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Therapeutic Recreation (TR) is in the midst of exciting and challenging changes in health and human services. One of the toughest challenges is creating, planning, implementing, and evaluating TR intervention programs that are based on “best practice” and provide maximum accountability to invested persons and parties. These services are designed and delivered to produce outcomes that are valued by, meaningful to, and important to the consumer as well as other service providers. This book represents a synergistic, collective effort to bring the newest information on outcomes, accountability, and evidence-based practice to the field of therapeutic recreation. It does so with a specific focus on the process of designing, delivering, and evaluating comprehensive and specific programs (as opposed to specific groups of clients). The actions and decisions described in these chapters apply to all population groups with which therapeutic recreation specialists work. The book begins with three chapters on background information on outcomes and accountability from national and international perspectives, within and external to the profession of therapeutic recreation. In the next three chapters, past, present, and future directions for outcomes research in therapeutic recreation are highlighted. The next seven chapters address the process of theory selection, program design, assessment, implementation, evaluation, performance improvement, and marketing. The last chapter provides a brief state-of-the-art of outcomes and evidence-based practice in therapeutic recreation. Collectively, these chapters are intended to upgrade and update the outcomes literature within the field and spur professionals into providing higher quality and more meaningful services to all clients. These tasks are not without effort; we are not implying that creating evidence-based practice is easy—but we are saying it is desirable, necessary, and must be taken seriously by every student and professional. Today is the day to start, if even with a small step. We welcome you to open this book, open your mind, and determine how you can best contribute to the outcomes movement within therapeutic recreation. The field and our clients are depending on you.