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Crawford, Michael E., Ed.; Card, Jaclyn A., Ed.Annual in Therapeutic Recreation. Volume 2.American Alliance for Health, Physical Education,Recreation and Dance, Reston, VA.

ISBN-0-88314-511-191117p.; For Volume One, see ED 322 092.AAHPERD, Publications Sales, 1900 Association Drive,

Reston, VA 22091 ($9.00 members, $16.50non-members).Collected Works - Serials (022)

MF01 Plus Postage. PC Not Available from EDRS.Adolescents; Adults; Alzheimers Disease; Children;*Coping; Disabilities; Drug Addiction; *FamilyCalegivers; *Leisure Education; Measures(Individuals); *Research Methodology; SocialPsychology; Standards; *Therapeutic Recreation; WorkAttitudes*AAHPERD

This volume focuses on therapeutic recreation, as asubject of inquiry and as a treatment tool. The 11 articles include

original field based research, program development initiatives, .1.nsue

and theory of practice papers, and original tutorials in assessment

and research. The article titles are: "The Role of Leisure Education

with Fmily Caregivers of Persons with Alzheimer's Disease andRelated Disorders" (M. J. Keller, S. Hughes); "Selected Assessment

Resources: A Review of Instruments and References" (N. Stumbo); "The

Family Lab: An Interdisciplinary Family Leisure Education Progvam"

(M. Malkin, R. Phillips, J. Chumbler); "Perception of Client Needs in

Chemical Dependency Treatment Programs" (C. Hood); "Caregivers, the

Hiddelt Victims: Easing Caregiver's Burden through Recreation and

Leisure Services" (L. Bedini, C. W. Bilbro); "Facilitating the

Child's Adjustment to Parental Disability" (R. Blesch-Hill, L.

Heeney); "The Interface between Social and Clinical Psychology:Implications for Therapeutic Recreation" (D. Austin); "Relationships

between Meanings of Work and Meanings of Leisure among Wheelchair

(Basketball) Athletes" (S. Hunt); "Answering Questions aboutTherapeutic Recreation Part 1: Formulating Research Questions" (B.

McCormick, D. Scott, J. Dattilo); "Answering Questions aboutTherapeutic Recreation Part 2: Choosing Research Methods" (J.

Dattilo, B. McCormick, D. Scott); and "Standards: A Tool forAccountability, the CARF Process" (A. Toppel, B. Beach, L.

Hutchinson-Troyer). (IAH)

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NNUAL

Volume Two, 1991

PERMISSION TO REPRODUCE THISMATERIAL IN MICROFICHE ONLYHAS BEEN GRANTED BY

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TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC).-

U.S. DEPARTMENT OF EDUCATIONOffice oil durat.onal Resew( h ane Irhow,ernohtEDI 'CA TIONAt. RESOURCES INFORMATION

CEN1ER (ERIC)

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2 REST COPY AVAILABLE

The Annual is a joint ventwe of the American Association forLeisure and Recreation, The American Therapeutic RecreationAssociation, and the University of Missouri-Columbia Departmentof Parks, Recreation and Tourism.

Tim Department of Parks, Recreation and Tourism at tiv.:University of Missouri-Coliraibia is one of the largest i:epartmentsti the midwest. The department has a rich tradition of providing

quality undergraduate and graduate cducation. The departmenthosts numerous workshops, seminars, institutes, and conferences,and coordinates the largest continuing education program intherapeutic recreation the nation. For mom infcmnation write:Department of Parks, Recreation and Tourism, 624 Old Clark Hall,University of Missouri-Columbia, Columbia, MO 65211.

The American Association for Leisure and Recreation is avoluntary professional organization dedicated to the developmentof school and community programs of leisure ".rviees andrecmation education, It is one of six associations making up theAmerican Alliance for Health, Physical Education, Recreationand Dance. For more information writc: AALR, 1900 AssociationDrive, Reston, VA 22091.

The American Therapeutic Recreation Association wasfounded in 1984 to advance the pmfession of TherapeuticRecreation. ATRA is a nonprofit professional organizationwith a priority focus of promoting the needs of therapeuticrecreation professionals in health care and human services settings.For more information write: ATRA, P.O. Box 15215,Hattiesburg, MS 39402-5215.

13

American Alliance forHealth, Physical Education,

. Recreation and Dance

® 1991Air lerican Alliance for Health,

Physical Education, Recreation and Dance1900 Association Drive

Reston, VA 22091

ISBN 0-88314-511-1 4

ANNUAL IN

Co-editorsDr. Michael E. CrawfordDr. Jaclyn A. Card

Associate Editors

Dr. David AustinIndiana University

Dr. Patricia Barrett-MalikIllinois State University

Dr. Randy BlackPurdue University

Dr. F.ank BrasileUniversity of Nebraska-Omaha

Dr. John DattiloUniversity of Georgia-Athens

Dr. Dan FergusonMichigan State University

Production EditorMs. Paula J. Belyea

Dr. Donald GreerUniversity of Nebraska-Omaha

Dr. Barbara HawkinsIndiana University

Dr. John HultsmanArizona State University-West

Dr. Robin Kunst lerLehman College

Dr. Ron MendellMt. Olive College

Dr. Michael TeagueUniversity of Iowa

Editorial Board

Dr. Christen G. SmithAALR/AAHPERD

Dr. Thom SkalkoFlorida International University

Mr. Roger ColesCentral Michigan University

Special Tribute

In 1989, the University of Missouri, Department of Parks, Recreation and Tourism presented to theAmerican Association for Leisure and Recreation (AALR) a proposal for the establishment of an annualpublication in therapeutic recreation. AALR, under the leadership of then Executive Director Dr. BarbaraSampson, recognized the significant contributions such a publication could make to the profession oftherapeutic recreation and thus entered into a joint agreement with the Department of Parks, Recreationadn Tourism at the University of Missouri and also contracted with the American Therapeutic hecirationAssociation (ATRA) to launch such a publication. Under the terms of the agreement, AALR was to bethe publisher, the University of Missouri would serve as editor for the first several years, and ATRAwould purchase the publication as a membership journal. This provided a unique opportunity for twonational professional associations and a university to work together cooperatively.

Thus, upon successful production of the second volume of The Annual In Therapeutic Recreation, AALRand ATRA wish to acknowledge the contributions of the Department of Parks, Recreation and Tourism ofthe University of Missouri and to thank Drs. Michael Crawford and Jaclyn Card for their benefactions aseditors.

ForewordWe arc: pleased to present in this second volume of theAnnual articles representing original field based

research, program development initiatives, issue and theory of practice papers, and original tutorials inassessment and research. The breadth and depth of work in Volume Two is a fitting testimony to the growthof therapeutic recreation as a discipline and professional therapy. One new editorial feature of the secondvolume is an irivited work. Each year the Annual's editorial board will solicit a select number of originalmanuscripts to ensure that issues of timely importance are developed an i placed before the Annual's read-ership. Your ideas and thoughts related to invited works are welcome, ana we encourage you to communicatewith the Annual's editori...a board on this new feature of the Annual.

This second volume of the Annual also represents the concluding volume for the University ofMissouri's editorship. Several years ago the UMC Deparnrent of Parks, Recreation and Tourism facultyagreed to pursue an exciting new venturethe birth of a professional journal dedicated to the therapeuticrecreation profession. Our goal was to create a unique vehicle which would serve as a catalyst in assistingresearchers and practitioners to work together toward our common goal of validating the therapeuticrecreation process across all its varied constituencies and service settings. Toward that end a unique editorialmission was developed to encourage and promote communication between and among researchers andpractitioners by providing for a focus on clinical and community based program development and research.

We feel fortunate to have been able to assemble and work with what is one of the finest associate editorreview boards in recreation and leisure literature. The unselfish energy, enthusiasm, and high quality ofreview work that our associate editors have contributed to the Annual has made our collective experience aseditors a positivP and enjoyable growth experience. Our associate editors are to be congratulated for theirefforts in extending formative critical reviews of contributors' works. Through their collective talents theAnnual has established a high standard of editorial excellence.

Wc wish to give a special thanks and recognition to our style and production editor, Ms. Paula Belyea.Ms. Belyea's creative talents in layout and design in conjunction with her seemingly endless devotion toproduction detail are responsible for the Annucsr s "look." Ms. Belyea has surely been the "heart" of theAnnual.

As we statcd in our inaugural foreword, "we believe that the vitality of a profession is measured bythe excellence of its research and literature." We have been pleased to be able to present Volumes One andTwo of the Annua/ in Therapeutic Recreation to the profession and we hope that the Annua/ has and willcontinue to be a measure of the quality that exists within the field. To our partners in this venture, AALR andATRA, we wish continued professional success. As their stewardship of the Annual continues we trust theeditorial mission and product produced will continue to do honor to the field. We have appreciated theopportunity to serve and are pleased to present Volum:: Two tO you at this time.

Michael E. Crawford, Re.D., Cl RSCo-cditor

Jaclyn A. Card, Ph.D.Co-editor

7

Table of Contents

The Role of Leisure Education with Family Caregivers of Persons with Alzheimer'sDisease and Related Disorders, M. Jean Keller and Susan Hughes . . . . . ........ 1

Selected Assessment Resources: A Review of Instruments and ReferencesNorma J. Stumbo 8

The Family Lab: An Interdisciplinary Family Leisure Education Program,Marjorie J. Malkin, Randall W. Phillips and Janice A. Chumbler 25

Perception of Client Needs in Chemical Dependency Treatment ProgramsColleen Deyell Hood 37

Caregivers, the Hidden Victims: Easing Caregiver's Burden through Recreationand Leisure Services, Leandra A. Bedim and C.W. Bilbro 49

Facilitating the Child's Adjustment to Parental Disability, Carol A. Mushett,Renee Blesch-Hill and Laura L. Heeney 55

The Interface Between Social and Clinical Psychology: Implications for TherapeuticRecreation, David R. Austin 59

Relationships Between Meanings of Work and Meanings of Leisure Among Wheelchair(Basketball) Athletes, Sharon B. Hunt 69

Answering Questions About Therapeutic Recreation Part I: Formulating ResearchQuestions, B yan McCormick, David Scott, and John Dattilo 78

Answering Questions About Therapeutic Recreation Part II: Choosing ResearchMethods, John Dattilo, Bryan McCormick and David Scott 85

Standards: A Tool for Accountability, The CARF Process, Alan H. Toppel,Barbara A. Beach and Linda Hiachinson-Troyer 96

8

The Role of Leisure Educationwith Family Caregivers of Persons with

Alzheimer's Disease and Related Disorders

M. Jean Keller, Ed.D., C.T.R.S.Susan Hughes, M.S.

Abstract

Research and literature have well established that stresses of family caregiving to persons with Alzheimer'sdisease and related disorders can have negative effects on caregivers' mental, physical, emotional, and socialfunctioning. This article presents the concept of using leisure time as a potential coping resource for familycaregivers of persons with Alzheimer's disease and related disorders. Leisure education programs are proposedas possible intervention strategies within caregiver support groups to facilitate leisure involvement. An overviewof stresses of caregiving, barriers to caregivers' leisure involvement, leisure participation as a means of coping,and the role of leisure education as a component of family caregiver support groups is introduced. It is suggestedthat leisure education programs be developed and operationalized by therapeutic recreation specialists using thetenets of leisure awareness, leisure activity skills, leisure resources, and social skills. Each component isconsidered in relation to the needs, interests, and capabilities of caregivers of persons with Alzheimer's diseaseand related disorders.

"Caregiving has generated more interest amonggerontologists than any other topic (George, 1990, p.580). With the changing demographic landscape ofcontemporary society, the number of persons needingboth formal and informal caregiving is elimated todouble within the next 40 years (Fowles, 1988).Presently, there is an estimated four million olderadults with Alzheimer's disease and related disordersand 1,600 support groups serving approximately twomillion caregivers in the United States (Rutledge,1990). The demand for care of adults withAlzheimer's disease has and will continue to placetremendous burdens on family members. Sneegas(1988) concluded, "the burden associated withcaregiving included deteriorating psychological andphysical health of caregivers, limited social contact,and reduced opportunities for leisure activities" (p.81).

Support groups are being used with increasingfrequency to help caregivers cope with stresses ofcaregiving (Lawton, Brody, & Saperstein, 1989;Tose land & Rossiter, 1989). Most support groupsmaintain a supportive approach that links educational

and therapeutic components. Seven major themes areusually presented during a caregiver support groupsession: information about care receivers' situations;the groups and its members as a mutual supportsystem; emotional impacts of caregiving; self-care ofcaregivers; problematic interpersonal relationships;development and use of support systems outside ofthe group; and home care skills (Tose land &Rossiter, 1989). While a self-care theme mayexplore personal well-being for caregivers, very littleof the literature on support groups addresses theleisure aspect of caregivers' lives. Many caregiversfail to recognize the importance and role leisure couldplay in their lives. Caregivers ten0 to withdraw fromleisure activities, friends, and communityinvolvement while engaging in caregiving (Sneegas,1988). Thus, there appears to be a need to explorethe role of leisure education in the lives of caregiversof persons with Alzheimer's disease and relateddisorders.

Dr. Keller is an associate professor and Ms. Hughes is aresearch associate at the University of North Texas, Denton,Texas.

ANNUAL IN THERAPEUTIC RECREATION, No. U. 1991 1

KELLER AND HUGHES

This article will examine how therapeuticrecreation specialists may be able to help caregiversexplore and address their leisure-related needs andinterests as a means to relieving stress andmaintaining personal well-being. Specifically, thisarticle will: (a) discuss caregiving stressors and theireffect on caregivers' mental, social, emotional, andphysical well-being; (b) explore leisure participationas a means for coping with caregiving; and (c)present a rationale for the role of leisure education incaregiver support groups.

Caregiving Stressors

Providing care for persons with Alzheimer'sdisease and related disorders can have negativeeffects on caregivers' physical, psychological, andsocial functioning. George and Gwyther (1986)compared the well-being of family caregivers ofmemory-impaired adults to available random samplesof com'aunity adults to determine the areas ofwell-be ng most at risk. The findings revealed,cvegivers were more likely to experience problemswith mental health, emotional well-being, and socialparticipation. Deimling and Bass (1986) suggestedfrom their research that caring for functionallyimpaired elders created physical and social stresses inthe lives of caregivers. Stresses were created formost caregivers because of limitations inopportunities for social and recreational pursuits.Caregiving transforms the ordinary exchange ofassistance among people standing in close relationshipto each other to an "extraordinary and unequallydistributed burden" (Pear lin, Mullen, Semple, &Skaff, 1990, p. 583).

Sneegas (1988) found that caregivers' leisureinvolvement was significantly changed whencompared to participation prior to assuming caregiverroles. Caregivers reported a decline in homeentertaining, traveling, dining out, participating incommunity organizations and clubs, and walking(Sneegas, 1988). The majority of caregiversindicated that constraints of caregiving reduced theirfreedom of choice. Freedom of choice has beencorrelated with leisure well-being and participation,as well as life satisfaction (Kelly, 1982).

Additional research findings cite changes in leisureas problematic to family caregivers. Clark andRakowski (1983) found that compensating for orrecovering personal time was listed as a difficult task

2 ANNUAL 1N THEAAPEUTIC RECREATION, No. 11, 1991

faced by family caregivers. Rabins, Mace, & Lucas(1982) reported that 50% of the respondents in theirstudy identified loss of friends and hobbies asburdensome aspects of caregiving. Although leisureinvolvement is drastically reduced and challenging forfamily caregivers, it has been shown to be aneffective coping technique for some caregivers.

Leisure Participation as a Meansto Cope

Coping represents specific behaviors and practicesof individuals as they act on their own behalf(Pear lin, 1990). The degree of burden thatcaregivers perceive depends more on the caregivers'ability to cope than on the degree of severity ofpatients' impairment (George & Gwyther, 1986;Montenko, 1989; Zarit, Reever, & Bach-Peterson,1980; Sneegas, 1988; Zarit, Todd, & Zarit, 1986;Zarit & Zai it, 1982). Studies by Sneegas (1988) andZarit and Zarit (1982) concluded, interventions toimprove the coping ability of caregivers may relievethe physical, social , and emotional difficulty thatthey may be experiencing.

Leisure involvement has been found to facilitatecoping behaviors among caregivers of individualswith Alzheimer's disease (Sneegas, 1988). Leisuremay be defined as an activity chosen for its own sake(Kelly, 1982). According to Sneegas (1988), leisureinvolvement provided an escape from caregiving andhelped to reduce tension. The findings of Sneegas'(1988) study supported the concept that leisureinvolvement is a means to enhance the coping abilityfor caregivers and suggested provisions of specializedleisure services for caregivers of persons withAlzheimer's disease. Another btudy whichinvestigated the contribution of leisure in adjusting tolife transitions indicated nearly 80% of a randomsample (N=120) reported that leisure had been aresource for them in coping with change (Kelly,Steinkamp, & Kelly, 1986). This same study alsorevealed that 44% of the respondents reported leisurehad provided a context for maintaining or developingimportant relationships; over 19% felt leisure allowedan escape from problems, and an additional 12%said, leisure participation led to personal expressionand satisfaction. This research indicates theimportance of leisure for caregivers' well-beiil andthe role of leisure involvement as a copingmechanism for controlling the stressors associated

1 0

KELLER AND HUGHES

with caregiving. However, caregivers' leisure andself attitudes, awareness, skills, and resources mayinhibit them from engaging in meaningful leisureexperiences (Pratt, Schmall, & Wright, 1987;Sneegas, 1988; and 'Lark & Zarit, 1982).

Caregivers have indicated various barriers to theirleisure involvement. Time was a major barrier fornot participadng in leisure activities according tosome caregivers, as caring for family membersconsumed inordinate amounts of personal time (Prattet al., 1987; Sneegas, 1988). Repaying what wasgiven may contribute to caregivers' sense of moralobligation to provide care for family members (Prattet aL, 1987). Many caregivers believed that it waswrong to turn the care of their relatives over tosomeone else or they felt guilty for having to askothers to help (Zarit & Zarit, 1982). Several studiesprovide evidence that many caregivers have expressedconcern with their own needs as selfish andguilt-provoking (Brody, 1985; Hooyman &Lustbader, 1986; Pratt et al., 1987). However, otherstudies reveal that it is essential to impress uponcaregivers the importance of taking care ofthemselves in order to continue to provide quality andappropriate care to impaired family members (Pearlinet al., 1990; Zarit & Zarit, 1982). A potential meansof addressing caregivers' barriers to leisureparticipation is through structured leisure educationprograms within family caregiver support groups.

Leisure Education Programs

The potential of ieisure as a coping resourceprovides a clear rationale for the development andimplementation of leisure education programs forcaregivers of persons with Alzheimer's disease andrelated disorders. Peterson and Gunn (1984) statedthat the purpose of leisure education was to provideopportunities for acquiring skills, knowledge, andattinides related to leisure involvement. A leisureeducation program designed for family caregiversupport groups could be beneficial to caregivers inseveral ways: (a) to help caregivers balance their timeand responsibility for care of patients and themselves;(h) to help caregivers adjust to changes andconstraints caregiving places on their leisureinvolvement; and (c) to assist caregivers inidentifying personal, family, and communityresources that could enable them to engage inmeaningful leisure experiences while providing care.

I

A leisure education pie gram could assistcaregivers in utilizing leisure as a coping resource.A major objective for a leisure education programwould be to assist eech caregiver in the developmentof a personalized plan of aoion and identification ofnecessary resources for implementation of the plan(Mundy & Odum, 1979; Peterson & Gurm, 1984;Sneegas, 1988). This could be facilitated bytherapeutic recreation specialists through a programdesign that develops awareness, knowledge, skills,and decision making necessary to enable caregivers tounderstand the role of leisure in their lives andincrease opportunities for leisure involvement.

Mundy and Odum (1979) presented a potentialscope and sequencing for leisure education under sixcategories including self-awareness, leisureawareness, a:titudes, decision making, socialinteraction, aed leisure skills. Peterson and Gunn(1984) proposed four major components, leisureawareness, leisure activity skills, knowledge andawareness of leisure resources, and social skills, intheir leisure education model. A combination ofthese two models are highlighted for possible use bytherapeutic recreation specialists with caregiversupport groups.

Lcisure Awareness

An important aspect of an active leisure lifesty:eappears to be an awareness of leisure and its benefits,a valuing of leisure experiences, and the consciousdecision making process to engage in leisure activities(Keller, McCombs, Pilgrim, & Booth, 1987; Mundy& Odum, 1979; and Peterson & Gunn, 1984). Theieisure education program content emphasizing leisureawareness may include information on the value andpotential benefits of leisure related to caregivers'roles. During this phase of a leisure educationprogram, caregivers are also challenged to exploreleisure attitudes and discuss skills needed for decisionmaking and planning leisure involvement. A focus ofthis step in a leisure education program would be trassist caregivers in assessing how they expended theirtime before being a caregiver, how their time isexpended now; and what leisure meant to them priorto caregiving and what it means to them now.Exercises presented in a manual entitled, HelpingOlder Adults Develop Active Leisure Lifestyles, couldbe adapted and utilized for this phase. Exercise oneconsists of a time diary or a record of daily activitieswhich could provide caregivers with insight into what

ANNUAL IN THERAPEUTIC RECREATION. No. II, 1991 3

KELLER AND HUGHES

they are presently doing with their time (Keller et al.,1987). Caregivers may be surprised, with the help oftherapeutic recreation specialists, to discover timeperceived as occupied with caregiving tasks, may notbe as engaged or could be allocated in a differentmanner. Caregivers will initially need a soundunderstanding of the time available to them in orderto view leisure involvement as feasible within their

Brody, Saperstein, & Lawton (1989) using casestudies explored the use of a multi- service respiteprogram for caregivers of Alzheimer's patients andcaregivers initial reluctance to utilize supportservices. It was discovered that an elderly spousesuffering from multiple health problems andexhaustion from caring for her demented husband,reluctantly agreed to try day care for her husband'swell-being. Respite care services proved to be asbeneficial for the wife as her husband because shewas able to rest, relax and engage in meaningfulleisure experiences which she no longer thought wereoptions for her.

Some caregivers may be unable to personallyintegrate leisure into their lives if there is not anestablished balance between self and care of familymembers. Brody et al. (1989) reported that manycaregivers needed assistance in recognizing that "theytoo had needs that differed from the needs of thepatient" (p. 49). These problems were compoundedby the fact that some caregivers had no outsideinterests. These findings support a need for a leisureeducation component that explores leisure awarenesswithin a support group context.

Leisure Activity Skills

Based on the findings of Brody et al., (1989)another component of a leisure education program forcaregivers may be knowledge of leisure activities andskill development. The content of this phase of aleisure education program may consider new leisureinterests or modifying former ones. Therapeuticrecreation specialists could assist caregivers in

exploring leisure activities they enjoyed and foundsatisfying prior to caring for family members.Additionally, therapeutic recreation specialists mayexamine with caregivers leisure activities theypresently enjoy which could be adapted so the activitycould be engaged in with impaired family members.Caregivers may likewise explore leisure activities thatthey find satisfying that could be participated in with

4 ANNUAL IN THERAPEUTIC RECREATION, No. II, 1991

other family members, friends, or alone. This mayinclude exploring traditional and non-traditionalleisure pursuits. Therapeutic recreation speialistsmay help a caregiver identify reading to a familymember as a potential leisure activity, if the caregiverenjoyed reading in the past, yet, no longer felt therewas time to read; or walking with the patient may beproposed, if walking elicited feelings of satisfactionfor the caregiver. Examples of non-traditionalactivitiet; are stress management, relaxationtechniques, meditation, and bio-feedback (Sneegas,1988) which could he introduced by therapeuticrecreation specialists to caregivers. Brody et al.(1989, p. 55) provided the following case thatillustrates a caregiver who was unable to identify herown leisure interests and pursue them withoutassistance.

"Mrs. K. had been caring for her severelydemented husbanti r more than six years. The onlyother family member lived 1,500 miles away. Mrs.K. never went out of the home and the social workerwas able to identify only one interest: cooking. Aftermuch case work, the worker struck a bargain withMrs. K. She would allow her to teach the workerhow to cook an ethnic dessert, if at the time of thelesson, an aide could be brought in to watch Mr. K.The successful outcome was that the worker then wasable to involve Mrs. K. in a cooking class in a localcommunity center's senior citizen group." A leisureeducation program would need to focus on helpingcaregivers discover their own separate needs andinterests and assisting them in identifying anddeveloping activity skills.

Knowledge and Awareness of Leisure Resources

Montgomery and Borgatta (1989) found from astudy of family caregivers, that these families arefiercely independent and have little contact withformal service providers. However, caregivers'ability to engage in leisure involvement will depenuheavily on their knowledge and awareness of supportservices and leisure. resources (Sneegas, 1988; Zarit

Zarit, 1982). This third phase of a leisureeducation program is important for caregivers ofpersons with Alzheimer's disease or related disorders.Therapeutic recreation specialists should be aware offormal support services available in communities suchas respite care (e.g., in-home, day, evening, andinstitutional care). Caregivers may also need help ininvestigating their own personal and family resources

1 2

KELLER AND HUOHES

(relatives, friends, neighbors, and finances) whichcould help them create meaningful leisureopportunities for themselves. With knowledge ofrespite services, caregivers may be more willing toexplore leisure resources for themselves. Haley(1989) found that caregivers, from lower incomelevels who wanted to participate in support servicesto assist them in coping with the stressors ofcaregiving, were not able to do so due tounavailability of sitters and transportation.Caregivers also were found to have limitedknowledge of leisure resources in their communitiesand how to access them (Sneegas, 1988).Therapeutic recreation specialists may be challengedto work with caregivers to overcome leisureinvolvement barriers by identifying and utilizing awide variety of resources.

Caregivers in this phase of a leisure educationprogram ma; be exploring new and different leisurepursuits due to the responsibilities of providing carefor family members. Thus, caregivers may needadditional support in locating appropriate leisureequipment, facilities, and activities. Therapeuticrecreation specialists should maintain up to dateresource files to help caregivers locate communityresources and make suitable referrals.

Social Skills

The last stage of a leisure education program withcaregivers involves the development of social skills.Sneegas (1988) recommended potential areas of focusmay be helping caregivers increase their abilities toask for assistance, accept offers of assistance, andassert themselves related to their personal needs.Many caregivers do no have these skills or fail toexercise them due to various reasons. Caregiversmay refuse help because they feel a deep sense ofresponsibility to the people tor whom they areproviding care (I3rody et al., 1989). Caregivers oftenhave strong needs for repaying what was given tothem (Pratt et al., 1987). An example of caregivinghighlighted by Brody et al. (1989) demonstrates theneed for a caregiver to socialize and her inability toexperience it. A daughter caring for her mother wasinitially reluctant to use respite services; however,four hours of in-home re-spite were scheduled so thatthe daughter could attend a social event. Thedaughter's first respite experience was upsettingbecause the respite worker was late. As a result, thedaughter had difficulty enjoying her leisure time

13

because she constantly worried about her mother'scare. The guilt over relinquishing caregivingresponsibilities may inhibit many caregivers fromintegrating leisure into their life unless they have theopportunity to process feelings and developappropriate social skills. Brody et al. (1989) alsofound that many caregivers were unable to use respitecare until they were helped to express their anxieties,fears, avid negative feelings about the patients.Caregivers may need reassurance from professionalsand support groups members that their feelings ailnatural, real, acceptable, and experienced by othercaregivers (Brody et al., 1989). It appears thaLtherapeutic recreation specialists may need to processwith caregivers their feelings in order to help themobtain the social skills needed to engage inmeaningful leisure involvement.

Therapeutic recreation specialists may offeropportunities for assertiveness training; sharing offeelings in a supportive, yet, confrontationalenvironment; and leisure counseling as aspects ofleisure education in order to help caregivers developsocial skills which will facilitate meaningful leisureinvolvement. For instance, many family caregiverswere found to be older, isolated women who hadbeen caring for their husbands for many years.According to Brody et al. (1989), "it was difficult forthem to grasp the concept that the instrumental tasksof caregiving were not inextricably bound to the loveand support they provided and the former could beaccomplished (even if not as well), by others" (p.55). This example affirms a need for a leisureeducation program component which promotes anddevelops appropriate social skills to empowercaregivers to use leisure time as a means of copingand enhancement of personal weli-being.

Conclusions

Research and literature have well established thatstresses of family caregiving to persons withAlzheimer's disease and related disorders can havenegative effects on caregivers' mental, physical,emotional, and social functioning. Support groupsare increasingly being used as a means to help familycaregivers cope with the stresses of caregiving.Interestingly, support groups cover a wide range oftopics; yet, few have discussed the role of leisure incaregivers' lives. Sneegas' (1988) research findingsindicated that leisure involvement was a means of

ANNUAL IN THERAPEUTIC RECREATION, No. II, 1991 5

KELLER AND HUGHES

coping for family caregivers. While leisure educationhas been used by therapeutic recreation specialistswith numerous groups and individuals to facilitateand empower them to use leisure time to enrich andenhance their lives, it has not been readily used incaregiver support groups nor with family caregivers.It appears leisure education programs as part offamily caregiver support groups hold promise inhelping caregivers "...to better cope with theircaregiving responsibilities not the least of which is toprovide care and support to themselves" (Greene &Monahan, 1989, p. 477).

Facilitating leisure education programs withinsupport groups may be a new role and responsibilityfor therapeutic recreation specialists. Tose land,Rossiter, Labrecque (1989) studied theeffectiveness of peer and professionally led caregiversupport groups. The results indicated thatprofessionally led groups produced a significantlygreater improvement in psychological functioning.Participants in professionally led groups experiencedimprovement in coping with personal problems,knowledge of community resources, and increasedtheir informal support systems (Tose land et al.,1989). Based on these findings it would appear thatqualified therapeutic recreation specialists could bestfacilitate caregivers awareness about the necessaryskills, knowledge, and resources available toimplement a personal leisure plan while caring forfamily members with Alzheimer's disease and relateddisorders. Through a leisure education programwithin family caregiver support groups, caregivers ofpersons with Alzheimer' disease and related disordersmay be empowered to develop coping abilities whichwill foster leisure involvement and in turn overallwell-being.

References

Brody, E. (1985). Parcnt care as a normative family stress. TheGerontologist, 25, 19-29.

Brody, E.M., Saperstein, A.R., & Lawton, M.P. (1989). Amulti-service respite program for caregivers of alzheimer'spatients. Journal of Gerontological Social Work, 14(1/2),41-74.

Clark, N.M., & Rakowski, W. (1983). Family caregivers ofolder adults: Improving helping skills. The Gerontologists,23(6), 637-642.

Dcimling, G.T., & Bass, D.M. (1986). Symptoms of mentalimpairment among elderly adults and their effect on familycaregivers. Journal of Gerontology, 41(6), 778-784.

Fowles. G. (1988). A profile of older Americans (brochure).Long Beach: American Association of Retired Persons.

6 ANNUAL IN THERAPEUTIC RECREATION, No. 11, 1991

George, L.K. (1990). Caregiver stress studies-There really ismore to learn. The Gerontologist, 30(5), 580-581.

George, L.K., & Gwyther, L.P. (1986). Caregiver well-being:A multidimensional examination of family caregivers ofdemented adults. The Gerontologist, 26(3), 253-259.

Greene, V.L., & Monahan, D.J. (1989). The effect of a supportand education program on stress and burden among familycaregivers to frail elderly pereons. The Gerontologist, 29(4),472-477.

Haley, W.E. (1989). Group intervention for dementia familycaregivers: A longitudinal perspective. The Gerontologist,29(4), 478-480.

Hooyman, N., & Lustbader, W. (1986). Taking care: Supportingolder people and their families. New York: Free Press.

Keller. MI., McCombs, J., Pilgrim, V.C., Booth, S.A. (1987).Helping older adults develop active leisure lifestyles. Athens,GA: Institut: of Community and Area Development,University of Georgia.

Kelly, J.R. (1982). Leisure. Englewood Cliffs, NJ: Prentice-Hall.

Kelly, J.R., Stcinkamp, M.W., & Kelly, J.R. (1986). Later lifeleisure: How thcy play in Peoria. The Gerontologist, 26(5),531-537.

Lawton, M.P , Brody, E.M., & Saperstein, A.R. (1989). Acontrolled study of respite service for caregivers ofalzheimer's patients. The Gerontologist, 29(1), 8-16.

Montgomery, R.J. , & Borgatta, E.F. ( 1989). The effe.cts ofalternative support strategies on family earegiving. TheGerontologist, 29(4), 457-464.

Montenko, A.K. (1989). The frustration, gratifications, andwell-being of dementia caregivers. The Gerontologist, 2A2),166-172.

Mundy, J., & Odum, L. (1979). Leisure education.- Theory andPractice. New York: John Wiley & Sons.

Rabins, P.V., Mace, N.L., & Lucas, Mi. (1982). The impactof dementia on the family. Journal of the American MedicalAssociation, 284(3), 333-335.

Rutledge, A. (1990). Family caregivers (pamphlet). Dallas:Dallas Alzheimer's Disease Chapter.

Peteraon, C.A., & Gunn, S.L. (1984). Therapeutic recreationprogram design. Englewood Cliffs, NJ: Prentice-Hall.

Pearlin. L.I. (1990). The study of coping: An overview ofproblems and directions. In J. Eckenrode (Ed.), The socialcontext of coping. Ncw York: Plenun Press.

Pearlin, L.I., Mullan, J.T., Semple, Si., & Skaff, M.M.(1990). Caregiving and thc stress process: An overview ofconcepts and their measures. The Geront6.logist. 30(5),583-594.

Pratt, C., Schmall, V., & Wright, S. (1987). Ethical concerns offamily caregivers to dementia patients. The Gerontologist,27(5), 632-638.

Sneegas, J. (1988). The role of leisure for caregivers ofindividuals with Alzheimer's disease. Paper presented at themeeting of thc annual National Recreation & Pa:k AssociationLeisure Research Symposium, Indianapolis, IN.

Toseland, R.W., & Rossiter, C.M. (1989). Group interventionsto support family caregivers: A review and analysis. TheGerontologist, 29(4), 438-448.

Toseland. R.W., Rossitcr, C.M., & Labreeque, M.S. (1989).The effectiveness of peer-led and professionally led groups tosupport family caregivers. The Gerontologist, 29(4), 465-471.

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KELLER AND HUGHES

Zarit, S.H , Keever, K.E. , & Bach-Peterson, J. (1980). Relativesof the impaired elderly: Correbtes of feelings of b tn. The(3erontologist, 20(6), 649-655.

Zarit, S.H. , Todd, P.A., & Zarit, J.M. (1986). Subjectiveburden of husbands and wives as caregivers: A longitudinalstudy. The Gerontologist, 26, 260-266.

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Zarit, S.H . , Zar! J.M. (1982). Families under stress:Interventions for caregivers of senile dementia patients.Psychotherapy: Theory, Research and Practice, 19(4),461-471.


Selected Assessment Resources:A Review of Instruments and References

Norma J. Stumbo, Ph.D., C.T.R.S.

Abstract

Client assessment plays a vital role in planning appropriate intervention strategies and in measuring clientoutcomes. While its importance has been recognized repeatedly, several problems have detracted from itsmeaningful use. The problems include: lack of assessment tools in general; limited content, scope and intent ofassessment tools; lack of psychometric adequacy of existing tools; lack of specialists' expertise; and lack ofavailability. The primary intent of this article is to improve upon the fifth problem by providing an overviewof 45 assessment tools and supplying relevant references. As more tools are developed, validated and madeavailable, the profession should see an increase in the quality of client assessment procedures.

Dunn (1984, p. 268) defines assessment intherapeutic recreation as "a systematic procedure forgathering select information about an individual forthe purpose of making decisions regarding thatindividual's program or treatment plan." It is thefirst link in establishing a meaningful baseline of theclient's leisure-related interests, abilities, knowledgelevel and/or attitudes. Only after a complete initialevaluation can the therapeutic recreation specialistbegin to design a purposeful plan of activities andtreatment fer intervention purposes (Dunn, 1984;Stumbo & Rickards, 1986). In this way, clientassessment is the foundation for determining theoutcomes of therapeutic recreation intervention in thatit provides the foundation information for a pre- andpost-treatment comparison of client behavior. "Thekey element...is the ability to accurately assess leisureinterests and needs as well as identify leisure deficitsand strengths to facilitate freedom, choice,opportunity and intrinsic motivation (Olsson, Shearer& Halberg, 1988, p. 35). As such, client assessmentis the mandatory prerequisite to the appropriateprovision of therapeutic recreation services (Witt,Connolly & Compton, 1980; Wehman & Schleien,1980a).


Problems Associated with Client Assessment

Until quite recently, therapeutic recreation sorelylacked quality assessment irrtruments. Severalproblems mi.., 1ave contributed to the historical lackof available and appropriate instruments. Theseproblems have been well-documented in thetherapeutic recreation literature and are outlinedbriefly below.

Lack of assessment tools in general. Fewassessment instruments have been developedexclusively for use in therapeutic recreation servicesdue to leveral factors. Among these explanations arethe limited definition of therapeutic recreation as arecreational or diversional program which did notmandate the use of assessment, the lack of thetherapeutic recreation specialists' ability toconceptualize a comprehensive program of services

Norma J. Stionbo is an associate professor and coordinator ofTherapeutic Recreation within the Recreation and ParkAdministration Program at Illinois State University in Normal.The author would like to thank Joan Burlingame, C.IR.S., IdyllArbors, Inc., and Dena Filisha, a former ISU undergraduatetherapeutic recreation student, for their assistance in locating andveriAing assessment resources used in this article.

16

STUMBO

for the leisure ability approach (Peterson & Gunn,1984) and the lack of understanding the role clientassessment can play in the total programmingprocess. Dunn (1984, p. 270) stated that whenconfronted with these conditions, therapeuticrecreation specialists often inappropriately borrowasseaments from other disciplines that do not relateto leisure or use assessments that were created fornon-disabled populations Also, therapeutic recreationspecialists may have created their own assessments atthe agency level, without concerning themselves withthe validation or refinement of the instrument (Dunn,1984; Kinney, 1980; Touchstone, 1975). Both ofthese situations put the validity and reliability of theassessment results in question.

Limited content, scope and intent of assessmenttools. Assessment tools of the 1970s and early 1980sconsisted almost solely of leisure interest inventories,with an occasional tool developed for determiningclient skills in specific leisure activities (Witt et al.,1980). The content of these instruments reflected arelatively narrow definition of therapeutic recreationservices, heavily weighted toward an activityorientation rather than a more encompassing leisurebehavior focus (Dunn, 1984; Stumbo & Rickards,1986; Witt et al., 1980). Often viewed from alimited intake purpose, the results may have had littlereal meaning and may have made a minimalcontribution to understanding client behavior. "Afrustrating outcome of this misguided use ofassessment as measurement is the realization that theresults derived from an irrelevant assessmentinstrument are of little informative value in providingprogram direction and may totally misdirect programdecisions" (Witt et al., 1980, p. 6).

Lack of psychometric adequacy. Closely relatedto the above concern, the beginning instruments oftenlacked credibility, standardization, generalizabilityand other appropriate psychometric qualities, such asvalidity and reliability (Burlingame & Blaschko, inpress, p. 1; Kinney, 1980; Stumbo & Rickards,1986; Touchstone, 1975). Often, assessment tools orprocedures are utilized routinely without greatconcern for the measurement properties of validityand reliability (Dunn, 1989). These concepts arediscussed in greater detail in the following section.

Lack of specialists' expertise. Although thecontent area of assessment was rated as one of themost important in the national job analysis conductedfor the National Council for Therapeutic Recreation

Certification (Oltman, Norback & Rosenfeld, 1989),most therapeutic recreation staff do not have adequateknowledge of and/or skills in client assessment(Dunn, 1984). While this scenario may be changing,on the whole it appears to be changing slowly.Professional preparation curricula and continuingeducation opportunities often do not have adequatetime and resources to equip future and currentprofessionals with functional expertise in assessmentconcepts and procedures.

Lack of availability. Given some of the aboveconsiderations, one of the major problems faced bypracticing therapeutic recreation professionals is theavailability of usable assessment instruments. Pastefforts to make assessments available nationally wereminimal, and dissemination efforts by professionalorganizations, publishing companies and the like wereunheard of. Assessment instruments were, andsometimes still are, difficult to find. Several shifts inthe provision of therapeutic recreation services,including the emphasis on program accountability andthe measurement of client outcomes (Olsson et al.,1988), the increasing sophistication of therapeuticrecreation specialists, and the increasing number ofcottage industry publishers, have improved this bleakoutlook considerably in the past five years. Moreand better instruments are being produced andvalidated, client assessments are conducted morefrequently and at a higher level of quality and theavailability of instruments is greater than ever.

The above problems documented throughout theliterature point to the fact that much work still needsto be undertaken with regard to client assessment.Specialists' skills must be improved, assessmentinstruments need further testing for validity andreliability and information about assessment mustcontinue to be shared. It is the purpose of this articleto provide an overview of assessment information andto review a selected number of assessment tools aswell as to provide information on their intendedpurpose, availability and documentation. Prior to thisreview, the next section will outline the measurementconcerns of validity, reliability and usability.

Measurement Characteristics

The job of the specialists is to select the best, most;npropriate and useful assessment instruments andprocedures to fit the purposes of the program and theneeds of the client (Stumbo & Thompson, 1985). To


STUMBO

perform this task, the specialist must become familiarwith the measurement characteristics of assessmentinstruments. The three relevant concepts here arevalidity, reliability and usability. Because theseconcepts have been covered in-depth elsewhere in thetherapeutic recreation literature (cf., Dunn, 1984,1989), the discussion will be limited to a briefsummary.

Validity "refers to the extent to which the resultsof an evaluation procedure serve the particular usesfor which they are intended" (Gronlund, 1981, p.65). It describes how well the assessment resultsmatch their intended purpose; whether it is measuringwhat the user thinks it is measuring. Three types ofvalidity exist: content, criterion-related and constructvalidity. Briefly, content validity is the degree towhich the use "is able to show that the questions andproblems on the test are representative of a specifiedcontent domain that the test items sample" (Shimberg,1981, p. 1143). Content validity asks the question ofhow representative the assessment is to the overallconcept (e.g. leisure behavior) it is supposed to bemeasuring. Criterion-related validity concerns theinferences made from a person's assessment results inrelation to some other variable called an outsidecriterion. Typical criterions in therapeutic recreationmight include leisure participation after discharge,community living skills and the like (assuming acorrelation between the assessment, the interventionand the post-discharge measurement). Constructvalidity, as the third validation strategy, is used whenan unobservable trait is being measured to assure thatit is being measured adequately. Constructs intherapeutic recreation may include leisuresatisfaction, perceived freedom, etc.

Reliability refers to the accuracy or consistency ofthe assessment results. Reliability can be indicated inthree ways: stability measures (how stable is theinstrument over time?); equivalency measures (howclosely correlated are two or more forms of the sameassessment?); ane- internal consistency measures (howclosely are items on the assessment relay r). Thetype(s) of reliability tested on an assessment dependsupon the nature of the information needed and thepurpose and intended use of the instrument.

Usability is a non-statistical concept that isconcerned with the practicality of the assessment.Typical usability concerns include availability, cost,time for administration, scoring and interpretationand amount of staff expertise needed.

10 ANNUAL IN THEMPEUTIC RECREATION, No. 11, 1991

To help the reader apply these concepts, the nextsection discusses the process and questions used inselecting an assessment instrument or procedure.This information is provided so that the user canmore readily select an appropriate assessment fromthe resources at the end of this article.

Selection and Use of Assessment Instruments

The selection and utilization of valid, reliable ahdpractical assessments is vital to the provision oftherapeutic recreation programs that are based onclient need and have the ability to affect and measureclient outcomes. Other sources (cf., Dunn, 1983,1984, 1989; Stumbo & Rickards, 1986) havedocumented processes and questions to be answeredduring the instrument selection stage.

Dunn (1984) outlined a six-step process whichincludes: (a) determining the purpose of the programand the intended purpose of the assessment; (b)specifying the content or areas that the assessmentshould cover; (c) identifying other selection criteria(e.g. , validity and reliability); (d) searching andreviewing available assessment resources; (e)comparing assessments against criteria identified insteps b, c and d; and (f) selecting the assessment thatbest fits the criteria. Stumbo and Rickards (1986)identified four major categories of criteria to be usedin the selection process; (a) program, (b) population,(c) staff, and (d) administrative concerns. Undereach of these four headings, the assessment user isasked to respond to questions which address validity,reliability and usability concerns. Dunn (1989)provided 19 guidelines for the selection,administration, scoring and reporting of assessmentprocedures and for protecting clients' rights.Examples of these guidelines include: "Theassessment should provide evidence of validity" (p.60) and "The manual and test materials should becomplete and of appropriate quality" (p. 65). Detailedinformation is given under each guideline.

During the selection process, the specialist shouldreview articles such as the ones mentioned above andbecome familiar with the systematic process whichshould be used. Not using such a process can greatlydecrease the validity, reliability and usefulness of anassessment tool or procedure. Since the selectionprocess is generic, in that the same process can beused to evaluate a variety of assessment tools, oncefamiliarity is gained, the process can be used

1 8

STUMBO

repeatedly. Its use is suggested in reviewing theresources given in a later section of this article.

Types of Assessment Instruments Reviewed

One of the major purposes of this article was toprovide therapeutic recreation specialists with currentinformation concerning available assessmentresources. Connolly (1981), Howe (1984), Stumboand Thompson (1985) and Wehman and Schleien(1980b) also provided such resources, although eachof these was more narrow in scope and are becomingdated due to the more recent activity in assessmentdevelopment and publication.

To meet the article's intended purpose,information about 45 assessment tools is presented intable format, followed by relevant literaturereferences. Publisher information is also given to aidthe user in locating and purchasing instruments.Availability, diversity and potential usefulness totherapeutic recreation practice were the two maincriteria for inclusion. It is acknowledged that otherpotentially useful assessments may have beenoverlooked and this is not to detract from their use.It is also acknowledged that, due to space limitationsand sometimes the lack of complete documentation,the description given for each tool is brief. It wasnot the intention of the author to provide in-depthinformation or to judge the quality andappropriateness of each instrument , as it is felt thatthis becomes the responsibility of the user.

For the purposes of this discussion, the 45reviewed client assessment tools have beencategorized under four major sub-headings. First,

are those that measure Leisure Attitudes and Barriers.Instruments in this category measure concepts such asperceived leisure competence, perceived leisurecontrol, leisure satisfaction, leisure barriers andleisure attitudes. Twelve instruments were placedwithin this heading. The second major categoryincludes those tools which measure FunctionalAbilities, such as motor, cognitive and socialinteraction skills and developmental levels. Nineteentools were categorized within Functional Abilities.The third division includes three instruments whichmeasure specific Leisure Activity Skills in hiking,downhill skiing and cross country skiing. The fourthcategory contains eleven instruments which examineLeisure Interests and Participation Patterns.Typically, these instruments examine the client's past,present or anticipated leisure behavior.

It should be noted here that several instrumentssample from more than one of the categories listedabove. Some combine leisure attitudes andparticipation patterns, others combine leisure interestsand functional abilities. These types of assessmentswere created to reflect a multi-pronged programmingapproach and often defied simple categorization.However, they have been categorized by whatappears to be their major emphasis in content andtheir similarity to other instruments within aparticular section.

Following the section on assessment instruments isa selected list of references. General and historicalreferences are given as well as references forindividual assessments. These may be helpful to thoseindividuals wanting further information concerningthe development and intended use of particular tools.


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CATEGORY/ASSESSMENTNAME BRIEF DESCRIPTION PUBLISHER

LEISURE ATTITUDES & BARRIERS

0.z2. Life Satisfaction Scale (LSS)

I. Leisure Diagnostic Battery(LDB) (Win & Ellis, 1982)

(Lohmann, 1980)

3. Leisure Satisfaction Scale(LSS) (Beard & Ragheb, 1980)

4. Leisure Motivation Scale(LMS) (Bcard & Ragheb,1983)

5. Leisure Attitude Scale (LAS)(Beard & Ragheb, 1982)

6. Brief Leisure Rating Scale(BLRS) (Ellis & Niles, 1985)

Assesses client's perceived freedom in leisure and of factors which are potentialbarriers to this freedom. Composed of eight scales grouped in two sections.Individual scales: Perceived Leisure Competence, Perceived Leisure Control,Leisure Needs, Depth of Involvement, Playfulness, Barriers to LeisureExperiences, Knowledge of Leisure Opportunities and Leisure Preferences.Extensive documentation and information on validity and rHiability available.Short forms and long form.

Measures perceived satisfaction with life through 32 items. Can be self-administered by client or given by therapist. No validity and reliability studiesreported. May be useful to compare client from one year to next.

Measures leisure satisfaction through six components: Psychological, Educational,Social, Relaxation, Physiological, and Aesthetic. Twenty-four items are rated on5-point scale from Almost Never True to Almost Always True (e.g., "My leisureactivities are interesting to me." Validity and reliability information available.

Measures leisure motivation through four sub-scales: Intellectual, Social,Competence/Mastery and Stimulus/Avoidance. Scale has 48 items (12 in eachsub-scale), which are rated on 5-point scale: "Never True" to "Always True."both short and long forms available. Validity and reliability information available.

Measures leisure attitudes through three sub-scales: Cognitive (general knowledgeabout leisure and how it relates to one's life), Affective (feelings toward leisure),and Behavioral (past, present and intended actions). Consists of 36 items rated ona 5-point scale of Strongly Disagree to Strongly Agree. Validity and reliabilityinformation available.

Measures degree of learned helplessness, as completed by an external evaluatorfamiliar with the client. Consists of 25 items rated on 5-point scale. Initialvalidity and reliability information available.

Venture Publishing1640 Oxford CircleState College, PA 16803(814) 234-4561

Idyll Arbor, Inc. (#109)25119 S.E. 262 StreetRavensdale, WA 98051

Mounir G. RaghebLeisure Services/StudiesCollege of EducationFlorida State UniversityTallahassee, FL 32306



Gary EllisDept. of Rec. & LeisureUniversity of UtahSalt Lake City, UT 84112


7. Comprehensive Leisure RatingScale (CLEIRS) (Card,Compton & Ellis, 1986)

8. Leisure Barriers Inventory(Peterson, 1982)

9. What Am I Doing? (WAID)(Neulinger, 1986)

10. Leisure Well-Being Inventory(McDowell, 1987)

11. Perceived Competence Scalefor Children / Self-PerceptionProtile for Children (Harter,1982/83)

12. Over 50 (Edwards, 1988)

Designed to measure independence level of older individuals with mental illnesses,

contains combination of perceived freedom (28 items), helplessness (25 items),

breadth of activity skills (12 items), and depth of activity skills (12 items).

Borrows concepts from LDB, BLRS and ST1LAP assesynents. Validity andreliability information available.

Examines leisure barriers in eight categories (e.g., Time, Money andTransportation; Leisure Responsibility; Leisure Partners, etc.). Client responds to

48 items on 3-point scale (Agree, Don't Know, Disagree) such as "Leisure is freetime" and "I like to do different recreation activities." Score reported for eight

sub-categories. Initial validity and reliability information available.

Measures quality of life through three dimensions: Perceived Freedom (Choice),

Intrinsic Motivation (Reason), and Feeling Tone (Feeling). Client completes dailylog of activities, then examines degree of choice, reason for engagement andfeeling tone of each activity. Validity and reliability indices reported. Forms andmanual available.

Through yes/no checklist, asks clients to examine leisure attitudes and knowledge.Categories include: Coping, Awareness/Understanding (including influence ofwork, ability to leisure, and value of leisure) and Knowledge (including interests,resourcefulness, and fitness). Clients encouraged to use score to examine leisurewell-being. No validity and reliability information available. Related books alsoavailable.

Intended for children 8 to 11 years of agc, the scale measures self-perceptionthrough six sub-scales: Cognitive Competence, Athletic Competence, SocialAcceptance, Physical Appearance, Conduct/Behavior, and General Self-Worth.Each item under the broad categories is responded to on a 4-point scale (roughlyfrom "Really Sounds A Lot Like Me" to "Doesn't Sound At All Like Me."Teachers' Rating forms, manual, validity and reliability information available.

Computerized assessment to evaluate the client's personal needs, values andattitudes for better self-understanding, relationships and life/career/leisureplanning. Computer aids in analysis and interpretation. User's Manual available.Intended for older clients, may be used with young adults.

Jaclyn CardDept. of Parks, Rec. & Tourism624 Clark HallUniversity of MissouriColumbia, MO 65211(314) 882-7086

Julie DunnDept. of Rec. & LeisureUniversity of North TexasDenton, TX 76203

The Leisure InstituteR.D. #1, Hopson RoadBox 416Dolgeville, NY 13329

C. Forrest McDowellSunMoon PressP.O. Box 1516Eugene, OR 97440(503) 343-9544

Susan HarterDepartment of Psychology2040 South YorkUniversity of DenverDenver, CO 80208(Pre-Payment of $9.95 for packetis appreciated.)

Patsy EdwardsConstructive Leisure511 N. La Cienega Blvd.Los Angeles, CA 90048

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le e


FUNCTIONAL ABILITIES

13. Functional Assessment ofCharacteristics for TherapeuticRecreation (FACTR)(Peterson, Dunn & Carruthers.1983)

14. Ohio Leisure Skills Scales onNormal Functioning(OLSSON) (Olsson, 1988)

15. Comprehensive Evaluation inRecreation Therapy PhysicalDisabilities (CERT) - Phys.Dis.) (Parker, 1977)

16. Comprehensive Evaluation inRecreation Therapy -Psychiatric/Behavioral (CERT-Psych.) (Parker, 1977)

17. Maladapted Social FunctioningScale for TherapeuticRecreation Programming(MASF) (Idyll Arbor, Inc.,1988)

18. Therapeutic Recreation Index(TRI) (Faulkner, 1987

0 41

Examines functional skills and behaviors considered to be prerequisite to leisureinvolvement. Eleven behaviors are in each of three categories: Physical,Cognitive and Social/Emotional. Sub-categories are to be rated on 3 or 4-pcintscales after observation by therapist. Some reliability studies reported. Usable forany special population.

Measures twenty functional abilities in three major areas: Functional Skills,Behavioral Skills and Social/Communication Skills. Intended for clients withcognitive impairments. Therapist implements five activities in which the client isobserved and assessed, then summarizes observations in two sections ofinstrument. Validity and reliability information available. Assessment kit includessupplies, manual and forms.

Measures 50 behaviors in eight categories: Gross Motor Function, FineMovement, Locomotion, Motor Skills, Sensory, Cognition, Communication andBehavior. Uses 5-point observation checklist to be used by therapists in PMRsettings for initial and ongoing assessments. Initial validity and reliability studiesreported.

Measures 25 behaviors required in variety of leisure activities, including General,Individual and Group behaviors. Uses 5-point observation checklist to be used bytherapists in psychiatric settings for initial and ongoing assessments. Validity an.Ireliability studies in progress.

Adapted from the Brief Psychiatric Rating Scale, the instrument examines 21problematic behavior(s) (e.g., Hostility, Disorientation, Suicidal Preoccupation,etc.) Behaviors are rated on a 7-point scale, from Not Present to ExtremelySevere, based on observational descriptions No validity and reliability informationavailable.

Designed for adolescents/adults in substance abuse, rehabilitation and intermediatecare facilities, instrument comes in three "forms" with different questions. Eachsetting has ten different areas to be assessed (e.g., economic, problem solving,leisure skills). Items rated on 5-point scale that is then weighted for importance toleisure involvement. No validity and reliability information available. Paper andcomputerized versions.

Idyll Arbor, Inc. (#113)25119 S.E. 262 StreetRavensdale, WA 98051(206) 432-3231

Roy OlssonDept. of HPHPHealth Education Bldg.University of Toledo2801 W. BancroftToledo, OH 0,3606




Rounne W. FaulknerLeisure Enrichment ServicesP.O. Box 1190Seaside, OR 97138


19. General Recreation ScreeningTool (GRST) (Burlingame ,1988)

20. Recreation Early DevelopmentScreening Tool (REDS)(Burlingame, 1988)

21. Fox Activity Therapy SocialSkills Baseline (Patterson,1977)

22. Mundy Recreation Inventoryfor the Trainable MentallyRetarded (Mundy, 1966)

23. Recreation Behavior Inventory(RBI) (Berryman & Lefebvre,1981)

24. Bruninks-Oseretsky Test ofMotor Proficiency (Bruninks &Gseretsky, 1972)

25. Idyll Arbor Reality OrientationAssessment (Idyll Arbor, Inc.,1989)

2 ti

Measures functional abilities in three areas (Physical, Cognitive and Affective)according to developmental age groups up to ten years. Intended for individual

with developmental disabilities and is de.-..1z.nerl for scoring after therapistobservation. No validity and reliability information reported.

Assesses developmental level of client functioning at or b low one year of age.Leisure-related areas include: Play, Fine Motor, Gross Motor, Sensory,Social/Cognition, which are detailed by descriptive checklist. Completed throughgraphed observations of play activities by therapist. No validity and reliabilityinformation available.

Developed for use with people who are severely/profoundly mentally disabled, theinstrument covers six basic areas of soeial skills (e.g., Reaction to Others). Eacharca of social skills is divided into six to levels of social skills to provide baselineand then monitoring of client progress. Primarily conducted through therapistobservation. Validity and reliability studies in progress.

Assesses client's performance and abilities, as well as concepts related torecreation participation (e.g., motor skills, rhythm, manipulation skills, colorconcepts, etc.) Client asked to perform various tasks while therapist administers

assessment. Validity and reliability information available in manual. Manual

includes program plann.ag information.

Observational tool to assess cognitive, sensory and perceptual motor skills asprerequisites to leisure participation. Eighty-seven behaviors arc to be observedduring 20 recreation activities, then rated on 3-point scale. Intended for children,but use reported for psychiatric and long term care. Manual and validity andreliability information available.

Designed for adolescents, instrument measures motor skills. Scale includes foursubscales on gross motor, three on fine motor and one combining both gross andfine. Both long and short forms available. Equipment, supplies, manual andvalidity and reliability information available.

Measures client's orientation to reality, through a section on Screening Questions(e.g., "Professional baseball is played during what season?") and ObservationalCheeklist (e.g., Appearance, Body Posture, etc.). Assessment includes bothinterview and observation completed in abrsut 20-30 minutes. No validity andreliability information available.




Jean MundyLeisure Services/Studies215 Stone BuildingFlorida State UniversityTallahassee, FL 32306

Doris BerrymanDept. of RLPES2.39 Greene St. Room 635New York UniversityNew York, NY 10003

American Guidance ServicesCircle Pines, MN 55014


2 .7


26. Idyll Arbor ActivityAssessment (Burlingame,1989)

27. Activity Therapy (AT)Assessment (Persrbbacher,19V28)

28. The Bond-Howard Assessmenton Neglect in RecreationTherapy (BANRT) (Bond-Howard, 1990)

29. BUS Utilization Assessment(Burlingame, 1989)

30. Burlingame Software Scale(Burtingarne, 1980)

31. Conimunication DeviseEvaluation (Burlingame, 1990)

Intended for use in long term care facilities, instrument includes: PemographicInformation, Leisure Interests and Leisure History, Individual Performance andSocial Strengths, and Maladaptive Behaviors. Relying primarily on a checklistformat, instrument has space for three separate administrations. Extensivedirections. No validity and reliability information available.

Designed for long term care residents, two page assessment contains sections on:Resident Profile, Lifestyle and Related Abilitier .nd Activity Pursuits, SupportsSystems, Psychosocial and Cognitive Functioning, and Primary Strengths andWeaknesses. Requires primarily open-ended notes. Other forms (e.g., ProgressNote) and activities manual are available. No validity and reliability informationavailable.

Measures density and scope of visual neglect for clients with Right CVA whodemonstrate left side neglect. "Bu!l's eye" type target face is used to have clientlocate appropriate numbers and throw dart as therapist times reactions andcorrectness of information. Score sheets include Daily Score Sheet #135 (forrecording answeesl. and #136 for assessing density and scope. No validity andreliability information available.

Checklist used to determine client's performance and understanding of using publicbuses as transportation. Surveys both functional skills and maladaptive behaviorsin detailed checklist format, resulting in accurate picture of ability to independentlyfunction. Intended for individuals with mental retardation or cognitiveimpairments. Initial validity or reliability information available.

Rating scale for analyzing appropriateness (difficulty) of computer games forpeople with disabilities; may also be used to assess some functional abilities of theclient. Topics include Memory Required, Planning Skills, Scanning, etc. Novalidity or reliability information available. Individual computer log available totrack client use.

Measures compatibility of client's augmentative communication device to leisurelifestyle. Used to evaluate individual devices available to the client. Includesseveral characteristics under six general categories (e.g., Interface Options, OutputOptions, etc.) and five leisure settings (e.g., Store/Restaurant, Transportation,etc.) in which device may be net-vied. No validity and reliability informationreported.

Idyll Arbor, Inc. (#124)25119 S.E. 262 StreetRavensdalc, WA 98051(206) 432-3231

Ruth PerschbacherBristlecone ConsultingRt. #2, Box 458Asheville, NC 28805(704) 298-7357

Ptarmigan Wcst1061 Josh Wilson RoadMt. Vernon, WA 98273-9619(206) 428-9785



Idyll Arbor, Inc. (#132)25119 S.E. 262 StreetRavensuale, WA 98051(206) 432-3231


LEISURE ACTIVITY SKILLS

32. Functional Hiking Technique(Burlingame, 1979)

33. Downhill Skiing Assessment(Peterson, 1990)

34. Cross Country SkiingAssessment (Peterson, 1990)

Assesses client's ability to demonstrate basic skills necessary to hikeindependently. Divides hiking skills into five skill levels (e.g., Select PropuAttire, Moving Under Obstacles, Moving Over Obstacles, etc.) under which areseveral more specific skills. Includes instructional strategies. No validity andreliability information available.

In checklist format, assesses clients for placement into appropriate skill classes.Clients are to be assessed in each skill area three times, with scores andobservations recorded. Documentation of modification is encouraged. Skill levelsrange from Beginner to Dynamic Skiing. No validity and reliability informationavailable.

In checklist format, assesses clients for placement into appropriate skill classes.Clients are to be assessed in each skill area three times, with scores andobservations recorded. Documentation of modifications is encouraged. Novalidity and reliability information available.

LEISURE INTERESTS & PARTICIPATION

35. Leis urescope/Teenseope (Nall,1983)

36. State Technical InstituteAssessment Process (ST1L.AP)(Navar, 1980)

37. Influential People Who HaveMade an Imprint on My Life(Korb, Azok & Leutenberg,1989)

Examines leisure preferences for adults (Leisurescope) and adolescents(Teenscope). Preferences are divided into nine categories (e.g., Games, Musicand Art) to which client responds after viewing "collages" (either laminated cardsor slides), feeling during activities art also recorded. Validity and reliabilitystudies repotted. Supplies and activity file also available.

Translates preference and involvement in 123 activities into 14 categories ofleisure competence or skills. Can be self-administered or completed by therapist.Initial validity and reliability information available. Created for use with adultswith physical disabilities.

Examines both positive and negative influences on one's life through self-examination and group discussion. Nine categories of people are reviewed (e.g.,Teachers and Family Members) according to the influence they exerted on theclient. Intended for group administration. No validity and reliability infonnationavailable. Other instruments available from company.

Idyll Arbor, Inc. (#140)25119 S.E. 262 StreetRamada le, WA 98051(206) 432-3231



Leisure Dynamics10106 Bear Paw LanePanama City, FL 32404(904) 681-5462


Wellness Reproductions23945 Mercantile RoadBachwood, OH 441221-800-669-9208FAX 216-831-1355

31


38. Recreation Participation DataSheet (RPD) (Burlingame,1987)

39. Joswiak's Leisure CounselingAsseument (Joswiak, 1979189)

40. Leisure and Social/SexualAssessment (Coyne, 1980)

41. 1.41MITC Activities Blank(McKechnic, 1975)

42. Family Leisure AssessmentChecklist (FLAC) (Folkcrth,1978)

43. Constructive Leisure ActivitySurvey #1 (Edwards, 1980)

44. Constructive Leisure ActivitySurvey #2 (Edwards, 1980)

Generically analyzes client participation in any activity by examining sevencategories (e.g., Initiation, Independence, Satisfaction, etc.). completion of formallows therapist picture of client's leisure behavior. No validity or reliabilityinformation available. Also Supplemental Physical Activity available, focusing onheart rate analysis.

Three part assessment for individual with developmental disabilities: ClientInformation Sheet (Personal Leisure Resources, Leisure Preferences, etc.),Participation in Leisure Activity Assessment Sheet (observation concerning self-initiation, structure, independence, etc.) and Enabling Objectives Assessment Sheet(specific objectives client is to attain). Book focuses on program development andimplementation. No validity and reliability information available.

Measures combination of leisure interests, participation, skills and knowledge inthree sections: General Demographics, Leisure Participation Patterns, and SexualKnowledge. Scored on combination of open-ended questions, checklists and ratingscales. Interview format. Intended for people with developmental delays. Novalidity and reliability information available.

Measures past leisure participation and intentionality of future involvement through3-point rating scales. Categories of leisure participation include such areas as:Mechanics, Sports, and Slow Living. Past involvement includes six categories;future includes eight. Manual includes instructions and validity and reliabilityinformation.

Assesses leisure interests of families with children who have disabilities.Activities arc grouped in to eight major categories, to which the clients respond ona 7-point scale (e.g., from "Do activity presently" to "Inappropriate tohandicapping condition.") Families' scores are then culminated on one sheet toassess differences and similarities. No validity and reliability informationavailable.

Examines leisure interests within five broad categories: Physical and Outdoor,Social and Personal Satisfaction, Arts and Craftsmanship, Learning, and GeneralWelfare. Approximately 50 activities (250 total) are given under each heading.Documentation available.

Examines leisure interests in over 400 leisure activities; also asseFsell feelingsabout past, present and future activities, and relationship between work andleisure. Documentation available.


Venture Pub balling Company1640 Oxford CircleState College, PA 16803(814) 234-4561


Consulting Psychologists577 College AvenuePalo Alto, CA 94306

Jean FolkerthDepartment of HPERWarner BuildingEastern Michigan Univ.Ypsilanti, MI 48191(313) 487-0090

Patsy EdwardsConstructive Leisure511 N. La Cienega blvd.Los Angeles, CA 90048

Constructive Leisure511 N. La Cienega Blvd.Los Angeles, CA 90048


45. Leisure Pref (Edwards, 1986) Computerized interest inventory involving 92 activities. Computer capability toanalyze and interpret results. AvailaMt in variety of computer formats. User'sManual available.

Constructive Leisure511 N. La Cienega Blvd.Los Angeles, CA 90048

3 4 3

STUMM)

References

General and Historical AssessmentReferences for Therapeutic Recreation

Armand V.S. (1977). A review of evaluation in therapeuticrecreation. Therapeutic Recreation Journal, 2, 42-47.

Beddall, T., & Kennedy, D. (1985). Attitudes of therapeuticrecreators toward evaluation and client assessment.Therapeutic Recreation Journal, 19(1), 62-70.

Burdge. R.J. (1961). The development of a leisure orientationscale. Unpublished master's thesis, The Ohio StateUniversity, Columbus, OH.

Burlingame, J. (1990). How much time? AMA Newsletter. 6(4),5-6.

Burlingame, J., & Blaschko. T.M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdale, WA:Idyll Arbor, Inc.

Connolly, P. (1981). Selected references on assessment.Therapeutic Recreation Journal, 15(3), 27-29.

Cousins, B., & Brown, E. (1979). Recreation therapyassessment. Jacksonville, FL: Amelia Island/CFMR.

Crandall, R., & Slivken, K. (1980). Leisure attitudes and theirmeasurement. In S.E. Iso-Ahola (Ed.), Social psychologicalperspectives on leisure and recreation (pp. 261-284).Springfield, IL: Charles C. Thomas.

D'Agostini, N. (1972). Avocational activities interest index.Unpublished manuscript.

Dixon, .1. (1980). The role of evaluation in therapeutic recreationservice. Journal of Physical Education and Recreation, 5 1(8),48-49.

Doe, J. (1980). Recreation therapy assessment. TherapeuticRecreation Journal, 14(4), 36-38.

Dunn, J.K. (1983). Improving client assessment procedures intherapeutic recreation programming. In G.L. Hitzhusen (Ed.),Expanding horizons in therapeutic recreation X (pp. 61-84).Columbia, MO: University of Missouri.

Dunn, J. (1984). Assessment. In C.A. Peterson and S.L. Gunn(Eds.), Therapeutic recreation program design: Principlesand procedures (2nd ed.) (pp. 267-320). Englewood Cliffs,NJ: Prentice-Hall, Inc.

Dunn, J.K. (1987). Establishing reliability and validity ofevaluation instruments. Journal of Park and RecreationAdministration, 5(4), 61-70.

Dunn, J.K. (1989). Guidelines for using published assessmentprocedures. Therapeutic Recreation Journal, 23(2), 59-69.

Erlandson, M.E. (1981). The therapeutic recreation assessmentprocess: Meeting JCAH standards. In N. Navar and J. Dunn,(Eds.), Quality assurance: Concerns for therapeuticrecreation (pp. 68-69). Champaign, IL: University of Illinoisat Urbana-Champaign.

G., & Shank, J. (1980). Individual assessment throughleisure profile construction. Therapeutic Recreation Journal,14(4), 46-52.

Ferguson, D. (1983). Assessment interviewing techniques: Auseful tool in developing individual program plans.Therapeutic Recreation Journal, 17(2), 16-22.


Forsyth, P. (1982). Development of a leisure knowledge test.Unpublished muter's thesis, North Texas State University,Denton, TX.

Howe, C. (1984). Leisure assessment instrumentation intherapeutic recreation. Therapeutic Recreation Journal, 18(2),14-24.

Howe, C.Z. (1989). Assessment instruments in therapeuticrecreation: To what extent do they work? In D. Compton(Ed.), Issues in therapeutic recreation: A profession intransition (pp. 205-221). Champaign, IL: SagamorePublishing Co.

Hubert, E.E. (1969). The development of an inventory of leisureinterests. Unpublished doctoral dissertation, University ofNorth Carolina- Chapel Hill, Chapel Hill, NC.

Jewell, D. (1980). Documentation: Shibboleth forprofessionalism. Therapeutic Recreation Journal, 14(1),23-29.

)Cinney, W.B. (1980). Clinical assessment in mental healthsettings. Therapeutic Recreation Journal, 14(4), 39-45.

Loesch, L.C. (1980). Leisure counseling. Ann Arbor, MI:ERIC/CAPS.

Loesch, L.C., & Wheeler, P.T. (1982). Principles of leisurecounseling. Minneapolis, MN: Educational MediaCorporation.

Olsson, R., Halberg, K., Edgington, C., & Cherry, M. (1987).An evaluation of an automated leisure assessment forcommunity-based recreation. Journal of Park and RecreationAdministration, 5(2), 27-39.

Olsson, R.H., Shearer, T.W., & Halberg, K.J. (1988). Theeffectiveness of a computerized leisure assessment system forindividuals with spinal cord injuries. Journal of ExpandingHorizons, 3(3), 35-40.

Peterson, C.A. & Gunn, S.L. (1984). Therapeutic recreationprogram design: PrincOks and procedures (2nd ed).Englewood Cliffs, NJ: Prentice Hall, Inc.

Rimmer, S.M. (1979). The development of an instrument toassess leisure satisfaction among secondary school students.Unpublished doctoral dissertation, University of Florida,Gainesville, FL.

Slivken, K.E. (1978). Development of a leisure ethic scale.Unpublished master's thesis, University of Illinois atUrbana-Champaign, Urbana-Champaign, IL.

Sneegas, J.J. (1989). Can we really measure leisure behavior ofspecial populations and individuals with disabilities? In D.Compton (Ed.), Issues in therapeutic recreation: A professionin transition (pp. 223 - 236). Champaign, IL: SagamorePublishing Co.

Stumbo, N. (1983). Systematic observation as a research tool forassessing client behavior. Therapeutic Recreation Journal,17(4), 53-63.

Sumba, N.J., & Rickards, W.H. (1986). Selecting assessmentinstruments: Theory into practice. Journal of ExpandingHorizons in Therapeutic Recreation, 1(1),1-6.

Stumbo, N.J., & Thompson, S.R. (1985). Leisure education: Amanual of activities and resources. State College, PA:Venture Publishing.

3 6

STUMBO

Teague, M. (1986). Comprehensive health usessment: Analgorithmic model. Therapeutic Recreation Journal, 20(2),39-50.

Touchstone, W. A. (1975). The status of client evaluation inpsychiatric settings. Therapeutic Recreation Journal, 14(4),166-172.

Touchstone, W. (1984). A personalized approach to goalplanning and evaluation in a clinical setting. TherapeuticRecreation Journal, 18(2), 25-31.

Walshe, W.A. (1977). Leisure counseling instrumentation. InD.M. Compton & J.E. Goldstein (Eds.), Perspectives ofleisure counseling. Arlington,VA: National Recreation andPark Association.

Wehman, P., & Schleien, S. (1980a). Assessment and selectionof leisure skills for severely handicapped individuals.&lucation and Thaining of th Mentally Retarded, 15(1),50-57.

Wehman, P & Schleien, S. (1980b). Relevant assessment inleisure skill mining programs. Therapeutic RecreationJournal, 14(4), ..)-29

Witt, P., Connolly, P., (*... Cottpton, D. (1980). Assessment: Aplea for sophistic...hot: Therapeutic Recreation Journal,14(4), 3-8.

Witt, P.A., & Groom, R. 1979). Dangers and problemsassociated with current approaches in developing leisureinterest tindery. Therapeutic Recreation Journal, 13(1), 19-

31.Wright, S. (1987). Quality assessment: Practical approaches in

therapeutic recreation. In B. Riley (Ed.), Evaluation oftherapeutic recreation through quality assurance (pp. 55-66).State College,PA: Venture Publishing.

Spec* References for IndividualAssessments

Leisure Attitudes and Barriers

1. Leisure Diagnostic Battery(LDB) (Witt & Ellis,1982)

Dunn, J. (1986). Generalizability of the leisure diagnosticbattery. Unpublished doctoral disertation, University ofIllinois at Urbana-Champaign, Urbana-Champaign, IL.

Ellis, G., & Witt, P. (1982). The leisure diagnostic battery:Theoretical and empirical structure. Denton,TX: North TexasState University/State College, us. Vi:iture Publishing Co.

Ellis, G., & Witt, P. (1984). The rn.-3surement of perceivedfreedom in leisure. Journal ofLeisure Research, 16, 110-123.

Ellis, G., & Witt, P. (1986). The leisure diagnostic battery: Past,present, future. Therapeutic Recreation Journal, 20(4), 31-47.

Ellis, G., Witt, P. & Niles, S. The leisure diagnostic batteryremediation guide. Denton, TX: North Texas State

University.Witt. P., & Ellis, G. (1985). Development of a short form to

assess perceived freedom in leisure. Journal of LeisureResearch, 17(3), 225-233.

3

2. Life Satafaction Scale (I..SS) (Lahmann. 1980)

Burlingame, J., & Blaschko, T.M. (in press). As.ressmera toolsfor recreational therapy: Red book #1. Ravensdale, WA: IdyllArbor, Inc.

3. Leisure Satisfaction Scale (Beard & Ragheb,1980)

4. Leisure Motivation Scale (Beard & Ragheb,1983)

S. Leisure Attitude Scale (Beard & Ragheb. 1982)

Beard, J., & Ragheb,14. (1980). Measuring leisure satisfaction.Journal of Leisure Res:arch, 12(1), 20-33.

Beard, J., & Ragheb, M. (19C3). Measuring leisure motivation.Journal of Leisure Research, 15(3), 219-228.

Ragheb, M.G. (1980). Interrelationships among leisureparticipation, leisure satisfaction and leisure attitudes. Journalof Leisure Research, 12, 138-149.

Ragheb, M.G., & Beard J.G. (1980). Leisure satisfaction:Concept, theory and measurement. In S.E. Iso-Ahola (Ed.),Sodal psychological perspectives on leisure and recreation.Springfield, IL: Charles C. Thomas.

Raghcb, M., & Beard, J. (lc-n.0. Measuring leisure attitude.Journal of Leisure Research, 14(2), 155-167 .

6. Brief Leisure Rating Scale (BLRS) (Ellis & Niles,198S)

Ellis, G., & Niles, S. (1985). Development, reliability andpreliminary validation of a brief leisure rating scale,Therapeutic Recreation Journal, 19(1), 50-6 1 .

7. Comprehensive Leisure Rating Scale (CLEIRS)(Card, Compton & Ellis. 1986)

Card, J., Compton, D., & Ellis, G. (1986). Reliability andvalidity of the comprehensive leisure rating scale. Journal of&paneling Horizons in Therapeutic Recreation, 1(1), 21-27.

Lindsey, S.P., & Card J . A. (1990). Inter-rater reliability of thecomprthensive leisure rating scale (CLEIRS). In G.L.Hitzhusen and J. O'Neil (Eds.), Ezpanding horizons intherapeutic recreation X111, (pp.54-67). Columbia, MO:University of Missouri.

8. Leisure Barriers Inventory (1983) (Peterson.1982)

9. What Am I Doing? (WAID) (Neulinger. 1986)

Burlingame, J., & Blaschko, T.M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdale, WA: IdyllArbor, Inc.

ANNUAL IN THERAPEUTIC RECREATION. No. IL 1991 21

STUMBO

Hultsman, & Black, D.R. (1990). Baseline age norms forNeu linger's "What am I doing?" instrument. Annual inTherapeutic Recreation, 1(1), 37-47.

Hultsman, J. & Black, D.R. (1990). Baseline gender norms andcohort comparisons for Neu linger's "What am I doing?"::istrument. Annual in Therapeutic Recreation, 1(1), 28-36.

10. Leisure Well-Bring Inventory (McDowell. 1987)

McDowell, C.F. (1978). Leisure well-being inventory.Eugene,OR: Sun Moon Press.

McDowell, C. (1983). Lisure wellness: Concepts and helpingstrategies. Eugene,OR: Sun Moon Press.

McDowell, C. (1986). Wellness and therapeutic recreation:Challenges for service. Therapeutic Recreation Journal,20(2), 27-38.

11. Self-perception Profile for Children (Harter.1982/83)

Harter, S. (1979). Perceived competence scalefor children, Form0. Denver,CO: University of Denver.Harter, S. (1982). The perceived competence scale for children.Child Development, 53, 87-97.

12. Over SO (Edwards, 1988)

Edwards, P. (1988). Guide to over 50. Los Angeles,CA:Constructive Leisure.

Functional Abilities

13. Functional Assessment of Chwucteristics forTherapeutic Recreation (FACTR) (Peterson.Dunn & Carruthers, 1983)

Burlingame, J., & Blaschko, T.M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdale,WA: IdyllArbor, Inc.

14. Ohio Leisure Skills Scales on NormalFunctioning (OLSSON) (Olsson. 1988)


Olsson, R.H. (1990). The Ohio leisure skills scala fornormal-functioning: A systems approach to clinicalassessment, In G.L. Hitzhusen and J. O'Neil (Eds.),E.wanding horizons in thrraperitic recreation X111, (pp.132-145). Columbia,MO: University of Missouri.

22 ANNUAL IN ThERAPEUTIC RECREATION, No. II, 1991

15. Comprehensive Evaluation in RecreationTherapy - Physical Disabilities (CERT-PD)(Parker, 1977)

16. Comprehensive Evaluation in RecreationTherapy - PsychiatricIllehavioral (CERT-Psych)(Parker, 1975)

Burlingame, J., & Bluchko, T.M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdale,WA: IdyllArbor, Inc.

Parker, R., & Downie, G. (1981). Recreation therapy: A modelfor consideration. Therapeutic Recreation Jowrnal, 15(3),22-26.

Parker, R.A., Elliaon, C.H., Kirby. T.F., & iort, M.J. (1975).Thf; comprehensive evaluation in ree- ti. therapy scale: Atool for patient evaluation. Therapt ......Recreation Journal,9(4), 143-1.52.

Parker, R., Keller, K., Davis, M., & Downie, R. (1984). Thecomprehensive evaluation in recreation therapy scale -rehabilitation: A tool for patient ovaluation in rehabilitation.Unpublished manuscript.

17. Maladapted Social I'unctioning Scale forTherapeutic Recreation Programming (MAST)(1d:111 Atbor, Inc.. 1988)

Burlingame, J., & Blaschko, T.M. (in press). Assessment tootsfor recreational die i-apy: Red book #1. Ravensdale, WA: IdyllArbor, Inc.

18. Therapeutic Recreation Index (TR1) (Faulkner,1987)

Burlingame, J., & Blaschko, T.M. (in press). Assessment toolsfor recreational therqy: Red book #1. Ravensdale, WA: IdyllArbor. Inc.

Faulkner, R. (1987). TR/ manual. Seaside, OR: LeisureEnrichment Service.

19. General Recreation Screening Tool (GRST)(Burlingame. 1988)

Burlingame, J., & Blaschko, T M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdale, WA: IdyllArbor, Inc.

20. Recreation Early Development Screening Tool(REDS) (Budingame. 1988)

Burlingame. J., & Blaschko, T.M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdale, WA: IdyllArbor, Inc.

3 S

STUMBO

21 . Activity Therapy Sosial Skills Baseline(Patterson, 1985)

Burlingame, I., & Blasehko, T.M. (in press). Asse.ssmera toolsfor recreational therapy: Red book #1. Ravensdale, WA:Idyll Arbor, Inc.

Patterson, (190). Activity therapy social skills baseline. Dwight,IL: Wm. W. Fox Developmental Center. Unpublishedmanuscript.

22. Mundy Recreation Inventory for the PainableMentally Retarded

Mundy, J. (1965). The Mwviy recreation inventory for thetrainable mentally retarded. Tallahassee, FL: Florida StateUniversity. Unpublished manuscript.

23. Recreation Behavior Inventory (RBI (Berryman& Lefebvre. 1984)

l3erryman, D., & Lefebvre, C. (1984). Recreation behaviorinventory. Denton, TX: Leisure Lear. Systems

24. Bruninks-Oseretsky Test of Motor Proficiency

Bruninks-Oserasky Test Kit. Circle Pines, MN: AmericanGuidance Service.

25. Idyll Arbor Reality Orientation Assessment (IdyllArbor. Inc., 1989)

13vrlingame, J., & Blaschko, T.M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdalc, WA:Idyll Arbor, Inc.

26. Idyll Arbor Activity Assessment (Burlingame,1988)

Burlingame, J., & Blechko, T.M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdale, WA:Idyll Arbor, Inc.

27. Activity Therapy (AT Assessment)(Perschbacher, 1989)

Perschbacher, R. (1989). Stepping forward with activities.Asheville,NC: Bristlecone Consulting Company.

28. The Bond-Howard Assessment on Neglect inRecreation Therapy (Bond-Howard. 1990)

29. BUS Utilization Assessment (Burlingame, 1980)

39

30. Burlingame Software Scale (Burlingame, 1980)

31. Communication Device Evaluation (Budingante,1990)

32. Functional Hiking Technique (Burlingame.1979)

33. Downhill Skiing Assessment (Peterson, 1990)

34. Cross Country Skiing Assessment (Peterson,1990)


Leisure Interests and Participation

35. Leisurescope/Teen Leisurescope (Nall,1983/1985)

Burlingame, J., & Blaschko, T.M. (in press). Assessment toolsfor recreagonal therapy: Red book #1 Ravensdale,WA: IdyllArbor, Inc.

Nall, C. (1983). instructional manual for leisurescope. ColoradoSprings,CO: Leisure Dynamics.

Nall, C. (1985). instructional manual for teen lelsurescope.Colorado Springs, CO: Leisure Dynamics.

36. State Technical Institute Assessment Process(STILAP) (Navar, .1980)


Navar, N. (1980). A rationale for leisure skill assessment withhandicapped adults. Therapeutic Recreation lownal, 14(4),21-28.

Navar, N., & Clancy, T. (1979). Leisure skill assessmentprocess in leisure counseling. In DJ. Szymanski & G.L.Hitzhusen (Eds.), Expanding horizons in therapeuticrecreation VI. (pp. 68-94). Columbia, MO: University ofMissouri.

37. Influential People Who Ikve Made an Imprinton My Life (Korb. Azok & Leutenberg, 1989)


ANNUAL IN THMAPEUTIC RFCREATION, No. IL 1991 23

STUMBO

38. Recreation Participation Data Sheet (RPD)(Burlingame, 1987)

Burlingame, J., & Blaschko, T.M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdale, WA:Idyll Arbor, Inc.

39. Joswiak's Leisure Counseling Assessment(loswiak 1975, 1989)

Joswiak K. (1975). Leisure counseling program materials for thedevelopmentoW disabled. Washington, D.C.: Hawkins andAssociates.

Joswisk K.F. (1980). Recreation therapy assessment withdevelopmentally dimbled persons. Therapeutic RecreationJou:nal, 14, 29-3 8.

Joswiak K.P. (1989). Leisure education: Program materials forpersons with developmental disabilities. State College, PA:Venture Publishing.

40. Leisure and Social/Sexual Assessment (Coyne,1980)

Burlingame, J., & Blaschko, T.M. (in press). Assessment toolsfor recreational therapy: Red book #1. Ravensdale, WA:Idyll Arbor, Inc.

41. Leisure Activities Blank (McKechnie. 1975)

McKechnie, G. (1974). Manual for environmental responseinventoty. Palo Alto: Consulting Psychologists Press.

McKechnie, G. (1974). The psychological structure of leisure.Journal of Leisure Research, 6(1).

McKechnie, G. (1974). The structure of leisure activities.Berkeley, CA: Institute of Personality Assessment andResearch.

McKechnie, G. (1975). Manual for leisure activities blank. PaloAlto, CA: Consulting Psychologists Press.

42. Family Leisure Assessment Checklist (FLAW(Folkerth. 1979)

Folkerth, J. (1979). Give the family flac. In D.J. Szymanski andG.L. Hitzhusen (Eds.), Expanding horizons in therapeuticrecreation VI (pp. 174-179). Columbia, MO: University ofMissouri.


43. Constructive Leisure Activity Survey #1(CL4S#1) (Edwards, 1980)

44. Constructive Leisure Activity Survey #2(CLAS#2) (Edwards. 1980)

Edwards P. (1980). Leisure counseling techniques: Individualand Group counseling step-by- step! (3rd. ed.) Los Mgeles,CA: Constructive Leisure.

Edwards, P., & Bloland, P. (1980). Leisure counseling andconsultation. Personnel and Guidance, 58 (6), 435-440.

45. Leisure Pre (Edwards. 1986)

Edwards, P. (1986). Manual for leisure pref Los Angeles, CA:Constructive Leisure.

Additional References Used in Article

Gronlund, N . E. (1981). Measurement and evaluation in teaching.(4th ed.). New York: MacMillan.

Oltman, P.K., Norback J., & Rosenfeld, M. (1989). A nationalstudy of the profession of therapeutic recreation specialist.Therapeutic Recreation Journal, 23(2), 48-58.

Shimberg, B. (1981). Testing for licensure and certification.American Psychologist, 36(10), 1138-1146.

4

The Family Lab: An Interdisciplinary FamilyLeisure Education Program

Marjorie J. Malkin, Ed.D., C.T.R.S.Randall W. Phillips, M.A.Janice A. Chumbler, M.A.

Abstract

The purpoze of this article is to describe the theoretical framework and programmatic elements of the FamilyLab, an interdisciplinary family leisure education program. The Family Lab is a series of scheduled, prescribedactivities designed to fulfill diagnostic needs of the clinical staff, and provide instructive and therapeutic benefitsto the family. Areas of focus include communication, trust, values clarification, role playing, and enjoyment ofleisure activities. This program was designed for families of adolescents in substance abuse treatment. Literaturewas reviewed in the areas of leisure education and substance abuse, codependency and family dysfunction, andfamily leisure counseling. The effectiveness of family and activity therapies is reviewed. The leisure assessmentof family Lembers, and the coordination of parenting skills classes with family leisure education sessions arediscussed. The programmatic elements of the Family Lab, based upon the above theoretical constructs, arepresented in outline form.

The national focus on the War on Drugs indicatesthe extent of substance abuse in the United States.The increased number of adolescent alcoholics anddnig abusers has become common knowledge (Leo,1985). Perdue and Rainwater (1984) state thatadolescent alcohol use and misuse is a nationalconcern, attracting increased public and scientificattention. These authors completed a study whichindicated that because alcohol consumption is anintegral part of many adolescent recreationalactivities, the need exists for leisure counseling inadolescent treatment programs. The NationalRecreation and Park Association has acknowledged agrowing problem and emphasized the need for asubst: .e abuse prevention program targeted at theyouth market (National Recreation and ParkAssociation, 1989; Prince, 1990).

. The family, and substance abuse, has been theemphasis of public concern since 1980, evidenced bythe President's address to the White HouseConference on Families (Carter, 1980) emphasizingdrugs, alcohol and the younger members of families,and by the attention to alcohol related familyproblems (Orford & Harwin, 1982; AmericanPsychiatric Association, 1987, p. 174; Steinglass,Bennett, Wolin, & Reiss, 1987). The American

41

Psychiatric Association (Diagnostic and StatisticalManual Of Mental Disorders, 3rd ed., revised, 1987)estimates that alcoholism affects approximately 13%of the population at some time in their lives. One outof four children may grow up in families wheresubstance abuse is a major influence (Norton, 1986)and 85% of adolescents diagnosed as chemicallydependent will have a family history of substanceabuse (Goodwin, 1988).

The abuse of alcohol and other mood alteringchemicals disnt-ts the family system and can causepatterns of cou..pendency to develop (Beattie, 1987;Steinglass et al., 1981). Organizations such asALANON, AL-A TEEN, and ACOA (Adult Childrenof Alcoholics) have proliferated due to increasedrecognition of the lasting effects of substance abuseupon the family as a whole, and upon familymembers individually.

The importance of the assessment of leisure andlifestyle behavioral changes in the treatment of

Marjorie Malkin is an assistant professor in the Department ofRecreation al Southern Illinois University, Carbondale, IL.Randall Phillips is a clinical member of the American Associationfor Marriage and Family Therapy and is certified by theTennessee Board of Health as a Marital and Family therapi.st.Janice Chumber is a substance abuse therapist.

ANNUAL IN THERAPEUTIC RECREATION, No. U, 1991 25

MALKIN Er AL.

alcoholism is emphasized by recent literature(Di Lorenzo, Prue, & Scott, 1987; Ransom,Waishwell, & Griffin, 1987). Leisure for addictedpersons often involves drinking, drugging, otherdestructive uses of leisure time, and accompanyingfamily disruption. Dysfunctional leisure patterns forthe user may involve centering all recreationalactivities around his or her drug of choice, orwithdrawal, isolation, and a total lack of participationin previous leisure pursuits (O'Dea-Evans, 1990; W.,Anne, 1985). Ranson et al. reviewed a study (Moos,Bromet, Tsu, & Moss, 1979) which indicated that asthe alcoholic patient improved, family cohesion andactivity-recreational orientation and organizationincreased. The same families experienced morepositive life events.

This article describes the family leisure educationcomponent of a family program for adolescents in aninpatient substance abuse treatment program. Thisprogram can be adapted for use in an outpatient orcommunity-based setting. The Family Lab programis interdisciplinary, and involves family therapists,family program counselors, mental health technicians,and nurses, in addition to the recreation therapist, ortherapeutic recreation specialist. The theoretical basisfor this program was developed as a result of ananalys's of the various aspects of the dysfunctionalfamily which may contribute to dysfunction inleisure.

Exploration of the Family Lab Program includesa review of the literature related to codependency andrelated family roles within the family system; leisureneeds, benefits, and barriers of the family of asubstance abuser; assessment of family leisureinterests; and leisure education activities. Evaluationand follow-up procedures are indicated.

Two versions of this program were developed. Afour-week rotation of selected sessions was designedfor the adult treatment unit as the length of stayaveraged 28 days. A longer series of 6-8 sessionswas used for the adolescents whose length of stayaveraged 8-12 weeks. This paper describes theadolescent program, in which the family leisureeducation sessions were coordinated with parentaleducation and parenting skills classes. The leisureeducation sessions were based upon dysfunctionalaspects of the codependent family and emphasizedcommunications, parenting styles, values clarificationand role playing.

Accepting the Narcotics Aiionymous dictum that


"a drug is a drug is a drug," the treatment approachdescribed does not separate the adolescent alcoholicsfrom abusers of other chemicals. Clinical experienceof the authors in this regard, supported by theliterature (Beattie, 1987), indicates that similardysfunctional patterns, such as enabling and denial,are evident within most families which include amember with an addictive disease be it alcohol orother drug related. Norton (1988) states that littleprogress can be made in the treatment of adolescentsubstance abusers "unless the impact and influence oftheir chemically dep.q..lent family system is

addressed" (p. 35).

Review of Related Literature

In designing the family leisure education program(The Family Lab), literature was reviewed in thefollowing areas: leisure education and counseling andsubstance abuse treatment; codependency and familysystems theory; family leisure education; parentingtraining; and the effectiveness of famiiy and activitytherapy as treatment modalities.

Leisure Education and Substance Abuse

A review of th'. literature reveals increasedattention to the issues of leisure education orcounseling within substance abuse treatmentprograms. O'Dea-Evans (1990) has developed LEAP(Leisure Education for Addicted Persons). Thisprogram analyzes leisure participation for substanceabusers. Paralleling the Jellinek Curve of theprogression of the disease of alcoholism (Steinglass etal., 1987), LEAP (O'Dea-Evans & Dugan, caw inO'Dea-Evans, 1990) includes an analysis of thestages of leisure in chemical dependency, indicatingthe increasing focus upon using within allrecreational, social, and family activities as theaddictive disease progresses. This analysis indicatesimprovements in leisure interest and function as therecovery process begins. Ransom et al.'s (1987)review of the literature on leisure and alcoholismindicates that alcoholics view leisure negatively.Most studies have focused upon attitude change, butRansom et al. stress that a behavioral change leadingto "functional independence, (managing leisure timewithout drinking)" (p. 108) is necessary. To that endthey propose a leisure counseling program consistingof Assessment, Leisure Lifestyle Analysis, Action

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Plans (Intervention), Leisure Profile Assessment, andProgram Revision. The focus is upon attitude changewith the belief supported within social psychologytheory that "attitude shifts act as causal agents in thebehavioral change process" (Ransom et al., 1987, p.110). DiLorenzo, Prue, and Scott (1987) indicate thelimitations of currently available leisure assessmentprocedures. They note the clinically observedrelationship of leisure skills to treatment outcome.Citing Moos et al., (1979) these authors suggest thatsuccessful leisure experiences may contribute toadjustment and personal happiness. DiLorenzo et al.(1987), note that behavioral change, not merelyattitudinal change, should be the focus of leisurecounseling. They note the lack of empirical researchon the effects or outcomes of leisure couns ,lingprograms.

Perdue and Rainwater (1984) stressed therelationship between decreasing levels of socialcontrol and increased recreational participation, withincreased adolescent alcohol consumption. Mereprovision of recreational activities will not decreaseconsumption. A leisure education program isrecommended in order to enhance the social benefitsof leisure choices (Hitzhusen, 1977, and Mobily,1982, both cited in Perdue & Rainwater, 1984).Current theories of alcoholism involve complex andmultivariate social and psychological approaches,necessitating comprehensive programs which focusupon all aspects of an individual's lifestyle (Purdue &Rainwater, 1984).

Family DAfunction and Leisure

Literature in the areas of family dysfunction,codependency, and family therapy was reviewed todetermine the relationship bet f ise patterns offamily behavior and fan ,,ce dysfunction.Family patterns cf alcoholism xi..., e been the focus ofmany studies. Wolin, Bennett, and Noonan (1979,cited in Leland, 1982) found that an alcoholic'sdisruption of family rituals (holidays, mealtimes,vacations, etc.) was associated with alcohol abuse inthe following generation. Leland (1982) reviewedstudies indicating that drinking in offspring is relatedto deficits in parental group maintenance functionsand socialization. Zucher found the patterns ofalcoholic families to include parental absence, highfamily tension, emotional distance, and frequentparental alcohol abuse (1979, cited in Leland, 1982).

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The family of an alcoholic may be isolated orwithdrawn from social contact due to social stigma(Wilson, 1982). Children in alcoholic families arehesitant to develop close peer relationships (Wilson,1982). When drinking is associated with maritalconflict or aggressive behavior, the children may bebadly affected (Wilson, 1982). Family and individualsocial and peer relationships, as well asrecreation/leisure and other "family ritual" patternsmay be disrupted in the alcoholic family, as indicatedby the above studies. Furthermore, there is a highrisk that the children may become alcoholicsthemselves. The risk of children of problem drinkersdeveloping alcohol problems is about 33% (Cotton,1979, cited in Wilson, 1982).

The concept of "codependency" has beendeveloped to describe the relationships of an addictedindividual with family, friends, peers, andco-workers. One definition of a codependent(Beattie, 1987) is a person who has let someoneelse's behavior affect him or her, and is obsessedwith controlling the other person's behavior. Thecodependent may appear strong, but in fact isdependent upon others to need them. Codependentfamily members are individuals whose lives hadbecome unmanageable due to living in a closerelationship with an alcoholic or addict. The spouseor child or parent of someone who is chemicallyaddicted develops unhealthy patterns of coping withlife. Roles within the codependent family mayinclude the chief enabler, the family hero, the clownor scapegoat, and the lost child (Wegscheider-Cruse,1981). What are some behavioral patterns withinthese families which may contribute to leisuredysfunction? Codependents have difficultycommunicating, trusting, expressing emotions,detaching emotionally or enjoying themselves(Beanie, 1987; Black, 1982; O'Connell, 1986;Woititz, 1983). Codependents frequently blame,threaten, coerce, complain, beg, bribe, manipulate,and lie. They are afraid to express feelings openly.Low self-esteem is evident (Beattie, 1987; Woititz,1983). Anger and depression are frequentlyobserved. The addict and his/her family may navedifficulty with spontaneity, or fun (Beattie, 1987;Woititz, 1983).

Such characteristics led Black to describe the don'ttalk, don't trust, don't feel model in her book It'llNever Happen To Me, (1982). This dysfunctionalpattern of family interrelationships was used as the


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basis for the Family Lab family leisure counselingprogram. Black describes family laws which developin the alcoholic family. The first of these, don't talk,refers to a prohibition toward discussing the realissues, in this case the drinking. Such a prohibitionleads to excuse making and a lack of understandingon the part of family members. This also occurs inpart due to denial of the actual problem--alcoholism.The second prohibition, don't trust, develops becauseof the lack of confidence, reliance, and faith familymembers develop due to the erratic behaviors andemotional states of the alcoholic family member. Thethird prohibition, don't feel, develops as part of thedenial system of family members. In order to bringsome stability and consistency into their lives, familymembers tend to deny both their perceptions and theirfeelings about what is happening in the home (Black,1985, chap. 3). The other concept included in theFamily Lab is Whitfield's idea of The Child Within,the spontaneous, childlike state which may berepressed by the user or various family members(1989). Other problem areas noted within theliterature for codependnt families and addicts includedifficulty with problem solving, values clarification,clarifying family boundaries, and issues ofresponsibility and independency (Steinglass, et al.,1987).

Family Leisure Education

There is little precedent within the therapeuticrecreation literature for a family leisure educationprogram. Orthner and Herron (1984) note thelinkage between leisure problems and familyproblems. They review literature which indicates theneed for family leisure intervention. These authorsnote the lack of prior serious writings on leisurecounseling in family therapy, or on families in leisurecounseling. Two subsequent articles specificallyaddress these topics; Monroe's 1987 article entitledFamily Leisure Programming" , concerns a programfor children with physical disabilities, and a secondby DeSalvatore, (1989) is entitled TherapeuticRecreators as Family Therapists: Working WithFamilies On a Children's Psychiatric Unit. Becautioned in review of the latter article, that thetherapeutic recreation specialist is not a familytherapist, unless he or she has received additionaltraining and certification. However, recreationtherapists may participate as members of an

28 ANNUAL IN THERAPEUTIC RE1/47REATI0N, No. II, 1991

interdisciplinary treatment team in a family therapyprogram. Monroe reviews studies indicating thepositive relationship between family leisureinvolvement and healthy family dynamics. Edwards(1984, cited in Monroe, 1987) recommended familyleisure education in order to increase communication,positive feelings, cooperation, and understanding.Program components for Monroe include teamreferral and assessment, including a family interviewexploring areas such as leisure skills, interests, andbarriers, of leisure needs. Following assessment, atreatment plan is developed and the programimplemented. Evaluation methods which aresuggested include: formative program evaluationprocedure; and an analysis of client performance ontreatment goals and objectives (Monroe, 1987).

Parenting Training

Parenting styles are a focus for the familyeducation sessions attended by parents participating inthe family lab program. The basis for these trainingsessions includes The Parent's Guide STEP/Teen:Systematic Training For Effective Parenting(Dinkmeyer & McKay, 1983), and The FamilyGame: A Situational Approach To Effective Parenting(Hersey & Blanchard, 1978). The STEP/Teensessions focus upon communication, responsibility,family meetings, conflict resolution and limit setting.

Goals of the program include the development ofindependence and responsibility on the part of theteen. This goal focuses on knowing that the alcoholicor addict is adept at manipulating, triangulating,involving family aS enablers or codependents, andkeeping the family in a crisis state (Dinkmeyer &McKay, 1983). Alcohol or drug use may be anattempt to exert power over one's parents, or a signof feelings of inadequacy, and low self-esteem.Therefore, the program focuses upon positive goals,encouragement, cooperation, and concern. Parentsare taught that behavior changes take time, and achange in approach is necessary in order to avoidpower struggles.

The Family Game approach includes an analysis ofparenting styles, from directive to supportive, as thematurity level of child increases. Parents learn toevaluate their approach to parenting. During FamilyLab sessions parents, family members, andadolescents are given the opportunity to role-playprevious problem situations, and practice alternativeresponses or behaviors.

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Effectiveness of Family and Activity Therapies

How effective are the proposed treatmentmodalities: family therapy; and leisure education orcounseling? Due to a lack of conceptual clarityconcerning alcoholism and addiction, treatmentprograms tend to be comprehensive or all-inclusive,offering a wide variety of treatment modalities andtherapeutic activities (Parihar & Kirchhoff, 1985).These authors point out that this array of servicesmakes it difficult to evaluate the effectiveness orcontribution of one modality toward recovery. Toexplore these difficulties, they conducted apre-experimental study to determine the relationshipbetween treatment variables and outcome behavior.Family therapy sessions were correlated withfavorable outcomes, although less significantly thansix other variables including length of stay, numberof individual sessions, group therapy sessions,activity sessions, number of AA meetings, and film-discussion sessions studied. No statisticallysignificant results were reported.

Activity therapy sessions were correlatedpositively with positive outcome, in contrast to othergroup treatment varieties (Parihar, & Kirchhoff1985). The authors attribute this effectiveness to theunique approach of activity therapy. Such uniqueaspects, according to Parihar and Kirchhoff, include:the use of a variety of activities from social skillsexercises to handicrafts, etc.; the individual focuswithin a group milieu; and client perception of thistherapy as fim.

Based upon this review of the literature and theclinical approach employed by the adolescenttreatment program, the Family Lab, orinterdisciplinary family leisure program, wasdesigned and implemented. Assessment procedures,program activities and evaluation/follow-upprocedures are described below.

Implementation of an InterdisciplinaryFamily Leisure Education Program

Family Lab Assessment Procedures

The family therapist completes a social historywhich includes information regarding family socialand leisure interests and participation. Theadolescent client completes a structured-inteNiew

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format leisure assessment. This assessment focuseson leisure needs, history, present interests, strengthsand limitations, and on the developmental tasks ofadolescence. Adolescent assessment issues shouldinclude separation from parents, individualresponsibilities and identity, gender identity, valuesclarification, and peer influence.

O'Morrow and Reynolds (1989) point out thatadolescence is a period of transition from theexpectations and competencies of childhood to a newset of expectations and competencies. Eriksondiscusses the adolescent identity crisis and notes that"at no other stage of the life cycle are the promise offinding oneself and the threat of losing oneself soclosely allied" (Erikson, 1968, cited in O'Morrow &Reynolds, 1989, p. 255). Chemical abuse may be adysfunctional adolescent response to these socialstresses.

Following individual and family assessment,referral to the appropriate family program is made bythe treatment team for each client who has familymembers available and willing to participate. Familyleisure education (the Family Lab) is included withinthe interdisciplinary treatment plan.

Further assessment of family members' leisureinterests was initially attempted using a computeranalyzed instrument (Edward's 1980 ConstructiveLeisure Activity Schedule, as recommended byDiLorenzo et al., 1987). However, limitations onstaff time and lack of computer access made thisapproach impractical. Programs wishing toincorporate this element of assessment should use aninteractive computerized leisure interest inventorysuch as LeisurePREF (Edwards, 1986) to be mosttime-efficient. In this case, clients enter resultsdirectly on the computer. Data entry and analysis isfacilitated as the computer categorizes and interpretsthe scores. If such a program is instituted,determining common leisure interests of familymembers would aid in treatment planning duringhospitalization, and in planing for activities ontherapeutic leave assignments and followingdischarge.

Family Lab Prognzm Interventions

The Family Lab is one of several components ofthe Adolescent Family Treatment Program. Familiesparticipating in this program meet individually witha family therapist four times during the course of


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treatment, and attend 6-8 Family Program sessions onsuccessive Sundays. Sunday afternoon activitiesconsist of three sessions of approximately Ph hourseach. They are (a) Parents' Class, educationalsessions for parents only focusing on parentingtechniques; (b) Family Lab, family interactive/leisureeducation sessions with topics coordinated weeklywith material covered in that day's Parents' Class;and (c) Family Group, group family therapy.

The Family Lab is a series of scheduled,prescribed activities designed to fulfill diagnosticneeds of the clinical staff and provide instructive andtherapeutic benefits to the family. Family Labprovides parents with opportunities to practiceparenting and communication skills learned inParent's Class. The experiences in Family Lab alsoprovide material to be processed in succeedingParents' Classes, and in family therapy sessions.Activities are monitored actively by clinical staff, anddirect support can be provided to the families whoare reaching the limits of their family's ability to dealwith thc task and stress of the activity. The FamilyLab is designed to be a precipitous experience whichserves to (a) manifest the symptoms of theparent-child relationship; (b) support the family whennecessary; (c) assist the family in identifying andowning their dysfunctional behaviors; (d) assist thefamily to use new skills; and e) increase their familyleisure awareness and range of leisure interests.Focus is on enlarging the family's ability to practicehealthy forms of interaction and communication.

Family Lab leisure education group sessions aredesigned to address the admonitions of thecodependent family: DON'T TALK, DON'T FEEL,DON'T TRUST, DON'T ENJOY. Sessions are Phhours in length and are facilitated by the recreationtherapist, with assistance from other interdisciplinarystaff members including family therapists andcounselors. Warm-up activities are designed forenjoyment and stimulation of The Child Within.Sessions I-VII are outlined below.

1. Don't enjoy: introduction to leisure counseang(values clarification). Goals of the session: to havethe family successfully plan an activity and becomeaware of how communication patterns influenceeffective problem solving. The family will learn thatgood experiences or family leisure happenings requireplanning and choice.

A. Warm-up activities: The Name Game is anexample of an appropriate warm-up activity.


Introduce family members to other families. Relatetheir name and name of animal (or vegetable) whichbegins with the same letter: "I'm Ann, and I'm anaardvark, etc. Such a warm-up activity serves tointroduce participants to members of other families,to break the ice, reduce inhibitions, and introducefamilies to interactive, participatory activities.

B. Discuss benefits of leisure, family leisureneeds, barriers to constructive use of leisure time,and community resources. Use brainstormingtechniques on a blackboard to elicit responses fromparticipants.

C. Assess family leisure preferences. UseLeisurePREF (Edwards 1986) as the proposedcomputerized assessment if access to interactivecomputers is available. Have family membersdevelop a family leisure collageleisure favorites bycollaboratively constructing a collage which illustratestheir family leisure pursuits. Materials providedinclude poster board, magazines, scissors, glue,marking pens. The activity serves to clarify familyleisure values and interests and to allow observationof how well the family organizes itself around a taskand divides task responsibilities, verbal andnon-verbal communication patterns, and how well thefamily allows for individual expression. It alsoprovides the opportunity to identify enabling andusing dynamics, to observe who in the family isactive in the planning process, and to complete theproject and process with the recreational therapist insmall groups.

/1. Don't trust: trust exercises. Goals of session:to explore and experience trust within the family ina positive way. To observe for levels and kinds ofanxiety and discomfort, and to see how family reactsto this.

A. Warm-up activity: The Wave. Ask thegroup to sit in a circle on chairs. Beginning slowlyat first, practice football stadium wave action,proceeding more rapidly around circle as youcontinue.

B. Trust Walk: A family member guides ablindfolded partner on a ten minute walk. Then theroles are reversed. Willow in the Wind, allowsfamily members to take turns standing in the middleof a tight circle of other family members. Theindividual in the center leans into supporting handsand is gently passed around the circle. The purposeof the exercise is to explore issues of trust/distrust.It enables various family members to practice

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dependent/independent roles and to process the resultsof these exercises in group setting.

III. Don't feel: feelings activities. Goal ofsession: to observe for suppression of feelings orexpressiveness that would cover or defend denial andto assist family members with validating each other'sfeelings and thoughts during the family activities.

A. Warm-up activity: Zoom. Participants sitin a circle, and pass the word Zoom from the personon their left to the one on their right, etc. Theactivity is timed as it completes a circle for zoomworld record.

B. Encouragement Game: Each familymember is to write positive statements on eachindividual's paper, resulting in a list of positivestatements accumulated by each. Discuss and processthe results in the group.

C. Positive Affirmations: Positive affirmationsinvolve standing behind each individual familymember, with hands of their shoulders, and makinga positive statement to that individual. Discuss andprocess feelings revealed in group. The activityallows participants to express feelings openly to otherfamily members. It enables a positive expression offeelings to counteract previously negativeinteractions.

IV. Don't talk: communication activities. Goal ofsession: to encourage family members to participatein a variety of communication exercises in order toenhance awareness of verbal and non-verbalcommunication patterns.

A. Warm-up ativity: Untangling HumanKnot (problem-solving). With one family memberout in the hall, families form a circle holding hands,then knot the circle. The absent individual returnsand un-knots the group.

B. Back to Back Activities (conversation,designs, drawings). Participants are paired andseated back to back. They practice communicating orconversing without non-verbal clues, then they faceeach other and continue conversation. Participantsdiscuss reactions to this exercise. Pairs then returnto the back to back position. The first participant isgiven a pen and paper on which draw on, or 10toothpicks or popsicle sticks to create a picture ordesign. The first individual instructs the partner toreproduce the drawing or design, one-way (givingdirections only) and two-way (allowing questions andclarification). Communication patterns are practicedand the results of this exercise are processed (see

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Carter, Van Andel & Robb, 1985, pp. 121-25).Blindfold Exercises (verbal and non-verbal).

Blindfolded groups of 10-14 (two or more families)are asked to sort themselves verbally, by height andnon-verbally, by shoe size. Patterns ofcommunication and leadership are then discussed.

The purpose of these activities is to enhanceawareness of previous communication styles andpatterns and to provide an opportunity to practicenewly learned communication methods.

V. Don't talk, don't trust, don't feel: leisure roleplay (to coordinate with Parent's Class ParentingSkills Session). Goal of session: to provide patientsand family members the opportunity to act out familyroles and patterns. The exercise will exposeexamples of dysfunctional responses to the usingattitudes and behaviors of adolescents to substitutetherapists and other program participants. It canreverse family rcles in order to help families gaininsight into their dysfunctional behaviors. It providesthe chance to discuss and clarify leisure and socialissues and values for family.

A. Parenting Styles. Discuss changes fromauthoritarian to democratic parenting styles as teenbecomes more mature and responsible. Increaseawareness of interaction styles, and power andcontrol issues. Stress open communication betweenparents to avoid triangulation by teens. Anintroductory session with only parents presentreviews these parenting issues.

B. Expressive Therapy Warm-up. Practicemirroring or pantomiming activity briefly to reduceinhibitions of group and to begin to introduceinteractive drama techniques (Thurman & Piggins,1982). The activity increases awareness ofnon-verbal aspects in communications and roleplaying.

C. Activity: Leisure-oriented Role Plays. Roleplays improve communication and interaction patternswithin the family. Sample scenarios include thefollowing:

Your 15 year old son is planning to attend aconcert with friends. You are concerned sincemany attending the concert may be drinkingand using drugs.

Your 16 year old daughter has begun datingand requests permission to date on week nights.You are concerned that her social life willinterfere with homework.


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VI. Don't talk, don't enjoy: family leisurecontract. Goals of session; to allow the family tosuccessfully plan an activity, complete writtencontract, and learn that positive family leisureexperiences may require planning, choice, andnegotiation between family members.

Complete a written Family Leisure Contract (seeAppendix) during Family Lab. The family will carryout the planned activity as part of a therapeutic leaveassignment prior to the adolescent's discharge. Theexperience will be reported and processed during asubsequent individual family therapy and recreationtherapy session in order to complete the patient'sbehavioral contract.

The purpose of the activity is to clarify familyleisure values and interests, to see how well thefamily carries out planned experience. It allowsobservation of how the family accommodatesindividual choices and preferences in planning agroup activity. It demonstrates changed leisurebehaviors required to complete the project and toprocess the results with the family and recreationtherapists. Upon completion, it will help to establishpatterns for family leisure experiences followingdischarge.

VII. Don't enjoy: family leisure participation(values clarification: meeting family needs in leisure).Goals of session: to increase awareness of benefits offamily leisure participation. In addition, familymembers learn to relax and enjoy leisure activities asa group while all are sober. The family learns thatthey can develop and carry out a family experiencewith a sense of order, accomplishment, andcooperation.

A. Activity: family leisure needs checklist.Each family member completes Family Leisure NeedsChecklist (see Appendix) by ranking his or her topfive needs. The results are discussed and processedwithin the family group, facilitated by staff members.The purpose of this exercise is to make explicit somebenefits of family leisure participation, and someindividual and group needs which may be satisfiedthrough constructive recreational activities.

B. Family Leisure Activity (groupparticipation). The therapeutic recreation therapistand support staff facilitate leisure activities such asNew games, beachball or blanket volleyball, quiet oractive games as appropriate for participants, or picnicwith softball or volleyball requiring the teens to cookand clean-up the meal. The purpose of this activity


is enjoyment. Also, it allows one to assess how wellthe family carries out various tasks in completing thefamily activity. It looks at how well the family dealswith inability or lack of cooperation on the part offamily members. It further allows observation ofparenting interactions and how well families,especially parents, employ new communication skills.It allows the therapist to observe for and identifyenabling and using dynamics.

Evaluation and Follow-up Procedures

Summative evaluation of this program is plovidedby patient and family satisfaction surveys completedby all participants at the time of discharge. TheActivity Therapy Department head reviewed thesesurveys monthly. He or she noted the ratings of thefamily treatment program and noted all writtencomments referring to the adolescent family programas a whole, or the Family Lab in particular. Resultsof these evaluations were complied as part of thedepartment's quality assurance program. Becausethese evaluations were carried out for internal reviewonly, results to date are not available. In the future,the authors recommend that a formal researchprogram and statistical analysis be conducted todetermine the efficacy of such an approach.

Ongoing formative evaluation procedures are alsocarried out by the Activity Therapy Department Headas part of the quality assurance monitoring program.Such evaluations determine if the program is beingcarried out as planned, and if individual clients aremeeting indicated treatment goals successfully.Follow-up procedures are the responsibility of theaftercare coordinator. Aftercare is provided free atthe treatment center for a period of two years afterdischarge, and family members as well as individualclients participate. The aftercare coordinatorevaluates participation in leisure, social, andsupport-group activities.

Conclusion

One or more family members with an addictivedisease can disrupt the entire family and negativelyaffect leisure, recreational, and social participation.A review of the literature indicates the significance ofboth family the..4py and activity therapy in thetreatment of addictive disease. Family leisure

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Education is emerging as valid intervention modality.Experts in adolescent chemical dependency treatmentemphasize the need for family involvement in

treatment. According to Smith and Sartor, "thesingle most important predictor of whether anadolescent will achieve success is the level of familyinvolvement" (1988, p. 4).

Many of the dysfunctional patterns evident in thecodependent family relate to leisure, recreation, andsocial issues, and are available to therapeuticrecreation intervention. Following discharge,continued work by families in the areas ofcommunication, trust, feelings, and enjoyment isrecommended. It is hoped that co-dependency issuescan be addressed more frequently within alcohol anddrug treatment milieus, and that family leisurecounseling/education be incorporated to a largerextent within such programs. In addition, closerexamination of the effectiveness of such programs isrecommended.

The Family Lab has been designed specifically tomeet the needs of families with an adolescent intreatment for substance abuse. The success of thisprogram lies not only in the activities presented,which have been carefully designed with particularpurposes in mind, but in the ability of theinterdisciplinary staff to process family interactions ina constructive and therapeutic manner. In thisregard, it is to be noted that the therapeutic recreationspecialist as facilitator was supported by familytherapists, family counselors, nurses, and mentalhealth technicians. The therapeutic skills of all staffcontributed to the success of this program. Sincethese were dysfunctional families, the additional staffallowed for the opportunity to break up the groupinto small& groups of families in conductingactivities, and to remove families in crisis from thesession if the need arose. It is recommended that atherapeutic recreation specialist contemplating theimplementation of such a program increasel .ir herfamily counseling skills through additionalcoursework or workshops in this area, and insureinterdisciplinary staft suppo t.

Programs such as the Family Lab can contributetoward the goal of moving codependent familiescloser to the idea! family. Such a family, accordingto Secunda, is "a safe harbor for growth, optimism,and a sense of belonging" (1990, p. 54). Such afamily will provide commitment, intililacy, andmutual support (Secunda, 1990). The therapeutic

recreation profession must respond with sufficientprogrammatic concern and research effort to thepressing social problem of adolescent substance abuseand the resulting family dysfunction.

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Goodwin, D.W. (1988). Is alcoholism hereditary? New York:Ballantine Books.

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Orthner, D.K. & Herron, R.W. (1984). Leisure counseling forfamilies. In E.T. Dowd (Ed.), Leisure counseling: conceptsand applications. (chap. 7, pp. 198-199). Springfield, IL:Charles C. Thomas.

Parihar, B., & Kirchhoff, 5.13. (1985). Alcoholism treatment: Anexploratory study of the relationship between treatmentvariables and outcome behavior. Social Casework: TheJournal of Contemporary Social Work, 65,304-309.

Perdue, R.R. & Rainwater, A. (1984). Adolescent recreation andalcohol consumption. Therapeutic Recreafion Journal,18(2) ,41-51.

Prince, R. (1990). Drug prevention through parks and revreation.Parks & Recreation, 25(2), pp. 8, 11.

Ransom, F., Waishwell, L., & Griffm, J.A. (1988). Leisure:The enigma for alcoholism recovery. Alcoholism TreatmentQuarter6,, 4(3),103-115.

Secunda, V. (1990, June). The 12 stepping of America. NewWoman, 49-50, 52..54.

Smith, N.B., & Sartor, F. (1988, November/December).Alternatives in adolescent chemical dependence treatment.Student Assistanc r Journal, 42-44.

Steinglass, P., Bennett, L.A., Wolin, S.J., & Reiss, D. (1987).The Akoholk Famik New York: Basic Books.


Stumbo, N.J., & Thompson, S.R. (1986) Leisure education: Amanual of activities and resources. State College, PA:Venture.

Thurman, A.H. & Piggins, C.A. (1982). Drama activities witholder adults: A handbook for leaders. New York: TheHaworth Press.

W., Anne. (1985). Now what do I do for fun? Center City, MN:Hazelden Educational Materials.

Wegseheider-Cruse, S. (1981). Another chance: Hope and healthfor the alcoholic family.. Palo-Alto, CA: Science and BehaviorBooks.

Whitfield, C. (1989). Healing the child within. Deerfield Beach,FL: Health Communications.

Wilson, C. (1982).The impact on children. In J. Orford & J.Harwin (Eds.) Alcohol and the Fami6, (pp. 151-166).London: Croon, Helm.

Woititz, J.G. (1983). Adult children of alcoholics. DeerfieldBeach. FL: Health Communications.

Endnote

Warm-up and program activities are described only briefly. Acomplete description of procedures is available from Marjorie J.Malkin, Department of Recreation, Southern Illinois University,Carbondale, IL 62901

3 o

MAIXIN ET AL.

Appendix

Family Leisure Contract

A contract often serves to define a plan of action. Use the following contract to exploreleisure issues and to plan a family leisure experience for a weekend afternoon. You will beexpected to carry out this plan as part of a therapeutic leave assignment during treatment.

1. List some leisure activities the whole family might enjoy (may include favoritepastimes or new activities):

2. Indicate here one activity the whole family has decided upon:

3. What are some of the good things you might experience as you participate in this

activity?

4. What are some barriers that could prevent the entire family from participating?

5. Considering the above barriers, do you think a different activity would be more

successful?

6. List the activity you have now agreed upon to try:

* Based upon a clinically revised ver on of A Leisure Contract, McDowell, 1983.

51 ANNUAL IN THERAPEUTIC RECREATION, No. U, 1991 35

MALKIN ET AL.

Family Leisure Needs Checklist

It is important to me to:

Spend quality time with family members.

Become physically fit as a family.

Develop family trust.

Build communication in the family.

Be in attractive surroundings as a family.

Enjoy each other.

compete within and without the family.

Improve family decision making.

Make and carry out family plans.

Be spontaneous together.

Relax and take it easy as a family.

Develop feelings of self-worth within the family.

Be proud of each other for accomplishments.

Learn a variety of new skills in leisure together.

Learn to help family members.

Learn new things about family members.

Be creative as a family.

Develop friendship within a family.

Develop tolerance and patience within the family.

Develop common leisure interests.

Be part of family group or team.

*Based in part upon "Meeting Personal Needs in Leisure", Lady & Whipple, cited in Stumbo &Thompson, 1986.

36 ANNUAL IN THERAPEUTIC RECREATION, No. II, 1991 5 2

Perception of Client Needs inChemical Dependency Treatment Programs

Colleen Deyell Hood, M.S., C.T.R.S

Abstract

Therapeutic recreation specialism, program administrators, and clients in chemical dependency treatment programs

were surveyed to determine the degree of agreement or disagreement between staff and clients in their perceptionsof treatment needs. Client treatment issues were derived from the chemical dependency and therapeutic recreation

literature and were broadly categorized into eight areas: physical problems, emotional/cognitive problems,social/family problems, knowledge of leisure, self-awareness related to :emure, attitudes towards leisure, leisureactivity skills, and leisure resources. Resultp indicate that, in general, there are significant differences betweenstaff and clients in their perceptions of treatment needs. However, there were twelve specific issues that mostclients and staff agreed upon as being critical for recovery.

The delivery of leisure services to individuals withdisabilities, illnesses, or other limiting conditionsthrough therapeutic recreation services is based onthe accurate identification of problem areas or needs.Peterson and Gunn (1984) indicated that thisidentification of needs is an essential prerequisite toquality program development and client assessment.Bullock, McGuire, and Barch ( 1984) found tht theidentification of client needs which can be metthrough leisure is one of the top five researchpriorities identified by therapeutic recreationprofessionals.

There is evidence to indicate that, in general, staffand clients in psychiatric and chemical dependencytreatment programs do not agree on the identificationof treatment needs (Dimsdale, Klerman, & Shershaw,1979; Jordan, Roszell, Calsyn, & Chaney, 1985;Mayer & Rosenblatt, 1974). The degree to whichclients and therapists concur about treatment needsdirectly affects the outcomes of treatment (Hurst,Weigel, Thatcher, & Nyman, 1969; Starfield et al.,1981).

Jordan et al. (1985) fGund that client and staffperceptions of treatment needs in a chemicaldependency setting also were markedly different.They indicated that patients participated more activelyand displayed more commitment to treatment groupsthat they rated as important. Jordan concluded thatincluding patients in treatment planning incre: ses thelikelihood of active participation; not includingpatients reduces their commitment to the treatment

53

program. Rollnick (1982) further indicated thatpatients who disagreed with staff in relation totreatment issues often had poor relationships withstaff and, as a result, experienced less success intreatment.

There are two general approaches to treatmentwithin the area of chemical dependency. The firstapproach (the unitary model) is based on the conceptthat addiction is the primary problem and that anyother functional problems are a result of the addiction(McLellan, Luborsky, Woody, O'Brien, & Kron.1981). Abstinence is the main criterion forevaluation of treatment effectiveness (Hart, 1977).The second approach to the treatment of chemicaldependency is labelled the multidimensional approach(Hart, 1977). This approach emphasizes thepsycho-social problems (such as physical health,social activities, psychological state. and occupationalperformance) and the patterns of these problemsexhibited by chemically dependent individuals. Thesepsycho-social areas are the primary focuses oftreatment. It is felt that the remediation of theaddiction and return to a high level of functioning isdependent on a variety of factors, not merelyabstinence, though abstinence remains an importantaspect of recovery. The multidimensional approachis used frequently as a framework for the delivery of

Colleen Deyell Hood is a doctoral student at the University ofIllinois at Urbana-Champaign.


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chemical dependency treatment services. It providesthe theoretical base for this study.

This exploratory research identifies those addictionrelated problems which therapeutic recreationspecialists (TRSs), program administrators and clientsagree are problems in leisure during recovery. Itspecifically addresses the following researchquestions: (a) are there differences between client,TRS, and program administrator perceptions oftreatment needs, and (b) which treatment needs areidentified by staff and clients as being important inrecovery? For study purposes the terms treatmentneeds and addiction related problems, relating toclient issues to be addressed through treatment areconsidered synonymous.

Method

Subjects and Data Collection

Data were collected by TRSs working in chemicaldependency treatment programs. Initially, 43agencies identified through the American TherapeuticRecreation Association, the National TherapeuticRecreation Society, and the University of Illinoisinternship list were contacted to request assistancewith this project. Each of these agencies was aseparate chemical dependency facility, unit orprogram within a larger facility where clientsaveraged a 30 day length of stay. Of the 43 agenciescontacted, nine participated in the data collectionprocess (a response rate of 21%). However, not ailnine were able to collect the requested ten clientquestionnaires, primarily due to low census withintheir programs. The agencies that did not participatein the data collection procedures cit.A1 several reasonsfor non-participation: lack of adequate numbers ofclients, lack of clients who fit the stated criteria, lackof support from agency administrators, and lack oftime and/or staff to conduct the data collectionprocedures. The total sample reported hereinconsisted of nine program administrators, 11 TRSs,39 early-treatment clients, and 40 later-treatmentclients.

One TRS from each agency administeredquestionnaires to ten clients and one programadministrator, and completed a TRS questionnaire.In one instance, three TRS's working in the chemicaldependency unit each completed a TRS questionnaire.If a client were unable to complete the questionnaireindependently, the TRS was directed to assist the

38 ANNUAL IN THEZkAPEUTIC RECREATION, NO. II, 1991

client by reading the questions out loud, etc. Toexplore the impact of treatment involvement onperception of treatment needs, two client groups wereincluded. The first group consisted of five clientswho completed the questionnaire during their firstweek in treatment (early-treatment clients) and thesecond group consisted of five different clients intheir last week of treatment (later-treatment clients).The selection a clients was based on pre-determinedcriteria including being over the age of 18, having noprior chemical dependency treatment, voluntaryadmission, and willingness to participate. Theselection of the early-treatment clients did not rely onrandom sampling methods. The first five clients whowere admitted after the beginning of the datacollection, and who met the stated criteria forinvolvement, were asked to participate by completinga client questionnaire. The selection of the later-treatment client utilized random sampling methods.The TRS identified each client who was in theprogram as a first admission and randomly selectedfive names from this group. Clients who wereincluded in the early-treatment group were notincluded in the later-treatment group. Each of thelater-treatment clients completed a clientquestionnaire prior to discharge during their lastweek of admission, usually the fourth week oftreatment.

Experimental Design

This study was accomplished by comparativesurvey design. The responses of different groups ofsubjects were compared to determine areas ofconsensus and areas of difference. The independentvariable in this study was the classification of theindividuals completing the questionnaire. Thisvariable is divided into four groups: TRSs, programadministrators, early-treatment clients, and later-treatment clients. The dependent variables were the43 problem statements clustered in the eight subscalesidentified within the literature: physical,emotional/cognitive, social, leisure knowledge,self-awareness related to leisure, leisure attitudes,leisure activity skills, and leisure resources.

Instrument

The study instrument was a self-reportedquestionnaire developed through extensive review ofthe literature. Items representing treatment needs

5 (1

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were generated from a literature review and throughinteraction with therapeutic sc....creation professionalsworking in the field. Each psycho-social problemcategory related to chemical dependency identified inthe literature was reviewed to determine if theproblem was appropriate for therapeutic recreationintervention.

Three categories, physical problems, emotional/cognitive problems and social/family problems, wereidentified as appropriate and were translated intobehavioral problem statements. Areas directly relatedto leisure involvement and functioning were derivedboth from the literature and from the Leisure AbilityModel of Therapeutic Recreation (Peterson & Gunn,1984), selected for its wide use in practice and itsendorsement by the National Therapeutic RecreationSociety. The categories derived from the model andthe literature were knowledge of leisure, self-awareness, attitudes towards leisure, leisure activityskills, and leisure resources. These areas also weretranslated into behavioral problem statements.

Table 1Questionnaire Subscales and Items

The subscales and items on the questionnaire werereviewed by a panel of experts to determine thevalidity of the items and subscales. This panelconsisted of two practitioners and one faculty memberwith expertise in the area of therapeutic recreationand chemical dependency treatment. Based on theliterature and the review by the panel of experts, theeight content areas or subscales were translated into43 behavioral problem statements. The eightsubscales and their respective items are depicted inTable 1.

The behavioral pronlem statements were reviewedby a panel of experts to evaluate the validity of theitems. The panel of experts included TRSs withexpertise in chemical dependency and therapeuticrecreation educators. Each questionnaire alsocontained demographic and informational questionsspecific to the individual (client, TRS or programadministrator) completing the questionnaire.

Subsea le Specific Items

Physical Problems: Lack of physical fitness.Not being very healthy.

Emotional/Cognitive Problems:

Social Problems:

Difficulty solving problems.Difficulty making decisions.Questioning own self worth.Difficulty appropriately expressing feelings.Experiencing feelings of boredom.Difficulty coping with stress.Difficulty in concentration.Feeling depressed.Questioning own abilities.

Lack of friends who don't drink or use drugs.Not feeling comfortable in social situations.Not knowing how to talk with others.Difficulty being assertive.Not having many friends.Difficulty cooperating with others.Feeling uncomfortable talking with others.Lack of people to do things with in leisure.

r ANNUAL IN THERAPEUTIC RECREATION, No, II, 1991 39

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Table I ContinuedQuestionnaire Subscales and Items

Subscale Specific Items

Knowledge of Leisure:

Self-Awareness:

Leisure Attitudes:

Leisure Activity:

eistwe Resources:

Not understanding what leisure is.Lack of awareness of the variety c possible places

for leisure.Being unaware of the benefits of leisure.

Difficulty having fun.Not taking responsibility for own actions in leisure.Not feeling in control.Difficulty being playful.Lack of interest in community leisure opportunities.Preferring to do activities alone.Wanting to know outcomes before becoming

involved.Preferring passive activities.Difficulty feeling spontaneous.Desire for order and structure in leisu..e

experiences.Not taking responsibility for own actions.Not understanding where leisure fits in one's life.

Feeling like they should be doing something elsewhen they are involved in leisure.

Seeing work as more important than leisure.Viewing leisure as not important.

Not having a variety of leisure skills.Not having a variety of leisure interests.

Lack of transportation for leisure involvement.Lack of money for leisure involvement.Lack of knowledge of leisure resources available

in the community.

The subjects responded to the following directions:"Please indicate the extent to which you think each ofthe following is a problem for you (your clients) inyour (their) leisure during recovery." Subjects werenot asked to directly evaluate whether the problemscould be addrased through therapeutic rec:eationintervention. The assumption was that the problemswhich arise during leisure would be most

40 ANNUAL IN THERAPEUTIC RECREATION, NO. II, 1991

appropriate: y addressed through therapeutic recreationintervention. Staff and clielits rated all 43 items ona four-pottr Liken scale with I -,often a problem,2=sometimes a problt: , 3= rarely a problem, and4=never 1.4 problen. The instructions werespecifically designou to repi iment the current processof program development and implementation, in that,staff generally base program development decisions

5r

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on their understanding of general populationcharacteristics and needs, rather than upon eachindividual client's specific problems.

'Mita Analysis

The independent variable in this study is theclassification of individuals completing the question-naire. This variable is divided into the four groupspreviously defined in experimental design section.The dependent variables are the 43 problem state-ments clustered in the eight subscales identifiedwithin the literature as previously des..a:bed.Cronbach's alpha was used to assess the reliability ofeach of the scales (Cronbach, 1984). This measureindicates the degree of internal consistency of itemsthat make up a scale and considers the relationshipbetween each variable and every other variable in thesubscale in all possible combinations. This measureis appropriate for use when the items in the subscaleshave no correct or incorrect answers (Cronbach,1984). Perfect internal consistency is indicated by avalue of 1.00. A value of 0.5 or higher is consideredacceptable in the social sciences (Thorndike &Hagen, 1977).

Multivariate analysis of variance (MANOVA)which assesses the interdependence among the depen-dent variables while minimizing Type T error, wasused to examine the differences between the fourgroups of the independent variable on the eightdependent variable subscales. This analysis wasconducted to determine if there were differencesbetween the TRS, program administrator, early-treatment client aid later-treatment client perceptionsof treatment needs appropriate for therapeutic recre-ation intervention.

The research question regarding the importance oftreatment needs by the four groups of individuals wasaddressed by calculating means and standard devia-tions for each subscale, and for each item within thesubscale, to determine the degree of importance inrecovery. Frequencies of responses on each itemalso were calculated to determine those items mostoften considered to be a problem by staff and clients.

Results

Each client completed questions related to demo-graphic information. The mean age of the clientswas 35.8 years, the majority of clients were male(82.3%). Almost one-third (30.4%) of the clients

57

had completed high school, 29.1% had some collegeeducation. A large percentage of clients were mar-ried (40.2%) and were employed full time (73.4%).The primary diagnosis was alcohol abuse for 38% ofthe clients, drug abuse (other than alcohol) for29.1%, and a combination of the two for 21.5% ofthe clients. I tests were used to compare early-treatment clients and later-treatment clients. Thesetests showed that there were no statistically significantdifferences (p < .05 ) between the two groups ofclients in all but one demographic variable. Thisvariable, the degree of client insight, was based on arating, attempting to address the issues of denial, byeach client's therapist. The results of the testindicated that there were significant differencesbetween the two groups of clients (1(75) = 2.09,p < .05) on this measure. The later-treatment clientswere rated as having signhicantly more insight thanthe early-treatment clients. Table 2 presents morespecific informailbn related to client demographics.

Information related to the TRSs indicated that themajority of the TRSs were educated at theBaccalaureate level (63.4%), had more than fivecourses related to therapeutic re-Teation (81.1%), andat least two courses related to chemical dependency(60%). Over 70% of the TRSs had been employedin chemical dependency treatment for at least twoyears, two TRSs were Certified AlcoholismCounselors or possessed some equivalentcertification. One TRS was in recovery. All of theTRSs completing the questionnaire indicated that theyutilize the Leisure Ability Model of TherapeuticRecreation. For more detailed information, see Table3.

The program administrators were primarilyeducated in the area of chemical dependency (50%).Other areas of preparation included nursing (12.5%),social work (12.5%), and counselling (25%). Themajority of administrators (62.5%) had beenemployed in their current position for at least oneyear. Over 50% of the administrators had beenemployed in chemical dependency treatment for atleast eight years. Most of the administrators (87.5%)indicated that they understood therapeutic recreationcontent and services quite or very well.

Results of the Cronbach's Alpha indicated thatseven of the eight subscales had acceptable Alphacoefficients (.6980 to .9144), while including allitems on the scale. The last scale, LeisureResources, had an initial alpha coefficient of .5891


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Table 2 .

Client Demographic Wormation

Variable

Early-Tx

(n = 39)

Later-Tx

(11=40)

Combined

(n=79)

f % f % f %

Age18-29 11 28.2 13 32.5 24 30.330-39 19 48.7 13 32.5 32 40.540-49 6 15.4 9 22.5 15 19.050-59 2 5.1 3 7.5 5 6.360-69 1 2.6 2 5.0 3 3.8M 34.9 36.55 35.8

SexMen 33 84.6 32 80.0 65 82.3Women 6 15.4 8 20.0 14 17.7

Educational LevelLess than high school 9 23.1 11 27.5 20 25.3High school graduate 14 35.9 10 25.0 24 30.41-3 yrs of college 10 25.6 13 32.5 23 29.12 yr professional degree 3 7.7 4 2.5 4 5.1College or university degree or more 3 7.7 4 10.0 7 8.8

Marital StatusNever married 10 25.6 13 32.5 23 29.1Married 17 43.6 15 37.5 32 40.2Divorced 6 15.4 7 17.5 13 16.5Separated 6 15.4 3 7.5 9 11.4Widowed 0 '', 1 2.5 1 1.3

Employment StatusEmployed full time 29 74.4 29 72.5 58 73.4Employed part time 1 2.6 1 2.5 2 2.5Not employed 6 15.4 6 15.0 12 15.2Never employed 1 2.6 1 2.5 2 2.5Retired 1 2.6 2 5.0 3 3.8

5S42 ANNUAL IN THERAPEUTIC RECREATION, NO. II, 1991

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Table 2 Continuedalent Demographic Information

Early-Tx Later-Tx Combined

(n=39) (n=40) (B=79)

Variable

Days in Treatment

1-5

6-10

11-15

f %

18 46.2

15 38.5

5 12.8

f %

o o

o o

5 12.5

16-20 o o 15 37.5

21-25 0 o 8 20.0

26-30 1 2.6 10 25.0

31-35 o o 1 2.5

36-40 o o o o o o

f %

18 22.8

15 19.0

10 12.7

15 19.0

8 10.1

11 13.9

1 1.3

41-45 o o

M

Diagnosis

7.03

Alcohol Abuse 10 25.6

Drug Abuse 15 38.5

Mixed (Drug and Alcohol) 9 23.1

Missing 5 12.8

Degree of Client Insight

Almost no insight 4 10.3

Very little insight 10 25.6

Some insight 20 51.3

A great deal of insight 5 12.8

1 2.5 1 1.3

21.85 14.54

20 50.0 30 38.0

8 20.0 23 29.1

8 20.0 17 21.5

4 10.0 9 11.4

1 2.5 5 6.3

7 17.5 17 21.5

17 42.5 37 46.8

13 32.5 18 22.8

Note: f=frequency % =percentage

5 9ANNUAL IN THERAPEUTIC RECREATION, No. II, 1991 43

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Table 3Therapeutic Recreation Specialist Demographic Characteristics (n=11)

Variable Frequency Percentage

Length of Employment in Chemical Dependency0-6 months 2 18.22-5 years 5 45.4More than 5 years 3 27.3

Certified Alcoholism Counselor?No 8 72.7Yes 2 18.2

In Recovery?Yes 1 9.1No 9 81.8

Philosophy of Therapeutic RecreationTherapy to improve functional behavior. 0 0Services to promote independent functioning. 0 0Development of an appropriate leisure lifestyle. 11 100Provision of opportunities for recreation participation 0 0

Educational BackgroundBaccalaureate degree in TR 7 63.4Master's degree in TR 3 27.3

Number of therapeutic recreation coursesFive 1 9.0More than five 9 81.1

Number of Specific CD CoursesPart of a course 1 9.0One 2 18.2Two 4 36.4More than three 2 18.2

44 ANNUAL IN THERAPEUTIC RECREATION, NO. II, 1991 t; ()

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but the alpha c4) Ificient rose to .7194 wher. one ofthe items, lack of knowledge of leisure opportunitiesavailable in the community, was deleted. Therefore,this item was deleted for the remaining analysis. Ananalysis of the specific research questions revealedthe following results.

Are there d(fferences between early-treatmentclient and later-treatment client perceptions oftreatment needs? The MANOVA results indicatedthat there were no statistically significant differencesbetween early-treatment clients and later-treatmentclients E(1,95) = 1,4, p > .05) on their subscalescores. Additionally, each subscale was examined inisolation for each group and there were nodifferences. As stated previously, analysis of thedemographic information using tests and dacriptivestatistics indicated that these two groups of clientswere not significantly different from each other,except in the number of days in treatment and degreeof insight. The difference in degree of insight didnot appear to affect the perception of treatment needs,therefore these two groups were combined for furtheranal ys is.

Are :ltere differences between TRS and programadministrator perceptions of treatment needs? TheMANOVA results also indicated that there were nostatistically significant differences between TRSs andprogram administrators (E(1,95) = .41, p > .05).Additionally, when each subscale wa.s examined inisolation, using ANOVA, for each of these groups,no differences were found.

Are there differences between ste, combining7RSs and program administrators, and client,combining early-treatment aid later-treatment clients ,

perceptions of treatment needs? Statisticallysignificant differences between all staff and all clients(f(1,95) =13.65, p < .000) were found to exist.These differences also appearixi when each subscalewas analyzed separately.

Which treatment needs are identified by staff andclients as being important in recovery? Each item onthe subscale was rated as to the degree the item wasa concern in recovery. A low score (I) indicated thatthe item was perceived as often being a problemwhile a high score (5) indicated that the item wasperceived rarely or never as a problem. Mean scoresand standard deviations for each item for each of thefour groups were calculated to determine the relativerankings of the items. This analysis of the items oneach subscale indicated that over 80% of staff rated

most of the problems as being sometimes or often aproblem. The TRSs identified this as being true in91% of the cases, program administrators, 95%.There was less agreement on the ratings of specificitems by clients.

Within each group of clients (early-treatment andlater-treatment), over 50% perceived 16 of the 43items as sometimes or often a problem. The ratingsof the remaining items were fairly evenly split as towhether the item was perceived as a problem. Of the16 items each group of clients perceived as problems,12 items were common to both groups. As indicatedin Table 4, these 12 items also were identified assometimes or often a problem by staff.

Discussion

The findings of this study indicate that there wereno differences between early-treatment clients andlater-treatment clients in their perceptions of theirown treatment needs. No differences were foundbetween TRSs' and program administrators'perceptions of their clients' treatment needs.However, significant differences did exist betweenstafrs and clients' perception of treatment needs.Additionally, staff generally rated most of the itemsas being often or sometimes a problem. Clientsshowed much less agreement on the rating ofproblems. It is interesting to note that there were 12items which both clients and staff agreed weretreatment needs that should be addressed forrecovery.

The ability to generalize results of this study arelimited due to the small sample size and designlimitations. However, they do contribute to the bodyof evidence indicating that discrepancies betweenclients and staff in the identification of treatmentnetNis exist. This discrepancy may be explained inone of several ways.

First, clients nriy l.;e an accurate perception oftheir treatment reds while staff do not. If this weretrue, the assessments and programs designed by staffwould not address the treatment needs identified byclients. Second, staff may have an accurateperception of client treatment neals while clients donot. This second notion may have been accepted inthe past, but current literature indicates that clients inpsychiatric and chemical dependency treatment dohave the ability to accurately identify their own


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Table 4The TWelve Items Identified as Being Sometimes or Often a Problem by Clients and Staff

Item

Percentage Rating Item as a Problem

Early-Tx Later-Tx TRS Program Ad.

1. Experiencing feelings of boredom. 75.7 63.2 90.9 100.0

2. Feeling depressed. 65.8 70.3 100.0 100.0

3. Difficulty appropriately expressing feelings. 65.8 66.6 100.0 100.0

4. Lack of friends who don't drink or use drugs. 71.8 55.0 100.0 100.0

5. Difficulty coping with stress. 63.8 63.2 100.0 100.0

6. Difficulty communicating with family. 64.8 61.5 81.8 100.0

7. Lack of interest in community leisureopportunities.

68.4 55.2 100.0 100.0

8. Questioning their own self worth. 50.0 65.8 90.9 100.0

9. Not feeling comfortab!e in social situations. 54.0 59.0 100.0 100.0

10. Not feeling in control. 55.2 55.0 100.0 87.5

11. Lack of physical fitness. 53.9 55.0 90.9 100.0

12. Feeling like they should be doing somethingelse when involved in leisure.

51.3 51.3 81.8 87.5

treatment needs (Fitzgibbons, Cutler, & Cohen,1971; Leonard, Dunn, & Jacob, 1983).

A third possible explanation for the differencesbetween staff and clients is that neither has anaccurate perception of treatment needs. Finally, bothclients and staff may have accurate perceptions oftreatment needs.

Even though the results indicate that there aredifferences, both groups may have accurateperceptions of treatment needs. Staff may bereferring to population treatment needs (clusteredneeds based on general population characteristics),while clients are focusing on their own personal,individually-focused treatment needs. Thispossibilitylikely arises as a result of instrumentation. Clientswere directed to identify specific problems theyexperience and staff were directed to identifyproblems experienced by all their clients. Thisapproach to the identification of treatment needs in allprobability is refleeive of the process of assessment

46 ANNUAL 1N THERAPEUTIC RECREATION, NO. 11, 1991

and program development currently used in the field.Ideally, each TRS should have completed aquestionnaire for each client included in the study.This was not possible due to the time constraints ofthe TRSs.

Realistically, most therapeutic recreationassessments and programs are based on perceptionsof general client characteristics. If this explanation iscorrect, TRSs may choose to incorporateopportunities to address specific individualized clientissues into both the assessment process and programdevelopment

It appears there is a discrepancy between staff andclient perceptions of treatment needs. Thisdiscrepancy has implications for the delivery ofservices in chemical dependency treatment as well asfor the efficacy of the treatment. If the programsbeing delivered do not address the needs that theclients feel are important, then the efficacy of theprograms may be limited. Perhaps one reason

6 2

Alcoholics Anonymous (A.A.) is relatively successfulin assisting individuals to maintain sobriety is that theclients determine which recovery areas to address andfacilitate the process themselves. Treatmentprograms, although often based upon A.A.philosophy, do not historically have the same successrate as A.A. A possible explanation, perhaps, is thelevel of staff determination of treatment needsaddressed in treatment programs.

The fact that staff and clients are not in totalagreement as to which problems occur most often hasan impact on all aspects of the delivery of services.The assessments developed and conducted by staffwill likely reflect their perceptions of the problemsclients in chemical dependency treatment face as agroup rather than the issues identified by theindividual client. The programs developed to addressclient needs, therefore, likely reflect the therapist'sperception of the needs of the population rather thanthe self-perceived needs of the clients. Theevaluation of client progress also is likely based onthe staff perception of needs and progress.

The literature indicates that clients often respondnegatively to discrepancies in perceptions of treatmentneeds (Friedman & Glickman, 1986; Hurst et al.,1969; Jordan et al., 1985; Rollnick, 1982; Selzer,1977; Starfield et al., 1981). Clients who areinvolved in a treatment program that does not addressthe needs they think are important may be lesscooperative with the treatment process. Clients maybe less invested in a program that does not addressthe needs they think are important. It also may bepossible that a discrepancy in perception of treatmentneeds plays a role in premature discharges as patientswould likely perceive the programs ineffective inaddressing their needs.

A significant implication is that staff solicit andencourage client involvement in treatment planning.While it is impossible to develop programs to addresseach individual need, time should be available towork with clients on an individual basis if necessary.Flexibility also should be incorporated into programsto allow clients the latitude to direct content where itis most personally relevant. This discussion of therole of clients in determining treatment plans andinterventions does not negate the significant impact ofclient denial on the chemical dependency treatmentprocess. However, clients may be more invested in

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and committed to a treatment plan which incorporatestheir own perceived needs as well as needs identifiedby staff.

The finding that there was agreement on some ofthe problem statements indicates that there areproblems that stand out to both clients and staff asbeing important. Although this study does notdirectly address the validity of clients' or therapists'identification of treatment needs, the literatureindicates that clients have the ability to identify theirown treatment issues. Therefore, problems identifiedas important by both staff and clients appear to becritical issues in recovery and may provide directionfor therapeutic recreation services. This issue is animportant consideration when deciding the degree towhich clients will be involved in their own treatmentplanning.

This study also provides directions for futureresearch. First, research is needed regarding thedevelopment of refined and validated measures oftreatment needs, addressing issues such as reliabilityof scales, and content and construct validity.Thorough examination of the significance ofdifferences in ratings between staff and clients wouldprove valuable information for program development.Likewise, so would assessments to determine whichtreatment needs are most and least agreed upon.Examination of the impact of disagreement betweenstaff and clients on treatment outcomes also would beuseful. Further examination of factors such as;educational level, philosophical position, sex,alcoholism and employment history, which may affectboth staff and cl:ent perceptions of treatment needs,may provide much needed information about staffidentification of treatment needs.

Development and testing of model programs basedon the identification of treatment needs is

recommended. These programs could then beutilized in studies that address the impact and efficacyof therapeutic recreation services. Development andvalidation of assessment instruments for use inclinical settings, based on the identification oftreatment needs, also would be a significantcontribution to the therapeutic recreation profession.Finally, a study that addresses the role of therapeuticrecreation in recovery may provide justification andvalidation for the inclusion of therapeutic recreationin chemical dependency.

6 ,1ANNUAL IN THERAPEUTIC RECREATION, No. II, 1991 47

HOOD

References

Bullock, C.C., McGuire, P.M., & Batch, E.M. (1984).Perceived research needs of therapeutic recreators.Therapeutic Recreation Journal, 18,17-24.

Cronbach, L. (1984). EssentiaLs of psychological testing (4thed.). NY: Harper & Row.

Dimsdale, J., Klerman, G., & Shershaw, J.C. (1979). Conflictin treatment goals between patients and staff. SocialPsychiatry, 14,1-4.

Fitzgibbons, D.J., Cutler, R., & Cohen, J. (1971). Patients' self-perceived treatment needs and their relationship tobackground variables. Journal of Consulting and ClinicalPsychology, 37,253-258.

Friedman, A.S., & Glickman, N.W. (1986). Programcharacteristics for successful treatment of adolescent drugabuse. 7he Journal of Nervosa and Mental Disorders,174,669-679.

Hart, L. (1977). Rehabilitation need patterns of men alcoholics.Journal of Studies on Alcohol, 38,494-511.

Hurst, J.C., Weigel, R.G., Thatcher, R., & Nyman, A.J.(1969). Counselor-client diagnostic agreement and perceivedoutcomes of counseling. Journal of Counseling P.sychology,16,421-426.

Jordan, K., Roszell, D.K., Calsyn, D.A., & Chaney, E.F.(1985). Perception of treatment needs: Differences betweenpatients and staff of a drug abuse treatment program. Theinternational Journal of the Addictions, 20,345-351.

48 ANNUAL IN THERAPEUTIC RECREATION, NO. IL 1991

Leonard, K., Dunn, N.J., & Jacob, T. (1983). Drinkingproblems of alcoholics: Correspondence between self andspouse reports. Addictive Behaviors, 8,369-373.

Mayer, J.E., & Rosenblatt, A. (1974). Clash in perspectivebetween mental patients and staff. American Journal ofOrthopsychkary, 8,432-44 1.

McLellan, A.T., Luborsky, L., Woody, G.E., O'Brien C.P., &Kron, R. (1981). Are the "Addiction-related" problems ofsubstance abusers really related? The Journal of Nervous andMental Disorders, 169,232-239.

Peterson, C.A., & Gunn, S.L. (1984). Therapeutic recreationprogram design (2nd ed.). Englewood Cliffs, NJ:

Rollnick, S. (1982). Staff-patient perceptions of the helpfulnessof an alcoholism treatment program: An exploratory study oftreatment relationships. The International Journal of theAddictions, 17,513-521.

Selzer, M.L. (1977). Treatment-related factors in alcoholicpopulations. Akohol Health and Research World, 1,23-27.

Starfield, B., Wray, C., Hess, K., Gross, R., Birk, P.S., &D'Lugoff, B.B. (1981). Thc influence of patient-practitioneragreement on outcome of care. American Journal of PublicHealth, 71,127-132.

Thorndike, R., & Hagen, E. (1977). Measurement andevaluation in psychology and education (4th ed.). New York:Wiley & Sons.

6.1

Caregivers, the Hidden Victims:Easing Caregiver's Burden through

Recreation and Leisure Services

Leandra A. Bedini, Ph.D.C.W. Bilbro

Abstract

Caregivers, especially those who voluntarily care tbr parents, adult children and relatives, experience greatstress, strain and burden in their roles. The literature suggests that caregivers identify loss of leisure andrecreation as a contributing factor to their burden. However, no support or treatment programs for caregiverswere identified that included either education or training for leisure and recreation in their services. The purposeof this paper is to describe the caregiver population, identify their areas of need, illustrate how leisure andrecreation might benefit them, and discuss the currently available leisure services and the development of newservices for caregivers.

As baby boomers grow oider and the average ageof society increases, much attention is being directedto the needs of older adults. In therapeutic recreationand other related fields, the literature about disabledolder adults, people with Alzheimer's disease, anddevelopmentally disabled adul4 is emerging (e.g.Rancourt, 1990), Knowledge :bout the therapeuticrecreation needs of these newest target groups, andhow recreation and leisure services can help them, isessential when considering their overall well-being.

Although much of the therapeutic recreationliterature focuses on older adults as care recipients,little attention is given to those who provide for theircare. These persons, calltx1 caregivers, are thosewho stay at home to aid a disabled or ill relative orfriend. Caregivers may he family members, spouses,or friends and neighbors who actually alter their livesto care for someone eke (Stone, Cafferata, & Sangl,1987). A selective review of the literature describedthese caregivers as severely stressed and strained bythe burden of caring tbr a disabltx1 family member orfriend with little hope of relief (Pilisuk & Parks,1988; Sheehan & Nuttall, 1988; Stone, Cafferata, &Sangl, 1987; Zarit, 1989), Recreation and leisurepursuits are minimal, if not non-existent. Thepurpose of this paper is to &scribe the caregiverpopulation, identify their areas of' need, illustrate howleisure and recreation might benefit them, and discuss

the existence and development of leisure services forcaregivers.

Caregivers Profile

When considering the range and number of'disabling illnesses in society, each of us can expect tobe a caregiver at some point in our lives (Pilisuk &Parks, 1988). Caregivers can he defined as personswho care for other individuals in either formal orinformal capacities. Formal caregiving occurs innursing facilities and convalescent homo or throughin-home health care services. Professionals are hiredto care for the disabled and ill older adult. Informalcaregiving occurs within the families of' the carerecipient and tako place primarily in the home.These informal support groups include not onlyfamilies, who are usually spouses and children of thecare recipient, hut also friends and neighbors.Cantor (1983) suggested that it is the informalsupport systems that provide the majority ofassistance to care recipients.

Informal caregiving is performxi by all types ofpeople; however, caregivers share particular

Leandra Bedini is a lecturer in Leisure Studies and RecreationAthninistration at the Universay ofNorth Carolina at Chapel Hilland C.W. Bilbro is an activities director at Carolina MeadowsRetirement Conununity in Chapel Hill

ANNUAL IN THERAPEU1 IC RECREATION, No IL 1991 49

HEDINI AND IIILBRO

characteristics. Stone et al. (1987) described theprofile of caregivers as 36% spouses, 37% children,and 27% others, relatives and neighbors. Accordingto U.S. Select Committee on Aging (1988), themajority of informal caregivers to disabled and illolder adults were women (72%), 29% of whom wereadult daughters and 23%, wives. Husbandscomprised only 13% of this population. The averageage of caregivers was 57.3 years; however, 25%were 65 to 74 years (U.S. Select Committee onAging, 1988). Three-fourths of caregivers lived withthe recipients and gave on the average of six hours ofcare per day (Pilisuk & Parks, 1988).

Caregivers who are spouses and grown children ofthe care recipient have high likelihood of stress. Ofparticular note are the vast majority of adult daughtercaregivers were married with children of their own,and found to be a "generation in the middle with thepotential for considerable stress from situational aswell as personal factors" (Cantor, 1983, p. 599).Cantor also found that, in husband/wife caregivingsituations, where the couple lived alone at homewithout children there was "increased the potentialfor isolation and psychological stress" (1983, p. 599).

In a study of responsibilities of the caregivers,Stone, et al. (1987) noted that while 80% of allcaregivers provided unpaid assistance often sevendays a week, thirty- one percent of the caregiverswere otherwise employed, 29% had to alter schedulesto care for the recipient, 20% were forced to cutbackon work hours, and 9% left the work force becauseof time constraints. In a similar study, Brody (1985)found that almost half of the respondents had eitherquit their jobs or reduced the number of work hoursbecause of caregiving responsibilities.

Characteristics of' Burden

A consistent characteristic of caregivers is thatthese individuals take on additional responsibilitiesfcr the care and maintenance of someone who isdisabled or frail. These responsibilities often areperceived as a burden for the caregiver. That is notto say that they do not willingly assume theseresponsibilities; however, adding these tasks requirespersonally demanding efforts.

Hypotheses of how burden is defined andperceived and the subsequent effects of burdenabound in the literature. Although closely related tostress, burden is related primarily to the management


of tasks. While burden deals with mlnagement,acwrding to Pilisuk and Parks (1988), stress is theappraisal of strain on the caregiver. Pilisuk andParks (1988) also suggested that to understand burdenof care, one must examine both ohjective burden(physical tasks and financial burder) and subjectivetasks to "assess the meaning of events to theindividuals experiencing them" (p. 436). Sheehanand Nuttal (1988) proposed that the concept of roleoverload or competing demands on time andresources can create the burden, which in turn cancause stress in the caregiver. As a result, thecaregiver may experience depression, anxiety, andhealth problems.

Caregiving does not always involve a spouse orchild taking care of an older adult. Elderly parentsas caregivers for adult dependent children experiencemajor stress as well (Jennings, 1987). Jennings(1987) suggested that perpetual parenthood maycontribute to the recognition of caregiver's own agingand the lifelong dependency of the child. Concernabout what will happen to the dependent child afterthe parents' death adds to this burden.

Barusch (1988), in a needs assessment study,sought to design, develop, and evaluate interventionsto reduce the stress of caregivers. Common types ofcaregiver stress were identified as follows: (a)missing the way the spouse was; (b) worrying overwhat would happen if the caregiver became ill; (c)feeling depressed; (d) feeling lonely; (e) feelingangry; (f) finding it difficult to physically performcare related tasks; (g) and arguments with(Barusch, 1988). Primary problems regarding thecaregivers interactions with others were the failure ofothers to understand what hia is like for thecaregiver. Personal health problems also were ofprimary concern. Several other factors can beconsidered in the perception of burden and stress.Social isolation, lack of respite care, financial oreconomic need, and infrequent and/or inadequatecounseling have been identified as contributors tostress (e.g. Barusch, 1988; Jennings, 1987; Sheehan& Nuttall, 1988; Stoller, 1983).

Caregiver Coping Strategies

Caregivers attempt to cope with the burden ofcaregiving in several ways. For example, Pratt,Schinall, Wright & Cleland (1985) examined fivecoping strategies which reduced caregiver burden:

BEDINI AND BILBAO

(a) having confidence in problem solving abilities; (b)refraining; (c) passivity or avoidance response; (d)using spiritual support; and (e) using extendedfamily.

Barusch (1988) examined problem situations whichcaused strain in the caregiver's ability to function andthe coping mechanism they derived. This studyidentified that the majority of caregivers either soughthelp from family and professionals or failed to cope(Barusch, 1988). When viewing the associationbetween coping strategy and coping effectiveness,Barusch (1988) found that caregivers did not alwaysagree on effectiveness of particular strategies.Interestingly, in some cases the strategies that thecaregivers perceived to be most effective were in factunsuccessful. This result suggests that developingcoping strategies involves more than justeffectiveness.

Sheehan and Nuttall (1988) critiqued four differentcoping strategies, or caregiver intervention strateg'ies:(a) caregiver education and training, (b) self-helpgroups, (c) comprehensive service programs, and (d)family therapy. While each was determined to haveits good points, a lack of attention to emotional andaffective issues in caregiving stood out. Overallsupport groups designed for, and comprised of,caregivers have proved to be most effective inincreasing the cat egiver's coping abilities (Winogond,Fisk, Kirsling, & Keyes, 1987; Zarit, Reever, &Bach-Peterson, 1980).

Unmet Leisure Needs

The literature has clearly identified how the stress,strain, and negative responses of caregiving cangreatly alter the caregiver's lifestyle, includingrecreation and leisure and social interaction (Cantor,1983; Chenoweth & Spencer, 1986; Hooeyman &Lustbader, 1986; Sheehan & Nuttall, 1988; Snyder &Keefe, 1985). The U.S. Select Committee on Aging(1988) specifically noted that "caregivers tend todouble up on their responsibilities and to cut back ontheir leisure time to fulfill all of their caregiver tasks"(p. 27).

In a related study predicting caregiver strain andnegative emotion, Sheehan and Nuttall (1988)examined the influence of a variety of factors,including distress and caregiving satisfaction. Theydefined personal strain as "the extent of physical,social, and financial disruption experienced in the life

of the caregiver as a result of caregivingresponsibilities" (1988, p. 94). Each subject in thestudy responded to the degree to which caregivingresponsibilities affected job, financial, social, andrecreational activities and relationships with others.Results indicated that several subjective factors suchas attitude toward caregiving, satisfaction associatedwith caregiving, distress, and personal conflict withthe care recipient played important and complex rolesin explaining the negative consequences ofcaregiving, which in turn potentially affect recreationand leisure satisfaction and pursuits (Sheehan &Nuttall, 1988).

Several studies noted how caregivers adjusted tin .

lives to accommodate their responsibilities. Theygave up things that were considered to be marginal tothe balance of the caregiver her/himself or thefamily, such as regular exercise, hobbies, free timefor oneself, socialization with friends, vacations, andleisure time pursuits and activities (Barusch, 1988;Cantor, 1983; Snyder & Keefe, 1985). Adjustmentswere personally restrictive in all cases. Such aphilosophy certainly has negative implications forrecreat13n and leisure wellness of the individual.

Similarly, Chenoweth and Spencer (1986)examined factors including major problems facingcaregivers of individuals with Alzheimer's disease.Twenty percent feh that the greatest problemsinvolved the inability to get away from home and theisolation from friends and activities. Sixty percentsaid the relative's illness affected their relationshipswith others, their leisure activities and social contacts(Chenoweth & Spencer, 1986).

Freedom and free time are rare commodities forcaregivers. Montgomery, Gonyea and Hooyman(1985) identified lack of freedom as responsible forthe sense of burden reported by caregivers. In astudy to assess the amount of burden experienced bycaregivers of individuals with dementia, Zarit et al.,(1980) found that caregivers identified lack of timefor themselves and sleep disturbances as the greatestproblems related to caregiving. Shuman and Johnson(1983) also found that caregivers reported a need tospend a portion of their free time alone.

Similarly, Brody and Schoonover (1986)conducted a study that noted how adult daughtercaregivers have unique constraints in meetingfamilial, employment, and caregiver responsibilitieswhich warrant the sacrifice of free time (Brody &Schoonover, 1986; Stoller, 1983). Women

ANNU AL IN THERAPEUTIC RECREATION. No. U. 1991 51

BEDIM AND EURO

caregivers who are also in the work force, full-time,often experience few changes in householdresponsibilities. Thus, adult daughter caregivers, inparticular, confront very difficult problems in leisuretime allocation when their work week increases.According to Henderson, Bialeschki, Shaw, &Freysinger (1989), women in general experiencetraditional gender role related constraints to theirleisure activities. The additional role of caregiversmay further restrict a woman already suffering fromrole overload. She most likely will experience orperceive that s'oe has less leisure time.

Caregiving can lead to social isolation, a problemfor many caregivers. Studies by Jennings (1987)noted that caregivers often abandon normal socialactivities. This abandonment is &specially true whenthe caregivers are elderly parents of the care receiver.The effect is cumulative and cyclical: decreasedinterpersonal interactions lead to isolation, which inturn leads to even less interaction and more isolation(Jennings, 1987). Stephens and Christianson (1986)studied caregiver strain and found over 63% of therespondents found limitations in social life to be asevere problem.

Much of the literature identified lack of leisure ascontributing to caregiver burden. Similarly, severalstudies demonstrated how leisure can be brought into,ne's life to help cope with caregiver burden.According to Barusch (1988), the majority ofcaregivers (52%) reported little time or energy foractivities outside of caregiving. When asked howthey coped, they responded that they just managed.This approach proved not very effective. Othersreported cultivating a support group of friends whoshared leisure activities. This group scored aboveaverage on mean effectiveness. Solitary action inwhich persons involved themselves in leisureactivities such as letter writing, listening to songs, orgoing for walks, scored the most effective meanresponse (4 out of 5). Barusch (1988) suggested thatthe attraction to these leisure activities might be theflexibility they allow.

Barusch (1988) noted that "caregivers generallyreported most success when they changed thesituation either on their own or with help" (p. 684).The majority of those who reported loneliness copedby taking direct action that often involved recreationor leisure activities. Examples included activitiessuch as playing cards, reading, talking with friends,and getting out of the house socially. Similarly,

52 ANNUAL IN THERAPEUTIC RECREATION, plo. II, 1991

many respondents reported that depression wasreduced by activities which included going out andplaying cards, or simply going for a walk (Barusch,1988). Additionally, caregivers reported thatphysical activities and exercise helped them deal withfeelings of resentment, guilt, and strain (Barusch,1988; Cilenoweth & Spencer, 1986).

Lack of Leisure Services

Pratt, Schmall, and Wright (1987) conducted astudy which looked at ethical concerns perceived bythe caregiver. When asked about other obligations(e.g., family or job) most respondents felt confrontedwith the moral dilemma regarding self-care(autonomy) and responsibility to self. Self-care andresponsibility to self requires more than just attentionto personal hygiene. Mental and physical health areessential to the individual's well being, especially tothose individuals who are also responsible for thewell being of others. In light of this, leisure andrecreation services should be considered in anyoverall service plan designed to relieve caregiver:burden.

As evidenced previously in the literature, leisureand recreation pursuits were identified as importantto caregivers. Additionally, many studies noted therespondents' frustration over the loss of hobbies,social activities, exercise, and other leisure pursuits.Not one study, however, referred to leisure andrecreation services as dart of the proposed solutionsfor relieving stress of caregiver burden. Forexample, while Barusch (1988) reported that takingdirect action was an Jfective coping strategy,specifically noting recce.: n and leisure examplesgiven by respondents, the conclusions clearly omittedrecreation and leisure services from proposedservices.

Similarly, several studies identified constructivemethods or actions to initiate relief for caregiverstress. For example, Pilisuk and Parks (1988)suggested eleven services that should be promotedand made more available to caregivers. Theseservices, which included health care, communityeducation, housing, transportation, mental healthcounseling, and family counseling also failed to noteleisure services as on important part of the treatmentplan.

Implications for recreation and leisure servicescannot be ignored as contributing to the relief of

Os

BEDIN1 AND BILBRO

caregiver burden. Although leisure and recreationservices cannot lift all of the burden of caregivers,they can help alleviate some of the perceived stressand strain cf caregiving as well as help maintain themental and physical health of the caregiver.Iso-Ahola (1980) cited many studies which concludethat continued recreation participation through one'sentire life cycle contributes greatly to long andsuccessful aging. Additionally, Iso-Ahola exploredthe important relationship between perceived freedomthrough leisure and one's well-being and how thethreat of losing freedom can elicit a reactive behaviorthat can be detrimental. Unfortunately, &s severalstudies indicate, many caregivers are probably notaware of their overall needs, much less leisure needsand therefore do not seek leisure services.

Program Needs for the Future

Many models and approaches of support servicesare outlined in the literature. Some are very clinicaland many focus primarily on the care recipient,suggesting that positive changes in the care recipientmight provide positive changes for the caregiver.Barusch (1988), hcwever, challenged practitioners todesign programs that would initiate and increase theuse of services and social support by the caregiversthemselves. Such programs must encouragecaregivers to identify and seek help for their personalneeds. Similarly, it is essential that this call forinnovation and dedication include recreation andleisure services in its plea.

Zarit et al. (1980) endorsed a community supportprogram that focused on the caregiver's well-beingrather than on soiutions to problems specific tocaregivers situations. The two most common copingstrategies were caregiver education and training forcaregivers. Additionally, problem-solving has provedan important technique and needs to be included intraining (Haley, Brown, & Levine, 1987). Sheehanand Nuttall (1988) noted that many programs focuson information and knowledge. However, attentionneeds be given to the emotional and affectiveelements within the caregiving situation as well.

It is important to note that inadequacy of services,rather than the wishes of the caregivers andrecipients, is responsible for low use of services(Pilisuk & Parks, 1988). Caserta, Lund, Wright &Redburn (1987) sought to determine the need and theuse of respite oriented services by caregivers. They

found that lack of availability and access to theseservices are responsible for low use. The existenceof awareneris and access of services, however, do notalways lead to use. Results also indicated that themain reason that caregivers do not use availableservices is the perceived lack of immediate need.With regard to recreation and leisure services, strongimplications for leisure education exist.

Recommendations

The provision of recreation and leisure servicesmust be incorporated into an interactive system withother services. Jennings (1987) proposed that acoordinated and accessible system of support forcaregivers be established. Jennings also suggestedproviding information about services to potential andcurrent caregivers. The barriers for service as notedabove are not only the provision of services, whichhas been identified as quite meager, but also theutilization of these services by the caregiversthemselves. Through networks and cooperativesystems, services and information can be providedthat can help caregivers understand the importance ofrecreation and leisure in their own lives.

Specifically, recreation and leisure services canaddress these unique needs in two basic ways. First,caregivers tend to ignore or dismiss their own needs,included recreation and leisure. Leisure educationprograms can address these needs and should beavailable to caregivers through cooperativecommunity programs. For example, leisureeducation courses could be provided in communityand municipal recreation programs. These classeswould address such issues as assertiveness, leisureawareness, problem solving, decision-making, andempowerment for leisure pursuits. Other communitysei vices could incorporate recreation and leisureservices as well. Women's centers and mental healthservices can easily incorporate leisure issues into theirservices. Outreach programs which include educationfor leisure and recreation brought into the homes canhelp caregivers realize not only the importance ofleisure in their lives but also its role in relieving thecaregiving burden.

Second, leisure services need to provideopportunities for caregivers to meet their identifiedrecreational needs with innovative programs andopportunities both within the community and in thehome. For example, skills courses, packets of

ANNUAL IN THERAPEUTIC RECREATION, No. U, 1991 .53

ti,(1

BIMINI AND BILBRO

printed information, mobile units, and socialnetworks must be considered to meet unique needs.These services could be incorporated into models likeCouper's (1985) Family Dynamics Model, whichhelped identify sources of strain and conflict andincluded units on communication and logisticalconcerns. Similarly, Crorman's, London's andBerry's (1981) support group outreach modelencouraged the caregivers to facilitate their ownexpression of feelings, and to discuss their socialisolation, coping and problem solving issues. Bothmodels could easily add and incorporate sessionsaddressing the need for recreation and leisure.

In conclusion, caregivers are a unique group ofindividuals who, through their care of others,sometimes ignore their own needs. Leisure andrecreation activities and needs have been consistentlyidentified in the literature as important butexpendable facets of the caregivers' lives.Additionally, leisure and recreation activities havebeen identified as potential avenues for coping withcaregiver burden. Unfortunately, the literaturesuggested nothing that includes leisure and recreationservices as necessary parts of treatment or as viablestrategies for the caregiver. This article has been anattempt to summarize the caregiver dilemma and isintended to initiate action toward cooperative andcreative multifaceted programs which address theunique needs of caregivers in all areas of their lives,including leisure.

REFERENCESBarusch, A.S. (1988). Problems and coping strategics ef elderly

spouse caregivers. The Gerontologist, 28(5), 677-685.Brody, E.M. (1985). Parent care as a normative family stress.

The Gerontologists, 25(1), 19-29.Brody, E.M., & Schoonover, C.B. (1986). Patterns of

parent-care when adult daughters work and when thcy do not.The Gerontologist, 26(4), 372- 381.

Cantor, M.H. (1983). Strain among caregivers: A study ofexperience in the United States. The Gerontologist, 23(6),597-642.

Caserta, M.S., Lund, D.A., Wright, S.D., & Redburn, D.E.(1987). Caregivers to dementia patients: The utilization ofcommunity services. The Gerontologist, 27(2) 209-214.

Chenoweth, B., & Spencer, B. (198o). Dementia: Thcexperience of family caregivers. The flerontologist, 26(3),267-272.

Crossman, L., London, C., & Berry, C. (1981). Older womencaring for disabled spouses: A model for supportive services.The Gerontologist, 21 (5), 464-470.

Couper, D.P. (1985). Family caregivers of elderly relatives: Aneducational support group model. Hartford, CT: Connecticut

54 ANNUAL 1N THERAPEUTIC RECREATION, No U, 1991

Department on Aging.Haley, W.E., Brown, S.L., & Levine, E.G. (1987).

Experimental evaluation of the effectiveness of groupintervention for dementia caregivers. The Cerontologist, 27(3), 376-?82.

Henderson, K.A., Bialeschki, M.D., Shaw, S.M., & Freysinger,V.I. (1989). A leisure of ore's own: A feminist perspectiveon women's leisure. State College, PA: Venture Publications

Inc.Hooeyman, N.R., & Lustbader, W. (1986). Taking care:

Supporting older people and their families. NY: The FreePress.

Iso-Ahola, S.E. (1980). The social psychology of leisure andrecreation. Dubuque, IA: Wm C. Brown, Publishers.

Jennings, C. (1987). Elderly parents as caregivers for their adultdependent children. Social Work, 32 (5), 430-433.

Montgomery, R.J.V., Gonyea, J.G., & Hooyman, N.R. (1985).Caregiving and the experience of subjective and objectiveburden. Family Relations, 34, 19-26.

Pilisuk, M., & Parks, S.H. (1988). Caregiving: Where familiesneed help. Social Work, 33 (5),436-440.

Pratt, C.C., Schmall, V .L. , & Wright, S. (1987). Ethical

concerns of family caregivers to dementia patients. The

Gerontologist, 27 (5), 632-638.Pratt, C.C., Schmall, V.L., Wright, S., & Cleland, M. (1985).

Burdcn aod coping strategies of caregivers to alzheimer'spatients. Family Relations, 34, 27- 34,

Rancourt, A.M. (1990). Older adults with developmentaldisabilities/mental retardation: A research agenda for anemerging sub-population. Annual in Therapeutic Recreation,1, 48-55.

Sheehan, N.W., & Nuttall, P. (1988). Conflict, emotion, andpersonal strain among family caregivers. Family Relations,37 (1 ), 92-98.

Shuman, S., &Johnson, M. (1983). Understanding parent-childrelations in later life: An application of Kelley's personalrelationship framework. Paper presented at the NationalCouncil on Family Relat;ons. St. Paul. MN, October.

Snyder, B., & Keefe, K. (1985). The unmet needs of familycaregivers for frail and disabled adults. Social Work inHealth Care, 10, (3), 1-14.

Stephens, S.A., & Christianson, J.B. (1986). Informal care ofthe elderly. Lexington, MA: Lexington Books.

Stoller, E.P. (1983). Parental caregiving by adult children.Journal of Marriage and the Family, 45(4), 851-865.

Stone, R., Cafferata, G.L., & Sangl, J. (1987). Caregivers ofthe frail elderly: A national profile. The Gerontologist, 27(5), 616-626.

U.S. Select Committee on Aging (1988). Exploding the myths:Caregiving in Amerka (Committee Publication 100-665).Washington, DC: U. S. Government Printing Office.

Winogond, I.R., Fisk, A.A., Kirsling, R.A., & Keyes, B.(1987). The relationship of caregiver burden and morale toalzheimer's disease patient function in a treatment setting.The Gerontologist, 27 (3), 336-339.

Zarit, S.H. (1989). Do we need another stress and caregivingstudy? The Gerontologist, 29 (2), 147-148.

Zarit, S.H., Reever, K.E., & Bach-Peterson, J. (1980). Relativesof impaired elderly: Correlates of feelings of burden. The

Gerontologist, 20(6), 649- 655.

7()

Facilitating the Child's Adjustmentto Parental Disability

Carol A. Mushett, M.Ed., C.T.R.S.Renee Blesch-Hill, B.A., C.T.RS.

Laura L. Heeney, B.A.

Abstract

The onset of a disability or chronic illness can be a traumatic and, at times, devastating experience for theentire family. Children are particularly vulnerable to the instability which often results from the necessaryadjustments within the family. Progri.ms are needed to assist the children of rehabilitation patients who areadjusting to, and coping with changes within their family. Parents frequently report changes in their children'sbehavior during the adjustment process such as withdrawal, depression, sleeping and eating disturbances, andacting out behavior. Long term challenges may include dealing with feelings of isolation, an ongoing need forage-appropriate information, and identification of appropriate roles for children. The Sinai Kids InformationProgram for Rehabilitation (SKIP-R) is an educational program designed to assist children in adjusting to andunderstanding a parent's disability. The program includes direct and indirect services to insure the systematicinclusion of children in the rehabilitation process. The program provides children between the ages of 6 and 14years with the opportunity to: (a) lean about their parent's disability, (b) develop an understanding of how thatdisability or illness will impact on their family, (c) meet and nurture friendships with children in similarsituations, and (d) assist children k. identifying their role in the rehabilitation process.

The onset of a long term chronic disease or injurywhich results in permanent disability can be atraumatic and, at times, devastating experience forthe entire family (Olsson, Rosenthal, (ireninger,Pituch, & Metress, 1990). The children in the familyare particularly vulnerable. Families frequentlyreport dramatic changes in their children's behaviorwhen a parent becomes disabled. These changesinclude withdrawal, depression, sleeping and eatingdisturbances, nightmares, and acting out behaviors.With the healthy parent's energy and attentionfocused on the patient during the rehabilitationprocess, children may feel forgotten or neglected.They are often left uninformed and confused aboutwhat has happened to their loved one. Thisconfusion can lead to fear, anxiety and guilt(Fleming, 1987).

Children may also be faced with long-termchallengez to their emotional adjustment. At times,children who have a disabled parent may feel

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painfully different from their peers. Missing orlonging for the parent to be as he/she was before thedisability is common. Children do not generally havethe opportunity to meet older children who sharesimilar concerns. These feelings of isolation maybecome amplified when the family does notappropriately address the subject of the disabilitywithin the home (Featherstone, 1980).

Children have an ongoing need for current andaccurate information regarding the parent's disabilityand rehabilitation status. Often, families denychildren access to information or fail to address theirquestions in an attempt to protect them from thispainful situation. This lack of communication tendsto increase children's apprehension and slow their

Carol Mushett is the coordinator of therapeutic recreation atWayne State University, Detroit, Michigan; Renee Blesch-Hill iscoordinator of the SKIP-R Program at Sinai Hospital, Detroit,Michigan.' and Laura Keeney is a graduate research assistant aiWayne State University.


MUSHEIT El AL.

adjustment to, and acceptance of the changes withintheir family (Meyer, Vadasy, Sewell, 1985).

Children often become confused about their roleand may attempt to compensate for perceived changesin the physical and emotional functioning of thefamily. They begin to take on additional adultresponsibilities and may try to fill the role of thedisabled parent by doing household chores orproviding care for younger children. In somefamilies, a child may even become a caregiver to thedisabled parent. Excessive responsibilities andpressure to achieve can quickly become anoverwhelming burden for the child.

Traditional rehabilitation programs fail tosystematically include children in the rehabilitationprocess. Families may feel reluctant to include theirchildren in therapy sessions, family education, andpatient related conferences. Furthermore, hospitalsand rehabilitation centers are ill-equipped to providethe comfortable atmosphere needed to facilitate theinclusion of children (Fleming, 1987).

Identification of Need

A comprehensive literature search revealed littleabout children whose families are undergoing, orhave undergone the rehabilitation process. Theidentification of need was based on: (a) directobservation of children in the rehabilitation setting;(b) patient and family input on the changes in theirchildren's behavior following the onset of disability;and (c) the children's statements and questionsreflecting general apprehension and lack ofunderstanding.

Therefore, in response to the identified need ofchildren within rehabilitation families, TherapeuticRecreation Services in the Department ofRehabilitation Medicine at Sinai Hospital developedan activity-based educational program called the SinaiKids Information ProgramRehabilitation (SKIP-R).

Program Objectives

SKIP-R is designed to assist children in adjustingto and understanding a parent's disability. Theobjectives of the program are as follows:

1. To provide children with accurate andage-appropriate information regarding their parent'sdisability,

2. To decre2 e the child's feelings of isolation

56 ANNUAL IN THERAPEUTIC RECREATION, No. II, 199 i

through interaction with children hi similar situations,3. To provide parents with educational information

and increase their awareness of factors affectingchildren throughout the rehabilitation process, and

4. To provide strategies to minimize the potentialnegative impact that a parental disability may have onthe child's life and to identify the potential positiveimpact this experience can have on a child's growthand development.

Method

Over 150 children between the ages of 6 and 14have participated in the SKIP-R program since itsinception in 1987. Most of the children have a parentwith a significant physical disability who wasreceiving or had recently received rehabilitationservices. The parent's handicapping conditionsincluded: multiple sclerosis, amputation, spinal cordinjury, stroke, cancer and closed head injury. Thechildren were identified through internal and externalreferral and a community outreach program for selfreferral.

Program Implementation

The program is organized by therapeutic recreationservices and implemented with the support of theinterdisciplinary team. An activity-based,age-appropriate curriculum is provided to the childrenby physical, occupational and speech therapies;audiology; nursing; and neuropsychology. Physiciansinteract with the children throughout the week toinsure individualization of information regarding themedical implications of disability within each family.

Components of the program include one dayseminars, a summer day camp, and family educationservices. The one day seminars are designed forchildren of recently disabled parents. They providechildren with immediate access to informationregarding their parent's unique situation. Informationincludes clarification of the vocabulary now beingused within their home which may be as basic asstroke, PT, and 'imp or as threatening asneuropsychology, aphasia, and chemotherapy.Appropriate expectations including discharge plansare also included. The children are allowed theopportunity for hands-on experience with adaptedequipment which will be utilized by their parent.

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The day camp is an annual service held in thesummer for five consecutive days. Children attendfrom 10:00 a.m. until 2:00 p.m. This week-longservice allows the participating disciplines to providemore in-depth educational support to the children. Itfurther allows therapeutic recreation staff theopportunity to identify and assess the individualizedneeds of each child. Assessment is primarily basedon clinical observation, interviews, and parentalinput.

The average attendance at the summer day campranges from 30 to 40 children. The group is dividedinto smaller units of six to eight children based onage. Therapeutic recreation coordinates the masterschedule and facilitates the smooth transition ofgroups from one activity or location to another. Thisoften resembles the changing of classes at a localelementary or junior high school.

Therapeutic recreation also provides therapeuticplay activities and social recreation experiences forthe children. Therapeutic play activities includevalues clarification activities, psychotherapeuticgames, puppetry, creative arts, and storyimprovisation. Social recreation experiences includephysical activities, parties, entertainment, andunstructured sharing time. Together, these activitiesserve to encourage the establishment of healthypatterns of communication and to foster relationshipsbetween children.

Family education services are provided throughwritten material and individual education sessions.Referrals are also made to community mental healthservices for families who need ongoing intervention.Additional community resources are explored througha variety of field trips in accordance with theirindividual needs. One of the more popular trips hasbeen to local durable medical equipment suppliers totry out some of the adaptive equipment and liberatingtechnology currently available.

The SKIP-I? services are available free of chargeto all participants. The cost of the program isminimal and requires only a few basic supplies;snacks; and the efforts, energies, and creativity of therehabilitation staff. The program utilizes the hospitalfacilities, including physical, occupational and speechtherapy tteatment areas, two large conference rooms,and a multi-purpose auditorium, as well as thetehabilitation unit itself.

Program Evaluation

Ongoing program evaluation is implemented tomonitor the effectiveness of the program. Focus isplaced on quality improvement both programmaticallyand individually. Program evaluation includes pre-and post-tests and follow-up interviews.

Pre- and post-tests are completed by each child inthe program. Questionnaires are completedindependently by children who can read and writeand privately with the assista ice of a singular staffmember by children who cannot. The questionnaire-sassess basic knowledge of parental disability,emotional response to the changes within theirfamily, and direct feedback on the activities utilizedin the curricula.

Follow-up telephone interviews are conducted withthe children's parents one month after the program toevaluate its effects. Both parents are asked a seriesof questions designed to identify their perception ofthe impact of the program on the child's overalladjustment. Parents are asked to identify specificbehavioral observations reflecting the child's abilityto relate to and communicate with the disabledpaeent.

Results

Feedback from the parents of the children whoparticipated in this program indicated a significantchange in their children's attitude towards, andunderstanding of, the loved one's disability. Parentsfurther noted improvement in their children'semotional acceptance of the change in their familylife. However, they also identified a need forongoing assistance. The children continued toexpress persistent feelings of isolation throughout theyear. Follow up revealed that for many, camp wasthe only opportunity to meet friends in similarsituations.

Pre- and post-tests were specific to the portion(s)of the program in which the child participated,therefore comparing results from the SaturdaySeminars to the Summer Day Camps is notappropriate. However, a study in 1988 regardingpeogram effectiveness reflected the following trend.The 1988 SKIP-R program sponsored a one-weeksummer day camp for 27 children between the agesof 7 and 14, 20 of whom participated in pre- andpost-tests with the following results: feelings of

7 3 ANNUAL IN THERAPEUTIC RECREATION, No. II, 1991 57

MUSHETT ET AL.

confusion regarding the disability of their familymember were expressed by 95% in the pre-test, and55% in the post-test; embarrassment about thedisability was expressed by 70% in the pre-test, and40% in the post-test; ability to explain the causes andeffects of the disability improved in 75% of thechildren. One month follow-up telephone interviewswith the parents revealed that 80% of the childrendemonstrated positive changes in their ability to relateto the disabled family member, 10% had nosignificant change, and 5% had increased withdrawalfrom the disabled family member (Mushett, Ellenberg& Hyman, 1989, p 78).

Conclusion

The immediate and long-term needs of manychildren with recently disabled parents are great.Therapeutic recreation professionals can play a

significant role in facilitating the healthy adjustmentof these children to the changes within their family.Therapeutic recreation services have long recognizedthe significance of the family network in positiveoutcomes. Therefore, the development and

comprehensive implementation of activity-basedprograms for children is an appropriate expression ofinterdisciplinary family focused rehabilitation.


References

Featherstone, H. (1980). A difference in the family: Life with adisabled child. New York: Basic Books.

Fleming, S. (1987, January-Februsry). Supporting the family'srole in patient recovery, rehabilitation. Promoting Health, (8),

10-12Meyer, D., Vadasy, P., Sewell, R. (1985). Sib shops: A

handbook for impkmetuing morkshops for siblings of childrenwith special needs. Seattle: University of Washington Press.

Mushett, C., Ellenoerg, M., Hyman, S. (1989). SKJP-R: helpingchildren adjust to parental disability (abstract), Archives ofPhysical Medicine and Rehabilitation, 70, 18.

Olsson, R., Rosenthal, S., Greninger, L., Pituch, M., Metress,E. (1990). Therapeutic recreation and family therapy: Aneeds analysis of wives of stroke patients. Annual inTherapeutic Recreation, 1, 15-20.

Endnote

Additional information regarding the SKIP-R program is availablefrom Renee Blesch-Hill at Sinai Hospital, Department ofRehabilitation Medicine, 6767 W. Outer Drive, Detroit, MI48235.

74

The Interface Between Social andClinical Psychology:

Implications for Therapeutic Recreation

David R. Austin, Ph.D.

Abstract

A case is made for the application of knowledge from so ;ial psychology into clinical practice in therapeuticrecreation. The historical relationship between social and clinical psychology that has lead to the interfacebetween the fields is examined and assumptions underlyins, the interface are delineated. Work central to theinterface is discussed including interpersonal processes related to the development and prevention of psychologicaldifficulties, social processes in identifying and classifying psychological problems, and interpersonal processesinvolved with clinical interventions. Finally, implications for the interface are given for therapeutic recreationpractice and a call is made for researchers and teachers to avail themselves of theory and knowledge resultingfrom the reunion of social and clinical psychology.

My advisor in graduate school, who was trailied insocial psychology, used to refer to those of us intherapeutic recreation as applied social psychologists.He perceived therapeutic recreation as a disciplinethat applied thoories and research findings from socialpsychology t9 clinical practice, and, as a result of hisurging, I chose social psychology as the cognate areafor my /WI). work. This turned out to be anexceller, choice as I was able to relate much of whatI learned in social psychology to experiences I hadgained as a practLioner in mental health. Forinstance, I was able to apply aggression theory fromsocial psychology in my dissertation research.Aggression had been an area in which I haddeveloped a great deal of interest while working as atherapeutic recreation specialist in a psychiatrichospital, so I was able to tie together socialpsychological theory and clinical practice.

Through my graduate study I came to understandwhat my advisor meant when referring to those of usin therapeutic recreation as applied socialpsychologists. There were a number of areas ofsocial psychology that I found had direct implicationsfor practice in therapeutic recreation. In addition toaggression, these areas included attribution theory,attitudes, locus of control, self-concept,self-actualization, social facilitation, the inverted-Ueffect, sensation seeking, need achievement,leadership, and group dynamics. It seemed that

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everywhere I turned there was information fromsocial psychology relevant to the practice oftherapeutic recreation.

Since that time and throughout nearly 20 years asa professor, however, I have had to work with adouble handicap. Unfortunately, other than a fewtexts that have given limited coverage to socialpsychological concepts (e.g., Austin, 1982;Howe-Murphy & Charboneau, 1987; Kennedy,Austin & Smith, 1987), authors of therapeuticrecreation texts have not integrated social psychologytheory and research into the therapeutic recreationliterature. Likewise, only a limited number of paperspublished in therapeutic recreation journals havedrawn heavily on social psychological theory. Tocompound the problem, few social psychologists haverelated their field to clinical psychology, nor haveclinical psychologists typically attempted to interfacewith social psychologists. Subsequently, there hasbeen a lack of literature to borrow from social andclinical psychology that made a connection betweenacademic social psychology and clinical practice.

The reasons for this lack appear to be obvious.First, therapeutic recreation itself is relatively newand is just building its body of literature. It is still

Dr. Austin is professor of Therapeutic Recreation in theDepartment of Recreation and Park Administration at IndianaUniversity.

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defining itself and its relationship to other disciplines,including social psychology. Second, socialpsychology and clinical psychology traditionally haveexisted as two separate entities. There havehistorically been two types of approaches tointerpersonal interactions, and, accordingly, socialpsychologists have developed one body ofknowledge, while clinical psychologists havedeveloped another. Although an occasionalcollaboration has occurred from time to time betweenthese two disciplines, to a large extent they haveexisted independently.

Social psychology is a discipline that usesscientific methods to "understand and explain how thethoughts, feelings, and behaviors of individuals areinfluenced by the actual, imagined, or impliedpresence, of others" (Allport, 1985, p. 3). Much ofclinical psychology similarly concerns the effects ofsocial situations on the individeal (Sheras & Worchel,1979). Yet, despite the obvious shared area ofinterest, these two branches of psychology untilrecently remainetl separate. Why is this? Anexamination of their history reveals the answer to thisquestion.

History of Social and Clinical Psychology

Social psychology is a relatively young field. Thefirst social psychology exper:Tnent was done byTriplett in 1897, and the first social psychology text,by McDougall, was published in 1908 (Sheras &Worchel, 1979). But it was not until Kurt Lewinemerged in the late 1930s that the field achieved itsown identity separate from sociology and psychology(Weyant, 1986). Known as the founder of socialpsychology, Lewin was an advocate for both basicand applied aspects of social psychology. Perhapsthe best known quote in social psychology is that ofLewin who wrote that "nothing is so practical as agood theory" (Lewin, 1951, p. 169).

Even though the founder of social psychologybelieved that his field should research the pressingsocial problems of the day, interest in the practicalapplication of social psychology was lost afterLewin's death. Weyant (1986) has written:

Given that the discipline began with a strongbend toward practical applications, it may comeas a surprise that after Lewin's death in 1947social psychologists virtually abandoned realworld problem-solving. Instead, they turned

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almost exclusively to laboratory research andset about developing and testing theories andprinciples. (p. 9)It was not until the 1970s that social psychologists

once more began to show interest in the applicationof their knowledge outside their laboratories. Due toan initial desire to test basic theories in naturalsettings, applied social psychology began to reemerge(Sheras & Worchel, 1979; Weyant, 1986).

Lightner Witmer, the founder of clinicalpsychology, began the first psychological clinic inAmerican in 1896 at the University of Pennsylvania.Witmer also initially proposed the term clinicalpsychology for his new profession. As a chartermember of the American Psychological Association,he recognized the need for a scientific basis forclinical practice. In 1908 Witmer published anextensive criticism of those in the mental healthmovement whom he felt were unscientific in theirapproach (McReynolds, 1987).

World War II had a tremendous impact on clinicalpsychology. It developed a very applied nature aspsychologists attempted to treat those withbattle-related psychological difficulties. Even thoughthe field of clinical psychology adopted a scientist-practitioner model of professional preparation, theprofession came to embrace an applied approach thatemphasized clinical techniques and applications ratherthan research and theory development. By the 1950s,clinical psychology had separated itself from purescience. Only recently have clinical psychologistsbegun to recognize the value of research and theoryin understanding the delivery of therapy (Leary &Maddux, 1987; Sheras & Worchel, 1979).

It is ironic that the two fields moved apart,because such separation is not in keeping with theviews of their founders. Lewin urged his colleaguesin social psychology to enter into exploration of realworld problems only to have his discipline displaylittle interest 1. practical applications and emphasizebasic research. Witmer strongly believed in scienceas the basis for clinical psychology and yrt clinicalpsychologists moved away from scientific researchand the quantitication found in social psychology (seeTable 1). Though the two disciplines were joinedtogether in the Journal of Abnormal and SocialPsychology (JASP) in the 1920s, even pleas by notedpsychologists Morton Prince and Floyd Allport couldnot keep the fields together. By 1965 JASP ceasedproduction (Garfield & Bergin, 1986; Hill & Weary,

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1983). Garfield and Bergin described the situation:During the early sixties, clinical psychologistsappeared for the most part, to be sharplydivided from their colleagues in socialpsychology. One group practicedpsychotherapy; the other group conductedbasic, theoretical research. One group readcase studies; the other would consider resultsonly from methodologically rigorousexperiments. One group cared about the realworld; the other seemed content to studycollege sophomores. (p. 70)Things have changed markedly, however, for the

disciplines of clinical and social psychology in recentyears. With the arrival of the behavioral approach inthe 1960s, clinical psychology became moreconcerned with empirical research and scientificiiiethodology. At the same time, social psychologyfaced a crisis in which leaders questioned the reasonfor the existence of the field and urged greaterwincern for doing applied social psychology (Garfield& Bergin, 1986). Weary (1987) has further noted thatthere was a conceptual convergence of the two fieldsas social psychology began to focus more oncognitive processes. Additionally, Weary has statedthat practical considerations, such as a tight jobmarket and the necessity to do appv work in orderto receive grants, may have influenced the comingtogether of the two groups. These influences, alongwith continuing pleas for unification from coheaguesin both groups, brought social and clinicalpsychology together once more. In 1983 the Journalof Social and Clinical Psychology (JSCP) wascreated, "dedicated to work representing the rich andextensive interface of social and clinical psychology"(Harvey, 1983). A remarriage had occurred.

Table 1Fathers of Social and Clinical Psychology

Publications that influenced the fields toward theinterface included Brehm's (1976) The Application ofSocial Psychology to CTinical Practice, Goldstein'sand Simonson's (1971) and Strong's (1978) chapterson an integrated approach in the Handbook ofPsychotherapy and Behavior Change, and Weary'sand Mirels' (1982) Integration of ainical and SocialPsychology (Brehm & Smith, 1986; Leary &Maddux, 1987). Since the publication of JSCP,Mark Leary has widely promoted the integration ofsocial and clinical psychology through a number ofpublications including articles (Leary, 1987; Leary,Jenkins & Shepperd, 1984; Leary & Maddux, 1987)and the book, Social Psychology and DysfunctionalBehavior: Origins, Diagnosis, and Theatment (Leary& Miller, 1986). Also influential has been Brehm andSmith's (1986) chapter titled "Social PsychologicalApproaches to Psychotherapy and Behavior Change,"in the Handbook of Psychotherapy and BehaviorChange.

Underlying Assumptions

Assumptions that underlie the emerging interfacebetween social and clinical psychology have beenpresented by Leary and Maddux (1987) and Maddux(1987). Maddux (1989, p. 96) has summarized thisset of assumptions, which deal with the nature ofpsychological difficulties and their treatment (seeTable 2).

To these assumptions Leary and Maddux (1987)provide two additional assumptions. One is thatpsychotherapy is first and foremost a social encounterwhether done in a dyad or group. Their otherassumption is that social psychological theoriesprovide a foundation on which may be built models

Kurt Lewin, the founder of modern social psychology, was an advocate for practical applications of socialpsychology. Lewin believed social psychologists should study real-world problems.

Lightner Witmer, the founder of clinical psychology, recognized the need for a scientific basis for practice inclinical psychology. He criticized those in the menta! health movement for being unscientific.

Sources: McReynolds, 1987; Weyant, 1986.


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Table 2Assumptions that Underlie the Interface

1. Psychological problems are essentially interpersonal or social problems that in many or most cases can be bestdefined and understood in terms of social cognitions and interpersonal behavior.

2. So-called normal social behaviorsupposedly the subject of study of social psychologyis often maladaptiveand dysfunctional (e.g., common errors in information processing and reasoning, inaccurate causalattributions).

3. The distinction between normality and abnormality is determined by social means and conventions.

4. Most effective clinical and counseling interviews target for change social norms and conventions.

5. Psychotherapy and counseling are essentially interpersonal encounters.

6. Clinical judgment and decision-making (e.g., diagnosis and assessment) are more similar to, than differentfrom, everyday social perception, evaluation, and categorization.

for behavioral change. The overriding implicitassumption of those who work at the interface ofsocial and clinical psychology would seem to be thatproblems in mental health (whether termed mentalillness, psychopathology, emotional disturbance orwhatever) are disturbances in interpersonal behaviorthat may be treated through an interpersonalenterprise.

Defining the Interface of Social and ClinicalPsychology

Three categories or areas encompass work at theinterface of social and clinical psychology accordingto Leary and Maddux (1987), Leary and Miller(1986) and Maddux (1989). These aresocial-dysgenic psychology, social-diagnosticpsychology, and social-therapeutic psychology (seeTable 3).

Social-Dysgenic Psychology. The social-dysgeniccategory is the study of interpersonal processesrelated to the development, maintenance, andprevention of psychological disorders. The notionunderlying this category is that many psychologicalproblems vring from interpersonal interactions andthat most psychological problems involve humanrelationships. Social psychological phenomenarelated to this area are attribution, aggression, self--presentation, relationships, social comparison,conformity, the self, modeling, and roles. Specifictopics under this category include: attributional

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models of stress, loneliness, and depression;self-presentation models of social anxiety,schizophrenia, and aggression; the role of socialsupport in coping; problems associated withself-estw= maintenance; and self-efficacy models ofavoidance and fear.

Social-Diagnostic Psychology. The concern of thesecond category, social-diagnostic psychology, is withthe role of social processes in identifying andclassifying psychological problems. The ideaunderlying this category is that social inference isinvolved in the identification and classification ofpsychological problems. Person perception,judgment heuristics, attribution, labeling, inferentialbiases, and conformity are social psychologicalphenomena related to this second category. Specifictopics that may fall under this area include: effectsof psychulogists' theoretical orientations onperceptions and analyses of data, effects of label'Ingclients on subsequent diagnosis, and choices cliniciaesmake to test their preconceptions about clients.

Social-7herapeutic Psychology.. The final categoryof social-therapeutic psychology deals withinterpersonal processes associated with clinicalinterventions. Social psychological phenomenarelated to this area are attitudes, social influence andpower, resistance to influence, interpersonalattraction, group dynamics, self-fulfilling prophecies,cognitive dissonance, the self, modeling, andrelationships. Examples of specific topics under thiscategory related to treatment include: effects of

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Table 3Categories at the Intetface

1. Social-Dysgenic Psychology. Deals with socialprevention of psychological disorders.

2. Social-Diagnostic Psychology. Deals with socialpsychological problems.

processes related to the develc xent, maintenance, and

processes related to the identification and classification of

3. Social-Therapeutic Psychology. Deals with social processes associated with clinical intervention programs.

Sources: Leary & Maddux (1987), Leary & Miller (1986), Maddux (1989)

therapist characteristics and behaviors on treatmentoutcomes, attitude change in therapy, expectancyeffects in treatment, self efficacy in behavioralchange, effects of social support on treatmentoutcomes, therapist-client relationship, and effects ofloss of control (Leary & Maddux, 1987; Leary &Miller, 1986).

Brehm and Smith (1986) have completed anextensive review of social-therapeutic psychologyfrom three perspectives. These are, respectively, thesocial psychology of the therapist, the client, and thetherapy. Topics under the heading of the therapistinclude those such as therapist beliefs about mentalhealth, interpersonal judgments, attributions todispositional cause, and stress and burnout amongtherapists. Concerns related to the client includeeffects of social support, effects of positive outcomes,attributions and depression, self-concept,self-awareness, self-handicapping, and personPerception. Under the third and final heading,Brehm and Smith (1986) review studies related totopics such as choice and control, paradoxicalinterventions and reactance, inisattributions, andcausal attributions.

Other authors have likewise explored the socialpsychology of clinical interventions. Harari (1983)has, for example, discussed six topics as clinicaltechniques that have roots in social psychology:screening and diagnosis, role playiag, cognitivebalance testing, attitude changes, group dynamics,and reverse placebo therapy (i.e., telling clients theplacebo would aggravate their condition). Spring,Chiodo and Bowen (1987) have discussed perceptionsof social and personal space and sense of control asareas of concern for the interface of social andclinical psychology. Weyant (1986) has discussed

three treatment approaches based on socialpsychology. These are: vicarious extinction (basedon social loarning theory), effort justification (basedon cognitive dissonance theory), and atttibutiontherapy (based on attribution theory).

In introducing the Journal of Social and ClinicalPsychology in the inaugural issue, Harvey (1983)listed a number of topics to illustrate thoseappropriate for the new journal including: closerelationships, helplessness and perceived control,social skills, attributions and labeling of mAntalillness, client-therapist interactions, social aspects ofjudgments of psychopathology, compliance withmedical regimens, beliefs about the nature of mentalillness, sex differences in mental disorders, and broadclinical issues such as de-institutionalization andmainstreaming.

A final means of defining the interface betweensocial and clinical psychology is to examine chaptersin major works dealing with the . terface. SocialProcesses in Clinical and Counseli1.0 Psychology byMaddux, Stoltenberg and Rosenwein (1987) haschapters that cover social support, self-efficacytheory, counseling and persuasion, social influence,social comparison and depression, self-handicapping,social anxiety, and attributional approaches.Chapters in Leary an,1 Miller's (1986) SocialPsychology and Dysfunctional Behavior include:attributional processes; attributions, perceivedcontrol, and depression; self-processes;self-presentation; anxiety and inhibition ininterpersonal relations; troubled relationships; clinicalinference; social influence; behavioral compliance;and expectancy theory.

As Weary (1987) and Maddux (1989) havecommented, the flow of information at the interface

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has largely been in one direction. It is clear that thedirection has been from social psychology to clinicalpsychology at this point.

Implications for Therapeutic Recreation

On a practical level, one obvious implicationresulting from the interface of social and clinicalpsychology is that a body of literature is beginning toform from which therapeutic recreation may borrow.For instance, Leary and Miller's (1986) book, SocialPsychology and Dysfunctional Behavior: Origins,Diagnosis, and Dratment, has served as an excellentsource of readings for students in my course on thesocial psychology of therapeutic recreation.

But, one may ask, what specific things cantherapeutic recreation derive from the work of thosedoing research at the interface of social and clinicalpsychology? Two areas emerge as ones from whichtherapeutic recreation can gain a great deal. One isunderstanding dynamics that relate to thedevelopment and treatment of psychologicalproblems. A second deals with social-therapeuticprocesses involved with providing interventions.Within this second area fall such concerns asclient-therapist relationships, personal space andtouch. leadership and power, and group dynamics.While not dealt with to the extent that they could be,topics within this sec.ond area traditionally have beengiven at ieast minimal attention in the therapeuticrecreation literature. It is the first group of topicsthat generally has not been given coverage. In theinterest of space and because it has been soneglected, only this first area related .o understandingthe development and treatment of psychologicalproblems will N.: reviewed within this paper.

In order to provide treatment, therapists mustunderstand the dynamics surrounding the client'sproblem. Austin (in press) has drawn on theliterature of social-clinical psychology to provideunderstarlings for therapeutic recreation specialistsof interpersonal processes involv-4 with such socialpsychological concepts as sei Incept, learnedhelplessness, the self-fulfilling pi,phecy, labeling,loneliness, self-efficacy, and attributional processes.While not inclusive, these topics represent highlyuseful areas of information and understandings fortherapeutic recreation specialists. A brief discussionof each of these topics follows, together with a briefcase study to illustrate clinical application of the

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concept.Self-Concept. Self-concept can be a pervasive

factor in determining behavior. If we see ourselvesas highly competent, we are much more likely to takerisks and enter into new behaviors. On the otherhand, if we perceive ourselves to lack competence,our feeling of inadequacy can be debilitating(Iso-Ahola, 1980). Self-concepts are gained throughour experiences, Including evaluations from others,social comparisons, role playing, and perceptions ofbeing distinctive from others (Gergen & Gergen,1986).

The affective part of self-concept, our self-esteemor how we regard ourselves, is developed throughthese same mechanisms. Knowledge of the dynamicsupon which self-esteem rests may be extremelyhelpful to understanding the etiology of clientproblems and how these problems may be approachedthrough treatment. For instance, unhealthy behaviorscan arise as clients attempt to protect self-esteemthrough self-handicapping. In self-handicapping,people actually arrange impediments that they canlater blame for their failures. They self-handicapthemselves so they will have excuses if they do notsucceed. An example would be pulling an all-nighterbefore an examination so any failure could be blamedon a lack of sleep. A more serious example might betaking drugs before an important life occurrence inorder to blame any possible negative outcome on thedebilitating effects of the drug (Leary & Miller,1986).

Realizing that clients may engage inself-handicapping can be important information foitherapeutic recreation specialists. For example, whenclients do not give their best effort, therapeuticrecreation specialists may recognize that clients areengaging in self-handicapping to save face shouldthey fail. Such clients may need extra support inorder to do their best. Knowing the dynamics ofself-handicapping helps therapeutic recreationspecialists understand clients' behaviors and providemeans to assist clients with more adaptive ways tocope.

Jim, an adolescent being treated forpsychological problems, did not freelyparticipate in volleyball games, choosing toblow-off the activity. It became clear duringgroup processing, following a volleyball game,that Jim was trying to save face by not

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appearing to take the activity seriously.Self-handicapping was being used by Jim toavoid embarrassment for what he perceived tobe an inadequate ability level due to hisself-concept of being physically weak whencompared to his muscularly sLonger peers.With the help of the therapeutic recreationspecialisc and others in the group he beeameaware of his behavior and decided to enter intoa program to increase his muscular strength sohe could feel mare comfortable about hisself-image and ennarce his physical abilities.

Learned Helplessness. We humans strive forcontrol over ourselves and our environments(Guelak, 1985). Research has sho.,,n thatexperiencing a lack of control over aversive situationscan produce a sense of uncontrolability (Leary &Miller, 19E6) Repeated failure to exercise controlcan create feelings that an individual is helpless tocontrol his or her environment (Iso-Ahola, 1980).This can create a debilitating effect, termed learnedhelplessness, that can lead to the development ofapathy, depression, and withdrawal. In extremecases, even death may result due to the perceiveduncontrolability of a stressful situation (Gatchel,1980).

In light of this, it is tragic that the environments ofmany institutions, hospitals and other health carefacilities bring about feelings of helplessness. Therecognition, by therapeutic recreation specialists, thathelplessness can be a problem for clients and maycause depression can be helpful to planninginterventions for those suffering from learnedhelplessness and to preventing the occurrence ofhelplessness within the health care setting. Clientscan become involved in activities that allow them tomaster challenges and learn to endure frustration.Recreation can provide a means to exercise controlwithin the health care environment.

Mary, a patient in the admission unit of a statepsychiatric hospital, felt helpless. It seemedshe had little control over her life. "No matterwhat I do, I can't change anything," Maryexclaimed. Learning of Mary's feeling ofhelplessness, the therapeutic recreationspecialist began to work with Mary to increaseher perceived control and provide opportunitiesto achieve mastery over her environment.

Self-Fulfilling Prophecy. The self-fulfillingprophecy is sometimes referred to as theself-fulfilling expectation. By others, it is referred toas the Pygmalion effect after the Greek sculptorwhose statue of a beautiful woman came alive due tohis expectations (Gergen & Gergen, 198(). Byv,hatever name, this phenomenon deals with whathappens to persons as a result of the expectationsothers hold about them. The most well known studyof self-fulfilling prophecy is the now classic spurters'study by Rosenthal and Jacobson (1968). In thisstudy, students thought to be especially prone toachieve (i.e., spurters) were shown to outperformtheir peers at the end of the school year. While theattribute of being a spurter was randomly assigned,the teachers' expectations and ensuing actionsproduced the outcomes they had expected. Thisstudy and others established what can happen topersons due to others' expectations. In the Rosenthaland Jacobson study the outcome was a happy one (atleast for the spurters) but negative expectations cansimilarly have an effect on others. Therapeuticrecreation specialists need to be aware of the effectthat prejudices or preformed expectations may haveon clients.

Staff in a camp for children with disabilitieswere observed to be giving minimal feedback tocampers who were generally not successful intheir performance during activities. It wasdiscovered that staff did not believe that thecampers could succeed due to the severity oftheir disabilities. With training, the staff cameto understand their self-fulfilling expectationsand began to provide encouragement andcorrective feedback to the campers who wereable to achieve at a much higher level than hadbeen anticipated before staff became aware oftheir self-fulfilling expectations.

Labeling. Labeling individuals can result inhaving them being perceived in a certain way, ratherthan being appreciated for their uniquecharacteristics. For example, an individual who islabeled mentally ill may be perceived as a personpossessing negative traits. Whether or not the labelis valid, labeling a person can affect others' responsesto the individual (Austin, 1982). The effects can bedamaging if staff devalue the person due to adiagnostic label to which they have connected

8 1 ANNUAL IN THERAPEUTIC RECREATION, No. II, 1991 65

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negative counotations. It is important for toerapeuticrecreation specialists to understand how harmfid thelabeling of clients by others can be and to avoidstereotyping clients themselves.

Michael, a therapeutic recreation studentintern, initially attempted xo apply his learningfrom his abnormal psychology class during hispsychiaulc internship. He soon disceweredhow unreliable diagnostic labels can be, eventhough assigned by medical experts. In ameeting with his clinical supervisor, Michaelrevealed that he had found that diagnosticlabels could limit his perceptions of clients andthat he would be cautious not to perceive theperson pureiy as a diagnostic label.

Loneliness, Lonely Individuals do not have theirexpeetations for social relationships filled. They feeldeprived of intimate relationships with others.Ensuing despair, dejection, and depression may befelt by those who experience loneliness (Perko &Kreigh, 1988; Shultz, 1988). Those who are lonelyoften hold negative perceptions of themselves andothers, exhibit social skills deficits, are moresuperficial and inhibited, and are less intimate theliothers (Leary & Miller, 1986).

All 4 these traits of lonely persons haveimplications for transactions that therapeuticrecreation specialists ha .e with clients whoexperience feelings of loneliness. It is important fortherapeutic recreatien specialists to understand thedynamics of loneliness because treatment willnecessarily have to be concerned with negativeoutlooks, social skill deficits, and superficialfun, _ming due to taking few social risks. Trustbuilding vo kh those clients who are lonely becomes animportant first step for therapeutic recreationspecialists to talze.

Joe, a 20 year old man with mild mentalretardation, felt lonely and J;..pressed. He toldthe therapeutic recreation specialist he did notknow how to nake friends. Joe and histherapist decideo P ni al skills training would behelpful to the solving of this problem. Joe wasable to overcome his social skills deficienciesafter several Lionths of social skills trainingclasses. He began to make friends and feelnetter about himself.

Self-efftcacy. According to Bandura's (1986)

66 ANNUAL 1N THERAPEPUTIC RECRF AT1ON, No. 11, 1991

self-efficacy theory, self-referent thoughts play acentral role in mediating behavioral change. Clients'efficacy judgments (i.e., their personal evaluations oftheir abilities) have a direct effect on how they copewith their problems according to self-efficacy theory.Client expectations about themselva greatly influencetheir approach to problems. Clients who areself-doubters will generally have limited confidencein their abilities, will have little willingness to copewith problems, will put forth a minimal effort, andwill give up easily. In contrast, those with highefficacy will likely meet their difficulties and exertmaximum effort, even in the face of adversity (Leary& Miller, 1986). It is therefore critical thattherapeutic recreation specialists understandself-efficacy theory end the means by which efficacyjudgments are developed and altered,

Judi wished to take control over her life butlacked confidence in her abilities. She decidedto do something about her perceived problem.She became involved in an adventure challengetherapy group as a part of her treatmentprogram. Following her successfulparticipation in the greup, she experiencedrenewed confidence in her ability to direct herI ife.

Attributional Processes. Attribution theory dealswitn the processes through which we infer causes forevents fiom our observations. Attributional processesexplain the events that occur in our lives. Suchexplanations have significant psychologicaiconsequences because our reactions to emotionalevents, our self-esteem, our judgments aboutourselves and others, and our expectations about thefuture are all subject to the influences of our causalattributions (Leary & Miller, 1986). Such are theramifications of attributional processes forunderstanding psychological problems and treatingthem that at least one entire book has been devoted tothe topic, Attribution Theory in Clinical Psychologyby Forsterling (1988). Attribution theory assists usin understanding cognitive determinants ofpsychological disorders such as anger and depressionand allows us to derive therapeutic techniques fromattribution research (Forsterling, 1988).

Bonni did not believe she could make itoutside the hospital. While her job would P ft(' er

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structure and security during the work hours, she didnot feel she had the social skills to enjoy her leisuretime. The therapeutic recreation specialist suggestedthat Bonni might benefit from a leisure counselinggroup. Based on information provided by othersduring counseling sessions, Bonni was able tounderstand that she was making unrealisticattributions and that she did have the ability tosucceed in her leisure pursuits.

Conclusion

The disciplines of social psychology and clinicalpsychology have recently acknowledged their jointconcern for interpersonal processes that affect people.After many years of separation, these two fields haveshown that a theory-based. academic discipline and apractice-basal, real world discipline can complementand gain from one another. The implications of themarriage of social and clinical psychology fortherapeutic recreation are far reaching. Knowledgefrom the interface of these disciplines provides theoryfor research and knowledge for practice fortherapeutic recreation specialists who may beperceived to be applied social psychologists as theyapply information from social psychology in clinicalpractice.

The focus of this paper has been on the interfaceof social and clinical psychology and its relevance forpractice in therapeutic recreation. While it could beinferred that the understandings from the describedinterface deal exclusively with severe psychiatricproblems, this is not the case. Most of the socialpsychological concepts that have been discussedwithin this paper have application with diversepopulations within a variety of clinical settings.Therapeutic recreation specialists working with anyspecial population, including persons who aredevelopmentally disabled, physically disabled, orelderly, can profit form the remarriage of social andclinical psychology.

Within this paper, I have argued for the value ofthe interface of social and clinical psychology fortherapeutic recreation. It is my hope that researchersand authors in therapeutic recreation will begin toavail themselves of theories and information resultingfrom the reunion of social and clinical psychology.Further, I would call on educator to expose theirstudents to the literature at the interface. There is awealth of new information now aveilaNe to

therapeutic recreation. Let us have the foresight toimprove practice within therapeutic recreation bytaking advantage of the emerging field of social-clinical psychology.

References

AI Iport, G.W. (1985). The historical background of socialpsychology. In G. Lindzey & F.. Aronson (Eds.), Handbookof Social Psychnlogy (3rd ed., Vol. 1, 1-46). New York:Random House.

Austin, D.R. (1982). Therapeutic recreation processes chidtechniques. New York: John Wiley & Sons.

Austin, D.R. (in press). Therapeutic recreation processes andtechniqued. (2nd edition). Champaign, IL: SagamorcPublications.

Bandura, A. (1986). Social foundations of thought & action: Asocial cognitive theory. Englewood Cliffs, NJ: Prentice-Hall,Inc.

Brehm, S.S. (1976). The application of social psychology toclinical practice. Washington, DC: Hemisphere.

Brehm, S.S. & Smith, T.W. (1986). Social psychologicalapproaches to psychothempy and behavior change. In S.L.Garfield & A.E. Bergin (Eds.), Handbook of Psychotherapyand Behavior Change. (3rd edition). New York: John Wiley& Sons.

Forsterling, F. (1988). Attribution theory in clinical psychology.New York: John Wiley & Sons.

Garfield, S.L. & Bergin, A.E. (1986). Handbook ofpsychotherapy and behavior change. (3rd edition). NewYork: John Wiley & Sons.

Gatchel,R.J. (1980). Perceived control: A review and evaluationof therapeutic implications. In A. Baum & J.E. Singer (Eds.).Advances in Environmental Psychology: Volume 2.

Applications of Perceived Control. Hillsdale, NJ: LawrenceEribaum Associates, Publishers.

Gergen, K.J. & Gergen,M.M. (1986). Social psychology. (2ndedition). New York:Springer Verlag.

Goldstein, A.P. & Simonson, N.R. (1971). Social psychologicalapproaches to psychotherapy reaearch. In A.E. Bergin & S.L.Garfield (Eds.), Handbook of Psychotherapy and BehaviorChange: An Empirical Analysis. New York: John Wiley &Sons.

Grzelak,J.L. (1985). Desire for control: Cognitive, emotionaland behavioral consequences. In F.L. Denmark (Ed.).Social/Ecological Psychology ant' the Psychology of Women.New York: Elsevier Seienct Publ;shing Company, Inc.

Harari, H. (1983). Point-Counterpoint: Social psychology ofclinical practice and in clinical practice. Journal of Social andClinical Psychology. 1,173-192.

Harvey, J.H. (1983). Editorial: The founding of the Journal ofSocial and Clinical Plychoiogy. Journal of Social andClinical Psychology. 1,1-3.

Hill, M.G. & Weary, G. (1983). Perspectives on the Journal ofAbnormal ond Oocial Psychology: How it began and how iswas traAsformod. Jourual of Social and Clinical Psychology.1,4-14.

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Howe-Murphy, R. & Charboneau, B.G. (1987). Therapeuticrecreation intervention: An ecological perspective . EnglewoodCliffs, NJ: Prentice-Hall, Inc.

Iso-Ahola, S.E. (1980). The social psychology of leisure andrecreation. Dubuque, IA: Wm. C. Brown CompanyPublishers.

Kennedy, D.W., Austin, D.R. & Smith, R.W. (1987). Socialrecreation: Opportunities for persons with disabilities.Philadelphia: Saunders College Publishing.

Leary, M.R. (1987). The three faces of social-clinical-counselingpsychology. Journal of Social and Clinical Psychology.2,168-175.

Leary, M.R., Jenkins, L.T. & Shepperd, LA. (1984). Thegrowth of interest in clinical relevant research In socialpsychology 1965-1983. Journal of Social and ClinicalPsychology. 4,333-338.

Leary, M.R. & Maddux, J.E. (1987). Progress toward a viableinterface between social and clinical-counsding psychology.American Psychologist. 42,904-911.

Leary, M.R. & Miller, R.S. (1986). Social psychology anddysfiinctional behavior: Origins, diagnostic, and treatment.New York: Springer-Verlag.

Lewin, K. (1951). Field theory in social science. Chicago:University of Chicr.go Press.

Maddux, J.E. (1989). Social-clinical-counseling integnitionindigestion: How do you spell relief? In M.R. Leary (Ed.).The State of Social Psychology. Newbury Park, CA: SAGEPublications, Inc.

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Maddux, J.E. (1987). The interface of social, clinical, andcounseling psychology: Why bother and what is it anyway?Journal of Social and Clinical Psychology. 5,27-33.

Maddux, I.E., Stoltenberg, C.D., & Rosenwein, R. (Ws.).(1987). Social processes in clinical and counselingpsychology. New York: Springer-Verlag.

McReynolds, P. (1987). Lighter Witmer: Little-known founderof clinical psychology. American P.sychologist. 42,849-858.

Perko, J.E. & Kreigh, H.Z. (1988). Psychiatric and mentalhealth nursing. (3rd edition). Norwalk, CT: Appleton &Lange.

Rosenthal, R. & Jacobson, L. (1968). Pygmalion in theclassroom: Teacher expectation and pupils' intellectualdevelopment. New York: Holt, Rinehart, & Winston.

Shoras, P.L. & Worchel, S. (1979). Clinical psychology: Asocial psychological approach. New York: Van NostrandReinhold Company.

Shuitz, C. (1988). Loneliness. In C.K. Beck, R.P. Rawlins &S.R. Williams. Mental health-psychiatric nursing. St. Louis:The C.V. Mosby Company.

Spring, B., Chiodo, J. & Bowen, D.J. (1987). The social-clinicalpsychobiology interface: Implications for health psychology.Journal of Social and Clinical Psychology. 5,1-7 .

Wcary, G. (1987). Natural bridges: The interface of social andclinical psychology. Journal of Social and ClinicalPsycbc,logy. 5,160-167.

Wevant, J.M. (1986). Applied social psychology. New York:Oxford University Press.

8 4

Relationships Between Meanings of Workand Meanings of Leisure AmongWheelchair (Basketball) Athletes

Sharon B. Hunt, Ed.D.

Abstract

The purpose of this study was to examine related meanings of work and leisure as they were perceived by arandom s4mple of 200 disabled adults (N=124) who were chosen from the National Wheelchair BasketballAssociation's team rosters. The theoretical base of research in the area of work-leisure relationships lies in theevaluation of the tenability of two rival hypotheses that attempt to describe the relationship between meanings ofwork and meanings of leisure. The compensatory hypothesis suggests that an individual will select leisureactivities which compensate for deprivations experienced in the work settirig. In contrast, the spillover hypothesisargues that meanings derived from the work environment will simply spill over into the leisure domain. In orderto examine the meanings of work and leisure along a common scale of measurement, a semantic differentialinstrument, the Work Leisure Attitude Inventory (WLAI) (Hunt, 1979) was utilized. The WLAI consists of 11evaluative bipolar adjective scales designed to rate 13 concepts identified by Havighurst (1957) as importantaspects of the work and leisure domains. The results of the Pearson product-moment coefficients of correlationcalculated for each of the 13 work-leisure concepts indicated that there were significant (p < .05) positivecorrelations between three of the 13 concepts. Results also suggested that this sample of wheelchair athletesperceived both their work and their leisure experiences as meaningful, as evidenced by the finding that 12 of the13 concepts statements received positive ratings in both the work and leisure domains. Assuming that theperceptions of the individual are a valid data source in occupational and leisure planning, the information providedby this study could be utilized in developing strategies for the future realization of favorable work and leisuremeanings on behalf of disabled persons.

Work-Leisure Theory

Work and leisure represent major life segmentsfrom which individuals derive considerablepsychological meaning. While the psychologicalmeanings of work have been consistently explored vianumerous types of job satisfaction studies (Friedmann& Havighurst, 1954; Morse & Weiss, 1955; Orzack,1963; Berger, 1964; Tausky, 1969), considerably lessattention has been given to the psychological aspectsof leisure (Neulinger, 1971) or the psychologicalaspects of the work-leisure relationship.

Most researchers concerned with work andoccupation agree that the concept of meaningoverlaps tnat of satisfaction. Parker (1971, p.49)asserted that when an individual finds worksatisfying, "This is a way of saying that work hasmeaning for him, that he can see the purpose for

which it is done and that he agrees with the purpose."Although meanings of work vary according to thespecific job context and the particular personality ofthe worker, findings in this area have basicallyagreed on several key points.

The professional and upper echelon workersgenerally value work highly rot only for economicbenefits but also for the self-identification andprestige provided by a respectable job (Friedmann &Havighurst, 1954: Morse & Weiss, 1955; Orzack,1963). Distinctions between work and leisurepatterns of profczsional people were found to beunclear in that much of the work for this group mayalso be considered as leisure. Workers inoccupations which permit neither sociai standing nor

Sharon Hunt is head of the Department of Health Science, Kinesiology,Recreation and Danze at the University of Arkansas, Fayetteville,A441,1,114.

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making a living, and their job was often seen as adirect threat to .self-identification (Blauner, 1964;Tausky, 1969). Perhaps the large bulk of bothwhite-collar and the blue-collar workers could beclassified in a third group that neither rejoices norsuffers in work but puts up with it more or less forthe sake of other things (Berger, 1964).

One of the major problems confronted in studyingthe meaning of leisure is the fact that there exists noone consistent definition of the subject (Ennis, 1968;Neu linger, 1971). Most of the published research inthe area of leisure has dealt with leisure activities,leisure expenditures of time and money, or leisuredefinitions, rather than with the social-psychologicalaspects of leisure (Neulinger, 1971). Of those studiesfocusing upon the psychological aspects of leisure,the majority have viewed leisure in relation to someaspect of work (Kelly, 1972; Neu linger, 1971;Spreitzer & Snyder, 1974: Hunt, 1979; Iso-Ahola,1979).

Havighurst (1961) asserted that the psychologicalmeanings of leisure are also the psychologicalmeanings of work, but a strict comparison is notpossible due to the difficulty in making exactquartitative comparisons. Kando (1975) delineated atleast two possible approaches to relating work andleisure: to correlate specific occupations with specificforms of leisure, and compare the meanings andfunctions of leisure and work.

Zuzanek and Mannell (1983) suggested thatempirical studies examining the work-leisurerelationship vary in terms of the way in which theyoperationalize work and leisure. Most classicwork-leisure conceptualilations examined the effectsof work structure--complexity, amount ofsupervision, opportunities for persona! interaction,and degree of autoliomy--on leisure behavior.However, many researchers have advocated that it isnot the work structure but rather the sociallyinternalized attitudes and meanings associated withwork which affect leisure participation (Kando &Summers, 1971). Studies supporting this view haveoften concentrated on correlations betweenwork-leisure meanings.

This pervasive influence of work into the non-work domai.i was described by Wilensky :1960) interms of two general hypothatkal formulations,compensatory and spillover. The compensatoryhypothesis suggests that workers who experienwdeprivation at work will compensate for thisdeficiency by becoming involved in more gratifying

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non-work activities. Spillover signifies that leisureactivity may be influenced by characteristics that havespilled over from work.

According to Zuzanek and Mannell (1983) severaltentative generalizations can be made abo'lt the natureof the empirical support for the cipillover andcompensatory conceptualizations of the work-leisurerelationship, these include the following: the spilloverrelationship appears to be stronger for workers whoperceive work as being important to them. There islittle support behaviorally for compensation, but itdoes have some support when attitudes are assessedand people's rationalizations for why they getinvolved in various leisure activities are considered.The types of relationships between work and leisurevary among different groups of people. Finally,there is no unequivocal support for either of the twowork-leisure hypotheses.

Several studi$m have investigated certain aspects ofthe leisure-work relationship within the framework ofcompensation and spillover (Spreitzer & Snyder,1974; Shepard, 1974; Hunt, 1979; Hunt & Brooks,1980). Within the context of the compensatoryhypothesis, Spreitzer and Snyder (1974) explored therelationship between work orientation and thesubjective meanings assigned to leisure a^tivities by510 urban dwellers. Findings strongly supported thecompensatory hypothesis that persons lackirgintrinsic involvement with their jobs were more likelyto define leisure activities as means of self-identity.Multiple indicators of leisure meaning revealed adefinite relationship to work orientation.

Shepard (1974), based on the notions ofcompensation and spillover, proposed a theoreticalmodel of work-leisure relationships within the contextof the selected social-psychological variables. Thesevariables include self-evaluation, status recognition,and alienation. Shepard theorized that persons whocannot maintain a favorable self-evaluation duringwork activities will engage in non-work activities thatwill provide positive feedback for self. Similarly,persons who are denied opportunities for statusrecognition at work will attempt to engage in

status-giving activities outside of work to avoid lowself-esteem. With respect to the spillover leisurehypothesis, a complete lack of opportunity for statusrecognition at work will cause person3 not toattempt to gain status regnition outside ofwo:k, thus assuming that work has over-ridingsocial-psychological effects.

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Hunt (1979) investigated the relationship betweenthe subjective meanings of work and leisure among asample of 133 university employees comprising threedifferent occupational classifications. Significantpositive correlations were found to exist between themeanings of work and meanings of leisure in each ofthe three occupational groups, indicating a spillovereffect. Significant differences were found in the wayin which the three occupational groups conceptualizedale meanings of work.

Hunt and Brooks (1980) studied the relationshipbetween the subjective meanings of work and leisureamong a sample of 71 Niustrial employeescomprising two occupational groups. Findingsindicated a spillover effect independent of sex oroccupational group.

In examining the relevance of the compensatoryand spillover hypotheses for the study of leisurebehavior, Kando am. Summers (1971) identified threeproblem areas which interfere with the developmentof a theory of work-leisure. The first problem areahas been the failure to isolate the work-leisurerelationship from other impacting demographicvariables such as sex, education and occupation. Asecond problem area has been the failure todistinguish between meanings of work and leisure,and forms of work and leisure. A third problem hasbeen the failure to specify the conditions under whichthe spillover and compensation occur.

The Physically Disabled in the Work Setting

The vast majority of studies that invettigate therole of the peysically handicapped in the work settingconcentrate on barriers to employment faced by thedisabled and the degree of acceptance of the disabledby their able-bodied fellow workerl (Krafting andBrief, 1976; Rose and Brief, 1979; Siegfried andToner, 1981). Very few studies have asked thephysically disabled to reflect on the meanings thatthey attach to work.

In 1982 Florian identified three primary factor& inthe meaning of work for a group of physicallydisabled rehabilitation clients, social contact,self-image, and financial-economic. Among the threefactors, the clients indicated that social contact wasthe most important to them. In a later study Florianand Har-Even (1984) investigated the meanings ofwork for three groups undergoing rehabilitation. Thegroups included clients with schizophrenic diagnoses,depressive diagnoses, or physical disabilitiee, and a

8 7

centrol group of non-disabled participants. Onceagain, the profiles of factor scores revealed that thosesubjects with physical disabilities rated social masteryas the most important factor.

Bolton (1980) conducted an item factor analysis ofthe 45 items of the Work Values Inventory (WVI) for445 physically disabled clients. The WVI wasdesigned to assess the range of values that influencethe motivation to work. This item factor analysisproduced six major dimensions that described thisphysically disabled population's motivation to workincluding stimulating work, interpersonalsatisfaction, economic security, responsibleautonomy, comfortable existence and aestheticconcerns. The six factors were found to be virtuallyindependent of age, education and intelligence.

There is little doubt that work represents a majorfocus of life for most adults. In addition to enablingone to earn a living the job provides one withchallenge and an opportunity to do somethingworthwhile. Of perhaps equal importance is thesocial context of work in which one invariably comesinto contact wlth many different people. Often someof these relationships become significant ones whichmay extend far beyond the work place. In manyinstances, however, the socializing that thehandicapped individual experiences at work does notalways extend past the work place. Sandys andLeaker (1987) suggest that, transportation problems,lesser income levels, variations in personality, andlack of experience are all factors that affect theongoing process of leisure integration for thedisabled.

Participation by Physically Disabledin Wheelchair Sports

Since their beg,'Aning in Veteran's AdministrationHospitals in tee mid-1940s, wheelchair sports haveacquired a suE,T.emial following of professionals whobelieve that ht.ly are a means to enhance theself-esteem and self-perceptions of competence ofphysically disabled participants (Guttmann, 1976;Labanowich, 1978; Madorsky and Kiley, 1984).This relationship between wheelchair sportengagement and positive psychological change hasbeen examined (Szyman, 1979; Patrick, 1984;Robinson, 1985; Hendrick, 1985) with fiadings thatdiffer in the degree to which they support the strengthof this relationship. For example, Szyman (197))reported that his investigation of a sample of

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physically disabled college students revealed nosupport for a causal relationship between wheelchairsport participation and self esteem. Hendrick's (1985)investigation of the effect of participation in aninstructional wheelchair tennis program uponphysically disabled adolescents' self-perceptions oftheir own general cognitive, social and physicalcompetence found that participation in wheelchairtennis can significantly improve the disabledadolescent's general percept'ons of his or her physicalcompetence. Patrick (1986) measured ten novicemobility impaired athletes prior to, and five monthsafter, their first competitive wheelchair experience.He compared them to veteran athletes andnon-athletes on issues of self-concept and acceptanceof disability. He found that, as an effect of theathletic participation, significant gains were maderegarding self-concept and on sub-scales of perceivedbehavior, family self, as well as acceptance ofdisability.

This review of literature has highlighted researchin the area of work-leisure theory, because thetheoretical direction of the study's research questionis so grounded. The meanings that the physicallydisabled assign to their work and leisure, and theeffect that participation in wheelchair sports has onthe wheelchair athlete have been discussed to betterdescribe the unique population from which thesubjects of this study were selected. It appears thatnumerous studies which focus on the integration ofthe physically disabled into both the work and leisuresettings have been conducted. However, a paucity ofresearch still exists in the area of meanings that thephysically disabled attribute to their work and leisure.

In this regard, the study sought to determine therelationship between the meanings of work andleisure among physically disabled wheelchairbasketball players within the framework of thecompensatory and spillover hypotheses. Thesignificance of the study lies in its attempt to examinea unique population in a continued effort to shed lighton the work-leisure relationship as well as to provideexploratory data concerning the subjective meaningsassigned to work and leisure by a population ofathletes with physical disabilities.

Methodology

Sample Descvtion

With the cooperation and approval of the National

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Wheelchair Basketball Association (NWBA)Commissioner's office, a random sample of 200players was selected from the NWBA team rosters.All 200 players were mailed a questionnaireconsisting of a cover letter which endorsed the study,the actual instrument and questions regardingdemographic data. The respondents were assuredanonymity and asked to return the completedquestionnaire to the researcher within two weeks.Those not returning the original questionnaire weresent a second questionnaire which again asked fortheir cooperation. As a result of the initial mailingand the follow-up a total of 124 athletes submitted acompleted questionnaire.

All subjects were physically disabled as evidencedby the fact that they were eligible to participate in theNWBA, but they were not asked to record the levelof their disability. The sample included 117 malesand seven females. The vast majority of the sample(77%) were between 25 and 44 years of age. Morethan half of the sample (55%) reported that they weremarried. Only 6% of the sample had never beenemployed on a full-time basis, and 64% of thesample reported a family income of $15,000 ormore with a majority (62%) reporting theiroccupational classification as managerial/self-employed or professional. While this random sampleshould be representative of those athletes participating

NWBA, it may not be overly representative ofthe physically disabled in general.

Data Collection

Data concerning the meanings of work and leisurewere collected via the use of a survey questionnaire.To examine the meanings of work and leisure alonga common scale of measurement, a semanticdifferenVal instrument, the Work-Leisure AttitudeInventory (WLAI) (Hunt, 1979) was utilized (Figure1). Subjects were asked to respond to 13 workconcepts and to respond to the same 13 concepts intheir leisure-based lives. For purposes of this studywork was defined as the occupational position held byan individual for which he/she receives a paid salary.Leisure was defined as the sum total of allexperiences within one's life that he/she personallyperceives to be leisure.

The WLAI consists of 11 evaluative bipolaradjective scales designed to rate 13 conceptsidentified by Havighurst (1957) as important aspectsof the work and leisure domains. The adjective

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Figure 1 . Concept statements and bipolar adjective scales of the Work-Leisure Attitude Inventory.

1. When I am at work/leisure I feel the following ways about pvself.

2. When I am at work/leisure I feel the freedom I experience is:

3. When I am at work/leisure I feel that my opportunity to experience creative behavior is:

4. I feel the following ways about time-killing activity in my work/leisure:

5. When I am at work/leisure I feel that tha opportunity for devel opment of my talent is:

6. When I am at work/leisure I feel the following ways about the amount of physicalenergy that I must use:

7. In my work/leisure I feel that my opportunity to serve others is:

8. In my work/leisure I feel that the itatis (or social position) that I occupy is:

9. When I am at work/leisure I feel that my opportunity to relax from tension is:

10. When I am at work/leisure I feel that the social relationships that I experience are:

11. When I am at work/leisure I feel that my opportunity for new experience is:

12. When I am at work/leisure I feel that the competition that I experience is:

13. In my work/leisure I feel that my opportunity for leadership is:

Bipolar Adjective Scales*

1. Valuable .. Worthless

Pleasant

Unimportant

Uninteresting

Satisfying

UndPsirable

Meaningful

Good

Harmful

Not Fun

Not Frequent

2. Unpleasant .

3. Important .

4. Boring .

5. Frustrating ..

6. Desirable . ...

7. Meaningless ..

8. Bad . .

9. Leneficial

10. Fun

11 Frequent .. . a

* All 13 concepts wete scored for work, and then they were all scored for leisure.

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scales were developed through factor analysis andpiloted for purposes of reliability. The Cronbackalpha internal consistency scores for eadi of theconcepts in both the work and leisure domainsindicated that the lowest reliability for any of the 26concept statements was .90.

Each page of the WLAI conta:-...4 a conceptstatement followed by bipolar scales on which thedirection and intensity of reaction to the statementwere indicated. The instrument yielded two scoresfor each concept statement, a work score and aleisure snore. For purposes of scoring consistency,the unfavorable pole of each scale was uniformlyassigned the score of 1, and the favorable pole ofeach scale was assigned the score of 7; then theattitude score was obtained by merely summing overall ratings. The possible range of scores for any oneconcept was 11 to 77. A score of 11 would indicatethat i terms representing a particular conceptstatem 'nt were rated 1, or the lowest possible score.

A score of 77 would indicate that all items wererated 7, the highest possible score. A score of 44would indicate that the mean on ratings for thatconcept was 4, or neutral. This instrument has beenused in previous studies with industrial employees(Hunt & Brooks, 1980), retired individuals (Hunt andWeiner, 1982) and unemployed adults (Hunt, 1985).

Results

Overall respondents perceived the majority of thework-leisure concept statements favorably. Meanscores on 12 of the 13 concepts were above theneutral point (neutral point = 4) on each scale. Theconcept time-killing activity was the only one toreceive a less than neutral score, thus indicating thatrespondents did not perceive the notion of wastingtime in either work or leisure as a favorable concept.A summary of the mean scores for the respondentsappears in Table 1.

Table 1Summary of Mean Scores for Work-Leisure C9ncepts

Work-Leisure ConceptsSubjects

Work Leisure

1. Myself 5.53 6.03

2. Freedom 5.50 6.46

3. Creative Behavior 5.49 6.13

4. Time-Killing Activity 2.60 3.02

5. Development of Talent 5.52 6.07

6. Physical Energy Input 4.57 6.40

7 Service to Others 5.86 6.1C

8. Status 4.66 5.61

9. Relaxation from Tension 5.44 6.26

10. Social Relationships 6.15 6.47

11. New Experiences 5.36 6.11

12. Competition 4.73 6.23

- 13. Leadershi 5.32 5.89

Meanrating

saores are based on individual responses to a semantic differentiale3ch work-leisure statement from a low score of 1 to a high score of 7.

74 ANNUAL IN THERAPEUTIC RECREATION. No. II. 1991

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In order to determine whether a significantrelationship existed between scores on work andleisure concepts, Pearson's product-momentcoefficients of correlation were calculated for the 13work-leisure concepts. Table 2 presents thecoefficients of correlation.

Among the respondents three of the 13 conceptswere significantly (p .05) similar for both the

work and leisure domains with the absolute valuesranging from r = .19 to r = .10. Because acommon instrument was utilized to measure bothwork and leisure attitudes, there is undoubtedly somecommon methods variance in the correlations betweenthe work and leisure responses. Also, the r of .19 israther low and reaches significance prima:ily becauseof the large sample N's. Therefore, it would seembest to interpret the r's rather conservatively.

Table 2Sununaly of Correlation Coefficients for Work-Leisure Concepts

Work-Leisure ConceptsSubjects

Coefficient Probability

1. Myself .34 .69

2. Freedom .01 .92

3. Creative Behavior -.02. .82

4. Time-Killing Activity .70

5. Development of Talent .09 .34

6. Physical Energy Input -.14 .11

7. Service to Others .10 .27

8. Status .08 .40

9. Relaxation from Tension .07 .41

10. Social E Aionships .26 .003

11. New Experiences .06 .53

12. Competition -.07 .46

13. Leadership .19

Significant at (p < .05) level.

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Conclusions

Given that this study surveyed only wheelchairbasketball participants, one must be careful wet togeneralize the findings to all wheelchair athletes andmost certainly not to all physically disabled persons.The results obtained in this study indicate that thissample of wheelchair athletes favorably perceivedboth their work and their leisure as evidenced by thefinding that 12 of the 13 work-leisure conceptstatements received positive, ratings. These resultswere consistent with other studies that have utilizedthe WLAT to enan.ine work-ieisure meanings amonguniversity employees (Hunt, 1979), induzialworkers (Hunt and Brooks, 1980), retirees (Hunt andWeiner, 1932) and unemployed adults (Hunt, 1985).It should be noted that the number of concepts foundto be significantly similar in this study (three) wasmuch lower than the number of statisticallysignificant relationships found in those studies listedabove which utilized the same instrument withdifferent populations. However, all statisticallysignificant relationships have been positivecorrelations, high score on work concept - high scoreon leisure concept; low score on work concept - lowscore on leisure concept. This seems to indicate aspillover effect, in that work attitudes and meaningsmay be so ingrained in American culture that theycarry over to non-work activities as well.

Implications for Future ResearchAs is the case in most research projects, this

investigation has probably raised as many questionsas it has answered. Specifically, the followingconcerns cou:d be addressed in future studies:(1) Do wheelchair athletes in individual sports suchas tennis or swimming conceptualize their work andleisure differently than those who participate inwheelchair basketball?(2) Do physically disabled individuals who are notinvolved in competitive wheelchair sports feeldifferently about the meanings of work and leisure intheir lives?(3) Does the level of disability experienced by thewheelchair athlete affect his/her perceptions of workand leisure?(4) Do individuals with different types of phys;caldisabilities feel differently about the meanings ofwork and leisure in their lives?

In summary, social science research on thework-leisure relationships has produced fewconclusive findings. This investigat;an is no

76 ANNUAL IN THERAPEUI1C RECREATION, No. II, 1991

exceftion to that rule. However, several re-conceptualizations of the work-leisure relationship arebeginning to evolve. Such evolution is due to thedissatisfaction with the overall state of research in thework-leisure relationship and its limited ability toexplain variance in leisure behavior (Zuzanek &Mannell, 1983).

The following suggest;ons made by researchers inthis area of study are enlightening regarding problemsencountered in this investigation. Mannell &Iso-Ahola (1984) have suggested that the difficultiesin establishing clearer relationships between work andleisuee stem from methodological and operationaldeficiencies. These deficiencies includeunidimensionality in defining the work situation andhighly insensitive measures of leisure. Improvementof measurement tools might increase the explanatorypotential of research into the work-leisurerelationship. Another problem area addressed byresearchers is related to the mut.tifaceted andmultidirectional nature of the work-leisurerelationship. Kando & Summers (1971) noted thatthe same individual can experience spillover andcompensation relationships between work and leisureunder different circumstances. Roadburg (1982)suggested the study of work-leisure relationshipsexamine the interaction effects of specific work andleisure situations rather than more broadly definedwork and leisure activities. Others believe that thechoices of work and leisure, as well as theirrelationships, may reflect basic differences in thepersonality structure of the individual. They purportthat work-leisure relationships stem from suchvariables as values, motives, and social attitudeswhich influence both occupational and leisure choices(Bishop & Ikeda, 1971). Kabanoff & O'Brien (1980)suggested that the work-leisure relationship be usedas an independent variable, or an active personalitycharacteristic. Such use can explain how activitiesand satisfaction with life are structured by individualdifferences in personal orientations to work andleisure rather than solely by the constraints of thework situation.

Irrespective of few conclusive findings thus far inthis particular area of social science research, it isencouraging to note that the receni reconceptualiza-tions of the work-leisure relationship may provide asound basis for continuing study. This entire area ofwork-leisure meanings, and the factors which shapetheir relationship, appears to be one which is fertilefor empirical investigation.

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References

Berger, P.L. (1964) The hianan shape of work. New York:Macmillan

Bishop, D. & Ikeda, M. (1971). Status and role factors in theleisure behavior of different occupations. Sociology andSocial Research, 54, 190-208.

Blauner, R. (1964) Alienation and freedom. Chicago: Universityof Chicago Press.

Bolton, B. (1980). Second-order dimensions of the work valuesinventory. Journal of Vocational Behavior, 17, 33-40.

Ennis, P.H. (1968). The definition and measurement of leisure.In E.B. Sheldon and W.E. Moore (Eds.), Indicators of socialchange: Concepts and measurements. New York: 7i issellSage.

Florian, V. (1982). The meanings of work for physically disabledclients undergoing vocational rehabilitation. InternationalJournal of Rehabilitation Research, 5, 375-377.

Florian, V. & Har-Even, D. (1984, December). The meaning ofwork: a comparison of rehabilitation client groups.Rehabilitation Counseling Bulletin, 129-132.

Friedmann, E.A. & Havighurst, R.J. (1954). The meaning ofwork and retirement. Chicago: University of Chicago Press.

Guttmann, Sir L. (1976). Textbook of sport for the disabled.Aylesbury, Bucks, England: H.M. & M. Publisher, Ltd.

Havighurst, R.J. (1957). The leisure activities of theraiddle-age6. American Journal of Sociology, 63,152-162.

Havighurst, R.I. (1961). The nature and values of meaningfulfree-time activity. In R.W. Kleemier (Ed.) Aging andLeisure. New York: Oxford University Press.

Hendrick, B. (1985). The effect of wheelchair tennispaiticipation and mainstreaming upon the perceptions ofcompetence of physically disabled adolescents. TherapeuticRecreation Journal 19,34-46.

Hunt, S. (1979). Work and leisure in an academic environment:Relationships between selected meanings. ResearchQuarterly, 50,388-395

Hunt, S. (1985). Work-leisure relationships among theunemployed. Recreation Research Review, 11,14-21.

Hunt, S. & Brooks, K. (1980, August). Perceptions of wcrk andleisure: A study of industrial workers. RecreationManagemera, 31-35.

Hunt, S. & Weiner, A. (1982). Relationships between meaningsof work and meanings of leisure in a retirement community.Reciection Research Review, 9,29-37.

Iso-Ahola, S. (1)79). Basic dimensions of definitions of leisure.Journal of Leisure Resewch, 11,28-29.

Kabanoff, B. & O'Brien, G. (1980). Work and leisure: a taskattributes analysis. Journal of Applied Psychology,65,596-609.

Kando, T. (1975). Leisure and popular culture in transition. St.Louis: The C.V. Mosby Co.

Kando, T. & Summers, W. ,1971, Summer). The impact ofwork on leisure: toward a paradigm and research strategy.Pacific Sociological Review, 310-327.

Kelly, J.R. (1972). Work and leisure: a simplified paradigm.Journal of Leisure Research, 4,50-62.

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Krafting, L. & Brief .1976). The impact of applicantdissbility on colt% jgentents in the selection process.Academy of Management Journal, 19,675-680.

Labanowich, S. (1978). The psychology of wheelchair sports.Therapeutic Recreation Jountal, 1,11-17.

Madorsky, J. & Kiley, D. (1984).Wheclehair mountaineering.Archives of Physical Medicine and Rehabilitation,65,490-492.

Mannell, R. & Iso-Ahola, S. (1984). Work constraints onleisure. In M. Nadc (Ed.) Constraints on Leisure. Springfield,IL: Charles C. Thomas Publishing Co.

Morse, N.C. & Weiss, R.S. (1955). The function and meaningof work and the job. American Sociological Review,20,191-198.

Neulinger, J. (1971). Leisure arid mental health: a study in aprogram of leisure research. Pacific Sociological Review,14,288-300.

Orzack, L.H. (1963). Work as a central life interest ofprofessionals. In E.O. Smigel (Ed.) Work and Leisure: Acontemporary social problem. New Haven, CT: College andUniversity Press.

Parker, S.R. (1971). The future of work and leisure. London:MacGibbon & Kec.

Patrick, G. (1934) The effects of wheelchair competition onself-concept and acceptance of disability in novice athletas.Therapeutic Recreation Journal, 20,61-71.

Roadburg, A. (1982). Is there leisure without work? Journal ofLeisurability, 9,23-27.

Robinson, C. (1485). A comparison of the acceptance ofdisability by wheelchair athletes and wheelchair nen-athletes.Unpublished Masters thesis, Texas Women's University,Dcnton.

Rose, (3. & Brief, A. (1979). Effeets of handicap and jobcharacteristics on selection evaluations. PersonnelPsychology, 32,385-392.

Sandys, I. & Leaker, D. (1987). The impact of integratedemployment on leisure lifestyle. Journal of Leisurability,/4,19-23.

Shepard, J.M. (1974). A status recognition model of work-leisurerelationships. Journal of Leisure Research, 6,58-63.

Siegfried, W. & Toner, 1. (1981, September). Students' attitudestoward physical disability in prospective co-workers andsupervisors. Rehabilitation Counseling Bulletin, 20-25.

Stireitzer, E.A. & Snyder, E.E. (1974). Wo:k orientation,meaning of leisure and mental health. Journal of LeisureResearch, 6,207-219.

&Lyman, R. (1979). The effect of participation in wheelchairsports. Unpublished doctoral dissertation, University ofIllinois, Urbana-Champaign, Illinois.

Tausky, C. (1969). Meanings of work among blue-collar men.Pac0c Sociological Review, 12,49-54.

Wilensky, H. (1960). Work, careers and social integration.International Social Science Journal, 12,543-560.

bizanek, & Mannell, R. (1981). Work-leisurt. relationshipsfrom a sociological and social psychological perspective.Leisure Studies, 2,327-344.

ANNUAL IN THERAPEUTIC RECREATION, No. IL 1991 77

Answering Questions AboutTherapeutic Recreation Part I:

Formulating Research Questions

Bryan McCormick, M.S.David Scott, Ph.D.John Dattilo, Ph.D.

Abstract

Recognizing that therapeutic recreation specialists may find the prospect of conducting ristematic research anawesome task, thit paper seeks to explain how research methods are related to theoretical assumptions. Asubsequent paper identifies and describes specific research strategies that therapeutic recreation specialists mayfind useful when attempting to answer research questions. In the first part of this paper, we show how the choiceof research methods is related to underlying paradigmatic asswnptions espoused consciously or unconsciously bythe investigator. Two categories of paradigms are discussed within this paper: normative paradigms andinterpretive paradigms. Next, we will show how these two paradigms are related to the generation of theory.Finally, we show how these paradigms are related to the formulation of hypotheses and specific research questionsin therapeutic recreation research. This paper is intended to encourage specialists to consider different paradigmswhen attempting to answer questions relevant to the practice of therapeutic recreation.

Though research in the field of therapeuticrecreation has potential impact upon leisure servicedelivery to people with disabilities (Compton, 1984),research in this area has been shown to have anumber of limitations. Perhaps the most debilitatinglimitation is the absence of a systematic researchtradition in therapeutic recreation. The knowledgebase of therapeutic recreation has been dominated bywhat Witt (1988) described as the "power of thoughtapart from testable data" (p.15). Witt added thattherapeutic recreation research is slowly progressingfrom the social philosophy stage of knowledge, whereknowledge is based on speculation, rationalizationand conjecture, through the social empiricism stageof knowledge, where knowledge is based ondescriptions of existing conditions, to finally thesocial analysis stage of knowledge, where knowledgeis based on systematic efforts to understandrelationships. A related limitation is the smallnumber of actual research studies annually published(cf. Iso-Ahola, 1988). Of the studies that have beenpublished, the majority have reported findings dealingwith a few disability groups, with some groups


receiving scant empirical attention (Iso-Ahola, 1988).A third limitation is that therapeutic recreationresearch has relied on a limited number of specificresearch methods. For example, Mannell (1983)reported that survey methods were the predominantmethod of data collection in research published in theTherapeutic Recreation Journal and di.: Journal ofLeisurability between the years 1968-19532. Similarfindings were reported by Schleien and ermakoff(1983).

The above discussion may be summarized verysimply: the body of knowledge upon whichtherapeutic recreation practice is based is limited dueto the absence of a research tradition and theover-reliance upon survey methods. To advance the

Bryan McCormick is a doctoral student at Clemson University inthe Department of Parks, Recreation, and Tourism Management;David Scott is a visiting assistant professor at the University ofIllinois in the Department of Leisure Studies; and John Dattilo isan associate professor at the Universit; of Georgia in theDepartment of Recreation and Leisure Studies. The peper wasconceptualized while all three authors were at the PennsylvaniaState University.

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knowledge base in which therapeutic recreationpractice must be grounded, continued research effortsare needed. Many therapeutic recreation specialists,however, find the prospect of conducting researchoverwhelming given their inexperience in conductingresearch and/or the numerous options of researchmethods available in social sciences. If there isanxiety among thecapeutic recreation professionals inthese matters, it may be a result of a lack ofknowledge of research principles. Anxiety may alsostem from a lack of exposure to the linkage betweenthe act of creating research questions and the choiceof appropriate research methods. Indeed, thedecision to use one research method over anothermay be a function of the investigator's familiaritywith the method rather than his or her understandingof whether the method is appropriate in answering aspecific question. Finally, anxiety among therapeuticrecreation professionals may also be related to theirunfamiliarity with how theoretical perspectives guideresearch.

This paper provides the therapeutic recreationpractitioner a basic understanding of how researchmethods are related to theoretical assumptions. In thefirst part of the paper, we will show how the choiceof research methods is related to underlyingparadigmatic assumptions espoused consciously orunconsciously by the investigator. In the second partof the paper, we demonstrate how these assumptionsare related to the generation of theory. In the lastsection of the paper, we discuss how paradigmaticassumptions are related to the formulation ofhypotheses and specific research questions in

therapeutic recreation research. A subsequent paperwill identify and describe specific research strategiesthat therapeutic recreation professionals can use whenattempting to answer research questions.

As a point of departure, we agree with Compton(1989) who advocated that researchers in therapeuticrecreation should be familiar with a variety ofresearch methods. An eclectic research focusprovides the professional a myriad of research toolsto answer different research questions relevant totherapeutic recreation. An eclectic approach alsoechoes Kelly's (1980) argument that leisureresearchers, such as those attempting to answerquestions relevant to therapeutic recreation, cannotbegin to understand the complexities of leisurewithout embracing a range of research strategies:

Leisure is such a multi-dimensionalphenomenon that each research approach hasthe potential of furthering our understanding ofsome dimension. . . . There is no singlemethod that can begin to encompass, much lessexhaust, a complex phenomenon as leisure (p.312).

The Grounding of Researchin Theoretical Paradigms

Research questions tend to lend themselves todifferent methods of study (Mannell, 1983; Zelditch,1969). Furthermore, the choice of research methodsdictates how information is defined, collected,analyzed, and reported (Denzin 1978). In reality,however, the use of a particular research method is_Aten related to a person's academic training, anindication of acceptable practice, and/or a person'sphilosophical assumption& about the nature of theempirical world (Rist, 1977). In this section weexplore these hidden factors as a means of elucidatinghow paradigmatic assumptions underlie most socialresearch.

Theoretical paradigms were described by Ritzer(1975) in the following terms: A paradigm is afundamental image of the subject matter withina scienk.e. It serves to define what should bestudied, what questions should ba asked, howthey should be asked, and what rules should befollowed in interpreting the answers obtained.The paradigm is the broadest unit of consensuswithin a science and serves to differentiate onescientific community (or sub-community) fromanother (p. 157).

Weimer (1979) used a similar tern, metatheory, todescribe a conceptual scheme that enables resedrchersto interpret any conceivable instance of a phenomeafalling within its domain. Both the notions oftheoretical paradigm and metatheory suggest thatobservations or occurrences within the world areordered and interpreted in terms of paradigmatic ordomain assumptions. As noted below, this hasprofound impact on how researchers view a particularphenomenon, and how research questions aresubsequently formulued.

There are many specific theoretical paradigmswithin the social sciences. In sociology, examples ofspecific paradigms include structural-functional

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theory, conflict t'Aeory, exchange theory, andsymbolic interactionism. Examples of paradigms inpsychology and social psychology include gestalttheory, field theory, reinforcement theory, andpsychoanalytic theory. Two broad categories ofparadigms appear to incorporate individualparadigms. These two categories, as described byWilson (1970), include normative paradigms andinterpretive paradigms.' Normative paradigmsexplain behavior in terms of rules, and the form ofthe explanation is largely deductive. The deductivemethod of reasoning, attributed to Aristotle and theGreeks, is one in which general premises are relatedto specific instances (nest, 1977). Deci's (1980)organismic theory of motivation serves as a usefulexample. A basic assumption of the theory is thatpeople's perceptions and cognitive evaluations of theenvironment develop from their experiences insatisfying the basic needs of self-determination andcompetence. This premise nu y be readily applied toan analysis of people with disabilities. Specifically,the therapeutic recreation specialist may hypothesizethat when people with disabilities are given choicesduring recreation participation they will express ahigher level of satisfaction than if they are notafforded such choices.

Interpretive paradigms include theoretical systemswhich conceive behavior as a formative and emergentprocess, and explanations are largely inductive ratherthan deductive. Inductive reasoning begins withspecific observations and then builds toward generalpatterns, thus, attempting to make sense of a situationwithout imposing preexisting expectations (Patton,1980). For example, therapeutic recreationspecialists working in chemical dependence observethat people suffering from alcoholism frequentlyexpress feelings of deviancy during counselingsessions. This observation may lead to t'le generalhypothesis that people with alcoholism perceivethemselves to be differ, from others and act towardthe world based on the lerceptions.

The Grounding of Research Within N 'nativeParadigms

What does it mean that behavior is explained interms of rules? Very simply, it means that behavioris conceived in terms lf a causal chain, wherebyvariation in one factor (an independent variable)produces a necessary change in another factor (adependent variable). The fundamental premise to this

80 ANNUAL IN THERAPEUTIC RECREATION, No. IL 1991

position is that there are various social,psychological, and physiological forces and driveswhich have an objective reality apart from individualmeaning and motivation. Although people may beregarded as conscious and capable of decisive action,human thought and action are ultimately explained interms of these forces and drives.

Sociological paradigms that are characteristic ofthe normative framework explain social life in termsof social facts. That is, the individual and his/hersocial behavior are "largely determined by socialstructure and institutions" (Ritzer, 1975, p. 159).There is virtually an endless number of social factsthat can be seen to have an impact on humanbehavior, including occupation, education, income,laws, customs and so on. Psychological and socialpsychological paradigms - gestalt theory, field theory,reinforcement theory, and psychoanalytic theory -explain behavior in terms of different conceptions ofhumankind. Together, however, the perspectivesassume that the individual is composed of "a set ofbuilt-in needs, drives, and psychic or physiologicaldemands which call out fixed responses (Lindesmith,Strauss, & Denzin, 1975, p. 8).

With normative paradigms, explanations ofbehavior follow the deductive logic of the naturalsciences (Wilson, 1970). A deductive argument inthe natural sciences includes a description of objectsor events that has a stable meaning across a range ofsituations. In research, this is facilitated by thecreation of concepts and operational definitions thatare unambiguous and context-free in terms of theirmeaning. Concepts, in their most elemewal form,are intellectual tools used for guiding research.Concepts are abstract, however, and are ordinarilyoperationalized using fixed or established indices.Once a concept is given a stable meaning, it may beeasily expressed in quantitative terms, thus, providingan empirical standard so that phenomena may becompared across a variety of situations (Rist, 1977;Scott & Godbey, 1990). For example, a conceptsuch as social class becomes simplified and readilycommunicated if operationalized using indicators suchas income and level of education. These operationsare straightforward and unambiguous, and provide areliable index for measuring the concept.

The Grounding of Research Within InterpretiveParadigms

Interpretive paradigms are united under the

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assumption that behavior is a formative and emergentprocess in its own right. More simply, the individualis conceived as an active agent within his or herparticular life-space. Unlike the normative paradigm,then, behavior is not treated as an expression ofstructural forces and acquired dispositions. Instead,the individual is seen as actively involved in theorganization of daily routines (Blumer, 1966, 1969).

Advocates of the interpretive paradigm seek toexplain behavior by discovering the social meaningsunderlying human activity. It is believed that themeaning of social phenomena (ways of doing things,material objects, etc.) are constructed out of socialinteraction. From an interpretive paradigm, then,social phenomena 'line no intrinsic meaning. That is,reality is not constructed in the same manner for allpeople (Bullock, 1983). For example, the meaningof the term leisure may have qualitatively differentmeanings for different people. For some people, theterm may connote the freedom to pursue activity thatis pleasurable. For others, the term may suggest anabsence of productive work. In any case, a researchapproach grounded within the interpretive paradigmmight seek to discover the meaning of the term acrossdifferent groups and explain how people within thesegroups act on the basis of their shared defi.iition ofthe term.

Methodologically, research grounded withininterpretive paradigms use n inductive logic ratherthan a deductive logic. Methods chosen are ones thatare sensitive to individual experiences. Examples ofmethods appropriate for this type of research includeparticipant observation, in-depth (open-ended)interviewing, life history interviewing, contentanalysis of personal and official documents, andexpel ience sampling method. These methods havebeen described as naturalistic bei:ause they seek todepict social life as it appears to people underinvestigation. Frequendy, neither hypotheses noroperational definitions are used when usingnaturalistic methods. Instead, concepts andhypotheses are actually generated from data (Glaser& Strauss, 1967).

Theory and Generating ResearchQuestions

A theoretical r aradigm, although bound by keyassumptions, represents only a general orientation to

9 7

the study of behavior. The paradigm provides clues

as to the types of variables or questions of interestwithout providirg a systematic explanation of anygiven phenomenon (Deutsch & Krauss, 1965). Tosystematically explain behavior, theoretical paradigmsare comprised of a number of middle range theories(Merton, 1957). A theory of dm middle range is

consistent with traditional definitions of theories.That is, it is a systematic explanation of somephenomenon which includes an integrated body ofdefinitions and propositions. Theories of this typetypically seek to explain a limited amount of humanbehavior. Examples of middle range theories inleisure research include Iso-Ahola's (1986) theory ofsubstitutability of leisure activity, Csikszentmihalyi'stheory of enjoyment (1975), and Parker's theory ofwork-leisure relationships (1971). Althoug'l theoriesgenerated within both normative and interpretiveparadigms seek to explain phenomena in the socialworld, the process in which this occurs differsmarkedly depending on one's paradigmaticorientation.

Theories grounded within a normative paradigmspecify the need to establish causal relationshipsamong selected variables prior to implementinginvestigations. This is done by generating hypothesesthat lend themselves to systematic testing. Theresearch act is then a means of ver6ing theusefulness of the theory. Hence, normative theoriesnot only seek to explain social life, but they alsoideally serve as a guide, in the form of hypotheses,for systematic research.

Theories grounded in interpretive paradigms, onthe other hand, are discovered after pursuingsystematic research. Hypotheses and explanations ofbehavior are proposed (grounded) from actualincidents in the empirkal world (Glaser & Strauss,1967) once intimate experience and in-depthknowledge of social world activity is developed.Therefore, something other than hypotheses andoperational definitions must be used in guidingresearch. To provide the opportunity for discovery,general research questions are used that are relativelyopen-ended in conjunction with sensitizing concepts(Blumer, 1954). Sensitizing concepts provide cluesand suggestions upon which to make observations.Concepts of this sort are not treated in a precise,definitive manner. Instead, they are used merely asa point of reference in the process of discoveringpatterns of behavior.

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Normative Pamdivns

Ideally, a research approach grounded within anormative paradigm would be one where hypothesesare derived and tested within the framework of amiddle range theory. In many cases, however,hypotheses or specific research questions are derivedwhich are divorced from theory. Still, there is anunderlying belief that the empirical world is lawfuland is subject to systematic investigation usingconcepts and definitions that have an unambiguousand objective meaning.

What does this say about the study of leisure?From a normative paradigm, leisure is defined(treated) as something that can be observed orinferred as it is believed to exist independently ofsubjective experiences. The implication is thatleisure may be reduced to its most elementalcomponents for purposes of systematic inquiry. Asnoted above, this is accomplished by defining andoperationalizing terms using straightforward andunambiguous procedures.

Studies on leisure motivation (e.g., Beard &Ragheb, 1983; Crandall, 1980; Iso-Ahola & Allen,1982) serve as a useful case in point. A researchquestion might be posed as follows: "Are certainleisure motives associated with certain leisurebehaviors?" Two variables or components areinferred from this question. First, there is the issueof what constitutes a leisure motive. Leisure motivesmust be defined in such a way that it provides a cleardefinition of the concept as well as providing amethod for observation. This is typically done bygenerating a number of questions that collectivelyform a leisure motives scale. For instance, a sampleitem used to measure leisure motivation is "I like tosee the results of my efforts" (e.g., Crandall, 1980).The assumption here is that all people who see orhear this statement will interpret it in a similarmanner. To the extent that the item is shown to becorrelated with items of a similar nature, theassumption seems plausible. Second, leisurebehaviors must be operationalized in some systematicfashion. This may be readily done by definingleisure as activity, such as dancing, camping, cycling,and so on. This definition is not only unambiguous,it provides a ready means of classifying people intocategories of leisuce behavior. After a sample ofrepresentatives of each category of leisure behaviorare tested in regard to their leisure motives, a simple


statistical procedure (e.g., analysis of variance) maybe performed. From this, it may be determinedwhether certain motives are associated with certainleisure behaviors.

This approach may oe readily extended to studyingthe efficacy of therapeutic recreation interventions.Therapeutic recreation professionals are interested ina number of questions. What is the most efficaciousleadership style in a specified leisure educationprogram with a specific group of people withdisabilities? Is one type of leisure education programmore effective in increasing leisure satisfaction thananother? Does an appropriate leisure lifastylecontribute to a high quality of life? Each of thesequestions can be answered using a similar strategy asdescribed above. In short, variables of interest areoperationalized in such a way as to facilitatesystematic testing.

Interpretive Paradigm

Research grounded within an interpretive paradigmdoes not seek to explain social life in terms of merevariables. As noted already, interpretive paradigmstreat humans as active agents in the way they goabout their daily routines. Hence, behavior is not amere expression of social and psychological forces;rather, it is conceived as something that peopleaccomplish. The goal, then, of interpretive researchis to discover how people go about organizing theirbehavior. This entails discovering how peopleinterpret and define both their environment and theiractions. To this end, a research design is naturalisticand holistic: researchers ideally study people withinthe context of their day-to day affairs, and analysisincorporates a range of factors and conditions.

The implications for leisure research may be statedas follows: the proper study of leisure is within thecontext of actual involvement. On the one hand, thismeans that ieisure may be studied within the streamof people's on-going experiences. The experiencesampling method, for example, provides data whichassess people's moods, emotional and physical states,and their rationale for participation in a givenactivity.' On the other hand, studying leisure interms of actual involvement means studying leisure asa formative process. In this regard, research iscentered on how people create patterns (styles) ofactivity in light of opportunities, role definitions,

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perceived constraints, various personality needs, andSO on.

A fundamental question, then, to be answered inresearch grounded within the interpretive paradigmis: how do the people under study view their worldor certain aspects of it? Specific research questionsrelevant to therapeutic recreation can readily begenerated; What is the experience (meaning) ofleisure among people with disabilities? What is theexperience (meaning) of leisure in institutions? Whatstrategies do people in institutions employ toexperience leisure? What is the perception oftherapeutic recreation programs among people withdisabilities? Can therapeutic recreation interventionschange how people view their world? An answer tothese questions entails an integrated and holisticexplanation that is gleaned from the study of livedexperiences, as expressed in verbal accounts andobserved behavnr.

Therapeutic Recreation as anEclectic Profession

In this paper, we have sought to demonstrate hownormative and interpretive paradigms are related tothe choice of research methods. In general, researchconducted within the framework of a normativeparadigm seeks to demonstrate the relationship amongvariables. This approach to research stems from anassumption that social life is law-like. That is,behavior is explained in terms of a causal chain:change in one factor (an independent variable) isthought to lead to change in another factor (adependent variable). Consistent with the logic ofdeductive reasoning, hypothesis and operationaldefinition are constructed a pr., ri as a means ofguiding the research process. On the other hand,research grounded within an ihwrpretive paradigmseeks to discover how people actively go aboutorganizing their daily routines. Research, then, ismore of an inductive affair whereby hypotheses andconcepts are discovered from having participated inthe lives of the people under investigation. Researchmethods are naturalistic in the sense that people arestudied within the context cf their day-to-day affairs,and analysis inorporates a variety of factors andconditions. This research approach stems from thebelief that the individual is an active agent within hisor her life space.

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Historically, people conducting research related totherapeutic recreation have been trained using onlyone paradigm. While a particular paradigm is usefulin many situations, it is only one perspective inapproaching the study of leisure in therapeuticsettings. Educators exposing their students to onlyone paradigm are encouraged to explain anddemonstrate the effectiveness of other paradigms andassociated methods. Such an approach to the studyof social life results in questions dictating the types ofmethods appropriate for study. The practice ofchoosing research methods prior to establishing aresearch question, rather than the reverse, can behazardous to professionals attempting to conductuseful research.

Therapeutic recreation is a profession serving awide range of individuals. People receivingtherapeutic recreation services may vary considerablyin skills, limitations, age, interests and experiences.For hstance, therapeutic recreation specialists can befound providing intense therapy with youngadolescents recovering from traumatic injuries,leisure education with older adults requestingpsychiatric services, or recreation participation foryoung children experiencing serious terminalillnesses. To respond to the diversity of peopleserved and the myriad of environments whereservices are provided, therapeutic recreationspecialists are required to employ a variety ofintervention strategies generated from differenttheoretical perspectives. Therefore, therapeuticrecreation is viewed as an eclectic profession (Austin,1982). To meet the needs of their consumers,therapeutic recreation specialists must be open todifferent perspectives and recognize that someintervention strategies may be more effective withsome individuals than others. Practitioners oftenblend interventions emerging from humanistic,behavioristic and psychoanalytic perspectives.

The acceptance of an eclectic position in referenceto the practice of therapeutic recreation is not onlyvaluable but appears necessary for survival of theprofession. The intention of the authors is toencourage professionals to continue using this eclecticperspective when attempting to empirically answerquestions related to therapeutic recreation. Thediversity associated with therapeutic recreation createsa multitude of questions to be answered. Somequestions related to therapeutic recreation may bebest answered through a normative paradigm while


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the interpretive paradigm may be superior inanswering other questions. In many situations it maybe extremely valuable to incorporate both paradigmsto allow professionals to gain in depth understandinginto some issues.

References

Austin, D. (1982). Therapeutic recreation: Processes andtechniques. New York: John WLey & Sons.

Beard, J.G., & Ragheb, M.G. (1983). Measuring leiauremotivation. Journal of Leisure Research, 15, 219-228.

Best, J.W. (1977). Research in education (3rd ed.). EnglewoodCliffs, NJ: Prentice Hall.

Blumer, H. (1954). What is wrong with social theory? AmericanSociological Review, 19(1), 3-10.

Blumer, H. (1966). Sociological implications of the thought ofGeorge Herbert Mead. American Journal of Sociology, 71,535-544.

Bullock C. (1983). Qualitative research in therapmtic recreation.Therapeutic Recreation Journal, 17(4), 36-43.

Csikszentmihalyi, M. (1975). Beyond boredom and anxiety. SanFrancisco: Jossey-Bass Publishers.

Compton, D.A. (1989). Reaearch initiatives in therapeuticrecreation. In D.A. Compton (Ed.), Issues in therapeuticrecreation (pp. 427-444). Champaign, IL: Sagantore.

Compton, D.A. (1984). Research priorities in recreation forspecial populations. Therapeutic Recreation Journal, 18(1),9-17.

Crandall, R. (1980). Motivations for leisure. Journal of LeisureResearch, 12, 45-54.

Deci, E.L. (1980). The psychology of self-determination.Lexington, MA: Lexington Books.

Denzin, N.K. (1978). The research act. New York:McGraw-Hill.

Deutsch, M., & Krauss, R.M. (1965). Theories in socialpsychology. New York: Basic Books, Inc.

Glaser, B.G., & Strauss, A.L. (1967). The discovery of groundedtheory: Strategies for qualitative research. New York: AldineDe Gruyter.

Iso-Ahola, S.E. (1986). A theory of substitutability of leisurebehavior. Leisure Sciences, 8(4), 367-389.

Iso-Ahola, S.E. (1988). Research in therapeutic recreation.Therapeutic Recreation Journal, 22(1), 7-13.

Iso-Ahola, S.E., & Allen, J.R. (1982). The dynamics of leisuremotivation: The effects of outcome on leisure needs.Research Quarterly for Exercise and Sport Science, 53,141-149.

Kelly, J. (1980). Leisure and quality: Beyond the quantitativebarrier in research. In T.L. Goodale, & P.A. Witt (Ed.),Recreation and leisure: Issues in an era of change (pp.300-314). State College, PA: Venture Publishing.


Lindeamith, A.R., Strauss, A.L., & Denzin, N.K. (1975). Astatement of position: Symbolic interactionism as perspectiveand method. In A.R. Lindesmith, A.L. Strauss, & N.K.Denzin (Ed.), Readings in social psychology (pp. 5-19).Hinsdale, IL: The Dryden Press.

Manna, R.C. (1983). Research methodology in therapeuticrecreation. Therapeutic Recreation Journal, 17(4), 9-16.

Merton, R.K. (1957). Social theory and social structure.Glencoe, IL: The Free Press.

Patton, M.Q. (1980). Qualitative evaluation methods. BoverlyHills: Sage.

Parker, S. (1971). The future of work and leisure. New York:Priteger Publishers.

Rist, R. (1977). On the relations among education researchparadigms: From disdain to detente. Anthropology andEducation Quarterly, 8(2), 42-49.

Ritzer, G. (1975). Sociobgy: A multiple paradigm science. TheAmerican Sociologist, 10(3), 156-167.

Scott, D., & Godbey, G. (1990). Reorienting leisure research -The case for qualitative methods. Society and Leisure, 13(1),89-205.

Schleien, S.J., & Yermakoff, N. (1963). Data-based research intherapeutic recreation. Therapeutic Recreation Journal, 17(4)17-26.

Weimer, W.B. (1979). Notes on the methodology of scientricresearch. Hillsdale, NJ: Lawrence Earlbaum Associates.

Wilson, T.P. (1970). Normative and interpretive paradigms insociology. In J. Douglass (Ed.), Understanding everyday life(pp. 57- 79). Chicago: Aldine.

Witt, P.A. (1988). Therapeutic recreation research: Past, presentand future. Therapeutic Recreation Journal, 22(1), 14-23.

Zelditch, M. (1969). Some methodological problems of fieldresearch. In G.J. McCall, & J.L. Simmons (Ed.), Issues inparticipant observation: A text and reader (pp. 5-19).Reading, MA: Addison-Wesley Publishing Company.

Footnotes

1. We do not criticize the use of survey methods in therapeuticrecreation research; we do question, however, the use of surveymethods at the expense of other methods.

2. Many writers associate normative paradigms with quantitativeresearch and interpretive paradigms with qualitative research.Although there is a tendency for researchers working within anormative paradigm to use methods that generate quantitativedata and researchers working within an interpretive paradigm touse methods that generate qualitative data, the methodsthemselves are not in themselves inherently quantitative orqualitative.

3. In studies utilizing the experience sampling technique,subjects carry an electronic pager and a questionnaire bookletfor a specified period of time. At random intervals, subjects arcbeeped thus serving as a stimulus for them to complete self-reportforms.

lPu

Answering Questions AboutTherapeutic Recreation Part II:

Choosing Research Methods

John Dattilo, Ph.D.Bryan McCormick, M.S.

David Scott, M.S.

Abstract

To systematically answer questions relevant to the practice of therapeutic recreation. specialists increasinglyrecognize the necessity of pursuing research. If therap4utic recreation professionals are to build a specializedbody of knowledge, they must become familiar with a variety of research methods. In this paper, five researchmethods are presented: experimental methods, single-subject methods, survey methods, participant observation,and in-depth interviewing. The first three methods are generally associated with normativeparadigms, while thelatter two are generally associated with interpretive paradigms. The five methods are discussed in terms ofsampling, data collection, data analysis, strengths and weaknesses, and applications to therapeutic recreation.It is hoped that specialists will consider a variety of research methods when attempting to answer questionsrelevant to the practice of therapeutic recreation.

The purpose of the paper, Answering QuestionsAbout Therapeutic Recreation Part I: FormulatingResearch Questions, was to provide therapeuticrecreation professionals an understanding of thelinkage between theoretical paradigms and thegeneration of hypotheses and research questions. Twocategories of paradigms were discussed: normativeand interpretive. Normative paradigms explainbehavior in terms of a causal chain, whereby changein one factor (an independent variable) is examined intains of its influence on another factor (a dependentvariable). Following the logic of deductivereasoning, hypotheses and research questions areconstructed to allow for systematic testing of therelationship among variables. This is facilitated byoperational definitions that are unambiguous and havea stable meaning across different situations.Interpretive paradigms, on the other hand, explainbehavior as a formative process: the ind;vidual istreated as an active agent within his or her life space.Research grounded in the interpretive paradigm seeksto discover how people actively go about organizing

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their daily routines. Research, then, is an inductiveprocess where hypothesis and explanations arediscovered from having participated in the lives ofpeople under investigation.

The focus of the previous paper serves as afoundation for this paper--the examination of specificresearch methods appropriate for therapeuticrecreation. In this paper, five types of researchmethods are presented: (a) experimental research, (b)single-subject research, (c) survey methods, (d)participant observation, and (e) in-depth interviewing.The first three methods are generally associated withnormative paradigms, while the latter are typical ofinterpretive paradigms.' The choice of these

John Dattilo is an associate professor at the University ofGeorgia in the Department of Recreation and Leisure Studies;Bryan McCormick is a doctoral student at Clemson University inthe Department of Parks, Recreation, and Tourism Management;and David Scott is a visiting assistant professor at the Universityof Illinois in the Department of Leisure Studies. The paper wasconceptualized while all three authors were at the PennsylvaniaState University.

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methods, on the one hand, serves to illustrate hownormative and interpretive research strategies areused. On the other hand, the five research methodswere chosen because they appear to be the mostfrequently used and suited to answer questions aboutthe implications of therapeutic recreation services onthe lives of persons with disabilities. Each researchmethod will be described relative to sampling, datacollection', and data analysis. Moreover, thestrengths and weaknesses associated with eachmethod will be briefly discussed. Finally, specificexamples of the application of each research methodin therapeutic recreation research will be presentad.

Given the space limitation, it is impossible todescribe all factors relevant to each of the fiveresearch methods. What we hope to do is providethe therapeutic recreation practitioner a simpleunderstanding of how each of the methods may beused. The reader is advised to examine the variousreferences to further his or her knowledge of how thefive methods may be applied to his or her particularsiturition.

Research Methods Appropriatefor Normative Research

Three methods associated with normative researchare described: (a) experimental designs, (b)single-subject designs, and (c) survey designs. Thesethree methods have been selected because they offerways to clearly understand leisure behavior ofpersons with disabilities and allow therapeuCe.recreation research to focus on relationships amongvariables.

Erperimental Methods

Studies that use experimental research methodsseek to answer questions concerning causalrelationships among factors (variables) through aprocess of manipulation and control. In the mostsimple case, one factor is deliberately manipulatedwhile all other factors are held constant (controlled),and the effects of the manipulation upon anotherfactor are observed. In experimental terms, themanipulated factor is termed the independent variableand the observed factor is the dependent variable.The logic of experimental research is straightforward:if distinct groups of subjects are treated exactly thesame except for the independent variable, anydifference observed among the groups in terms of


some dependent variable is due in all likelihood to theindependent variable (Johnson & Solso, 1978).

Before describing the elements of experimentaldesign, it should be noted that therapeutic recreationresearch is more apt to use what is known as quasi-experimental research rather than true experimentalresearch. In true experimental raearch, control ofextraneous variables is accomplished at the expenseof realism. Indeed, subjects in true experimentalresearch are often conscious that they are participantswithin an experiment. In quasi-experimental research,control of extraneous variables is often sacrificed infavor of realism: subjects in quasi-experimentalresearch are frequently not aware that they areparticipants within an experiment. Although notalways possible, quasi-experimental designs shouldapproximate true experimental daigns as a means ofinsuring validity of results.

Sampling. In experimaital research, subjects inthe experimental group should possess similarcharacteristics (age, intelligence, personality type,level of education, type of disability, and so on) assubjects in the control group. This may beaccomplished by randomly assigning subjects toexperimental and control groups respectively or bymatching. If subjects in experimental and controlconditions are not different, the external validity ofexperimental findings are strengthened. If theseconditions are not met, the generalizability ofexperimental results to other groups, situations, orsettings may be questioned (Cook & Campbell,1979).

Data collection. Data collection in experimentalresearch revolves around themanipulation of one ormore independent variables and determining how thisinfluences a dependent variable. An independentvariable is manipulated in such a way that subjectswithin an experimental group receive some differenttreatment than subjects within a control group. Forexample, in a therapeutic recreation setting, clientsmay be divided into two programs which differ interms of the types of motor skills used. Thedependent variable is measured using some specifictest or instrument. In some studies, it may be ofinterest to determine how clients change over time inregard to some predefined measurement. In thwecases, a test or instrument is administered at somepoint preceding (pre-test) and at some point following(post-test) experimental manipulation. Differencesbetween pre- and post-test scores constitute thedependent variable for all experimental and controlgroup subjects.

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During experimental manipulation, it is 'Tnportantthat experimental and control group subjects receivethe same treatment except for the specifiedexperimental manipulation. The internal validity ofthe study is threatated if observed differencesbetwlen experimental and control gmp subjects canbe explained away by some measurement artifact.For example, exprzimental and control group subjectsmay participate in the experiment under the directionof different investigators. Observed differences maybe a function of investigator error rather thanexperimental manipulation (Cook & Campbell, 1979).

In choosing an instrument to measure thedependent variable, the reliability of the test must bedetermined. Reliability of an instrument focuses onthe consistency and accuracy of the test. The pivotalquestion surrounding the reliability of a measurementmay be stated as follows: would similar results beobtained if this experiment were performed againwith the same groups?

Data Analysis. Measures of the dependentvariable are first reduced by calculating measnres ofcentral tendency (e.g., means) and dispersion (e.g.,standard deviations) for pre- and post-test scores foreach group separately. Statistical analysis is thenused to determine whether differences betweengroups ar; greater 'than chance occurrence. Resultsof this analysis are generally presented in tabularform, particularly in the form of t-test tables andanalysis of variance tables.

Strengths and weakiesses of experimentalmethods. True experimental research is regarded bymany writer5 as invaluable in explaining hypothesizedrelationships between two variables (Isaac andMichael, 1981; Mannell, 1980). The reason for thisis that experimental methods allow for the isolation ofan independent variable to determine its effect onsome dependent variable. Hence, a key advantage oftrue experimental research is the experimental controlover extraneous variables. The major disadvantageof this method is that to gain this degree of control,the experiment is usually conducted in a laboratorywhere subjects behave under highly artificialconditions. Indeed, true experimental resezrch hasbeen criticized because subjects tend to be responsiveto the demand characteristics of the experiment(Orne, 1962). Second, it is difficult to strictly followconventions of probability sampling in therapeuticrecreation settings because of problems in identifyingthe entire population. While researchers may wish to

conduct an experiment with a particular group ofpeople with a disability, it may be infeasible becausepeople who have the particular disability may not beinstitutional!zed or known. Similarly, the designcited as affording the most controlRandomizedSolomon Four Group designrequires four separategroups of subjects (Campbell & Stanley, 1963).Locating enough subjects to fulfill the requirementsof this design is "ften prohibitive in therapeuticrecreation settings. Another difficulty arises inethical concerns of withholding treatment, or using aplacebo treatment, with control groups. However,this difficulty may be overcome by allowing thecontrol groups to receive the treatment following thefinal post-test.

The net result of these difficulties is that mostexperimental research in therapeutic recreation ismore appropriately termed quasi-experimentalresearch (Mannell, 1983). As noted, in quasi-experimental research, researchers approximateconditions of the experiment (cf. Isaac & Michael,1981). These approximations lessen the degree ofcontrol over threats to both internal and externalval idity.

Example of experimental research to therapeuticrecreation. Shary and Iso-Ahola (1989) wereinterested in examining the effects of a control-relevant intervention strategy (independent variable)on nursing home residents' perceived competence andself-esteem (dependent variables). Specifically, itwas of interest to determine whether increased oppor-tunities to exercise personal choice and responsibilityled to an increased feeling of competence andself-esteem. The independent variable wasmanipulated by varying the amount of personalchoice and responsibility nursing home residents wereallowed to exercise. The dependent variable wasmeasured using two scales. Perceived competencewas measured by a 10-item scale developed by theauthors, and self-esteem was measured by a 10-itemSelf-Esteem Scale developed by Rosenburg (1965).Subjects were administered pre- and post-tests beforeand following the intervention strategy. Afteranalyzing the data with one-way analysis ofcovariance, Shary and Iso-Ahola (1989) reported thatnursing home residents allowed to exercise personalcontrol and responsibility had a significantlyincreased sense of competence and self-esteem

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compared to nursing home nsidents not allowed toexercLe personal control and responsibility.

Single-Subject Methods

Single-subject methods offer an alternativeexperimental approach to answering questions ofcausal relationships. The essential feature of asingle-subject design is that all conditions are appliedto the same subject, and the results of the change inbehavior are analyzed with respect to that individual(Repp, 1981). Typically, single-subject designsexamine a few cases extensively, via repeatedmeasurement, to verify functional relationshipsbetween an individual's behavior and environmentalchanges (Dattilo, 1986). This procedure stressesinferences perta!ning to and findings applicable to theindividual (Dattilo, 1989). The application of thismethod involves designing investigations which allowtherapeutic recreation specialists to determine anindividual's performance and infer with confidencethat a functional relationship between plannedinterventions and behavior change ex:st (Dattilo,1986).

Sampling. Sampling in single-subject designs isusually accomplished through judgmental sampling(Babble, 1989) which is a form of purposivesampling.' Subjects are chosen based on criteria thatare judged relevant by the researcher. Effective useof judgmental sampling requires an adequateknowledge of the population under investigation.Since utilization of single-subject designs permitdevelopment of applied research, therapeuticrecreation practitioners are able to work directly withsubjects as a means of generating resu!ts that have animpact on their day-to-day lives (Kazdin, 1982).

Data collection. Single-subject research seeks toaddress changes in a dependent variable followingintroduction of an independent variable on anindividual. While single-subject experiments mayinvolve more than a single person, results arereported in terms of each individual rather than as anaggregate. To control for internal validity,single-subject designs require each individual to actas his or her own control by permitting the systematicapplication of all conditions to each subject (Dattilo,1987; Repp 1981). In addition, internal validity isenhanced through repeated measurement of thedependent variable. This permits extensiveexamination of changes in behaviors over time, thusmitigating the possibility of attributing change to

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historical accidents. External validity is enhanced insingle-subject research through various forms ofreplication (McReynolds & Thompson, 1986). Sinceovert behavior is the most common form of data insine:. subject research, reliability is strengthened byassessing the correspondence of data collected byseparate observers.

Data analysis. In single-subject research, visualinspection of data are emphasized (Dattilo, 1989).According to Dattilo, visual inspection involvescreating a graphic representation of the observationsof each subject over the course of the experiment andvisually inspecting this graph to identify magnitudesand rates of change. The creation of a graphicrepresentation results in data display. Once thisdisplay has been created, data are reduced for eachindividual by identifying trends in data.

Strengths and weaknesses of single-subjectresearch. Dattilo (1989) cited a number ofadvantages of single-subject research. One advantageis that this approach requires fewer subjects than tnieor quasi-experimental research, since subjects act astheir own control. This contributes to a clinicallyfeasible procedure. Because subjects act as their owncontrol, treatment (independent variable) is applied toall subjects in the study. Thus, ethical concerns ofwithholding treatment can be addressed. Anotheradvantage is that results are reported in terms ofindividuals as opposed to averages, allowing personswishing to use the treatment in a therapeuticenvironment to examitle Mividual responses totreatment. A major -vantage of single-subjectdesigns is that it has Ili' ...IL.% external validity du- tothe small number ti" sub! cts. Another disadvautageis that units of analisis in single-subject designs aretypically observat hrAl measurable behaviors(Dattilo, 1989). Aa h result, concepts not readilyoperationalized in terms of behaviors may not lendthemselves to this method.

Example of single-subject research to therapeuticrecreation. Schleien, Cameron, Rynders and Slicl:(1988) examined the effects of a multi-facetedtraining program on the acquisition and generalizationof (a) three specific recreation activity skills, (b)social interaction skills, and (c) play behaviors (i.e.,cooperative and appropriate). The investigatorsemployed a multiple-baseline design across behaviors(different activities) replicated across two childrenwith severe multiple disabilities. Schleien andcolleagues observed that both children gained

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sufficient skills to participate independently in two ofle three recreation activities, and demonstratedimprovements in social interactions and the ability toplay.

Survey MethodsAccording to Kerlinger (1973), survey research

examines populations, both large and small, as ameans of answering questions about the "relativeincidence, distribution, and interrelationa ofsociological and psychological variabla" (p. 410).Examples of relevant kciological variables includesex, education, race, age, and size of family, whileexamples of psychological variables include attitudes,motives, and opinions. Survey research isparticularly appropriate when variables do not lendthemselves to experimental treatment and controlledmanipulation. Historically, survey research has beenthe predominant method in leisure (Riddick,DeSchriver, & Weissinger, 1984) and therapeuticrecreation research (Iso-Ahola, 1988; Mannell,1983). While this trend has been criticized (Mannell,1983), the need for rigorous survey usearch exists asa means answering various research questions.

Sampling. The ideal sampling method in surveyresearch is probability sampling (Babble, 1989). Asin experimental research, probability sampling isparticularly useful for establishing external validitysince respondents are assumed to be representative ofthe population from which it was drawn.

Data Collection. Data collection involves twoprimary steps. First, a suitable survey instrumentmust be located or developed. The primary criterionfor using or not using an instrument is the extent towhich it adequately addresses the research question(Babbie, 1989). This means that concepts must beoperationalized in the form of questions or statementsthat allow for consistent and straightforwardmeasurement. Equally important, however, is thatoperational procedures must accurately define theconcepts under investigation. For example, using apreviously developed scale that includes multipleitems is often prudent because it allows foridentification of reliability and internal validity priorto implementation. If a suitable instrument cannot belocated, the researcher may face the task of creatinga new one. Pilot-tating the new instrument allowsfor the identification of biased, ambiguous orconfusing questions (Isaac & Michael, 1981). In thisway, the reliability and internal validity of the

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instrument is maximized.In conjunction with the development of an

instrument, implementation strategies must beconsidered. Survey instruments are typicallyimplemented in one of three ways: (a) through themail; (b) in the context of face-to-face interviews;and (c) in the form of a telephone interviews.Depending on the type of implementation strategydevised, researchers must consider factors such as thenumber of mailings, strategia for randomlyselecting subjects (e.g., random digit dialing,selection of individuals from households), training ofinterviewers, and handling of non-responses.

Data Analysis. As with experimental groupdesign, statistical procedures are typically used in theanalysis of survey data. Indeed, the hallmark ofsurvey research is the testing of statisticalrelationships among several variables. In this way,results of survey analysis are reported in the form ofiliterrelationships, main effects, and interactions(Rosenburg, 1968).

Strengths and weaknesses of surveys. Surveysoffer some advantages in studying complex conceptssince it is possible to operationalize a single conceptthrough a number of procedures. Another advantageis that surveys can collect data frun large numbers ofsubjects efficiently. If researchers are studying alarge population, a survey is the most efficientmethod that can be utilized to collect data from asample large enough to be considered representative.A third advantage is that surveys frequently offer thepossibility of testing rival hypotheses and exploringother (secondary) relationships. This is facilitated byincorporating a multitude of other survey items withinthe data set. The primary disadvantage of surveys isthat they are unable to determine cause and effectamong variables. The best a survey can do isidentify relationships, but even these may bemisleading because of the presence of extraneous oruncontrolled variables (Rosenburg, 1968). A seconddisadvantage of surveys is they are a reactive method(Isaac & Michael, 1981; Kerlinger, 1973). Theinstrument may tip-ofi the respondent as to sociallyappropKate responses. Similarly, surveys oftenencourage people to respond to questions pertainingto situations that are completely hypothetical, if notcompletely divorced, from their day-to-dayexperiences (Scott & Godbey, 1990). In these ways,respondents can control or manipulate their responsesin such a way that the validity of the results are

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threatened. A final disadvantage is that surveys arenot structured to allow for detailed answers. Asnoted by Kerlinger (1973), "the scope of theinfcrmation sought is usually emphasized at theexpense of depth" (p. 422).

Example of survey research to therapeuticrecreation. Cunningham and Bartuska (1989) utilizedthe survey method in order to determine whetherthere was a relationship between stress and leisuresatisfaction among therapeutic recreation specialists.Level of stress was operationalized using the PersonalStrain Questionnaire (Osipow & Spokane, 1987).Leisure satisfaction was measured using the LeisureSatisfaction Scale (Beard & Ragheb, 1983). Theresearchers collected this information, along withpertinent demographi: information, from 159therapeutic recreation specialists. Correlationcoefficients between the two scales were calculatedyielding high negative correlation coefficients.Cunningham and Bartuska concluded that upondentswith high levels of stress displayed low levels ofleisure satisfaction.

Research Methods Appropriatefor Interpretive Research

Topics appropriate for interpretive stinly can be inany area of substantive interest. However, topics thatappear to be most appropriate to interpretive researchare those defying quantification, best understood in anatural setting, and seeking to study social processesover time. Ideally, interpretive studies combine"in-depth understanding of the particular settingstudied and general theoretical insights that transcendthat particular type of setting" (Taylor and Bogdan,1984, p. 17). Understanding occurs by becomingsensitive to the point of view of the people(informants) under investigation. Understanding alsoprovides insight into how informants organize theirknowledge (Spradley, 1979).

At the outset of the research project, researchquestions tend to be broad and general. As researchprogresses, however, a more focused approachensues. The logic here is that researchers begin toknow what questions to ask and how to ask themonly after acquiring experience in the field. In lightof this approach, sampling, data collection, and dataanalysis are highly fle.xible allowing researchers to


adapt them to a particular setting. Two predominantinterpretive research methods include participantobservation and in-depth (open-ended) interviewing.These methods are, actually, better understood azforms of data collection, rather than distinct researchmethods. Indeed, matters of sampling and dataanalysis are identical in participant observation andin-depth interviewing. For this reason, the discussionof sampling and data analysis in this section isgeneric to interpretive research irt general. However,participant observation and in-depth interviewing arediscussed as distinct forms of data collection, andexamples of how these methods have been used intherapeutic recreation research are provided.

Sampling

Generally speaking, data collection and dataanalysis occur simultaneously in interpretive research.Once themes and relevant categories of behavior areidentified, specific incidents, activities, andindividuals are sampled because they are believed tobe relevant to emerging themes and theory. Hence,sampling in interpretive research ideally occursthrough a process of theoretical sampling. Theoreticalsampling is the purposeful sampling of cases orinformants based on their presumed relevance fordeveloping theory (Glaser & Strauss, 1967). In otherwords, sampling within interpretive research isdirected by emerging theory.

Related to this approach is the concept of negativecases. According to Denzin (1978) negative case arecases which appear to contradict emerging theory andare sought to test and modify theory. Samplingcontinues until saturation is reached - when traditionalsampling fails to yield additional insights (Strauss,1987).

Data Collection

Methods of data collection are sought which reflecthow informants orgaCze and view their world. Tothe extent that data collection procedures captureinformants' perspectives, they enhance the internalvalidity of the study.

Participant Observation. Taylor and Bogtian(11984) defined participant observation as "research

"..volves social interaction between the researcheranu in:urmants in the milieu of the latter, duringwhich data are systematically and unobtrusivelycollected" (p. 15). Utilization of participant

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observatien by therapeutic recreation professionalswould require them to systematically adoptperspectives of people studied. In participantobservation, then, investigators enter the world of thesubject with tile guiding question, "What is going onhere?" (Bullock, 1983). As a means of answeringthis question, behavior and the contexts in which thebehavior occurred are noted. These Oservations arerecorded in field notes and become the data foranalysis. The field notes ideally capture as accuratea description of the informants' world as possible.Field notes should also include the researcher'sreflections. These reflective field notes are used toidentify emerging themes of informants' worlds(Strauss, 1987).

Example of observational strategies to therapeuticrecreation. Hunter (1987) sought to determine thetypes of changes that occurred among ten maleyouths, identified as adjudicated juveniles, as a resultof participation in an outdoor rehabilitation program.Hunter collected data using the participantobservation method supplemented with someunstructured interviews. Data were analyzed using aconstant comparative strategy, whereby data weresystematically recordel, coded and analyzed.Participant observation revealed that the rehabilitativeprogram led to participants' experiencing success attasks which were previously considered impossible bythem, and participants' increased willingness to domore work than was required. Results of the studyled to the generation of grounded theory--a set ofintegrated propositions gleaned from data that wassystematically collected and analyzed.

In-depth interviewing. In general, interviewingmay range from being completely closed andstructured, . o being completely open and unstnictured(Burgess, 1984). In interpretive research, interviewslean toward the latter. Moreover, such interviewstend to resemble conversations in which neither theresearcher nor the informant control the interchange(Burgess, 1984; Taylor & Bogdan, 1984; Schatzman& Strauss, 1973). Interviews are in-depth and areflexible enough to provide latitude n pursuing areasof informants' perceptions and knowledge which areidentified in the course of the interview.Furthet more, questions tend to be non-directive,allowing informants to provide answers using tht irown words.

The interviewing process begins with a generalarea of interest and becomes increasingly focused

1 0

with the emergence of themes of knowledge (Bullock,1983). This means that even though the interview isconversational in nature, researchers enter theinterview with a list of issues to be covered. Becausein-depth interviews are open-ended, they arefrequently tape-recorded and transcribed verbatim.As with participant observation, the recordedinterviews are the data upon which analysis occurs.

Example of in-depth interviewing to therapeuticrecreation. West (1986) was interested in exploringlinkages between social service agencies that servedpersons with disabilities and agencies managingoutdoor recreation resources. To accomplish hisgoal, West conducted in-depth interviews with 40administrators from 16 park and recreation agencies.Interviews contained standardized open-endedquestions followed by unstructured probing by theinterviewer. Interviews were tape recorded and thentranscribed. The author was able to determine typesof linkage (ranging from informal linkage, involvingminimal cooperation, to formal regularized linkage,involving mutual coordination), effects of linkagepiaveipation (e.g., additional use of parks), functionso: linkage (e.g., expanding access to facilities andprograms), negative consequenceo of linkage (e.g.,channeling groups of people with disabilities into lessused park arcas), and barriers to and means offacilitating linkage (e.g., defensive reactions toprotect organizational autonomy may be resolvedthrough a linkage initiatal through interpersonalcontact.

Data Analysis

As noted, data collection and analysis (ideally)occur simultaneously in interpretive research.According to Strauss (1987), this is done through adual process of coding and memoing. Coding servesto fracture data so that conceptualbation is possible.This entails identifying and naming categories ofbehaviors which are relevant within a given setting(cf. Spradley, 1979). In the context of the data, thecategory is treated as an emergent or groundedconcept. Specific behavioral acts, then, are used asindicators of the concept. Central to this process isthe identification of one or multiple core categories(Strauss, 1987). For example, in a hypothetical studyof leisure behavior in a street gang, a core categorycould be demonstration of bravery. Shop-lifting andplaying chicken might be indicators of the


DATTILO ET AL.

methods. Indeed, matters of sampling and dataanalysis are identical in participant observation andin-depth interviewing. For this reason, the discussionof sampling and data analysis in this section isgeneric to interpretive research in general. However,participant observation and in-depth interviewing arediscussed as distinct forms of data collection, andexamples of how these methods have been used intherapeutic recreation research are provided.

Sampling

Generally speaking, data collection and dataanalysis occur simultaneously in interpretive research.Once themes and relevant categories of behavior areidentified, specific incidents, activities, andindividuals are sampled because they are believed tobe relevant to emerging themes and theory. Hence,sampling in interpretive research ideally occursthrough a proems of theoretical sampling. Theoreticalsampling is the purposeful sampling of cases orinformants based on their presumed relevance fordeveloping theory (Glaser & Strauss, 1967). In otherwords, sampling within interpretive research isdirected by emerging theory.

Related to this approach is the concept of negativecases. According to Denzin (1978) negative cases arecases which appear to contradict emerging theory andare sought to test and modify theory. Samplingcontinues until saturation is reached - when traditionalsampling fails to yield additional insights (Strauss,1987).

Data Collection

Methods of data collection are sought whichreflect how informants organize and view theirworld. To the extent that data collection procedurescapture informants' perspectives, they enhance theinternal validity of the study.

Participant Observation. Taylor and Bogtian(1984) defined participant observation as "researchthat involves social interaction between the researcherand informants in the milieu of the latter, duringwhich data are systematically and unobtrusivelycollected" (p. 15). Utilization of participantobservation by therapeutic recreation professionalswould require them to systematically adoptperspectives of people studied. In participantobservation, then, investigators enter the world of thesubject with the guiding question, "What is going on


here?" (Bullock, 1983). As a means of answeringthis question, behavior and the contexts in which thebehavior oncurred are noted. These observations arerecorded in field notes and become the data foranalysis. The field notes ideally capture as accuratea description of the informants' world as possible.Field notes should also include the researcher'sreflections. These reflective field notes are used toidentify emerging themes of informants' worlds(Strauss, 1987).

Example of observational strategies to therapeuticrecreation. Hunter (1987) sought to determine thetypes of changes that occarred among ten maleyouths, identified as adjudicated juveniles, as a resultof participation in an outdoor rehabilitation program.Hunter collected data using the participantobservation method supplemented with someunstructured interviews. Data were analyzed using aconstant comparative strategy, whereby data weresystematically recorded, coded and analyzed.Participant observation revealed that the rehabilitativeprogram led to participants' experiencing success attasks which were previously considered impossible bythem, and participants' increased willingness to domore work than was required. Results of the studyled to the generation of grounded theorya set ofintegrated propositions gleaned from data that wassystematically collected and analyzed.

In-depth interviewing. In general, interviewingmay range f.om being completely closed andstructured, to being completely open and unstructured(Burgess, 1984). In interpretive research, interviewslean toward the latter. Moreover, such interviewstend to resemble conversations in which neither theresearcher nor the informant control the interchange(Burgess, 1984; Taylor & Bogdan, 1984; Schatzman& Strauss, 1973). Interviews are in-depth and areflexible enough to provide latitude in pursuing areasof informants' perceptions and knowledge which areidentified in the course of the interview.Furthermore, questions tend to be non-directive,allowing informants to provide answers using theirown words.

The interviewing process begins with a generalarea of interest and becomes increasingly focusedwith the emergence of themes of knowledge (Bullock,1983). This means that even though the interview isconversational in nature, researchers enter theinterview with a list of issues to be covered. Becausein-depth interviews are open-ended, they are

I d

DATTILO Er id-

frequently tape-recorded and transcribed verbatim.As with participant observation, the recordedinterviews are the data upon which analysis occurs.

Example of in-depth interviewing to therapeuticrecreation. West (1986) was interested in exploringlinkages between social service agencies that servedpersons with disabilities and agencies managingoutdoor recreation resources. To accomplish hisgoal, West conducted in-depth interviews with 40administrators from 16 park and recreation agencies.Interviews contained standardized open-endedquestions followed by unstructured probing by theinterviewer. interviews were tape recorded and thenvanscribed. The author Was able to determine typesof linkage (ranging from informal linkage, involvingminimal cooperation, to formal regularized linkage,involving mutual coordination), effects of linkageparticipation (e.g., additional use of parks), functionsof linkage (e.g., expanding access to facilities andprograms), negative consequences of linkage (e.g.,channeling groups of people with disabilities into lessused park areas), and barriers to and means offacilitating linkage (e.g., defensive reactions toprotect organizational autonomy may be resolvedthrough a linkage initiated through interpersonalcontact.

Data Analysis

As noted, data collection and analysis (ideally)occur simultaneously in interpretive research.According to Strauss (1987), this is done through adual process of coding and memoing. Coding servesto fracture data so that conceptualization is possible.This entails identifying and naming categories ofbehaviors which are relevant within a given setting(cf. Spradley, 1979). In the context of the data, thecategory is treated as an emergent or groundedconcept. Specific behavioral acts, then, are used asindicators of the concept. Central to this process isthe identification of one or multiple core categories(Strauss, 1987). For example, in a hypothetical studyof leisure behavior in a street gang, a core categorycould be demonstration of bravery. Shop-lifting andplaying chicken might be indicators of thehypothetical core category (an emergent concept).The utility of developing a core category is that othercategories of behavior can be seen to be potentiallyrelated and understandable in terms of the category.

Memoing serves a number of functions.' First,

11)9

memoing serves as a record of the analytic process ofdata collection. Memos of this Port may includereflective notes, such as successful or unsuccessfulresearch strategies. Second, memoing provides abasis for drawing together categories of behavior intoemerging theory. In this case, memos are hunches orhypotheses which explicate the nature of relationshipsamong emerging concepts. Finally, memoingprovides a basis for theoretical sampling. This type ofmemo provides concrete instructions as to whichcases (e.g., informants) to subsequently sample. Thebasis for such decisions follow directly from th;second type of memo. That is, emerging theoryleads to purposeful sampling of cases in order tofurther elucidate how grounded concepts are relatedto one another.

Coding and memoing facilitate data reduction.Coding and memoing also serve to enhance internalvalidity by grounding theory in informants' actions,and the contexts and settings in which behavior isobserved.

Data display is then facilitated through presentationof resulting data as well as the procedural andanalytic methods that produced the data. Presentationof data is frequently supplemented by excerpts ofdialogue from informants and diagrams. Excerpts ofdialogue serve as indicators of chosen aspects of data,while diagrams are utilized to indicate theorganization of a number of concepts. Thepresentation of data and methods by which data wasderived facilitates replication of a particular study.Through replication of studies, reliability can beaddressed (LeCompte & Goetz, 1932).

Strengths and Weaknesses of InterpretiveResearch

The principle advantage of interpretive researchstrategies is that they provide in-depth knowledge andunderstanding of a particular setting or social world.The in-depth nature of interpretive researchapproaches tends to make for findings that score highin terms of internal validity (LeCompte & Goetz,1982). A second advantage of qualitative researchapproaches is that they bring to light importantvariables that might otherwise be overlooked with amore controlled research strategy. This point waswell stated by Whyte (1955) in his study of streetcorner life: "As I sat and listened, I learned theanswers to questions that I would not even have had


DATTELO Er AL.

the sense to ask if I had been getting my informationsolely on an interviewing basis" (p. 303). Third,interpretive research strategies are relatively flexibleand inexpensive in terms of equipment (Babble,1989). The principle disadvantage of interpretiveresearch studies is that they are frequently notgeneralizable to other settings. Such studies are oftencriticized because they are weak in terms of externalvalidity. A second disadvantage of interpretiveresearch strategies is that matters pertaining toreliability are not readily controlled. Unlikenormative research strategies, standardized conceptsare ordinarily not used in interpretive research.Furthermore, the research process tends to be highlyindividualistic. Hence a common criticism ofinterpretive research is that findings are biased byobserver effects and idiosyncratic judgements on thepart of the researcher. [See LeCompte 471 Goetz(1982) for a thorough discussion of matters pertainingto reliability and validity in interpretive research.]Finally, interpretive research studies tend to be costlyin terms of time, and they require a flexible anduncontrolled approach to pursuing research that bothexperienced and inexperienced researchers may findintimidating.

Conclusion

The purpose of this paper was to present fiveresearch methods (experimental methods,single-subject method, survey method, participantobservation, and unstructured interviewing) thattherapeutic recreation professionals might findsuitable in answering rftearch questions. Each ofthese approaches was described in terms of matterspertaining to sampling, data collection, and dataanalysis. As noted in our previous paper, weadvocate an eclectic approach to pursuing systematicresearch. Therefore, the five research approaches arepresented with the belief that each is best suited toanswering distinct research questions. In general,experimental methods, single-subject methods, andsurvey methods are appropriate research strategies foranswering research questions grounded in anormative paradigm. Participant observation andin-depth interviewing are more appropriate foranswering questions grounded in an interpretiveparadigm.

94 ANNUAL IN THERAPEUTIC RECREATION, No. Ii, 1991

References

Babbie, E. (1989). The practice of social research. Belmont, CA:Wadsworth.

Beard, J. G., & Ragheb, M. G. (1983). Measuring leisuremotivation. Journal of Leisure Research, 15, 219-228.

Bullock, C. (1983). Qualitative research in therapeuticrecreation. Therapeutic Recreation Journal, 17(4), 36-43.

Burgess, R.O. (1984). In the field: An introduction to fieldresearch. London: George Allen & Unwin.

Campbell, D., & Stanley, J. C. (1963). Experimental andquasi-experimental designs for research. Chicago: RandMcNally College Publishing Co.

Cook, T. D., & Campbell, D. T. (1979). Quasi-experimentation:Design and anaOsis issues for field settings. Chicago: RandMcNally College Publishing Company.

Cunningham, P. H., & Bartuska, T. (1989). The relationshipbetween stress and leisure satisfaction among therapeuticrecreation personnel. Therapeutic Recreation Journal, 23(3),65-70.

Dattilo, J. (1986). Single-subject research in therapeuticrecreation: Implications to individuals with limitations.Therapeutic Recreation Journal, 20(1), 76-87.

Dattilo, J. (1987). Encouraging the emergence of therapeuticrecreation practitionen through single-subject design. Journalof &pending Horizons in Tharapeutic Recreation, 2, 1-5.

Dattilo, J. (1989). Unique horizons in research: Single subjectdesigns. In D. A. Cempt-n (Ed.), Issues in therapeuticrecreation (pp. 445-451). Champaign IL: Sagamore.

Denzin, N.K. (1978). The research act. New York:McGraw-Hill.

Glaser, B. G., & Strauss, A. L. (1967). The discovery ofgrounded theory. New York: Aldine.

Hunter, I.R. (1987). The impact of an outdoor rehabilitativeprogram fer adjudicated juvenilea. Therapeutic RecreationJournal 21, 30-43.

Isaac, S., & Michael, W. B. (1981). Handbook in ressarch andevaluation. San Diego: EDITS.

lso-Ahola, S. E. (1988). Research in therapeutic recreation.Therapeutic Recreation Journal, 22(1), 7-13.

Johnson, H. H., & Solso, R. L. (1978). An introduction toexperimental design in psychology: A case approach. NewYork: Harper & Row.

Kazdin, A. E. (1982). Single-case research designs: Methods forclinical and applied settings. New York. Oxford UniversityPress.

Kerlinger, F. N. (1973). Foundations of behavioral research(2nd ed.). New York: Holt, Rinehart and Varmston.

LeCompte, M. D., & Goetz, J. P. (1982). Problems of reliabilityand validity in ethnographic research. Review of EducationalResearch, 52(1), 31-60.

Mannell, R. C. (1980). Social psychological techniques andstrategies for studying leisure experiences. In S. E. Iso-Ahola(Ed.) Social psychological perspectives on leisure asdrecreation (pp. 62-88). Springfield, IL: Charles C. Thomas.

Menne% R. C. (1983). Research methodology in therapeuticrecreation. Therapeutic Recreation Journal, 17(4), 9-16.

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McReynolds, L.V. & Thompson, K (1986). Flexibility of single-subject experimental designs: Part I. Review of the basics ofsingle-subject designs. Journal of Speech and HearingDisorders, 51, 194-203.

Orne, M.T. (1962). On the social psychology of thepsychological experiment with particuhr reference to demandcharacteristics and their implications. American Psychologist,17, 776-783.

Osipow, S.H. & Spokane, A.R. (1981). Measures ofoccupational stress, strain and coping. Columbus, OH:Marathon Consulting and Press.

Rcpp, A. C. (1981). Teaching the mentally retarded. EnglewoodCliffs, NJ: Prentice-Hall.

Riddick, C., DeSchriver, M., & Weissinger, E. (1984). Amethodological review of research in Journal of LeisureResearch from 1978 to 1982. Journal of Leisure Research,16, 311-321.

Rosenburg, M. (1965). Society and the adolescent self image.Princton, NJ: Princeton University Press.

Rosenburg, M. (1968). The logic of survey analysis. New York:Basic Books.

Schatzman, L., & Strauss, A. L. (1973). Field research:Strategies for a natural sociology. Englewood Cliffs, NJ:Prentice-Hall, Inc.

Schleien, S.J., Cameron, J., Rynders, & Slick, C. (1988).Acquisition and generalization of leisure skills from school tothe home community by learners with severe multihar.dicaps.Therapeutic Recreation Journal, 22(3), 72-79.

Scots, D., & Godbey, G. (1990). Reorienting leicure research -The case for qualitative methods. Society and Leisure, 13(1),89-205.

Shary, J. M., & Iso-Ahola, S. E. (1989). Effects of acontrol-releva .= intervention on nursing home residents'perceived conti.dence and self-esteem. TherapeuticRecreation Journal, 23(1), 7-16

Spradley, J. P. (1979). The ethnographic interview. New York:Holt, Rinehart and Winston.

Strauss, A. L. (1987). Qualitative analYsis for social scientists.Cambiidge: Cambridge University Press.

Taylor, S. J., & Bogdan, R. (1984). Introduction to qualitativeresearch methods: The search for meanings. New Yost:Wiley and Sons.

West, P. C. (1986). Interorganizational linkage and outdoorrecreation and persons with physical and mental disabilities.Therapeutic Recreation Journal, 20(1), 63-75.

Whyte, W. F. (1955). Street corner society. Chicago: Universityof Chicago Press.

Footnotes

1. A number of writers have noted that norni c paradigms areclosely usociated with quantitative research, while interpretiveparadigm:- are associated with qualitative research. This tenis tobe a misleading generalization since quantitative data (data whichis numerical) and qualitative data (data wh:ch is descriptiire) tendto be generated by a myriad of research methods. For example,experimental research may draw upon voice or video recordingswhich represents qualitative data. Similarly, in-depthinterviewing may result in the quantification of verbal responsesto various topics thereby providing a basia for quantitativeanalysis.

2. The discussion of data collection includes a treatment of thcrole of internal validity, external validity, and reliability.Internal validity basically deals with the authenticity of results.That is, findings arc examined in terms of whether the methodsactually measured what they purportedly intended. Externalvalidity pertains to the generalizability of findings. In this case,findings are evaluated in terms what groups, situations, andpeople the research findings may be said to apply. Finally,reliability deals with the replicability of findings. Generallyspeaking, reliability is determined by evaluating whether researchinstruments yield consistent findings across time and acros;different situations.

3. There are two broad categories of sampling methods:probability sampling and purposive sampling. A probabilitysample is one in which people within a population have an equalchance of being represented. Examples of probability samplesinclude simple random samples and stratified random samples.A purposive sample is one in which people within a populationhave an unequal chance of being represented. A purposivesample is often used when all cases within a population cannot beidentified.

4. For a more complete description of memoing, the reader maywish to examine Strauss' (1987) treatment of the subjeet.


Standards: A Tool for AccountabilityThe CARF Process

Alan H. ToppelBarbara A. Beach

Linda Hutchinson-Troyer, C.T.R.S

Abstract

1 his article provides a brief rationale and history of the development of quality assurance standards within theTR discipline as they relate specifically to CARF. A review of the chronology of standards development ispursued along with a call for more TR practitioners to became actively involved in the process. Without clearstandards to measure the quality of treatment results TR will not be able to keep pace until the rapidly expandingnational health care system.

Introduction

Health-care is advancing at an incredibly rapidpace; with this comes the demand for the provider tobe professionally accountable and to provide costeffective services. A tool for determining the qualityof the services provided is via the implementation ofstandards, or predetermined elements against whichthe treatment can be compared (Riley, 1987).

The profession of Therapeutic Recreation is guidedby one set of nationally recognized competencystandards for qualified personnel. This is theexamination process that has been established by theNational Council for Therapeutic RecreationCertification (NCTRC), and overseen by theEducational Testing Service (NCTRC, 1990).

The Therapeutic Recreation profession also hasGuidelines For The Administration of TherapeuticRecreation Services (NTRS, 1990). The latterprovides some basic parameters to utilize whenimplementing Therapeutic Recreation programs invarious practice settings; e.g. philosophy!goals, scopeof service, personnel practices, evaluation andconsumer involvement. The tools that are currentlyavailable within the area of professional expertiseserve as a within discipline benchmarks.

However, certified TR specialists are now part ofa much larger arena; the health-care industry.Therapeutic recreation must become attuned to theexternal accrediting bodies, that shape and pay for


health-care services. As an interdisciplinary teammember the CTRS will be required to adhere toindustry and consumer driven standards in an effortto keep pace, be accountable and cost effective.

C. A. R. F.

A major non-governmental body thzt . -

standards for organizations providing rehabilitationservices is the Commission on Accreditation ofRehabilitation Facilities (C.A.R.F.). C.A.R.F. wasformed in 1966 when the Association ofRehabilitation Centers (A.R.C.) and the NationalAssociation of Sheltered Workshops and HomeboundPrograms (N.A.S.W.H .P.) agreed to pool theirinterests in standards. The consolidation resulted inthe formation of the Commission.

The CARF Commission, based in Chicago,Illinois, entered into an administrative relationshipwith the Joint Commission on Accreditation ofHospitals (J.C.A.H.), which provided the neededexpertise in the area of accreditation (CARF 1990).JCAH and CARF continued this agreement until 1971

Alan Toppel is executive director of the Conunission onAccreditation of Rehabilitation Facilities; Barbara Beach isdirector of medical rehabilitation, Commission on Accreditationon Accreditation of Rehabilitation Facilities; and LindaHutchinson-Troyer is a certified therapeutic recreation specialistat Montebello Rehabilitation Hospital, University of MatylandMedkal System.

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when they became separate entities establishingdifferent missions, goals and objectives for theirrespective organizations.

In the years since its formation, the Commissionhas steadily and dramatically grown in size andstature. Currently, there are over 2800 accreditedorganizations. In addition, numerous entities - bothgovernmental and private - hay adoptedexpectations, requirements, and/or endorsements ofaccreditation by the Commission for organizationsserving people with disabilities.

The Standards Process

Why were standards developed? Initially standardsfor rehabilitation services did not exist, thus at asystems level organizations could not be heldaccountable for the quality of services rendered.Neither method to reassure consumers or purchasersof the effectiveness and efficiency of programs norcommon definitions in the field of rehabilitationexisted. Over the years, the Commission has servedas a vehicle to define and hold organizationsaccountable for service outcomes.

Regarding the development of standardsthemselves, three processes set CARF's approachapart from other accrediting bodies: 1) the field basedapproach to standards development; 2) the surveyprocess which utilizes independent peer review; 3)and the focus on program evaluation which measuresprogram outcome.

Field Based Approach

Since it's inception, the Commission has utilizedpracticing clinicians to develop standards through theconvening of National Advisory Committees.Clinicians, consumers, and third party payerrepresentatives, who are nationally recognized leaderswith expertise in a particular program area, arebrought together to develop consensual standardswhich reflect current practices in the field. Byexample, the profession of therapeutic recreation wasrepresented by Joanne Finegan, CTRS in January of1991. 'That National Advisory Committee wascharged by the Commission to review Section 2.1 -Overall Program Standards and the specific standardsfor Brain Injury Programs, Acute and Post Acute, inSection 2.11.

Recommendations developet by these National

1 1 3

Advisory Committees are then sent out for fieldreview to 2000-5000 recipients, including providers,consumers, professionals, and organizations involvedin the field ot' rehabilitation. As an advocate for theTherapeutic Recreation profession, any CTRS cantake an active role in supporting revisions of theseproposed standards. All CARF accreditedorganizations, supporting members, associatemembers, surveyors, and interested professionalorganizations, can receive the proposed standardrevisions and submit comments.

Following the field review process, commentsregarding the proposed standards are compiled andreviewed in the CARF office. Standards aresubmitted to the standards committee of theCommission's Board of Trustees and must beaccepted by the entire Board of Trustees prior toinclusion in the Standards Manual.

Survey Process

Practicing clinicians participate in a peer reviewprocess to provide on-site surveys of rehabilitationorganizations. Surveyors are selected for site surveysbased on the experience and expertise which bestmatches the organization's programs. The firstCertified Therapeutic Recreation Specialist to betrained as a surveyor, outside of CARF professionalstaff, was Christine Lay, CTRS. Administrative andprogram surveyors must do a comprehensive reviewof an organization to determine if the organization isin compliance with the standards for which they arebeing reviewed. Organizational records such as:fiscal reports, safety reports, case records, andadministrative records are reviewed in the surveyprocess. Staff members and consumers areinterviewed and program manuals and evaluationsystems are also examined (CARF, 1991).

Outcome Oriented Evaluation

Recent trends in health-care oriented systems callfor establishment of an outcome review program.This system requires the articulation of theorganizations role and commitment toward continuousimprovement of patient/client services. TheCommission and the American TherapeuticRecreation Association (ATRA) are committed to thereview of program outcomes through programevaluation. CA1117 was the first accrediting body to

ANNUAL IN TUERAPEUTIC RECREATION, No. II, 1991 97

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focus on specified program outcomes as a means toevaluate success. In the early 1970s, the field ofrehabilitation began to articulate the need formeasurement of treatment results. Global questionslike, "Did the lives of people significantly improve asa result of participation in rehabilitation programs?"went largely unanswered. There was a sense offrustration among professionals with what was seenas preoccupation by providers, purchasers, andconsumers with the input and process aspects of therehabilitation system. If program evaluation systemswere to become part of the human service network,these systems sh9uld meet standards of quality likeany other element of the delivery system. InNovember 1973, the Commission published a newsection of the Standards Manual specificallyidentifying program evaluation standards. Theprogram evaluation system is designed to generatecontinuous reports that delineate the accomplishmentsof the persons served. The program reports are thenutilized by the interdisciplinary team members, (whoprovide goal directed services), to maintain and/orimprove program performance.

CARF's Core Team

The Commission identifies the make-up andfunctions of the interdisciplinary team in its role asthe primary decision-making body regardingprovision of services to persons with disabilities.Where the industry has evolved and certification orstandards of practice have been established, CARFhas incorporated these requirements into the Glossarysection of the Standards Manual. In 1983, theStandards Manual included a definition fortherapeutic recreation. In this manual TherapeuticRecreation is defined as services provided bysomeone who currently meets applicable legalrequirements, and/or who is certified or eligible forcertification by the N.C.T.R.C. as a TherapeuticRecreation Specialist. The inclusion of definitions,qualifications and licensing/certification requirementsin the CARF manual glossary serves to legitimize therole of the TR profession as part of the Core teamand reinforces our position as professional providersof care within in the treaunent milieu.

ConclusionThe Commission has developed an impartial and

objective means of evaluating accountability.Accreditation becomes a tool to identify programs

98 ANNUAL IN THERAPEUTIC RECREATION,No. 11,1991

that can substantiate their claims of success. This isimportant in an era of competition and limited dollarresources. Previously, there was no certifying orlicensing body for program areas. The role of theCommission is to impact upon the quality of careprovided by organizations. To that end programstandards have been developed which substantiate theorganization's adherence to national standards.

Certified Therapeutic Recreation Specialists mustinterface their professional competency with thelarger rehabilitation arena. Interfacing with CARFand similar organizations allows for greatermonitoring of standards that impact on patient care,organizational performance, and managementeffectiveness. The profession of TR must continue toprovide external and internal feedback to CARF thusdemonstrating our professional commitment to thecontinuous improvement of quality of care. ATRAhas moved to ensure such representation for itsmembership by achieving Associate Sponsor statuswith CARF, since December of 1988.

References

Commission on Accreditation of Rehabilitation Faciliti.s (1991).Standards Manual for Organizations Serving People withDis ;Nies. Tucson, rtz. Author.

CommisLIon on Accreditation of Rehabilitation Facilities (1990).The CARP History. Tucson, AZ. Author.

National Council for Therapeutic Recreation Certification (19()0).Candidate Bulletin of Information. Spring Valley, N.Y.Author.

National Therapeutic Recreation Society (1990). Guidelines forthe Administration of Therapeutic Recreation Services 19%.Alexandria, VA. Author.

Riley, B. (ed.). Evaluation of Therapeutic Recreation ThroughQuality Assurance. State College, PA.: Venture Publishing,Inc. , 1987.

Editors' NoteIn the Fall of 1990, the Annual's advisory board, in

conjunction with the editors, agreed to expand the editorialmission. Each year the advisory bor.r x! may decide to issueinvitations for manuscripts on select topics deemed particularlyrelevant or timely to the practice of therapeutic recreation. inthis regard such invited works ensure that coverage of critical orkey issues will appear and not be dependent upon the random orchance factors of an open call. These invited works, whileundergoing editorial scrutiny, are not subject to the same blindreview process as open call manuscripts. The advisory board,alone, has final authority in the publication decision of invitedmanuscripts.

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For the readers' benefit, editors of the Annual will alwaysnote invited manuscripts as such. The above article representsthe inaugural manuscript of thia editorial feature. Readers of

the Annual who have suggestions or comment regarding invitedworks arc encourage/A to write directly to: Editors, Annual inTherapeutk Recreation, c/o AALR, 1900 Association Drive,Reston, VA 22091.

1 1 5


The Annual in Therapeutic Recreation represents a new national refereed publication whichwill be published annually. Free form research and program development will be the Annual'semphasis.

The objectives of the Annual in Therapeutic Recreation include:

-- To encourage and facilitate dissemination of research which will enrich the depthand scope of the practice of therapeutic recreation.

-- To stimulate continuous development in practice and research standards.

-- To promote communication between researchers and practitioners.

-- To focus on areas worthy of program devzlopment and/or research demonstration.

-- To provide a forum for tutorials relevant to research and practice in therapeuticrecreation.

-- To provide exchange of innovative techniques for service delivery.

ANNUAL IN THERAPEUTIC RECREATIONSUBSCRIPTION FORM

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Please enclose your check with the subscriptionform and send to:

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1 1 6

CALL FOR PAPERSAnnual in Therapeutic Recreation

Guidelines for Contributors

1. Unpublished manuscripts for the Annual will be accepted for review by the editors. A paper cannot be

submitted to another journal while it is under review.

2. The Annual publishes a wide variety of papers:

a. Programmatic/Inovative Techniques - Effective and/or innovative progams and techniques utilized within

therapeutic recreation service deliery. Description of program/innovative techniques and program evaluation

proctdures are suggested.b. Current Isues and Trends - Manuscripts discussing currnet issues and practices in the delivery of therapeutic

recreation services. Such topics as quality improvement, third party reimbursement and alternative fundings,

standards of practice, and professional credentialing are examples of potential topics. Analyses of trends

in the field are also appropriate.

c. Qualitative and Quantitative Research - Applied and/or action oriented small case designs and case studies

are encouraged. Empirical data relating to standard experimental designs, surveys, and/or replication designs

are appropriate.d. Theoretical and/or Evaluative - Critical reviews or literature and/or proposals for refinements or additions

of models for delivery are encouraged.

c. Tutorials - Research notes which provide practical demonstration of new technological applications,

approaches to research design and/or analysis, or model program dei4gn and development are encouraged.

Preparation of Mantscripts

Manuscripts should be typed on 8 1/2 x 11 inch paper and double spaced. Normally, they should not exceed 25

pages, including references and tables. Authors are requested to follow the directions given in the Publication

Manual of the American Psychological Association (3rd ed.). Figures and tables must conform to the guidelines

given in the APA stylebook and figures must be camera ready. Abstracts are required. Manuscripts that do not

follow the proper format will be returned to the author(s). Four clean copies must be submitted to the editors.

Authors are requested to include their telephone numbers in a separate cover letter. Authors should keep a copy

of their manuscripts.

Addresses

All correspondence concerning manuscripts should be directed to the Editors, Annual in Therapeutic Recreation

AALR/AAHPERD, 1900 Association Drive, Reston, VA 22091.

The Annual is published by the American Alliance for Health, Physical Education, Recreation and Dance, with

headquarters offices at 1900 Association Drive, Reston, VA 22091. Requests for permission to quote and for

information about subscriptions should be sent to the headquarters office.

Blind Reviews

All reviews are blind and thus the title page of the manuscript should not be attached to the paper. The title page

should include the title of the paper and the author's name(s) and institutional affiliation(s). The title of the

manuscript should be typed at the top of the abstract page, but the author's name(s) should not appear on the

manuscript. Manuscripts will be reviewed by one editor and two associate editors.

Copyright and Permissions

AAHPERD holds the copyright for the Annual. In keeping with the new copyright law (P.L. 94-553), authors are

required, whenever legally possible, to assign the copyright of accepted manuscripts to the AAHPERD, so that both

the author(s) and the Alliance are protected from misuse of copyrighted materials. Upon receipt of legitimate,

written requests, permission is granted by AAHPERD for use of brief quotations (approximately 500 wo ds) in

published wz-eks. Permission is automatically granted to authors to use their own articles in any other published

work witn which they are connected. Permission to reprint entire articles, for inclusion in a publication to be

offered for sale, is granted only upon payment to AAHPERD of a fee of $100 per article. AAHPERD also requests

that permission be obtained from the author(s).

DEADLINE FOR SUBMISSION FaR V OLUME THREENOVEMBER 1, 1991

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Transcript of W*********Mi********************************ft - ERIC · hosts numerous workshops, seminars,...

W*Mi************************ft - ERIC · hosts numerous workshops, seminars,...

Transcript of W*Mi************************ft - ERIC · hosts numerous workshops, seminars,...