This document summarizes a research poster presentation on a therapeutic recreation program for inpatients in an acute psychiatric care unit. The program aimed to address challenges like isolation, depression, and lack of motivation through weekly group interventions including yoga, pet therapy, music therapy, and expressive arts. Participants completed pre- and post-surveys to evaluate changes in mood and depression symptoms. Results found statistically significant improvements in mood and high patient satisfaction rates, showing that the multi-modal recreation therapy program was effective in improving outcomes for psychiatric inpatients.

1. RESEARCH POSTER PRESENTATION DESIGN © 2015
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Setting: Inpatient acute care units are treatment settings
designed to insure close observation and safety, and are
therefore by design somewhat constricting and restrictive in
nature.
Challenges for RT’s: Often patients will be unmotivated
depressed and isolative. The literature states that “In an
acute mental health setting interventions have been linked to
outcomes in depression, anxiety, and self-efficacy.”
(McCormick, Funderburk; 2000)
Goals: Discourage isolation and withdrawal, and encourage
socialization, participation, and interaction that will help to
alleviate the symptoms of depression as well as to help
prevent the iatrogenic worsening of depression.
Modalities and rationale: Qualitative and quantitative
changes in mood after four, hour long therapeutic recreation
weekly interventions; Yoga, Pet Therapy, Music Therapy, and
Expressive Arts. The interventions were repeated for three
months until a minimum of twenty five participants for each
modality was collected. These four interventions were
chosen by the clinician according to likelihood of intervention
effectiveness .
Initial Evaluation Process: After admission the participants
were initially assessed by the treatment team . The clinician
conducted further assessment to determine ability to
participate in the therapeutic recreation group programming.
Eligibility depended on safety, admitting diagnosis, projected
benefit, and ability to comprehend group process.
Program Design: Specific volunteer group leaders were
recruited for specific group types based on relevant
background and credentials while the clinician was charged
with supervising ,overseeing and facilitating the evidence
based interventions.
Further Evaluation: A survey was created to present at the
beginning of the session, the researcher was present for the
duration of the intervention, and then a follow up survey was
presented to collect the post intervention data. The survey
was a simple likert scale that measured depressive symptoms
and asked participants to describe their mood qualitatively.
Analysis: Data from this study were entered to an excel
spread sheet and a t test was performed to determine
statistical significance . . The percentages in the results
sections are based on excel calculations.
Program Overview Program Goals
Regulations: The Joint Commission Accreditation Healthcare
Organization (JCAHO), an organization designed to monitor
hospital care, requires that specific organization defines the
scope of assessment used by clinicians. The techniques may
need to be modified if being used in another facility. As
required by ATRA the assessment of participants consists of
three parts; structured interview, direct observation, and
information from others as well as record. The structured
interview assesses leisure interests, strengths, limitations, and
goes over specific goals for treatment and plan of care. This
information is also uploaded into the treatment plan in the
record and shared with other members of the treatment
team. In a psychiatric setting the doctor must prescribe RT
treatment of a patient and the structured interview is only
conducted after the order is received..
Methods and Rationale: Research indicates that direct client
feedback as well as clinical observations are important
sources of information. (Peterson) The direct client
information is obtained through pre-intervention on site
surveys that measure depressive symptoms and asks
participants to describe their mood. The clinician collects
data post intervention and data is inputted. Research notes
that “evaluation of a comprehensive program includes the
relationship between program design, clients, and
evaluation.” (Peterson, 353) Essentially ,all three of these
areas have to be present in order for the evaluation to be
accurate.
Self-Evaluation: As stated by ATRA the results of the program
evaluation and research are routinely done in order to
improve service delivery. This data should be recollected
every several months in order to have up to date information
on the program and above mentioned goals.
Why this works: The researcher found that after repeatedly
evaluating the program there were some strengths to take
into consideration. For example, this is a person-centered
approach to care which allows participants to be an active
member in their treatment. They are allowed to choose which
interventions they would like to attend. This empowers
participants and has been proven to increase attendance.
Evaluations
Paired samples t- tests demonstrated positive outcomes
were statistically significantly for improved patient mood
(p < .01, d = 1.86) with a large effect size, and high patient
satisfaction, with the majority (82.5%) of participant’s
rating the program as very or extremely helpful.
86% of participants described their mood
positively
98% of participants reported a positive change
in mood
Expressive Arts: “I liked being able to combine relaxation with
creativity. ”I liked being allowed to express my inner
demons.”“[This activity] Helped take my mind off things.”
Yoga: “Helped me to calm down. ”My back hurt before and
now it does not. ” “This group brought me peace [of
mind]”“[This group] taught me relaxation techniques I will use
again.”
Music Therapy: “It calmed me down and I am not as anxious
as I was before” “Entertaining and enjoyable” “Found it very
relaxing”
Pet Therapy: “The dog helped to soothe my stress.” “Loved
petting the dog and learning more about my peers.” “The
interaction is always therapeutic”
Results and Outcomes Suggestions for Replications
Original: This program is designed for acute psychiatric adults
and should only be replicated exactly if the clinician is
working with the intended population. Program length,
schedule, and rotation of groups are all based on this
population and may need to be modified.
Expanding to different facilities: It is important for the
clinician to analyze the research relating to their specific
population if they wish to modify this program. This model
can also be applied to long term psychiatric patients by
changing the content of the sessions more regularly, but still
having the sessions fall under the four categories mentioned.
Recruitment: In order to have Pet Therapy, Yoga, and Music
Therapy the individuals leading the sessions must hold a
credential or have advanced training relevant to that specific
area. In this organization we have community volunteers that
fulfill this requirement and the clinicians serves as supervisor
to monitor for any emotional difficulties that surface for
patients. This model can also be expanded if there are other
credentialed facilitators for other interventions( i.e. Drama
therapy)
Evaluation: The clinician would need to create an initial
evaluation process which is both population and organization
specific in order to determine which patients are appropriate
to attend intervention sessions. Those designing the study
would need to create a pre-intervention and post-
intervention survey which includes both qualitative and
quantitative data to begin to determine the effectiveness of
these groups for their specific population. There should be at
least twenty surveys collected for each modality in order to
begin to analyze the data.
Considerations: These results were all collected while each
participant was also receiving services from the treatment
team which includes, but is not limited to, a psychiatrist, a
psychologist, clinical social workers, and nurse.
References
Lavey, Roberta; Sherman, Tom; Mueser, Kim T.; Osborne, Donna
D.; Currier, Melinda; Wolfe, Rosemarie . (2005) The Effects of
Yoga on Mood in Psychiatric Inpatients, Psychiatric
Rehabilitation Journal, Vol 28(4)399-402.
Heaney, Christopher J. (1992) Evaluation of Music Therapy and
Other Treatment Modalities by Adult Psychiatric Inpatients ,The
Journal of Music Therapy, Vol 29 (2) 70-86.
Körlin,Dag. Nybäck, Hendrik. Goldberg, Frances S. (2009)
Creative arts groups in psychiatric care Development and
evaluation of a therapeutic alternative, Nordic Journal of
Psychiatry, Vol 54 (5), 333-340.
Nimer, Janelle. Lundahl, Brad. (2015) Animal-Assisted Therapy:
A Meta-Analysis, Anthrozoös , Vol 20 (3) 225-238
McCormick, Bryan P. Funderburk, Janet. (2000) Therapeutic
Recreation Outcomes in Mental Health Practice, Annual in
Therapeutic Recreation, Vol 9, 1-19
Peterson, Carol Ann. (2010) Therapeutic Recreation Program
Design, Las Vegas, NV, Pearson Education
 Identify the need and challenges associated with TR in a
behavioral health setting
 Design and implement a TR program based upon the model
provided in the presentation
 Perform outcome-based measurement of behavioral
health TR programs
 Improve patient mood after participation in interventions
 Increase patient satisfaction of groups
 Decrease Isolation by improving socialization skills through
increased attendance of interventions.
 Decrease Depressive Symptoms
Newport Hospital Behavioral Health Unit, Newport, RI
Author: Bethany K. Diedrich
Multi-Modal TR in Behavioral Health