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 Carter · Smith · O’Morrow
Effective Management

in Therapeutic Recreation Service

Effective Management
in Therapeutic
Recreation Service
THIRD EDITION

Marcia Jean Carter,

Christen G. Smith, and
Gerald S. O’Morrow
EFFECTIVE MANAGEMENT IN THERAPEUTIC RECREATION SERVICE (THIRD EDITION)

ISBN-13: 978-1-939476-05-0
ISBN-10: 1-939476-05-4

9 781939 476050
VENTURE

P02_VEN_CarterSmith_Cover.indd 1 7/28/14 6:02 PM

 Effective Management in
Therapeutic Recreation Service
Third Edition
 Effective Management in
Therapeutic Recreation Service
Third Edition

by
Marcia Jean Carter, Re.D., CPRP, CTRS
Christen G. Smith, Ph.D., CPRP
Gerald S. O’Morrow, Ph.D., CTRS

Venture Publishing, Inc.

State College, Pennsylvania
Copyright © 2014

Venture Publishing, Inc.

1999 Cato Avenue
State College, PA 16801
Phone 814-234-4561; Fax 814-234-1651

No part of the material protected by this copyright notice may be reproduced or

utilized in any form or by any means, electronic or mechanical, including photocopying,
recording, or by any information storage and retrieval system, without
written permission from the copyright owner.

Trademarks: All brand names and product names used in this book are trademarks,
registered trademarks, or trade names of their respective holders.

Cover by StepUp Communications, Inc.

Library of Congress Catalogue Card Number 2014947454

ISBN-10: 1-939476-05-4
ISBN-13: 978-1-939476-05-0
 Table of Contents
Preface......................................................................................................................................................xvii
Acknowledgments......................................................................................................................................xix

Section 1: Management Concepts........................................................................................1

Chapter 1: Introducing First-Line Management: Trends Impacting Your Future..........................................3

Keywords/Learning Outcomes/Overview...................................................................................................... 3
Health and Human Service in the 21st Century............................................................................................ 4
First-Line Managers...................................................................................................................................... 5
Settings and Populations.......................................................................................................................... 5
Managerial Qualities, Responsibilities, Professional Expectations............................................................. 6
References..................................................................................................................................................... 8

Chapter 2: Becoming a First-Line Manager..................................................................................................9

Keywords/Learning Outcomes/Overview...................................................................................................... 9
Management................................................................................................................................................. 9
Three Levels of Management................................................................................................................. 10
Therapeutic Recreation First-Line Manager........................................................................................... 10
Management Functions................................................................................................................... 11
Planning.................................................................................................................................... 11
Organizing................................................................................................................................ 11
Leading..................................................................................................................................... 11
Controlling................................................................................................................................ 12
Resources to be Managed................................................................................................................ 12
First-Line Manager as a Supervisor.................................................................................................. 12
First-Line Manager as a Leader........................................................................................................ 12
Making the Transition: Practitioner to First-Line Manager.................................................................... 14
Organizational Stress Management.................................................................................................. 15
Consequences of Organizational Stress...................................................................................... 16
Managing Organizational Stress and Burnout................................................................................. 16
Managing Time............................................................................................................................... 18
Time Analysis............................................................................................................................ 18
Setting Objectives...................................................................................................................... 18
Controlling Interruptions.......................................................................................................... 18
Summary..................................................................................................................................................... 19
Critical Thinking Activities.......................................................................................................................... 20
References................................................................................................................................................... 20

Chapter 3: Managing and Leading..............................................................................................................23

Keywords/Learning Outcomes/Overview.................................................................................................... 23
Management............................................................................................................................................... 23
Management Theory.............................................................................................................................. 23
Classical Management Theory......................................................................................................... 24
Behavioral Management Theory...................................................................................................... 25
Human Relations Management Theory........................................................................................... 26
vi Effective Management in Therapeutic Recreation Service, Third Edition

Modern Management Theory.......................................................................................................... 27

General Systems Theory............................................................................................................. 27
Contingency Theory.................................................................................................................. 28
Management Theory and Therapeutic Recreation.................................................................................. 28
Leadership................................................................................................................................................... 28
Leadership Theory................................................................................................................................. 28
Trait Theories.................................................................................................................................. 29
Behavioral Theories......................................................................................................................... 29
Contingency Theories..................................................................................................................... 30
Fiedler’s Contingency Model..................................................................................................... 30
Life-Cycle Model....................................................................................................................... 31
Path-Goal Model....................................................................................................................... 31
Contemporary Theories......................................................................................................................... 32
Transactional Leadership................................................................................................................. 32
Transformational Leadership........................................................................................................... 32
Charismatic Leadership................................................................................................................... 32
Leadership and Power.................................................................................................................................. 33
Base of Power........................................................................................................................................ 33
Power Strategies..................................................................................................................................... 34
Leadership and Supervision................................................................................................................... 34
Professional Clinical Supervision........................................................................................................... 36
Vision, Mission, Goals, and Objectives....................................................................................................... 37
Vision Statement................................................................................................................................... 37
Mission Statement................................................................................................................................. 38
Goals and Objectives............................................................................................................................. 38
Implications for Therapeutic Recreation................................................................................................ 39
Summary..................................................................................................................................................... 40
Critical Thinking Activities.......................................................................................................................... 40
References................................................................................................................................................... 41

Chapter 4: Managing Organizational Behavior..........................................................................................43

Keywords/Learning Outcomes/Overview.................................................................................................... 43
Organizational Culture and Climate........................................................................................................... 43
Organizational Change................................................................................................................................ 44
Factors Affecting Individual Performance.................................................................................................... 46
Attitude................................................................................................................................................. 46
Personality............................................................................................................................................. 47
Motivation............................................................................................................................................ 47
Perception............................................................................................................................................. 48
Learning Styles...................................................................................................................................... 48
Diversity................................................................................................................................................ 49
Group Dynamics................................................................................................................................... 49
Groups ....................................................................................................................................................... 49
Formal Groups...................................................................................................................................... 50
Informal Groups.................................................................................................................................... 50
Group Development................................................................................................................................... 50
Forming................................................................................................................................................ 51
Storming............................................................................................................................................... 51
 Table of Contents vii

Norming............................................................................................................................................... 51
Performing............................................................................................................................................ 51
Re-forming/Adjourning......................................................................................................................... 51
Group Dynamics......................................................................................................................................... 51
Group Rank.......................................................................................................................................... 51
Group Status......................................................................................................................................... 52
Group Role........................................................................................................................................... 52
Group Size ........................................................................................................................................... 53
Group Norms........................................................................................................................................ 53
Group Cohesiveness.............................................................................................................................. 54
Manager’s Roles in Group Performance....................................................................................................... 54
Teams.......................................................................................................................................................... 54
Manager’s Roles in Team Performance......................................................................................................... 56
Summary..................................................................................................................................................... 57
Critical Thinking Activities.......................................................................................................................... 57
References................................................................................................................................................... 58

Chapter 5: Decision Making, Problem Solving, and Managing Conflict....................................................59

Keywords/Learning Outcomes/Overview.................................................................................................... 59
Critical Thinking......................................................................................................................................... 60
Decision Making......................................................................................................................................... 60
Types of Decisions................................................................................................................................. 61
Decision-Making Conditions................................................................................................................ 61
Policies, Procedures, Rules..................................................................................................................... 61
Policies ........................................................................................................................................... 62
Procedures....................................................................................................................................... 63
Rules............................................................................................................................................... 64
Decision-Making Process....................................................................................................................... 64
Issue Identification.......................................................................................................................... 64
Exploring Alternatives through Creative Thinking........................................................................... 64
Evaluating Alternatives.................................................................................................................... 68
Selecting an Alternative................................................................................................................... 68
Implementing the Decision............................................................................................................. 69
Evaluating the Decision................................................................................................................... 69
Group Decision-Making Techniques..................................................................................................... 69
Interaction Group........................................................................................................................... 70
Brainstorming................................................................................................................................. 70
Nominal Group Technique............................................................................................................. 70
Delphi Group Method.................................................................................................................... 70
Electronic Meetings......................................................................................................................... 71
Analytical Decision-Making Tools......................................................................................................... 71
Decision Grids, Gantt Charts, Consequence Tables......................................................................... 71
Decision Trees................................................................................................................................. 72
Program Evaluation and Review Technique (PERT)/Critical Path Method (CPM)......................... 72
Problem Solving.......................................................................................................................................... 72
Problem-Solving Process........................................................................................................................ 73
Define the Problem......................................................................................................................... 73
Gather Information......................................................................................................................... 73
viii Effective Management in Therapeutic Recreation Service, Third Edition

Analyze Information........................................................................................................................ 73
Develop Solutions........................................................................................................................... 74
Make Decision................................................................................................................................ 74
Implement...................................................................................................................................... 74
Evaluate........................................................................................................................................... 74
Personal Elements of Making Decisions and Solving Problems.................................................................... 75
Managing Conflict...................................................................................................................................... 75
Sources of Conflict................................................................................................................................ 75
Conflict Prevention and Resolution....................................................................................................... 76
Resolution Strategies.............................................................................................................................. 77
Resolution Outcomes............................................................................................................................ 77
Summary..................................................................................................................................................... 79
Critical Thinking Activities.......................................................................................................................... 80
References................................................................................................................................................... 80

Section 2: Managing Operations........................................................................................81

Chapter 6: Applying Technology and Implementing Research...................................................................83

Keywords/Learning Outcomes/Overview.................................................................................................... 83
Technology.................................................................................................................................................. 83
Technology Supporting Management Decisions.................................................................................... 84
Dashboard Reports.......................................................................................................................... 85
Handheld Electronic Devices and Wireless Access........................................................................... 85
Internet Resources........................................................................................................................... 87
Electronic Health Records........................................................................................................................... 87
Technology Opportunities and Barriers....................................................................................................... 89
Applying Technology to Research................................................................................................................ 90
Evidence-Based Practice in Therapeutic Recreation................................................................................ 90
Evidence-Based Practice Model for Implementation.............................................................................. 91
Challenges to Implementation of Evidence-Based Practice..................................................................... 92
Enhancing Research.................................................................................................................................... 92
Summary..................................................................................................................................................... 94
Critical Thinking Activities.......................................................................................................................... 94
References................................................................................................................................................... 95

Chapter 7: Marketing and Advocating........................................................................................................97

Keywords/Learning Outcomes/Overview.................................................................................................... 97
Trends......................................................................................................................................................... 98
Marketing Concepts.................................................................................................................................... 99
The Marketing Process: A Marketing Plan................................................................................................. 100
Step 1: Assessment............................................................................................................................... 100
Step 2: Planning.................................................................................................................................. 101
Step 3: Implementation....................................................................................................................... 103
Branding....................................................................................................................................... 103
Logo.............................................................................................................................................. 104
Tagline ......................................................................................................................................... 104
Bundling....................................................................................................................................... 104
Digital Networking....................................................................................................................... 105
 Table of Contents ix

Marketing Benefits........................................................................................................................ 105

Step 4: Evaluation and Control............................................................................................................ 106
Managerial Roles....................................................................................................................................... 106
Ethics in Marketing................................................................................................................................... 107
Summary................................................................................................................................................... 108
Critical Thinking Activities........................................................................................................................ 108
References................................................................................................................................................. 108

Chapter 8: Financial Management............................................................................................................111

Keywords/Learning Outcomes/Overview.................................................................................................. 111
Health-Care Financing: Milestones and Concepts..................................................................................... 112
Milestones: United States and Canada................................................................................................. 112
United States................................................................................................................................. 112
Canada ......................................................................................................................................... 113
Concepts: Regulations and Financial Practices in North America........................................................ 114
Revenue Sources and Coverage.................................................................................................................. 117
Revenue Sources.................................................................................................................................. 117
Coverage.............................................................................................................................................. 118
United States................................................................................................................................. 118
The Budgeting Process............................................................................................................................... 119
Types of Budgets.................................................................................................................................. 120
Budget Formats................................................................................................................................... 121
Budget Monitoring.............................................................................................................................. 122
Trends and Challenges in Health-Care Financing...................................................................................... 123
Summary................................................................................................................................................... 124
Critical Thinking Activities........................................................................................................................ 125
References................................................................................................................................................. 126

Section 3: Managing Human Resources...........................................................................127

Chapter 9: Staffing Services......................................................................................................................129

Keywords/Learning Outcomes/Overview.................................................................................................. 129
Human Resource Planning........................................................................................................................ 131
Position Opens.................................................................................................................................... 131
Budget Review..................................................................................................................................... 131
Job Description Review and Job Analysis............................................................................................. 131
Candidate-Selection Criteria................................................................................................................ 133
Recruitment Plan................................................................................................................................. 134
Job Announcement....................................................................................................................... 135
Selection Process.................................................................................................................................. 135
Application Form.......................................................................................................................... 136
Interview....................................................................................................................................... 137
Background Checks....................................................................................................................... 137
Selection Decision......................................................................................................................... 138
Job Offer............................................................................................................................................. 140
Probationary Period............................................................................................................................. 140
Professional Standards......................................................................................................................... 141
Staff Training and Development................................................................................................................ 141
x Effective Management in Therapeutic Recreation Service, Third Edition

Training Cycle..................................................................................................................................... 142

Needs Assessment.......................................................................................................................... 142
Objectives..................................................................................................................................... 143
Implementation............................................................................................................................ 143
Evaluation..................................................................................................................................... 144
Training and Development Trends....................................................................................................... 145
Performance Appraisals............................................................................................................................. 146
Performance Appraisal Systems............................................................................................................ 147
Results-Oriented Evaluations (Objectives)..................................................................................... 147
Critical Incident Reports............................................................................................................... 148
Rubrics (Behaviorally Anchored Rating Scale)............................................................................... 148
Ranking........................................................................................................................................ 148
Narrative....................................................................................................................................... 149
Performance Appraisal Interview......................................................................................................... 149
Performance-Improvement Action Plan............................................................................................... 149
Progressive Discipline.......................................................................................................................... 150
Grievance Procedure............................................................................................................................ 151
Retaining Staff..................................................................................................................................... 151
Legal Environment.................................................................................................................................... 152
Equal Employment Opportunity......................................................................................................... 152
U.S. Legislation................................................................................................................................... 152
Summary................................................................................................................................................... 156
Critical Thinking Activities........................................................................................................................ 157
References................................................................................................................................................. 157

Chapter 10: Volunteer and Intern Management........................................................................................159

Keywords/Learning Outcomes/Overview.................................................................................................. 159
Planning.................................................................................................................................................... 160
Assessment ......................................................................................................................................... 160
Policies and Procedures........................................................................................................................ 161
Job Descriptions.................................................................................................................................. 161
Staff and Training Resources................................................................................................................ 162
Screening............................................................................................................................................. 162
Marketing Plan.................................................................................................................................... 163
Selection and Orientation......................................................................................................................... 164
Selection and Interview....................................................................................................................... 164
Placement and Orientation.................................................................................................................. 165
Training, Supervision/Evaluation, Contracts........................................................................................ 166
Training and Supervision........................................................................................................................... 168
Training............................................................................................................................................... 168
Supervision ......................................................................................................................................... 169
Evaluation, Termination, and Recognition................................................................................................ 170
Formative Evaluation........................................................................................................................... 170
Summative Evaluation and Termination.............................................................................................. 170
Recognition......................................................................................................................................... 172
Trends and Issues....................................................................................................................................... 172
Summary................................................................................................................................................... 173
Critical Thinking Activities........................................................................................................................ 174
References................................................................................................................................................. 174
 Table of Contents xi

Chapter 11: Communicating Effectively in the Workplace.......................................................................177

Keywords/Learning Outcomes/Overview.................................................................................................. 177
Interpersonal Communication in the Workplace....................................................................................... 178
Formal Communication Modes........................................................................................................... 179
Verbal Communication................................................................................................................. 179
Nonverbal Communication........................................................................................................... 179
Appearance.................................................................................................................................... 179
Written Communication............................................................................................................... 179
Informal Communication Mode......................................................................................................... 180
Technology’s Impact on Workplace Communication........................................................................... 180
Workplace Variables Impacting Communication................................................................................. 180
Physical......................................................................................................................................... 181
Emotional..................................................................................................................................... 181
Semantics...................................................................................................................................... 181
Role.............................................................................................................................................. 181
Gender ......................................................................................................................................... 181
Generational................................................................................................................................. 181
Culture......................................................................................................................................... 181
Organizational Culture.................................................................................................................. 182
Information Overload................................................................................................................... 182
Principles of Effective Communication................................................................................................ 182
Feedback....................................................................................................................................... 183
Active Listening............................................................................................................................. 183
The Manager and Organizational Communication.................................................................................... 183
Variables Affecting Organizational Communication............................................................................ 184
Organizational Communication Strategies........................................................................................... 184
Effective Meeting Strategies................................................................................................................. 185
Delegation ......................................................................................................................................... 185
Negotiation......................................................................................................................................... 187
Collaboration...................................................................................................................................... 187
Criticism, Complaints, and Confrontation.......................................................................................... 188
The Manager—A Professional Advocate.................................................................................................... 189
Summary................................................................................................................................................... 190
Critical Thinking Activities........................................................................................................................ 190
References................................................................................................................................................. 190

Chapter 12: Creating a Motivating Work Environment............................................................................191

Keywords/Learning Outcomes/Overview.................................................................................................. 191
Motivational Theories................................................................................................................................ 192
Maslow’s Hierarchy of Needs............................................................................................................... 192
Clayton Alderfer’s Modified Need Hierarchy (ERG)............................................................................ 192
Herzberg’s Two-Factor Theory............................................................................................................. 193
Skinner’s Positive Reinforcement Theory............................................................................................. 193
Argyris’s Maturity-Immaturity Continuum.......................................................................................... 193
McClelland’s Three Needs Theory........................................................................................................ 193
McGregor’s Theory X and Theory Y..................................................................................................... 194
Vroom’s Expectancy Theory................................................................................................................. 194
Equity Theory...................................................................................................................................... 195
xii Effective Management in Therapeutic Recreation Service, Third Edition

Goal-Setting Theory............................................................................................................................ 195

Theory Z............................................................................................................................................. 195
Need Fulfillment and a Motivating Work Environment............................................................................ 196
Need Fulfillment through Intrinsic and Extrinsic Motivators............................................................... 196
Manager’s Role in Creating a Motivating Work Environment.............................................................. 197
Trends and Issues Challenging Motivational Work Environments............................................................. 200
Summary................................................................................................................................................... 201
Critical Thinking Activities........................................................................................................................ 201
References................................................................................................................................................. 202

Section 4: Managing Service Delivery. ............................................................................203

Chapter 13: Managing for Service Accountability....................................................................................205

Keywords/Learning Outcomes/Overview.................................................................................................. 205
Staffing and Scheduling Options............................................................................................................... 206
Staffing Variables................................................................................................................................. 206
Scheduling Options and Challenges.................................................................................................... 207
Therapeutic Recreation Process.................................................................................................................. 208
Accountability in the Therapeutic Recreation Process.......................................................................... 208
Assessing....................................................................................................................................... 209
Planning........................................................................................................................................ 209
Implementation............................................................................................................................ 209
Evaluation..................................................................................................................................... 209
Accountability Tools, Protocols and Critical Pathways......................................................................... 210
Protocol........................................................................................................................................ 210
Critical Pathway............................................................................................................................ 210
Documenting APIE............................................................................................................................. 211
Monitoring and Consulting Practitioner Performance............................................................................... 213
Monitoring/Coaching and Practitioner Performance........................................................................... 213
Consultant and Practitioner Performance............................................................................................ 214
Summary................................................................................................................................................... 215
Critical Thinking Activities........................................................................................................................ 216
References................................................................................................................................................. 216

Chapter 14: Managing Risk, Safety, Security, and Legal Aspects...............................................................219

Keywords/Learning Outcomes/Overview.................................................................................................. 219
Risk Management..................................................................................................................................... 220
Components of a Risk Management Program...................................................................................... 221
Step 1: Risk Identification............................................................................................................. 223
Step 2: Risk Evaluation................................................................................................................. 224
Step 3: Risk Management Strategies.............................................................................................. 225
Step 4: Risk Management Implementation and Reporting............................................................ 226
Security and Personal Safety...................................................................................................................... 227
Legislation and Laws, United States and Canada................................................................................. 228
Organizations in United States and Canada......................................................................................... 229
Legal Issues and Concerns......................................................................................................................... 230
Legal Responsibilities of the Manager.................................................................................................. 232
Summary................................................................................................................................................... 233
 Table of Contents xiii

Critical Thinking Activities........................................................................................................................ 234

References................................................................................................................................................. 234

Chapter 15: Managing Service Quality in Health Care.............................................................................237

Keywords/Learning Outcomes/Overview.................................................................................................. 237
Brief Evolution of Quality Concerns in Health Care................................................................................. 238
How is Quality Defined in Health Care?................................................................................................... 239
Client Perceptions of Quality in Health Care............................................................................................ 241
Quality Initiatives Applied to Health Care................................................................................................ 241
TQM as a Broad Philosophy of Quality Improvement........................................................................ 242
CQI as a Process of Quality Improvement........................................................................................... 243
The Deming cycle......................................................................................................................... 244
Quality Assurance................................................................................................................................ 245
Structure....................................................................................................................................... 245
Process ......................................................................................................................................... 245
Outcome....................................................................................................................................... 246
Indicators...................................................................................................................................... 247
Quality Improvement.......................................................................................................................... 248
Quality Improvement through Evidence-Based Practice............................................................................ 248
Summary................................................................................................................................................... 250
Critical Thinking Activities........................................................................................................................ 251
References................................................................................................................................................. 251

Chapter 16: Managing Your Future: Professional Qualities and Career Planning.....................................255
Keywords/Learning Outcomes/Overview.................................................................................................. 255
A Professional Career................................................................................................................................ 255
Ethical Practices and Principles............................................................................................................ 256
Values and Rights................................................................................................................................ 257
Values............................................................................................................................................ 257
Rights............................................................................................................................................ 258
The Manager and Professional Ethics................................................................................................... 259
Ethical Decision-Making and Moral-Reasoning Model....................................................................... 260
Managing and Advancing Your Career...................................................................................................... 261
Career Planning................................................................................................................................... 261
Assessment.................................................................................................................................... 261
Planning........................................................................................................................................ 261
Implementation............................................................................................................................ 262
Evaluation..................................................................................................................................... 263
Advancing Your Professional Future..................................................................................................... 263
Summary................................................................................................................................................... 263
Critical Thinking Activities........................................................................................................................ 265
References................................................................................................................................................. 266

Index.........................................................................................................................................................269
xiv Effective Management in Therapeutic Recreation Service, Third Edition

List of Tables and Figures

Table 1.1 Trends, Issues, and Challenges in Recreation Therapy/Therapeutic Recreation .................................... 5
Table 1.2 Managerial Responsibilities by NCTRC Professional Knowledge Domains ......................................... 7
Figure 2.1 Three Levels of Management ........................................................................................................... 10
Figure 2.2 Managerial Responsibilities by NCTRC Professional Knowledge Domains ..................................... 13
Figure 2.3 Expectations of First-Line Managers ................................................................................................ 14
Figure 2.4 Variables Affecting the Therapeutic Recreation Manager .................................................................. 15
Figure 2.5 Prolonged Stress: Physical, Psychological, and Behavioral Symptoms of Stress ................................. 17
Figure 2.6 The Differences Between Stress and Burnout ................................................................................... 17
Figure 2.7 Managing for Effective Meetings ..................................................................................................... 20
Figure 3.1 Functions of Management and Leadership ...................................................................................... 24
Figure 3.2 Functions of Management and Leadership ...................................................................................... 26
Figure 3.3 Theory X and Theory Y Assumptions .............................................................................................. 26
Figure 3.4 Open System ................................................................................................................................... 27
Figure 3.5 Examples of Common Leadership Traits .......................................................................................... 29
Figure 3.6 Behavior Styles of Leadership .......................................................................................................... 29
Figure 3.7 Continuum of Leadership Behavior ................................................................................................. 30
Figure 3.8 Fiedler’s Contingency Theory Model ............................................................................................... 31
Figure 3.9 The Life-Cycle Model ...................................................................................................................... 32
Figure 3.10 Path-Goal Theory .......................................................................................................................... 32
Figure 3.11 Rules of Using Power ..................................................................................................................... 35
Figure 3.12 Planning Statements: Vision, Mission, Goals, and Objectives ........................................................ 37
Figure 3.13 Mission Statements for Therapeutic Recreation ............................................................................. 39
Table 4.1 Work Rules and Climate and Culture ............................................................................................... 44
Table 4.2 Manager Change Agent Abilities ....................................................................................................... 45
Figure 4.1 Phases of Planned Change ............................................................................................................... 45
Table 4.3 Manager’s Strategies to Build Employee Consensus ........................................................................... 46
Table 4.4 Managerial Processes to Manage Perceptions ..................................................................................... 48
Table 4.5 Personal Differences Contributing to Diversity ................................................................................. 49
Table 4.6 Positive Group Task Roles ................................................................................................................. 53
Table 4.7 Positive Group Maintenance Roles .................................................................................................... 53
Table 4.8 Roles That Inhibit Group Functioning .............................................................................................. 53
Table 4.9 Managerial Actions Contribute to Positive Group Norms ................................................................. 54
Table 4.10 Comparative Features of Effective and Ineffective Groups ............................................................... 55
Table 4.11 Variations between Groups and Teams ............................................................................................ 56
Table 4.12 Qualities of Effective Teams ............................................................................................................ 56
Table 5.1 Critical Analysis Questions ............................................................................................................... 60
Table 5.2 Decision Making Conditions ............................................................................................................ 62
Table 5.3 Policy Statement Guidelines .............................................................................................................. 63
Figure 5.1 Organizational Policy ...................................................................................................................... 65
Figure 5.2 Departmental Policy Aligned with Organizational Policy ................................................................. 66
Figure 5.3 Procedures within Department Policy .............................................................................................. 67
Table 5.4 Creative Thinking Steps .................................................................................................................... 67
Figure 5.4 A Decision Grid .............................................................................................................................. 71
Figure 5.5 A Decision Tree ............................................................................................................................... 72
Table 5.5 Comparison of the Problem-Solving and Therapeutic Recreation Processes ....................................... 73
 Table of Contents xv

Table 5.6 Criteria to Review Collected Information ......................................................................................... 74

Table 5.7 Selected Resolution Strategies ........................................................................................................... 78
Table 6.1 The Technology Plan ......................................................................................................................... 85
Figure 6.1 Dashboard Report ........................................................................................................................... 86
Table 6.2 Data Security for Electronic Health Records ..................................................................................... 89
Table 6.3 Categories of Evidence ...................................................................................................................... 91
Table 7.1 Marketing Plan Outline .................................................................................................................. 101
Figure 7.1 Target Audiences for Therapeutic Recreation Marketing ................................................................ 101
Figure 7.2 Marketing Goals and Objectives .................................................................................................... 101
Figure 7.3 Action Plan .................................................................................................................................... 102
Figure 7.4 Marketing Timetable ..................................................................................................................... 103
Table 7.2 Steps to Developing a Tagline ......................................................................................................... 105
Table 8.1 USA Payment Shifts and Legislation ............................................................................................... 113
Table 8.2 Canadian Health-Care Legislation .................................................................................................. 114
Table 8.3 U.S. Payment-Related Programs ..................................................................................................... 116
Table 8.4 Fiscal Terms .................................................................................................................................... 117
Table 9.1 Human Resource Department Responsibilities ............................................................................... 130
Figure 9.1 Entry-Level Job Description .................................................................................................. 132–133
Figure 9.2 Selection Criteria Form ................................................................................................................. 134
Figure 9.3 Common Media for Distribution of Job Announcements ............................................................. 135
Figure 9.4 Advantages and Disadvantages of Recruitment Software ................................................................ 136
Figure 9.5 Position Announcement ................................................................................................................ 136
Table 9.2 Preparing for the Interview ............................................................................................................. 138
Table 9.3 Pre-Employment Questions: What is Legal ..................................................................................... 139
Table 9.4 Common Selection Decision Mistakes ............................................................................................ 140
Table 9.5 Purposes of New Employee Orientation .......................................................................................... 142
Table 9.6 Types of Staff Training and Development Programs ........................................................................ 143
Table 9.7 Advantages and Disadvantages of E-Learning Training .................................................................... 144
Table 9.8 Training Methods Summary ............................................................................................................ 145
Table 9.9 Performance Appraisal Methods ...................................................................................................... 147
Table 9.10 Potential Performance-Appraisal Rating Errors .............................................................................. 148
Table 9.11 Major United States Federal Laws and Regulations Related to Human Resource Management ..... 153
Table 9.12 Summary of Canadian Employment Law ..................................................................................... 154
Table 10.1 Management of Agency Volunteers and Interns ............................................................................ 160
Table 10.2 Volunteer and Intern Job Description Information ....................................................................... 162
Table 10.3 Contract/Affiliation Agreement Content ....................................................................................... 162
Table 10.4 Volunteer and Intern Screening Criteria ........................................................................................ 163
Table 10.5 Marketing Plan to Recruit Volunteers and Interns ........................................................................ 164
Table 10.6 Preliminary Interview Content ...................................................................................................... 165
Table 10.7 Volunteer/Intern Interview Questions ........................................................................................... 165
Table 10.8 Volunteer/Intern Behavioral Questions ......................................................................................... 165
Table 10.9 Agency and Unit Orientation Topics ............................................................................................. 166
Table 10.10 Work Assignment Orientation Topics ......................................................................................... 166
Table 10.11 Weekly Assignment Checklist ..................................................................................................... 167
Table 10.12 Volunteer Assignment ................................................................................................................. 168
Table 11.1 Choosing Communication Modes ................................................................................................ 178
Table 11.2 Effective Communication Principles ............................................................................................. 182
Table 11.3 Effective Feedback Techniques ...................................................................................................... 182
xvi Effective Management in Therapeutic Recreation Service, Third Edition

Table 11.4 Active Listening Skills ................................................................................................................... 183

Table 11.5 Organizational Communication Variables ..................................................................................... 184
Table 11.6 Organizational Communication Strategies .................................................................................... 184
Table 11.7 Effective Meeting Strategies .......................................................................................................... 186
Table 11.8 Delegation Process ........................................................................................................................ 187
Table 11.9 Negotiation Process ....................................................................................................................... 187
Table 11.10 Managing Criticism, Complaints, Confrontation ....................................................................... 188
Table 12.1 Job Dimensions ............................................................................................................................ 198
Table 12.2 Managerial Guidelines to Promote Satisfaction and Quality .......................................................... 199
Table 13.1 Staffing Goals ................................................................................................................................ 206
Table 13.2 Manager’s Evaluation Tasks ........................................................................................................... 210
Table 13.3 Documentation Best Practices ....................................................................................................... 212
Table 13.4 Coaching Objectives ..................................................................................................................... 213
Table 13.5 Manager’s Coaching Practices ....................................................................................................... 214
Figure 14.1 Risk Management Decision-Making Process in Therapeutic Recreation ....................................... 221
Table 14.1 Risk Management Responsibilities of Manager ............................................................................. 222
Table 14.2 Risk Management Policy Statement ...................................................................................... 222–223
Table 14.3 Risk Management Concerns in Health-Care Agencies .................................................................. 224
Table 14.4 Illustrations of Potential Errors in Recreation Therapy .................................................................. 224
Table 14.5 Hazards in Recreation Therapy Services ........................................................................................ 224
Table 14.6 Content of Incident Reports ......................................................................................................... 225
Table 14.7 Risk Management Plan Documents and Practices ......................................................................... 226
Table 14.8 Security Devices ............................................................................................................................ 227
Table 14.9 Safety and Quality related Organizations in US and Canada ......................................................... 229
Table 14.10 Criteria for Tort .......................................................................................................................... 231
Table 14.11 Legal Considerations for Professional Liability ............................................................................ 231
Table 14.12 Professional Behavior Important to Minimizing Litigation ......................................................... 231
Table 14.13 HIPAA and PIPEDA Regulations ............................................................................................... 233
Figure 15.1 Triad of Health Care Concerns .................................................................................................... 238
Figure 15.2 Quality Initiatives ........................................................................................................................ 242
Figure 15.3 Elements of TQM as a Philosophy of Management ..................................................................... 243
Figure 15.4 The Deming Cycle ....................................................................................................................... 244
Figure 15.5 Five Steps to Improving Health-Care Quality .............................................................................. 248
Table 16.1 Ethical Principles that Guide Practice Behaviors ........................................................................... 257
Table 16.2 ATRA and CTRA Ethical Principles ............................................................................................. 260
Table 16.3 Ethical Decision-Making/Moral-Reasoning Model ....................................................................... 261
Table 16.4 Career Planning Model ................................................................................................................. 262
Table 16.5 SWOT Analysis to Manage and Advance Your Career .................................................................. 264
 are acknowledged: Students and practicing managers
Preface may engage in professional preparation, live, and practice
Effective Management in Therapeutic Recreation Services, in completely different geographic areas, so culture and
Third Edition provides theoretical and practical diversity are integrated into topics throughout the text.
knowledge about the management of therapeutic rec-
reation services* in health and human service organi- Text Organization
zations in North America. The text was written for This third edition reflects a management perspective,
upper-level undergraduate and graduate students as well as opposed to a program perspective. Therefore, in the
as practitioners. The text was also prepared for a ther- sequence of chapters, program and consumer informa-
apeutic recreation specialist who has responsibility for tion follow management as quality consumer program-
managing direct therapeutic recreation service and the ming relies on successful execution of management
assignment and direction of staff, volunteers, and interns functions. The third edition is organized into four parts.
who deliver the service. Section 1 considers management and leadership
While we realize all the information useful to a concepts. In Chapter 1, new to this edition, the trends
potential manager or practicing manager is not in this and issues creating challenges to managing services are
one volume, the intent is to present the most important summarized and precede a brief description of the
portions of management information relevant to the settings, populations, and responsibilities of the first-line
professional who is a first-line manager. Changes are taking manager. Chapter 2 outlines management functions of
place on a daily basis in health and human service orga- the first-line manager and the transitions from a prac-
nizations, which in turn affect therapeutic recreation titioner to first-line manager. New to the text is con-
service and its management. Management of therapeutic sideration of organizational stress and techniques that
recreation service, regardless of setting, will change dra- first-line managers use to adjust to the demands of their
matically in the future. Hence, we foresee that some work environment. In Chapter 3, management and
statements may not be as appropriate as they were at the leadership theories are summarized and applied to
time the manuscript was prepared. therapeutic recreation. The chapter concludes with
discussion of the manager-leader’s role in preparing
Instructor and Student Learning Tools planning statements to guide the department or agency.
New features of this third edition introduced to support Organizational behavior, Chapter 4, focuses on the
instructors and learners are an instructor’s manual and nature of human behavior in the department. In-depth
text format with interactive pedagogical tools. The in- consideration is given to change, teams, and individual
structor’s manual includes PowerPoints, test questions, factors affecting performance—topics expanded from
and review questions. Each text chapter is introduced the previous edition. Chapter 5, on decision making,
with learner outcomes that are then embedded in the problem-solving, and conflict, addresses fundamental
text narrative in close proximity to the relevant learner tasks found in all management functions and in situations
content. Within the chapters, significant content is where people work together in a constantly changing
presented in Figures and Tables and enumerated in the environment. Expanded in this edition are examples of
chapter summary. Lastly, the text has been reduced in agency policies, procedures, and rules, as well as sources
length so instructors may organize units according to of conflict such as bullying.
the average number of weeks in an academic term. Section 2 reviews operational aspects of manage-
ment, including technology and research (Chapter 6),
New Content marketing and advocacy (Chapter 7), and financing
Another new feature of this edition is the introduction (Chapter 8). Technology, in addition to contributing
of information relevant to therapeutic recreation man- to the increasingly rapid rate of change and access to
agement in Canada. Since publication of the second information, is also affecting how services are delivered
edition, academic programs in Canada are increasing; and how professionals carry out their responsibilities.
where appropriate, discussion presents information Chapter 6 introduces expanded content on health-care
unique to Canadian learners. Likewise, throughout the technology, including dashboards, electronic health
text, the global interactions of health and human services
xviii Effective Management in Therapeutic Recreation Service, Third Edition

records, informatics, a technology plan, and the signif- (Chapter 14); quality (Chapter 15); and managing a
icance of research in evidence-based practice. Health professional future (Chapter 16). Chapter 13 introduces
care is a business, which is most evident with the new evidence-based staffing and enhances discussion of the
business concepts introduced in the marketing and manager’s roles in assessment, planning, implementation,
advocacy chapter (7). Trends like social marketing are and evaluation by adding information on critical
influencing the manager’s advocacy roles and concerns pathways. A contemporary social issue is security and
for assuring ethical relationships among stakeholders personal safety in the workplace. The content of Chapter
and the larger community that benefits from therapeutic 14 expands beyond risk to address safety and security
recreation outcomes. Financing health care in the of professionals and stakeholders in health care. A
United States and Canada is the focus of Chapter 8. number of laws, organizations, and regulations govern
New to the chapter are consideration of the global fiscal and provide resources in Canada and the United States
challenges affecting health care, review of health-care to help the manager ensure safety, quality, and privacy;
payment shifts and legislation in Canada and the United websites are presented, relevant terms defined, elements
States, coverage, and financial trends. of safety and security plans described, and management
Human resources are the focus of Section 3 of the of the therapeutic recreation process to reduce malprac-
text. Chapters consider staffing (Chapter 9), volunteers tice concerns is outlined. Chapter 15 presents the
and interns (Chapter 10), workplace communication manager’s responsibility to sustain quality in service
(Chapter 11), and motivating work environments delivery. New to this edition are reviews of quality
(Chapter 12). Chapter 9 covers staff planning and initiatives applied to health care, evolution of quality
selection, training and development, and performance concerns in health care, expanded definitions of quality
appraisal. New content includes recruitment software, by the Institute Of Medicine and World Health
e-learning, results-oriented assessments and evaluation Organization, and an introduction to the American
in addition to expanded information on interviewing, Hospital Association quality-improvement model.
orientation, staff retention, and employment regula- Closing the text (Chapter 16) is a new chapter on
tions. Chapter 10 introduces a Canadian perspective managing a professional future. This chapter reiterates
to managing volunteers and interns. Also introduced the trends and issues shared in the introduction and
are the changing natures of volunteer commitments throughout the text. Also, the chapter summarizes the
and student internship needs that impact the manager’s critical nature of ethics and ethical decision making as
responsibility to create capacity-building experiences. professional qualities and behaviors. To manage a future
Chapter 11 emphasizes that because a manager is in a that advances the emerging professional’s career requires
high-profile position, everything a manager does continued acquisition of relevant knowledge, skills, and
communicates. An expanded emphasis is given to abilities and the flexibility to change. To accomplish
workplace variables, influencing communication and these goals, a career-planning model grounded on the
the manager’s role as a professional advocate. The closing process of assessment, planning, implementation, and
chapter in this section, Chapter 12, expands information evaluation and a strategic-planning-analysis template
on motivational theories—the manager’s role in relating are presented. These tools help professionals identify
to the unique needs of staff in order to create a motivating their assets and plan strategies to remain abreast of global
environment that satisfies staff goals and department and professional challenges while advancing the
or agency goals—and shares research on intrinsic and profession.
extrinsic forms of motivation in therapeutic recreation.
Also, trends like the global and generational workforce *The term “therapeutic recreation service” is used
are challenging managers to introduce new intangible for ease of readership and is intended to be inclusive of
and tangible motivational features to the work the terms “recreational therapy” and “recreation therapy.”
environment.
Four chapters comprise Section 4 and focus on
service delivery: They include service accountability
(Chapter 13); risk, safety, security, and legal aspects
 Acknowledgments
Professionals who contributed to chapters in this edition
include:

M. Jean Keller, CTRS, University of North

Texas, Denton, Texas (Chapter 6)

Shane Pegg, Ph.D., University of Queensland,

St. Lucia Campus, Australia (Chapter 15)

Norma J. Stumbo, Ph.D., CTRS, President, Edu-

cation Associates, Normal, Illinois (Chapter 15)

Health and human service professionals and organiza-

tions that generously offered materials that have con-
tributed to this third edition include the following:

Craig Hospital, Englewood, Colorado,

Kenneth R. Hosack, M.A., Director of
Marketing and Public Relations

Fox Valley Special Recreation Association,

Aurora, Illinois, Carolyn Nagle, MPA, CTRS,
CPRP, Executive Director

Genesis Health System, Davenport, Iowa, Kelly

Sigler, M.S., CTRS, Lean Specialist

Howard County, Maryland, Susan L. Potts,

M.S., CTRS, Recreation Manager

National Council for Therapeutic Recreation

Certification, New City, New York, Bob Riley,
Ph.D., CTRS, Executive Director

Dr. Gerald S. O’Morrow conceived and was the primary

author of the first edition of Effective Management in
Therapeutic Recreation Service. With acknowledgment
of continued support from his family, we are honored
to have the opportunity to show our appreciation and
respect for his dedication to the profession through this
third edition.

Marcia Jean Carter

Christen G. Smith
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