Therapeutic Recreation in Residential Treatment: A Forgotten Frontier

By Jeff Levy

Reprinted from Illinois Parks and Recreation, January/February 1989, pp. 20-21.

Residential treatment for disturbed and/or delinquent youth is an often forgotten setting for therapeutic recreation service delivery. These residential treatment agencies, located throughout the state of Illinois (as well as around the country) serve thousands of children. These children are in placement due to neglect, physical and/or sexual abuse, learning and behavior problems, developmental disabilities, physical disabilities, delinquency, substance abuse/chemical dependence or any combination of the above. Through a discussion of the obstacles faced in service delivery, the current status of therapeutic recreation in residential treatment, potential roles of therapeutic recreation, and the review of a sample program and consumer, this forgotten arena for service delivery can be better understood. The need for professionals to address this setting and population becomes apparent.

The obstacles
Most recreation professionals would agree that services should be extended to youth in placement, yet in most agencies and institutions, recreation services are viewed as any or all of the following: time filling, babysitting, tiring kids out so they are easier to manage, or as a reward for "good" behavior. Consequently, professionals trained in therapeutic recreation may not be attracted to this type of setting due to the historically low priority that is placed on organized and professionally delivered services. Instead, professionals opt for Illinois' hospitals, day treatment centers, community mental health agencies, or special recreation associations/municipal settings. This contributes to the perceptions of some residential treatment agencies that recreation services can be delivered by "anyone" because they have not been exposed to trained professionals and, if there are full time staff specifically utilized to deliver therapeutic recreation services, they are not staff with professional training or credentials in the field.

The current status of TR in residential treatment
Because therapeutic recreation is a relatively new discipline and is viewed as fairly progressive, comprehensive and professionally delivered programs are most often found, as previously discussed, in hospital-based or community-based programs where certified staff are members of large therapeutic recreation departments/agencies. Residential child and youth care, however, has not taken advantage of the role of therapeutic recreation in meeting youth needs.

In Illinois alone, of the 48 residential agencies that are members of the Illinois Inter-agency Athletic Association (a state funded agency coordinating organized athletic competition within and between residential treatment agencies), only 24, or half, have any type of recreation worker. Only 11 have more than one recreation worker. Eight agencies have professionals trained and certified in therapeutic recreation, and even fewer have supervisory staff in therapeutic recreation with advanced degrees.

The role of TR in residential treatment
The special needs youth served by residential treatment agencies often receive specialized educational services, vocational services and social work services. Often times, however, youth may not respond to traditional forms of therapy. Therapeutic recreation services have been recognized as an alternative/additional modality that may impact troubled and otherwise hard-to-reach youth. Social and peer skills may be improved through athletics and team sports. Self-esteem and self-confidence may be improved through music and art. With these same interventions and the addition of dance, dramatics, and other creative arts, youth may be assisted in expressing feelings of anger, sadness, isolation, and hopelessness so that they may then deal with these feelings as they mature and develop. Cognitive, decision-making and problem-solving skills may be developed through cooperative games, initiatives, and team-building activities. Youth may be educated on the role of leisure time and leisure/recreation resources in their community so that a functional leisure lifestyle may be developed as opposed to youth who, being faced with idle time and, not knowing how or having the skills to use this time, would vandalize, rob, steal, and/or abuse substances.

A sample program
Therapeutic recreation in residential child and youth treatment must not only be philosophically defined, but must also be translated into a definition of service with corresponding goals. An example from one residential treatment agency follows:

Therapeutic Recreation is the provision of treatment/leisure education services and recreation services to persons with special needs. The primary purpose of treatment/leisure education services, which is sometimes referred to as recreation therapy, is to restore, remediate, or rehabilitate in order to improve functioning and independence as well as reduce or eliminate the effects of social, emotional, cognitive, or physical illness/disadvantages. The primary purpose of recreation services is to provide recreation resources and opportunities in order to improve health and well-being. Therapeutic recreation is provided by professionals who are trained and certified, registered or licensed to provide therapeutic recreation.

This definition implies that therapeutic recreation is utilized as one method to address client treatment issues and/or goals, while holding constant the underlying philosophy of the agency.

The Therapeutic Recreation Department maintains the following statement of purpose and corresponding departmental goals:

Statement of Purpose: To provide a wide range of therapeutic recreation services to develop and improve cognitive, social, emotional, and physical abilities as they relate to overall development and functional independence.

Goals

1. To develop and improve social skills.
2. To develop and improve self-esteem and self-concept.
3. To improve expression of feelings and self-awareness.
4. To develop and improve physical fitness and motor coordination.
5. To develop and improve cognitive skills.
6. To develop and expand leisure skills.
7. To develop the knowledge and skills to utilize leisure resources.
8. To provide opportunities for voluntary independent recreation participation.

A sample consumer
More important than what can be written by any professional is the perception of the youth/consumers receiving therapeutic recreation services. Below is a brief narrative written by a 14 year old boy currently in residential placement. His name has been changed but his writing has not been altered and is presented here as a reflection of the value and need for therapeutic recreation services in the residential treatment of children and youth.

"My name is Robert and I've been in an agency in Chicago, Illinois for about nine months because I had problems both at home and at school. Mostly because of my behavior and a CHAOTIC home environment. The judge decided I needed a controlled and supervised environment because I saw too much violence at my house.

At Lawrence Hall, all activities have something to do with Therapeutic Recreation. Therapeutic Recreation to me is a series of different things and activities for me to do. Therapeutic Recreation is used to help kids with their problems through group activities or even a one on one activity with a recreation staff member. Therapeutic Recreation to me is probably a system that helps me get all of the exercise and activities that I need to stay in shape both physically and mentally.

I think the people at recreation are a bunch of people who help kids realize their full potential through sports, talks, leisure activities, etc. Also, many recreation staff go out of their way to help children deal with problems. Sometimes, even if you need someone to talk to, you can turn to a staff member of the recreation department and they will try to take time out to sit down and talk to you, give you a word of advice. Some people I know have trouble believing that staff are there to help you.

Recreation runs all different sorts of programs for all different kinds of reasons. They run music therapy programs for kids who don't believe they can work and help themselves more than people tell them. Leisure programs are the games and quiet exercises or activities. They have sports and games where you have to try hard and improve. But the most important ideas they stress are fun, and trying, because if you don't try you'll never learn what it feels like to win or even do good.

I've gotten a lot out of recreation while at Lawrence Hall. I've been in just about every program offered, or at least I've sat in a couple of the ones I wasn't in. I've learned self-reassurance, and also, when I first came to Lawrence Hall, I didn't believe in myself. I listened to what other people thought of me and believed them, but here at Lawrence Hall I learned, through recreation, that I could be good or even better than other people when I try. "

The challenge
Robert is only one of the thousands of youth served by residential child and youth care agencies. The role of, and need for, therapeutic recreation services in his life, and in the lives of the many children in residential placement, is clear. The challenge remains for professionals to meet these needs through concerted efforts at service delivery in this setting where therapeutic recreation is often ignored, forgotten, and misunderstood.