A Model That Works:
Linking the Hospital and the Local Recreation Agency

By Bonnie Laudick, RTR
John McGovern, MTRS
Susan Cosgrove

A linking of services, a joining of staffs, and a true community-based treatment approach have been employed to benefit two special groups in West Suburban Chicago.

Riveredge Hospital, a 204-bed private psychiatric hospital in Forest Park, and the West Suburban Special Recreation Association (WSSRA), an extension of the parks and recreation programs of Berwyn, Oak Park, and River Forest, began a shared services program in early 1980. It began as an effort to better serve the adolescent patients of Riveredge through progressive reintegration and leisure skills development. Forty-seven adolescents from the WSSRA catchment area had been hospitalized at Riveredge for short term acute episodes in 1979. Both Riveredge Hospital and WSSRA were committed to better linkages between community-based programs and clinical treatment facilities. Riveredge felt the need for increased access to facilities and services in the community. WSSRA agreed to provide them.

The principals involved in the formation and implementation of the program were Bonnie Laudick, RTR, Director of Activity Therapy at Riveredge Hospital, and John McGovern, MTRS, Director of WSSRA. They met in December, 1979, to identify the program possibilities and develop a viable working proposal. Ms. Laudick and Mr. McGovern developed four options for implementation. They were as follows:

1. Sharing of Common Facilities - This alternative involved providing the Riveredge groups with access to community facilities for their own use, i.e., recreation centers, park district facilities and schools. The use of these facilities would be contingent upon availability. Community groups were also invited to use Riveredge facilities also contingent upon availability.

2. Riveredge Participation in WSSRA Activities -This involved groups of Riveredge patients and staff participating in WSSRA activities under the direction of WSSRA staff. This enabled both groups to become familiar with each other and place WSSRA staff in a supervisory role with Riveredge patients, facilitated by Riveredge staff.

3. Near Discharge Options - This option involved Riveredge patients nearing discharge participating in the WSSRA activities as a volunteer recreation aide. Programs selected would be generally sports oriented, yet others such as drama could be chosen. It was believed that the best potential to increase the patients' self-esteem, increase WSSRA volunteer numbers, and expand awareness for the Riveredge patient of community options available for creative use of free time would all be derived from this program option. Riveredge assumed all transportation responsibilities and WSSRA staff provided pre-service training on the disabilities of the community participants in the activity.

4. Post Discharge Participation - This step involved Riveredge patients who participated successfully

BONNIE LAUDICK, RTR, (L) is the Director of Activity Therapy at Riveredge Hospital. Her department recently was awarded the Illinois Therapeutic Recreation Society 1980 Outstanding Program Award for Illinois. Ms. Laudick received her degree in Recrecreation from Indiana University.
JOHN McCOVERN, MTRS, is currently the Director of West Suburban Special Recreation Association, which provides services to the western suburbs of Chicago. He received his B.A. and M.A. from the University of New Mexico in Albuquerque while working for the Parks and Recreation Department prior to his move to Illinois in 1979.
SUSAN COSGROVE (R) is the Director of Public Relations at Riveredge Hospital. She assisted in the preparation, writing and editing of this article, as well as publicizing public relations/communications assistance in the program. She received her B.S. in Journalism from Northern Illinois University.

Illinois Parks and Recreation 4 July/August 1981

Getting acquainted is a good first step.

in Option 3. Observations by WSSRA staff on the volunteer's performance would be available to Riveredge staff when requested. This was seen as a key step, as it actually re-integrated discharged patients into community-based programs without hospital supervision.

In January, 1980, a pilot program was developed by Ms. Laudick and Mr. McGovern. It served to further clarify and refine the implementation of the program. A program with a high degree of potential success needed to be the initial step, and the Special Olympics Swimming Program for the mentally retarded was the choice. The Special Olympics was chosen as it required a higher concentration of volunteers, and also placed the Riveredge patients in a setting with visibly handicapped individuals. As the swim allowed for use of existent patient skills, it maximized the potential for increased self esteem for the selected volunteers.

The Riveredge patients selected had experience and expertise in swimming programs. A well-defined set of objectives and tasks were outlined for them by the WSSRA staff. For this program, Riveredge sent three adolescents, one staff member, and a therapeutic recreation field work student. The WSSRA staff led the activity and supervised the patients in their role as volunteers. The Riveredge staff acted as role models as well as monitoring the behavior of the patients.

The program ran for eight weeks. During that time, significant gains were made by both the patients and the participants. The increased one-to-one instruction helped the participants learn new swimming skills, improve physical endurance and increase their understanding of the rules of competition. Due to their roles as volunteers, the patients were able to develop an increased sense of responsibility, to realize they had the ability to help others, and to experience volunteerism as a viable leisure alternative.

There were numerous problems encountered in administering the program. The basic need of the WSSRA program was to have qualified volunteers on a regular basis. Being a short-term inpatient psychiatric hospital, Riveredge discharges adolescents after an average of ninety days. Those patients clearly identified as volunteer possibilities were frequently nearing discharge. Therefore, there was a problem of maintaining qualified volunteers in the necessary numbers for the duration of the program. Also, special behavior problems occasionally necessitated the discontinuation of a patient's participation in the program.

Turnover in volunteers affected the community participants as they often grew to depend on the volunteer. The loss of volunteers who had grown into responsible roles tended to interfere with program continuity. To deal with these problems, a system of alternative volunteers was established to insure adequate numbers of trained volunteers being available to the WSSRA program. As in the original selection process, WSSRA staff interviewed the alternative volunteers prior to placement in the program.

Another area of concern involved gaining the recognition of the Riveredge clinical staff that the program was a necessary and beneficial program for patients. Obviously the support of all staff was imperative to successful use of the activity as a treatment model. Closer involvement of the attending physician improved accuracy in determining anticipated discharge dates, the establishment of the program as a clinical priority, and full support of the hospital administration all helped in resolving problems related to maintaining an adequate number of appropriate patient volunteers.

Still another problem was the community acceptance of Riveredge patients being placed as volunteers.

A bit of discussion before the plunge.

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This lack of acceptance often resulted from a lack of understanding about mental illness and specifically treatment received at Riveredge Hospital. This was resolved by a series of visits by the Activity Therapy staff to WSSRA parent meetings. The WSSRA Board of Directors visited Riveredge Hospital where tours of the facility were conducted by staff and the patients who were also volunteers in the WSSRA program. This effort assisted in alleviating the anxiety and misunderstanding of psychiatric treatment commonly perceived by the community at large.

Confidentiality is always an issue in a psychiatric setting. The necessity in maintaining a patient's right to privacy and the sometimes conflicting goals to be fully integrated in a community-based program, posed several problems. WSSRA traditionally provided names of volunteers to local newspapers as a method of recognition for their efforts. In these instances, the Riveredge patients were listed by name along with all other volunteers, but with no mention of their association with Riveredge Hospital. This helped to avoid segregating them from the peer group. Thus, they could benefit from the increased self-esteem accruing from appropriate due recognition while still maintaining their right to privacy.

For purposes of obtaining liability insurance, WSSRA requires complete volunteer applications which posed the same question of confidentiality. Patient volunteers were requested to complete the application utilizing their home address and personal data with no mention of hospitalization at Riveredge.

Following the success of the pilot program, the cooperative venture grew to include participation in two additional WSSRA programs. One was the bowling program for mentally retarded youth. The other was a Special Olympics Track and Field Program. The same model was used for these programs and few problems were encountered.

From these initial model programs, the cooperative efforts between WSSRA and Riveredge ventured into a new area. An eight week, four times per week, co-ed summer day camp program utilizing volunteers from all three adolescent units at Riveredge, was developed.

The Riveredge volunteers provided staff support and development of special skills with the WSSRA participants. Along with this ambitious program was the addition of a dance therapy component provided by the Riveredge Dance Therapist. WSSRA contracted with Riveredge for this service which also included the training of Riveredge patients to work as teacher's aides in the Dance Therapy Program. The patients benefited tremendously from this opportunity. Their self-esteem, group cooperation level, and dance therapy and teaching skills improved throughout this program. The addition of dance therapy aides allowed the therapist to focus her efforts on the participants needing individual attention. The participants developed self-expression through movement and increased body awareness as a result of the dance therapy component.

The future direction of the WSSRA/Riveredge Hospital cooperative programming includes: additional contracting for specialized services; exchange of staffs to increase mutual understanding of hospital and community settings; the establishment and measurement of specific program objectives; an increase in the network to include hospitalized adult patients; establishment of an ongoing education inservice program open to other agencies, and the production of a communication network designed to increase understanding of all disabling conditions to facilitate reintegration and ultimate acceptance of handicappers by the community at large.

The obvious benefits of these programs were clear from their beginning but it is the more subtle, or indirect benefits, which help make these programs extremely worthwhile. The participants, staffs, organizations and families of those having contact with these programs benefited beyond the improved development that was targeted. Improved understanding and increased recognition of the needs and capabilities of everyone involved, and a sense of successful shared effort are ongoing outcomes of this project.

We are hopeful of building upon this successful program in a way that will ultimately include not only the individuals and agencies already involved—but the public at large as well.

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