Lethbridge College TRG1150 - Intro Therapeutic Recreation

1. Living Options for
Individuals who have
Support Needs
Click through the slides to learn about each model

2. Institutional Model
The number and size of institutions have decreased considerably since the
1970s, but some facilities for individuals with significant developmental
disabilities and mental illness still exist. There is a focus on providing the basics:
shelter, food, clothing, and essential medical care. The environment is typically
impersonal and hospital-like in nature, although many of the residents may not
have acute medical conditions requiring daily nursing care. The range of
activities provided is limited, with few, if any, outings occurring in the
community. Recreation activities are often group-based and diversional in
nature. Many individuals have lived, or will live, most of their lives in this type
of environment. Some people feel that not only they, but also people in the
community, would have difficulty if they attempted to integrate into
mainstream society.

3. Medical Model
This model focuses on an individual’s
medical needs and primarily takes place in
a hospital setting. Initially, the person may
have required acute medical care, but
depending on the availability of
alternative living arrangements that
provide supports, he or she may end up
living in a hospital setting for an extended
period of time. Recreation activities may
be diversional in nature-something to
keep the patients happy and to reduce
frustration. These recreational activities
may depend on the availability of
volunteers and/or family members, as
nursing staff must focus on health care
issues. On a long-term basis, this is not a
positive living arrangement for either the
person or his or her family.
© (2011). Tomasz Sienicki. Licensed under Creative Commons

4. Medical Model
In some cases, however, the goal of a medical setting is to provide specialized
rehabilitative services. This would be true in a clinical setting: serving individuals
who have had, for example, a stroke, a heart attack, a limb amputated or a spinal
injury. The person may still require medical treatment at this point in his or her
recovery, but a range of therapeutic activities, including recreation, are provided
in order to enhance his or her level of independence or quality of life.
Others may have received medical treatment and then been released to
recuperate at home with little or no follow up. Depending on the natural
supports (family, friends) that may be available, the person may continue to have
health issues or be isolated both physically and socially from the community. If
there is limited attention given to his or her support needs, the individual may
repeatedly return to a medical setting for care.

5. Therapeutic Milieu Model
This model is primarily seen in facilities that provide services to individuals with
mental health issues or addictions. Certainly, some programs are housed in
institutional or hospital-like settings, but there is a planned approach to “help”
the individual deal with his or her condition or addiction. It is felt that with
treatment or therapy, the person can return to the community. The client is
involved in determining the direction of his or her care; treatment focuses on
wellness.
Unfortunately, individuals are often returned to communities without sufficient
ongoing supports available. Many return to the treatment facility unable to cope
without the structure. The greatest success occurs when there is a focus on the
unique needs of each individual and the environment to which he or she will
return.

6. Education and Training Model
The first institutions for the developmentally handicapped had a primary
objective of educating or training the resident to live in the community. Societal
attitudes and a lack of trained staff prevented this from happening in most cases.
More recently, group homes and sheltered day programs for individuals with
developmental disabilities and halfway homes for those with mental health
illnesses would be examples of settings using an education and training model.
The key idea is to teach the person the skills needed to function in a community
setting.
There were (and sometimes still are) problems with discrimination-“We don’t
want those people living next door.” Although these programs may be physically
integrated in the community, their congregate nature makes social integration
difficult. Smaller communities also do not always have the full range of services
required; individuals with a wide range of support needs may be grouped
together without much consideration for their unique needs.

7. Education and Training Model
Other examples of programs using an education and training model would be
settings that provide rehabilitative services after the need for acute medical care
has passed. For example, an individual who has experienced a brain injury may
no longer need the daily medical care of a hospital, but still requires
physiotherapy, speech therapy, occupational therapy and/or recreational therapy
in order to regain skills or learn new adaptive ways to accomplish tasks. Someone
who has suffered a spinal cord injury would have a similar need for specialized
education and training.

8. Community Model
Starting in the 1970s, most provinces moved toward de-institutionalization for individuals
with disabilities. Not only were fewer people admitted, but community organizations began
to open up group homes. They typically housed between six and 20 individuals who had
mild to moderate support needs. There was certainly some resistance from neighbours
initially, but strong advocacy efforts persevered. Group homes allowed for more
individualized programming; some had a strong training component, as noted in the
Education and Training Model description. Beginning in the 1980s and still today, there is
more of an emphasis on community inclusion rather than just physical integration. This has
resulted in more options that involve smaller group settings (two to three people),
clustered apartments, roommate companion or independent living arrangements. Support
staff is provided as needed to assist the person to live as independently as possible.
Involvement in community recreation has also become more inclusive.
As the philosophy for service provision has switched from the person needing to fit into
available services, to the services fitting the person’s individual needs, many individuals
have been able to remain in their own homes. Home care and respite for family members
providing daily care often enhances strong natural supports in a familiar setting.

9. Continuum of Care Model
This model considers a range of housing options for
seniors, although it may also be applicable for those
with chronic health issues. Each health region will
have a process to follow in order to access supports,
but it is common for a community or home care
nurse to carry out an assessment identifying an
individual’s health care needs.
It may be quite feasible for the person to remain in
his or her own home with auxiliary supports such as
handyman or lawn services, Lifeline emergency
support or Meals on Wheels. If the individual
requires some assistance with personal care or
household tasks, then a contract with an approved
agency is set up to provide in-home support for a set
number of hours per week. Some communities may
have seniors-only apartments/complexes. The extra
benefit to this option is increased opportunities for
social interaction and group recreational activities.
© (2011). By U.S. Navy photo by Mass Communication
Specialist 1st Class Terry Matlock.
Licensed under Creative Commons

10. Continuum of Care Model
If a person is not able, or does not wish to remain in his or her own home, many
communities are expanding the options for living arrangements. Some of these are:
• Lodge
• Enhanced
• Supervised group homes
• Designated Assisted Living Facility
• Continuing Care Facility (Nursing Homes)
As previously stated, not all communities will have all options available, or different terms
may be used. The following reading outlines the terminology that is used in the Chinook
Health Region, which includes the City of Lethbridge. Essentially, the difference lies in the
level of support that is available to residents: housekeeping, prepared meals, laundry,
medication administration, recreational programming, in-house personal care services or
on-site registered nurses. The emphasis is on meeting the social needs of the residents,
while providing health and/or medical care as needed. The Continuum of Care Model is
designed to minimize the need to move an individual; supports are added as the needs or
preferences of the person changes.