Leisure, Strengths-Based Practice, and the Interprofessional Team

Transcription

1 Leisure, Strengths-Based Practice, and the Interprofessional Team UNCW College of Health and Human Services Strengths-Based Interprofessional Practice: Focusing on the Person Beyond the Paperwork Saturday, May 5, 2012 Courage is not the towering oak that sees storms come and go; it is the fragile blossom that opens in the snow. Alice M. Swaim, American author Lynn Anderson, Ph.D., CTRS, CPRP Recreation, Parks and Leisure Studies SUNY Cortland P.O. Box 2000 Cortland, NY (607)

2 Self-Reflection Exercise Describing People from Deficit and Capability Perspectives 1. Describe what you do not like about yourself. How does writing this list make you feel? 2. Describe what you like about yourself. How does writing this list make you feel?

3 Compare/Contrast: Deficits-Based Services and Strengths-Based Services From a Deficit Approach. Stereotypes, diagnoses, and labels Low expectations Developmental, stepping stone model Segregated, special services System-centered and professionally driven Services in places Programs Paid service providers Uni- or multi-disciplinary teams, professionally driven Assessment by separate disciplines in isolated environments Interventions in isolated contexts, with established cues and professionally directed To a Strengths Approach People first Challenges, risks, growth Ecological model Inclusion Family-centered and participant-driven Services as supports (ordinary environments with extra ordinary supports) Individualized supports Natural supports Transdisciplinary teams, collaboration and equal partnership Assessment by observation and interaction in natural environments Facilitation in natural contexts, with natural cues referenced to the context and natural supports From Anderson, L., & Heyne, L. (2012). Therapeutic recreation practice: A strengths approach. State College, PA: Venture Publishing.

4 Compare/Contrast: The Role of Leisure in the Strengths versus the Deficits Approach Deficits approach - the medical model perspective Health and functional outcomes are a key focus. Because it is not controlled by the therapist, leisure is diversional and outside the treatment process. The therapist must control and prescribe the intervention for predicted health and functional outcomes to occur. The freedom associated with leisure makes it a difficult tool to use to make prescribed change. Participant problems and deficits drive the helping relationship leisure is reduced to an activity to be used as a tool to fix the deficits in a prescribed manner. Participant strengths are used as a tool to fix deficits. Strengths are only important in that they can be directed at remediation of weaknesses, which, in the medical model, is the focus of the helping process. Enhancement of the leisure experience is only useful if it leads to a remediation of deficits on which the helping process is focused. Leisure is a means to an end. According to Mobily (1999), The angst created is evident in the tortuous fit between recreation/leisure (demanded by leisure theory and research) and the health/functional outcomes (necessary for reimbursement of services) evident in most of the models [using a deficits approach]. The difficulties reflect the difference between what has been learned theoretically (about leisure behavior) and the expectations and standards of the audiences the TR profession must play to in reality. Trying to wed therapeutic outcomes to leisure without losing the essence of the leisure experience is the struggle. Strengths approach - a capabilities perspective Leisure is a key component of life quality and well-being as it is controlled by the participant, providing important sources for selfdetermination and utilization of strengths. In the process of building meaningful leisure, wellbeing is improved across multiple domains. Participant aspirations and dreams drive the helping relationship leisure is often a key part of a participant s personal goals for a meaningful life. Participant strengths are nurtured and developed to a higher level. Leisure, freely chosen, is an arena and context to build strengths. Enhancement of the leisure experience is an important outcome of therapeutic recreation services. It also contributes to improved wellbeing. Leisure is an end in and of itself, and is also a means to a higher quality of life. There is a harmonious fit between leisure and the outcomes expected by the audiences the TR profession plays to in a strengths approach. Leisure is closely tied to therapeutic outcomes that build strengths and a life of meaning and well-being. Agencies and professionals using the strengths approach clearly see the need for high quality leisure experiences as a part of the helping process. From: Anderson, L., & Heyne, L. (2012). Therapeutic Recreation Practice: A Strengths Approach. State College, PA: Venture Publishing.

5 Flourishing through Leisure: An Ecological Extension of the Leisure and Well-Being Model (Anderson & Heyne, 2012) PERSON in the ENVIRONMENT Enhancing the Leisure Experience Facilitation of leisure skills and knowledge: Savoring leisure* Interests, preferences Authentic leisure* Talents, abilities Leisure gratifications* Skills and competencies Mindful leisure * Leisure knowledge Virtuous leisure * Aspirations Facilitation of leisure environments: Real choices for leisure Typical lifestyle rhythms Social supports Inclusive environments Physical accessibility Administrative inclusivity Programming inclusivity Developing Strengths and Resources Facilitation of psychological and emotional strengths: Capacity for happiness* Emotion regulation* Self-awareness/self-acceptance/self-congruence* Autonomy/self-determination/goal directednesss* Competence* Optimism* Play Recreate Perceive Feel Facilitation of psychological and emotional resources: Positive behavioral supports Natural cues Quiet spaces in public areas High expectations and positive attitudes Other supports and accommodations PSYCHOLOGICAL & EMOTIONAL WELL-BEING I feel happy and perceive I am in control of my life LEISURE WELL-BEING I find enjoyment in my leisure experiences and they positively impact other aspects of my life WELL-BEING COGNITIVE WELL-BEING I think in a focused way and learn eagerly Facilitation of cognitive strengths: Ability to attend* Concentration* Following directions* Memory* Problem Solving Goal setting*, aspiration discovery Facilitation of social strengths: Communication skills* Interpersonal skills* Reciprocal relationship skills*, friendship skills Leadership and citizenship skills Social confidence* Think Learn Relate Belong Facilitation of cognitive resources: Environmental cues Environmental modifications Quiet spaces in public areas Activity adaptations Other supports and accommodations Facilitation of social resources: Inclusivity and diversity Opportunities to engage in meaningful social roles Trained staff Peer support development Other supports and accommodations SOCIAL WELL-BEING I relate well to others and belong to valued social groups I experience a state of successful, satisfying, and productive engagement with my life* SPIRITUAL WELL-BEING I live my life hopefully, in harmony with my values and beliefs PHYSICAL WELL-BEING I do and act in my daily life with vitality and no barriers Facilitation of physical strengths: Physical health* Mobility* Fitness endurance, strength, flexibility* Energy and vitality Physical activity skills Act Do Facilitation of physical resources: Safe environments Universal design Adapted equipment Affordability, equitable resource distribution Home recreation resource development Community recreation resource development Facilitation of spiritual strengths: Hope and inspiration Sense of meaning and purpose Peace of mind Reflection and wisdom Self-actualization Sense of connectedness/feeling a part of something bigger Other character strengths and virtues Believe Value Facilitation of spiritual resources: Culture of hope, support and encouragement Proximity to nature Quiet places in public spaces Places of spiritual nourishment Beauty and aesthetics in the environment What the Therapeutic Recreation Specialist Does *From the Leisure and Well-Being Model (Carruthers & Hood, 2007; Hood & Carruthers, 2007) Participant s goals, dreams, and aspirations A Flourishing Life Environmental resources and personal strengths that cultivate growth, adaptation, and inclusion Outcomes the Participant Experiences

6 Values in Action (VIA) Strengths Assessment (Peterson & Seligman, 2004; Seligman, 2002) Very Much Like Me Like Me Neutral Unlike Me Very Much Unlike Me Cluster 1: 1a. I am always curious about the world is: b. I am easily bored is: a. I am thrilled when I learn something new is: b. I never go out of my way to visit museums or other educational sites is: 3a. When the topic calls for it, I can be a highly rational thinker is: b. I tend to make snap judgments is: a. I like to think of new ways to do things is: b. Most of my friends are more imaginative than I am is: a. I am always able to look at things and see the big picture is: b. Others rarely come to me for advice is: Cluster 2: 6a. I have taken frequent stands in the face of strong opposition is: b. Pain and disappointment often get the better of me is: a. I always finish what I start is: b. I get sidetracked when I work is: a. I always keep my promises is: b. My friends never tell me I m down to earth is: a. I throw myself into everything I do is: b. I mope a lot is: Cluster 3: 10a. I have voluntarily helped a neighbor in the last month is: b. I am rarely excited about the good fortune of others as I am about my own is: 11a. There are people in my life who care as much about my feelings and well-being as they do about their own is: 11b. I have trouble accepting love from others is: a. No matter what the social situation, I am able to fit in is: b. I am not very good at sensing what other people are feeling is: Cluster 4: 13a. I work at my best when I am in a group is: b. I hesitate to sacrifice my self-interest for the benefit of the group is: 14a. I treat all people equally regardless of who they might be is: b. If I do not like someone, it is difficult for me to treat him or her fairly is: 15a. I can always get people to do things together without nagging them is: 15b. I am not very good at planning group activities is: Cluster 5: 16a. I control my emotions is: b. I can rarely stay on a diet is: a. I avoid activities that are physically dangerous is: b. I sometimes make poor choices in friendships or relationships is: a. I change the subject when people pay me compliments is: b. I often talk about my accomplishments is: a. I always let bygones be bygones is: b. I always try to get even is:

7 Cluster 6: 20a. In the last month, I have been thrilled by excellence in music, art, drama, film, sport, science, or mathematics is Very Much Like Me Like Me Neutral Unlike Me Very Much Unlike Me b. I have not created anything of beauty in the last year is: a. I always say thank you, even for little things is: b. I rarely stop and count my blessings is: a. I always look on the bright side is: b. I rarely have a well-thought-out plan for what I want to do is: a. My life has a strong purpose is: b. I do not have a calling in life is: a. I always mix work and play as much as possible is: b. I rarely say funny things is: Scoring Your Strengths: Enter your score from the items above in each blank below; add the scores for each strength and each virtue in the Totals columns. Note that the Virtues score is an average of all of the strengths items in that box. Virtue 1: WISDOM Total Virtue 4: JUSTICE Total Curiosity 1a. + 1b. Citizenship 13a. + 13b. Love of learning 2a. + 2b. Fairness 14a. + 14b. Judgment/openmindedness 3a. + 3b. Ingenuity/creativity 4a. + 4b. Leadership 15a. + 15b. Justice Subtotal (divide by 3 for average) Perspective 5a. + 5b. Wisdom Subtotal (divide by 5 for average) Virtue 5: TEMPERANCE Total Self-control 16a. + 16b. Virtue 2: COURAGE Valor 6a. + 6b. Perseverance 7a. + 7b. Integrity 8a. + 8b. Zest/vitality 9a. + 9b. Total Prudence 17a. + 17b. Humility 18a. + 18b. Forgiveness 19a. + 19b. Temperance Subtotal (divide by 4 for average) Courage Subtotal (divide by 4 for average) Virtue 6: TRANSCENDENCE Total Appreciation of beauty 20a. + 20b. Virtue 3: HUMANITY Kindness 10a. + 10b. Loving 11a. + 11b. Social intelligence 12a. + 12b. Total Gratitude 21a. + 21b. Hope 22a. + 22b. Spirituality 23a. + 23b. Humor 24a. + 24b. Humanity Subtotal (divide by 3 for average) Transcendence Subtotal (divide by 5 for average) Circle your top 5 strengths. Circle your top 2 virtues. What is your signature strength?

8 Developmental Levels and Characteristics of Transdisciplinary Teams Level Characteristics How Teams Develop and Nurture This Level Level One: Role Extension Increasing one s own knowledge and skills in his or her discipline Reading research journals and new books in the field Attending conferences and research symposia Joining professional organizations Participating in clinical supervision within the profession Level Two: Role Enrichment Level Three: Role Expansion Level Four: Role Exchange Level Five: Role Release Level Six: Role Support Developing awareness and understanding of other disciplines; sharing terminology and basic information about each other s practices Learning how to observe and make judgments and recommendations outside one s own discipline; teaching other disciplines how to observe and make judgments in one s discipline Team members have learned the knowledge and skills of other disciplines sufficiently to begin to implement techniques from these disciplines under direct supervision Team members put newly acquired skills and knowledge from other disciplines into practice with consultation from other disciplinary team members, who will be accountable for the techniques used Team members support other disciplines in providing transdisciplinary services, or they provide services directly if the skills are too complex to reasonably transfer to another discipline or if the law requires it. Team meetings and team conferences Carefully listening to participants and team members Participating in clinical supervision across disciplines Attending workshops within agencies across disciplines Observing other disciplines working with a participant and discussing what was learned Attending workshops in another field that include hands-on training Rotating the role of primary team facilitator among all service providers Working side-by-side with team members, providing co-facilitated services Observing and providing feedback to each other to improve skills across disciplines Checking for accuracy of judgments and techniques with the discipline being practiced Having one primary service provider carry out the entire plan with a participant, using approaches from many disciplines to help reach goals Meeting frequently to discuss services, presenting the whole participant to the team and developing new or improved approaches together Completing continual self-assessment of skills and techniques needed, and asking for help from other disciplines as needed to ensure high quality services Understanding the limits of one s skills and knowledge, and using other team members to assist where needed Asking for help when it is needed to give the highest quality services in a holistic manner Offering help when a team member needs it within the discipline, when struggling with more complex interventions Directly providing the interventions within the discipline which are required by law or very complex, while sharing progress frequently and openly with the primary facilitator and participant/family From Anderson, L., & Heyne, L. (2012). Therapeutic recreation practice: A strengths approach. State College, PA: Venture Publishing.

9 From Anderson, L., & Heyne, L. (2012). Therapeutic recreation practice: A strengths approach. State College, PA: Venture Publishing. Assess Your Interpersonal Skills for Collaboration On a 5-point scale (1 = I never do; 5 = I always do), rate yourself on the following skills: FORMING SKILLS (skills needed to build initial trust in a partnership) I encourage everyone to participate I use members' names I use no "put-downs" I get to meetings on time I ask for opinions and elaboration FUNCTIONING SKILLS (skills needed to manage and organize team activities so that tasks are completed and relationships are maintained) I offer ideas I state and restate the purpose of the meeting I offer procedures on how to most effectively do a task I volunteer for a task I express support and acceptance I ask for help, clarification or technical assistance I offer to explain or clarify I show enthusiasm and optimism I am non-judgmental of others' contributions FORMULATING SKILLS (skills needed to stimulate creative problem-solving and decision-making) I summarize what has been discussed I encourage assigning of specific roles I seek accuracy of information by adding to summaries or questioning I ask for feedback in a non-confrontational way FERMENTING SKILLS (skills needed to manage controversy and conflict and stimulate refinement of solutions) I see ideas from other persons' perspective I criticize ideas without criticizing people I integrate different ideas/opinions into a single position I ask for justification of others' conclusions or ideas I extend or build on others' ideas I help decide next steps I generate additional strategies I test reality of ideas by assessing the feasibility of their implementation I help compromise, harmonize Reprinted with permission from Anderson and Kress (2003)

10 Compare/Contrast: Examples of the Language that Teams Use Deficits Approach Patient, client, the C-5 in Bed 4 Aide Adult diaper Feeders Admission, discharge Bib Patient lounge Unit, wing Strengths Approach Person, participant, resident Team member, caregiver Product, pad, brief Participants who need assistance with eating Move in, move out; transition Napkin Living room Neighborhood EBD classroom Sally s classroom, classroom number 5 Wanderers Professional jargon used in documentation Participants who need to walk Understandable, every day language used in documentation Treatment Joint plan of action Disorders, diseases Challenges with living From Anderson, L., & Heyne, L. (2012). Therapeutic recreation practice: A strengths approach. State College, PA: Venture Publishing.

11 Compare/Contrast: A Traditional Plan versus an I Plan Adapted from Krugh & Bowman (2006) Focus From a Traditional Approach.. To an I Plan Strengths Approach Assessment Summary Problem List Joe is an 88 year old man with dementia. He has a short attention span. He is very pleasant most of the time. Joe likes to walk around the facility a considerable amount of his waking hours. He is unable to distinguish between areas he is welcomed to enter and those where he is not welcomed. His ambulation skills are excellent; no assistance is required. Some residents are disturbed by him because he may enter their rooms against their wishes. He prefers to be with staff at all times as he does not tolerate being alone. He and his wife raised 11 children. Joe owned a hardware store and was a respected businessman in town. Problem List: - Wanders due to dementia - Cannot tolerate being alone I am Joe. I owned a hardware store for years in town, and am respected in my community. Most of my life, I have been active and around a lot of people, which I really enjoy. My wife, Ann and I raised 11 wonderful children. I don t remember things as well now, but I enjoy life and like people. I am usually in a pretty good mood. I do love to walk it calms me. I enjoy walking most with others. I often look for others to walk with me, and will look in rooms and hallways here at the home to find walking companions. Interests: - I love to walk - I enjoy being with other people Goals - Will not wander into others rooms - I will continue to walk freely throughout my home while respecting the privacy of others Interventions - Redirect resident to appropriate areas of the facility - Praise for cooperation - Teach resident not to enter rooms with sashes across door - Encourage resident to sit in lounge and other common areas - After I eat breakfast and get dressed, I want to walk with staff. I will accompany you anywhere. I like to help while we are together. I can fold linen and put things away with you. I do not like to nap. If weather permits, please walk outside with me. I like to keep walking in the evening until I go to bed. I sit when I am tired, so don t fuss over asking me to sit. From Anderson, L., & Heyne, L. (2012). Therapeutic recreation practice: A strengths approach. State College, PA: Venture Publishing.

12 References for Strengths-Based Therapeutic Recreation Practice Anderson, L., & Heyne, L. (in press). Therapeutic recreation practice: A strengths approach. State College, PA: Venture Publishing. Ben-Shahar, T. (2007. Happier. New York: McGraw Hill. Biswas-Diener, R., & Dean, B. (2007). Positive psychology coaching: Putting the science of happiness to work for your clients. Hoboken, NJ: John Wiley & Sons. Bryant, F., & Veroff, J. (2007). Savoring: A new model of positive experience. Mahwah, NJ: Lawrence Erlbaum. Carruthers, C. & Hood, C. (2007). Building a life of meaning through therapeutic recreation: The Leisure and Well-Being Model, part I. Therapeutic Recreation Journal, 41(4), Carruthers, C., & Hood, C. (2011). Mindfulness and well-being: Implications for TR practice. Therapeutic Recreation Journal, 45(3), Diener, E. (2006). Guidelines for national indicators of subjective well-being and ill-being. Journal of Happiness Studies, 7, Fava, G., & Ruini, C. (2003). Development and characteristics of a well-being enhancing psychotherapeutic strategy: Wellbeing therapy. Journal of Behavioral Therapy and Experimental Psychology, 34, Fredrickson, B. L. (2009). Positivity: Groundbreaking research reveals how to embrace the hidden strength of positive emotions, overcome negativity, and thrive. New York: Crown Publishers. Hobfoll, S.E. (2002). Social and psychological resources and adaptation. Review of General Psychology, 6(4), Hood, C., & Carruthers, C. (2007). Enhancing leisure experience and developing resources: The Leisure and Well-Being Model, part II. Therapeutic Recreation Journal, 41(4), House, J. S., Umberson, D., & Landis, K. R. (1988). Structures and processes of social support. Annual Review of Sociology, 14, Joseph, S., & Linley, P.A. (2006). Positive therapy: A meta-theory for positive psychological practice. London: Routledge. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Bantam Dell. Kahneman, D., Diener, E., & Schwarz, N. (Eds.) (1999). Well-being: The foundations of hedonic psychology. New York: Russell Sage Foundation. Lyubomirsky, S. (2008). The how of happiness. New York: The Penguin Press. Nolen-Hoeksema, S. (2003). Women who think too much: How to break free of overthinking and reclaim your life. New York: Holt. Nussbaum, M. (2006). Frontiers of justice: Disability, nationality, species membership. Cambridge, MA: Harvard University Press. Nussbaum, M. (2011). Creating capabilities: The human development approach. Cambridge, MA: Harvard University Press. Pedlar, A., Haworth, L., Hutchinson, P., Taylor, A., & Dunn, P. (1999). A textured life: Empowerment and adults with developmental disabilities. Waterloo, Ontario: Wilfrid Laurier University Press. Peterson, C. (2006). A primer in positive psychology. New York: Oxford University Press. Peterson, C., & Seligman, M. (2004). Character strengths and virtues: A handbook and classification. New York: Oxford University Press. Ratey, J. T. (2008). Spark: The revolutionary new science of exercise and the brain. New York: Little, Brown and Company. Richman, L, Kubzansky, L, Maselko, J., Kawachi, I., Choo, P., & Bauer, M. (2005). Positive emotion and health: Going beyond the negative. Health Psychology, 24, Saleeby, D. (2005). The strengths perspective in social work practice (4 th ed.). Boston, MA: Allyn and Bacon. (2008 and 2012 editions also available) Seligman, M. (1991). Learned optimism. New York: Alfred A. Knopf. Seligman, M. (2002). Authentic happiness: Using the new positive psychology to realize your full potential for lasting fulfillment. New York: Free Press. Seligman, M. (2011). Flourish. New York: Free Press. Sylvester, C. (Ed). (2005). Philosophy of therapeutic recreation: Ideas and issues (Vol. III). Ashburn, VA: National Therapeutic Recreation Society. Sylvester, C., Voekl, J., & Ellis, G. (2001). Therapeutic recreation programming: Theory and practice. State College, PA: Venture Publishing. Trenberth, L. (2005). The role, nature and purpose of leisure and its contribution to individual development and well-being. British Journal of Guidance and Counselling, 33, 1-6. Vaillant, G. (2002). Aging well. Boston: Little Brown and Company. Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York: Guilford Press.

13 Leisure, Strengths Based Practice, and the Inter Professional Team Dr. Lynn Anderson, CTRS, CPRP SUNY Cortland Who s in the house? 1

14 Acknowledgements Dr. Linda Heyne Dr. Cynthia Carruthers Dr. Colleen Hood Session Overview Strengths vs. deficits approach in health and human services Principles and theories of the strengths approach 2

15 Session Overview Getting clear on strengths Leisure as a strength and strength builder What are your strengths? Session Overview Strengths on a team Transdisciplinary teams Your ideas and questions 3

16 Learning Objectives Compare and contrast the strengths approach versus the deficits approach to working on a team Discuss how leisure and recreation are key aspects of the strengths based approach. Discuss how strengths based perspective can help promote effective interprofessionalpractice Discuss how all team members can work collaboratively to foster the goals and dreams of participants that often focus on play and leisure. Describe the transdisciplinary model of interprofessional practice, where role release fosters contextualized and meaningful work with participants. Strengths versus Deficits Approach in Health and Human Services 4

17 Self reflection! Meet.. Jenny Sara 5

18 A little about each girl: Jenny Fixates on animals and lights/motion Displays attention seeking behaviors around peers Displays off task behaviors when fatigued at school Is at times non compliant Displays self stimulating behaviors Displays poor socialization skills Has dependencies on others Runs away Has tantrums Disoriented and short attention span Splinter skills Sara Likes cats and playing computer games Likes to make friends Works hard at school, but likes to take breaks Stands up for herself when picked on Has many hobbies that interest and absorb her Chooses her friends wisely Loves people Goes for walks Insists on having her way Changes her mind about things at times Talented in some areas A new way of thinking is needed in helping others 6

19 ASSUMPTIONS in deficit based approach The participant is the pathology or problem The participant needs to be fixed ASSUMPTIONS in deficit based approach Relationship marked by distance, power inequality, control, and manipulation Context is stripped away 7

20 ASSUMPTIONS in deficit based approach Since disease or pathology assumes the cause of the problem, it also becomes the solution ASSUMPTIONS in the strengths approach The participant has aspirations and dreams The participant may need help realizing those dreams 8

21 ASSUMPTIONS in the strengths approach Professional hopefulness Relationship marked by collaboration, equality, mutual respect, and confidence in one s abilities ASSUMPTIONS in the strengths approach Context matters Since hopes and dreams are central to the helping process, they lead to solutions 9

22 The Strengths Perspective A Sea Change in Health and Human Services Paradigm Shifts. Sea Changes From deficits.. to capabilities From places. to programs.. to services as supports From problems.. to goals and aspirations, to people asking for help with certain aspects of their lives to reach their dreams From isolated, clinic based intervention to contextualized, in situ learning in the community 10

23 Paradigm Shifts. Sea Changes From absence of illness. to high quality of life and well being From expert centered. to person centered From multidisciplinary.. to transdisciplinary From ongoing professional/ volunteer supports. to natural supports Paradigm Shifts. Sea Changes From separate, segregated services to inclusion with others From passive recipients of services. to self advocacy and education From the medical model. to a capability based, holistic, ecological model 11

24 Principles of the strengths approach Every individual, group, family, and community has strengths We do not know the upper limits of a participant s capacity to grow, change, and achieve never assume we do! Principles of the strengths approach Difficulties (illness, disability, addiction, etc.) are also sources of opportunity and challenge 12

25 Principles of the strengths approach Collaboration (not expert domination) with participants Every environment is full of resources Context matters Principles of the strengths approach Hopefulness matters Strengths can be nurtured (thus, must be assessed, planned, focused on, and evaluated) 13

26 Principles of the strengths approach Leisure and play matter Comparing the two approaches Strengths Approach Focus is on internal and external strengths as avenues to a high quality of life Participant is viewed as potential waiting to be developed A framework and vocabulary is developed to describe strengths Understanding strengths leads to understanding solutions and creative ways to improve a person s life Focus is on the whole person in the context of his or her life Deficit Approach Focus is on problems and weaknesses; strengths are just tools to help fix the person Participant is viewed as a problem needing to be fixed A framework and vocabulary is developed to describe problems Understanding problems may or may not lead to solutions for a person, but will lead to greater understanding of the problem Focus is narrower, and mostly on remediation of deficits in the person 14

27 Create a new way of thinking Create a new response 15

28 Theories that Support the Strengths Based Approach Ecological Approach Well Being Flow Learned Optimism Authentic Happiness The Pleasant Life The Good Life The Meaningful Life The Full Life Normalization/Social Role Valorization Self Determination Coping and Social Support Community Building Health and disability theories Theories that Support the Strengths Based Approach Brain based research What we focus on increases 16

29 How does new research on brain functioning inform strengths based practice? Integration of psychology and neurology (fmri, PET, QEEG..) Focus is power The act of paying attention creates chemical and physical changes in the brain. Expectation shapes reality People s preconceptions have a significant impact on what they perceive. Attention density shapes identity Repeated, purposeful, and focused attention can lead to long lasting personal evolution. 17

30 Broaden and Build Theory Broadens 18

31 Builds Undoes 19

32 Ratio of Positivity for Flourishing 3:1 Physical Well Being What does the research say? Physical activity: Improves neuroplasicity and the ability of the brain to learn Boosts mood and positive emotion Decreases anxiety and depression Improves ability to concentration (esp. ADD) Guards against negative effects of stress Reverses aging process 20

33 Let s move! In the strengths approach.. Strengths can be nurtured and thus, must be assessed, planned, focused on, and evaluated 21

34 Strengths The Heart of Practice A definition of strength: The quality or state of being strong; vigor; power of resistance; vigor of action; a strong or valuable attribute; a source of power or encouragement; sustenance. (Webster s Dictionary) Internal Strengths External Strengths Internal and External Strengths 22

35 Internal Strengths Interests and preferences Talents Skills and competencies Knowledge Aspirations and goals Character strengths and virtues External Strengths Family support Social support, friends Community resources Home resources Opportunities for participation and contribution (inclusive communities) High expectations 23

36 Leisure as a strength Leisure as a context to build strengths Why do you play? What are your favorite leisure activities? Why do you do them? 24

37 Leisure is the heart of therapeutic recreation practice It has power to help people feel good about their lives and make the positive changes they want to see in their lives When people have interests, preferences, talents, and passions that they pursue in life, they feel alive, vibrant, strong, and complex as human beings Their lives are textured and interesting infused with meaning and purpose Involvement in high quality leisure experiences also leads to growth and adaptation. Leisure is necessary for well being Leisure provides a context for the experience of positive emotions, which are directly linked to health and wellbeing. Leisure contributes to the development of resources and strengths in one s life, from physical to social to cognitive to environmental resources. 25

38 Leisure is necessary for well being Leisure directly impacts self development and selfdetermination, essential to well being. Leisure provides opportunities to fully engage in activity and acts as a stimulus to health. Leisure directly meets the creative expressive needs of people, and their drive to find meaning and purpose in their lives. Leisure is necessary for well being Leisure provides a natural vehicle to promote inclusion in community and develop friendship circles, essential to well being. Leisure can change communities, making communities healthier and more welcoming of differences, including disability and illness. 26

39 Leisure is necessary for well being Leisure can be pursued by everyone, everyday, everywhere regardless of how ill, how impaired, or how broken they may be. Leisure can infuse well being in everyone s life everyday, regardless of functional ability. People, all people, have a fundamental right to leisure. The role of leisure in a strengths versus a deficits approach Deficits approach the medical model perspective Strengths approach a capabilities perspective See Handout 27

40 Flourishing Through Leisure A closer look at strengths Internal Strengths Interests and preferences Talents Skills and competencies Knowledge Aspirations and goals Character strengths and virtues 28

41 Virtues are core characteristics valued across culture and time: Wisdom Courage Humanity Justice Temperance Transcendence Character strengths are the psychological ingredients that define virtues Character strengths are the routes to displaying virtue 24 strengths in Peterson and Seligman s classification, each clustered within core virtues 29

42 Anti DSM Values in Action Signature Strengths Questionnaire Measures character strengths and virtues 24 item short form Long form online Six Core Virtues and 24 Character Strengths Wisdom Curiosity Love of learning Judgment Ingenuity Perspective Humanity Kindness Loving Social intelligence Temperance Self control Prudence Humility Forgiveness Courage Valor Perseverance Integrity Zest and vitality Justice Citizenship Fairness Leadership Transcendence Appreciation of beauty Gratitude Hope Spirituality Humor (Peterson & Seligman, 2004) 30

43 Let s assess your strengths and virtues! The VIA Signature Strengths Questionnaire The VIA Scoring Scoring Your Strengths: Enter your score from the first two pages in each blank in the scoring boxes Add the scores for each strength and each cluster or virtue in the "Totals" columns To obtain the average score for each virtue, divide the virtue s total by the number of strengths in that cluster. 31

44 Virtue: Wisdom & Knowledge Curiosity Love of learning Judgment Ingenuity Perspective Virtue: Courage Valor Perseverance Integrity Zest/vitality 32

45 Virtue: Humanity and Love Kindness Loving Social intelligence Virtue: Justice Citizenship Fairness Leadership 33

46 Virtue: Temperance Self control Prudence Humility Forgiveness Virtue: Transcendence Appreciation of beauty Gratitude Hope Spirituality Humor 34

47 Strengths and Teams What are the personal strengths you bring to the team? What are the strengths of your profession that help the team flourish? Interprofessional Practice Two or more professions working together as a team with a common purpose, commitment and mutual respect (Freeth et al., 2005) 35

48 The strength of collaborative teams Teams offer diverse and numerous perspectives across multiple environments Teams enrich the helping process through complementary areas of expertise Teams provide a thorough information base from which to plan and design services and supports The strength of collaborative teams Teams can generate more ideas and are more creative than one professional alone Teams have increased resources, information, and expertise at their disposal, to benefit the participant When working in a team approach, goals and services are coordinated 36

49 The strength of collaborative teams Splintered, disjointed, or incomplete services can be avoided more effectively Through the group process, teams can solve problems and resolve conflict more effectively than individual professionals Teams provide needed therapeutic support Teams can provide one point of contact for the participant and his or her circle of support, versus having to work with and communicate with several different professionals The strength of collaborative teams A team of respected professionals, communicating high expectations, hope, and support, can be a powerful therapeutic change agent for the participant Hope is like a road in the country, created by a team that believes in its destination and its traveler. 37

50 Who is on a team? Depends on the setting and the service system Typical team members vary Roles also vary Central to the team: The participant Dreams and aspirations Well being 38

51 Central to the team: The participant s circle of support Goals and dreams Well being Approaches to Teams in Service Delivery Multidisciplinary Interdisciplinary Transdisciplinary 39

52 Multidisciplinary Approach Multiple disciplines contribute to assessment, treatment design, and service provision Each discipline works independently with little communication across disciplines Multidisciplinary Approach Services are more comprehensive than unidisciplinary model No formal attempt to coordinate services or communicate across disciplines Serves are fragmented across time, locations, disciplines ( pull out programs) High risk for service gaps or duplication 40

53 Interdisciplinary Approach Multiple disciplines contribute to assessment, treatment design, and service provision Though each discipline works independently, the team establishes formal communication channels, appoints a case manager, and coordinates efforts and services Interdisciplinary Approach Commitment to group decision making and development of a unified plan Increased coordination reduces duplication and gaps in services Professionals collaborate in design of assessment and intervention Professionals still operate independently 41

54 Transdisciplinary Approach Professionals from multiple disciplines work collaboratively to form a joint plan for assessment, treatment, and evaluation Professionals retain responsibility for expertise of home discipline, but information and competency from any single discipline is actively transmitted to members of other disciplines Collaborate To labor together; to work jointly with others; to cooperate with A process of problem solving by team members, each of whom contributes his or her knowledge and skills and is viewed as having equal status Work accomplished jointly by a group of people in a spirit of willingness and mutual reward 42

55 Transdisciplinary Approach Joint decision making Shared responsibility Frequent, joint evaluation of program or services Stages of Development of Transdisciplinary Teams Level One Level Two Level Three Level Four Level Five Level Six Role Extension Role Enrichment Role Expansion Role Exchange Role Release Role Support 43

56 Role Release Involves Sharing General information so that others are knowledgeable about basic procedures and practices Example: a physical therapist describes the role of muscle tone in positioning and other tasks Informational skills so that others can make specific judgments and decisions Example: a physical therapist teaches a CTRS to look at a patient in a wheelchair and determine where the patient is correctly positioned Role Release Involves Sharing Performance competencies so that others can perform specific overt physical actions Example: a CTRS teaches a parent how to do activity analysis, so the parent can choose activities for his child that will best meet goals 44

57 Role Support Team members support other disciplines in providing transdisciplinary services Example: A therapeutic recreation specialist and a physical therapist work together closely in an adaptive sports program Comparison of Interdisciplinary and Transdisciplinary Approaches Interdisciplinary Transdisciplinary Assessment Planning Implementation Each discipline separately Priorities within each discipline Work separately (isolated context) All disciplines together Priorities across disciplines Train, support others (integrated context) Teamwork Episodic, formal Ongoing 45

58 Comparison of Assumptions: Isolated Therapy versus Integrated Therapy Isolated Therapy Episodic therapy will produce significant change Skills development in therapy room will generalize Only therapists can provide treatment Integrated Therapy Frequent therapy is necessary to produce significant change Skills are best learned and maintained in settings/ activities in which they will be used All team members, including family and friends, can be taught to implement therapy programs Effective teams have members who: Are familiar with the participant and come prepared to participate Encourage equal participation don t allow domination or withdrawal Provide constructive input Guarantee respect Accept and challenge expertise Share responsibility and accountability for the team s decisions Are flexible, even under stressful situations Are willing learners Have excellent collaborative skills 46

59 Assess Your Collaborative Skills Are you a good team member? Assess your collaborative skills Are you a good collaborator? The heart of the interprofessional collaborative teams The participant is at the center of services The participant s goals, dreams, and aspirations drive the helping process The team considers all aspects of the participant holistically psychological, emotional, cognitive, social, physical, social, as well as leisure The participant is seen with the rich contexts of his or her environments The participant s individual strengths AND environmental strengths and resources are taken into account during assessment and planning The participant s strengths and the environmental resources are like the fertilizer that nourishes the soul, from which a flourishing life grows Services are outcomes based and reflect the multidimensionality of human well being and quality of life 47

60 Advocating for a strengths approach on the team Focus Language What action will you take to enhance your strengths? As a person, as a professional, as a team member 48

61 Final Thoughts One evening an old Cherokee told his grandson about a battle that goes on inside people. He said, My son, the battle is between two wolves inside us all. One is Negativity. It s anger, sadness, stress, contempt, disgust, fear, embarrassment, guilt, shame and hate. The other is Positivity. It s joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe, and above all, love. The grandson thought about it for a minute and then asked his grandfather: Which wolf wins? The old Cherokee simply replied, The one you feed 49