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American Journal of Recreation Therapy
Winter 2016, Volume 15
, Number 1


Article
Editorial. It is time for recreational therapists to declare themselves to be health care professionals
David R. Austin, PhD, FDRT, FALS; Marieke Van Puymbroeck, PhD, CTRS, FDRT
Winter 2016; pages 7-8

Abstract
DOI: 10.5055/ajrt.2016.0094


Article
Editorial. Advocating for the profession: Your role in supporting HR 1906, the Access to Inpatient Rehabilitation Therapy Act of 2015
Richard Williams, EdD, LRT, CTRS, FDRT; Thomas Skalko, PhD, LRT, CTRS, FDRT
Winter 2016; pages 9-13

Abstract
Public policy advocacy is critical to the profession of Recreational Therapy. Currently, HR 1906, the Access to Inpatient Rehabilitation Therapy Act of 2015 has been introduced to the US House of Representatives. Essentially, if enacted into law, the bill will amend the Social Security Act to include Recreational Therapy among the therapy modalities that constitute an intensive rehabilitation therapy program in an inpatient rehabilitation hospital or unit. The designation of RT among the therapy modalities allows the rehabilitation treatment team to access RT services for use in the 3-hour rule. Key words: public policy, advocacy, professional engagement, HR 1906 DOI: 10.5055/ajrt.2016.0095


Article
A brief review of loneliness: Correlates, consequences, and considerations for recreational therapists
Ellen Rozek, PhD; Nancy E. Richeson, PhD
Winter 2016; pages 15-22

Abstract
Loneliness is a complex human experience that most people experience in their lifetimes. The authors review how the construct of loneliness is defined and how it is distinguished from the concept of social isolation. Common risk factors that predict loneliness such as gender, marital status, and age are discussed. Potential consequences for people who are lonely can be emotional, physical, and cognitive. Research on these functional outcomes is reviewed. Because loneliness is a prevalent human experience, recreational therapists are likely to encounter individuals who may be dealing with loneliness. The authors discuss how recreational therapists can use this information in clinical practice. Keywords: loneliness, older adults, social isolation, therapeutic recreation DOI: 10.5055/ajrt.2016.0096


Article
Effects of exercise on disability in older adults with arthritis: A 3-year follow-up
Kenneth E. Mobily, PhD
Winter 2016; pages 23-29

Abstract
The purpose of this study was to investigate the effects of exercise on functional disability outcomes in older adults with arthritis. Exercise was operationalized as frequency of exercise per week at baseline and follow-up, and as miles walked per week at baseline and follow-up. Results indicated that subjects reporting high exercise frequency at baseline and follow-up were least impaired after 3 years. Surprisingly, changing from low rate of exercise to a high rate of exercise by follow-up was not associated with less impairment. These data suggest that benefit is secured only with adoption and continuity of exercise. Additional results indicated that frequent walking at follow-up yielded benefit, irrespective of walking mileage at baseline. Implications and applications for therapeutic recreation inducing comparable outcomes in practice are discussed. Keywords: arthritis, exercise, longitudinal DOI: 10.5055/ajrt.2016.0097


Article
A Flex-Model for long-term assessment of community-residing older adults following disasters
Marlene M. Rosenkoetter, PhD, RN, CNS, FAAN; JoEllen McDonough, PhD, RN; Amber McCall, PhD, RN; Deborah Smith, DNP, RN; Stephen Looney, PhD
Winter 2016; pages 31-46

Abstract
For the rapidly growing older adult population, disaster consequences are frequently life disruptive and even life threatening. By 2050, it is estimated that the global older adult population will reach 22 percent of the total. With declining health, this population poses a particular risk needing to be addressed in emergency preparedness and disaster recovery. The purpose of this article is to describe a Flex-Model (F-M) for the long-term assessment of older adults following a disaster. An F-M is a series of three-dimensional representations of an archetype with flexible components, both linear and parallel, that can be adapted to situations, time, place, and needs. The model incorporates the Life Patterns Model and provides a template that can be adjusted to meet the needs of a local community, healthcare providers, and emergency management officials, regardless of the country or region, during the months after a disaster. The focus is on changes resulting from the disaster including roles, relationships, support systems, use of time, self-esteem, and life structure. Following a baseline assessment, each of these life patterns is assessed through the model with options for interventions over time. A pilot study was conducted in Georgia to gain information that would be helpful in developing a more specific assessment tool following a severe winter storm. While this is a local study, the findings can nevertheless be used to refine and focus the F-M for future implementation. Results indicated that older adults used high-risk heating and lighting sources and many were totally responsible for their own welfare. Findings have implications for emergency preparedness and long-term recovery. Key words: disasters, assessments of older adults DOI: 10.5055/ajrt.2016.0098


Article
World Health Organization Disability Health Assessment 2.0 for Health Monitoring: Examining the potential use of the WHODAS 2.0 as a health screening tool among older adults in rural North Carolina
Amanda Warren, MS, CTRS; Richard Williams, EdD, LRT/CTRS/FDRT
Winter 2016; pages 47-53

Abstract
Unless measures are taken, escalating healthcare costs and an aging population will increasingly contribute to financial burdens on federal and state healthcare budgets. With the help of appropriate supports, many older adults can remain in their homes and communities and delay expensive long-term care placements. An important aspect of aging in place is health monitoring so that health issues can be addressed before they escalate. The WHODAS 2.0 is a standardized assessment tool that may be valuable for recreational therapists and others to use to monitor health and functional status of community-dwelling older adults. Key words: World Health Organization, International Classification of Disability, Health and Functioning (ICF), World Health Organization-Disability Assessment Survey 2.0, health monitoring, older adults, aging in place DOI: 10.5055/ajrt.2016.0099

American Journal of Recreation Therapy
Spring 2016, Volume 15
, Number 2


Article
Editorial. Using the Beers criteria to advocate and advance recreational therapy: Understanding clinical competencies
Nancy E. Richeson, PhD, CTRS, FDRT
Spring 2016; pages 6-6

Abstract
DOI: 10.5055/ajrt.2016.0100


Article
Therapeutic recreation at camp: A Delphi study identifying important elements
W. Thomas Means, MS, CTRS; Steven Simpson, PhD
Spring 2016; pages 7-12

Abstract
For many individuals with disabilities, specialized camps offer intentional recreational activities designed to meet specific goals. The purpose of this study was to identify the most important elements of Therapeutic Recreation (TR) when applied to residential summer camps for individuals with disabilities. This study used a panel of experts using a Delphi approach. Experts initially identified 29 elements and in subsequent rounds provided ratings and definitions of each element. Statistical analysis identified nine elements as most important: Planning, Evaluation, Socialization, Implementation, Staff Qualifications & Competency Assessment, Management, Prevention, Safety Planning, & Risk Management, Program Evaluation & Research, Quality Improvement. Identifying key elements is critical in developing a framework for future research, as well as justifying TR service and prioritizing which elements should be considered when creating a TR camp program. Key words: camp, therapeutic recreation, elements, components DOI: 10.5055/ajrt.2016.0101


Article
A comparison of recreational therapy and child life practice: Similarities, differences, and opportunities
Victoria L. Cooper, MSRT, CTRS, CCLS; Heather R. Porter, PhD, CTRS
Spring 2016; pages 13-28

Abstract
Transdisciplinary care and collaboration among team members is necessary and essential to maximize patient outcomes. Collaboration is the most effective when professionals understand the unique role of each discipline. This is potentially more difficult when disciplines overlap in some services provided, or when an individual on the team is dually certified. In pediatric care settings, this is often the case for recreational therapy (RT) and child life (CL). The purpose of this study is to highlight the benefits of transdisciplinary care, as well as summarize similarities and differences between the two fields based on profession-based documents. Findings indicate 28 unique areas of RT practice, 18 grey areas (items found in both RT and CL profession-based documents with shades of differences), eight items found in one profession that are highly likely to occur in both professions, and 31 areas of similarity. Items of similarity do not raise concern, as the items appear to be common among many healthcare professions, such as developing a therapeutic relationship and conducting an assessment. Differences stem from underlying principles of each profession. RT is primarily a treatment/therapy-based profession (eg, functional skill development), whereas the foundation of CL is a helping-based profession (eg, coping within the hospitalized environment). RT must effectively deliver a message of its unique contribution to the healthcare landscape with special emphasis on functional skills development, client and family education and counseling, and community integration and transition training related to maximizing healthy engagement in play, leisure, recreation, and community activities post hospitalization for continued recovery, development, and prevention. Methods of disseminating findings and strengthening RT evidence-based research in pediatric acute care are provided, along with suggested opportunities for collaborative research. Key words: recreational therapy, child life, scope of practice, comparison DOI: 10.5055/ajrt.2016.0102


Article
Family Battle Buddies Program: A therapeutic program for reintegrating National Guard families
Shay Dawson, MA, CTRS; Kathleen Gilbert, PhD; Rebecca Gilbert, PhD; Jonathon Beckmeyer, PhD; Bryan McCormick, PhD
Spring 2016; pages 29-38

Abstract
It is widely documented that military deployment contributes to family stress, yet little attention has been given to the psychosocial stressors associated with the reintegration phase post-deployment. Challenges associated with reintegration include role ambiguity, communication breakdown, conflict, and increased risk for parental divorce. The Family Battle Buddies Program (FBBP) was developed as an evidenced-based practice approach to address the reintegration phase of military life for returning National Guard families. In this report, the authors detail the theoretical foundations and specific program components of the FBBP. Key words: military, family, recreational therapy, reintegration DOI: 10.5055/ajrt.2016.0103


Article
Recreational therapy competencies for working with older adults
Nancy E. Richeson, PhD, CTRS, FDRT; Angie Sardina, MS, CTRS
Spring 2016; pages 39-48

Abstract
This article explores the work of the American Therapeutic Recreation Association's (ATRA's) Geriatric Treatment Network (GTN). For the past 4 years, the GTN has worked to develop recreational therapy competencies for older adults based on recommendations from the Institute of Medicine (IOM) report, which stated that the existing workforce was ill equipped to meet the needs of an aging America. Industry-wide competencies developed by the Association for Gerontology and Higher Education (AGHE) and the Partnership for Health in Aging (PHA) are highlighted as necessary knowledge needed for a trained workforce. To adequately meet the needs of older adults, the recreational therapist is encouraged to find resources and educational opportunities to implement industry-wide and recreational therapy competencies. Keywords: therapeutic recreation, knowledge, skills, abilities, geriatric practice, AGHE DOI: 10.5055/ajrt.2016.0104

American Journal of Recreation Therapy
Summer 2016, Volume 15
, Number 3


Article
Calling professionals to action
James B. Wise, PhD, CTRS
Summer 2016; pages 6-7

Abstract
Professionals who advocate for cleaving the present therapeutic recreation practice along philosophical lines are called to step forward and lead preparations for the separation. The primary and most crucial task facing each group of advocates is developing a philosophical foundation. A foundation is critical because it guides every aspect of a practice including the identification of requisite knowledge, skills and abilities to excel as practitioners, and determination of the profession’s name and practitioners’ title. Developing philosophical foundations for the two desired practices and completing the concomitant tasks ensures the formation of viable practices that can benefit everyone. Key words: leisure, recreation therapy, therapeutic recreation, treatment DOI: 10.5055/ajrt.2016.0106


Article
Activity-in-a-Box for engaging persons with dementia in groups: Implications for therapeutic recreation practice
Jiska Cohen-Mansfield, PhD; Karen Hirshfeld, MA, CTRS; Rachel Gavendo, BA, CTRS; Erin Corey, BA, CTRS; Tasmia Hai, Med
Summer 2016; pages 8-18

Abstract
Therapeutic recreation (TR) activities benefit the affect and behavior of persons with dementia. The authors examine the perceived utility of an Activity-in-a-Box methodology as part of a larger study examining the impact of group activities on persons with dementia. The box contained items such as a program protocol and materials adapted to the abilities of persons with dementia. This article reports about the perceptions of 10 TR staff concerning the utility of the Activity-in-a-Box format. Staff reported that materials were very useful and enumerated multiple benefits, including: enhancing therapists’ ability to engage participants in different activities, facilitating new types of activities for staff members to try, and a useful tool for training. The authors recommend further investment in enhancing the scope and the quality of Activities-in-a-Box materials. Key words: dementia, engagement, quality of life, therapeutic recreation, activities DOI: 10.5055/ajrt.2016.0107


Article
The truth about strengths-based practice: Not a new paradigm for recreational therapy--But an important one
David R. Austin, PhD, FDRT, FALS; Bryan P. McCormick, PhD, CTRS, FDRT, FALS
Summer 2016; pages 19-28

Abstract
Although Heyne and Anderson have offered their strengths-based approach as a sea change in the practice of recreational therapy, there is compelling evidence that the strengths-based approach has existed within recreational therapy for some time. In fact, recreational therapists should take pride in being among the early adopters of the strengths-based approach. Recreational therapy’s foundation in humanistic psychology, and subsequently in positive psychology, has always provided an orientation to practice in which therapists were encouraged to focus on client strengths and resources. In addition, the authors argue that Heyne and Anderson’s exclusive focus on strengths, to the neglect of client problems and concerns, does not represent the entire spectrum served by recreational therapists. Further, Heyne and Anderson have inaccurately characterized recreational therapists as following a medical model, which emphasizes only client problems or health conditions. Further, they erroneously portray recreational therapists as exerting dominance over clients. This representation is simply not in keeping with practices in recreational therapy. The authors suggest that Heyne and Anderson should be applauded for bringing attention to the importance of recreational therapists focusing on using a strengths-based approach to assist clients to move toward the achievement of optimal functioning and well-being. In doing so, however, they have failed to acknowledge that recreational therapists work along the full range of human functioning that includes helping clients to alleviate problems at one end of the spectrum to the promotion of optimal functioning at the other end. The roles of alleviating client health problems and issues and the promoting of optimal functioning are dual roles that recreational therapists do and should take. Key words: humanistic psychology, strengths approach, positive psychology, developmental approach DOI: 10.5055/ajrt.2016.0108


Article
A comparative study on the effects of Tai Chi and Matter of Balance on measures of balance and fall efficacy in older adults
Thomas K. Skalko, PhD, LRT/CTRS, FDRT; Lacey A. Burgess, LRT/CTRS; Megan Janke, PhD, LRT/CTRS
Summer 2016; pages 29-39

Abstract
The purpose of this study was to compare two intervention strategies, Tai Chi (TC) (n = 12) and Matter of Balance (MOB) (n = 13) on balance and fall efficacy of older adults (=65 years) as compared to a control group (n = 12). The study compared changes in balance and fall efficacy of the two strategies in an effort to evaluate fall reduction programs for future application. Participants were assessed via a pretest to post-test, 8-10 weeks apart using two balance tests: 8-Foot Up and Go test and the Multi-Directional Reach Test. Fall efficacy was measured with the Activities-specific Balance Confidence (ABC) Scale. Results from this study indicate that the TC group and MOB group were both effective in improving or maintaining balance and fall efficacy as compared to the control group. Results demonstrated trending toward TC as having a greater impact on participants’ overall balance measures. Key words: Tai Chi, balance, fall efficacy, older adults DOI: 10.5055/ajrt.2016.0109


Article
An exploration of recreational therapy students’ attitudes toward adults with developmental disabilities
Cara M. Prinzo, MS, CTRS; Gretchen Snethen, PhD, CTRS
Summer 2016; pages 40-48

Abstract
While more adults with developmental disabilities are living in the community, negative attitudes and stigma remain a barrier to independence and community integration. Both community members and healthcare providers harbor these attitudes, and thus may discriminate against this population. The adverse consequences of stigma particularly within the healthcare system have a negative impact on the health and well-being of adults with developmental disabilities. Because recreational therapists provide services that often promote independence and community integration, it is important to have an understanding of underlying attitudes toward this population. This article reports on the attitudes of recreational therapy undergraduate students toward adults with developmental disabilities and factors that may be associated with these attitudes. Based on correlational analyses, recommendations are made for recreational therapy curriculum to reduce stigmatizing attitudes. Key words: stigma, developmental disabilities, students, education DOI: 10.5055/ajrt.2016.0110


Article
Book review.
Tameka S. Battle, CTRS, CDP
Summer 2016; pages 49-50

Abstract
Therapeutic Recreation Leadership and Programming. Robin Kunstler, ReD, CTRS and Frances Stavola Daly, EdD, CTRS, CPRP. Champaign, IL: Human Kinetics. 2010. DOI: 10.5055/ajrt.2016.0111

American Journal of Recreation Therapy
Fall 2016, Volume 15
, Number 4


Article
Editorial. Topics in gerontology and geriatrics that every Recreational Therapist should know
Nancy E. Richeson, PhD, CTRS, FDRT
Fall 2016; pages 6-6

Abstract
DOI: 10.5055/ajrt.2016.0113


Article
An update of a physical health community-based treatment program for clients with severe and persistent mental illness
Ron Tankel, BS, CTRS
Fall 2016; pages 7-10

Abstract
This article revisits the case study of a program published in the American Journal of Recreation Therapy (December 2014. Vol. 13, Number 1, pp. 31-35) and describes how the program has evolved in the last 2 years. We have found that motivation on the part of clients has been maintained and have implemented additional programming to meet the needs of clients. Key words: severe and persistent mental illness, physical wellness, outpatient mental health treatment DOI: 10.5055/ajrt.2016.0114


Article
Current status of assessment in recreational therapy practice
M. Elizabeth Kemeny, PhD, CTRS; Deborah Hutchins, EdD, FDRT, CTRS; Colleen A. Cooke, EdD, CTRS, CLL
Fall 2016; pages 11-21

Abstract
Client assessment is the basis for program planning and implementation in recreational therapy. It is through the assessment process that individualized goals and objectives are formulated. Entry-level professionals must be proficient in the assessment process and have knowledge about various assessment tools. The purpose of this project was to conduct a survey of practicing Certified Therapeutic Recreation Specialists to determine what is current practice in terms of recreational therapy assessment across settings. It was hoped that this project would advance recreational therapy by informing educators and aiding current practitioners in their efforts to identify and use reliable and valid assessment tools in their practice setting. Key words: recreational therapy assessment, recreational therapy education, current practice in recreational therapy, reliable and valid assessment in recreational therapy DOI: 10.5055/ajrt.2016.0115


Article
The effects of exercise on depressive symptoms of individuals with dementia: A pilot study
Deborah Logan, MS, LRT/CTRS; Marieke Van Puymbroeck, PhD, CTRS, FDRT
Fall 2016; pages 23-28

Abstract
Dementia is a disease that can affect individuals as they age, and for many individuals with dementia, there is a chance of additional comorbidities, such as depression. When these two health conditions occur simultaneously, it is more difficult to treat the depressive symptoms. To evaluate changes of depressive symptoms in residents of an assisted living facility who have the diagnosis of dementia, 10 days of 30-minute exercise sessions were conducted. Nonparametric statistics indicated a significant decrease in depressive symptoms for the seven participants in this exploratory pilot study. The results from this study indicate that a decrease in depressive symptoms is possible and can be facilitated by a recreational therapist via a structured exercise group. Further research ideas and implications for practice are described. Key words: dementia, Alzheimer's disease, exercise, depression, recreational therapy DOI: 10.5055/ajrt.2016.0116


Article
Companionship with a robot? Therapists’ perspectives on socially assistive robots as therapeutic interventions in community mental health for older adults
Jennifer Piatt, PhD, CTRS; Shinichi Nagata, MS, CTRS; Selma Šabanovic, PhD; Wan-Ling Cheng, MS; Casey Bennett, PhD; Hee Rin Lee, MS; David Hakken, PhD
Fall 2016; pages 29-39

Abstract
Lack of companionship, loneliness, and social isolation are often experienced by older adults diagnosed with clinical depression living independently within the community. Socially assistive robots (SARs), a relatively new concept within recreational therapy, may be one treatment modality that can address each one of these concerns. This exploratory study consisted of interviews with community mental health professionals, including a recreational therapist, to determine if they perceived SARs as an appropriate interdisciplinary clinical intervention for older adults diagnosed with clinical depression. Results indicated that SARs, especially those which can provide companionship and social interaction similar to animal assisted therapy, are an appropriate interdisciplinary intervention for this population and may have an impact on improving overall quality of life by decreasing loneliness and social isolation associated with clinical depression. Key words: socially assistive robots, older adult, clinical depression, community-based Rehabilitation DOI: 10.5055/ajrt.2016.0117


Article
Therapeutic riding and children with Autism Spectrum Disorder: An application of the theory of self-efficacy
Brenna Jeanne Goodwin, MS, CTRS, TRS; Brent L. Hawkins, PhD, CTRS, LRT; Jasmine A. Townsend, PhD, CTRS; Marieke Van Puymbroeck, PhD, CTRS, FDRT; Stephen Lewis, PhD, CTRS
Fall 2016; pages 41-47

Abstract
Research supports claims of benefits of therapeutic riding for children with Autism Spectrum Disorder (ASD); however, the effect of specific subtypes of therapeutic riding (eg, therapeutic riding drill team) has been underinvestigated. Furthermore, the theories underlying therapeutic riding programs have not been well reported, especially among studies with children with ASD. This study used qualitative data from interviews to determine which aspects of Bandura's self-efficacy were evident among participants in a 16-week therapeutic riding drill team program. Results provided evidence of the presence of selfefficacy among participants during the program. Results of this study may be used to help recreational therapists target aspects of self-efficacy in therapeutic programs for children with ASD as a way to increase self-efficacy. Key words: therapeutic riding, Autism Spectrum Disorder, self-efficacy, equine DOI: 10.5055/ajrt.2016.0118


Article
Book review
Nancy E. Richeson, PhD, CTRS, FDRT
Fall 2016; pages 48-48

Abstract
Disrupt Aging: A Bold New Path to Living Your Best Life at Every Age. Jo Ann Jenkins. New York, NY: PublicAffairs. 2016, 272 pages. DOI: 10.5055/ajrt.2016.0119