The changing face of health care is having a dramatic effect on therapeutic recreation (TR) services in physical rehabilitation settings. Nationwide, restructuring and reorganization of physical rehabilitation units is the trend as facilities struggle to increase efficiency without jeopardizing the quality of their health care services. As these changes occur, approaches to therapeutic recreation service delivery for individuals with physical disabilities are being re-examined as well.
The traditional TR department, with a certified therapeutic recreation specialist (CTRS) as director, is often replaced by a "product line" or "program" model. Such models organize rehabilitative services according to the disability, diagnosis, or medical goals of the client or patient, rather than the discipline of the service provider. Thus, there is a movement away from hierarchically organized, discipline-specific services toward services that require multi-disciplinary cooperation among allied health professionals.
Naturally, such change profoundly affects TR practitioners, cuts in middle management have been accompanied by increased productivity standards (i.e., hands on service delivery) for allied health professionals with administrative duties.
This kind of story is becoming increasingly common and reflects a trend away from specialization in physical rehabilitation. The result is a new challenge for TR specialists to maintain their professional identity. This is particularly difficult in light of the fact that TR specialists increasingly are being supervised by professionals from other disciplines, and these supervisors may not have a clear understanding of the purpose and scope of TR. This is especially problematic for TR specialists who are new to the field and do not have past experiences from which they can derive a self-image.
Managed Care
Another trend that affects both TR specialists and their clients with physical disabilities is the dramatic decrease in the length of stay for patients in rehabilitation facilities. As soon as the patient is mobilized, they are discharged. Shortened stays mean that the TR specialist not only has less time to complete essential services (e.g. assessment, evaluation), but also less time to establish a beneficial therapeutic relationship with clients during their hospitalization. In turn, the client may leave the rehabilitation facility without mastering leisure-related skills that are essential for successful reintegration in the community.
Nonetheless, with the advent of managed care and a government focus on reducing health care expenditures, this trend is likely to stay. There are other trends that also contribute to TR's changing nature. These include:
* Client-to-staff ratios are increasing, with fewer TR specialists providing services to more clients with disabilities. The demand for increased efficiency in services and pressure for cost containment in health care will undoubtedly continue this trend.
* As managed care puts pressure on specialists to prove their cost-effectiveness and contribution to positive outcomes, TR providers are devoting more time to promoting the profession and "selling" their services to case managers.
* The use of TR in co-treatments (i.e., professionals from one or more allied health disciplines collaborating and delivering services to a single client simultaneously) is expanding rapidly.
* Community re-integration, a strength of TR services in most facilities, is increasing in importance, with emphasis on functional skills that enable a client to return to his or her community as quickly as possible. Concurrently, increased collaboration is taking place between TR specialists in physical rehabilitation facilities and community recreation professionals. This helps to ensure continuity of leisure services for the person with a physical disability, thus reducing the risk of re-hospitalization.
* Lengthy assessments are being shortened so that essential information can be gathered at a minimum amount of time.
* Outpatient TR services are becoming more prevalent in physical rehabilitation. Not only are outpatient services more cost-effective than in-patient care, but high-profile, community-based activities often serve as good public relations for the facility.
Programming Trends
Although trends in TR service delivery reflect rapid change, the program trends in TR for persons with physical disabilities are less dynamic. The current emphasis is on collaboration with community agencies to ensure that programs provided in clinical facilities are available to clients after discharge. Programs that were once run by TR staff members and sponsored by rehabilitation hospitals increasingly are being transferred to community control.
As the trend toward cooperation with community-based agencies continues, a number of TR programs activities for persons with physical disabilities appear poised for expansion. These activities, most of which encourage opportunities for transition to community living, are discussed below.
Adventure/Risk and Outdoor Activities. Although they long have been popular among persons with physical disabilities, activities that include adventure and risk are receiving increasing emphasis in physical rehabilitation. -- Activity and Competitive Sports. Sports activities offering vigorous physical exertion often are employed in physical rehabilitation. -- Health Enhancement Activities. Aerobics, dance, adapted aquatics, weight training, and other fitness-related activities are growing in popularity in physical rehabilitation. -- Computer-related Activities. Computers rapidly are becoming a necessity in contemporary society, and their use in TR programs is expanding. -- Technology and Other Tools. Underlying all the program trends in TR and Physical rehabilitation are technological advancements and innovations.
Co-treatment and other forms of collaboration with a variety of allied health fields also are becoming essential for TR specialists. Although transdisciplinary efforts may blur professional roles somewhat, the end result should be enhanced cooperation among allied health disciplines and, more important, better services for clients. Of course, the fundamental goal of TR services in physical rehabilitation is to enable clients to return successfully to their communities. This not only requires improvement of functional skills, but it also means that physical and social environments in the community must be receptive to the individual. TR specialists need to ensure that their clients with physical disabilities are able to participate in all aspects of community life.