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Miller Childrens & Womens Hospital Long

Beach
Table of Contents

Physical
Intervention Protocol
Health and 2

Well- Being
Physical Activity Intervention 3-5

Psycho educational activity intervention 6-7

Game-like activity
Program
Creative activity intervention 8-10

11-13
Intervention Protocol
Challenge activity intervention 14-16

Staff Training/Certification requirements 17

Risk
Miranda Doing

management considerations 17

Outcome expected 17

Program evaluation 17

References 18
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Intervention Protocol

Program title: Physical Health and Well-Being Program

General statement of purpose: Assist clients and their families in understanding how to manage
clients physical health, nutrition and coping skills through leisure activity.

Description of program: Regular activity is a key part of managing diabetes along with proper
meal planning, taking medications as prescribed, and stress management. The Physical Health
and Well-Being program is designed to assist clients in creating and understanding the positive
outcomes of exercise and physical activity on the maintenance of diabetes. Through individual
recreational therapy sessions, client will develop an exercise plan to assist them in learning to
manage their weight, build personal endurance, and increase physical strength. During weekly
family sessions, the family and client will review plan and create family fitness goals.

Client problems that may be addressed:

Physical health
Nutrition
Lack of coping skills

Referral criteria-how they enter your program:

Individual request
Physician referral
Assessed need by Recreational Therapist

Contraindicated criteria:

None noted except if client is medically unstable at time of session.

Intervention activities or techniques:

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Physical activity Intervention

Name of Activity: Ball Toss

Population: Young teens who are overweight managing diabetes. Who may also struggle with
physical health, nutrition and coping skills.

Age: 12-14 years old.

Group Size: 10-12 participants.

Setting Considerations: This physical activity would be great to do at a park with an open field.
It can help participants get more animated and excited to be going somewhere and will give them
space to participate.

Group Stage Considerations: For groups that are norming or performing. Generally we would
see groups that are norming or performing because they will have more group cohesion and
become more devote to achieving individual or group goals.

Purpose/Goals:

Have participants understand the importance of physical health.

Generate a fitness plan to increase endurance.
Set goals to maintain a healthy lifestyle with the help of family.

Supplies Needed:

1. 3 tennis balls for each group of 4-6

2. 1 bucket or trash can for each group
3. 1 blindfold for each group
4. A pencil and a piece of paper for each group

Intervention Description:

Gather participants in facility vehicle, follow Policies and Procedures for transporting
participants.
Travel to near-by park
Divide your group into smaller groups of four to six people by drawing a number out of a
bucket.
Have group members write a short or long term goal they want to achieve (can be
anything).
Have each group get in a line and select a person to go first.
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Give each group one tennis ball and put a bucket about 10 feet in front of each group. The
person who is going to throw must be blind folded or have their back to the bucket. Have
each person throw the ball in the bucket without looking.
After this part of the activity, begin to process the fact that if you dont have any goals,
then you wont know which direction you are heading or how to get there. Blindly
throwing the tennis ball shows how hard it is to hit a goal you cant see or havent set.
Place the bucket about 3 feet away and give each group three tennis balls to throw in the
bucket. Make sure to rotate so everyone gets a chance to throw the tennis balls.
Move the buckets to about 20 feet away, again, make sure everyone gets the opportunity
to participate.
Move each groups bucket 30-40 feet in front of each group, this time having one person
pick up the bucket and moving it to try and catch the tennis balls land inside.
During each round, the therapist is demonstrating difficulty levels of reaching goals and
also showing how it can be easier to accomplish goals when someone helps you (ex.
When group member follows the ball to catch it).

Special Considerations or Risks:

Waivers/ signed consent to go to the park.

Follow Policies and Procedures to make sure to make safe travel.
Explain not to throw tennis balls at other team members, only at your target.

Possible Discussion Questions:

a. Remembering: How do you think this activity related to goal setting and physical
health? What part of your body had to work the most in doing this activity? What
thoughts came into your mind as you were completing this activity? Do you remember
what your goal was before the activity started? Would you like to share it?
b. Understanding: Why is your health important to you? What are things you can
accomplish in your life if you have good health? How would you accomplish those
goals? Why is it important for you to set goals? Think about the activity, were you more
successful in making the tennis ball in the bucket at 40 feet with the help of someone?
Why would it be important to have someone help you accomplish your goals?
c. Applying: Has anyone ever set a goal that was challenging but were still able to do it on
your own? On a piece of paper I would like you to generate a fitness plan. Write it down,
and show steps of how you can improve your health and increase your endurance. Now
write down how your family or support group can help you accomplish that. Why would
this be important to involve your family and/or support group?
d. Analyzing: Should you set goals that are really difficult for you to reach? Why or why
not? What did you notice when you first were trying to get the ball in the bucket
blindfolded then when it was three feet in front of you? What about when someone was
helping you by moving the bucket to catch the tennis balls? What was the difference
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between each stage? How does this relate to your physical health? What do you need to
do to maintain a healthy lifestyle?
e. Evaluating: Is it important to you to reach your goals? Why? How can maintaining a
healthy lifestyle change your life? What are some barriers you face? What are some
examples of goals that seem impossible to reach?
f. Creating: How can, not managing your physical health, diabetes, and exercise impede on
reaching a goal? How will you prove you can maintain to live a healthy lifestyle?

Possible Group or Individual Assignments: Generate a fitness plan to increase endurance as a

group, with family or support group, then individually. Discuss in following session.

Modification or Adaptations:

Designate an area of play by using tape or cones that they cannot pass to make sure
everyone is under close supervision.

Source:

Ball Toss. (2016). In M. E. Tom Jackson, More Activities That Teach (pp. 98-101). Red Rock
Publishing.
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Psycho-educational activity Intervention

Name of Activity: Do you treat others as good as an egg?

Population: Young teens who are overweight managing diabetes. Who may also struggle with
physical health, nutrition and coping skills.

Age: 12-14 years old.

Group Size: 10-12 participants.

Setting Considerations: If the weather is nice, group can use facilities outdoor location on the
lawn. If not, use the north conference room on the first floor.

Group Stage Considerations: Mainly for groups that are forming. Participants are developing
trust, fostering identification with others in the group, and gaining a commitment to the group
from members.

Purpose/Goals:

By the end of group, client will be able to apply knowledge of recreation and physical
activity as a coping skill through the development of a fitness family recreation plan.

Supplies Needed:

1. 1 raw egg
2. 1 hard-boiled egg (clearly marked with marker)
3. Plastic tarp or table cloth (for dropping the raw egg).

Intervention Description:

Gather group into a circle.

Without explanation, pass out a raw egg and have people pass it around.
After everyone has had a chance to pass the raw egg, then take out a hard-boiled egg and
ask someone to catch it. You can reassure them that it is hard boiled, and can withstand
more toughness.
Ask them to throw the hard-boiled egg to one another.
Throw the raw egg onto the plastic tarp that is on the floor. Make the point that if we are
rough with peoples feelings and do not handle with care, feelings as well as relationships
can be splattered and just like Humpty Dumpty, it will never go back the same way.
Ask them how they thought this activity related to their relationships.

Special Considerations or Risks:

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Make sure participants are not allergic to eggs.

Participants do not throw eggs overhand or target the upper body (i.e. face).

Possible Discussion Questions:

a. Remembering: How can recreation and physical activity be used as a coping skill?
b. Understanding: What other types of leisure, recreation, or physical activity can you use
as a coping skill? How does recreation/ leisure play into your life? When you think of
recreation, do you always think of doing it alone or with other people? Explain.
c. Applying: How can we obtain and maintain the coping skills we developed?
d. Analyzing: Is it important to you to involve your family in developing a recreation plan?
Why or why not?
e. Evaluating: What benefits can you receive from developing a fitness family recreation
plan?
f. Creating: What other ways can you involve your family in trying to maintain a healthy
lifestyle?

Possible Group or Individual Assignments: Write in a journal and reflect on feelings that was
felt. Be able to apply knowledge that was learned by writing one thing they can change to
develop trust in a relationship and bring to the following group session to discuss.

Modification or Adaptations: If one participant has hard time standing to do the activity,
everyone sits on the ground.

Source:

Belmont, J. (2016, February 21). Psychoeducational Handout, Quizzes, and Activities. Retrieved
from belmontwellness: http://www.belmontwellness.com/for-mental-health-
professionals/psychoeducational-handouts-quizzes-group-activities/

Creative activity Intervention

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Name of Activity: Butterflies in My Stomach.

Population: Young teens who are overweight managing diabetes. Who may also struggle with
physical health, nutrition and coping skills.

Age: 12-14 years old.

Group Size: 6-10 participants

Setting Considerations: Use the playroom on the ground floor for open space with partly
hardwood flooring.

Group Stage Considerations: For groups that are forming. Participants are developing trust,
fostering identification with others in the group, and gaining a commitment to the group from
members. Can also be used in the storming stage to be able to communicate openly with
conflicts that are arising or participants that are more reserved and is hard opening up and
revealing themselves.

Purpose/Goals:

Client will be able to identify the use of recreation and physical activity as a coping skill
and will be able to communicate with therapist which problems or worries need priority
in his/her treatment.

Supplies Needed:

1. Large sheet of banner paper for each participant,

2. Colored markers, pens, crayons
3. Scissors,
4. Assorted sized paper butterflies,
5. Glue sticks.

Intervention Description:

Butterflies in My Stomach (Lowenstein, 1999). The therapist introduces the activity by pointing
out that everyone has problems and worries. The therapist outlines the different ways the body
reacts to stress; for example, when a person is scared, his heart might pound faster, or when a
person is sad and about to cry, he might feel like he has a lump in his throat. The therapist then
asks the client if he has ever heard of the expression, "I have butterflies in my stomach." If the
client is unfamiliar with the expression, the therapist can offer an explanation, such as, "When
you are worried or nervous about something, your stomach might feel funny or jittery, as if you
have butterflies in your stomach. You don't really have butterflies in your stomach, it just feels
like you do." Next, the child lies down on a large sheet of banner paper, while the therapist
outlines the child's body. (Alternatively, the child can draw a body outline.) Then the therapist
gives the child assorted sized paper butterflies (self-made butterflies can be used, or the
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practitioner can copy butterfly outlines from the book, Creative Interventions for Troubled
Children and Youth, Lowenstein, 1999). The child writes his or her worries on the paper
butterflies. Bigger worries are written on the larger butterflies, smaller worries on the smaller
ones. If the child is reluctant to identify worries, the therapist can give prompts, such as, Write
about a worry you have at school Write about a worry you have at home and Write about a
worry you have with other kids. The butterflies are then glued onto the child's body outline,
inside the stomach. As the child identifies each worry, the therapist can facilitate further
discussion by asking open-ended questions, such as, "Tell me more about this worry." The
client's problem-solving abilities can be assessed and encouraged by asking, "What could you do
about this worry to help yourself feel better?" To assess the client's available support network,
the therapist can inquire, "Who are some people who can help you with this worry?" At the end
of the exercise, the child can color the butterflies and decorate the body outline. This activity
facilitates self-awareness, open communication, problem solving, and catharsis of negative or
overwhelming feelings. It is a useful assessment tool that can be applied to a wide variety of
client populations. This is a particularly useful activity with children who have a multitude of
presenting problems, as it enables them to communicate to the therapist which problems are most
pressing and need priority in treatment.

Special Considerations or Risks: Therapist and or other adults are supervising while
participants are using scissors so they do not misuse them in any way.

Possible Discussion Questions:

a. Remembering: What did we focus on during this group?

b. Understanding: Why do you think it was important for you to think about your worries?
What worry did you select? Why did you select this specific worry? What could you do
about this worry to help yourself feel better? What did you learn about yourself?
c. Applying: Why is it important that you talk about these worries with the therapist? How
can you make these worries disappear? What coping skills do you wish to learn and
practice?
d. Analyzing: Who are some people that can help you with each thing/circumstance you
worry about? (Who can you talk to)?
e. Evaluating: How would your life change if these worries went away? Or would it change
at all? If you could manage these worries how would that help? Can some worries go
away? How? If you could let them fly away with the butterfly what would that look like?
f. Creating: Did this task help you surface worries and become more alert? What are some
coping skills you have to let go of your worries? Lets create a coping butterfly to use this
week. What would be on your butterfly? When can you use this skill this coming week?

Possible Group or Individual Assignments: Show and talk with support system about
insecurities or worries that you wrote on each butterfly to help overcome and manage them.

Modification or Adaptations:
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Have the butterflies pre-cut and ready to write on.

If participant has difficulty writing, have pictures or phrases available for participant to
choose from.
Have one person from participants support group there to understand the clients needs.

Source:

Lowenstein, L. (2016, February 22). Creative Interventions for Children, Youth and Families.
Retrieved from Creative Interventions to Engage:
http://www.childtherapytechniques.com/Creative%20Interventions%20by%20Liana
%20Lowenstein.pdf

Game-like activity Intervention

Name of Activity: My Plate Match Game

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Population: Young teens who are overweight managing diabetes. Who may also struggle with
physical health, nutrition and coping skills.

Age: 9-12 years old.

Group Size: 10-12 participants put into 3 groups.

Setting Considerations:

Classroom like setting with open wall space.

Hang pocket charts on wall giving space between the 3 groups.
Tables in center of the room to organize images, clip art and portion sizes on.

Group Stage Considerations: For groups that are forming, storming, norming, or performing.
This intervention can be done in any of the stages because it can be used as a tool to introduce
information to help them progress through the program. It involves communication and
teamwork, it helps develop trust and friendships, group members can also start taking
responsibility and do things on their own and be productive.

Purpose/Goals:

Client will be able to apply knowledge of physical activity and maintenance of diabetes
through discharge plan by generating a list of foods created by dietitian that you will eat
at each meal as well as exercises that will be accomplished each day.

Supplies Needed:

1. 3 pocket charts: labeled- food groups, serving size, physical activity.

2. Images/ clip art of different foods (i.e. peanut butter, tortilla, yogurt, bread, tomato,
banana, chicken)
3. 3x5 Paper labeled with different portion sizes
4. Images/ clip art of different physical activities (i.e. soccer ball, jump rope, bicycle).

Intervention Description:

Each group will be in charge of completing a pocket chart with the materials given to
them.
As a group, participants will have to discuss their subject (food groups, serving size, and
physical activity) and place correct answers inside the hang chart.
Therapist or dietitian will be providing the following information as the task is in
progress.
o Food groups
Fruits provide vitamin C which helps our bodies heal and grow new cells.
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Vegetables provide vitamin A which helps us have healthy skin and good
eyesight.
Meat, Beans and Nuts provide protein which helps build strong muscles.
Grains, Breads and Cereals provide B-vitamins which help turn the foods
we eat into energy that our bodies need to work, play and grow. Make half
of your choices whole grains, which are a good source of fiber.
Milk and Milk Products like cheese and yogurt, provide calcium which
helps build strong bones and teeth and Protein which builds strong
muscles.
o Serving size; eating a balanced meal (one from each food group) will help you get
the nutrients you need to grow healthy and strong.
Milk group: if you are 9 or older, you need 3 servings
Grains: 6 servings
Meat: 2 servings
Vegetables: 2.5 servings
Fruits: 1.5 servings
o Get plenty of Physical Activity
Recommended 60 minutes of moderate to vigorous level of physical
activity each day.
One by one, group members will be placing images or other materials into the hang chart
to complete it!
Once each team is done, rotate to the next hang chart and continue the same process.

Special Considerations or Risks:

If participant becomes stressed for not having the knowledge, be considerate of team
members and help one another learn.
Inform participants that it is a No Judge Zone! Support each other, the point is to gain
knowledge of how to take care of your body.

Possible Discussion Questions:

a. Remembering: What knowledge did you receive during this activity? Will it be useful in
regulating your diabetes? Will it help you make better choices when deciding what foods
to eat and what activities to play?
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b. Understanding: What are the 5 food groups? How much exercise is recommended each
day? What is the importance of this information? Why is it important to eat healthy and
be physically active? What do you think are the consequences of being physically active
but not healthy or vice versa?
c. Applying: Make a list of foods and/or snacks that you could have, remember the serving
sizes, for each meal. Do you think if you eat healthier, that it will give you more energy?
How will these changes in your diet effect your body? Having more energy would help
you how? What types of activities can help you maintain your diabetes?
d. Analyzing: Why is it important that your eating and exercise habits change? What bad
habits can you exchange for good healthy ones? Which one would you like to start with?
Who can do this with you?
e. Evaluating: Why would it be valuable to teach your family about this when you go
home? What are you willing to do and who are you willing to tell to make sure you eat
healthy and exercise every day? Why do you want this to be a daily habit?
f. Creating: Lets write one recipe to put in our recipe book.

Possible Group or Individual Assignments: Each participant will be assigned a category to

complete (with the help of group members), write suggestions of what can be eaten, how type of
activities can be done, and serving sizes so that the group can come up with physical wellness
book.

Modification or Adaptations: show an example of a small cook book to each participant that
has different healthy food options, diet and exercise plans.

Source:

(2016, February 22). Retrieved from Dairy Council of California:

http://www.healthyeating.org/Healthy-Kids/Kids-Games-Activities/My-Plate-Match-
Game.aspx

Challenge activity Intervention

Name of Activity: Pick Up Sticks

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Population: Young teens who are overweight managing diabetes. Who may also struggle with
physical health, nutrition and coping skills.

Age: 12-14 years old

Group Size: 4-6 participants

Setting Considerations: Because it is a small activity, group members will meet in a classroom
to complete the challenge activity.

Group Stage Considerations: For groups that are norming, performing, or terminating.
Participants begin to identify with the group leader and other group members and begin to work
as a team. With this activity, group members display maturity and are supportive of the members
that also creates change. Members are able to review their experience and look forward to
transferring their learning to real-life situations.

Purpose/Goals:

Identify past/current/future leisure interests to develop and maintain a healthy lifestyle.

Supplies Needed:

1. 15 trinkets of any kind

2. Desks
3. Chairs

Intervention Description:

(definitely need to change this to better help clients, adapt, evolve it, make it my own)
Have clients write down leisure interests from their childhood, as of right now, and what
they would like to do in the future.
Teach clients leisure activities that will help maintain a healthy lifestyle along with
activities that are negative or harmful to their bodies.
Explain how these activities can help them form a better lifestyle.
Them, give instructions, and demonstrate the activity; you each take turns taking one, two
or three of the items during each turn. The loser is the person who has to pick up the last
item. (the key is for the leader to remember that you want to try to get items number two,
six, and ten. If you pick up these numbers especially number ten, you will always be the
winner).
Ex. Lets say that we are using 15 trinkets. The volunteer takes one trinket on their first
pick. You would then take only one trinket since you want item number two. The
volunteer now takes three trinkets. A total of five trinkets have now been taken. Since you
want to pick up item number six you would take one trinkets. Lets say that the volunteer
takes two trinkets for a total of eight items. You would take two trinkets because you are
trying to get the tenth item. Once you have the tenth item, there is no way for them to
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beat you. No matter what combination they use, they will lose by having to pick up the
last item.
Every time you pick up a trinket, you have state one leisure activity.
The more information you have concerning a leisure activity, the more you want to do it
or not.

Special Considerations or Risks: If a participant realizes the sequence of the game, tell him or
her to keep it a secret until everyone has participated.

Possible Discussion Questions:

a. Remembering: What leisure activities peaked your interest that you didnt know about
before?
b. Understanding: Did your leisure interests evolve over time with the knowledge you
received? How?
c. Applying: Do you think you can accomplish at least one of these activities a minimum of
once a week? How will it benefit you?
d. Analyzing: When I had you write down your leisure activities, what thoughts came into
your head? What feelings were felt? Did it bring up a lot of memories? Who did you do
these activities with? Who motivates you to participate in activity? Who can you rely on
to help you develop and maintain a healthy lifestyle?
e. Evaluating: How does knowledge or information give you an advantage to maintain a
healthy lifestyle? If you had information about managing diabetes earlier in your life,
how would that have changed the way you recreate today? Which activities do you need
to give up doing and exchange for something better and more fulfilling?
f. Creating: Would you share at least one of the three leisure activities, past/present/future,
you wrote down at the start of group? Which of these do you wish you can do again or
want to accomplish.

Possible Group or Individual Assignments: Each participant come up with 2 commandments

that they will not break. Ex. Commandment is: I will not eat chocolate. If a situation arises that
participant has the opportunity to eat chocolate, participant has already firmly said NO. The
decision was already made beforehand so it wasnt difficult to make.

Modification or Adaptations: Tell one group member the strategy so that they too can play
against other participants. He will be able to talk about his experience about having knowledge
beforehand and not learn too late or as you go.

Source:

Pick Up Sticks. (2016). In M. E. Tom Jackson, More Activities That Teach (pp. 240-242). Red
Rock Publishing.
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Staff Training/Certification requirements

First-Aid certified
CPR certified
Must have national certification as a CTRS by NCTRC
Therapist is trained in physical exercise and diabetes.

Risk management considerations:

Monitor blood glucose levels, should avoid exercise if higher than 400 mg/dl.
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Avoid strenuous activity

Limit your choice of exercise to low impact or non-weight bearing activities for those
with diabetic peripheral neuropathy.
Therapist is trained in physical exercise and diabetes.

Outcome expected:

Apply knowledge of recreation and physical activity as a coping skill through the
development of a fitness family recreation plan.
Generate a fitness plan to increase endurance by discharge as measured by pre and post
endurance testing.
Apply knowledge of physical activity and maintenance of diabetes through discharge
plan by generating a list of foods created by dietitian that you will eat at each meal as
well as exercises that will be accomplished each day.
Identify past/current/future leisure interests to develop and maintain a healthy lifestyle.
Apply knowledge of personally identified life skills for successful integration into home,
school and community-based activities.

Program evaluation:

Measurement of individual client outcomes will be used in program evaluation.

Patient and Family surveys
Quality Improvement Indicators

M. Doing TRS, CTRS

2/24/2016
(Student)

References
(2015). Retrieved from Diabetes research Institute Founddation:
http://www.diabetesresearch.org/

(2015). Retrieved from American Diabetes Association: http://www.diabetes.org/food-and-

fitness/fitness/physical-activity-isimportant.html?referrer=https://www.google.com/

(2016, February 22). Retrieved from Dairy Council of California:

http://www.healthyeating.org/Healthy-Kids/Kids-Games-Activities/My-Plate-Match-
Game.aspx
 18

Ball Toss. (2016). In M. E. Tom Jackson, More Activities That Teach (pp. 98-101). Red Rock
Publishing.

Belmont, J. (2016, February 21). Psychoeducational Handout, Quizzes, and Activities. Retrieved
from belmontwellness: http://www.belmontwellness.com/for-mental-health-
professionals/psychoeducational-handouts-quizzes-group-activities/

Lowenstein, L. (2016, February 22). Creative Interventions for Children, Youth and Families.
Retrieved from Creative Interventions to Engage:
http://www.childtherapytechniques.com/Creative%20Interventions%20by%20Liana
%20Lowenstein.pdf

Pick Up Sticks. (2016). In M. E. Tom Jackson, More Activities That Teach (pp. 240-242). Red
Rock Publishing.
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