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the man behind the brand: Danny Pettry

Reimbursement of rec therapy

A recreational therapist emailed today and asked about reimbursement of recreational therapy services.  

That is a topic that I am also very interested in as well.

My thoughts: if a recreational therapist is employed then the services are being covered.

My best advice is to recommend Tim Passamore from Oklahoma University who is an expert on coverage and can discuss more in regards to the service setting and how it is covered: in example: physical rehab or mental/ behavioral health.

ATRA has team on the topic, which Dr. Tim Passamore is the chair.

ATRA also provides a webinar on coverage (worth Continuing Education credit).

Go here for information:

https://www.atra-online.com/policy/coverage

Recreational Therapy Month Presentation

I feel 100% confident that the Recreational Therapy month presentation that I had given today was effective. The turnout was a lot better than I had expected.

I had given a one-hour presentation on Recreational Therapy (in mental health focus) at River Park Hospital (Huntington, West Virginia).

It was a full house. Nurses, med students, CEOs, program directors, social workers, LPCs, and of course, our fun folks, the Recreational Therapists!

Way to go RTs! 

Recreational Therapy Month Promotions

Hello friend:

I've been advocating for our profession for many years. ATRA had presented me with a "Recreational Therapy Advocate of the Year" award in 2005.

Here are some things I've been doing to promote Recreational Therapy during this Feb. 2016:

• I had given a presentation about Recreational Therapy to a group of Family physicians at AccessHealth in Beckley, West Virginia on Thursday. 

The Beckley, West Virginia newspaper, The Register-Herald featured a newspaper article here: http://www.register-herald.com/news/beckley-native-celebrates-recreational-therapy-month-with-advocacy/article_82a5befd-5fe9-56e2-8fc2-84d2508d8724.html 

• Next week, I'll be providing a training about Recreational Therapy (with a mental health focus) to the public at River Park Hospital in Huntington, West Virginia. It is also worth one-hour of continuing education. Note: this one hour CE training has not been pre-approved by NCTRC or ATRA, but it has been approved for counselors, social workers, and nurses in West Virginia. 

The Huntington, West Virginia newspaper, the Herald-Dispatch has posted an announcement here:  http://www.herald-dispatch.com/news/recreational-therapy-workshop-planned/article_39f0c0ce-d6ce-11e5-b72a-47093090271b.html 

• I had written a blog entry about Recreational Therapy month that you can read here: http://dannypettry.blogspot.com/2016/02/feb-is-recreational-therapy-month.html  

Monster.com info. about rec therapy

Monster.com has a very interesting article for those people who are interested in becoming a recreational therapist.

Check it out here:
http://www.monster.com/healthcare/a/health-care-job-recreational-therapy 

US News: RepoRT on 6 things to know about Rec Therapists!

You may have already seen this, but in case you haven’t:

The US News/ Health posted an article that consisted of six things to know about recreational therapists!

Isn’t that exciting for our profession!?

Read about it here:

http://health.usnews.com/health-news/health-wellness/articles/2016-01-19/6-things-to-know-about-recreational-therapists

6 things to know about recreational therapists!

Six things to know about recreational therapists!
Go here:

http://health.usnews.com/health-news/health-wellness/articles/2016-01-19/6-things-to-know-about-recreational-therapists

St. Peter's Catholic School has a new autism and special needs unit

St. Peter’s Catholic School (Mansfield, Ohio) has a new autism and special needs unit.

I’m very pleased to see they will be offering recreational therapy and have a rec. therapist on staff.

It appears they’ll be offering an interdisciplinary approach, including:

Speech and language therapy

Occupational therapy

Physical therapy

Play therapy

And some applied behavior analysis components.

Check it out here:

http://www.richlandsource.com/education/st-peter-s-helping-students-with-autism-special-needs-blossom/article_36bf4486-9ac7-11e5-9c5b-0b84ac3e0b6c.html

And as always – if you need Rec Therapy CEUs, visit my site here:

http://www.dannypettry.com

Session 6: Using Counseling Skills in Rec. Therapy

Session 6:

Using Basic Counseling Skills in Rec. Therapy

Presented by: Danny Pettry, M.Ed., LPC,NCC, CTRS

Friday, October 28, 2015, at 2:30 p.m.

Danny Pettry’s

Mental Health Workshop for Recreational Therapists

at River Park Hospital, in Huntington, WV

I could talk about this subject for a long time. I have graduate degrees in Recreational Therapy and Counseling, from Indiana University and Lindsey Wilson College, respectively. I have the Certified Therapeutic Recreation Specialist (CTRS) credential for Recreational Therapists as well as (National Certified Counselor (NCC) credential. I work as a therapist/ practitioner for three residential treatment programs designed for children and adolescents. I’m currently working to complete training and certification in providing trauma-focused CBT.

Goals of this session included:

·         Identify at least three concepts for building a therapeutic relationship with patient/client

·         Identify at least three counseling skills that Recreation Therapists can use in different phases of the Rec. Therapy process including assessments, treatment planning, implementing the intervention and for evaluations.

·         Identify at least three counseling skills a Recreation Therapist can use in group settings.

Compassion fatigue/ burnout can  happen to RTs

RTs need to do some self-care in order to be the best RT they can be.

The Counseling for Dummies book suggested many self-care activities that are “recreational” in nature.

Some of the tips included:

•         Social support/ positive contact with families

•         Activities: walking, swimming sports, gym, dancing, gardening

•         Sedentary activities: reading, watching a movie, journaling, drawing, painting.

•         Spiritual activities

OF course, a healthy functioning individual can do those activities.

A person in treatment (example in acute-care psychiatric setting) is not at a point where they can independently choose those activities. They need assistance from professionals.

Let’s get started:

What is Rec. Therapy? ATRA definition:

–        Recreational Therapy, also known as Therapeutic Recreation, is a systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illness and/ or disabling conditions, as a means to psychological and physical health, recovery, and well-being (2015).

Basic counseling skills can be used in all four parts of the TR/RT process: assessment, planning, implementation of the intervention, and evaluation.

What is counseling? ACA definition:

•         ACA Definition:

–        Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals (2010).

Note: both Rec Therapy and Counseling are strength-based and wellness based human service professions. Skills in this session will focus on that “professional relationship”

•         This session won’t train an individual to become a counselor. That requires additional education, training, clinical supervision, and a license.

•         This session will take some of the counseling skills that can be used by other professionals, like Rec. Therapy or direct care, or teaching.

Listening is an important skill. I suggested Dr. David Austin’s video: Effective listening video:

https://scholarworks.iu.edu/dspace/handle/2022/3378

Some character traits for listening:

•         Empathy: be in their shoes/ feel their pain

•         Respect: value that individual

•         Integrity: honest/ doing right thing

•         Resilience: bounce back ability

•         Humility: we all have problems

•         Courage: break confidentiality for child safety.

•         Assertiveness: speak plain and direct 

Factors Why Therapy Works:

•         Michael Lambert’s research:

–        40%: factors outside of therapy: family, life situations, circumstances, biology,

–        30%: the helping relationship: caring, warmth, empathy, acceptance, mutual affirmation and encouragement

–        15%: the actual technique we use in therapy.

–        15%: placebo – just works.

http://www.socialworkers.org/pubs/news/2002/03/therapy.htm

How to build a helping therapeutic relationship? Carl Rogers:

Carl Rogers was a required reading for the Rec. Therapy graduate degree program.

His theory was also studied in graduate school for counselors.

Rogers discusses that concepts for building that helping/ healing/ professional relationship in his humanistic/ person-centered therapy approach.

Three concepts:

•         Realness: congruent and not hiding behind a professional mask.

•         Unconditional positive regard: accepting, prizing, unbiased, listening. Even when they mess up.

•         Empathetic: appreciates their perspective.

A side note on: empathy. Yawn effect. Sorry about your yawn, but congratulations too! 

Skills Needed for Groups

–        Active Listening

–        Reflection

–        Clarification

–        Questioning

–        Summarizing

–        Encouraging

–        Supporting

–        Lecture/ Info. Giving (keep that brief)

–        Tone setting

–        Use of eyes

–        Use of voice

–        Use of leader’s energy

–        Self-disclosure (use this one rarely and when it can benefit client)

–        Multicultural

–        Linking

Skills for Assessment:

•         Attending to the patient/ client

•         Listening: active/ fully/ non-distracted

•         Focusing: on the patient/ client

•         Observing: what do you see? Does what they share match/ is congruent with body language?

Skills for Planning:

•         Goal-setting is a skill to have.

•         Work with the patient/ client so they can be self-directed in their treatment goals.

Skills for Implementing the Intervention:

This is the “activities” part.

RTs can use several skills here:

Information giving: in example: the benefits

Modeling skills: showing/ demonstrating

Confronting behaviors: hitting

Decision-making skills: what is the best choice? Maturity of judgment

Challenging skills

Skills for Evaluation:

•         Questioning: what did you gain from Rec. Therapy sessions/ treatments?

–        Did you meet your goals?

•         Summarizing: the goals, the treatment, the outcomes

•         SuppoRTing: providing emotional support 

Session 1: RT in Mental Health

Session 1:

Recreational Therapy in Mental Health

Presented by: Margie Fletcher, M.A., M. ED., CTRS

Friday, October 28, 2015, at 8:30 a.m.

Danny Pettry’s 
Mental Health Workshop 
for Recreational Therapists
 at River Park Hospital, in Huntington, WV

A Review by Danny Pettry

(Sorry I didn't get a better picture of her). I feel bad about the "alien shadow." 

Goals of this session included:

·         Identify three differences between “activities” and “recreation therapy”

·         Identify three ways to manage a variety of cognitive and functioning levels in group sessions

·         Identify three recreation therapy goals for people with mental health needs

Margie has graduate degrees in counseling and recreational therapy. She works full-time as a Recreational Therapist and she supervises the internship program for Recreational Therapists at River Park Hospital.

I’ll briefly share some information regarding the goals of this session (that were listed above).

·         

Activities can diversional in nature. They could have therapeutic, beneficial, or even healing outcomes. However, these outcomes are random. Activities are good. Activities are fun. They’re great! However, activities for the sake of activities are not Recreational Therapy. 

·         

Recreational Therapy differs from activities (in mental health setting) in that it is a service that is prescribed by attending physician and is part of an overall treatment plan. The focus is on the person and their treatment needs. The Recreational Therapist works on an overall treatment team with other practitioners. Recreational therapists use a systematic process to bring about outcomes. This process includes: assessment of strengths and needs in several domains, treatment planning with the patient, the RT implements the treatments (RT interventions), and evaluates the progress.

·         Reimbursement factors: Healthcare in expensive. Costs are rising. Services must be necessary. It would be nice to say, here are some wonderful, super fun, and amazing activities for people who are admitted to inpatient acute-care psychiatric settings. However, it is expensive. Recreational Therapy must be outcome based. The services must assist a patient with one of their treatment goals. The goal can’t be: have fun and enjoy some activities while you’re here.

·         What are some goals of RT in mental health? These vary depending on the person, their age, interests, their specific diagnosis and treatment needs. Some general areas of goals could focus on these areas:

o   Anger management

o   Relaxation skills

o   Physical fitness

o   Self-esteem

o   Information about illnesses or impairments

o   Goal setting

o   Healthy ways to express feelings

o   Communication skills

o   Boundaries

o   Social skills

o   Community leisure resources

o   Coping skills to decrease depression or deal with substance abuse

·        

Of course, goals must be measurable to determine an outcome. An individual with anger management needs may have goals that could include:

o   Identify at least one healthy/ safe way to express feelings of anger (without use of physical or verbal aggression) by certain date. RT could provide several interventions to help teach expressive techniques. Another goal could be to identify at least one healthy relaxation technique to help sooth self when having anger episodes. RT could provide veracious relaxation skills trainings, including: deep breathing, yoga, meditation, light fitness, etc.

·         Here are some of the RT Goals she listed in her slideshow:

A. Patient will express having fun or enjoyment during a recreational activity a minimum of 2 times a week as evidence of improved mood.

B. Patient will focus on recreational activity a minimum of 20 minutes per session 3 times a week without responding to internal stimuli as evidence of improved reality orientation.

C. After each RT group the patient will identify 1 accomplishment to improve self-esteem/mood.

D. Prior to discharge the patient will identify 3 leisure activities that he/she can participate in to cope with depression/ or as an alternative to substance abuse.

E. Prior to discharge the pt. will identify at least one community leisure activity that he/she can participate in to develop social supports.

Margie discussed a lot more. I wish I could share it all.

Here are some of the sources she shared:

•      Burlingame, Joan, and Thomas Blaschko. Assessment Tools for Recreational Therapy and Related Fields: Fourth Edition. Ravensdale, WA: Idyll Arbor, Inc. 2010.

•      Dehn, Dave. Leisure Step Up Manual and Workbook. Ravensdale, WA: Idyll Arbor, Inc. 1994.

•      Randolph, Mary. Joggin’ Your Noggin: Fun and Challenging Word Games for Seniors, Volume One. Easton, CT: Noggin Joggin’ Books, 2012.

•      Rainwater, Agnes B. Therapeutic Recreation For Chemically Dependent Adolescents and Adults: Programming And Activities. Reston, VA:  American Alliance for Health, Physical Education, Recreation, and Dance, 1992.

Ssww.com – S and S Worldwide activity supplies: Anger Management Toss’n’Talk Ball, Positive Toss’n’Talk Ball, Brainwave Music

============================================================

Take Danny Pettry's Recreational Therapy Refresher Self-Study Course

TR Knowledge Area:Foundation Knowledge: Concepts and models of health and human services, Principles of group interaction, leadership, and safety.Practice of Therapeutic Recreation/ Recreational Therapy: Theories of human behavior and theories of behavior. changeConcepts of TR/RT

Five (5) Clock Hours or (0.5) CEUs. Notice ten (10) Clock Hours = 1.0 CEU

Course Objective: Independent learner will demonstrate an awareness of concepts, foundations, principles of group leadership, and psychology related to recreational therapy practice as evidenced by reading Dr. David Austin’s Lessons Learned: An open letter to recreational therapy students and practitioners, Watching  Models of practice [video] -- health protection/health promotion model and passing a written exam based on this book with a score of 70% or better within a one-year timeframe.recreational therapy students and practitioners, Watching  Models of practice [video] -- health protection/health promotion model and passing a written exam based on this book with a score of 70% or better within a one-year timeframe.recreational therapy students and practitioners, Watching  Models of practice [video] -- health protection/health promotion model and passing a written exam based on this book with a score of 70% or better within a one-year timeframe.

===>  <====

Understanding TBI and treatment

Many RTs provide services for people who have had a traumatic brain injury.

There is an article at the link below about: a massive study that gives researches hints about recovering from brain injury.

It discusses RT as a treatment.

I like the article because it helps a person to understand more about what a person is experiencing after brain injury, like, not being able to find words to identify objects.


http://www.deseretnews.com/article/865638763/Massive-study-gives-researchers-hints-about-recovering-from-brain-injuries.html

A federal grant is helping Vets

Check this out:

A federal grant is helping Veterans receive recreational therapy:


http://nhpr.org/post/federal-grant-unh-assists-recreational-therapy-veterans

Stress is bad as (maybe worse than) second-hand smoke.

CNN health often has interesting articles.

They had an interesting article that argues stress can be as bad as second-hand smoke.

Recreational therapists (in mental/ behavioral health) settings as well as physical rehab settings (based on my personal experiences) provide stress management interventions.

I provide a mix of interventions for children and adolescents at a residential treatment program for three different needs. My primary triaging and experience is providing services for children with abuse-reactive needs. These children have all had suffered some type of abuse or traumatic life experience. Some of the kids have Post-traumatic stress disorder.

I provide several types of interventions under the recommendation and supervision of physician to help these children (patients). Some of these include: psych-education about stress and trauma, relaxation skills training, emotional regulation skills (to cope with various emotions), and components of Trauma-Focused Cognitive Behavior Therapy (TF-CBT), which I’ve had additional training.

Of course, many types of relaxation skills for children are play-based. It includes outdoor activities, sports, games, fitness, and activities as a healthy distraction.

In my opinion, Recreation Therapists provide interventions that are best suited for helping people learn ways to cope with stress. I do think we, as RTs, need to find more ways to make outcomes measurable.

There are several ways. In examples, the Heart-Rate Variability measurement is one tool to determine if a person is in Heart-Rate Coherence. I’ve had training on using HeartMath tooks at several of the American Therapeutic Recreation Association (ATRA) conferences.

There are other ways to measure too, in example: measuring cortisol levels, which are associated with stress.

I’d like to argue that the education component of RT is very important. Patients/ clients/ (kids in my case who I provide services for) need to having an understanding of the benefits (what is in it for them), the outcomes: like less feelings of stress, less stress-related health problems,  improved health, less likely to have physical illness as a result of stress. That sentence felt redundant. The client also needs to have an awareness of the skills that they can take-home with them and use in daily living. This could be a mix of relaxation skills: taking walks, physical exercises, taking a mini-vacation/ relaxation break, self-care, basic renewal. In other words, work ourselves out of a job.

I’d like to point out that RTs should be using the American Therapeutic Recreation Association’s standards of practice. Services (in clinical settings) need to have physician order for assessment and treatment. A comprehensive assessment should be used to evaluate client’s strengths and areas of needed improvement in the functional domains. Treatment plan goals need to be written (with client) to be part of the overall treatment team plan. RTs will provide interventions they are competent to provide (in example: relaxation skills training, psycho-education or leisure-education that teaches healthy life skills, and of course, activity-based interventions to allow the client to practice the skill. The RT will be providing these interventions along with other members of the treatment team. In a psychiatric setting, this will probably include: professional counselors, social workers, psychologists, nurses, mental health technicians or direct care providers, dieticians, and other allied professionals.

Documentation along the process is important as well. Individual and group RT-based interventions are to be documented by the RT as part of the medical record to evaluate the client’s outcomes and progress (or lack of progress).

Well, I could go on for hours about this.

I will leave you with the CNN link about the harm of stress here:

http://www.cnn.com/2015/09/03/health/stress-work-secondhand-smoke/index.html

Greenhouse therapy for kids!

Rec. Therapy in the News!

A children’s home greenhouse teaches more than just gardening.

This horticultural therapy offers life lessons and personal growth along with the plants.

Read about it here:

http://www.sctimes.com/story/news/local/2015/05/14/childrens-home-greenhouse-teaches-gardening/27327647/

Fishing – therapy for Vets

Rec. Therapy in the News!

Go here to watch Rude Neal on fox sports:

http://www.foxsports.com/watch/foxsports1/story/watch-rudy-neal-go-fishing-a-story-of-one-veteran-s-therapy-on-fox-sports-1-051815

Join ATRA!

I renewed my membership with the American Therapeutic Recreation Association (ATRA). I’ve been a good-standing member of the association since 1999 or 2000.

I’m not an official spokesperson of ATRA. However, as a member, I’m writing to invite you to join ATRA too.

Here is the link to join:

https://www.atra-online.com/members/join