INTERVENTION PROTOCOL 1

Intervention Protocol:

Power of Positivity

Sasha Gordon

University of Utah

RECTH 3360

Sandy Negley

October 19, 2016

INTERVENTION PROTOCOL 2

Flourishing Through Leisure and the Upward Spiral Theory of Lifestyle Change

The Flourishing through Leisure Model: An Ecological Extension of the Leisure and
Well-Being Model posits that leisure can be a beneficial mechanism in experiencing a positive
lifestyle change, as well as helping people reach their goals for well-being (Anderson & Heyne,
2016). This model is a strengths-based approach to recreational therapy, and is based on the idea
that leisure is a strength in and of itself, and can also be used to build other strengths.
The Flourishing through Leisure Model extends the main components of the Leisure and
Well-Being Model (LWM). For example, the outcome of recreational therapy services is still
well-being, but this model encompasses five dimensions of well-being: cognitive, social,
psychological/emotional, physical, and spiritual. The model shows how leisure can influence a
persons well-being across these dimensions in the context of their environment (Anderson &
Heyne, 2016). In addition to the LWMs focus on developing resources, the Flourishing through
Leisure Model focuses on developing resources and strengths. Similarly, within the component
of enhancing the leisure experience, this model expands this construct to include the facilitation
of leisure skills, knowledge, and environments.
While numerous studies have shown that leisure is associated with increased positive
mood, improved life satisfaction, less stress, better coping, and enhanced physical health, these
studies have failed to show how leisure brings about these outcomes (Anderson & Heyne, 2016,
p. 123). The authors bring in the broaden-and-build theory, and even more specifically, the
Upward Spiral Theory of Lifestyle Change. The broaden-and-build theory is based on the idea
that positive emotions have both momentary and long-term benefits.
The Upward Spiral Theory of Lifestyle Change gives an explanation of how positive
emotions can be used to make lasting lifestyle changes that will increase well-being. According
to the theory, The driver, or engine, of sustainable lifestyle change is positive emotion in the
form of enjoyment (Anderson & Heyne, 2016, p. 124). Enjoyment is what motivates people to
sustain lifestyle changes where willpower alone does not work.
Within the article, enjoyment is described in the contexts of the neuroscience of
enjoyment, passion, and prioritizing positivity. The neuroscience context looks at wellness
behaviors, and how positive emotions create non-conscious and increasing motives for wellness
behaviors (Anderson & Heyne, 2016, p. 126). When someone likes an activity, they
unconsciously become more willing to work for it, and want to do it again. Similarly, when
explaining passion, the authors explain that when a person is passionate about an activity, and
when they associate it with enjoyment, spontaneous positive thoughts about the activity come to
mind more often, which means they are more likely to engage in it. This is the upward spiral: as
someone comes to enjoy something, they want to do it more often, which leads to those
sustainable changes.
The final context in which the theory is discussed is prioritizing positivity. The authors
explain that this is using situation selection as an emotion regulation tool to leverage positive
emotions (Anderson & Heyne, 2016, p. 127). When a person prioritizes positivity, they are
more willing to work or put effort into those things that will lead to enjoyment. They make it a
priority to experience happiness everyday, and look for positive emotions regularly.
Combining the Flourishing through Leisure Model and the Upward Spiral Theory of
Lifestyle Change, recreation therapists can help participants identify their passions and learn to
prioritize positive emotions into daily life, which will create the upward spiral of positive
lifestyle change (Anderson & Heyne, 2016).
INTERVENTION PROTOCOL 3

Program Title:
Power of Positivity

General Statement of Purpose:

The purpose of the Power of Positivity program is to assist adolescents with depression
in recognizing the power of positivity, and to learn strategies to implement positive
thinking techniques in their lives.

Description of Program/Program Outcomes:

The Power of Positivity program will be facilitated in small groups of 6-8 adolescents
with a patient to staff ratio of 1 to 5, two times per week, or according to the treatment
schedule. The program will use a diverse set of approachesexperiential, didactic, and
creative expressionto teach the value of positivity, and provide clients with strategies
that will assist them in establishing patterns of positive thinking in their lives. Each
session will focus on educating the clients on different aspects of positivity and
developing resources to implement these aspects into their lives. Some of the techniques
that will be used include:
o Reframing
o Positive self-talk
o Self esteem work
o Mindfulness
o Emotion regulation
o Journaling
o Goal setting
o Internal locus of control
o Leisure education
The overall goals of the program are as follows:
o Reduce negative thinking and unhealthy emotional expression, and replace them
with positive thinking and healthy emotional expression to increase the well-being
of the adolescents receiving treatment.
o Clients will learn the mindfulness concept of staying present and develop
strategies to implement of practice of staying present.
o Clients will learn how to identify what is within a persons control and strategies
of how to let go of what is not within their personal control.
o Clients will learn to recognize negative thinking (self-talk) in order to reframe to
implement better decision-making skills.
o Clients will identify strategies for regulating their mood and emotions.
o Clients will identify new leisure interests that will increase positive emotions and
enjoyment.

Client Problems:
Depressed mood (may be irritable mood in adolescents)
Feelings of worthlessness or excessive guilt
o Focusing on past failures or mistakes
o Placing unnecessary blame on self for things out of ones control
Difficulty regulating emotions
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Loss of interest in activities

Difficulty thinking clearly or concentrating

Referral Criteria:
Treatment team referral
Family request
Physician order

Contraindicated Criteria:
Clients with a currently high suicide risk
Extreme behavior problems (such as violence towards self or others) in school or home
lifeas measured by the facility (i.e. point system, etc.)

Intervention Activities or Techniques:

Staff Training/Certification Requirements:

Utah state licensure (TRS or MTRS)
National certification through NCTRC (CTRS)
CPR and First Aid certification
Behavior management training
Utah State Drivers License
Completed driving seminar
Mindfulness training

Risk Management:
Be aware of the risk factors, or related factors of the diagnosis with each patient (i.e.
anxiety, self-harm or suicide risk, substance abuse, eating disorders, violence, anger,
etc.).
Maintain appropriate patient to staff ratio at all times in intervention sessions (a minimum
of 1 staff to every 10 patients).
Careful monitoring of all supplies and materialsparticularly any that could be used for
self-harm.
Have a specific plan set up for responding to anger or violent outbursts that could
potentially take place during a sessionhow staff will respond to the individual, how to
get other patients out of harms way, etc.
Train all staff on appropriate responses to challenging behavior and violence.
Check any equipment for safety concerns before and after each use.
If transportation is necessary for any of the sessions, only trained staff will drive, and all
passengers will be checked to make sure seat belts are being used.

Outcomes Expected:
Clients will demonstrate an understanding of positive thinking.
Clients will demonstrate strategies to implement positive thinking techniques.
INTERVENTION PROTOCOL 5

Clients will demonstrate reframing as a positive thinking technique.

Clients will demonstrate the ability to use positive self-talk messages.
Clients will demonstrate mindfulness strategies to implement positive thinking
techniques.
Clients will identify techniques to refocus and stay in the present.
Clients will identify new positive leisure activities that can be used as coping strategies
for depressive symptoms and negative thinking.

Program Evaluation:
Client Outcomes:
o Each client will be given an individualized assessment upon admission to the
facility. The therapist and the client will work together to use the results of the
assessment to establish goals and objectives for the client related to positivity and
the outcomes of the program.
o Formative assessments will be used regularly to monitor client progress towards
the desired outcomes. These will include observations, interviews, participation,
journals, and worksheets during sessions. Interviews will be used to get the
clients perspective on how well they think they are doing at implementing the
positive thinking strategies and techniques they have been taught. Observations
will be used to gain a more objective view of their progress.
o The therapist will document progress notes for the client after each session. If
needed, changes will be made to the goals and objectives based on the clients
progress during the program.
o Summative evaluation will be done to measure overall client outcomes. This will
include another individualized assessment to measure changes and progress from
the time of admission. Additionally, the therapist will review documentation and
progress notes for the client from the formative evaluations.
Program Outcomes:
o Formative evaluations will be done to measure the effectiveness of the program in
meeting client goals and objectives. This will be done by compiling
documentation for the clients to see if their progress is leading towards the
expected outcomes of the program.
o Necessary changes will be made to the program based on formative evaluations if
it appears that client outcomes are not being accomplished.
o At the end of the program, a summative evaluation of the program will be done to
measure the client outcomes against the expected outcomes of the program. If
those expected outcomes were not met for the clients, the program will be
reevaluated to identify what changes need to be made in order to ensure those
outcomes in the future.
o This information will be used in the overall Quality Improvement Program.

S. Gordon TRS, CTRS

10/19/2016 (Student)
INTERVENTION PROTOCOL 6

References

Anderson, L.S., & Heyne, L.A. (2016). Flourishing through leisure and the upward spiral theory

of lifestyle change. Therapeutic Recreation Journal, 50(2), 118-137.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: American Psychiatric Publishing.