Sharlene Jacob Evans

U0912662
October 22, 2014

Program development
Facility Description
I.

II.

Facility: VA Salt Lake City Health Care System

A.
Healthcare based, providing both inpatient and outpatient services.
B.
Exclusively serves returning service members, homeless veterans, and women
veterans
Mission Vision and Values
A.
Mission
1.
Our mission is "to serve the veteran who served us". The VA Salt Lake
City Health Care System is committed to providing our patients with the highest
Quality of Care in an environment that is safe. We do this by focusing on
Continuous Process Improvement and by supporting a Culture of Safety.
B.
Vision
1.
To provide veterans the world-class benefits and services they have earned
- and to do so by adhering to the highest standards of compassion, commitment,
excellence, professionalism, integrity, accountability, and stewardship.
C.
Values
1.
VA embraces "Core Values" for all of our employees. We need values in
place as the "backbone" for our health care system. These five core values
(I.C.A.R.E.) are
2.
Integrity: Act with high moral principle. Adhere to
the highest professional standards. Maintain the
trust and confidence of all with whom I engage
3.
Commitment: Work diligently to serve Veterans and
other beneficiaries. Be driven by an earnest belief in
VAs mission. Fulfill my individual responsibilities and
organizational responsibilities.
4.
Advocacy: Be truly Veteran-centric by identifying, fully considering, and
appropriately
advancing the interests of Veterans and other beneficiaries
5.
Respect: Treat all those I serve and with whom I work with dignity and
respect. Show respect
to earn it
6.
Excellence: Strive for the highest quality and continuous improvement.
Be thoughtful
and decisive in leadership, accountable for my actions, willing to admit
mistakes, and rigorous in correcting them.

III.

IV.

V.

Populations served
A.
Diagnoses
1.
Cognitive: PTSD, substance abuse, domestic and sexual abuse, TBI, and
all other mental illnesses
2.
Physical: Any diagnoses in need of rehabilitation or physical medicine,
spinal cord injury, hearing, speech, language, voice, and swallowing disorders,
and aging.
B.
Age range
1.
Ages range from 18 and up to geriatrics
C.
Gender
1.
The VA salt lake center health care offers services to both males and
females, however there is a Women Veterans Program specifically for female
veterans.
D.
Other social and environmental considerations
1.
Homeless veterans/ risk of losing home
2.
unemployed
Facility description
A.
The VA Salt Lake City Health Care system is one of the many facilities within the
US Department of Veterans Affairs organization. This facility serves the purpose of
being both an inpatient treatment facility as well as an outpatient center providing various
clinical services to veterans and their families. The VA offers specific treatment for
homeless veterans, and women veterans. These services include: readjustment
counseling, mental health services, dental and emergency services. Both men and women
may receive MST (Military Sexual Trauma) and PTSD (Post Traumatic Stress Disorder)
counseling.
B.
The facility also has a Post Deployment Integrated Care clinic for veterans that
have recently returned. This clinic is responsible for offering referrals to any specialty
care needed, addressing readjustment issues, including problems with sleep, anger
management, relationships, and stress.
C.
The facility offers a long term care program for geriatric patients called Medical
Foster Home Program. They also offer outpatient rehabilitation services and have a
center specifically for geriatric patients called GRECC (Geriatric Research, Education
and Clinical Center). Their purpose is to conduct research and educate providers in order
to improve the quality of care for aging veterans.
Services offered.
A.
Professional
1.
M.D.- Doctor of Medicine
2.
PT- Physical Therapist
3.
Speech Therapist
4.
Nursing- profession used to protect, promote, and optimize health.
5.
TRS/CTRS- Therapeutic Recreation Specialist/Certified Therapeutic
Recreation Specialist
6.
LCSW- Licensed Clinical Social Worker

B.

7.
DDS/DMD- Doctor of Dental Surgery/ Doctor of Dental Medicine
8.
OT- Occupational Therapist
9.
Psychologist- Specializes in the study of the mind and behaviors for the
use of mental health.
10.
Dietitian- Professional that is trained in maintaining healthy diet and
nutrition
Treatment
1.
Dental, emergency care, audiology/speech pathology, recreation therapy,
Long term care, mental health treatments, physical therapy and rehabilitation,
occupational therapy.

S. Evans TRS, CTRS

Diagnostic Protocol
I.

Diagnostic grouping
A.
Spinal cord injury
1.
Damage to any part of the spinal cord or nerves at the end of the spinal
canal. This often results in permanent changes to the functions of the body that
include strength and sensation.

II.

Specific diagnoses
A.
Spinal cord injuries vary in regards to where the injury to the spine is.
B.
Areas of the spine
1.
Cervical (C1-7)
2.
Thoracic (T1-12)
3.
Lumbar (L1-5)
4.
Sacral (sacrum-located within the pelvis)
5.
Coccygeal (coccyx-located within the pelvis)
C.
Types and Classifications
1.
Complete spinal cord injury: No function below the level of injury
a)
Complete tetraplegia or quadriplegia
b)
Complete paraplegia
2.
Incomplete spinal cord injury: Some function below the level of injury
a)
Anterior cord Syndrome
b)
Central Cord Syndrome
c)
Posterior Cord Syndrome
d)
Brown-Sequard Syndrome
e)
Cauda Equina Lesion
f)
Triplegia

III.

Identified problems
A.
Social
1.
Isolation
2.
Sexual dysfunction
3.
Limited adaptive leisure education
B.
Emotional
1.
Depression
2.
Anxiety
C.
Cognitive
1.
Deficit in informational processing speed
2.
Memory processing

D.

E.

F.

IV.

V.

Physical
1.
Incognizance
2.
Muscle loss/loss of movement
3.
Pain sensations
4.
Loss of overall physical fitness
Environmental
1.
Attitudinal barriers or lack of social support
2.
Transportation barriers
3.
Inaccessible equipment and environmental barriers within the community
Related factors or etiologies

1.
PTSD
2.
Depression
4.
TBI
5.
Anxiety
6.
Amputation
7.
Employment issues
Process criteria
A.
Adaptive leisure education program
B.
Self-awareness classes
C.
Adaptive sports
D.
Mobility skills groups
E.
Strength training
F.
Self-care programs
G.
Socialization skills groups
H.
Coping skills
I.
Communication skills groups
Outcome criteria (client will)
A.
Social
1.
Build a list of at least three resources within the community.
2.
Increase in social confidence and interaction as well as the development of
interpersonal skills.
3.
Gain greater leisure motivation through enhancing social leisure
experiences.
B.
Emotional
1.
Develop a greater sense of self-worth and increased self-esteem.
2.
Demonstrate development or increased use of stress coping skills coupled
with lowered anxiety and depression.
3.
Show improved autonomy and independence in daily activities.
Reveal an increase in self-awareness/ self-determination

C.

Cognitive
1.
Demonstrate an increase processing skills
2.
Be able to show Improvement in overall memory functioning
Participate in programs that will enhance concentration and problem-solving skills

D.

E.

Physical
1.
Show Improvement in physical coordination during leisure activities and
while performing daily tasks.
2.
Be able to maintain or increase strength and mobility.
3.
Improve overall physical fitness strength and endurance.
Environmental
1.
Build a sustainable network social connectedness with peers.
2.
Experience increased opportunities for community engagement and
empowerment
3.
Increased knowledge of adaptive resources within the community.
4.
Increased access to and knowledge of adaptive equipment resources.

Sources
-

Johns Hopkins Medicine. (2014). Spinal Cord Injury | Johns Hopkins Medicine Health Library.
Retrieved from
http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/physical_medicine_and_rehabil
itation/spinal_cord_injury_85,P01180/
Types of Spinal Cord Injury. (2014). Retrieved from http://www.brainandspinalcord.org/spinalcord-injuries/index.html
UAB School of Medicine. (2005). UAB - Spinal Cord Injury Model System - Secondary
Conditions of SCI Health Education Video Series. Retrieved from
http://www.uab.edu/medicine/sci/uab-scims-information/secondary-conditions-of-sci-healtheducation-video-series
Veterans Administration. (July 16). Spinal Cord Injury & Disorders Home. Retrieved from
http://www.sci.va.gov/

S. Evans TRS, CRTS

Intervention Protocol
I.

Program Title
A.
Adaptive Leisure Education Program
II.
Purpose
A.
The program will increase overall well-being by providing adaptive leisure
programs that enhance leisure knowledge and socialization, alleviates stress and anxiety
that affect well-being, and improve muscle tone, muscle movement, and overall physical
fitness.
III.
Description
A.
The adaptive leisure education program will offer a variety of adaptive sport,
leisure, and recreation approaches and activities that are appropriate for the needs and
interests of the SCI population. Some of these activities include:
B.
Community integration programming and working to connect patients with local
and national leisure resources.
C.
Learning new leisure skills (e.g., leatherwork, fly fishing, creative arts, equine
therapy, wheelchair sports, water exercises, etc.)
D.
Group activities that promote social interaction and encourage peer support
E.
Adaptive techniques, strategies and equipment needed to fully engage in leisure
pursuits.
IV.
Problems to address
A.
Social
1.
Isolation
2.
Limited adaptive leisure education
B.
Emotional
1.
Depression
2.
Anxiety
C.
Physical
1.
Muscle loss/ loss of movement
2.
Pain sensation
3.
Loss of overall physical fitness
V.
Referral criteria
A.
Self-referrals
B.
MD referrals (ex. Hospital referrals)
C.
Other professional referrals such as OT and PT
D.
Referral from another treatment program (ex. One VA clinic to another)
VI.
Counter-indicated criteria
A.
An applicant does not meet the diagnostic criteria
B.
A person with a disability requiring one-on-one attention.
C.
Any person not yet able to function independently within a group setting.
VII. Intervention
VIII. Risk Management
A.
Keep inventory of sharp objects used during programs

IX.

X.

B.
Use safety devices for transporting clients
C.
Staff to patient ratio 1:5
D.
Maintenance of any program equipment
Staff Certifications and Training
A.
Four recreational Therapists that Have either a TRS or MTRS and hold a current
CTRS
B.
First aid/ CPR/ lifesaving
C.
Equine therapy certification (EAGALA)
D.
Aquatic therapy certification (WSI)
E.
Training on proper use of wheelchairs and other adaptive devices.
F.
Drivers Licenses
Outcomes (Client Will)
A.
Social
1.
Build a list of at least three resources within the community.
2.
Increase in social confidence and interaction as well as the development of
interpersonal skills.
3.
Gain greater leisure motivation through enhancing social leisure
experiences
B.
Emotional
1.
Develop a greater sense of self-worth and increased self-esteem.
2.
Demonstrate development or increased use of stress coping skills coupled with
lowered anxiety and depression.
3.
Show improved autonomy and independence in daily activities.
4.
Reveal an increase in self-awareness/ self-determination.
C.
Cognitive
1.
Demonstrate an increase processing skills
2.
Be able to show Improvement in overall memory functioning
3.
Participate in programs that will enhance concentration and problem-solving
skills.
D.
Physical

E.

1.
Show Improvement in physical coordination during leisure activities and
while performing daily tasks.
2.
Be able to maintain or increase strength and mobility.
3.
Improve overall physical fitness strength and endurance.
Environmental
1.
Build a sustainable network social connectedness with peers.
2.
Experience increased opportunities for community engagement and
empowerment
3.
Increased knowledge of adaptive resources within the community.
4.
Increased access to and knowledge of adaptive equipment resources.

XI.

Evaluation
A.
Pre and post experience assessment tools
B.
Patient satisfaction
C.
Evaluate patient physical, emotional, and social goals using:
1.
Standardized testing
2.
Observation
3.
Review of patients record
4.
Personal interviews
S. Evans TRS, CTRS

Research Article Review

Buffering the Effects of Stress On Well-being Among Individuals With Spinal Cord Injury: A Potential
Role For Exercise

The article covers in detail a study conducted with in the population of people with a
traumatic Spinal Cord Injury (SCI). The purpose of the study was to determine whether exercise
reduces the effects of stress on a persons overall well-being, specifically, how exercise reduces
stress among the SCI population. The study was conducted within a nine month period in which
the effects of a six month long exercise program consisting was observed. The exercise program
was comprised of 23 participants with traumatic SCI.
The study was set up with the Leisure and Health model being a main theoretical
underpinning. According the model, the stress buffering effects of leisure are due to the social
support and perceptions of self-determination afforded by leisure participation (Latimer, Martin
Ginis, Hicks pg. 136). With this model in mind, the study consisted of two groups; an exercise
group and a control group. The exercise group consisted of twice-weekly aerobic and strength
based training in a group setting with peers. Additionally each participant was provided with a
personal trainer. The control group, was instructed to continue their daily routine without any
exercise.
Assessments were given at the zero, three and six month points of the program to
determine the correlation between exercise, stress and depression as well as exercise, stress and
quality of life. Three assessment tools were used for the purpose of observing changes in
wellbeing, stress, and quality of life. Stress was measured using the PSS (Perceived Stress
Scale), while well-being was measured using the CES-D (Centre for Epidemiological Studies
Depression scale). Finally quality of life was assessed using the PQOL (Perceived Quality Of
Life) scale. Results at the end of the study showed that while the control group showed a
consistently significant relationship between stress and well-being throughout the study, the
exercise group showed no significant associations between stress and well-being by the 6 month
assessments.
One limitation discussed in the article is the small sample size of the population that was
studied. The article warns healthcare providers to be cautious in applying the findings of this
study to the general and larger SCI population. A result of this study consisting of a small sample
size is the statistical power that it has is weakened. The article suggests that in order to improve
future studies, a hierarchal regression process may prove more effective in exploring the
relationship between stress and well-being than the cross-sectional data that was used for this
study.
In spite of limitations, the data from the study serves to support the Leisure and Health
Model from a theoretical standpoint. The study provides an example of the role exercise plays in
maintaining physical and mental health. Finally, the data supports the role of exercise in
buffering the effects of stress on well-being and emphasizes the importance of exercise in the
SCI population.

Sources
-

Latimer, A., Martin Ginis, K., & Hicks, A. (n.d.). Buffering the Effects of Stress on Well-Being
Among Individuals with Spinal Cord Injury: A Potential Role for Exercise. Therapeutic Recreation
Journal, 39(2).