Limitations
  • Outcome-Based Literature Related to the Experiences of Individuals With Disabilities
  • Outcome-Based Literature Related to Societal Limitations

Looking to the Future

Closing Thoughts

Discussion Questions


Chapter 6

The Efficacy of Therapeutic Recreation: Back to the Future

Carmen V. Russoniello

Outcomes Movement

Evidence-Based Practice

Outcome Development in Therapeutic Recreation

Future Outcomes

  • Physical
  • Psychological
  • Social Support



Discussion Questions


Chapter 7

Selecting and Designing Intervention Programs for Outcomes

Jo-Ellen Ross and Candace Ashton-Shaeffer

A Quick Look at Outcomes

Selecting Meaningful Outcomes

  • Analysis of Setting and Population
  • Relevant Resources
  • Healthcare and Disability Paradigms
  • Benefits Categories

Systems Approach

Getting Started

  • Selecting Interventions
  • Selecting or Designing the Assessment
  • Planning the Intervention
  • Evaluation

Matching Clients With Intervention Programs

Designing the Outcome-Based Intervention Program From Start to Finish

Go Forth and Do it!


Discussion Questions


Chapter 8

Standardizing Practice and Outcomes Through Clinical Practice Guidelines: Recommendations for Therapeutic Recreation

Colleen Deyell Hood

Recommendations for the Development and Use of Clinical Guidelines in Therapeutic Recreation


Discussion Questions


Chapter 9

Assessment: The Key to Outcomes and Evidence-Based Practice

Norma J. Stumbo

Important Terminology

What Are Categories of Healthcare Outcomes?

The Relationship Between Assessment and Outcome Measures

Characteristics of Quality Measurement Procedures

  • Validity
  • Reliability
  • Practicality and Usability
  • Two Additional Characteristics: Sensitivity and Perspective

Clinical Decisions and Patient Management


Discussion Questions


Chapter 10

Objectives-Based Approach to Evaluating the Effectiveness of Therapeutic Recreation Services

Cynthia Carruthers

Determination of Outcomes

Ultimate Goals and Instrumental Objectives

  • Writing Performance Measures or Instrumental Objectives
  • Using Performance Measures To Evaluate Effectiveness
  • Using Ultimate Goals To Evaluate Effectiveness

Discussion Questions


Chapter 11

Program Evaluation: Collecting Data to Measure Outcomes

Mark A. Widmer, Ramon B. Zabriskie, and Mary Sara Wells

What Is Program Evaluation?

Why Perform Program Evaluations and Outcome Studies’

A Program Evaluation Model

Identifying Outcomes to Evaluate

Are You Looking at Consumer/Client or Staff Perceptions?

Data Collection and Standardized Procedures

  • Psychometric Assessment
  • Interviews
  • Observation
  • Clinically Relevant Behaviors

Measuring Outcomes Without a Comparison Group

Client and Staff Satisfaction


Discussion Questions


Chapter 12

Outcomes Measurement as a Tool for Performance Improvement

Bryan P. McCormick

Alphabet Soup: From Quality Assurance (QA) to Performance

  • Improvement (PI)
  • Quality Assurance (QA)
  • Continuous Quality Improvement (CQI) .
  • Performance Improvement (PI)

Changing Managerial Philosophy and Changing Outcomes

Role of Outcomes in Performance Improvement

Organizational Relevance and TR Outcomes


Discussion Questions


Chapter 13

Conveying the Possible With Client-Directed Outcomes and Social Marketing

Susan “BOON” Murray

Reframing the TRS’s Stance via Client-Directed Outcomes

How Social Marketing Aids Promotion of Outcomes

  • Promoting Therapeutic Recreation With Outcome-Based Program Announcments
  • Promoting Therapeutic Recreation With Outcome-Based Program Protocols
  • Professional Organization Resources for Promoting Outcomes


Discussion Questions


Chapter 14

Outcome Measurements From a Therapeutic Recreation Practitioner's Perspective

Diane Etzel-Wise and Norma J. Stumbo

Therapeutic Recreation: Daily Activities and Lifetime Achievements

Case Example of a TRS’s Efforts

Results of an Informal Survey: Practitioner’s Perspective on Outcomes

  • Outcome Measures
  • Barriers
  • Professional Preparation
  • Role of Professional Organizations

Outcomes: A Priority Focus for Professional Organizations and Professionals


Discussion Questions


About the Authors

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