Running head: COMPREHENSIVE PROGRAM PLAN

Comprehensive Program Plan

Surfside Behavioral Center
Aaron Pierre, Allyson Rodriguez, and Ryan Schultz
Florida International University

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Abstract

The Comprehensive Program Plan (CPP) for Surfside Behavioral Center (SBC) provides a
detailed look at the facilitys environment and structure, with an emphasis on the Therapeutic
Recreation (TR) department, as it relates to its clientele of children and adolescents with
behavioral disorders. This document currently holds only Section I (the Analysis) of the CPP,
which expands upon the surrounding community, the agency itself, the TR department, the
clients, and the TR profession as facets that all contribute to the potential programs provided for
successful intervention. Such programs will be discussed within Section II (the
Conceptualization, Investigation, and Determination) of the CPP, demonstrating how therapeutic
recreation options reflect the nature of the clients needs, the staff available, the facilities and
resources provided, and the environmental factors that can either bolster or hinder the likelihood
of certain activity programs. The objective of the CPP is to present a clear picture for how the
TR department (and, subsequently, the entire SBC) is aimed at providing the highest quality of
care for every client.

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Table of Contents
Abstract

Analysis

The Community
4
The Agency
6
The Therapeutic Recreation Department13
The Clients
21
The Therapeutic Recreation Profession 27
References..31
Appendices 34

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Comprehensive Program Plan: Section I Analysis

The Comprehensive Program Plan provides a Therapeutic Recreation Program Planning
Model for guiding all of Surfside Behavioral Centers efforts in fostering effective program
production, implementation, and evaluation. This first stage in that process, the analysis, is
meant to provide the background information necessary to write the mission statement and
program goals in the conceptualization stage (Stumbo & Peterson, 2009, p. 111).

The Community
Surfside Behavioral Center (SBC) is situated on the east coast of the town of Surfside,
which resides in the Miami-Dade County of Florida. The serene atmosphere, low population
numbers, and beach access inspired the SBC to establish its agency here.
Demographics
The majority of Surfsides residents are Hispanic or Caucasian, with over 80 percent of
the population being over the age of 18 (Population and Housing Narrative Profile, 2011). As
the facilities in SBC serve clients from the ages of 5-17, this allows the full range of
developmental stages and ages to be addressed from the middle adolescence. In terms of ethnic
backgrounds, SBC is an all-inclusive facility that welcomes people of all races, cultures, and
religious affiliations. Appendix A provides some brief statistics that include ethnicity and
educational-level percentages,
Geography

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The geography of Surfside, the community setting in which SBCs clients receive their
treatment, is located in a tropical climate. Situated right on the beach, this town features a warm
and humid environment. In the summer, Surfside reaches highs in the low 90s, which make its
beachy shoreline an invaluable opportunity that the clients have access to for reward-based
leisure trips. The flat landscape and close proximity to the beach make most water-based
activities virtually accessible. Surfside beach features soft sand, ample tress which provides
much-needed areas of shade, and gentle waves that provide all participants with a calming
environment.
Seasonal Variables
As mentioned earlier, the town of Surfside exhibits seasonal variables that are associated
with that of a tropical climate. For much of the year, clients enjoy warm and sunny weather when
engaging in outdoor activities at SBC. However, through much of the summer and early fall,
there tends to be a common occurrence of rain showers, occasionally accompanied by thunder
and lightning.

In addition, Surfsides coast is vulnerable to the inclement weather that is

typically associated with the hurricane season. In most cases, this hurricane season lasts from
June 1st to November 30th, and features storms varying in size and intensity (Beach
Information, n.d.). Due to the fairly predictable nature of hurricanes, necessary preparation and
precautions can be made to ensure the safety of all clients and staff/personnel. There are also
resources in place to help residents and visitors to prepare and learn more about these storms
such as the hurricane guides, instructional hurricane materials, and evacuation information.
However, in the cases of the more serious threats, a backup facility must always be ready to be
used in category 3 or higher hurricanes (Flood and Hurricane Preparedness Information, 2012).
Economic Conditions

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The economic conditions in Surfside feature an environment that is very tourism-based.

Despite its small size, the town holds many shopping centers, beachfront apartments, and
beautiful architecture which decorate the area. Its beachfront locale has made it an ideal
destination for out-of-towners and tourists alike. In terms of actual residents, only about 60
percent of the housing and apartment complexes are inhabited. Surfside has a population in
which over 1 in every ten people was living below the poverty line. The per capita for Surfside
residents averages at just over $38,000 (Population and Housing Narrative Profile, 2011).
Availability of Resources and Services
Transportation is readily available throughout Surfside; many bus options are featured, as
well as taxis. There are shuttlebus options from all of the major destinations within the area, and
a regular schedule can be found on the towns website (Miami-Dade Transit Trackers, 2012).
The fact that the town is only a square mile in land area also makes Surfside very traversable.
Surfside also features a public parks and recreation center, which SBC has previously
coordinated group functions with. Located within just two minutes walking distance from the
beach is a community pool and water play area that serves as a key area for leisure activities that
the clients engage in during reward-based trips. Between the beach and the pool, there is also a
field which would serve as the grounds for another area of recreation for the clients, should
SBCs soccer field prove too small for certain program functions. Ultimately, the beach serves as
the prized leisure area for SBCs clients, in which they can engage in multiple forms of
therapeutic recreation.

The Agency
Description

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Surfside Behavioral Center is a residential treatment center where children and

adolescent clients are treated for a variety of behavioral disorders as well as substance use
disorders. This facility caters to a population that ranges in ages from early childhood to late
adolescence (ages 5-17). The treated disorders include bipolar disorder, depression, personality
disorder traits, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder
(ADHD), anxiety disorder, post-traumatic stress disorder (PSTD), oppositional defiant disorder,
conduct disorder, intermittent explosive disorder, cerebral dysrhythmia, and impulsive control
disorder, as well as the aforementioned substance use disorders.
Currently, SBCs residential facilities are capable of serving up to 100 clients. Upon
admittance, clients are placed within a unit that (aside from the youngest unit) is determined by
both the age and gender of the client; this leads to a total of five different units hosting 20 beds
each. The youngest unit, the Coral unit, consists of both boys and girls between the ages of 5-9.
The next set of units, structured for children aged 9 through 13-years-old, begins to divide by
gender; the Nile unit houses boys within that age range, while the Amazon unit houses girls of
that same age group. Lastly, the Pacific and Atlantic units serve boys and girls respectively
between the ages of 14-17.
Agency History
As Florida as a whole gradually paid more attention to the mental and emotional wellbeing of its own youth, there came a clear need for more treatment facilities aimed at attending to
the disorders and behavioral issues that were becoming more and more prevalent within children
and adolescents. A comprehensive residential treatment facility was planned for the small town
of Surfside, enlisting the aid of teaching professionals, psychiatrists, therapists, nurses, and
counselors to provide clients with the best possible care. As a result, SBC was officially created

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in 1992, built on the ideology that a beachside facility would be inherently therapeutic for all
clients, offering a unique avenue of therapy which to this day has proven highly effective when
coupled with the teaching of emotional management strategies, regular counseling, and
professional psychiatric help.
Originally, SBC could only accommodate up to 30 clients, all of whom were adolescents
between the ages of 12-17. This allowed for a small and very personal community-like feel
between the clients and the personnel. However, as demand for the services that SBC provided
increased, and the supply of space and resources became stretched thin, changes had to be made
to keep up with the increasing call for these offerings. As a result, in 2000, SBC was renovated
and expanded to its current state and capacity, which made it possible for this residential agency
to accommodate up to 100 clients, all while providing them with up-to-date technology as well
as a more modern and aesthetically-pleasing facility. Regardless of the structural changes, SBC
was, and is, still solely committed to the betterment of the clients and, by extension, the
betterment of the community; this commitment remains evident in the way that operations are
carried out at the facility daily.
Agency, Mission, and Vision
The goal of SBC is to positively impact the life of every client by helping them to foster
healthy emotional and behavioral management techniques, promoting positive behaviors, and
integrating them safely into the community by building appropriate social skills. These sub-goals
guide the facility in its daily operations as well as lay the groundwork for SBCs persistent
mission and vision.
The mission of SBC is to encourage and develop personal growth within each and every
client through the practices and treatments offered at this residential site.

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As a treatment center, this facilitys vision is to stimulate steady and significant client
improvement throughout the course of treatment, with the end goal of them leaving the facility as
a higher-functioning member of society.
Regulatory Bodies
The organization within SBC is split into multiple departments. Each department not only
plays a role in the daily lives of the clients that are a part of SBC, but they are also instrumental
in their social, emotional, and psychological growth. These departments are the charter school,
the medical/therapeutic department, building and grounds maintenance, and the administrative
department. Each of these sections is staffed with employees that are fully licensed, wellexperienced, and have a passion for working with and bettering the youth.
SBC has full accreditation and also holds itself to the highest professional, medical, and
ethical standards. To start off, the facility itself is accredited by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) and the Commission on Accreditation of
Rehabilitation (CARF) in order to assure that the standards of care, professionalism and ethics
are met in every interaction that occurs between clients and professionals. In addition to this, all
staff within the facility are fully competent and licensed (see Appendix B) in order to give clients
the best possible treatment as well as experience at SBC.
Organizational Chart
All operations within SBC are managed by the Chief Executive Officer, who coordinates
with the Executive Assistant that serves as the next-in-command. From this apex, SBCs staff
are divided into the four departments touched on previously the business administration
department, the medical/therapeutic department, the charter school, and the building and grounds
maintenance. Each of these individual departments is managed by a respective director (or

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superintendent, in the case of SBCs charter school). In particular, the Therapeutic Recreation
(TR) department of SBC can be seen in Appendix C under the medical/therapeutic department,
which is overseen by the medical director.
Agency Resources: Staff
The business administration department of SBC is comprised of individuals (e.g.
directors, coordinators, secretaries) who manage the daily financial, legal, and organizational
operations of the facility, which include maintaining all of SBCs finances (e.g. program budgets,
department salaries), managing medical and insurance records, and overseeing the training and
regulatory compliance of all staff members. In other words, the business administration
department works behind the scenes to ensure that all other aspects of the center run smoothly.
The medical/therapeutic department of SBC focuses solely on managing client behavioral
issues as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSMV), such as
depression, post-traumatic stress disorder, or oppositional defiant disorder. This department is led
by a medical director and contains four separate areas of medical and therapeutic treatment
nursing, therapeutic recreation, psychiatry, and psychology in order to ensure that clients
receive a variety of contributive care that includes proper medication, individualized counseling,
group therapy sessions, diet management, functional interventions, and leisure education. As a
unit, the staff strives to promote social growth and progress in its clients, as well as reinforce
positive behaviors to replace negative or ineffective behaviors that may be in use by the clients.
This interdisciplinary core team includes psychiatrists certified by the American Board of
Psychiatry and Neurology, Florida Board Registered Psychologists with a specialization in
clinical and counseling psychology, Florida Board Registered psychiatric nurses, counselors who
hold a masters degree in substance abuse and rehabilitation counseling, licensed Florida Board

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Family Therapists and nutritionists certified by the Certification Board for Nutrition Specialists.
The members of this team collaborate in developing a diagnostic evaluation and treatment plan
for the patient, utilizing their particular skills, competencies, and perspectives. SBC also has
youth care counselors (YCC), who may be unlicensed but are under the direct and continuous
supervision of a fully professional staff member trained in one of the core disciplines described
of our core team. The TR department, high-lighted in Appendix C, will be expounded upon later
in particular.
Since the clients of this facility are all school-aged, the charter school at SBC is also a
key component of what the overall mission aims for, enabling clients to have the same learning
opportunities as their peers so that they are not deprived the same rights and privileges of other
children their age. The superintendent manages the four different sub-units within the charter
school; these consist of the schools administration, supportive staff (e.g. cafeteria workers), the
upper-level block (consisting of grades 6-12), and the lower-level block (grades K-5). All
teachers within the upper and lower-level blocks coordinate with a core team of counselors and
psychologists in order to tailor the curriculum to the needs and strengths of the students.
Lastly, while the other departments focus on maintaining SBCs infrastructure in
providing quality client care, the building and grounds maintenance department mainly focuses
on keeping the entire facility running smoothly in its operations, mainly regarding the physical
structures and components. Led by the director of operations, this department accomplishes
several jobs on a daily or as-needed basis depending on the immediacy of the issue whether it
involves lawn care, electrical work, or sustaining fire code regulations. This department includes
custodians, risk management, grounds management, information technology department (IT

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department), event and labor services, and operations services management (Building
Operations Group, n.d.).
Facilities
The distribution of each discipline is always likely to change within a behavioral health
center contingent on the volume of patients as well discipline to patient ratio. According to
Robiner, [theoretically,] estimates of demand must consider cost-effectiveness: Balancing the
clinical needs of the population served with the unique knowledge domains and skill sets of
practitioners of each discipline while factoring in their respective costs (Robiner, p. 617). In
short, SBC is consistently aware of client numbers and ratios, willing to temporarily re-purpose
certain buildings to suit any of a number of possible needs. Should the demand for client intake
become too high, SBC may have to either begin an expansion project where possible, or consider
creating a sister behavioral health center within another county in Florida.
Since SBC functions as a residential unit for children and adolescents with behavioral
disorders, it must come with enough components to build and reinforce as normal of an
atmosphere and daily life as possible, without seeming like a hospital facility. The five
specialized residential units (Coral, Nile, Amazon, Pacific, and Atlantic) run on consistent
schedules that include meals, regular school hours, leisure time, and even chores. Each of these
units are housed in physically separate buildings arranged by age level in order to ensure
separation with safety and focus in mind.
Surrounded by these five units, the medical and therapeutic staff hold their offices and
clinics in one common building that is virtually equidistant from each of the client residencies.
This ensures that staff are always nearby to assist with any sudden injuries, outbursts, medication
issues, or behaviors that are needing immediate counseling or treatment. Near the residential

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areas, SBCs charter school currently holds twelve classrooms, a cafeteria room, an
administrative office, and an outdoor pavilion and playground for recess. There are some
facilities that are either shared with or used exclusively by the TR department, and will be
discussed later.
The business administration as well as building and grounds maintenance teams reside in
an entirely separate building away from the residencies, medical building, school, and associated
activity facilities. Here, incoming clients and their parents or legal guardians can meet with staff
members that double as tour guides, receive information about insurance coverage and SBCs
policies, and become admitted into the care of SBC. This administration side of the building
houses seventeen offices, two copy rooms, two board rooms, a front lobby, a mailroom, a supply
office. Regarding the maintenance team, their section holds five offices as well a built-in supply
and tool shed.
Budget
Each fiscal year, a budget is drafted that takes into account the salaries of all employees,
insurance needed to keep the Surfside Behavioral Center running, as well as the expenses of
operations such as electricity and water. These expenses are all covered through funds that are
provided by payment for the services rendered to the clients, either through private payers or as
part of a third-party reimbursement. Appendix D shows a draft of SBCs anticipated budget
expenses for the upcoming year.

The Therapeutic Recreation Department

As a component of the Miami-Dade Parks and Recreation and Open Spaces Department,
SBCs Therapeutic Recreation (TR) departments mission is to offer quality recreational

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programs that provide opportunities for individuals with behavioral disorders to participate and
socialize in a multitude of inclusive, non-threatening activities. Its goal is to empower and
educate children and adolescents with supportive coping skills that enable them to freely pursue
and participate in positive leisure activities of their choice within their community.
Surfside Behavioral Centers TR department was officially created in 1994,
approximately two years after the main facility was established. Originally using therapeutic
recreation as an integrated component of the school curriculum for the Pacific, Atlantic, Nile,
and Amazon units, the department was eventually advised to move activity programs to afterschool hours in order to focus more on TR as a separate therapy modality. Once the Coral unit
was introduced to Surfside, the TR department reincorporated therapeutic activity programs
solely into the Coral units school days in order to accommodate their earlier bedtimes and lower
levels of energy, given that time is also allotted for recess.
Staff: Number of TR Staff/ Skills, Abilities, and Credentials
Within the medical/therapeutic component of SBC, the therapeutic recreation department
is led by a TR Program Director, who holds a masters degree in recreational therapy, is certified
by the National Council for Therapeutic Recreation Certification (NCTRC), and is a member of
the American Therapeutic Recreation Association (ATRA) (see Appendix E). The Program
Director oversees the functions and budgets of the three full-time TR specialists and five parttime TR assistants, each of whom has a bachelors degree in recreational therapy. However, TR
specialists have at least three years of experience working in the field professionally and are also
licensed CTRSs, whereas TR assistants are recommended to have completed at least two
semesters of internship as part of an accredited program before beginning their employment at
SBC.

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Currently, one TR specialist is assigned to each of the three age-group levels -- one
serving the Coral unit, one for both the Nile and Amazon units, and one for the Pacific and
Atlantic units. Within each unit, the TR specialist plans age-appropriate activities depending on
each groups overall needs and attitudes, gathers resources, prepares and proposes budgets for
future program activities, supervises interns, coordinates with facility schedules to make sure no
groups interfere with other agency operations, assesses incoming clients for their leisure
interests, and conducts group sessions (see Appendix F). The TR assistants can assist with any
of the daily unit programs as needed by the department, but there must always be two present onsite during normal operating hours; one TR assistant present must only assist with the Coral unit
on the day of their shift, while the other assistant may float between the Nile/Amazon and
Pacific/Amazon as an aid to the respective TR specialists during the allotted times for therapeutic
recreation. As noted in Appendix G, when TR volunteers are present, TR assistants will oversee
their respective tasks for the day.
Likelihood of Increasing TR Staff
If there appears to be a need for SBC to expand in order to accommodate more clients,
there is a possibility that the TR department could likewise expand. Instead of having one TR
specialist working with both the Nile and Amazon units and one specialist for both the Pacific
and Atlantic units, the units would have to be split up even further, leading to one TR specialist
per individual unit (e.g. one for Nile and one for Amazon, rather than one serving both). Only
one TR specialist would be needed to serve the Coral Unit, since the boys and girls participate
together in group activities, but a second TR assistant would be employed to assist with the
higher client numbers.
Contract Services Used

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While the TR Program Director continues to research new and various modalities for
contract services, there are a few baseline services that SBC has employed in the past to give
clients a variety of therapeutic experiences. Drum Magic, which involves a drum instructor
leading groups of young clients in rhythmic drumming activities, has a Miami base that provides
over fifty drums for use during sessions that occur at SBC once every two to three months. Bit
By Bit, an equine therapy center approximately 70-minutes from SBC, has offered hour-long
therapeutic riding sessions to small groups of clients (chosen and approved by both the TR
specialist and the appropriate medical staff) that could benefit from these up-close experiences.
One of the most popular contract services with the Coral Unit has been the Everglades
Encounter program provided by Jungle Islands Jungle Outreach, which comes to SBC and
gives clients the opportunity to see, touch, and learn about various reptiles and mammals native
to Florida in an engaging and safe presentation.
Volunteer Services and Guidelines
Volunteer opportunities are available at SBC in multiple areas, but the TR department
could especially use an extra pair of hands here and there, if the volunteer is willing to commit to
at least five four-hour blocks of time per month. In order to maintain the safety and
confidentiality of SBCs clients and their families, any volunteers who wish to provide their time
and talents must first go through a background check (e.g. criminal record, fingerprinting) and a
3-day orientation process that will instruct them on providing the most effective client care
possible within the limited scope of their position. The SBC requires that all volunteers must be
at least 18-years-old upon the first day of orientation, be in good health as well as up-to-date on
immunizations, and have a high school diploma at minimum. Volunteering in the TR department
can include a plethora of assistive jobs, including overseeing Family Day events, basic

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grounds-keeping for the soccer field, leading pre-planned activities for clients on unit
restrictions, chaperoning on field trips, and acting as hall monitors. See Appendix H for
extended information on volunteer expectations.
Student Internships and Guidelines
Local college students who are majoring in recreational therapy can be accepted as
interns in the TR department under the NCTRCs professional eligibility process, with a
maximum of one intern per age group (e.g. one for the Coral unit, one for both the Nile and
Amazon units) for a total of three interns on the premises during any given semester (see
Appendix I). All prospective interns must go through the same screening process as volunteers
would, adding the additional requirement of site approval by the lead administrator of the
colleges recreational therapy education department. Interns will work directly under the
designated units TR specialist in learning about the entire therapeutic recreation process from
start to finish. These students will shadow the specialists during leisure intake assessments,
client observations, activity planning, group sessions, post-group evaluations, and
documentation. Internships require at least 300 hours within a four-month semester period
(January-April, May-August, or September-December); previous SBC interns may not intern at
the same facility a second time. This policy is meant to maximize their potential for learning
from other agencies that might offer a different category of clientele.
Facilities: Facilities Exclusive for TR Department Use
Within the SBC grounds, there are some locations that will be used solely for the TR
departments use. While the Coral unit uses art as part of their school curriculum in its own
classroom space, the TR department has a separate art room to be used as a therapeutic modality
for the Nile, Amazon, Pacific, and Atlantic groups. There are twenty-four seats divided around

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four tables, as only one group is allowed to be in the art room at a time. This art room for the
older kids contains the supplies needed for various methods of creative expression, including
watercolor paints and canvases, sand art, soft-tipped pens for calligraphy, clay for sculpting, and
materials for collage-making.
The TR department also utilizes a fitness center separate from the gymnasium, which is
accessible to the Pacific and Atlantic groups based on a behavioral-reward system. Currently, the
fitness center houses three treadmills, one elliptical machine, two full-body strength training
machines, and one bicycle machine. Away from the machines, there is also a space with a fullwall mirror that can be used for stretching, yoga (five yoga mats are available), floor aerobics, or
ball exercises (two 75-cm exercise balls are available).
The sand volleyball court is another facility used only by the TR department. All units
have a chance to learn this fun outdoor sport here, which makes it an optimal leisure activity for
such a warm, coastal city. Due to the nature of the court, it cannot be converted into any other
type of facility space, unless to be used for a sport with a similar set-up (e.g. badminton).
Other Areas to be Converted or Shared
Throughout the school week, the Coral unit has recess time that takes place on a
playground as well as a full-length soccer field that runs adjacent to it. This same soccer field
can be used by the TR department for recreational activities like ultimate frisbee during nonrecess hours. Nearby, there is also a concrete court with an overhang to provide shade during the
hotter days of the year. While Coral clients can use this court for recess as well, the TR
department can still conduct outdoor group sessions here during the summer season.
Connected to the SBC school is a combination gymnasium and auditorium. While
serving primarily as a full-length basketball court, this site can also be used by the TR

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department as a potential indoor location in the event of rainy weather. Rain or shine, a TR
specialist can still conduct activities here that include variations of wiffleball, and dodgeball.
Within the gymnasiums storage shed, there are 200 stackable chairs that can be organized for
observing Family Day presentations, conducting group therapy sessions, or even to
occasionally watch a movie on a projector screen as a group reward. During special events or
weekends, two ping-pong tables can also be retrieved from the storage shed (along with eight
paddles and six balls), as well as a cart of basketballs for leisure use.
Equipment and Supplies Exclusively for TR Department Use
Given the Coral units time allotment for recess during the school day, sometimes certain
TR supplies and equipment can be used by these younger clients, whether they are outdoors on
the soccer field or inside the gymnasium (e.g. soccer balls, basketballs). However, some of these
recreational materials are meant to only serve a purpose designated by the TR specialists. While
the aforementioned fitness center and art room for the older units have been covered, there are
still some certain supplies reserved specifically for TR activities that include double-dutch ropes,
a BigMouth 12-foot beach ball, wiffleball bats and balls, kickballs, a 12-foot rainbow
parachute, and frisbees.
Transportation Services
The TR department has full access to three 14-passenger vans that can be used to
transport single units (e.g. the entire Amazon unit) to special events in the northern Miami area
such as equine therapy via Bit By Bit, or the ropes course offered at the nearby Biscayne Bay
campus of Florida International University. During each excursion, each van is driven by a TR
specialist or TR assistant with a valid Florida drivers license. No volunteers, interns, or clients
will ever be asked to assume the driver role.

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Budget
The TR departments budget comes from a percentage of allocated funds that SBC
acquires from both private payers and third-party reimbursements. As of 2014, the TR
department receives 7.6% of the agencys overall income, which generates revenue from the
current client fee of $700 per day per client. The departments annual budget is a
conglomeration of the proposed budgets sent to the TR Program Director by the three TR
specialists, who provide detailed documentation for what equipment and supplies are needed by
every age level of clients. With the three budget propositions, the TR Program Director then
approves or disapproves each item, and constructs a full budget proposal to submit to the payroll
supervisor (over in the business administration department) for review. Any rejected items can
be discussed between the Executive Assistant and the TR Program Director if the questioned
item is deemed a necessary component for future therapeutic activities.
Since many of the materials used for therapeutic recreation are typically long-lasting and
the TR staff is smaller than most other departments, the TR departments funding tends to be
lesser than other departments within the agency. Sometimes, this allows for more leniency in
hiring contract services to come visit the facility in order to provide unique TR experiences for
the clients. No other revenue is currently generated specifically for the TR department aside
from the budget designated by SBCs administration.
Proposed Budget Justification
A majority of the TR departments budget obviously goes to the salaries of the TR
Program Director, the three full-time TR specialists, and the five TR assistants. The TR Program
Director earns a salary of $44,578 on the basis of leadership and years of experience working as
a CTRS. Full-time TR specialists earn salaries averaging around $36,811 per person, with the

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pay grade depending more on the number of years they have worked at SBC specifically. Parttime TR assistants, on average, earn $19,281, which fluctuates with the number of hours worked
on-site. None of the five TR interns nor the twenty-one registered TR volunteers receive pay,
although completion of the internship program can result in up to 6-credit hours per semester.
Health benefits and taxes for employees contribute another $26,714 to the overall budget,
with items that cover Medicaid, social security, health insurance, and state and federal
reemployment taxes. These items only pertain to the full-time TR employees (the TR Program
Director and the three TR specialists). Also, this budget provides a separate section (Other)
that brings attention to the liability insurance necessary for all TR employees.
The remainder of projected expenses could fit under the umbrella category of Operating
Expenses, totaling a grand sum of 38,550. Unofficially, this list could be subcategorized into
department and program expenses. Department expenses denote items that bolster the TR staff
in terms of continuing education, resource materials, travel expenses, office supplies, supportive
technology, and membership dues for professional accreditations. Program expenses focus more
on the items that would support the TR departments output, meaning what resources they need
to maintain and improve both current and future programs. These items, as referred to in the line
budget in Appendix J, include field maintenance, sports equipment, miscellaneous activity
equipment, arts and crafts supplies, exercise machines, third-party contract services, and van
repairs.

Clients
Surfside Behavioral Center serves patients nationwide between the ages of 5 and 17, with
a usual ratio of boys to girls 2:3. The current capacity is 100 beds, distributed into five
residences. The majority of patients have a history of treatment failure in inpatient and outpatient

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psychiatric and behavioral care. Patients may have multiple diagnoses, including: bipolar
disorder, disruptive mood dysregulation disorder (DMDD), depression, generalized anxiety
disorder (GAD), attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder
(ODD), conduct disorder, post-traumatic stress disorder (PTSD), intermittent explosive disorder
(IDD), impulse control disorder, obsessive compulsive disorder (OCD), personality disorder
traits, autism spectrum disorder, Tourettes syndrome and substance use disorder as a dual
diagnosis. Patients within SBC often struggle with refusal of treatment, poor social skills, selfmedication, self-harm, impulsivity, and physical aggression. Many key behaviors include
manipulation, social anxiety, isolation and high risk.
Diagnoses/Disorder Levels
As mentioned, there are several behavioral disorders that SBC addresses; listed below are
the three most prevalent ones seen.
Bipolar I and II
(Diagnostic and Statistical Manual-IV of the American Psychiatric Association, Text
Revision):

Bipolar I periods of severe mood episodes from mania to depression occurring

over the same two week period and must include:
1. Depressed mood most of the day, nearly every day, as reported by self
(i.e. I feel sad or empty) or others (i.e. he appears tearful) Note: in
children and adolescents, can be irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities

most of the day, nearly every day.

Bipolar II- a milder form of mood elevation, involving milder episodes of
hypomania that alternate with periods of severe depression.

Depression
According to the Cleveland Clinic, a behavioral disorder may trigger depression. The
opposite is also possible, with depression being a trigger for a behavioral disorder, which can

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also lead to substance abuse. According to Psych Guides:

Major depressive disorder- occurs when a person has feelings of sadness,

hopelessness, or anger that persist over a period of weeks and interfere with daily

life.
Chronic depression/dysthymia- characterized by a persistently sad disposition, as
though the person is always in a bad mood. The symptoms last longer than with

major depression, but they are not as severe.

Psychotic Depression- Patients who suffer psychotic depression exhibit psychotic
symptoms along with the depression, such as delusions or hallucinations. The
hallucinations can affect any or all of the senses. Usually, the delusions involve
feelings of unwarranted guilt or inadequacy.

Post-Traumatic Stress Disorder

Though there can be innumerable causes for trauma experienced by a client, some of the
criteria for diagnosis remains consistent. According to the DSM-V, presenting symptoms can
potentially include:

Recurrent, involuntary, and intrusive distressing memories of the traumatic

event(s)
Marked physiological reactions to internal or external cues that symbolize or

resemble an aspect of the traumatic event(s)

Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about

or closely associated with the traumatic event(s).

Persistent, distorted cognitions about the cause or consequences of the traumatic
event(s) that lead the individual to blame himself/herself or others.

Three different types of post-traumatic stress disorder exist. If symptoms last less than
three months, the condition is considered acute PTSD. If symptoms last at least three months, the
disorder is referred to as chronic PTSD. If symptoms manifest at least six months following a

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traumatic event, the disorder is classified delayed-onset PTSD, according to the National
Institute of Health (NIH).
Demographics and General Characteristics
As noted prior, Surfside Behavioral Center is located in Surfside, Florida, a town within
Miami Dade County. Surfside is an oceanfront community with tranquil and attractive residential
neighborhoods that primarily have public beaches within walking distance. There are also a
number of public parks, playgrounds and recreational facilities available.
The effects of immigration over the past 40 years have dramatically shaped the ethnic
composition of Miami-Dade County. With Hispanics as the dominant ethnic group, many
patients primarily speak Spanish as either their first or second language. With 22% of MiamiDade residents being of Catholic religion, most of SBCs patients come from Catholic homes.
Low level of educational attainment appears attributable to the nature of immigration inflows,
and can be associated with current household income figures being quite low by national
standards. The current low incomes and family structure generate high poverty levels within
Miami-Dade County and clients of SBC.
Geographic Distribution of Patients

Florida: 56%
49 other states/ D.C: 44%
Eastern Time Zone: 38%
Central Time Zone: 30%
Pacific Time Zone: 32%

Population Transition
Mental disorders among children and adolescents are described as serious changes in the
way they typically learn, behave and handle their emotions. Symptoms usually start in early
childhood, although some of the disorders may develop throughout the teenage years. Mental
disorders are chronic health conditions that can continue through the lifespan. Without early

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diagnosis and treatment, children and adolescents with mental disorders can have problems at
home, in school, and in forming friendships. This can also interfere with their healthy
development, and these problems can continue into adulthood.
Discharge
Patients primarily live with their biological parents, adoptive parents, or grandparents.
Upon discharge, most patients return home. There are some special cases where patients are
transferred to a different behavioral center if their insurance benefits have been exhausted at the
facility and medical necessity has been granted. One of the most important goals stressed
amongst SBC staff is the need to create individualized plans of discharge for every client,
leaving none without a plan for what happens next.
Leisure Related Needs.
There are functional problems that may inhibit leisure involvement in patients with
behavioral disorders. Social skills deficits, negative behaviors, and low self-esteem are among
the top functional problems. Adding an unstable environment, neglect, abuse, and poverty to this
situation worsens the likelihood of appropriate behavior, including thoughts and emotions.
Problematic behaviors affect social competencies in peer relationships, which can regularly lead
to lack of leisure involvement and can create can create barriers to full leisure participation
According to the National Therapeutic Recreation Society (NTRS), therapeutic recreation
aims to develop, maintain and facilitate expressions of appropriate leisure lifestyles for
individuals with social, mental, emotional, or physical limitations. Functional therapeutic
recreation services in behavioral health focus on helping a patient develop adaptive coping skills,
stronger interpersonal/social relationships, increased self-esteem, and greater autonomy.
Particularly in behavioral health, a therapeutic recreation specialist will help clients increase their

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social skills and confidence through interventions that help reduce the effects of the disorders
previously discussed. Leisure experiences provided in clinical settings help transfer social skills
learned during therapeutic recreation interventions to daily interactions within the community.
Through therapeutic recreation and a comprehensive program at SBC, patients reach
appropriate leisure lifestyles and re-establish healthy child and adolescent behavior. The TR
department teaches leisure skill sets that help develop a successful transition back into the
family, home, school and community. TR specialists incorporate different activities designed to
teach leisure skill sets that can include learning productive ways to plan and spend their free
time, teach coping skills for stressful situations, and encourage positive communication and
problem solving. Equally important, TR specialists also help patients learn to develop safe and
trusting relationships with others. Emphasis is placed on helping the adolescent identify their
emotions and correct the actions that have created problems. Through this comprehensive
process, children and adolescents learn to accept responsibility for their behavior and develop
healthy modes of interaction with others. The behavioral program and level system that SBC
provides reinforces positive feedback and encourages clients to be self-motivated towards
personal progress and goal achievement.
Therapeutic Recreation Profession
Philosophy of TR Practice Model
The TR department at SBC adheres to the philosophy of one particular TR delivery
service model: the Leisure Ability Model. This practice model provides definition and direction
for the delivery of the TR services provided. The model takes into account the biological and
psychological factors, as well as any social contexts, like many other treatments within the
behavioral health field. Through functional interventions, leisure education, and recreation
participation components of the Leisure Ability Model, TR professionals are able to improve

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social skills in youth. The functional intervention component helps decrease limitations that may
hinder ones ability to learn leisure-related awareness, knowledge, skills, abilities, and
involvement. The leisure education component helps promote effective social skills in various
leisure environments. Lastly, the recreation participation component allows clients to practice
their newly learned social skills in leisure activities.
Impact of Standards of Practice and Code of Ethics
The TR services delivered to SBCs clients are upheld through the TR staffs strict
adherence to the American Therapeutic Recreation Associations (ATRA) Standards of Practice
(SOP) and Code of Ethics (COE). The Standards of Practice are a comprehensive set of practice
guidelines that were established for the TR profession; these standards assist the TR professional
in assuring the systematic provision of safe and effective quality services. Along with the SOP,
the TR department at SBC also adheres to self-assessments that evaluate the compliance of
practices and develop effective quality improvement plans that improve that compliance. The
Self-Assessment Guide is designed to evaluate the compliance of recreational therapy practice
with ATRAs SOP.
ATRAs Code of Ethics is used as a guide for promoting and maintaining the highest
standards of ethical behavior within a variety of TR settings. One of the first steps in organizing
an effective client treatment is to ensure that patients receive a copy of their Patient Bill of
Rights. This also keeps the department in compliance with governmental agencies standards
such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the
Commission on Accreditation of Rehabilitation Facilities (CARF). The TR department also
provides clients with a patient satisfaction questionnaire, which, in turn, provides opinions,
comments, and suggestions that can assist the specialists in improving the departments methods
of treatment.

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Appendix K contains the ATRA Standards of Practice and Code of Ethics. Appendix L
contains ATRAs SOP Self-Assessment Guide, Scoring Summary, Management Audit,
Documentation Audit, and Outcomes Audit. Appendix M contains the SBCs Patient Satisfaction
Questionnaire. Appendix N encloses the Patient Bill of Rights.
Credentials/Professional Preparation of Staff
The TR profession has an academic path and equivalency paths that can be viewed in
Appendix O. At SBC, the National Council for Therapeutic Recreation Certification (NCTRC)
has administered each of the TR professionals certifications (CTRS) for therapeutic recreation.
The NCTRC is the nationally recognized credentialing organization for the profession of RT, and
represents over 12,000 CTRSs employed in a variety of healthcare and human services settings.
This organization works in concert with state regulatory authorities through adherence to
consistent, fair and objective standards and full due process in its certification program. The
NCTRC complies with the Americans with Disabilities Act (ADA) in the implementation of the
certification program. All TR professionals within SBC also adhere to CTRS Annual
Maintenance (Appendix P) and CTRS Recertification administered by NCTRC. Any individual
CTRS that has extensive experience and expertise in a given area of TR practice is eligible to
apply for NCTRC Specialty Certification. The primary purpose of NCTRC Specialty
Certification is to acknowledge the CTRS whose practice has reached an advanced professional
level, and provides formal recognition of competence beyond the CTRS credential.
In addition to education, fieldwork and certification, the TR professional should enjoy
serving people in various capacities, outdoors, physical activities, people with developmental,
intellectual, and physical disabilities, or youth. The TR professional should always demonstrate
patience and courtesy.

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Professional Membership Held by Staff

At SBC, the CTRSs have a professional membership with The American Therapeutic
Recreation Association (ATRA), as it is the largest organization that represents the interests and
needs of Therapeutic Recreation Specialists. The ATRA membership application can be viewed
in Appendix Q.
Continuing Education/Professional Development
The CTRSs at SBC are encouraged to seek continued education and professional
development. These staff members are also encouraged to attend the ATRA Annual Conference
found in Appendix R. As per facility policy, all CTRSs are verified to be current with
continuing education unit (CEU) requirements. The American Therapeutic Recreation
Association offers numerous opportunities for professional growth and certification maintenance
through webinars, workshops and conferences. CTRSs can register for live webinars offered
through ATRA that are now CEU qualified webinars as well (specifically, series B, C, D, G, H on
the dates offered). Appendix S contains information on the different series. The expenses for
CEUs, conferences and webinars are included in the department budget (which can be found in
Appendix J.
Other Professional Resources
The TR department at SBC contains numerous literature and resources for both TR staff
and even curious interns and volunteers. These include quarterly newsletters from ATRA that are
packed with industry news, occupational advances and legislative alerts. The department also
receives publications of The Annual in Therapeutic Recreation, which is the official research
journal of ATRA. The Annual in Therapeutic Recreation publishes a wide range of original, peerreviewed articles, such as evidence-based practices, systematic reviews, application of theories
or models, current issues and trends in service delivery, and practice protocols. Books that can

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be found in the departments shelf include Inclusive Leisure Services, Therapeutic Recreation
Program Design, and Facilitation Techniques in Therapeutic Recreation: An Evidence-Based
and Best Practice Approach to Techniques and Processes, Facilitation Techniques in
Therapeutic Recreation.

References
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An Overview of the Socio-Economic Condition of Miami-Dade County. (2007, May 1).
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Beach Information [Surfside, Florida]. (n.d.). Retrieved from

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Meridell Achievement Center / Our Patients. (n.d.). Retrieved October 9, 2015, from
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Therapeutic Recreation Journal, 40(4). Retrieved from
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