Therapeutic Recreation and Chronic Disease

Therapeutic Recreation and Chronic DiseaseThe following presentation is a repeat of the presentation given at the 17th Annual CTRA conference.

BCTRA Teleconference December 4th 2013Therapeutic Recreation and Chronic Disease TR la carte : INNOVATION, ADAPTATION, INSPIRATION 17th Annual CTRA Conference May 17th, 2013 Montreal, Quebec CanadaPresented by : Jane Crawford CTRS

DisclosureEmployee of Alberta Health Services Living Well Program Calgary ZoneRecipient of the Alberta Therapeutic Recreation Calgary Chapter Scholarship program I have no relevant financially or non financial relationships to disclose.

3Session ObjectivesTwo Self Care Management ModelsRecreation Therapy and Self Care ManagementPotential challenges building TR into a very established program

4Psychology reviewHumanistic PsychologyPositive Psychology

5

Chronic Disease/Chronic IllnessDiseaseChronic disease is an illness that is prolonged, do not resolve spontaneously and are rarely cured completely.Both communicable and non communicable

http://www.cfp.ca/content/53/12/2086.full

IllnessChronic illness refers to the lived experience of long-term bodily or health disturbance, It is experience of intrusive bodily or mental unwelcome pleasant sensations

6HEALTH SYSTEM MODEL CHARACTERISTICCHRONIC CARE MODELFAMILY MEDICINE AS MEDICAL SPECIALTYMULTIDISCIPLINARY PRIMARY CARENEW ORIENTATIONS OF PRIMARY HEALTH CAREView of healthAbsence; control of disease; quality of lifeAbsence; control of diseaseAbsence; control of disease; quality of lifePositive well-beingLocus of controlHealth system managers, self-managementMedical practitionersHealth professionalsCommunities, families, and individualsMain focusHealth systems Patient self-management Providers Individuals Cradle-to-grave disease prevention and control through medical interventions Practice-based Cradle-to-grave disease prevention, management, and care through provider interventions Population- and community-based Improve individuals family and community, healthy living, and equity Health care providersMultidisciplinary systems, including physicians, intersectoral and community collaborationFamily physicians with other health care providersFamily physicians as part of multidisciplinary teamsMultidisciplinary networks include FPs and intersectoral collaborationStrategies for healthDisease prevention and management systems across health sectors Self-management, care coordination, evidence, and community involvement Medical interventions and systems Acute care paradigm between secondary and tertiary care; evidence-based guidelines First-level health system Prevention, chronic disease management; structured and planned care; self-management with professional, peer, and family support Population health systems Health promotion, prevention, self-care, and illness support; address inequalities and determinants; community empowerment; accountability 7Provincially for Self ManagementEvery province is doing something.Often falls under health promotion/prevention portfoliosEvidence informed practiceStrong part of the work that occurs in the primary or family doctors office. Introduction of the allied health care professional in family doctors officeEducation opportunities make up the bulk of the programs offered

8

What is Self Management? the tasks that an individual must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management, and emotional management of their conditions.http://www.healthcouncilcanada.ca/tree/HCC_SelfManagementReport_FA.pdf page 7

9

Other definitions of Self ManagementCentre for Advancement of Health: 'involves (the person with the chronic disease) engaging in activities that protect and promote health, monitoring and managing the symptoms and signs of illness, managing the impact of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes.' http://www.cfah.org/Stanford Definition:'participants to make informed choices, to adapt new perspectives and generic skills that can be applied to new problems as they arise, to practise new health behaviours, and to maintain or regain emotional stability.'Lorig, K; et.al. Living with a Healthy Life with Chronic Conditions. Bull Publishing Company 2000

10Wagners Model of Chronic Care

11Flinders Self Care Model

12Stanford Model Programs are designed to help people gain self-confidence in their ability to control their symptoms and how their health problems affect their livesSmall-group workshops are given in community settings and on the InternetFacilitated by two leaders/moderators with health problems of their ownWorkshops are highly interactive, focusing on building skills, sharing experiences, and support13Self Management TasksTo take care of the illnessTo carry out normal activitiesTo manage emotional changes

.14Tool Box for Self ManagementPain ManagementFatigue ManagementBreathing TechniquesRelaxing and managing emotionsNutrition ExerciseMedicationCommunity Resources.Communication with professionals

15Tool Box for Diabetes Medication takingDietPhysical activity/exerciseBlood Glucose MonitoringManaging high/low blood sugarsMedical monitoring/ doctor visitsManaging distress/depressionFoot care Eye care

16Roots of Recreation TherapyThe professions roots can be found in Humanistic and Positive psychologyRecreation Therapy applies interventions to change behaviours that promote growth and positive feelingsStrength based interventions

17National PhilosophyTherapeutic Recreation is directed toward functional interventions, leisure education and participation opportunities. These processes support the goal of assisting the individual to maximize the independence in leisure, optimal health and the highest possible quality of life.www.canadian-tr.org/About

18Alberta Official DefinitionTherapeutic Recreation/Recreation Therapy is a health profession which acknowledges the significance of leisure and recreation as integral components of optimal health and well-being of individuals with illnesses and disabling conditions.http://www.alberta-tr.org/

19Evolution of RT Conceptual ModelsEarly days there were general impressions provided but not truly conceptual models (e.g., recreation for the ill and handicapped or recreation as a treatment tool.).1970s/1980s RT worked frantically to define itself (Leisure Ability Model was embraced).1980s saw dissatisfaction with the Leisure Ability Model (Hamilton & Austin, 1992).Health Protection/Health Promotion Model presented in 1991 -- as an alternative to the Leisure Ability Model.Additional RT conceptual models have followed.Reformulated HP/HP Model in 2011.

Slide taken from Dr. Austins presentation The Reformulated Health Protection/Health Promotion Model

20Leisure Ability Model

21Health Protection/Health Promotion Model

22Skills of the Recreation TherapistIntegrationEncouraging independenceAccentuating the positiveProviding active listeningExploring new lifestyle optionsSetting appropriate goals.

23Skills for the Clinician of Self Managed ClientMotivational InterviewingOpen ended inquiryReflective ListeningHas skills to bring about changeCan measure conviction and confidencehttp://www.healthcouncilcanada.ca/tree/HCC_SelfManagementReport_FA.pdf page 9

.24

Therapeutic Recreation and Self ManagementClient is an active participant in the processClient has a clear understanding of the end goal in both styles of programsClient can identify the symptoms and/or barriers and make the necessary changes when they encounter a health changeClient can maintain a level of independence pursuing an activity that brings health improvementsClient develops self efficacy and confidence in ones own environment and community 25

26Living Well ProgramA support program for people with diabetes, high blood pressure, heart disease, chronic lung disease, chronic pain and other long term illnesses.There are three pillars to this program:supervised exercise classes education classes self managementworkshop (Better Choices, Better Health).

27Calgary ExperienceSo why add Recreation Therapy 10 years after the program had started.

28Community Partnership BuildingUnderstanding the core competencies of your programWhat will a client know when they leaveUnderstanding the partners goals and missionsWhat can the partner offer in their mandate

29Professional ChallengesDefining Recreation Therapy Language barriers (definitions such as community integration)Isolation as the lone Recreation Therapist program.Learning curve

30Future of TR in Living Well Program Strong community integration piece within the exercise pillarGroup and 1/1 Recreation Therapy support as assessed in accessing community programsDevelopment of TR role in the education pillar.Access to Recreation Therapy in the rural sites in 2014

31Session Objectives CompletedCan you name a Chronic Disease Model?What are the similarities of self management and recreation therapy models?What are some of the challenges a CTRS might face moving into an established Self Care Model?

32ResourcesHealth Council of Canada. Self management support for Canadians with Chronic health conditions. A focus for primary health care. May 2012: http://www.healthcouncilcanada.ca/tree/HCC_SelfManagementReport_FA.pdfStanford Program Self Management: http://patienteducation.stanford.edu/programs/College of Family Physicians: http://www.cfp.ca/content/53/12/2086.fullCentre for Advancing Health: http://www.cfah.org/Alberta Health Living Well Calgary Program: http://www.albertahealthservices.ca/services.asp?pid=service&rid=1005671

33Reference ListAlberta Health Services. Integrated Community Base Chronic Disease Management Program. A proposed Model for Alberta. Presented by: Community &Rural, Primary Care & Chronic Disease ManagementAnderson, L. & Heyne, L. Flourishing through Leisure: An Ecological Extension of the Leisure and Well Being Model in Therapeutic Recreation Strengths- Based Practice. Therapeutic Recreation Journal Vol. XLVI No 2 pp 129-152. 2012 Austin, D. Lessons Learned An Open Letter to Recreational Therapy Students and Practitioners, Sagmore Publishing 2011

34Reference List continuedAustin D. Therapeutic Recreation Processes and Techniques 5th Ed. Sagmore Publishing 2004Austin, D. Reformulation of the Health Protection/Health Promotion Model American Journal of Recreation Therapy Volume 10 Number 3 pages 19-26Austin, McCormick & Van Puymbroeck, Positive Psychology: A theoretical foundation for Recreation Therapy. American Journal of Recreation Therapy Vol.9 No. 3

35Reference List continuedChoices and Changes: Clinician Influence and Patient Action Workshop, Institute for Healthcare Communication. January 2013Chronic Disease Prevention and Management Conference. Calgary 2007Dieser, R. A Cross Cultural Critique of Newer Therapeutic Recreation Models: The Self Determination & Enjoyment Enhancement Model, Aristotelian Good Life Model, & the Optimizing Lifelong Health Through Recreation Model. Therapeutic Recreation Journal 4th Quarter 2002 p 352-368

Reference List ContinuedHood & Carruthers. Enhancing Leisure Experience and Developing Resources: The Leisure and Well Being Model Part I. Therapeutic Recreation Journal Vol 41 No 4 276 -297. 2007Hood & Carruthers. Enhancing Leisure Experience and Developing Resources: The Leisure and Well Being Model, Part II. Therapeutic Recreation Journal Vol. 41, No. 4. 298-325 2007Keogh Hoss & Kensinger, Medical Home: Is there a place for recreational therapy? American Journal of Recreation Therapy, Vol. 9 N0. 2

37Reference List ContinuedLee and McCormick: 2002 Sense Making Process in Defining health for People with Chronic Illnesses and Disabilities. Therapeutic Recreation Journal 3rd Quarter Vol 36. No 3 235-246 Loitz et al, Sociodemographic Patterns of Leisure-Time Physical Activity of Albertans 2000 to 2011. Health and Fitness Journal of Canada Vol. 5 No.1Lorig, K; et.al. Living with a Healthy Life with Chronic Conditions. Bull Publishing Company 2000Mobilily, K. Role of Exercise and Physical Activity in Therapeutic Recreation Services. Therapeutic Recreation Journal Vol. XLIII, No 2 pp 9-26, 2009Reference List ContinuedMobily & MacNeil, Therapeutic Recreation and the Nature of Disabilities Venture Publishing 2002.Parker, V. & Carmack, R. A Critique of Van Andelss TR Service Delivery and TR Outcome Models. Therapeutic Recreation Journal 3rd Quarter 1998 Porter & Burlingame. Recreational Therapy Handbook of Practice, ICF-Based Diagnosis and Treatment Idyll Arbour 2006Shank & Coyle. Therapeutic Recreation in Health Promotion and Rehabilitation, Venture Publishing 2002

39Reference List ContinuedSylvester, C. Therapeutic Recreation, the international Classification of Function, Disability and Health, and the Capability Approach. Therapeutic Recreation Journal Vol., XLV, No 2 pp. 85-104 2011.Wilhite, B. et al. Optimizing Lifelong health and Well Being: A Health Enhancing Model of Therapeutic Recreation. Therapeutic Recreation Journal. 2nd Quarter 1999 p98-108

40Thank you BCTRAContact information:jane.crawford@albertahealthservices.ca