beating boredom with purposeful activity: combining ... · collaboration: benefits that enhance...
TRANSCRIPT
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Beating Boredom with Purposeful Activity: Combining therapeutic recreation and behavioural analytic
interventions to maximize client outcomes
Beth Astles, C.T.R.S.
Recreation Therapist
Stacie Dertinger, M.ADS, BCBA
Behaviour Therapist
“Untitled”- Howard Soar
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AGENDA
• Who we are
• Enhancing client care through interdisciplinary teams
• Review evidence for the integration of recreation into client programming
• Review of our data
• Breakout brainstorming groups
• Conclusions and takeaways
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ABOUT US
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ABOUT US
Head Injury Rehabilitation Ontario (HIRO) provides a full range of integrated, clinically-based rehabilitation services:
o Mild to severe head injury
o “Dual diagnosis”; chronic disease, mental health and addiction
o Transitional services across continuum of care
HIRO. We are hope, you are strength.Together we will reach your full potential.
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ABOUT US
Our Mission:
We provide high-quality, person-centred rehabilitation and care for people with brain injuries to help them adapt, learn and live more independently.
Our Vision:
Every person with a brain injury realizes their full and unique potential.
Our Values:
• Respect
• Learning
• Independence
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SERVICES OVERVIEW
1. Residential Rehabilitation Services:• Hamilton –Elmhurst Place, John Reesor Centre (JRC), Transitional Living
Service (TLS)
• St. Catharines – Kenny House, Ravenda Place
• Vineland – Cathy Wever Place (CWP), Campden Heights (CH)
2. Outreach Services:• Locations: Hamilton, Brant, Haldimand and Norfolk counties
3. Group Services:• Locations: Hamilton, St. Catharines, Brantford, and Haldimand Abilities
Centre (Hagersville)
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SERVICES OVERVIEW – COMMUNITY SERVICES
• Services are HNHB LHIN wide
• Provides caregiver respite
• Supports independent living
• Community collaboration
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INTERDISCIPLINARY TEAM
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RECREATION THERAPYWhat is it?
A systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illnesses and/or disabling conditions, as a means to psychological and physical health, recovery and well-being. - NCTRC
How does it Benefit our Clients
• Clients gain a sense of purpose
• Building Skills through recreation programs
• Learning new things and try new experiences
• Build friendships and decrease mental health symptoms
• Increasing Mood
• Decreasing behaviours from residential setting
• Increased quality of life.
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BEHAVIOUR THERAPY
What is it?
A science of behaviour based on the premise that you can create behaviour changes by focusing on the behaviour itself (rather than less tangible concepts like willpower) by adjusting the environment, antecedents and consequences to the behaviour. Interventions seek to both reduce challenging or interfering behaviour and improve functional skills. (BACB, 2019)
Residential Vs. Group Programming
How does it Benefit our Clients
• Different programming options based on level of behavioural oversight and the opportunity for interventions.
• Allows great access to community and social environments
• Reduces need for intrusive interventions (PRNs, restraints)
• Enhances rehabilitation outcomes
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STUDY METHODS
“Sail Away”- Nicole
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DECREASING CHALLENGING BEHAVIOURS
Reinforcement Punishment Engaging Environment
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OUR HYPOTHESIS
Engagement in recreation can minimize the likelihood and severity of challenging behaviour (Ball & Fazil, 2012).
Integrating sensory stimulation into residential settings shifts the focus of frontline staff from traditional caretaking jobs to active engagement in their recreation, leisure and programming tasks (Mansell et al., 2002).
47% Reduction
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METHOD
To decrease social interruptions
Off task conversations, side conversations etc.
To increase Social engagement
Encourage interaction between clients
To decrease interfering
Used when someone is verbally aggressive, wandering, interrupting programs or others
To Increase Active participation
Used to encourage clients to participate in programs when fully capable of doing so
Rule Review
When rules of group need to be re-explained due to clients behaviour
Facilitation prompts
When leading a group and needing to refocus the group to the task at hand
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METHOD
Breakdown of the Type of Programs Run
During Structured Programming
Educational Skill Building Socialization
Educational
Behavior Therapy, Social Work and Nursing Presentations
“Mancave”
Skill Building
Lunch & Learning- preparing to cook the meal for Group
Creative Expression
Socialization
Friday Night Programs
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RESULTS
Similar prompting was given for decreasing off-task social behaviour in both programs
both programs also required relatively similar rates of decreasing interfering behaviour prompts
Prompts to increase active engagement were only required in unstructured programs
More rule reviews were required in unstructured programs
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
structured unstructured
Comparison of Types of Prompting Needed During
Structured and Unstructured Programs as a Percentage of
All Total Prompts
Increase Active Prompts Decrease Interferring Prompts
Increase Social Prompts Decrease Social Prompts
Program Prompts Rule Reviews
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CLIENTS PERSPECTIVE : Benefits of Structured Programs
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CLIENTS PERSPECTIVE : Enhance Quality of Life
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DISCUSSION
CONCLUSIONS
FUTURE DIRECTIONS
LIMITATIONS
• Full research study comparing the occurrence of challenging behaviour to task demands and request refusals in residential and group environments
• Collecting data on the number of structured vs. unstructured recreation programs in residential homes
• Examining the effects of increasing structured programs in residential settings
• Limited sampling of data
• No comparison group
• No tracking of challenging behaviour
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COLLABORATION: Benefits that Enhance Client Experience
1. Client’s receive Optimal (ABI Rehabilitation) Services
2. Team Approach Fosters Communication & Success
3. Ensuring Best Practice with current knowledge & trends
4. Maximizing the Strengths on your care team
5. Using a Person-Centred Care Approach
6. Building a Research profile to share with professionals
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BREAK OUT GROUPS – Brainstorming Solutions
What Tools and Methods can
you use?• What do you do now
• What haven’t you tapped into on your team
• Can you identify team strengths
• Think outside of the box.
What are the benefits of
Collaboration
• What benefits will your clients receive
• What benefits with the staff team receive
• What are the benefits for the agency
• What are the benefits for the profession
10 minutes
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LET’S DISCUSS
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FINAL THOUGHTS“Untitled”
- Eyyad
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FINAL THOUGHTS
Benefits of an Interdisciplinary Approach
Community vs. Residential/In-Patient
Maximizing Current Resources
Structured vs. Unstructured Time
Recreation Therapy as a Behavioural Intervention
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QUESTIONS
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REFERENCES
About behaviour analysis (2019). Retrieved from: https://www.bacb.com/about-behavior-analysis/
Ball, J., Fazil, Q. (2012). Does engagement in meaningful occupation reduce challenging behaviour in people with intellectual disabilities? A systematic review of the literature, Journal of Intellectual Disabilities, 17(1), 64-77, doi: 10.1177//1744629512473557
Mansell, J., Elliot, T., Beadle-Brown, J., Ashman, B., & Macdonald, S. (2002). Engagement in meaningful activity and ‘active support’ of people with intellectual disabilities in residential care, Research in Developmental Disabilities, 23(5), 342-352
About recreation therapy (2019). Retrieved from: https://www.nctrc.org/about-ncrtc/about-recreational-therapy/