TR Talk Show With Hawke Robinson
Episode 3 Transcript
Youtube.com autogenerated transcript:
welcome to the tiara talk show I'm your host Hawk Robinson and this is
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episode 3 of the therapeutic recreation slash recreation therapy talk show where
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we discuss all things related to recreation therapy music therapy neuroscience and research psychology and
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various adjunct modalities techniques theories assessment tools some of the
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political issues going on with the TR industry etc lobbying challenges
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certification licensing all of that and again once again just let you know we
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are looking for co-hosts and guests to be on this show
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we had hoped to have Danielle Whitworth on here today but she has been under the
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weather she and John Welker had both gone with me to this year's American
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therapeutic recreation Association conference in Reno Nevada and we each
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networked and met with various people had some wonderful experiences attended some great workshops and presentations
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and we talked a little bit about that from John's perspective last week he was here last week
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but Daniel hasn't quite recovered so we're hoping maybe next week we'll have her on the show to cover her side of the
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experience we also had a participant yesterday over at RPG research the 501 C
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3 non-profit research and human services organization studying the effects of all role play music and role-playing game
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formats and their potential helped improve lives a volunteer signed up there who was at atra and is joining as
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a volunteer over there and he gave some of his experience of the @r experience
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as a new student working towards the requirements for the CTS and certified
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therapeutic recreation specialist a certification the presentation we we did a all-day
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pre-conference workshop from 8 3 a.m. to 5 p.m. on bringing role-playing games
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first of all the awareness history myths research evidence-based practice and
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evidence-based information and evidence and practice information and the steps towards bringing role-playing games into
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a recreation therapists practice and had had fair attendance with that and some
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great interaction and it went well and then for the remaining days of the conference we were meeting with people
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conferencing we did the new the mentorship speed rounds etc so we were
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glad to be able to have that opportunity there we were down there with the wheelchair-accessible RPG trailer and RPG bus these are mobile facilities to
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provide therapeutic recreation activities music activities role-playing game activities etc in a comfortable
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controlled environment they're both prototypes of more idealized versions but they have worked we've used them for
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years to great effect across the country who've been driving them around the country with them this latest tour
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recovered 5 States last year we've covered eight states over the last two years we've covered around 20 states
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with these mobile facilities in addition to our local Northwest practice and such
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so again looking for guests and co-hosts particularly people CGR aces we spoke
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with a number of individuals from atra who seemed to be interested we just need
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to follow up with the conversations for getting them scheduled on here and I do hope to have guests on here fairly
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frequently at least one guest to show as we get them queued up you know we're all in episode 3 here takes a little bit to
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get momentum going but we're getting there word is spreading quite a bit more rapidly than I expected people are
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excited about this show existing as I had felt myself it fills a gap that's
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surprisingly there with the lack of a talk show to cover these topics and and
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this conference was yet another indicator as to how important I think the show will be for our profession
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again I had hoped that Danielle would be here to cover her atra experiences I'll give a little bit of a summary of mine
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and John's and then we're going to talk a little bit about assessment tools and
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some of my pet peeves about what's happening what happens in the TR
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industry which which I think others would know want to try to improve and change and we're gonna do in the context
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of love stuff we're doing over at RPG resource and normally TR talk-show we don't get into a whole other role-playing games stuff other than just
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these oblique mentions and again we welcome other guests and hosts to talk about other topics but this ties into
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the topic of assessment and assessment tools validity reliability inter-rater
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reliability etc so we'll get to that in a little bit so first to talk a little
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bit more about the ATRA experience some of it may be a little bit of a repeat of last week's show but I think there's
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other tidbits that have come up a discussion that you might have missed if you haven't caught the previous show go I do need to add links to it because
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until we get to a thousand views on our channel we can't have our own custom
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YouTube URL so for example youtube.com /tr talk show we can't do that till we get to about a thousand views so please
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do spread the word watch the videos it's best you can but TR talk show for now is
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where I'll post the links to each of the videos I just realized I didn't do that for the last episode so I need to take
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care of that right after the show I'll get all three of the episodes linked
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from the website I also want to let you know about an upcoming workshops so for
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those of you who couldn't attend the atra conference where you could get the CEUs first of all we did do three of the
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four sessions as webinars those will be available through the atra online website in a couple of months they said
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and those will be accredited for CEUs as well and they they're the first three of
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the four sessions session one was the history myths and research about role-playing games Session two was using
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role-playing games across the developmental lifecycle from Toddlers through senior adults then session three
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was the begin of covering a wide range of populations autism spectrum ADHD at-risk populations
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incarcerated populations brain injury deaf visually impaired muscular
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dystrophy cerebral palsy a whole wide range of populations and and there's that's actually more of a two-parter so
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we can only cover a portion of them in that session three and then session four we had covered professional more of the
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populations and then professional issues and we do not yet have a webinar for that but it sounds like they want to
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seduce some more so we will hopefully have that for you the future and that's the way for you to get some of your CEUs now those they do charge for because the
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CEUs they have to pay for and some of the editing they're doing and again
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there'll be a couple months oh we don't have control of those once we record them they they take care of it from there but also we have coming up because
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we have a lot of people asking for more training for those that couldn't attend now we're not able to give CEUs yet on
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our end we would love to do that but we're not quite where we can do that but we do have a ton of training we have
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nearly a hundred courses on bringing these kinds of programs between music programs and like drum circles and
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collaborative music programs as well as all sorts of role-playing games tabletop a live-action electronic so we have a
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workshop we're planning to do these workshops quarterly and so we have one scheduled tentatively at this point to
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pay upon attendance and I haven't quite announced it yet I'll be announcing it later tonight on the RPG therapy comm
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website in the news section on December 18th it's an all-day workshop from 9:00 a.m. to 6:00 p.m. there will be a lunch
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break in a dinner break we might move that a little later to 7 or 8 p.m. because of the breaks we're still
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nailing down that exact schedule it's around $500 without lunch provided so
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you'll get a break and there's places to eat nearby you can just go and get the food or for those who want it catered
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it'll be a little bit more we still have to work out the pricing it'll probably about you know 50 $100 more or something
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like that just depends on what the local catering will be and if anybody wants it right it might be everybody just decides
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to go take the break and go get food and that's fine for those who want to stay around and talk further during the lunch then
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that's a good reason to attend the catered version but that's about the price points about 500 ollars for an all-day workshop it
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covers the same material we covered at atra with a little more depth because we
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got a little bit more time to work with with the time line that we've set up so a few more sessions a little less rushed
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than we had to do with the atra conference but it will not have the CEUs at this point I'm not sure if there's a
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process and I'd love for anybody let us know that we can make our workshops accredited that's something we'll have
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to talk to the HR folks about I suspect at this point it can't be and you'll
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only be able to do that through the outro webinars or the conferences when we run those but but it will give you
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the training you need to get started on the pathway towards bringing role-playing games and music programs into your therapy preparation practice
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and it's a little bit broader it's not it's not TR only it's meant for all therapists and caretakers that want to
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bring those kinds of programs into their practice so that's coming up December 18th and if you're interested it'll be
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here in Spokane Washington we're also looking at doing web-based versions for those who can't make it to the state
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will probably do those staggered where we have quarterly the in-person workshop
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and then we'll have one that is remote so the next quarter would be a remote one and then in person then remote the
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remote one that's harder to do the hands-on programs so they will try to be
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as creative as possible but they won't be as much hands-on as the in-person
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workshops will be and so it would behoove you to do that and the price point will probably be about the same
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because the it still takes about the same time and such the workshops in
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person or at our offices so it doesn't cost us anything extra to do them there so letting you know about that so
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getting that aside talking about atra for those of you who couldn't attend and I've been emailed by many who really
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wished they could have and we're unable to do so by the way if you're watching the stream live remember in YouTube you
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can post a if you go to where you're seeing this video you can comment and
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chat real-time so I can answer any questions you might have real time in fact you know give me a moment here as
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well I need to have a crew to tweet this out so that people will actually know I
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don't know if I'm have to do it for another computer we've got to get this streamlined we've got everything running
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smoothly for RPG research in the studio but it's new to running RPG therapeutics
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and we don't have everything quite set up yet here so give me a moment like
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this is the joys of life without a crew to run it okay so here's my goal alive
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so anyway we were there we arrived at Friday and set up with the trailer and the boss and that's interesting if
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someone's still showing things happening then at the pepper mill in Reno and
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Saturday did the all-day workshop then Sunday attended many things Monday many
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things and then Tuesday I had to leave early with the bus Latrell actually what Monday night and then but John and
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Danielle remained behind to attend and meet with people during Sunday Monday lots of people came out to the bus and
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the trailer got to try out virtual reality and augmented reality equipment got to try out the computer based games
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they were able to try out the live-action role-playing and then I mostly the people were in the tabletop and then the electronic side and let's
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see here Oh doesn't like my browser of course so and that was that was great we
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even had one attendee who was fairly negative about role-playing games had bought into most of the negativity about it and said so upfront but by the end
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was participating in a role-playing game with Doctor Who in the bus and said that
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she believes she's going to be able to use that for a better connection with her daughter so her daughter apparently
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zindagi key things and such as how she phrased it and felt that that would give a better connection
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hmmm let me get to my actual channel here or so I'm gonna be tweeting about this so a tweet is twitter.com RPG
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therapeutics there's also RPG therapy and RPG therapists those are slightly different perspectives but I will be trying to
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spread the word on all of them so if you follow on there you'll be able to get announcements we'll try to get better about spreading the word in advance so
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that you know but just remember Tuesday's 1 p.m. to 2 p.m. is when we
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will be doing this show generally now we had to skip while we were at the
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conference and so I wanted to do some there at the conference but schedules every schedule just didn't work out so
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when we attend future conferences we'll see if we can range with the coordinators to have a set time in advance for doing a live show and
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potentially having an audience and everything we've done that with other organizations and other conferences so
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hopefully we can do that future atra and local regional ones so that we get it do some live streaming from the convention
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let's see sorry about having to do this
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on the air I should have thought of this before but we're still getting in the groove here alright and so that's at
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least on Twitter and I have to get it on the facebook those are the two main areas we've had people from Canada and
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throughout North America interested in what we're doing here and so it's great that people really want to
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see more of this and we're trying to address this accordingly we've got a
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number field who are asking about how to do training affordably and you can go
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join over at the nonprofit RPG research and as a volunteer and get free training we need to make sure you give back to
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the community you don't just take and it's usually about a year-long commitment of about three hours a week
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and you'll get a lot of training on a lot of the same topics it's a more
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dynamic environment the stuff we do tends to be more polished obviously but that is a place where people can do
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that let's see so met with president Machar I met with person doing webinars
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met with the president of Idol Arbor who does a lot of the publications he has
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interest in us doing some books and we were talking about assessment tools and I'm waiting for it to arrive they have a
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green book so there's the red book and we're still I'm still unpacking everything so I have it handy right now
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but the the red book that has all those wonderful assessment tools with their
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validity and reliability for some of them listed some with some pretty good
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data and some with others they're like yeah well that's better than nothing and then some that really don't have any validity or reliability information and
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we've gone through over the years about a year and a half a decade in half in practice and we really highlighted the
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ones that had good research versus the ones that are weak and none and we're shocked as we run into other
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recreational therapists and other professionals in general to see how few
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use well supported you know evidence
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supported empirical data about the efficacy of the tools that they're using
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like the different assessment tools whether for baselines or progress or exit etc it's a little disturbing a lot
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of them are in-house tools and you know as a profession we really want to be taken more seriously and part of that is
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using effective tools one of the areas that over an RPG research were working on trying to address because we've run
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through our own internal peer review is the activity assessment examples so yeah
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in the red book in the cook we're not the red book in the cookbook and several of the blue books from other people from
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idle Arbor and elsewhere they have and this is taught in the schools they're used as the examples and we have run
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into lots of recreational therapists who literally just take from the text book and create that as their own activity
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assessment form but there is no validity reliability there and I
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I've asked around and been trying to find a published activity analysis form
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that has undergone that level of scrutiny and so far nobody's been able
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to point me to anything that that really is there's lots of people saying oh we have our own internal we have our own internal has it been through any peer
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review no it is not ah so we've done some internal peer review of these different ones that are in the textbooks
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and what we found is the binary choices where it's a checkbox yes or no things
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like that those tend to hold up pretty well there they seem to be for the most part you know there's always a phrasing
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issue but for the most part they hold up on validity and reliability and interrater reliability and I'm gonna
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focus a little bit more right now on the inter rater reliability issue because
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for those of you who are in private practice or working in facility we're
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the only or the only therapist doing the work that might be less of an issue it's
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still a concern but it reduces one particular major confound to worry about
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and that is interpretation of what to the assessment tool means and what the
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results mean between different practitioners and that's the inner rater
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reliability issues so for example I've used for years my own versions of activity analysis tool and my pay my
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clients come in with existing medical data about their diagnosis and their function etc I do some additional
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functional assessments and so in a spreadsheet I get where their strengths and weaknesses are we establish what their
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goals are we said it's a program plan and in figuring out which is the bet which are the best activities from the
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large tool belt of activities available whether it's music role-playing games outdoor activities sports table crafts
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all you know all the wonderful tool belts that we as rec therapist develop over the years see what is gonna be the
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best match right which has the highest scoring from the activity analysis addressing the needs of this client and
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seeing where they mesh the best to be the most effective tool in the shortest amount of time whether we're talking
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about insurance or self pay or whatever is the situation and when it was only me
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before I had employees and such that seemed to work pretty well there's a
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combination of experience and intuition which is not good science but you know some professionals are just into it
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better than others and I would get good results and because I do baseline
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measurements of my clients when they come in they must complete assessments they must go through baselines if they
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haven't already been through baselines through other practitioners with tests that I recognize and that I wrote that I just think there's quality there like if
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it's just a general practitioner and we're doing dealing with an ADHD diagnosis I often will still refer the
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client to another location like neuro education to do the diagnosis in first
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especially if I do in a functional assessment and they're not showing up
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it's not fitting the pattern of ADHD I'm more likely to refer them to a
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facility that I know is very good at accurate diagnosis and assessment of all
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kinds of learning disabilities ADHD autism spectrum whole wide range and
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then I'll get back from them this detailed report or IQ all their areas and different you know their way as
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results all of this and now I can really put together a more effective program
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plan to meet their Knowles their goals as quickly as possible now neuro education for that type of assessment last I saw was about two
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thousand dollars spread out over several sessions depending upon their age and and what's being assessed that's not
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cheap insurance doesn't always pay for it it always depends so you need the GP to help with that referral process etc
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but unfortunately too many times GPS have diagnosed ADHD by just questioning the client and/or parents guardians and
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or schools and and not doing a more formal assessment at all and then giving them an ADHD diagnosis and wanting to do
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medication etc and the client comes because they're not having luck with the medication and hoping they can find
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another way to address the issues it's just one of many many examples so when
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it was just me when it was just my practice my assessment tool that was homemade worked pretty well for the most
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part it seemed to be fairly consistent at you it was usually giving me the right results etc where it really broke
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down is once I got employees so I as training employees and then now let's
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switch over to RPG research where we do research and we study and test these things we've got over over 80 volunteers
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across five continents four core plus continents four and five varies but we
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have about a dozen researchers ranging but from bachelor's to PhDs to post doctorate etc and we have gone through
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some of these assessment tools through an internal peer review and for example
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out of the cookbook and out of the blue books and such as I said the binary questions seem to hold up well the phrasing see people seem to interpret
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the same way and we get pretty consistent responses when I say for a drum circle activity is this X is this Y
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etc now if you want to see our detailed like we went through question by
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question and talked about where it broke down and where it held up that's over at RPG research so you go to youtube.com
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for slash RPG research and you'll find section there you have to search it's the YouTube makes a little difficult or
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ignore our page there patreon site at patreon.com for 10 star feeds research and join us a patron there and you get
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access a month earlier or more earlier but there are entire sessions of just
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going through the assessment tools line by line and seeing what held up and what
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and broke down in people's interpretations and why it breaks down is where we have the variant scales so
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some people like call them Likert scales but they're not quite there more graduated scales etc some are more
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Likert but those are really suffer when the questions are not phrased correctly
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or understanding what the scale is what is simple versus complex what is a lot
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of coordination of reverses very little coordination so we had people with the drum circles without understanding what
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was simple or complex was putting a 4 or 5 in high complexity for a drums for
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playing the drum versus a one or two my interpretation of it is it's a one or two to play a drum
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at the minimum we're talking the minimum basic level to participate even somebody
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with cerebral palsy muscular dystrophy brain injuries can you know unless they list it's very specific injuries can get
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at least some kind of beat you know if it's on the the the you know if you've
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got a four count and it's on one two three four nothing complicated or even
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just the initial down beat just one two three four one two three four we have as
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young as two and three-year-olds participants in those drum circles so in
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my experience which tends to be a lot more than my current employees and such so I'm looking for others who have more
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I always want to hire people who are better if possible that is not a lot of
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coordination to play at the minimum level to participate in a circle now solo that's a different story you
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need to do a lot more on your solo but when you're doing it in a circle everybody can be at their different levels and that works fine however both
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with my employees and then on the research side it was all over the place as far as what people interpreted for
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complexity and the only way to fix that was to set some examples of what as
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simple as complex and or change the phrasing and or change the scale and
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we've been playing around with different ways of doing that and so the problem is most of these and then you look at the newer assessments from the Blue Book's
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they don't even use a scale they just use blank lines to fill in the slots and that is all over the place so what
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happens with these assessment tools is inter-rater reliability completely falls apart and that is dangerous for your
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client you know some of these activities in themselves may not be harmful in any
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way but as far as wanting to make progress and what's what's most
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beneficial to them versus a complete waste of their time or completely going
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to alienate them maybe increase their frustration level too high this is a
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real problem not having some consistency and I'm seeing it across is not just laypersons and people from
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another pressure and it gets worse and worse the further you get which is not surprising you want to start with the core profession and then you go out from
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there like okay so if all the CTRs is who are of a generation and other training pretty much ants are the same
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that's a certain level of integrator reliability that's good we want to have that as a minimum then we go out to
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maybe a different generation a different level of CTRs training experience and we expect that it to goes from like 0.8
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correlation coefficient to maybe a point 7 or something but we're still okay
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we're not as good as we want to be our goal is to try to have everything point eight or higher is our standard
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generally we will allow the point six point seven range if there's no other choice we really don't like to use
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anything lower than a point six or we shore up the weaker parts of like if it's point eight point nine in most
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areas but it's got one area that's a point four point six or something then we might use an additional assessment
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tool for that area to shore up that section we've seen that with like the L
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RI and the Li M and things like that so
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the inner reliability of all of the assessment tools that are out there in the books that are being taught to all
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the students both from previous generation and the latest generation have not held up as we've done internal
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peer review and had different people will say here's an activity go through fill it out and then we'll discuss it after completely breaks down on either
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the blank spaces or the scales it is there you might as well flip a coin in
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fact yeah it's so bad so we've been undertaking an active project and it's
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spanning months already and it's probably going to take years but we are trying very hard to put together an
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activity analysis tool that gets to a point eight or better for all CTR s's
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you know of multiple generations that it's a point eight or better for CTR SS
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and that for related and adjunct care of
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professionals of physical therapy music therapists occupational therapist et cetera who are fairly close to that in
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the training that they're at least a point six are better and then as we get out farther from the
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circle of CTRs that were still like a point for better for other practitioners etc that's our goal with this assessment
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tool if we can get to that level we consider that a successful tool far
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better than what's there which at this point is you is basically other than the
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binary choices is completely random there is there is no it's bad and that
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exercise I've gone through the cookbook I've gone through the newer books and they do not hold up on the inner rate or
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liability at all they're not even a point to so this is very concerning
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because as I posted on the atra oklahoma state edu list about this months ago and a
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number people emailed me privately and such but they said yeah they're using
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these as guides for their tools and that's very very concerning because this is a foundational component of what we
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do as recreational therapists is our activity analysis are we using the right activities to meet the specific needs of
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a specific client or group so just you know I would love to hear people's feedback if you know of other resources
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I mean it's only been about I think four or six months that I've been really hammering on this and asking around
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so it's certainly in its infancy I keep hoping that somebody out there can point me to something that has undergone
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rigorous testing and does hold up at a point eight or better and I just and I
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would be because I don't want to reinvent the wheel I any chance to avoid reinventing the wheel so much the better
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but at the moment we haven't been able to find that now there's an adjunct to
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that which is more related to the role-playing game side where we want our activity analysis tool to include being
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able Turman which role playing game and which role-playing game format to use for the different populations so for
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those of you don't know about role-playing games tabletops and one most people aware of what dungeons dragons at the table with rolling dice then you have live-action which is the
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type where you see people with Foam swords or they just dress up in costume or they're going to do that but they're moving around and acting in some way as
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part of the roleplay and then you've got the electronic type Audio role-playing game computer-based role-playing games things
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like that world warcraft etc and then you get all these other hybrids which are crossovers between all of these in
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card games and board games and live-action electronic etc those are the four major formats and in the activity
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analysis we want to make sure that the information that's given to us includes because role-playing game is a very
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distinct modality that most people do not know and has some isms about it that
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none of the activity analysis forms include questions that help us determine what would be the the best system to use
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because there are different levels of complexity of systems different styles of play some are more action-oriented some or more social oriented some are
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more explorations somewhere puzzle-solving some are a nice mix and different clients are gonna have
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different play style preferences that's another assessment tool we're working we've aggregated all the existing play
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style assessment tools out there and we're trying to get it down to a condensed one and so that we can
34:33
actually determine what kind of play see if people who are explorers you have people who are problem solvers you
34:38
people who are socializers etc and we're trying to make sure we have that a
34:43
better in our because right now our current one has an aggregate of all the others is incredibly long we have to
34:49
have people do it in multiple sessions so they don't have too much cognitive fatigue so if you know if you're so most
34:57
rec therapist should be using some sort of activity analysis form in their practice whether a private practice or
35:04
in a facility if your facilities not doing that like they didn't at some point look at an activity and run it
35:10
through an activity analysis you need to do that and the question is what what is the tool you're using I would love to
35:15
see it if you're allowed to everybody can email me if you want to be on the show comment whatever RPG therapeutics
35:21
at gmail.com I'm working on one for the the TR talk show specifically but we're
35:27
still moving servers so for now just use RPG therapeutics at gmail.com and tell
35:34
me about your experiences with activity assessment tools and we're I mean we're
35:40
not talking task analysis yes we're talking about activity analysis right task analysis comes later in the process
35:47
that's really walking through every step and I use that all the time for training people and certification all of
35:53
that but we're talking at the higher level the activity analysis that foundational aspect upon which our
36:00
practice is built the tools I've seen so far they're all in the textbooks etc are
36:06
inherently terribly flawed and I'm really hoping there's something better out there so those of you who have far
36:12
more experience than I've been doing this about 15 years in TR and then other things you know over the decades in
36:17
nursing and habilitation therapy and computer science and neuroscience and psychology other years but in been in TR
36:25
over 15 years and so there's lots of you out there have far more experience than I do in TR I would really love to know
36:32
if you have what what tool you use where it was if you guys built it yourselves
36:37
if you found it published somewhere and what is was it peer reviewed at some
36:44
point it undergo tests for validity reliability inner rater all the different facets and what what were the
36:50
ratings for those if it didn't have you tried to do it internally at least at least have some sort of internal idea of
36:57
how useful it is if you didn't do that why are you using this tool I'd you know
37:03
because it just like everybody else has been well there's nothing else out there I got to make do with what there is but
37:09
if you're aware of one that has held up please tell me we would much rather use something that exists then have to start
37:15
from scratch but at the moment we were we're assuming until somebody tells us otherwise we've tried we searched and searched and
37:22
searched the databases and the websites we post it on the naturalist I asked all sorts of people at the atra conference
37:27
and nobody could give me an answer every every tool they mentioned we had already
37:33
is already in this list hopefully there's other tools that you know that you can point me to and we can take a
37:41
look at it and see if it solves this problem so but I do know about all these
37:47
therapists I talked to are using the ones that are based out of these books that you're not even really supposed to write they're just their teaching tools
37:53
they're not really what you're supposed to use in your practice but a lot of people seem to be using their practice and they don't hold up but if your
38:01
experience has been with that what did you even consider this were you were you aware of these concerns how
38:06
much when you went through your CTRs training how much because I but from my
38:11
experience the research side and understanding research side in the CTRs is pretty darn light you know compared
38:20
to other professions like research psychology neuroscience computer science cetera we had a lot of research experience and a lot of the tools so
38:30
definitely want to find out what the
38:36
best tools are out there for this profession and if it doesn't exist Wow
38:44
that would explain a lot of the grief we get from other professions who have more
38:49
robust tools so I hope that I hope it's
38:55
out there it would really love to know again I posted on the actual list some months ago nobody had a strong response
39:03
saying yes this is a great tool here's what we recommend not one and and you
39:08
know talking to all these people that is concerning this is again a fundamental
39:14
concern to our profession so would really appreciate your feedback on that
39:20
let's see how we're doing on time here ok we've got a little bit more they're still trying to get the word out to
39:26
people and again if you missed the live broadcast the recording I'll have the link right after the show added to the
39:32
TR talk-show calm things like let me
39:38
update that here if you miss the live broadcast check the talkshow website for
39:48
a link to their recorded episodes you
39:55
know and we're getting somewhere getting it to the different groups
40:04
and again would love to have folks on here I hope I'm talking to the president idle Arbor and such that maybe he'll be
40:10
willing to come in he seemed very fascinated by our efforts to to address
40:15
these assessment issues it was very excited that he was there I
40:20
have ordered the Green Book which is about building these assessment tools and the processes they have been used
40:27
but I went through and explained the process that we've used and he seemed
40:32
very happy with the approach we've been taking in trying to address this so you
40:39
know so that was encouraging from him with who created the red book and everything right they got a lot of
40:45
experience doing this in TR and so that was definitely encouraging and said the
40:52
green book should be arriving in a few days they don't they don't really have really expedited shipping but it'll be
40:58
here soon and we will go over it over the RPG research side and we'll also talk about it a little bit here on the
41:04
TR talk show as I said I'm still kind of unpacking from the tour so a lot of my
41:10
TR books aren't they're still in the trailer and the boss I got a few other things right now but as I get them back
41:16
on the Shelf here I'll be able to pull them and go over them and we will literally on this talk show from time to
41:22
time go right out of the textbooks and discuss some of these topics with with the specific examples we'll talk about
41:29
some of the assessment tools that we've been very happy with that we've seen have held up well under a peer review
41:36
and they already had good peer review to data we did some more peer review on our end and and they did continue to hold up
41:43
nicely with some populations that weren't tested in that particular sample we found that on it they still held up
41:50
or didn't but for the for the most part when they had a good scoring in the I de
41:56
Larbre book read book then it usually translated well into practice so that's
42:03
that's encouraging that their methodologies you know held up fairly well in practice let's see what was
42:12
another topic that somebody wanted to make sure we try to address so that's that's really focusing
42:17
on the assessment oh the the thread going around that was one of things as we were going to discuss threads I think we did last week talking about the a pie
42:23
a pied debate some of the upset about ACTRA unilaterally changing compared to
42:33
what's in the because they're there they're following the cart stuff but
42:39
there's some there's some upset on the list about using a pied versus a pie and
42:45
and I have often said a pie dar yes a pie is the core of the process
42:54
the DNR are just reminders because you see a lot of people who don't do it to
42:59
document and to re to redo to Aria value to re assess to replan to re-implement
43:07
to reevaluate and so when when we're training folks we we do a pie dr a pied
43:15
are a pie is the process DNR are reminders that you should be doing that through every step of the process but
43:23
there's some upset because they've been listening a straight a pie and that's creating some confusion for people and
43:29
and I can understand that our that argument and so I'm redoing some of our
43:37
training to reflect that more accurately where it'll say a pie and then in parentheses D slash R and then always
43:46
make sure we're illustrating that the a pie parts the process but document document document I can't tell how many
43:52
rec therapist we run into we ask to see the documentation they're not following any of you know whether it's antiquated
44:00
soap or any of the other newer formats there it's a little disturbing whether
44:06
they're younger it it's kind of interesting the very new ones will do
44:11
documentation but it's not always the most useful document they tend to document the wrong things sometimes and then the really experienced ones have
44:19
gotten I don't know lacy burned out what have you oh my god I've got the eye or
44:24
do you know then they'll use really cryptic notes sometimes and so it's kind of interesting it's kind of the middle the middle folk of
44:31
experience seem to do a better job on the documentation depending on the facility right there's a culture in
44:36
different facilities about documentation and some are better about that than
44:42
others where I'm a real because I come from the computer science neuroscience
44:47
research psychology background as well nursing and I did information security and physical security for a lot of years
44:53
where the logs will literally save you from jail and liability and lawsuits so
45:03
for example I used to do security for distressed properties so this this landowner guy who who he was a
45:10
contractor and he bought a duplex and their house and then he turned flipped it and he did a duplex and he flipped it
45:15
that he did a quad and he flipped it and by Italian enemies was 40s he's a multimillionaire from doing this kind of process and he
45:22
would buy now entire apartment complexes that were called distressed properties this meant that they were in rough shape
45:29
there and they were overrun with a lot of problematic tenants and that meant
45:36
they were cheap to buy and he got really good at judging which ones had good bones and could be improved for for a
45:42
minimal amount and those that would be a money pit and so I was living in a place
45:48
that he had already fixed up and such and I was doing security and then I was doing maintenance and then he started to
45:53
hire me to the other properties as he because they didn't even turn out and flip them sell them for a neat profit
45:59
and move on and then sometimes people who took over did a good job keeping it going and others let it descend he moved
46:06
on so he as this relationship developed over the years would buy a distressed
46:13
property move me into an apartment there and it would be roach infested and nasty
46:18
terrible neighborhood and there would be drug dealers and prostitutes and
46:23
gangbangers it was just oh my goodness it was a zoo and I'd have to do security
46:28
day and night wouldn't get a lot of sleep for about the first six months and I would log everything every time they
46:35
went in out of the door after 10 o'clock at night so monitoring traffic anybody
46:40
out in the parking lot every little thing that we could aggregate into the logs because it would create an overall
46:47
narrative overtime about if you will the health of that particular building that particular floor in that particular
46:53
apartment you could drill down through the logs and it was just literally just a little flip thing that I'd fill in the
46:58
notes and such and then aggregate those and by the end of six months had
47:04
typically evicted forty to sixty percent of the population as drug dealers prostitutes gangbangers etc because it
47:11
would be very dangerous and this made me unpopular my apartment gets shot up I'd have to move to another apartment oh man
47:18
this is why I was single and didn't have kids and it was a job and so and then it
47:28
would get better right once the troublemakers were out then we fixed the place up he'd replace all the furnaces
47:34
and all the locks so there all of a single key system all this and really make it a nice place he was not a slumlord
47:39
he really took slums and turned them to nice places and he wouldn't like crank up the rent he'd bring it up a little
47:45
bit to a little bit more market but but he would not jack up the rent really high and drive out those that were there
47:52
I never saw anybody leave because of the rent increases they were so happy to
47:59
have the place improve and still be close to say and he generally grandfathered people it'd be the new people that he might charge a higher
48:04
rent for that's how he had transition it the whole people that rent stayed the same generally so and they tend to be
48:12
very multicultural there are people from Vietnam and Colombia and just all over
48:20
the world and then often he had a section-8 building with a lot of people
48:25
back then it was M R now you know D di and such with developmental disabilities etc which you know after the place is
48:32
cleaned up that tended to be the place that I had got more calls as security and maintenance because they put a metal
48:38
cup in the microwave and tried to burn their apartment down things like that by accident so it still kept things a
48:43
little interesting but it was a lot safer so anyway the logging because a lot of these people like the drug
48:49
dealers and stuff some of them were making a lot of money and they had traffic going in and out
48:54
constantly it was 24/7 people going in and out and knocking on the door coming
49:00
in out of the parking lot etc so they're they're pretty easy to identify and deal with pretty quickly but they would
49:06
sometimes fight it some of them didn't care they just move to the next place where they wouldn't get harassed others would try to fight it and we would have
49:12
to go to court and the logs we never lost a single court contest because of
49:20
those logs and that was why he kept hiring me because he had other security guards who weren't as good at the
49:25
logging and they lot would lose some of the battles sometimes and we never lost one because of logging so let's bring
49:32
that back to tr and liability as well as safety so of course the first safety
49:37
thing now this is more for the students than the experienced er folks you guys all know this part but let you know
49:43
let's have this conversation and I welcome your comments and and again if if you think I'm what I'm saying is wrong I miss speaking please please
49:50
let's have a productive constructive conversation about where you think I'm going to miss I only have about 15 years
49:57
of TR experience and then I've got some additional years in nursing and
50:02
habilitation therapy and research and you know in some of these other fields
50:08
but in in TR you know there plenty of you who have far more experience and and
50:13
I and even those you were younger who just found other experiences let's let's have a conversation that's what this
50:19
whole show is about I'm starting I'm trying to start the momentum here with this monologue but I don't want it to
50:25
stay a monologue I want it to be a multiple person dialogue what we're
50:30
talking about these important topics so
50:35
let's see anything fun ok I'm still kind of spreading the word here well classed
50:42
few minutes of the show so with the with
50:48
the documenting and the logging and such big liability protection if you you know
50:54
and it could be to its sort if you document something that you did wrong well then that's evidence to be used
51:00
against you but it's better that you're better than trying to hide it and especially for if you're dealing with
51:06
where your clients have real health issues here in a rehab center and
51:11
such where there's significant health issues to worry about and people could you know brain injury Department and
51:17
such people can die if you don't document properly now those facilities typically have pretty good software and
51:24
policies to enforce it but even those I've seen some of the rec therapist be a bit lacks one of the challenges is that
51:31
they often will see several clients in a row excuse me before they then stop and
51:39
document and they don't do any of the logging as they go even to just a little
51:46
pen a pencil and paper a notebook or something so that they can keep their notes straight and I would be watching
51:52
over their shoulder and what do you know they sometimes conflated the the last
52:01
three patients they saw in their logs they either went oh I can't remember was that patient one or patient three I
52:07
can't remember I think it's this one or they would start right now in a way maybe that was patient number two that
52:14
wasn't patient one and this could have real serious effects it may not be a
52:19
medication thing but the activity so let's say they put them at level let's
52:24
say on a scale of one to ten you're trying to get them to at least a five and you put up at only two but really
52:30
they were at a four and they're getting near the end of their term they're in the facility or the program whatever it
52:35
is it now it looks like they went backwards from the last session maybe
52:40
you're handing off to different rec therapist maybe you're gone next week as a vacation or illness somebody else has
52:45
to handle it until whoa wait a minute they were going to three four now they're back to two what happened and
52:51
the clients can say I thought I was making progress I thought I was doing well I don't know why it was only a two
52:57
it's it's just so critical and and I was a little disturbed at how many
53:03
facilities I saw rec therapist be kind of blase about the documentation and this is this
53:09
is in every profession you see this everywhere there are people who are more on top of that than others so you know
53:17
one of the things I've always like to use is keep something a little handy I mean if you nowadays it's cell phones but the problem is
53:22
it often looks like you're texting and so right employers that others might be a little concerned about that
53:27
so I've fallen back to the old-fashioned flipped notebook with a pencil to keep
53:33
track of my quick notes if I'm not going to be able to go straight to and I've got back-to-back clients and I'm not
53:39
gonna be able to get didn't do my computer entry into the software right away I will do and you know I don't like
53:46
having to write I've got dysgraphia and everything it's painful to write but it's much better to do that because human memory is so fallible for
53:52
interference patterns it's really critical especially as we get busy and juggling all these things it we really
53:59
need to do that for our patient safety and then it's much easier to jog the memory go okay that was this client okay
54:05
let me put this in correctly etc and and I in some other trainees and sets that
54:12
have helped them do that they've really they've commented on how much it's improved not just the consistency of
54:20
them documenting but the accuracy that they because when they start to get fuzzy about who was who they'll they
54:26
they might err on the side of just leaving it out because they weren't sure and that doesn't serve the client or the
54:34
profession well either so these are some of the topics you know we're talking an assessment we're talking about
54:39
implementation here doing the programs monitoring how they're doing and keeping
54:46
track of the the information on how they're experiencing that and you know
54:52
another time we'll talk about the plan of Phase II and when we talk about the activity analysis you know that's part of the planning phase but we've got all
54:58
that documentation and then after you do it right we go through the assessment go through the planning and go through the implementation we got to evaluate how
55:05
they did do the exit plan their transitions how we did is for facilitators etc now I go back through
55:10
and redock you meant each step we need to go through and reevaluate eto reappraise how our sesamum tools are I
55:17
just talked about how our activity analysis tools in the industry as far as
55:22
I can find are really lacking well now now we know that how do we go back through and reevaluate that what tools
55:30
were using how we're using them to improve that and then we have to then go through and see how that changes our plans and then
55:37
we have to see how that's gonna change our actual implementations with those clients and then we've got to see how that with the exit evaluations and such
55:44
and how you have to train people and you have to evaluate how they did in their training and so it's all iterative
55:49
coming from computer software development of it's 40 years now had
55:55
been doing it I've been involved with software development on and often for 40 years it is an iterative process the in
56:02
computer tech we'd I really ride hard on the developers to actually document and they're terrible about it
56:08
they might comment their code unfortunately more experienced ones get really lazy about it and say it's in the
56:13
code just read the code no no no no no minimum minimum is commenting the code
56:19
but that is not documentation exporting it with Java Docs or Python Doc's don't like that is not proper documentation
56:25
you know unless you write really good comments and there are some developers who do but you need to comment and write
56:32
the documentation explaining what you're doing how things should work while they're working not working with the API
56:37
etc with that class call that method etc same thing with what we do into our
56:43
practice it's great to have our little short notes we need them to jog your
56:48
memory our software may limit what we can do our time may limit but have have
56:54
those short notes and then find a way to allocate the time the end of the day if you have to to go through those short
57:00
notes and turn them into a more comprehensive narrative the narratives as long as it's written properly reduces
57:07
some of the confusion right because sometimes we fall into abbreviations you know and the industry standards of
57:12
abbreviations have changed over the decades so that gets confusing and do everybody
57:18
a favor of the client especially but the facility and this is a liability thing right if we don't document it opens us
57:25
up to liabilities so much more you know then if we do we we can point to go well
57:31
this documentation said this this and this anybody else it creates an audit trail we can figure out who is screwing
57:37
up and so maybe those people don't want to document because it does make them accountable but that's critical that we
57:42
do that for our professor don't you think so I hope this has been useful for bringing up some topics that
57:49
that you may or may not have had time to stop and think about since you were in
57:54
school or maybe you are in school right now and weren't aware of some of these professional issues I hope it is a seed
58:02
for conversation with your peers with your professors with your facilitators with your trainees your interns and I
58:11
really hope you will contact me so we can have further conversations about this feel free to just post on the YouTube comments of course I'll get
58:17
notified and be able to respond or email our PG therapeutics at gmail.com and
58:23
again we're looking for co-hosts CTRs co-hosts and special guests I'd like to
58:30
have a special guest every episode I haven't racked people up yet I've had John on here last week Danielle can make
58:36
this week well hopefully next week she'll be feeling well enough and she can at least remote in if not in person
58:41
and you can do it remotely you can be on the show where you are you don't have to come to Spokane to be on the show we use
58:49
something called jitsi which is an open source encrypted web web conferencing tool and we're actually we have our own
58:57
HIPAA compliant servers and such so that when we use client work with clients in the EU and elsewhere we've got it all
59:02
encrypted and we control the servers so we're not getting the third party cloud issues and all that complexity we
59:08
control the servers or so that's the advantage of my having a tech background is I'm able to have my own infrastructure which solves a lot of
59:13
HIPAA issues and my information security certification back craft and tweet audits so that's helped a lot for us to
59:20
have a very expensive infrastructure inexpensively but anyway we used jitsi
59:26
it's JIT si there is a Android phone app I don't know if it's available for iPhone or not check it out let me know
59:32
and you what you want to do if you use that is unless you're on Wi-Fi if you're
59:38
in video mode it will consume a lot of your cell phone bandwidth so use it on
59:44
Wi-Fi or switch it there's a button as as audio only mode but that's how you can join our conversations if you want
59:50
you can always just chat real-time during the broadcast Tuesdays 1 to 2 p.m. Pacific time
59:56
YouTube has when you go there there should be a little chat thing that you can chat in or you can comment on the
1:00:02
recorded videos or if you want you'll be able to join on well we'll use the
1:00:08
public ones for now for the show at meet JIT si /t our talk show so m ee t dot
1:00:17
JIT si /t our talk show and I'm not gonna put a password on that yet and
1:00:24
only if we get a problem with somebody abusing it and being inappropriate then I'll have to put a password on it and we'll have to go through more security
1:00:31
processes but in the future if you want to be able to join the conversation even
1:00:36
not even a say is a formal guest just as an audience member who wants to comment if you'd rather not type and you'd
1:00:42
rather be able to voice and have a conversation through jitsi will be able to do that so let me let me go ahead and
1:00:48
before we wrap up the show here and before I go off to all the other client
1:00:53
stuff and interviews and stuff I have to go do for people let me go ahead and update this to have that info for the
1:01:03
future because I kind of forgot about it myself let's see so well we can just do
1:01:12
well you don't really need to type that first part there but just in case people
1:01:18
want to know and hear talk show alright
1:01:24
so that is a public it's still encrypted but it's public it's not password protected or anything so I hope people
1:01:31
will not abuse it I hope everybody that joins and watches this is the commensurate professional and we won't
1:01:38
have any problems if it becomes a problem I'll have to lock down access to the channel or use our own servers and
1:01:44
then we'll have to go through an email process to give you that password I hope it doesn't come to that we've been able to run the RPG research public jitsi for
1:01:52
years and we've never had anybody abuse it but we'll see what happens so that is the URL it's a little clunky
1:02:00
I'll get that added to the website as well so that in the future you'll be able to jump on there during the live
1:02:05
show if you want and comment directly that way so I look forward to your questions and comments
1:02:11
if you have topics you would like me to bring up on future shows please post
1:02:18
what topics you would like to hear us discuss I'm willing to cover pretty much if it has a new TR and RT or you know I
1:02:27
also bring in neuroscience and research psychology and compassion focus therapy and and nursing other backgrounds into
1:02:34
the conversation but if it's about TR R T in any aspect please post what topics
1:02:41
you'd like to hear mention discussed more and let's let's turn this into an
1:02:46
active community so I hope you found this useful I will be working also on
1:02:52
making these available as podcasts just the audio I probably have such a busy
1:02:57
schedule I probably don't have time to edit any of these as much as I'd love to have a better edited video and audio I'm
1:03:04
just gonna dump them straight to audio and we'll start putting them into podcast feeds once we get enough
1:03:09
episodes and the queue here but meanwhile I'll just go to TR talk-show calm and I'll have links right after the show I will quickly add a link to this
1:03:15
particular all three episodes and you'll be able to go through those and again thank you for joining and happy rec
1:03:24
therapy wherever you may be be well
Cleaned up transcript (pending):....