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| What Is the Therapeutic Process? By Debbie Hommel, BA, CRA, ACC Executive Director of DH Special Services As we enter the activity profession, one of the first ideas we are introduced to is the “therapeutic process”. Therapeutic interventions, therapeutic care plans, pet facilitated therapy, therapeutic groups, therapeutic activities - and the list goes on. Through our formal and informal training, we quickly learn the meaning behind this frequently used term. Therapy is commonly defined as a “curative process which brings about a positive change in an individual’s physical, mental or emotional well-being”. It is important to note the use of the word “process”. In using this word to describe what therapy is, it implies that it is something that occurs over time. Just one activity or one room visit is not always the answer, just like one dose of medicine is not the cure either. The second aspect of this definition worth discussing is use of the word well-being. In geriatrics, with the various aging diseases we encounter, our elders are not going to be “cured”. But, we do know they can live life well, happily and with purpose - in spite of the limitations and losses associated with aging. It is this idea of wellness that we embrace, knowing it has to do with spirit and state of mind - rather than with disease and diagnosis. The therapeutic process gives meaning to our methods. Unlike a cruise ship director, there is a significant reasoning behind each activity we plan and who we encourage to participate in our programs. The therapeutic process begins with the formal activity assessment, where we gather pertinent information about the resident. Physical, cognitive, social, leisure and recreational aspects of the resident are reviewed and documented. If we work in a nursing home setting, we are completing our section of the Minimum Data Set as well. With this information, we are ready for the second step of the therapeutic process which is establishing a plan of care. With pertinent information about the resident, the activity professional joins the rest of the health care team in creating an interdisciplinary plan of care. Being a member of the team is a privilege and responsibility, which requires commitment on our part. The team discusses the resident’s needs, defining goals and interventions. The activity department can play a significant role in assisting interdisciplinary concerns such as mobility, behavioral symptoms, communication, mood, and nutrition. If the activity professional is approaching the care plan in a single minded way, meaning only thinking of activity based concerns or needs, they are missing many opportunities to contribute to the resident’s overall improvement. Once the plan of care is finalized, the third step of the therapeutic process begins. Following through on documented care plan interventions is a legal, professional and ethical commitment for the activity professional. Communication is essential between the care plan team and the activity professionals conducting programming and 1-1 interventions. Methods to ensure care plan interventions occur as noted include meetings with the activity staff, targeted lists of participants, and permanent assignment of staff. The last step of the therapeutic process is evaluation. As the activity professional works with the resident, engaging them in programs according to the plan of care, we observe participation, notice responses, and identify barriers to participation. These responses are noted within an activity progress note or an interdisciplinary team note. This last step of the therapeutic process brings us back to the beginning - reassessing and re-defining the plan of care. The therapeutic process will never let us down. It guides the activity professional in addressing resident needs consistently, ensuring programs and interventions which enhance quality of life - are created and implemented. |
| About Debbie Debbie Hommel, BA, CRA, ACC, is the Executive Director of DH Special Services. She is a Certified Activity Consultant on State and National level, with over twenty-seven years of experience in providing direct care and consultation to long term care, medical day care, assisted living, and ICF/MR facilities throughout New Jersey, New York, Maryland, and Pennsylvania. She is an experienced trainer and workshop presenter, conducting a variety of seminars throughout the Tri-State area for the Activity Professional, Administrator, and allied healthcare professional. Debbie Hommel is an active member of Activity Professional Associations on State and National levels. She is ACC certified through the NCCAP. She is a founding member of the New Jersey Activity Professionals' Association, serving terms as Vice President and President. She received the Weidner Lifetime Achievement Award in 1994 and the Monmouth & Ocean County Activity Professionals Life Achievement Award in 1999. |
| Book Review 1 “Assessment, the Cornerstone of Activity Programs” by Ruth Perschbacher. Published by Venture Publishing. If one wants a good book which provides an overview of the assessment process while also reviewing aspects of aging and concepts related to understanding the elderly, this book is one you want for your library. It is a great book for the novice activity professional, seeking basics and fundamental ideas associated with activity assessment and care planning. However, the experienced activity professional will also find it informative as it also provides more in depth information about coordinating program choices with assessment information. The book is easy to read, well organized and includes a number of case studies to illustrate certain points. There is also some discussion of the Minimum Data Set, Resident Assessment Protocols and management of documentation requirements. The book is available through Venture Publishing. |
| Book Review 3 “The Activity Care Planning Cookbook” by Hall and Nolta. Published by Recreation Therapy Consultants. Every activity department needs a good care planning guidebook. This “cookbook” is a practical tool which many activity professionals find helpful. The first section of the book covers care planning basics, providing a few lists of action verbs and descriptive terms. The majority of the book are sample care plans. The care plans are created from triggers in the Minimum Data Set. The care plans are grouped by topic or problem and include sample problems/needs, goals, and interventions. There are spaces allowed for individualization of the goals and interventions. There is also a comprehensive listing of medical abbreviations and medical terminology. It is a available through Recreation Therapy Consultants. |
| Recommended Reading |
| Book Review 2 “The RAP Handbook for Activities – The Assessment Success Guide” is also by Hall and Nolta, along with Monaco. It is available through Recreation Therapy Consultants. This is the only book for activity professionals which focuses on understanding and creating activity based RAP notes. The beginning of the book offers some basics associated with the Minimum Data Set, the Resident Assessment Protocols and understanding them specifically from an activity perspective. The book goes into great detail, offering sample documentation for substantiating documentation. The remainder of the book offers a number of sample RAP notes, based on specific issues which may trigger in the MDS. Finally, there are clear guides for writing progress notes and evaluative documentation. There is a lot of information packed into this practical guide for activity professionals. It is also available through Recreation Therapy Consultants. |
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