Evidenced Based Practice

Providing Effective Recreational Therapy

Interventions For Geriatric Clients

Jo Lewis, MS/CTRS

Megan C. Janke, Ph.D., LRT/CTRS

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.

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)

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

Time For A Game!

Cognitive Functioning

Short term memory Long term memory Following directions Safety awareness Communication skills Word finding ability Money management Attention span Writing skills

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

Emotional/ PsychosocialWell-Being

Apathy/ Passivity Depressive symptoms Anxiety Communication skills Social skills Self-Esteem Coping skills Motivation Disturbing behaviors

Other Areas To Address Pain

Decrease pain Increase functional abilities

Community reintegration Independence in community

setting Community resources

Weight Loss/ Gain Caregiver

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?

Sources of Evidence RT/TR Journals

Therapeutic Recreation Journal Annual in Therapeutic Recreation American Journal of Recreational Therapy Other Professional Publications

Simple PleasuresDementia Practice Guidelines

Other Professional Journals RT Wise Owls

Recreational Therapy Evidence Based Practice: Strengthening the Profession (Temple University)

http://rtwiseowls.com

Looking at the Literature…

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

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

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