program protocol horticultural therapy recreation therapy

Charles A. Sourby MS Ed. HTR

Dedicated to Horticulture, Recreation and People with Disabilities

FORMATIVE PROGRAM PROTOCOL

for HT/TR

the People/Plant/Leisure Connection

Horticultural Therapy & Therapeutic Recreation

Formative Program Evaluation

Directions: The purpose of this form is to describe, in detail, the characteristics and content of an activities program. Copy it to a word document. Adjust it (add Lines to fill in the questions). Develop realistic goals and objectives for a program. Develop session plans and calendar.

Please answer each question as comprehensively as possible.

1. What is the title of program:___________________________________

2. What is the primary therapeutic service function within this program? (circle one)

Treatment of behavioral functioning…………………………1

Education. ............................................. ....................2

Other service function (explain)……………………………...3

3 a. What is the purpose of this program?

3.b What program goals are established for people who participate in this program?

4 a. Have these goals been stated in measurable objectives? (circle one)

Yes (skip to 4b)……………………………………..1

No (skip to 4c)………………………………………2

4 b. If the goals are stated in measurable objectives, describe the specific behavioral changes being sought.

{Who participates in the program:?}

4 c. If goals are not stated in measurable objectives, what specific behavior changes to you wish to observe?

Is this program designed for a specific client population? (circle one)

Yes (skip to 5a)……… ……………………………. .1

No (skip to 5b)………………………………………2

5a.What population benefits in this program design?

5b. What are the characteristics of participants who might benefit most from this program?

Primary diagnosis:

Secondary diagnosis

Functional Abilities:

Age range:

Necessary pre-requisite kills:

Other characteristics related to the program:

5c. How do you determine if a client is appropriate for or can benefit from this program? (circle one)

client assessment…………………………………...1

professional judgment…………………………….. 2

other (please explain)……………………………….3

5d. What is the primary method of assigning client is this program? (circle one)

assignment by horticultural/recreation professional ....1

referral by non-recreation staff............... ……….. .2

volunteers/families.....…………………..................3

combination of above assignment methods………... 4

other (please explain)………………………………5

6. Describe the activities and content selected to accomplish the goals of this program:

7. Describe the staff interaction or intervention strategies that will be used in this program:

8. What is the structure of the program?

time/day/schedule _______________________________________________________________

length of program (in weeks):_______________________________________________________

number of sessions per week:________________________________________________________

total number of sessions:___________________________________________________________

length of individual sessions:________________________________________________________

describe the format of a typical session:_________________________________________________

9. How many participants can you serve in this program?

Maximum #____________ minimum #________________ average #_____________

10. Describe the resources required for this program

a. Nature and amount of required equipment:____________________________________________________________

b. Nature and amount of required materials:___________________________________________________________

c. Description of facility requirements:_____________________________________________________________

d. Description of required support services (i.e., transportation, aids, or additional personnel other than program staff, etc.):___________________________________________________________________

e. Describe any other resources that are required for this program:

11. Describe the staffing requirements for this program.

a. How many staff are required to implement this program?

b. What is the desirable participant-staff ratio for this program (considering client needs and characteristics, as

well as the purpose and nature of the program?).

c. Do staff require special skills or special training to function as leaders in this program? (circle one)

Yes……………………………………….....1

No (skip to 11)…………………………….2

If yes, please describe the nature of skills or training required:

12. Additional comments or characteristics of the program:

Horticultural Therapy

The Formative Program Evaluation Procedure

PROGRAM PROTOCOL

Directions: The purpose of this form is to describe, in detail, the characteristics and content of the program

intended for evaluation. Please answer each question as comprehensively as possible. If the program

is described in an agency document or report, such information may be attached to this form.

1. What is the title of the program to be evaluated?

___________________________________________________________________________________________

What is the primary therapeutic recreation service function addresses within this program? (circle one)

Treatment of behavioral functioning…………………………1

Leisure education……………………………………………..2

Other service function (explain)……………………………...3

__________________________________________________

3. What is the purpose of this program? ___________________________________________________________

_____________________________________________________________________________________________

What program goals have been established for clients who participate in this program?

_____________________________________________________________________________________________

4a. Have these goals been stated in measurable objectives? (circle one)

Yes (skip to 4b)……………………………………..1

No (skip to 4c)………………………………………2

4b. If the goals are stated in measurable objectives, describe the specific behavioral changes being sought from

clients who participate in the program:

_____________________________________________________________________________________________

4c. If goals are not stated in measurable objectives, what specific behavior changes to you wish to observe

in clients to let you know they have accomplished the program goals?

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________

Is this program designed for a specific client population? (circle one) Yes (skip to 5a)……………………………………..1

No (skip to 5b)………………………………………2

5a. Which client population is this program designed for?

__________________________________________________________________________________________________________________________________________________________________________________________

5b. How would you describe the characteristics of clients who might benefit most from this program?

primary diagnosis: _______________________________________________________________________
_______________________________________________________________________________________
secondary diagnosis:______________________________________________________________________
_______________________________________________________________________________________
functional level:__________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
age range:______________________________________________________________________________
necessary pre-requisite kills: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________
other characteristics related to the program: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5c. How do you determine if a client is appropriate for or can benefit from this program? (circle one)

client assessment…………………………………...1

professional judgment……………………………..2

other (please explain)……………………………….3

___________________________________________

5d. What is the primary method of assigning client is this program? (circle one)

assignment by therapeutic recreation………………..1

referral by non- therapeutic recreation staff……….2

clients volunteer for the program…………………...3

combination of above assignment methods………...4

other (please explain)……………………………….5

___________________________________________

Describe the activities and content selected to accomplish the goals of this program:

Describe the staff interaction or intervention strategies that will be used in this program:

8. What is the structure of the program?

length of program (in weeks):_______________________________________________________________
number of sessions per week:_______________________________________________________________
total number of sessions:___________________________________________________________________
length of individual sessions:_______________________________________________________________
describe the format of a typical session:_______________________________________________________

- how many clients can you serve in this program?

Maximum #____________ minimum #________________ average #_____________

Describe the resources required for this program

a. nature and amount of required equipment:_____________________________________________________

_____________________________________________________________________________________________

b. nature and amount of required materials:______________________________________________________

_____________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________

c. description of facility requirements:__________________________________________________________

_____________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________

d. description of required support services (i.e., transportation, aids, or additional personnel other than program staff, etc.):__________________________________________________________________________

_____________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________

e. describe any other resources that are required for this program:

_____________________________________________________________________________________________

10. Describe the staffing requirements for this program.

a. How many staff are required to implement this program?__________

b. What is the desirable client-staff ratio for this program (considering client needs and characteristics, as

well as the purpose and nature of the program?).____________________________________________

c. Do staff require special skills or special training to function as leaders in this program? (circle one)

Yes………………………………………...1

No (skip to 11)…………………………….2

If yes, please describe the nature of skills or training required:

_____________________________________________________________________________________________

11. Additional comments or characteristics of the program: _____________________________________________

_____________________________________________________________________________________________

____________________________________________