Intervention Protocol

Kenzie Marrott and Lexi Mireles

RECTH 5360- Professor Steve Bell

April 2nd, 2021

 
Program Title:
This is Me

General Program Purpose: 

To provide opportunities for clients with depressive disorders to explore and discover self-
identity, healthy emotional expression, and a sense of purpose through expressive arts.
Through this program, clients will obtain skills that will assist in developing the motivation and
self-confidence to achieve their established life goals. 
 
Program Description: 
This is Me is a gender-neutral program that utilizes expressive arts as a therapeutic modality for
adolescents ages 13-17 with a diagnosed depressive disorder–– specifically major depressive
disorder. This program takes place in an in-patient youth facility and will include group
interventions that will be facilitated by a licensed and certified Recreational Therapist. This is a
12-week program that will take place 2x a week for a duration of 1 hour each session. This
program will give clients the opportunity to develop skills through engaging in various art
mediums that aim to increase sense of self-identity, increase self-confidence, and increase
motivation to establish and achieve life goals. 
 
Program Outcomes:
 Clients will learn to identify and healthily express their emotions.
  Clients will gain awareness of their potential through self-knowledge and self-
understanding.
  Clients will gain a sense of purpose which will allow them to find motivation and form
resiliency.
 
Client Problems to be Addressed:
 Emotional Concerns
o Clients may feel a lack of motivation to participate in interventions, a diminished
sense of pleasure or interest, low self-esteem, experience sadness, hopelessness,
guilt, stress and/or have suicidal ideation.
 Physical Concerns
o Clients may not have the energy or stamina to participate in activity due to
weight loss/weight gain, current or new medications, insomnia/hypersomnia,
psychomotor agitation, lack of self-care, etc. 
 Social Concerns
o Clients may not have a desire to be around others and would prefer to be alone
compared in a group setting.
Three Activity Interventions

Name of Activity: Letter to my future self 

Population: Adolescents with Major Depressive Disorders.
Age: 13-17
Group size: 6-12
Setting considerations: 
 Spacious Room for spreading group out 
 Safe therapeutic environment 
 2 large workspace tables 
 Adhere to the COVID-19 physical distancing guidelines
Purpose:
The  purpose of this activity is to help adolescents reflect on their self-identity and acknowledge
behaviors and/or characteristics that are no longer serving them. 

Outcomes:
 To identify behaviors that no longer serve them.
 To express emotions they currently feel. 
 To identify and express who they want to be in the future.

Supplies:
 12 pieces of lined paper
 6 pencils
 6 pens
 2 marker sets
 White board/marker
 Variety of colored construction paper
 3 glue sticks
 
 
Intervention Description:
 Opening:
o Group will sit at a crafting table. 
o Recreational therapists will welcome everybody to group and announce that the
activity will be creating a small booklet and writing a future letter to themselves. 
 “Welcome everybody! Today we are going to be creating a small booklet
and writing a future letter to yourself. The purpose of this activity is to
reflect on who you are today and where you would like to see yourself in
the future. This activity will help you identify what parts of your identity
you want to carry on with you into the future, and which parts you would
like to leave in the past.”
 Body:
o Start by passing out construction paper to each participant and have them follow
your step-by-step demonstration of how to fold the booklet. The recreational
 therapist will not move onto the next step until everybody in the group has
completed the step demonstrated. 
o Once all participants have finished folding the booklet, give the group 10 minutes
to glue on construction paper for the front and back of the book. Prompt them
to draw/color/decorate their cover as they like. 
o Next, instruct the group to silently write a letter to their future self in their
booklet for 15 minutes. Have them write down their thoughts, feelings, or any
other thing they would like their future self to be aware of or remember. Ask
them to be as specific as possible when writing about these topics. Let them
know they can write about whatever they want to, as long as they follow the
prompt of it being something they can learn from a challenge they currently
face. 
 Closure: 
o Gather in a seated circle and promptly discuss the general message each
participant wrote in their letter. Ensure that group is safe and let them know you
appreciated their cooperation today. Thank them for coming to group and end
the session.  
Processing Question:
o Remembering: 
 What did we do?
 What were the steps we did to complete the activity?
o Understanding:
 Why is it helpful to visualize your ideal future self?
 Why is it important to write this down?
o Applying:
 How can you apply these lessons in your lives now, not waiting until the
future?
 How can you apply what you learned today to other aspects of your life?
o Analyzing:
 What is the problem with not writing your goals down?
 How was this similar to what you have done in the past?
o Evaluating:
 How have these challenges strengthened you as a person?
 Did this activity change the way you think about yourself?
o Creating:
 Imagine yourself 15 years into the future, what advice do you think your
future-self would give the version of who you are today? 
 What other ways can you visualize goals?

Risk Considerations:
 Participants must understand how to use supplies properly.
o Sharps, glue, etc.
 The therapist will have an understanding of possible triggers and will adjust accordingly.
  The therapist will be very aware of art tools that participants could use to harm others
or themselves. 
 
Possible Assignments:
o End by giving them a small assignment to implement by the next RT activity.
Encourage the group to frequently write in these books about their experiences
and how it can help their future selves but ask them to write in these booklets at
least two more times by the next activity. Let them know that they can follow
the prompt on the board but ask that they write at least one journal discussing
where they want their future self to be in 1, 3, and 5+ years’ time. Let them
know that it will relate to next week's activity. 

Adaptations :
 If a participant has physical, emotional or cognitive limitations, the therapist will adjust
intervention as needed. 

References:
Andrea. "Letter to My Future Self." Blog post. Recreation Therapy Ideas. Blogger, 24 July 
2013. Web. 20 Mar. 2021. http://rectherapyideas.blogspot.com/2013/07/letter-to-my-futu re-
self.html
King, L. A. (2001). The Health Benefits of Writing about Life Goals. Personality and 
Social Psychology Bulletin, 27(7), 798–807. https://doi.org/10.1177/0146167201277003
 

Name of Activity: Who am I: Dream Board

Population: Adolescents with Major Depressive Disorder
Age: 13-17
Group size:  6-12

Setting considerations:
 2 large workspace tables 
 Well-lit room
 Adhere to the COVID-19 physical distancing guidelines

 Purpose:
 The purpose of this intervention is to inspire ideas for life goals by creating a visual
representation of achievements they wish to accomplish. 

Outcomes:
 To identify at least 5 goals they want to achieve 
 To express 1 emotion they felt during the activity
 To use art as a tool for visualizing goals
Supplies: 
 Box of magazines
 6 pairs of scissors 
 6 glue sticks 
 3 large poster boards 
 2 sets of markers
 Constructive paper 
 White paper
 6 pencils 
 Music speaker 
 Pack of stickers
 Rhinestones
 Glitter 
 
Intervention Description:
 Opening
o Participants will be seated at the crafting table
o The recreational therapists will welcome everybody to group and announce that
we will be creating a dream board for today’s activity. 
 “Today we are going to create a dream board, better known as a vision
board! The purpose of this intervention is to help you get an idea of what
kind of things you want to obtain in the future. This could relate to your
lifestyle, characteristics you want in yourself, your dream job, etc. It is
also beneficial to visualize the outcomes of your goals so it can help you
see a clear picture of what you want to achieve in life. Visualizing also
helps you become motivated to accomplish these goals. If you are having
a hard time setting goals for yourself, this is a great activity to explore
what goals you would be interested in setting.” 
o Before the activity starts, ask for participants to raise their hands if they have
ever heard of a vision board before. For the participants who have raised their
hand, ask for them to briefly share what their thoughts or experiences were in
creating one. 
 “Can I get a show of hands for how many people have heard of a vision
board before? Awesome! Now out of the individuals with your hands
raised, how many of you have created one yourselves? Great! You can
lower your hands now. Would any of you feel comfortable with sharing a
brief thought or experiences you have with vision boards?” 
o After hearing a few responses, begin by explaining a common misconception
about vision boards. 
  “There seems to be a misconception about vision boards, which is
thinking that if you manifest or simply imagine yourself accomplishing
these goals, then they will eventually come true. This is somewhat
partially true, but also not enough to get you to actually accomplish your
goals. A vision board will assist you to set your goals and develop steps to
 achieve those goals. It is wishful thinking to believe that only visualizing
and wanting will be enough to achieve success. In reality, you are going
to have to act out your plan to accomplish these, which can take hard
work and effort. Vision boards are really the first step in helping you
identify purposeful goals that you want to eventually act out and
achieve.”
 Body
o Pass out supplies, such as magazines and the boards. Place markers and coloring
pencils on the table for the group to use. Instruct the group to tear out pictures
from magazines and keep them in a pile. Once they are done finding their
pictures, have them advocate for scissors and glue. 
o The group will then begin creating their boards. Let them know that they are
welcome to draw whatever they want to achieve on their board if they were
unsuccessful in finding a magazine picture that reflects their goal.  
o Therapists will walk around the room and have brief check-ins with participants
to see where they are at with their boards and offer support when needed.
 Closure:
o Recreational therapists will facilitate a short closure of group experiences and to
ensure all are safe. The group will stand in a circle and express one word to sum
up their feelings about the vision they have created for themselves in the future.

Processing Questions:
o Remembering:
 What did we just do?
 How did we do it?
o Understanding:
 Why is it helpful to visualize your goal?
 Can you summarize what we just did?
o Applying:
 How can you apply these lessons in your lives now, not waiting until the
future?
 How can you apply what you learned today to other aspects of your life?
o Analyzing:
 Was this similar to any past interventions you have participated in?
 How did this method of goal settings compare to other goal settings
you've done?
o Evaluating:
 How effective do you think this method is?
 How did this activity make you feel?
o Creating:
 What other creative ways can you visualize your goals?
 What would happen if you didn’t write down your goals?
 
Risk Considerations:
  Participants must understand how to use supplies properly.
o Particular focus on sharps and glue. Count all sharps and harmful supplies before
and after the group takes place.
 Prior to the group beginning, the therapist will look through magazines and tear out (if
any) inappropriate content containing vulgar language, illegal substances, and/or images
that could potentially increase symptoms of depression. 

Adaptations:
 If a participant has physical, emotional or cognitive limitations, the therapist will adjust
intervention as needed. 
o The therapist will look over participant’s charts prior to intervention so they may
plan accordingly.
o If a participant is feeling unmotivated or lost about life direction, lower the
expectations of the participant depending on where their current emotional,
physical, cognitive level is at.  

References:
Pisciotta, G. (2018, January 19). Making no progress on your goals? Try a Vision Board. Rec, 
Play, Live. https://www.rec-play-live.com/making-no-progress-try-vision-board/. 
 
Fortuna, J. K. (2020). Healing the Mind and Soul with Art and Music. Open Journal of 
Occupational Therapy, 8(4), 1+. https://link.gale.com/apps/doc/A643530121/AONE
?u=marriottlibrary&sid=AONE&xid=16ecfbc5
 

Name of Activity: Nice to Meet Me: Expression Through Movement

Population: Adolescents with Major Depressive Disorder
Age: 13-17
Group size: 6-12
Setting Considerations:
 Large space (20x 30 ft)
 Smooth wood floors
 Large Mirror preferred
 Adhere to the COVID-19 physical distancing guidelines

Purpose:
The purpose of the Nice to Meet Me: Expression Through Movement program is to raise
awareness of one’s own emotions and how to healthily express and cope with those emotions.

Outcomes:
 Participants will identify an emotion and express that emotion through body movement.
 Participants will gain a sense of identity by recognizing one’s own emotions.
 Participants will engage in a physical activity to improve overall mental health.
Supplies: 
 Speaker to play music
 RT department’s ipod
 Playlist with variety of music
 Water Bottles & water
 Socks and shoes
  
  Intervention Description:
 Opening :
o Participants will sit in a large circle.
o The therapist will state the purpose of expressing feelings and how body
movement/dancing can be a great way to express feelings in a different way. The
therapist will state the goals of the intervention and have participants express
their expectation of the intervention
o Therapist may express the information about the importance of dancing as a way
to express emotions such as:
 “Dancing is an art form that has been around for thousands of years.
There are many different styles of dance and can all be used to express
emotions. Dance and movement is a great way to express how you are
feeling without the use of words. Expressing emotions can be
challenging, but it is important to understand our emotions and knowing
how to cope with what we are feeling. Movement of the body is a great
way to express ourselves, connect with others and to engage in physical
exercise.”
o Have a discussion covering the following:
 “Who are you?”
  How would you describe yourself to someone you just met?
 “What are emotions?” 
 Have students share what they interpret as emotions.
 “When was a time you felt scared, happy, etc”
 Talk about how experiences can lead to emotions.
 Body:
o Warm up:
 Have participants move their body freely to music to warm muscles up.
 Following, the therapist will guide participants in a simple 5 minute
stretch that will get their blood flowing and muscles warm.
 Therapist will remind participants that it is important to warm up their
body prior to any physical activity to reduce risk of injuries.
o Reminders:
 “No one can do this wrong. Focus on yourself and don’t worry about
others.”
 This activity is to understand our own emotions and how we are able to
express them in a healthy way.
o Part 1:
  The therapist will state different emotions that participants must express
through movement of the body.
 Angry, happy, scared, excited, etc.
 “Without saying words, show us that you are angry,
embarrassed, happy, etc.”

o   Part 2: 
   Therapist will remind participants that oftentimes, situations lead to
emotions. Whether that is a positive or negative emotion. 
· “Have any of you ever gotten a bad score on a test? How did that
make you feel?”
·       “What emotions do you feel when you’re watching your
favorite movie and why?
   The therapist will then combine part 1 and part 2 together having
participants express different emotions through everyday situations.
·       Example:
o   Have participants pretend to grocery shop through
dance as if they were angry, happy, sad, etc.”
o   Part 3:
 The therapist will then ask participants dance situations from their
own lives if they feel comfortable. If comfortable, have
participants go one at a time.” 
o  “Dance a situation where you felt scared.”
o  “Dance a situation where you felt excited.”
 Closure:
o The therapist will instruct participants to sit in a relaxing position and close their
eyes. 
 Relaxing music playing in the background.
o Participants will take several minutes to reflect their experience.
o Have participants repeat after the therapist while they express words of
affirmations.
 “I am important, “I have value,” etc.
o Close by asking if everyone feels safe and remind them that you as a therapist
are there for them. Thank them for attending and participating.

Processing Questions:
o Remembering:
 What did we just do?
 What were the steps we took to accomplish the activity?
o Understanding:
 Why did we do this?
 Why is expressing emotions important?
o Applying:
 Next time you are upset, how will you express yourself?
  What are other healthy ways to express yourself?
o Analyzing:
 What is the relationship between how you express yourself with words
compared to movement?
 Can you distinguish between healthy and unhealthy coping skills?
o Evaluating:
 Do you think bottling up your emotions is a good or bad thing? Why is
that?
 How would you have handled a situation when you were feeling alone?
o Creating:
 Can you see a possible solution to express yourself when you are feeling
helpless?
 How many ways can you express the feelings of sadness?
Risk Considerations:
 While doing physical activities, there is always a risk in hurting oneself or others.
o Remind participants to consider their limits when dancing.
o Have participants fully warm up before starting activities.
 Participants must bring personal supplies to group:
o Water bottles.  
o Closed toed shoes

Possible Assignments:
 Prior to the session, challenge participants to be aware of how they express their
emotions when they are sad, happy, annoyed, etc.
o Have participants write them down.
 After session, challenge participants to be aware of their emotions and a healthy way to
express those emotions.

Adaptations:
 If a participant has physical, emotional or cognitive limitations, the therapist will adjust
intervention as needed. 
 If unable to stand or support one’s self, adapt to participants using their upper
extremities. 
 If a participant is unable to participate in movement due to religious or cultural reasons,
the therapist will adjust as needed.
References:
Dixon, C. C. (n.d.). Dance and MOVEMENT activities for Recreation Therapy. 
https://www.recreationtherapy.com/tx/txmove.htm. 
Knestaut, M., Devine, M. A., C.T.R.S., & Verlezza, B. (2010). "It Gives Me Purpose": The Use 
of Dance with People Experiencing Homelessness. Therapeutic Recreation Journal, 
44(4), 289-301. 
 
 
Referral Criteria:
Clients may be referred by a parent/guardian, social worker or a judge in court. To register, the
parent/guardian must register either online or in person. The facility’s website will have
information on the different programs the Recreational Therapy department offers.. It will also
be posted in other mental health settings including treatment centers, physician offices, and
family medicine practices.
 
Contraindicated Criteria:
 Clients who are currently experiencing self-harm behaviors may require one-on-one
therapy with a recreational therapist prior to working with sharps  (scissors, etc.).
 Participants who deal with anxiety or have fears with social settings will be able to work
with recreational therapists prior to group sessions to work on healthy coping skills
while being in a social environment. 
 

Licenses/Certifications/Trainings:
 Recreational Therapist will have Utah State license as a TRS or MTRS
 Recreational Therapist will have national certification by MCTRC as a CRTS
 Therapists will be CPR and First Aid Certified
 Therapists will undergo training that includes:
o Understand and adhere to the facility’s policies, procedures, and protocols
o Knowledge of the This is Me program
o Goals and outcomes of the This is Me program
o Experience in using art as a therapeutic tool
o Understanding of a variety of mental disorders
 Suicide Prevention Training
 Cultural Competency certificate
o Completion of the facility's cultural competency training is required for all staff
members.
 
Risk Management Considerations:
 All sharps are counted prior to and after group activities
o All sharps are monitored at all times by therapist
o Participant’s use of sharps is at the discretion of the therapist
o Therapists will state the expectations of using sharps prior to each activity
 Appropriate ratio of therapists to participants (1 therapist: 12 participants)
 Participants are warmed up before participating in physical activities
 Medical emergency procedures are in place for participants and staff.
 
Cultural Considerations:
 Cultural considerations should be taken when choosing art, music and pictures. 
Therapists should take extra precaution when selecting these materials. 
 Representation of a variety of races should be considered while choosing pictures,
books, music, movement, etc. 
 Procedure in place for staff and participants in regard to cultural considerations.
  Recreational therapists will review all interventions for cultural sensitivity. 
 
Program Evaluation:
 Each client will be observed throughout interventions to allow the recreational
therapists to measure the client’s progression or regression. This will be charted and
recorded in the client’s treatment documentation for evaluation by all staff and
insurance needs.
 Each client will complete a survey after the end of each week. This survey will include
what the participant viewed as the intervention’s pros/cons, what they took away from
the intervention and how they will apply what they learned into their lives. 
 Recreational therapists will evaluate each intervention's completion. Recreational
therapists will document what they believe will allow for the program to continue to
progress. The department’s manager will review evaluations to make modifications to
the program as needed.
 
 
 
 
K. Marrott, Student
TRS, CTRS
L. Mireles, Student
TRS, CTRS
4/2/2021
 
 
  References 

Andrea. "Letter to My Future Self." Blog post. Recreation Therapy Ideas. Blogger, 24 July

2013. Web. 20 Mar. 2021. <http://rectherapyideas.blogspot.com/2013/07/letter-to-my-

future-self.html>.

Dixon, C. C. (n.d.). Dance and MOVEMENT activities for Recreation Therapy.

https://www.recreationtherapy.com/tx/txmove.htm. 

King, L. A. (2001). The Health Benefits of Writing about Life Goals. Personality and Social

Psychology Bulletin, 27(7), 798–807. https://doi.org/10.1177/0146167201277003

Knestaut, M., Devine, M. A., C.T.R.S., & Verlezza, B. (2010). "It Gives Me Purpose": The

Use of Dance with People Experiencing Homelessness. Therapeutic Recreation Journal,

44(4), 289-301. 

Pisciotta, G. (2018, January 19). Making no progress on your goals? Try a Vision Board.

Rec, Play, Live. https://www.rec-play-live.com/making-no-progress-try-vision-board/. 

Stumbo, N. J., & Peterson, C. A. (2009). Therapeutic recreation program design:     

Principles and procedures. San Francisco, Calif: Pearson/Benjamin-Cummings.