A Reminder of Where We Came From & An Identity for the Future

By: Nathan Lamaster, CTRS (Founder of SMART CEUs Hub, the Rec Therapy Directory, CEU Cloud, and the TR Entrepreneur Connection; Author of the book “The Entrepreneur Rec Therapist: The Business Education You Missed in School)

An Overview of Recreational Therapy’s History:

The premise of therapeutic recreation (TR) can be traced all the way back to the mid-1850s when Florence Nightingale (the founder of modern nursing) proposed that recreation/leisure experiences could be drawn upon to help improve the quality of life for all people (1). However, it was not until 1919 when brothers Karl and William Menninger (leaders in the field of psychiatry) coined the term “recreational therapy” that the world started adapting to this way of thinking. In 1931, the first “Recreation Hospital Workers” were being hired by the American Red Cross to help aid in treating behavioral health patients (1). After the first case studies by the Menninger brothers, recreational therapy showed its positive therapeutic value by improving clients’ behavioral health symptoms, and other psychiatrists throughout the country began to adopt this therapy as part of their treatment plans (2). Recreational therapy was also incorporated in the education efforts of people who had developmental disabilities, but eventually, these programs started to phase out as people held the unrealistic idea of a “cure” for these clients (2).

In 1948, the American Red Cross had a shortage of donations and eliminated nearly four-fifths of all of their recreational therapy programs. At this time, the “recreation hospital workers”, in an effort to preserve the profession, decided it would be best to align themselves with the American Recreation Society (ARS) and became the “Hospital Recreation Section” of ARS. This group, led by Harold D. Meyer, started to promote college curriculum that was very similar to the already existing community recreation component of the Parks and Recreation industry and held the philosophy that “recreation is an end in itself and as such met a specific human need for those persons who were institutionalized.” (2). In 1952, B. E. Phillips and other like-minded individuals did not agree that this was the best philosophy to allow for the field to develop and grow on a professional level. They dissented and formed the Recreation Therapy Association (RTA) which was a division of the American Association of Health, Physical Education, and Recreation (AAHPER).  AAHPER’s philosophy was that “recreational therapy’s primary purpose is to assist physicians in their treatment of patients as a means to recovery.” (2).

Unifying such a diverse profession, and representing the interests of over 19,000 professionals, continues to be a challenge for change and growth in the field.

The original credentialing body of therapeutic recreation personnel began in 1956 with the establishment of the Commission for the Advancement of Hospital Recreation (CAHR), which later was replaced by the National Council for Therapeutic Recreation Certification (NCTRC) in 1981. In 1965 AAHPER and the ARS combined to form the National Recreation Therapy Society (NTRS) which was a branch of the National Recreation and Park Association (NRPA). This was due to the idea that together could form a stronger whole along with the other branches of the NRPA. Both organizations believe that together with the other branches of NRPA they could be stronger.  However, because the differences in philosophies were still very apparent, NTRS could not agree on its own basic tenants. This disagreement lasted all the way into the 1970s and eventually became a point of disagreement with NRPA. It was the consensus of NTRS that one of its goals should be “treatment”, which was unlike the rest of the NRPA (2). This led to a discussion in the 1980s about the need to form a separate organization apart from NRPA. Dave Park, a former executive secretary and past president of NTRS, decided to take a bold position. He and a group of other Recreational Therapists met and decided to take action. A committee composed of Carol Peterson, Dave Austin, Ray West, Dick Beckley, and Melinda Conway proposed a definition of recreational therapy that would help to separate it from the rest of the parks and recreation industry. The definition they came up with at that time was: 

“Therapeutic Recreation is the provision of treatment services and the provision of recreation services to persons with illnesses or disabling conditions. The primary purposes of treatment services, which are often referred to as recreational therapy, are to restore, remediate or rehabilitate in order to improve functioning and independence as well as reduce or eliminate the effects of illness or disability. The primary purposes of recreation services are to provide recreation resources and opportunities in order to improve health and well-being. Therapeutic recreation is provided by professionals who are trained and certified, registered and/or licensed to provide therapeutic recreation (2).”

A huge impact of business is its ability to reach the masses with its message and more and more Recreational Therapists are interested in using this vehicle to lead to our success.

Due in part to the hard work of the committee, and the new definition formed, growth in the profession we know today continued.  On June 12, 1984, the American Therapeutic Recreation Association (ATRA) was officially incorporated in Washington, D.C. by fifty founding members who each contributed $100 to the forming of this new organization. These members elected an Interim Board of Directors (with Peg Connolly as the president), who were charged to complete the Articles of Incorporation for this new organization. By July 1985, the membership of ATRA had grown to three hundred members from the original fifty. As ATRA grew, there were still members of NTRS who held on to the prior philosophy that recreation is an end in itself which caused a divide in the field. Ultimately, in 1996, both organizations decided to adopt a joint resolution where both organizations would serve to direct the profession moving forward. It was in 2003 that NTRS phased out completely and left ATRA as the sole helm for the direction of our profession which remains true in present-day (3).

References Used in Section
  1. “What Is Recreation Therapy?”- http://www.zepfcenter.org/news/2015/09/28/regular-news/what-is-recreation-therapy/
  2. “The Conceptual Development of Recreational Therapy”- https://www.idyllarbor.com/journal/rthistory.shtml
  3. “ATRA – Famous since 1983 – Founded in 1984”: The Early History of the American Therapeutic Recreation Association”- https://cdn.ymaws.com/www.atra-online.com/resource/resmgr/ATRA_History/3_3_14_ATRA_is_Formed.pdf

Statistical Info in the Field of TR Today:

According to the US Bureau of Labor Statistics (BLS) website (as of 6/4/2020), there are currently nearly 19,800 Recreational Therapist jobs in the United States of America (4) and according to NCTRC, there are over 18,000 Recreational Therapists who hold the Certified Therapeutic Recreation Specialist (CTRS) certification (5). NCTRC’s statistics do not also capture the number of Recreational Therapists in licensed states (OK, UT, NH, NC, and NJ) or the number of Recreational Therapists solely holding state certifications in the states of Texas and California.

Currently, Recreational Therapists work in a variety of settings including Behavioral Health Facilities, Long Term Care Facilities, Adult Day Programs, Correctional Facilities, Camps/Community/Parks and Recreation Centers, Physical Rehabilitation Hospitals, In-Home Practice, Schools/Universities, Adaptive Sports Programs, Pediatric Hospitals/Facilities, and other locations as well (4). Unifying such a diverse profession, and representing the interests of over 19,000 professionals, continues to be a challenge for change and growth in the field.

 

References Used in Section
  1. US Bureau Of Labor Statistics: Recreational Therapist- https://www.bls.gov/OOH/healthcare/recreational-therapists.htm
  2. National Council for Therapeutic Recreation Certification (NCTRC)- https://www.nctrc.org/employers/information-for-employers/

Key Points of Understanding:

Knowing our history is key to understanding the current issues facing our profession today. As discovered by this look into our history, one of the biggest factors impacting recreational therapy is an identity crisis.

The questions we all must ask ourselves as Recreational Therapists are:

Do I align myself with the philosophy of recreational therapy’s primary purpose being that “recreation is an end in itself and as such met a specific human need for those persons who were institutionalized”? (2)

-or-

Do I align with the philosophy of recreational therapy’s primary purpose being “to assist in the treatment of our clients as a means to recovery, restoration, and/or rehabilitation?” (2)

I believe the answer to this question of philosophy must be agreed upon for us, the recreational therapists of the world, to successfully move forward in the same direction as a profession. Otherwise, I fear the danger will be that we continue down the same path of disagreements and dissentions that have held us back in the past. We cannot be headed in 2 separate directions and expect to make any headway. For a majority of those of us working in the profession, we want Recreational Therapy to grow, be internationally recognized and be respected.  In order to do this, however, we must first have a shared identity (AKA a professional brand) that we can market to the world. For people to really understand who we are, what we do, and to ask for us by name, we need a singular message to describe our field. Otherwise, we will continue on this Merry-Go-Round ride, going in circles but never really get anywhere. If we don’t make it a priority to fix this soon, we could dissolve as a profession together which none of us want.

 

References Used in Section

2. “The Conceptual Development of Recreational Therapy”- https://www.idyllarbor.com/journal/rthistory.shtml

Establishing Our Identity:

What is recreational therapy?  What is a recreational therapist?  What do we do? Do we have a brand and an identity? The problem area discussed above is a problem of “identity”. Thus, the goal I have decided to work toward in this section is to provide my reasoning for what identity I think the field of Therapeutic Recreation should align.

*Please understand that I am presenting my personal point of view. If you have a differing point of view of what our identity should be as a profession, I welcome you to add your perspective in the comments section below so that other Recreational Therapists can determine what they feel is the best identity for us to adopt.

That being said, I purpose we align ourselves with the following identity for describing Recreational Therapy and what a Recreational Therapist does to the masses:

“Recreational Therapy is the practice of using recreation and leisure activities as tools/interventions to help restore and improve the functioning of individuals in the five domains of human life (Physical, Cognitive, Emotional, Social, and Spiritual). The Recreational Therapist uses the systematic approach of the APIED process to deliver these interventions regardless of their work setting and/or their served population.”

The reasoning I have for proposing this to be our shared identity is that:

1. It establishes us as a helping profession, rather than an activity or event planner, which already exists separately from Recreational Therapy. (i.e.: Activity Directors, Cruise Ship Directors, Recreation Leaders, Sports Managers, etc.). By differentiating ourselves this way, it helps the public and members of the interdisciplinary team know that we play a different role in the workforce. *This does not say that those with roles in activity planning are less valuable than Recreational Therapy. They are just different.

2. It allows the profession to create streamlined marketing materials to spread the word of what we do and to create a brand. The way we describe ourselves to the general population should be unified across the board. (Example: Occupational Therapists, Firefighters, Policemen, Doctors, etc.). Within each of these broad titles there can still be specialties, but the main connecting job category is the same. (Example: Doctor of Podiatry, Firefighter Paramedic, Motorcycle Policeman, etc.).

 

3. It creates a place for us to thrive in the ever-expanding healthcare industry. According to the US Bureau of Labor Statistics (BLS), the healthcare industry as a whole is expected to grow by 1.9 million jobs in the next ten years. We need jobs and we want adequate pay for our education and expertise. In the healthcare environment where most Recreational Therapists work (Long Term Care, Behavioral Health, Physical Rehabilitation, etc.), we can create more jobs for us and also receive a higher paycheck due to the ability to bill insurance. I am not just talking about Medicare either. Some states currently allow Recreational Therapy to bill Medicaid waivers at the rate of up to $77.24/hour as well as let you start your own private practice (Example: Texas and Indiana) and one state allows Recreational Therapists to bill “No Fault” Auto Insurance (Example: Michigan). There are also current efforts and legislature promoting the inclusion of Recreational Therapy under Medicare’s “3 Hour Rule,” which would unquestionably increase the awareness of our profession, our ability to command larger salaries and increase the available Recreational Therapist jobs in the job market.

 

4. It allows us to establish a core curriculum for Recreational Therapy in our colleges and universities. Recently NCTRC made the important decision to increase the amount of recreational therapy (RT) related courses someone must take to obtain their certification to 6 from 5. This increase in the number of classes required by NCTRC has prompted colleges to change their curriculum. This along with a push for colleges and universities that have RT programs to adhere to accreditation standards through organizations such as CARTE and COAPRT is moving us toward a more unified profession as we speak. With a core curriculum, you create a baseline for the competencies of a Recreational Therapist across the board. Employers, patients/clients, families/caregivers, and other healthcare professionals can be easily educated on the educational background of the professional with which they have a relationship.

 

5. It will help us to explain to everyone why we exist and why we are unique. Having the treatment focus of using recreation and leisure activities as tools for aiding in a client’s recovery allows us to forge our own niche in the market that no other profession can encroach upon. This will also help to own the scope of practice that Occupational Therapists claim they currently own, but the general market does not associate with them. In contrast, if we instead adopt the “recreation and leisure as the outcome” mindset that NTRS promoted, our identity will continue to be indistinguishable between activity planners, recreation workers, cruise directors, and the other professions I mentioned in point one. I believe not choosing to distinguish Recreational Therapy as a treatment focused therapy is counterproductive to our goal of being recognized and respected for the unique skill set we possess, and the outcomes we achieve with clients.

Strategies for The Future:

By understanding the historical struggles we have faced as a profession, as well as choosing to work toward a unified identity that is both unique and marketable, we can make tremendous progress in our field. We cannot solely rely on others to make this happen for us and we can’t expect a singular membership organization or a person to have all of the answers. What else we can be doing that we are not already? What initiatives can we start to unify us? How can YOU fill in the gaps?

One strategy I can personally see recreational therapy benefiting from is business skills development. In the realm of business, one learns how to create demand for a certain skill set, how to market and brand yourself or your business, how to reach your target audience, how to form a complex strategy, how to manage finances efficiently, how our economy works, and how to leverage certain positions to achieve a win-win scenario for multiple interests. I speak to this as a business owner (who owns multiple types of businesses) myself and have achieved success in many of these areas through my own journey with learning and utilizing these skills. A huge impact of business is its ability to reach the masses with its message and more and more Recreational Therapists are interested in using this vehicle to lead to our success. This can be evidenced by the TR Entrepreneur Connection Facebook group that I created which is full of a mix of entrepreneurs (or to-be entrepreneurs) creating businesses and coming up with solutions for our profession to grow. (6)

For people to really understand who we are, what we do, and to ask for us by name, we need a singular message to describe our field.

Another strategy that we have worked on utilizing our platform at SMART CEUs Hub is “bridging the gap in RT education after graduation.” (7) As organizations that provide accreditation serve to impact the training of recreational therapists entering the field, we view our role as enhancing the learning/competencies of the 19,000 recreational therapists currently in the field. We have created a platform for information taught by experts in our field and reach thousands of therapists throughout the USA and Canada. Currently, 1 out of 5 Recreational Therapists uses SMART CEUs Hub to get their continuing education to build competencies in the field. As our library of courses increases, this, in turn, increases our profession’s access to this information from wherever they are and their own convenience. As recreational therapists build their competencies and skillsets, they build their marketability in the workforce. As marketability increases, we build awareness and can establish a “brand” as an entire profession.

A final strategy that I strongly believe should be implemented, is national marketing campaigns led by Recreational Therapists who are paid to advocate for us full time. These professionals could attend healthcare conferences to promote Recreational Therapy, provide training to recreational therapists about how to lobby within their own states to get laws passed and build their membership organizations, create an effective media awareness initiative and market on multiple platforms, create commercials that could be aired nationwide, build resources online for Recreational Therapists to use, etc. This organization could be a non-profit that uses its finances to pay these full-time staff to work on providing these services to us and get grants/donations to fund it. Having full-time paid staff that can devote themselves solely to these goals, instead of volunteers who can only rarely meet and devote time to making change, will greatly impact the growth of our profession. The campaigns created will bring RT to the attention of potential clients and employers, as well as harness a greater pool of support when it comes to getting legislation passed. It is not hard to imagine how bright a future the field of recreational therapy could have, and the amazing work recreational therapists could do for our deserving clients if we were able to provide it on a much larger scale.

References Used in Section

6. TR Entrepreneur Connection- www.facebook.com/groups/TREntrepreneurConnection
7. SMART CEUs Hub- www.smartceushub.com

Final Thoughts

I am only one recreational therapist.  I am only one business owner.  I am only one person who wants to effect change for the future of our profession.  I want each person who reads this to think critically about how they can impact our profession in a greater way than just receiving a paycheck. Of course, we all need money to survive, and maybe your primary reason taking initiative on these long-term goals is to help your paycheck to increase. For others, the idea of working in a more recognized profession motivates them.  And yet others may be more interested in the educational or legislative needs of RT.  For most of us, making a positive impact on the world we live in and allowing Recreational Therapists to impact thousands/millions of people more is enough.  Whichever the case, we cannot stand idly by and expect others to make this impact for us.  Remember the rule of insanity: “doing the same thing over and over, expecting different results”.  Let this be a call to action and a catalyst for positive dialogue and change.

Join me in the discussion via the platforms provided on this site.

This post is from Nathan Lamaster, CTRS (Founder of SMART CEUs Hub, the Rec Therapy Directory, CEU Cloud, and the TR Entrepreneur Connection; Author of the book “The Entrepreneur Rec Therapist: The Business Education You Missed in School)

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Website: smartceushub.com