Discharge and Referral

By Mari Pat Schager, CTRS

THERE HAVE BEEN many discussions on the differences and similarities of Clinical and Community Therapeutic Recreation settings. Frankly, these discussions will continue; each setting will continue to address their list of priorities and purpose for being. While this may be essential for professional recreators within their services, we need to be aware of the effect it has on the profession as a whole

In a service area that encompasses a variety of competitors other than degree and certified recreational

therapists, we must become united in our commitment to provide quality therapeutic recreation. We must coordinate our efforts to develop a strong system of leisure mainstreaming, specialized programs, community reintegration and education.

Professionals are constantly seeking ways in which they can monitor their efforts at providing the services their patients, participants or clients are needing. The Illinois Therapeutic Recreation Section (ITRS) has a contribution: The Therapeutic Recreation Discharge/Referral Process standards and guidelines

This reference can help unite the skills of community and clinical therapists in a working, successful relationship. Establishing supportive working relationships is important for the setting, but more important for the patient, participant or client involved.

The Discharge and Referral Committee, revived in 1988, has rejuvenated and revised this resource for the purpose of professional unity, quality assurance and monitoring the needs of our populations. The committee encourages participation from all therapeutic recreators. Currently 85 community and clinical settings have decided to evaluate, through implementation, this process/procedure. By utilizing it, settings can monitor successful referral, participation, follow up, and/or population recreational needs. Quality assurance is essential to community and clinical settings for the justification of their services. These standards and guidelines are a step in the right direction. They can enhance the communication of therapists in various settings, improve the system of therapeutic recreation services and keep professionals abreast of new trends and needs.

Our committee encourages you to contact Mari Pat Schager, CTRS, Hinsdale Hospital, 708/887-4177 or Laura Dunne, CTRS, Northeast Dupage Special Recreation Association, 708/530-5400 for any comments, questions or concerns pertaining to the discharge and referral process. We strongly suggest implementing this system within your setting and join other progressive professionals within the state of Illinois. Currently, we are developing a research project with Illinois State University to verify the impact of Discharge and Referral.

Monitoring the Process

In November 1988 a revision of the Discharge and Referral Process was distributed to 26 community sites, 55 clinical sites, and 10 universities/colleges for a trial period of one year. The following information is based upon a 6 month telephone survey, conducted by committee members, to monitor the use of this process and its forms.

Community

Of 26 sites, 20 reported to be familiar with the revised forms and have implemented their use. Of the remaining 6, 5 were unfamiliar with the process, 1 never responded to the survey.

Clinical

The results of overall status of the 55 clinical sites surveyed follow:

a. 17 agencies stated they did not receive the process mailing, new mailings were sent.

b. 1 agency no longer exists.

c. 1 agency has eliminated the position of C.T.R.S.

d. 8 agencies believe these standards do not apply, due to a lack of programming or the population does not require services.

1 psych setting

2 chemical dependence settings

2 long term care facilities

2 no S.R.A.'s for area

1 C.T.R.S. not responsible to

Refer.

e. 2 stated confidentiality issues both psych settings, but are retaining forms and working through issues.

f. 16 are actively using the system total of 29 referrals since November '88.

g. 7 agencies are confused as to process use.

2 state psych setting are difficult to apply because of no specific community program

4 state SRA's do not address their population's needs

1 generally confused

h. 2 unable to reach, phone calls not returned.

i. 1 awaiting approval from medical records.

Form Feedback

1. Statement of Participation and Confidentiality

Community — 20 sites utilized this form to arrange new contacts with clinical sites. Form was sufficient.

Clinical — response from all clinical sites using the process agreed the form was sufficient.

2. Referral Form

Community — Majority of community sites stated they had not been receiving the revised referral forms from clinical sites. Many community sites stated clinical symbols and language to be confusing and needed to contact the clinical sites for clarification. The addition of diagnosis, discharge date and the detailed leisure interest summary was beneficial. Referrals were being received for out-of-district clients.

Clinical — 8 agencies stated they required additional facility forms for lack of "release of information" included on the form itself. It is difficult for clinical sites when there is not an agency for referral, or potential SRA referral is out of district.

3. Follow-up form

Community — Majority of sites were not using the form because they used their internal documentation procedures/practices within their agencies. If feedback was provided to clinical sites, it was usually by phone. Follow up procedures were by: a. Contact by phone b. Added referral to mailing list c. Arranged home visits.

Clinical — 9 sites stated the forms are not being returned. Clinical sites need feed back for Quality Assurance tracking. Psychiatric needs for 1:1's or group levels are not being met per 5 agencies.

4. Chart

Community — Tracking being utilized.

Clinical — Utilizing to monitor referrals and program justification. No changes indicated.

Additional Comments

Community

A. Identified the need for referred clients to be more familiar with Special Recreation Opportunities. It was felt referred clients were unaware they would be contacted by community staff.

B. Community sites offered few, if any, programs for youths and adults needing psychiatric services. Many sites received referrals for this population but were unable to form a cohesive group to establish a program. Populations' lack of follow through and low motivation made it difficult for community agencies to service them. The alternative was to provide these individuals with volunteer experiences.

Clinical

Discharge and Referral Committee should offer inservices for problem solving when community programs are unavailable.

Recommendations

Community Sites

1. Return follow up forms.

2. Assist in placing individuals in community if they can not provide

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Discharge and Referral — Quality Assurance
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programs.

3. Research feasibility for individual programming, i.e., psychiatric, chemical dependents. Because of short hospital stays, leisure education and leisure skills are not fully developed.

Clinical Sites:

1. Utilize the committee to assist in problems.

2. Incorporate follow up forms and chart in quality assurance reports.

3. Reinforce the need for community sites to send back follow up forms.

4. Incorporate education of community resources in leisure education classes.

5.This process is not restricted to Special Recreation Associations.

Since this telephone survey, the Discharge and Referral Committee has:

1. Added a release of information clause on the Referral form.

2. Provided special services to those agencies who have indicated the need.

3. Contacted Illinois State University to assist in the evaluation of this process.

By providing the results of this six month survey, we hope to keep all the participating agencies abreast of current issues addressing this committee. As our profession continues to grow in both Certified Therapist and high professional expectations, it is our responsibility to improve accountability of our services as well as continue to be an effective and efficient component of the community and health care system. The ITRS Discharge and Referral Process is assisting our profession in addressing these responsibilities.

ABOUT THE AUTHOR: Man Pat Schager, CTRS, is Therapeutic Recreation Coordinator for Hinsdale Hospital and is Co-Chairperson of the Discharge and Referral Committee.