knowledge of leisure skills; and adaptations and community resources. These are all needs which are intermixed in each patient's path to recovery.

The recreation therapist must address these needs through the leisure interests of the patients. After assessing the patients and developing goals and a treatment plan, it is up to the recreation therapist to encourage patients to participate in some form of recreation activity and treatment. This activity can be done on an individual basis or in a group. Families of patients are also included in the recreation programming.

Programs conducted by the recreation therapist will emphasize interaction with others; meeting psychosocial needs; increasing strength and endurance; and addressing leisure education and community resource awareness. All programs are conducted with the ultimate goal of preparing individuals for discharge from the hospital. A critical form of treatment encompasses teaching patients new or adaptive leisure skills. It is important for patients to experience success with their activities and gain self confidence as well as a sense of comfort with other people.

The role of the recreation therapist can also involve planning and implementing community outings with the patients and families. It can be very difficult to initially venture out into a public facility for the first time in a wheel chair or without a limb. The recreation therapist can be a valuable asset for individuals through providing them with positive experiences within the community and the opportunity to try things for the first time as a person with a disability. Through these types of programs the patient has the opportunity to learn about accessibility in the community. This can also facilitate discussions of resources within the community and how to access them. The recreation therapist also has an obligation to assist people in knowing their rights as people with disabilities and how to advocate for themselves.

Prior to discharge from the hospital it is crucial that a thorough review of resources available to the patient is conducted. This may include phone numbers, addresses, individual and agency names and transportation options. The recreation therapist in the clinical setting can assist the patient by contacting recreation therapists in the community or other professionals who can assist the patient in making a smooth transition into the community. Follow-up contact with the patients is available once they have left the hospital. Recreation therapists from the clinical settings can also offer their leadership through support groups which offer services to patients on an on-going basis once they are discharged. This is a good opportunity for recreation therapists in both the clinical and community settings to work together in providing support groups. The challenges of working in the rehabilitation field are great. However, as recreation therapists, we can offer our skills and resources to enable people with disabilities to lead healthy and fulfilling lives. When these patients leave the hospital, community recreation professionals also have the skills, resources and requirement to empower people with disabilities to lead healthy leisure lifestyles.

About the Author:

Marilyn Tense is the Coordinator of Therapeutic Recreation at Paulson Rehabilitation Network at Hinsdale Hospital.

Children Live the Challenge of Rehabilitation
by Vicki Richman

Shriners' Hospital, Chicago unit, treats a whole variety of children with physical disabilities. This includes, but is not limited to, children with Cerebral Palsy, Spina Bifida, spinal cord injuries, limb length deficiency, Scoliosis, Osteo Imperfecta, cleft lip and palate and some plastic surgery. All surgeries, medical care and in-house rehabilitation services are free to the children. These services are paid for by donations raised by the Shriners organization. This is significant as it attempts to reduce the great financial burden that usually affects a family with a disabled child.

By far the greatest aspect of working in a pediatric surgical and rehabilitation hospital is the uniqueness of the children. Each child has an incredible amount of internal strength which is inspiring. The children want to succeed and they strive to achieve their maximum level of independence. The children have their own stories to tell, many of which are about the multiple surgeries they have had since birth. These children live the challenge of rehabilitation, school issues and peer adjustment each day. Even with their physical disabilities, they want to leam to explore their world like any other child.

The recreation therapist helps to teach the children the importance of leisure. Each patient at Shriners' Hospital receives a recreation therapy assessment which identifies the patients' leisure interests and needs. An individualized treatment plan is developed with goals to teach skill development and adapt previous leisure activities to enhance the patients' leisure life-styles after discharge. Along with skill development for recreation participation, the recreation therapist commonly addresses wheelchair skills, recreation activities that promote emotional, social, physical and cognitive development as well as self esteem. It is also important to educate the families regarding leisure activities that could promote positive family interactions. Recreation therapy provides weekly outings to address accessibility and assertiveness in the community. Discharge referrals are made on each patient to inform them of community programs and where special recreation equipment can be purchased.

The recreation therapist's primary goal is to teach the patient recreation skills that promote independence and enhance lifelong recreation participation within their home environment.

Many of the patients at Shriners' are from small towns throughout the Midwest which do not offer special recreation services. Therefore, community recreation professionals are responsible for assuring that each resident has the opportunity to participate in recreational pursuits. Due to the lack of resources available in some communities, it is also essential for the recreation therapist to educate the family of the importance of recreation in order to ensure follow through. Parents and patients are encouraged to play and learn together while in the hospital in hopes that the families will understand the importance of leisure for the entire family, not just the disabled child.

Community recreation, from a clinical recreation therapist's perspective, is critical. Children need to play in a fun, social environment where they can laugh with their peers. Community recreation provides this opportunity in the child's home environment. It is essential for a strong bond between clinical and community recreation so the patient can make a smooth transition from hospital to community recreation programs. This bond will ensure the quality continuum of care from treatment to independent recreation participation while providing positive recreation experiences for physically disabled persons. This is a goal both community and clinical recreation professionals would like to achieve.

About the Author

Vicki Richman is a Recreation Therapist in the Recreation Therapy/Child Life Department at Shriners' Hospital for Crippled Children, Chicago Unit.

Psychiatry Can be Gratifying for Recreation Therapists
by Jan Dunham

Psychiatry at Good Shepherd Hospital can be a gratifying, yet challenging environment for a recreation therapist. Each patient has varying degrees of psychiatric problems which makes working together in a group setting very interesting.

Upon admission to the hospital, each patient is assessed with regards to their presenting problems, current leisure interests and goals they feel they need to work on while in the hospital. Once problems and goals are identified, the interdisciplinary treatment team along with the patient agrees upon the critical issues and forms of treatment. The recreation therapist is an integral member of the treatment team which includes the psychiatrist, nurses, mental health counselors, occupational therapists and social workers.

Patients are admitted with various diagnosis such as: Major Depression, where the patient may have suicidal thoughts and have feelings of hopelessness, helplessness and worthlessness; Bipolar Disorder, in which patients may have an obscured sense of reality or may have paranoid thinking, believing others may cause them harm.

Most of the recreation therapy/therapeutic recreation groups focus on improving self-concept, concentration, coping skills, attention span and, of course, improving leisure pursuits. Many of the patient's individual goals are incorporated in the various activities, work sheets and exercises used in the groups.

Leisure lifestyle groups focus on the importance of having healthy leisure pursuits, defining the benefits of leisure and why leisure is important in people's lives, and educating patients about leisure resources available within their community.

Leisure awareness groups encourage patients to try new leisure skills or leam new games. One focus is to introduce a variety of different games. Patients may then decide which types of games best suits their needs, and therefore, may pursue that type when purchasing a new game.

Leisure planning groups relate the importance of planning for one's individual leisure time and following through with their decisions. As a group, patients work together to plan four activity groups. This promotes teamwork as well as improving decision making skills.

Creative expression and communication skills groups enhance the patients' ability to reflect on the issues and problems which lead to the hospitalization. Patients develop coping skills and more effective ways of communicating with others. Various media are used such as drawing, making collages, movement, music and creative writing.

Craft groups offer patients opportunities to leam new skills, improve their concentration, improve their problem solving skills and frustration tolerance.

One specialized group is the family leisure and recreation group. Often it is difficult for families to come together and "play" in a cooperative effort. Through this group, the family may realize the importance of group cooperation and effective communication among members.

Due to the decreasing length of stay, generally two to three weeks, recreation or activity therapy in a psychiatric setting promotes healthy leisure attitudes and encourages patients to follow through with discharge plans made while in the hospital. Many aspects are merely touched upon and referrals to outside agencies for follow-up are recommended to each patient. Many psychiatric patients lack the self confidence, social skills, initiation or resources to mainstream into community recreation programs. However, with additional support and/or initial contact, many of them could benefit from the recreation participation that is available within their community.

About the Author

Jan Dunham is employed at Good Shepherd Hospital.