Stay ConnectedClient Outcomes in Therapeutic Recreation Services - eBook
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
Summary
Discussion Questions
References
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
Summary
Discussion Questions
References
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
References
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
Summary
Endnotes
Discussion Questions
References
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
References
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
Summary
Endnote
Discussion Questions
References
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!
Endnote
Discussion Questions
References
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
Summary
Discussion Questions
References
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
Summary
Discussion Questions
References
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
References
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
Summary
Discussion Questions
References
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
Summary
Discussion Questions
References
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
Summary
Discussion Questions
References
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
Summary
Discussion Questions
References
About the Authors