Note: Recreational therapy is defined as “a treatment service designed to restore, remediate and rehabilitate a person’s level of functioning and independence in life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restriction to participation in life situations caused by an illness or disabling condition” (American Therapeutic Recreation Association [ATRA], 2009). Recreational therapy, an aspect of therapeutic recreation, is a skilled therapy provided as active treatment (as defined by the Centers for Medicare and Medicaid Services). Recreational therapy, which was recognized as an allied health discipline by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) at its 2010 annual meeting, is part of the broader field of therapeutic recreation, which also encompasses trained professionals dedicated to providing outcome-based recreation services to all citizens.
Recreational therapists are professionally trained practitioners who:
- Individually assess the patient or consumer
- Plan intervention programs
- Implement safe and effective evidence-based recreational therapy interventions
- Evaluate the effectiveness of intervention programs
- Manage recreational therapy practice
Recreational therapists provide individualized and group recreational therapy interventions for individuals experiencing limitations in life activities and community participation as a result of a disabling condition, illness or disease, aging, and/or developmental factors, including those at risk. Recreational therapists use a variety of educational, behavioral, recreational, and activity-oriented strategies with clients to enhance functional performance and improve positive lifestyle behaviors designed to increase independence, effective community participation, and well-being. Recreational therapists are effective members of treatment teams in health care and community-based health care and human service agencies.
The day-to-day work experience of recreational therapists can vary dramatically, depending on the setting and clients they serve. The recreational therapist works with the client, family, members of the treatment team, and others to design and implement an individualized treatment or program plan, depending on the setting. During a typical day, a recreational therapist will respond to physician orders for assessment and treatment, conduct individualized assessments, and provide individual and group-based interventions to address treatment goals for patients on their caseload. Treatment interventions might include a stress management group or use of various relaxation and other techniques including, but not limited to:
Progressive muscle relaxation
- Guided imagery
- Deep breathing
- Biofeedback-based relaxation techniques
- A high or low ropes course or initiatives interventions
- Adapted sports
- Manual, visual, and expressive arts
- A therapeutic outing designed to meet specific goals for community integration
- A family intervention
- A therapeutic exercise or aquatic therapy session
Recreational therapists also verbally process intervention experiences with patients to enhance the impact the activity experience has on achieving treatment goals. In a typical day the recreational therapist will also document interventions provided, note patient progress, or develop a discharge plan with a plan for aftercare.
An important responsibility for a recreational therapist in clinical settings is to advocate for individuals with disabling conditions to improve integration and community participation, especially through recreational activities, after discharge from a health care facility. This includes addressing such issues as limited knowledge of opportunities, transportation resources, inaccessible facilities attitudinal barriers, and legislation that affects people with disabling conditions. Professional activities may also include developing appropriate support groups, advocacy, and social networking strategies.
In clinical settings, such as hospitals, psychiatric or skilled nursing facilities, substance abuse programs, and rehabilitation centers, recreational therapists treat and rehabilitate individuals with specific medical, social, and behavioral problems, usually in cooperation with physicians; nurses; psychologists; social workers; and speech, physical, and occupational therapists. In long-term, continuing care or residential facilities, recreational therapists may be involved in providing treatment as well as activities designed to maintain functioning and enhance the life quality of residents. In community settings, therapeutic recreation specialists work in adult care, outpatient programming, adaptive sports and recreation programs, home health, private consulting, developmental disabilities services, and other health and human services. Therapeutic recreation specialists working in parks and recreation services facilitate the inclusive recreation services for individuals with disabling conditions.
Recreational therapists should have assessed competency (knowledge, skill and ability) in the following recreational therapy content areas:
- Foundations of professional practice
- Recreation and leisure services
- Individualized patient/client assessment
- Planning treatment interventions
- Implementing treatment interventions
- Evaluating treatment/programs
- Managing recreational therapy practice
Recreational therapists should also have assessed competency (knowledge skill and ability) in the following support content areas as a foundation of understanding health and human functioning:
- Anatomy and physiology
- Human growth and development (lifecycle)
- Abnormal psychology
- Disabling conditions
Many may also have support content in:
- Cognitive or educational psychology
- Group dynamics and leadership
- First aid and safety
- Motor skill learning
- Health care organization and delivery
- Legal aspects of health care
Knowledge of disabling conditions; physical, social, cognitive, and affective development and functioning; and the application of therapeutic activities are essential in adapting activities to individual needs.
Recreational therapists held about 23,300 jobs in 2008. About 40 percent were in hospitals and 30 percent were in skilled nursing and residential/transitional facilities. Others were in community mental health centers, adult day care programs, correctional facilities, and substance abuse centers. About seven percent of therapeutic recreation specialists work in community parks and recreation and approximately five percent were self-employed, generally contracting with long-term care facilities or community agencies to develop and oversee programs (www.nctrc.org, www.bls.gov/oco/ocos082.htm).
Projections from the BLS show that employment of recreational therapists is expected to increase 15 percent from 2008 to 2018, faster than the average for all occupations. Job growth will stem from the therapy needs of the aging population. With age comes an inevitable decrease in physical ability and, in some cases, mental ability, which can be limited or managed with recreation therapy. In nursing care facilities—the largest industry employing recreational therapists—employment will grow faster than the occupation as a whole as the number of older adults continues to grow. (www.bls.gov/oco/ocos082.htm).
A bachelor’s degree with a major in recreational therapy or therapeutic recreation or recreation with a specialization in recreational therapy or therapeutic recreation is required for national certification. Specific requirements can be obtained from the National Council for Therapeutic Recreation Certification (see www.nctrc.org
Curriculum. In addition to recreational therapy courses in aspects of clinical practice (assessment, planning, implementing, and evaluating recreational therapy services), foundations of professional practice, management of recreational therapy practice, modality/interventions skills, and recreation and leisure services, students study human anatomy and physiology, human growth and development, psychology, abnormal psychology, and human services supportive coursework. These content areas are required by the National Council for Therapeutic Recreation Certification. In addition, the CAAHEP accredited requires kinesiology and educational psychology. Additional content areas studied for the degree may also include motor skill learning, counseling, group dynamics and leadership, first aid and safety, pharmacology, health care organization and delivery, and legal aspects of health care. In addition, an internship under the supervision of a certified therapeutic recreation specialist or a licensed recreational therapist (who has held the credential at least one year prior to supervising the intern) is required. Refer to the NCTRC website to review curriculum standards changes, effective January 1, 2012 and 2013. (www.nctrc.org)
Licensure, Certification, and Registration
Some states regulate the recreational therapy profession through licensure, certification, or registration of titles. Licensure is required in New Hampshire, North Carolina, Oklahoma, and Utah. These states require individuals to make application to their state boards and meet designated competencies in order to provide safe and effective consumer services. Washington requires state registration and California requires state certification. For more information on state licensure requirements, contact:
North Carolina Board of Recreational Therapy Licensure
Oklahoma Board of Medical Licensure and Supervision
Utah Division of Occupational and Professional Licensure
National certification is available through the National Council for Therapeutic Recreation Certification (NCTRC), which awards the title of Certified Therapeutic Recreation Specialist (CTRS).
Career Planning Publications
The ATRA and the CAAHEP Committee on Accreditation of Recreational Therapy Education (CARTE) provide valuable information on curricula and faculty in recreational therapy or therapeutic recreation programs that prepare professionals for recreational therapy practice. These sources identify the degree levels offered and accreditation status of each program. For inclusive recreation services, contact the Inclusion and Accessibility Network of the National Recreation and Park Association.
National Council for Therapeutic Recreation Certification
7 Elmwood Drive
New City, NY 10956
American Therapeutic Recreation Association
629 North Main Street
Hattiesburg, MS 39401
National Recreation and Park Association
Inclusion and Accessibility Network
22377 Belmont Ridge Road
Ashburn, VA 20148-4501
(800) 626-NRPA—membership information and other services
Reprinted from the 2010-11 edition of the Health Care Careers Directory, published by the American Medical Association, Chicago, Ill
Note: Adapted in part from the Bureau of Labor Statistics, US Department of Labor, Occupational Outlook Handbook, Recreational Therapists, on the Internet at www.bls.gov/oco/ocos082.htm.