TR Past, Present, and Future: A Historical Analysis of Issues in TR

1. TR Past, Present, and Future: A Historical Analysis of Issues in TR Chapter 2 HPR 453

2. ATRA Definition 1988 • ...the provision of treatment services and the provision of recreation services to persons with illness or disabling conditions.  The primary purpose of treatment services, which are often referred to as recreational therapy, is 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 purpose of recreation services is to provide recreation resources and opportunities in order to improve health and well-being.  Therapeutic recreation is provided by professionals who are trained, certified, registered, or licensed to provide therapeutic recreation (ATRA, 1988).

3. ATRA Definition 2009 • 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).

4. North Carolina Def Rec Therapy What is Recreation Therapy? The term, "recreation therapy," refers specifically to treatment services provided by qualified therapeutic recreation professionals. The North Carolina Recreational Therapy  Association defines recreation therapy as: ...the provision of planned treatment or therapy (i.e. health restoration, remediation, habilitation, rehabilitation), which uses recreation and activities as the primary medium of treatment for persons who are limited in theirs functional abilities due to illness, disability, maladaptation, or other conditions (NCRTA, 1992). Sometimes therapeutic recreation specialists or therapeutic recreation assistants who provide recreation therapy are called recreation or recreational therapists and recreation or recreational therapy assistants.

5. North Carolina Def TR The term, "therapeutic recreation," refers to a continuum of services provided by qualified therapeutic recreation professionals.  Recreation therapy is often included as a component of therapeutic recreation.  The American Therapeutic Recreation Association defines therapeutic recreation as: ...the provision of treatment services and the provision of recreation services to persons with illness or disabling conditions.  The primary purpose of treatment services, which are often referred to as recreational therapy, is 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 purpose of recreation services is to provide recreation resources and opportunities in order to improve health and well-being.  Therapeutic recreation is provided by professionals who are trained, certified, registered, or licensed to provide therapeutic recreation (ATRA, 1988).

6. Old questions about TR/RT • Moving beyond Hospital Recreation…. • ATRA or ARTA? • Should TR Ed Programs be aligned with allied health or parks and rec? • What are minimal competencies to practice TR/RT? • Should we have additional certifications? • Do we need 2 organizations? • How can TR/RT be more acceptable and reimbursable?

7. TR/RT Nerds continue to wonder why we are still debating…. • Why can we not unite? • The profession continues to thrive due to passion, dedication, and commitment of professionals • Young professionals need to understand the issues that shape the future of the profession

8. Professionalization • Has been asked: “To what extent is TR a Profession?” • Are we distinct or a branch of another profession? If a branch, from which? • The quest to emerge resulted in: • Professional organizations • Scholarly journals and textbooks • Academic programs • Certification • Code of Ethics • Standards of Practice • Best Practices

9. Origins of the Profession • Must make a significant contribution to the needs of people • When did TR emerge as a profession??? • Florence Nightengale? 1800s – purposeful use of recreation in nursing • Purposeful use of rec in “schools for the blind”, emergence of playground movement, development of social work profession, military hospitals of 1920s, textbooks in 1930s??? • First professional organization in 1948?

10. Professional Organizations • 1948 - Hospital Recreation Section (HRS) of the American Recreation Society (ARS) • Developed standards for higher ed for “Recreation Therapy” and sponsored institutes on hospital recreation at various university campuses • 1952 – RT Section (RTS) of Am Assoc of Health, Phys Ed, and Rec (AAHPER) • Many of the founders worked at the VA through Phys Ed route – provided opps for networking with educators, RT journal articles, and RT presentations at conferences/meetings

11. 1953 – NART – National Assoc of RT – mostly HRS members - state hospital and school Rec professionals felt needs weren’t being met • Developed education and training standards • Established journal - Recreation for the Ill and Handicapped

12. November 1953 – HRS, RTS, and NART formed Council on Advancement of Hospital Recreation (CAHR) – The 3 organizations co-existed • 1956 - CAHR established “National Voluntary Registration for Hospital Recreation Personnel” • 1965 – HRS, RTS and NART joined other organizations to form NRPA • 1966 – NTRS formed

13. NTRS • Credentialing, professional standards • Legislation • Standards for external accrediting bodies • Third party reimbursement • Accreditation in higher education • Mission – Represent professional needs of individuals who work with special populations in community and clinical settings

14. 1984 – Questions on NTRS capacity to respond to increasing demands for professional action in the arena of healthcare systems • NTRS had no control over resources or accountability to Members • 1984 – ATRA was formed to “address the unique needs” of RTs in clinical settings

15. ATRA’s Vision for the profession • Accountable to membership • Decentralized organizational structure that emphasizes responsiveness to membership needs versus organizational expediency • Services founded on data-based operational system in touch with what’s happening in the field • Provide highest quality services available • Strategic Planning vs Crisis Mgmt

16. Develop & promote networking with other healthcare agencies and professional organizations • Focus on promoting the value of the TR Process within the healthcare delivery system

17. 1984 – 2010 two prof organizations co-existed • Alliance was formed in 1998 to allow NTRS and ATRA to collaborate to promote the profession in Legislation and state recognition and other areas • Resulted in Therapeutic Recreation Educator’s Conference (TREC) in 2004 • Alliance disbanded in Fall 2004 (No agreement on politics and philosophical positions) • NTRS disbanded in Fall 2010

18. Philosophical Differences“Is Recreation Therapy?” • 1950s & 60s – • “Is the recreator a therapist or a therapeutic agent?” • While recreation did not cure, it did augment and maximize the therapeutic outcomes • Leisure deficits could also be problematic for human functioning

19. 1962 – Meyer: • “It is during the treatment of an illness, when all forces of scientific medicine are applied, that recreation, whenever specifically indicated, is utilized as therapy. It may also be applied to attack specific problems, such as anxiety. Or more generally in the relief of pain or the maintenance of morale and the desire to get well.” • In the 1980s the debate continued…”Is TR a means to an end or an end its self?”

20. Accountability/Evidence/Outcomes • Accreditation Bodies – JC, CARF – Mandating outcome focus and quality improvement • Regulatory Bodies – CMS, third party payers demanding effectiveness • Research has been conducted and continues. Evidence found. RT is therapy. • Benefits of TR: A Consensus View • Dementia Practice Guidelines for Recreational Therapy

21. Outcomes…. • 1962 – It was found that 50% of over 200 individuals with cardiovascular disease who participated in recreation therapy reduced the need for medication. • Likewise there was a 35% reduction in the need for sedative and tranquilizer use among his patients with neurocirculatory asthenia (Weakness. Lack of energy and strength)

22. What is TR? • In 1981 – Study of 4 divergent views -Meyer • To provide recreative experiences (the recreation view) • To treat, change, or otherwise ameliorate the effects of illness or disability (the therapy view) • To enhance the therapeutic effects of the recreative experience (the therapeutic view) • To eliminate leisure barriers, provide leisure skills and attitudes, and enable leisure functioning and the recreative experience (the service continuum view)

23. These philosophical positions were considered by NTRS when writing their position statement and by ATRA when writing the definition statement • The broad philosophy was favored by most at the time • We are therapists, educators, facilitators • Recreators, Recreation Therapists, Therapeutic Recreation Specialists

24. The debate continues…however… Both organizations contributed separately to: • Standards of Practice and Code of Ethics established and revised • RT has been represented to JC and CARF • Members have monitored external trends including Healthy People 2010 and 2020 and ICF of World Health Organization (WHO) • Representation in public policy and coverage • Representation in areas of wheelchair sports and accessible golf • In 2006 NTRS suggested a need to determine how TR fits into the mission of NRPA

25. Polarization • ATRA or ARTA? (1993 and 2009) • Leisure services industry or allied health? • Curriculum standards/accreditation for education • Philosophies may differ but all are intended on behalf of the consumer

26. NCTRC • Key historical event in professional history • Established in 1981 to protect the consumer • Minimum competencies identified • Practice has been further defined • Markets the credential which is based on systematic approach • Consider the continuum of care…. • Young professionals need to step up to the plate • Will we let our past prevent us from imagining our future?