Therapeutic Recreation Program Design: Principles and Procedures
Third Edition 2000 - Allyn And Bacon
By Carol Ann Peterson and Norma J. Stumbo

Reviewed By
Dr. Janice Elich Monroe, CTRS
Department of Therapeutic Recreation and Leisure Services
Ithaca College - Ithaca New York

The long awaited third edition of Therapeutic Recreation Program Design: Principles and Procedures was released late in the fall of 1999. This textbook revision brings with it the wisdom of time, peppered with an astute understanding of the theory and practice of therapeutic recreation. The authors have kept what is tried and true and have added language and processes that clarify and facilitate the understanding of the therapeutic recreation process, from conceptualization, to the design, implementation, and evaluation of client centered programs. The textbook also provides a thorough review of the assessment and documentation process that effectively reflects changes in the provision of health related services particularly as it relates to the determination of measurable client outcomes and professional accountability.

In the forward, Nancy Navar refers to this text as providing, "…a contemporary body of knowledge that enables the beginning professional to practice therapeutic recreation with skill and understanding." She goes on to state, "It also enables the experienced Therapeutic Recreation Specialist to update his or her views through the integration of concepts" (p. ix). I believe that this is an accurate reflection of this book's value and context. As an educator, I would add that the format of the book enables the professor to teach the therapeutic recreation process in a comprehensible manner. For the student, this approach allows them to see the relationship between the individual parts of the therapeutic recreation process.

The purpose of this book, as described by Stumbo in the preface, is to help students and professionals meet the demands of consumers and proponents of health care concerning greater accountability, more effective methods of service delivery, and a higher degree of reliable, proven client outcomes. It is written for individuals who have an understanding of the therapeutic recreation process and is not designed as an introductory level textbook.

The introduction of the book includes sections on the provision of services based on client needs, the benefits of leisure, leisure behavior, and leisure lifestyle. It also provides an overview of the Leisure Ability Model, clients served by therapeutic recreation, barriers to leisure participation and related service settings. This chapter provides a strong basis for the provision of therapeutic recreation services. The knowledge presented in this chapter is strengthened through interdisciplinary references providing documented evidence that there is a need and purpose for therapeutic recreation services.

Chapter Two describes the Leisure Ability Model. As most readers are aware, the Leisure Ability Model comprises three areas of program focus. The focus areas include; Functional Intervention, Leisure Education, and Recreation Participation. The most significant change in this section of the book is the re-naming of the treatment component to the functional intervention component. The rationale for this change is that the term treatment implies, "any service that is (1) based on client deficits; (2) designed and implemented to improve, reduce, or eliminate those deficits; and (3) targeted toward specific client outcomes as the result of participation in those programs" (p. 28). Based on this premise, functional intervention (programs designed to reduce functional deficits that are prerequisite to leisure behavior), leisure education, or recreation can be considered treatment if assessment of client functioning occurs, client goals are established, a treatment plan is developed, intervention programs are implemented and monitored, and documentation occurs.

Another significant change lies in the definition of social interaction skills in the Leisure Education Component. In the second edition, sub-components of social interaction skills were listed as dual, small group and large group activities. This terminology has been replaced with the following sub-components: communication skills, relationship-building skills, and self-presentation skills. These new components more effectively define the focus of leisure education programs related to social skill development. The terms lend themselves to more defined observable behaviors thus enable more effective tracking of client outcomes.

The information presented in Chapter 3 is perhaps the most significant addition to this textbook. In this chapter the authors introduce the Therapeutic Recreation Accountability Model (TRAM). The rationale of enhancing professional accountability, the importance of utilizing intervention as a means for creating and measuring client change and client outcomes provides the basis for the development of this model. The factors identified as affecting service accountability include program design, client assessment and documentation, and program evaluation. After each of these areas is defined the authors list a series of questions that practitioners can ask to determine whether or not their program is accountable.

The components of TRAM include: comprehensive and specific program design; activity analysis, selection and modification; protocol development; client assessment plan; intervention programs and client documentation; program evaluation/program outcomes; client evaluation/client outcomes; and quality improvement and efficacy research. Each part of this model is discussed in detail in the following chapters. The authors have integrated recent changes in health care and human delivery service into their description of each component. They utilize terminology that is understandable by both health care and human service settings. Numerous examples are provided in each component. These examples enable the reader to view each concept from a variety of different perspectives: verbally, pictorially, and through examples. In addition, the authors seemed to be able to anticipate the concepts that were most difficult to understand and would provide additional examples and explanations for them.

The use of questions to clarify concepts was also a useful technique utilized by the authors. This technique is exemplified in how the authors described the assessment process as a measurement tool. After each concept (i.e. reliability, validity, usability, etc.) was explained, a checklist of questions was provided so that the reader could evaluate an instrument's ability to meet the measurement criteria. The chapter on assessment (Chapter 9) also discussed the principles of assessment, the relationship between assessment and program implementation.

The authors provide an Assessment Plan Model that walks the practitioner through the tasks associated with the selection and implementation of an assessment. These steps include analysis of the environment; definition of parameters; selection of commercial instruments or developing agency-specific instruments; establishment of assessment protocols; and training staff and interns on assessment protocols. This approach teaches the reader the critical thinking skills needed to select or develop their own assessment. The chapter also provides strategies for administering the assessment to the client. These suggestions are separated into the four primary approaches to the administration of assessments: interviews, observations, self-administered surveys, and record reviews. There is also a table that compares the four methods in terms of advantages and disadvantages.

In Chapter 10, Client Documentation, the authors discuss the different types of documentation and provide a strong rationale for quality documentation. The section on Principles of Quality of Client Documentation discusses such topics as accuracy of information, brevity, clarity and methods of charting. Numerous examples are given to clarify the meaning of each topical area. The section on the development of treatment plans focuses on how to identify problem areas and how to write measurable, outcome-oriented goals and objectives. Another strength of this chapter is the procedure described for writing the action plan for client involvement. Each component is fully described with tables providing examples. The section on progress notes delineates the procedure for writing SOAP notes. In addition, the authors explain in detail the content that is required in any format or type of progress note.

Chapter 8 focuses on the development of treatment and diagnostic protocols. The authors emphasize the need for standardized practice and provide models of protocol development.

The chapters on comprehensive (Chapter 4) and specific program planning (Chapter 5), activity analysis (Chapter 6), and program and client evaluation (Chapter 11) are all written in a very clear and understandable manner. The emphasis of these chapters is to demonstrate the importance of thoughtful and purposeful design and implementation of programs. The authors emphasize that therapeutic recreation professionals can no longer provide segmented programming based on the abilities and/or interests of the staff. The authors emphasize that to be accountable the program designers must reflect on the agency's mission and goals, the client needs based on a systematic assessment, utilize activities that are analyzed to meet the needs of the client and that lead to verifiable/measurable outcomes. The systems design approach to program planning, as delineated in this text enables therapeutic recreation professional to develop meaningful and purposeful programs.

In summary, this textbook is useful in helping the recreation therapist understand the importance of integrating all aspects of the therapeutic recreation process. It utilizes the language of outcomes and accountability that is so important in health care today.

Student Comments on the Textbook
· These comments were solicited from students who have utilized this textbook for two classes, Programming and Evaluation in Therapeutic Recreation and Assessment and Documentation in Therapeutic Recreation.
· The majority of the students related that they found the textbook to be clear and comprehensive.
· Many stated that, "It was a keeper", a book that they would not sell back at the end of the semester.
· They felt that the examples were helpful, although they suggested that a system designed program that focused on something abstract verses concrete would be helpful. The Yoga system appeared easier to conceptualize to them than something on social skill development or self-esteem.
· One student suggested that it would be helpful, "…to humanize this text - realizing it is clinical in nature I still believe examples and scenarios could have been a tad bit more personalized. This would make the reading more interesting. Also, using names and colorful scenarios makes it seem this system is useful, working, etc.
· Another student reflected that a section on case histories was not included in the text and felt that this information would be helpful.
· Finally, one student commented, "This was a comprehensive book that used updated information on TR and looked upon it as a science as a necessary service - not something optional". This is, perhaps, a position that many therapeutic recreation professionals would like to see promoted. I applaud the authors for their success at moving the field of therapeutic recreation into a more defined and accountable level through their efforts at revising this textbook. It's a keeper!

Reviewed By
Dr. Janice Elich Monroe, CTRS
Department of Therapeutic Recreation and Leisure Services
Ithaca College - Ithaca New York