Recreational Therapy State Licensure in Virginia: Moving Forward

1. Recreational Therapy State Licensure in Virginia: Moving Forward Betsy Kennedy, EdM, CTRS Susan Lynch, PhD, CTRS Old Dominion University Longwood University

2. Terminology for Licensure • Therapeutic Recreation: • Can encompass all that we do. • Therapy (APIE) • Inclusion, Adapted Sports, Activities, Special Events • Recreational Therapy: • APIE or the “TR Process” • Requires a CTRS • The treatment/therapy component only. • “Prescriptive Intervention” • This is what will be covered under a licensure bill.

3. History of TR Licensure in Virginia • Late 80s and early 90s the TR Section of VRPS (with a lot of help from VRPS) pursued a licensure bill. • In 1991 a TR license was defeated, however, a state certification for a “recreation specialist” was passed. • VRPS asked to have that credential rescinded. • A lot of time and money was spent without a positive result.

4. Fast forward to 2010 • Susan Lynch, Shannon Marling, and Betsy Kennedy met with Ken Jessup, a lobbyist. • Ken’s recommendations before we proceed with a licensure bill: • Establish a state TR professional organization. • Survey professional interest. • Begin to raise a lot of money. • State wide TR/RT survey: • With assistance from NCTRC, a survey was sent to approximately 500 CTRSs in Virginia.

5. 2011 • TR/RT State Survey Results: • Overall 65% response rate • 85.4% supported the idea of TR/RT state licensure. • 88.7% supported that only a CTRS be eligible for licensure. • 38.9% responded they would be willing to help • 3.2% responded they have contacts with state legislators • 34% responded they are willing to contribute money. • Longwood University Workshop: • In October Susan Lynch and Betsy Kennedy presented a workshop on TR practice issues and building a state TR professional association. • Out of that workshop an organizational committee was “born”.

6. 2012 • Organizational Committee Meeting in Richmond • January 2012 • Decided on the name VASTRA • Virginia State Therapeutic Recreation Association • First VASTRA meeting • April 2012 • Elected a BOD and a few committee chairs • VASTRA Formally Established • Facebook page created “VASTRA” • Website created http://trvirginia.com/ • Bank account opened • Non-profit status approved • Not affiliated with any other TR organization. • First workshop held in November!

7. Certification vs. Licensure • National Perspective • Voluntary (standards) • Peer Review & Sanction • Broad Scope (TR) • Less Restrictive • Protects the Public • Recognized Indirectly by Funding Source • Recognized by most Regulators • State Perspective • Legal Mandate • Legal Prosecution • Specific Scope (RT) • More Restrictive • Protects the Public • Recognized by State as pre-condition for funding. • Recognized by all Regulators

8. So, why licensing? • Because everyone else is doing it? • Because I want to pay more fees? • Because I will get more respect at work? • Because I will be paid more money? • Because I will get promoted? • Because a license sounds better than a certification? • Because NCTRC has told us to?

9. Licensure: Pros • Protect the public from harm. • Assures that all practitioners have the same education, training, practicum experiences, continuing education. • Elevates the profession to the same level as other allied health professions. • Prevents non qualified person from practicing RT and calling themselves something for which they are not qualified. • Requires that a person be an active CTRS. • Attorney General’s office is the legal arm of the licensing board & serves as prosecutor in disciplinary cases when necessary.

10. Licensure: Cons • Additional fees. • Requires a lot of attention and energy to monitor & oversee state legislative issues. • Need professionals (CTRSs) involved with the RT licensing board. • Remember the results of the state survey? • Rule making is laborious after the license bill has been passed into law. • “Devil is in the details” • Requires constant legislative vigilance!

11. Role of NCTRC? • Joint Task Force; ATRA, NTRS, NCTRC (1998) • Explored what types of practice under TR needs to be regulated. • Wrote an RT specific scope of practice. • Development of the NCTRC Position Paper It is hereby acknowledged and accepted that the National Council for Therapeutic Recreation Certification (NCTRC) supports the purpose & intent of the legal regulation of recreation therapy practice, including, but not limited to, professional registry, practice acts, and licensure.

12. Scope of Practice ofRecreational Therapy The primary purpose of recreational therapy practice is to improve health and quality of life by reducing impairments of body function and structure, activity limitations, participation restrictions, and environmental barriers of the clients served. The ultimate goal of recreational therapy is to facilitate full and optimal involvement in community life. (Accepted by ATRA, NTRS, & NCTRS in 2004)

13. Collaborate with NCTRC • When pursuing state licensure we need to openly communicate with NCTRC: • NCTRC Expertise and Resources (data on Virginia) • Mission of NCTRC is to protect the consumer, that is also the mission of a state licensure bill. • Use the NCTRC Exam Program • Use the NCTRC Job Analysis • Reinforces the APIE of RT • Use the NCTRC Recertification Process • Use the NCTRC Trademark

14. What other states have RT licensure? • Utah, 1975 • North Carolina, 2005 • New Hampshire, 2007 • Oklahoma, 2009 • New York – coming • Pennsylvania – coming soon

15. Virginia Department of Health Professions Health Regulatory Boards • Audiology & Speech-Language Pathology • Counseling • Dentistry • Funeral Directors & Embalmers • Health Professions (Dietitians, Dialysis Technician) • Long Term Care Administrators • Medicine • Nursing • Optometry • Pharmacy • Physical Therapy • Psychology • Social Work • Veterinary Medicine

16. Virginia Board of Medicine • Best fit for Recreational Therapy. • Includes; OT, Physician Assistants, Athletic Trainers, Respiratory Therapists etc. • They have a Board of Directors and licensing specialists assigned to groups of professions. • Applications and renewal can be done online. http://www.dhp.virginia.gov/medicine/

17. Establishing Licensure in Virginia • Money and Lobbyist? • Proof of harmcaused by a non-CTRS. • Licensure Committee: • Committed to do the work involved in a Board of Health Profession study (Sunrise Report) and a licensure bill. • Monitor legislative activities in Virginia. • Affordable Care Act Essential Health Benefits • RT listed as an exclusion

18. Meeting with Delegate Joe Morrissey • On February 6th (Betsy Kennedy, Susan Lynch, Chip Shefelton, & Scott Turner) • Met with his legislative assistant for about 45 minutes. The take-away: • 2016 is the next “Full Session” for the General Assembly with unlimited number of bills brought to the floor. • House Welfare & Institutions Committee should be a focus for VASTRA. • Advocacy Days • Board of Health Professions study (Sunrise Study) the need to regulate health professions in Virginia.

19. Virginia Board of Health Professions • Policy and procedures developed to evaluate the need to regulate a health profession. • “The Board of Health Professions shall study and prepare a report for submission to the Governor and the General Assembly”. • 17 members, appointed by the Governor. • The BHP study makes recommendations only. • The General Assembly will make the final determination to regulate a profession.

20. Levels of Regulation in VA: • Licensure • Most restrictive • High potential for harm • This is what we want • Statutory Certification • Title protection • Moderate potential for harm • We do not want this (remember the 1990s?) • Registration • Least restrictive • Low potential for harm

21. BHP’s criteria for evaluating a need for regulation (a study) 1. Risk for Harm to the Consumer: • Unregulated practice will endanger the public. • High potential for harm (licensure) 2. Specialized Skill & Training: • Requires specialized training. • Post-secondary education is required. • Clinical proficiency. (NCTRC) 3. Autonomous Practice: • Practice requires independent judgment. • High degree of autonomy, little direct supervision.

22. 4. Scope of Practice: • Is distinguished from other professions. • Definable in enforceable terms 5. Economic Impact: • Cost to the public is justified. • Restriction of supply of practitioners. 6. Alternatives to Regulation: • There are no alternatives to regulation 7. Least Restrictive Regulation: • We want licensure only.

23. What’s Next? • Health, Welfare and Institutions Committee • Contact Key Delegates on the committee • Legislative Assistants • Delegates Orrock, 54th District (Chair) • O’Bannon, 73rd District (Vice Chair) • Clarification on the process. • In PA bill was written while the sunrise report was written. Report was written by RTs. • In NH both report and bill were written by legislative aides. Report done first, then the bill was written. • Obtain more information on the Board of Health Profession’s study to regulate a profession.

24. HWI Key Delegates • Robert “Bobby” Orrock (Chair) • 54th District, part of Caroline & Spotsylvania • 4th in Seniority House of Delegates • John O’Bannon (Vice Chair) • 73rd District, part of Henrico • 17th in Seniority, House of Delegates • Chris Peace • 97th District, part of Hanover • Robert Krupicka • 45th District, part of Arlington Co. • James Edmunds • 60th District, Charlotte, Halifax, & Prince Edward

25. What can you do? • Join VASTRA! • The study will ask for the total number of CTRSs in Virginia (580) and membership of VASTRA. • Follow VASTRA’s website for licensure updates. • Know your House District and who your Delegate is. • Know your Senate District and who your Senator is. • Be prepared to contact them when asked!