Goal Oriented Activities
and Outcomes
Norma J. Stumbo, Ph.D., CTRS
President, Education Associates
Normal, Illinois, USA
April 2013
Topics

Defining Accountability, Intervention, Quality, Outcomes

Principles of Intervention and Outcomes

Leisure Ability Model

Therapeutic Recreation Accountability Model

Components - Practice
Goal Oriented Activities and Outcomes

What is Accountability?

How is Quality Defined?

What is Intervention (and how does it differ from other services)?

What are Client Outcomes?

How Does TR Produce Client Outcomes?

What Client Outcomes Should be Expected in High-Quality TR Intervention Programs?
Accountability

Being held responsible for the production and delivery of therapeutic recreation services that best meet
client needs and move clients toward predetermined outcomes in the most timely, efficient, and
effective manner as possible (Stumbo & Peterson, 2009, p. 73)
Intervention

A program that is designed and implemented to be intervention has as its outcome some degree of
client behavioral change (that is, behavioral change is the purpose of the program) (Stumbo &
Peterson, 2009, p. 79)

The direct, causal link between the process or delivery of care and the outcomes expected from it
(Riley, 1991a)
Quality

Providing the right patient with the right service [at] the right time in the right setting at the right
intensity and for the right duration (Navar, 1991, p. 5)

Intervention programs that lead to predictable and measurable client outcomes (Peterson & Stumbo,
2009)

Achievement of some pre-established standard or a desired level of service (Stumbo, Pegg, & Carter, in
press)

Degree to which health services for individual and populations increase the likelihood of desired health
outcomes (quality principles), are consistent with current professional knowledge (professional
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practitioner skills), and meet the expectations of healthcare users (the marketplace) (Buttell, Hendler, &
Daley, 2006, p. 62)
Client Outcomes - Categories

Change in clinical status (effect of tx. on pt. symptoms)

Change in functionality (effect of tx. on pt. lifestyle)

Change in utilization of medical resources (effect of tx. on using additional health care services)

Recidivism (examining patterns of relapse or re-entry into medical system) (Gorski, 1995, p. 33)
Client Outcomes

Observed changes in a client’s status as a result of our interventions and interactions... Outcomes can
be attributed to the process of providing care, and this should enable us to determine if we are doing
for our clients that which we purport to do (Shank & Kinney, 1991, p. 76)

Need to have relevance and importance to the client’s future lifestyle and are attainable within the time
frame of service delivery (Riley, 1987a, 1991a)
Client Outcomes
• Observable changes that result from intervention (Client status, functional status, well-being, care
satisfaction, cost/resource utilization)
• Changes over specified time
• Clinical results
• Results of performance
• Direct effects of service
• Difference between input (assessment baseline) and output (discharge)
• Both planned and unplanned
• Both beneficial and harmful
• Straightest line between A and B
Questions?

Accountability

Intervention

Quality

Client Outcomes

Application to your TR Program?
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Purpose of TR Service Models

Schematic Representations

Communication Tools


o
Explanation of TR Practice
o
Expression of Philosophy and Theory
Defines TR Practice
o
Directs Service Development, Delivery to Clients
o
Directs Selection of Client Outcomes
o
Directs Program Evaluation & Quality Improvement
o
Foundation for Research, Public Policy, & Future
Two Types
◦Content Models (Leisure Ability Model)
◦Process Models (TR Accountability Model)
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2009 Leisure Ability Model
Functional Intervention, Leisure Education, Recreation Participation
Purpose of Therapeutic Recreation:
To aid individuals with physical, intellectual, emotional, and/or social limitations in developing an
independent leisure lifestyle aimed at improving their overall health, well-being, and quality of life through
the provision of functional intervention, leisure education, and recreation participation services.
Functional Intervention
(formerly Recreation Therapy and Treatment)
o
Leisure Education
o
Recreation Participation
(formerly Special Recreation)
Functional Intervention
o
Addresses functional abilities that are prerequisite to, or a necessary part of, leisure
involvement and lifestyle
o
o
Physical
o
o
Orientation, ability to follow directions
Emotional
o
o
Endurance, strength, hand-eye coordination
Cognitive
o
o
Baseline abilities that peers without limitations would possess
Anger management, emotional expression
Social
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o
Refrain from biting, kicking, etc.
Leisure Education
o
Broad category of services that focuses on the development and acquisition of various leisurerelated skills, attitudes, and knowledges
o
Leisure Awareness
o
Social Skills
o
Leisure Resources
o
Leisure Skills
Leisure Awareness
Cognitive awareness of leisure and its benefits, a valuing of the leisure phenomenon, and a conscious
decision-making process to activate involvement
o
Knowledge of Leisure
o
Self-Awareness
o
Leisure and Play Attitudes
o
Related Participatory and Decision-Making Skills
Social Skills
Development of social interaction skills through direct instruction
o
Communication Skills
o
o
Assertiveness, Conversation, Active Listening, Information-Seeking, Information-Giving, etc.
Relationship-Building Skills
o
Greeting Skills, Friendship Development, Cooperation, Competition, Negotiation,
Compromise, Social Networks
o
Self-Presentation Skills
o
Etiquette & Manners; Hygiene, Health & Grooming Skills; Appropriate Attire, Responsibility
for Self-Care
Leisure Resources
Knowledge and ability to utilize a wide variety of leisure resources
o
Activity Opportunities
o
Personal Resources
o
Family and Home Resources
o
Community Resources
o
State and National Resources
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Leisure Activity Skills
Activity skill development
o
Traditional Leisure Skills
o
o
Sports, Dance, Drama, Music, Hobbies
Non-Traditional Leisure Skills
o
Social Interaction, Community Services, Relaxation, Food Preparation, Living Things
Maintenance
Recreation Participation
Structured, supervised programs with opportunities to practice skills learned previously,
express
preferences, display talents
o
Example:
After teaching leisure awareness, social interaction skills, activity opportunities, and decision-
making skills, taking clients to an arts performance or sporting event of their choice.
LAM - What It Is
TR Service Model – Conceptual Content Model
o
Addresses Spectrum of Services
o
Disability-, Setting-, & World-Inclusive
Definition of Scope of TR Practice
Pro-Intervention – Focused on Change of Client Behavior, Skills, Knowledges
o
Difference Between Entry to and Exit from TR Services
o
Evidence, Intervention, Measurement, Outcomes
Based on Leisure Behavior
Based on Normalized, Inclusive Ideals
Based on Health, Wellness, Well-Being, & QOL
LAM - What It Is Not
A Panacea for All that Ails TR
Not Based on Diversional Recreation Provision*
(Recreation for Recreation’s Sake)
Not Anti-Intervention
o
Not Loosy-Goosy Excuse to Program Poorly
Not Based on Activity Provision
o
Is Based on Evidence-Based, Outcome-Focused Program Provision
Not Focused on Medical Model – Sick Roles/Pathologies
* Diversional activities are not within LAM
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Therapeutic Recreation Accountability Model
Therapeutic Recreation Accountability Model
Comprehensive & Specific Program Design
Activity Analysis, Selection, Modification
Protocol Development
Client Assessment Plan
Intervention Programs
Assessment Implementation
Client Tracking & Documentation
Program Outcomes & Client Outcomes
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Quality Improvement/Efficacy Research
Connection between LAM and TRAM
LAM = Content of TR programs
o
Scope of practice
TRAM= Process of TR programs
o
Systems approach (whole greater than parts)
Results
o
Expansion of APIE into programs (instead of activities)
o
Greater accountability for input/process/output
o
Better standardization of practice/uniformity of services
o
Improved “teach-ability” to students
Relationship of TR Models and Evidence-based Interventions and Outcomes
o
Programs Developed Conceptually
o
Programs Drawn from Evidence & Protocols
o
Programs Based on Targeted Outcomes
o
Programs Provided Based on Systematic Plan
o
Program & Client Outcomes Measured
o
Program & Client Outcomes Reported
Principles of Intervention Programming
Connections between Content and Outcomes

Comprehensive Program Design

Activity Analysis, Selection, Modification

Protocol Development

Assessment Plan

Client Documentation

Program and Client Outcomes

Quality Improvement/Efficacy Research
Principles of Intervention Programming
Logical, planned, proven connection between

Client Needs/Deficits
Ex: barriers to leisure

Client Goals
Ex: reduce barriers

Interventions
Ex: programs to reduce barriers

Immediate Client Outcomes (^ Leisure K, S, A)
Ex: ability to remove or reduce leisure barriers
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
Ultimate Client Outcomes (Life Satisfaction, Wellness, Quality of Life)
Ex: independent functioning/invisibility
Typical TR Client Outcomes
Functional Intervention

Improving physical, social, emotional, and cognitive functional abilities
o
o
Increased ability to manage anger appropriately
Increased emotional control and healthy expression
Leisure Education


Leisure-related attitudes, knowledges, skills, and abilities
Leisure Awareness, Social Interaction Skills, Leisure Activity Skills, Leisure Resources


Increase ability to make decisions related to leisure participation
Increased knowledge of the importance of leisure in one’s life
Recreation Participation

Supervised, organized opportunities for practice


Improved ability to express self within leisure context
Improved ability to select and participate in activity(ies) of one’s choice
Guidelines for Outcomes
Efficiency and effectiveness of demonstrating client change
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Reasonable relationship between the services provided and expected outcome(s)
Connection between occurrence of outcome and timing of data collection
Relevance to client and society
Goals and intent of the program
Appropriate level of specification, but not trivial detail
Individual client variation within any given program
Long-term and short-term goals and objectives
Social and home environment to which client will return
Behaviors that are generalizable and transferable to variety of settings and situations
Building Goal Oriented Activities and Outcomes
Using LAM and TRAM to build programs and activities, based on goals and outcomes
Comprehensive and Specific Program Goals
Key Concept
 What program goals/areas will meet the needs of your client group(s)?
My example: TR program for individuals with addictions.
1.0 Functional Intervention
1.1 Emotional Control
2.0 Social Skills
2.1 Communication Skills
2.2 Relationship-Building Skills
2.3 Self-Presentation Skills
3.0 Stress Management
3.1 Personal Responsibility
3.2 Seeking Alternatives
3.3 Decision-Making
3.4 Social Support Networks
4.0 Leisure Awareness
4.1 Knowledge of Leisure
4.2 Self-Awareness in Leisure
4.3 Leisure and Play Attitudes
4.4 Related Participatory and Decision-making Skills
5.0 Leisure Resources
5.1 Activity Opportunities
5.2 Personal Resources
5.3 Family and Home Resources
5.4 Community Resources
5.5 State and National Resources
Comprehensive and Specific Program Goals
1.0 To provide programs which teach emotional control…
2.0 To provide social skill instruction programs which teach clients to …
2.1 To provide programs which directly teach a variety of communication skills, such as
compromise, cooperation, negotiation, persuasion, active listening skills, etc.
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2.2 To provide direct instruction in relationship-building skills, such as self-disclosure and privacy
skills, greeting and initiation skills, locating sober leisure partners, building social networks, etc.
3.0 To provide services that improve the clients’ ability to manage and cope with stress in a healthy
manner.
3.1 To provide programs that teach clients to take personal responsibility for own lifestyle.
3.2 To provide programs that teach clients alternatives to prevent and manage stressful situations.
3.3 To provide services that teach clients decision-making skills, leading to choice and control.
3.4 To provide services that improve clients’ ability to develop and utilize social support networks.
Comprehensive and Specific Program Goals
Your Turn:
1. Get into small groups of no more than three or four individuals (with common clients)
2. Choose comprehensive program areas based on client needs.
EX. Functional abilities, leisure awareness, social skills, leisure skills, leisure resources, recreation
participation.
3. Develop comprehensive program goal statements.
4. Develop specific program areas based on client needs.
5. Develop specific program goal statements.
1.0
1.1
1.2
1.3
1.4
2.0
2.1
2.2
2.3
2.4
3.0
3.1
3.2
3.3
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3.4
4.0
4.1
4.2
4.3
4.4
Functional Intervention
Physical, social, emotional, and intellectual functional abilities related to participation in leisure
Sample Functional Intervention Goals
 Increased ability to control agitation and irritability
 Increased frustration tolerance
 Improved ability to incorporate disability into current lifestyle
 Increased energy level
 Increased ability to express emotions appropriately to situation
 Improved frequency of contact with others
 Improved orientation to time, place, and people
 Improved both short-term and long-term memory skills
 Increased attention span and on-task time

Leisure Education
Leisure Awareness
Knowledge of Leisure
Self-Awareness
 The concept of leisure and its relation to quality of life  Actual and perceived abilities and skills that
impact leisure involvement
 The difference between leisure behaviors and other
behaviors
 Actual and perceived limitations that impact
leisure involvement
 Benefits and possible outcomes of leisure
involvement
 Effects of a disability or illness on leisure
behavior
 Barriers to leisure involvement
 Past leisure and play patterns and activities
 Forms of leisure involvement
 Current leisure involvement and satisfaction
 Leisure as a context to learn new skills, meet new
people, experience new events
 Areas for future discovery and involvement
 The concept of leisure lifestyle
 Personal resources for leisure involvement
 The balance between leisure, work, and other
 Goals areas for development through leisure
obligations
 Effects of family and friends on personal
 The concept of personal responsibility for leisure
leisure development
lifestyle
Leisure and Play Attitudes
 Evolution of attitudes about leisure
 Past, current, and future societal attitudes related to
throughout the life span
leisure
Leisure Participatory and Decision-Making
Skills
 Origin of one’s personal beliefs and values about
leisure
 Decision-making skills with regard to leisure
involvement
 Relationship between attitudes and behavior
 Leisure planning skills
 Appropriateness of former leisure attitudes with
regard to current life situation
 Problem-solving techniques for daily use
 Relationship between leisure attitudes and values,
 Long-term coping and adaptation strategies
and life satisfaction
 Creating and evaluating options for leisure
 Impact of leisure attitudes on current and future
participation
leisure lifestyle
 Reducing and managing stress through
conscious planning and decision-making
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Social Interaction Skills
Communication Skills
 Assertiveness skills
 Skills involving negotiation, disagreement,
conflict, and compromise
 Conversational skills
 Active listening skills and responsive behavior
 Expressing feelings and thoughts
 Information seeking and information giving skills
 Empathy and perspective taking skills
Self-Presentation Skills
 Skills involving politeness, etiquette, and
manners, such as taking turns, sharing, etc.
 Hygiene, health and grooming skills
 Appropriate attire and dressing
 Responsibility for self-care
Relationship Building Skills
 Greeting and initiation skills, such as
locating leisure partners
 Friendship development skills
 Self-disclosure and privacy issues
 Cooperation and competitive skills
 Developing and maintaining social networks
 Reciprocal social support (expressing care and
concern for others and vice versa)
Leisure Activity Skills
Traditional - Categories of Commonly Identified Forms of Recreation
 Sports

Music
 Dance

Arts and Crafts
 Aquatics and Water-Related Activities

Other Expressive Arts
 Drama

Mental Games and Activities
 Outdoor

Hobbies
NonTraditional - Categories of Adult Leisure Involvement
 Social Interaction
 Spectating and Appreciating
 Leadership and Community Service
 Fitness
 Relaxation and Meditation
 Cognitive and Mental Activities
 Eating
 Food Preparation
 Shopping
 Home Improvement
 Living Things Maintenance - Pets and Plants











Self-Development
Education
Computer and Internet Activities
Travel
Fantasy and Daydreaming
Intimacy and Sexually Related Activity
Substance use - Alcohol, drugs, tobacco
Nothing
Home Maintenance
Interaction with Family and Friends
Telephone/e-mail Conversations
Leisure Resources
Activity Opportunities
 Awareness of diverse range of leisure opportunities
 Preferences (choice, freedom, decision-making) for
possible inclusion in their personal repertoire
Personal Resources
 Personal abilities and limitations
 Personal characteristics, e.g., finances, educational
level, athleticism, creativity, and past leisure
experiences
Family and Home Resources
 House mates and their interests
 Home environment and equipment for leisure
 Expanding options for involvement





Community Resources
 Pubic recreation programs, services, and facilities,
such as a city’s recreation department or park
district
Programs offered through the school district, often
listed as adult education or community education
Voluntary, nonprofit agency programs and facilities,
such as the YMCA, YWCA, scouting, Campfire, and
Boys’ and Girls’ clubs
Commercial recreation such as bowling alleys, movie
theaters, billiards centers, dance studios, golf
courses, game arcades, and roller- and ice-skating
rinks, etc.
Non-agency-sponsored clubs, such as square dance,
bridge, motorcycle, or model airplane clubs
Youth and social and service organizations and clubs
Stumbo/Goal-Oriented Programs15
 Internet sites, chat rooms, electronic bulletin boards,
web television, etc.
 Multiple public and commercial resources and
opportunities
 Travel and tourism information
State and National Resources
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Activity Analysis, Selection and Modification
Key Concept: What activities meet the purpose of the program goals?
2.0 Stress Management
2.1 To provide programs that teach clients to take personal responsibility for own lifestyle.
Sample Titles:
Who’s Responsible?
Leisure and Self-Awareness
I’ll Do It My Way
Personal Resources
Reality Therapy
2.2 To provide programs that teach clients alternatives to prevent and manage stressful situations.
Sample Titles:
Preventative Strategies for Managing Stress
Taking Time for Leisure
Exercise, Nutrition and Sleep Patterns
Progressive Relaxation
Meditation and Breathing Control
2.3 To provide services that teach clients decision-making skills, leading to choice and control.
Sample Titles:
Decision-Making Skills
Leisure Choices
Leisure Planning Skills
Taking Control of Your Life
Balancing Your Needs
One Day at a Time
2.4 To provide services that improve clients’ ability to develop and utilize social support networks.
Sample Titles:
Developing New Friendships
Where to Find Leisure Partners
Connecting with Others
The Value of Social Networks
Asking for Help

Your Ideas for Your Program - Activity Analysis, Selection and Modification:

Specific Goal 1.1:
o Sample Titles:

Specific Goal 1.2:
o Sample Titles:

Specific Goal 1.3:
o Sample Titles:

Specific Goal 1.4:
o Sample Titles:

__________________________________
Protocol Development - Partial Example (Knight & Johnson, 1991)
Key Concept: How can you standardize program delivery to clients to ensure outcomes?
Sample Program Procotol: Stress Management
Problem:
o
Inability to manage stress
Definition:
o A marked inability to manage stress well enough to function in daily life on a consistent basis;
not being able to set and achieve personal (or professional) goals
Defining Characteristics:
o Not able to take personal responsibility for decisions and consequences
(2.1)**
o Not able to generate alternatives to stress-inducing situations
(2.2)**
o Not able to make decisions regarding lowering stress
(2.3)**
o Not able to adequately use social support networks to help handle stress (2.4)**
o Not able to control emotions, such as anger and frustration
o Not able to anticipate potential problems/situations before they occur
o Not able to present long-term, future orientation and outlook
Outcome Criteria (client will be able to...)
o Take personal responsibility for decisions and consequences
o Generate alternatives to stress-inducing situations
o Make decisions for lowering stress
o Use social support networks to help handle stress
o Manage emotions during times of stress
o Anticipate potential problems/situations
o Present long-term, future orientation and outlook
(2.1)**
(2.2)**
(2.3)**
(2.4)**
Process Criteria (TRS will...)
o Focus on personal responsibility for decision-making and consequences (2.1)**
o Teach stress-reduction alternatives
(2.2)**
o Teach decision-making skills
(2.3)**
o Teach methods of developing and eliciting social support networks (2.4)**
o Teach methods of emotional control
o Teach methods of anticipating potential problem situations
o Support verbalizations of long-term future orientation
Related Factors/Etiologies:
o Associated with traumatic illnesses, injuries and diseases, such as CV, SCI, TBI, cancer
Your Ideas for Your Program - Protocol Development:
Problem:
Definition:
Defining Characteristics:
Outcome Criteria (client will be able to...):
Process Criteria (TRS will...):
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Related Factors/Etiologies:
Assessment Plan
Key Concept: The content of the assessment must match the content of the programs.
2.1 To provide programs that teach clients to take personal responsibility for own lifestyle.
Who makes most of the daily decisions regarding your life, for example, where you dine out?
Scoring: Self
+1
(no program needed)
Others
-1
(program needed)
Who makes most of the big decisions regarding your life, for example, where you live?
Self
+1
(no program needed)
Others
-1
(program needed)
2.2 To provide programs that teach clients alternatives to prevent and manage stressful situations.
What can you do to help control stress before it builds up?
Anticipate, eat well, exercise, take small steps
+1
(no program needed)
Nothing, procrastinate, blame others
-1
(program needed)
What can you do when stress does build up, and perhaps, seems overwhelming?
Take the long view, tackle what you can
+1
(no program needed)
Get angry, take a nap, blame others, binge
-1
(program needed)
2.3 To provide services that teach clients decision-making skills, leading to choice and control.:
Your car breaks down on the interstate. What do you do?
Call for help, put hood up, walk for help
+1
(no program needed)
Sit and wait, get angry, beat the car
-1
(program needed)
You have three hours on a sunny Saturday with no chores. What do you do?
Call friends, go somewhere, enjoy the day
+1
(no program needed)
Don’t know, it will never happen, no idea
-1
(program needed)
2.4 To provide services that improve clients’ ability to develop and utilize social support networks.
When you experience lots of stress, do you have friends or family you could call for help?
Yes, probably, has at least 2-3 people
+1
(no program needed)
No, don’t know, I couldn’t do that, why?
-1
(program needed)
Where are places you could go to develop new friends?
Able to name community or public options
+1
(no program needed)
Unable to think of or name any place, limited
-1
(program needed)
Your Ideas for Your Program - Assessment Development:
Specific Goal Area (1.1, 1.2, 1.3, or 1.4) ________________________
Content Related Questions:
1.
No Program Needed Answers:
Program Needed Answers:
2.
No Program Needed Answers:
Program Needed Answers:
3.
No Program Needed Answers:
Program Needed Answers:
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Client Documentation
Key Concept: Document only that behavior which relates to program goals/client needs.
Assessment Results:
Client scored - 4 on assessment in Stress Management, indicating need for TR intervention.
Treatment Plans:
Problem Areas:
Inability to take responsibility for stress reduction and stress management
Inability to prevent stress prior to occurrence
Inability to manage stress after occurrence
Goals: (could also make behavioral client objectives)
To verbalize personal responsibility for reducing and managing personal stress
To verbalize three ideas for preventing stress prior to occurrence
To verbalize three ideas for managing stress after occurrence
Plan:
Place client into Stress Management series (including Who’s Responsible and Decision-Making Skills)
3 times per week, for two weeks. Re-assess in two weeks using initial assessment form.
Progress Notes:
Fact: Client unable to verbalize responsibility for personal stress; is able to verbalize two ideas for preventing
stress, and one idea for managing stress, when prompted.
Interpretation/Plan: Client making progress but needs additional intervention to meet goals. Continue
intervention.
Discharge/Referral Summaries:
Client entered treatment with minimal stress management skills (see baseline assessment scores). Attended
Who’s Responsible and Decision Making Skills for four weeks. Met goals in areas of taking personal
responsibility; and verbalizing stress prevention and stress management. Needs additional practice and
reinforcement of stress management skills. Refer to SRA for follow-up.
Your Ideas for Your Program - Client Documentation:
Assessment Results:
Treatment Plans:
Problem Areas:
Goals:
Plan:
Progress Notes:
Fact:
Interpretation:
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Discharge/Referral Summaries:
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Program and Client Outcomes
Key Concept: Only expect as an outcome, what you plan into and design the program to do.
Specific Program Goals (page 2):
2.0 To provide services that improve clients’ ability to manage and cope with stress in healthy manner.
2.1 To provide programs that teach clients to take personal responsibility for own lifestyle.
2.2 To provide programs that teach clients alternatives to prevent and manage stressful situations.
2.3 To provide services that teach clients decision-making skills, leading to choice and control.
2.4 To provide services that improve clients’ ability to develop and utilize social support networks.
Sample Program Titles (examples from page 3):
Who’s Responsible? Preventative Strategies for Managing Stress, Decision-Making Skills
Protocol Defining Characteristics (examples from page 4):
Not able to take personal responsibility for decisions and consequences
Not able to generate alternatives to stress-inducing situations
Not able to make decisions regarding lowering stress
Not able to adequately use social support networks to help handle stress
(2.1)**
(2.2)**
(2.3)**
(2.4)**
Protocol Outcome Criteria (client will be able to...) (examples from page 4):
Take personal responsibility for decisions and consequences
Generate alternatives to stress-inducing situations
Make decisions for lowering stress
Use social support networks to help handle stress
(2.1)**
(2.2)**
(2.3)**
(2.4)**
Sample Assessment Items (examples from page 5):
Who makes most of the daily decisions regarding your life, for example, where you might dine out?
Who makes most of the big decisions regarding your life, for example, where you live?
Sample Client Goals (examples from page 6):
To verbalize personal responsibility for reducing and managing personal stress
To verbalize three ideas for preventing stress prior to occurrence
To verbalize three ideas for managing stress after occurrence
Sample Client Outcomes (examples from pages 3 + 6):
Take personal responsibility for decisions and consequences
(2.1)**
To verbalize personal responsibility for reducing and managing personal stress
Generate alternatives to stress-inducing situations
(2.2)**
To verbalize three ideas for preventing stress prior to occurrence
To verbalize three ideas for managing stress after occurrence
Make decisions for lowering stress
(2.3)**
Use social support networks to help handle stress
(2.4)**
Your Ideas for Your Program - Program and Client Outcomes:
___
Specific Program Goals:
Protocol Development:
Assessment Plan:
Activity Analysis, Selection and Modification:
Client Documentation:
Stumbo/Goal-Oriented Programs22
Client Outcomes:
Quality Improvement/Efficacy Research
Key Concept: How effective are your programs at producing targeted outcomes?
Major Aspects of Care: Stress Management Program
Indicator (Outcomes):
Clients attend and participate in activity sessions of stress management program.
Clients meet stated goals of stress management program.
Clients report satisfaction with goal attainment of stress management program.
Criteria/Thresholds:
Clients will attend/participate in three out of four sessions (75%).
Clients will meet goals, as noted on progress notes, at rate of 80%.
Clients will report “high” satisfaction on post-discharge survey at rate of 80%.
Methods/Data Sources:
Review of individual client medical records (10% of clients within month)
Review of individual client medical records (10% of clients within month)
Review of client satisfaction monthly summary reports.
Evaluate Care: If criteria for “quality” is not met, probe problem area and take measures
necessary to correct deficiency.
Your Ideas for Your Program - Quality Improvement/Efficacy Research
Major Aspects of Care:
Indicator (Outcomes):
1.1
1.2
1.3
Criteria/Thresholds:
1.1
1.2
1.3
Methods/Data Sources:
1.1
1.2
1.3
Evaluate Care:
Stumbo/Goal-Oriented Programs23
Application to Your TR Program
Summary of Connections and Key Concepts
(aka: What I learned today that I can use tomorrow!)
Comprehensive and Specific Program Goals
Key Concept: What program goals/areas will meet the needs of your client group(s)?
Activity Analysis, Selection, and Modification
Key Concept: What activities meet the purpose of the program goals?
Protocol Development
Key Concept: How can you standardize program delivery to clients to ensure outcomes?
Assessment Plan
Key Concept: The content of the assessment must match the content of the programs.
Client Documentation
Key Concept: Document only that behavior which relates to program goals/client needs.
Program and Client Outcomes
Key Concept: Only expect as an outcome, what you plan into and design the program to do.
Quality Improvement/Efficacy Research
Key Concept: How effective are your programs at producing targeted outcomes?
Stumbo/Goal-Oriented Programs24
Stumbo/Goal-Oriented Programs25