Advancement of the Profession

Question 1

Historical development of TR/RT

Answer 1

• Use of activities as a therapeutic tool can be traced back to the beginning of civilization.
• Its history in the U.S. probably began with the development of some of the specialty schools, institutions or hospitals for persons w/ visual impairments, physical disabilities, emotional disorders or developmental disabilities. Its roots can also be found with the rise of the playground movement, which was used to prevent delinquency.
• TR continued its sporadic growth until WWI when the American Red Cross used recreational activities to treat those who sustained various injuries in military combat. The Red Cross continued to employ and train recreation leaders during WWII.
• In the 1930s the Menninger Clinic, following the psychoanalytic model of treatment of psychiatric disorders, used activities to help clients learn to reduce tension, anxiety and release aggression appropriately.
• In the 1950s Beatrice Hill established “Comeback, Inc.,” which promoted recreation services in the community for noninstitutionalized people w/ disabilities and also promoted recreation for person who were hospitalized or in a special school or nursing home. During this time period, Janet Pomeroy founded the San Francisco Recreation Center for the Handicapped.
• During the 1950s and 1960s, community-based recreation programs for people w/ disabilities continued to grow.
• In the 1980s, health care began to go through major changes in order to contain costs. Hospitals needed to be accountable for the quality, appropriateness and outcome of their services.

Question 2

History of the Profession

Answer 2

• 1949—Hospital Recreation Section (HRS) of the American Recreation Society was formed and was comprised of primarily hospital recreation workers from the military, veterans, and public institutions who emphasized leisure experience for hospitalized individuals. Hospital Recreation Section (HRS) of the American Recreation Society (ARS) was formed for the employees of military hospitals for the purpose of creating a recreation program.
• 1952—The Recreation Therapy Section (RTS) within the Recreation Section of the American Association of Health, Physical Education and Recreation was formed by people primarily w/ a physical education background who offered recreation and physical education programs in schools that served people w/ disabilities. Recreation Therapy Section of the American Association for Health, Physical Education, and Recreation (AAH PER) was created for people who were interested in being physically active.
• 1953—The National Association of Recreation Therapists (NART) formed to serve the needs of people who were recreation therapists in state hospitals or schools serving people w/ mental illness or intellectual disability. National Association of Recreational Therapies (NART) was designed for the purpose of creating a tool to enhance treatment for mentally-challenged individuals in state schools and psychiatric hospitals.
• 1953—Representatives of each organization formed the Council for the Advancement of Hospital Recreation (CAHR) to address common problems. Provided a cooperative structure for organizations to strengthen the professional image of hospital recreation.
• 1956—Council for the Advancement of Hospital Recreation (CAHR) established the first voluntary registration plan for hospital recreation.
• 1966—The Hospital Recreation Service (HRS) and the National Association of Recreation Therapists (NART) merged to form the National Therapeutic Recreation Society (NTRS), a branch of the National Recreation and Parks Association (NRPA). Thus, NTRS also became responsible for the administration of the voluntary registration plan. National Association of Recreational Therapies (NART) was designed for the purpose of creating a tool to enhance treatment for mentally-challenged individuals in state schools and psychiatric hospitals. National Recreation and Park Association (NRPA) is the leading non-profit organization dedicated to the advancement of public parks, recreation and conservation. Our work draws national focus to the far-reaching impact of successes generated at the local level. NTRS specializes in the provision of therapeutic recreation services for persons with disabilities in clinical facilities and in the community. NTRS members include practitioners, administrators, educators, volunteers, students, and consumers.
• 1981—The NTRS Registration Board separated from NTRS/NRPA and became an independent certifying body for the therapeutic recreation profession: the National Council for Therapeutic Recreation Certification (NCTRC).
• 1984—The American Therapeutic Recreation Association was established. American Therapeutic Recreation Association (ATRA) was created for the purpose of therapeutic recreation for clinical practice. Therapeutic recreation then became a profession that required training at a university and certification by the National Council on Therapeutic Recreation. ATRA’s vision statement- The vision of the American Therapeutic Recreation Association is to be the premiere professional membership association representing recreational therapists, consumers and stakeholders. The mission of the American Therapeutic Recreation Association is to serve as a member-driven association that collectively supports the recreational therapy profession.
• 1998—Alliance for Therapeutic Recreation was formed which enabled Board members of NTRS and ATRA to communicate and work together on specific issues.
• 2010— National Recreation and Parks Association (NRPA) dissolved ALL branches and NTRS was replaced with the Therapeutic Recreation/ Inclusion network. NTRS Board voted to remove the name Therapeutic Recreation from the network and it is now the Inclusion Network.

Question 3

National Council for Therapeutic Recreation Certification (NCTRC) History

Answer 3

Established in 1981, the National Council for Therapeutic Recreation Certification (NCTRC) is
a non-profit, international organization dedicated to professional excellence for the protection
of consumers through the certification of recreation therapists. Professional recognition is
granted by NCTRC to individuals who apply and meet established standards for certification,
including education, experience, and continuing professional development. The Certified
Therapeutic Recreation Specialist (CTRS) credential is offered to qualified individuals based
on these stringent requirements.

NCTRC supports quality human service and health care standards and maintains recognition
by the Joint Commission and the Commission for Accreditation of Rehabilitation Facilities (CARF). NCTRC provides credential verification services to employers and health care agencies. These services are strongly encouraged by NCTRC to monitor personnel adherence to the standards of the CertifiedTherapeutic Recreation Specialist.

NCTRC’s Board of Directors is elected by actively certified professionals. The Board is comprised of nine voting members and includes a consumer and an employer representative. Since the mission of the Council is to protect the consumer, it is critical that the consumer and employer have input into NCTRC’s credentialing program.
NCTRC is a charter member organization of the Institute of Credentialing Excellence (ICE), formerly known as National Organization for Competency Assurance (NOCA). NCTRC is accredited by the National Commission for Certifying Agencies (NCCA).

Background and Organizational History-
NCTRC is the nationally recognized credentialing organization for the profession of therapeutic recreation. NCTRC continues a long history of credentialing in the profession of therapeutic recreation. Credentialing of therapeutic recreation personnel began in 1956 with the establishment of the Commission for the Advancement of Hospital Recreation (CAHR). In 1967, with the formation of the National Therapeutic Recreation Society (NTRS), the NTRS Registration Board continued the voluntary registration program for therapeutic recreation personnel. NCTRC was founded in 1981 as an independent credentialing agency designed to meet national credentialing standards in the United States.

A volunteer leadership managed NCTRC in 1981. By 1985 three part-time staff were added to manage the growing certification program. In September 1986, the first full-time Executive Director was hired along with two full-time clerical personnel. By 1998, NCTRC staff had grown to 12 full-time and three part-time staff members.

The number of certified professionals served by NCTRC has also shown steady growth over the past 16 years. The first registration by CAHR in 1959 credentialed 68 hospital recreation personnel. During NTRS’s management of the therapeutic recreation registration program the numbers grew from over 260 in 1967 to just over 3,000 in 1981. NCTRC currently has over 12,000 active certificants and receives approximately 1,200 new applications for certification each year.

Since NCTRC was founded to meet national standards for certifying agencies, the organization has followed the standards of the Institute of Credentialing Excellence (ICE) and its accreditation branch, the National Commission for Certifying Agencies (NCCA). NCTRC has maintained its charter membership in ICE since 1987. In 1993, NCTRC’s program was first accredited by NCCA and it was recently reaccredited through March 2013.

Question 4

Vision of NCTRC

Answer 4

To be publically recognized as the largest international body of Certified Therapeutic Recreation Specialists to provide recreation therapy services.

To have premier recognition status among consumers, employers, and regulators.

To use research and technology to enhance the certification exam program and the critical functions of the Council.

To establish a viable and effective organizational marketing program and promote the validity and value of the credential.

To enhance opportunities for research and serve as a repository of information pertaining to credentialing opportunities within therapeutic recreation.

To Achieve this Vision we…
•Establish the Value and Worth of the CTRS Credential
•Ensure Practice-based Certification Standards
•Maintain an Effective and Technologically Advanced Exam Program
•Promote Legal Recognition of the CTRS Credential
•Increase the Number of New Applicants for NCTRC certification
•Increase Recertification Retention
•Ensure Fiscal Responsibility

Question 5

Mission of NCTRC

Answer 5

To protect the consumer of therapeutic recreation services by promoting the provision of quality therapeutic recreation services by NCTRC certificants.
To Achieve this Mission we…
•Develop standards for certification.
•Establish standards of conduct and apply a disciplinary process.
•Conduct entry, recertification, and reentry testing.
•Maintain an up-to-date job analysis.
•Liaison with professional organizations with regards to standards of practice.
•Verify certification for employers.
•Conduct research and development.
•Provide recertification and reentry.
•Liaison with educators to provide information and develop opportunities for student acquisition of education and experience necessary for certification.
•Provide information to the public regarding standards, disciplinary processes, and certification.

Question 6

Goals of NCTRC

Answer 6

Current Strategic Goals- 
•Promote the Value of the Credential
•Create Broad Based Partner Affiliations
•Create Global market Certification
•Lead in Consumer Protection
•Create innovative Education/Training/Research Opportunities for Consumers, Practitioners and Policy Makers.

Question 7

Accreditation standards and regulations

Answer 7

Joint Commission JCAHO, Commission on Accreditation of Rehabilitation Facilities CARF, The Centers for Medicare and Medicaid Services CMS

Question 8

The Centers for Medicare and Medicaid Services (CMS)

Answer 8

Responsible for establishing the regulations for both Medicare and Medicaid. CMS was formerly the Health Care Financing Administration. It is important to keep track of regulations established by CMS if you have patients who are receiving funding from Medicare or Medicaid. Although CMS is NOT an accrediting body, CMS is usually discussed w/ the Joint Commission and CARF, due to its regulatory nature.

Question 9

Joint Commission (JCAHO)

Answer 9

Accredits a variety of hospitals and facilities.

Question 10

CARF

Answer 10

Mandates standards that relate directly to the provision of TR services. Founded in 1966 as the Commission on Accreditation of Rehabilitation Facilities, CARF International is an independent, nonprofit accreditor of health and human services

Question 11

The Council on Accreditation for Parks, Recreation, Tourism and Related Professions (COAPRT)

Answer 11

Responsible for the revision and administration of the standards for the accreditation of recreation education programs in colleges and universities. It is responsible for the creation and administration of the standards for a therapeutic recreation option.

Question 12

The Council for the Accreditation of Recreation Therapy Education (CARTE)

Answer 12

Established standards for recreation therapy education. This accreditation program is part of the Commission on Accreditation for Allied Health Education Programs (CAAHEP). CARTE is a new accreditation program with the first education program being accredited in Fall 2011.

Question 13

9 Qualities That Help Define Professionalism

Answer 13

1) An appropriate educational background, meaning that you should have received a degree in therapeutic recreation or recreation with an emphasis in therapeutic recreation with the appropriate quantity and quality of coursework that prepares you to work in the field. Following graduation, you should feel like you are ready to practice. 2) Should have a professional organization as your major reference. ATRA is our professional organization. Many states also have Chapters of the ATRA. These chapters can provide you w/ a local contact and resources. Attend conferences and read literature from that organization to keep you up-to-date on trends and issues within the field.
3) Individual believes in autonomy and self-regulation. The person follows a specific code of ethics and standard of practice. They believe they can make their own professional judgments.
4) You should believe in the value of your profession. Do you believe that TR is important, and do you behave in a way that demonstrates that belief by advocating for the profession?
5) Having a calling for the profession. Do you believe that this is something you just have to do; you truly believe that TR is something that you have been drawn to and you must work in this field to be satisfied?
6) Contributing to the body of knowledge. Whether it is participating in research, writing an article for a newsletter or a book, a professional makes contributions to the body of knowledge.
7) Providing professional and community service. A professional takes an active role in a professional organization, whether it is at the local or national level and also works to improve services in the community for people w/ disabilities.
8) The professional will continue to grow and learn by attending conferences or reading professional literature.
9) Theory-based practice. Every professional should follow the TR process, accept and follow a practice model, and continue to read and incorporate techniques that have been researched and accepted as an appropriate intervention technique.

Question 14

professional behavior

Answer 14

When a person demonstrates professional behavior, he/she is professionally involved. This involvement may include attendance or presentations at professional conferences, providing leadership in professional organizations, advocating for the profession and reading and implementing research found in professional journals.

Question 15

Requirements for TR/RT credentialing

Answer 15

Ex.- certification, recertification, licensure

Question 16

2 Paths to Certification

Answer 16

1) Most common path is the academic path. To qualify for the academic path, an individual must have a major in therapeutic recreation or a major in recreation w/ an option in therapeutic recreation. The major in TR must contain a minimum of 18 semester hours (for this section all hours are calculated to semester hours—for quarter hours please go to the NCTRC website) of TR and general recreation content coursework with no less than 15 semester hours in TR content. A minimum of 5 courses in TR is required and each course must be for 3 credit hours. Effective January 2013 there will be content specific TR coursework required. It will include, assessment, TR process, and advancement of the profession. There must be support coursework totaling 18 semester hours, including 3 hours of coursework in anatomy and physiology, 3 hours in abnormal psychology and 3 hours in human growth and development across the lifespan. The remaining hours must be taken in approved human service areas. Also, the applicant must complete a minimum of 560 hours, 14 consecutive weeks of field placement (internship) in an agency that uses the TR process and be supervised by a certified therapeutic recreation specialist. The university supervisor must also be a CTRS.
2) Second path is the equivalency path. 2 equivalency paths to certification. Like the academic path, all individual must take 18 semester hours in TR and general recreation coursework with 15 of those hours being in TR. The supportive coursework requirements are different depending upon whether the person takes equivalency path A or B. Under the equivalency path, full-time paid work experience can be substituted for the field placement requirement
•After submitting college transcripts to NCTRC and the application to sit for the exam, the applicant will be notified whether he/she is eligible to sit for the exam. If there is an error or the individual is not eligible, the applicant may appeal. If the applicant meets the standards, he/she will be notified that he/she may sit for the exam.

Question 17

Equivalency Path A (certification)

Answer 17

The eligibility requirements to take the CTRS exam are a baccalaureate degree or higher from an accredited college or university verified by an official transcript and the following:

1. A minimum of 18 semester or 24 quarter hours of therapeutic recreation and general recreation content coursework with no less than a minimum of 15 semester or 20 quarter hours in therapeutic recreation content. A minimum of five (5) courses in therapeutic recreation is required and each course must be a minimum of three (3) credit hours. Two (2) of the required therapeutic recreation courses may be taught by the applicant as a full-time educator. Content specific therapeutic recreation coursework is recommended as part of the NCTRC professional eligibility requirements. Specific course content in the following areas: a) Assessment; b) TR Process; and c) Advancement of the Profession is highly recommended but not required for eligibility.
2. Supportive courses to include a minimum of 24 semester hours or 32 quarter hours in the content areas of social sciences and humanities.
3. A minimum of five (5) years of full-time paid work experience in therapeutic recreation services that uses the therapeutic recreation process as defined by the current NCTRC Job Analysis. Applicants who possess a graduate degree in therapeutic recreation need a minimum of three (3) years of full-time paid work experience in therapeutic recreation services that uses the therapeutic recreation process as defined by the current NCTRC Job Analysis.

Question 18

Equivalency Path B (certification)

Answer 18

The eligibility requirements to take the CTRS examination are a baccalaureate degree or higher from an accredited college or university verified by an official transcript and the following:

1. A minimum of 18 semester or 24 quarter hours of therapeutic recreation and general recreation content coursework with no less than a minimum of 15 semester or 20 quarter hours in therapeutic recreation content. A minimum of five (5) courses in therapeutic recreation is required and each course must be a minimum of three (3) credit hours. Two (2) of the required therapeutic recreation courses may be taught by the applicant as a full-time educator. Content specific therapeutic recreation coursework is recommended as part of the NCTRC professional eligibility requirements. Specific course content in the following areas: a) Assessment; b) TR Process; and c) Advancement of the Profession is highly recommended but not required for eligibility.
2. Supportive courses to include a total of 18 semester hours or 24 quarter hours of support coursework with a minimum of: (i) three (3) semester hours or three (3) quarter hours coursework in the content area of anatomy and physiology; (ii) three (3) semester hours or three (3) quarter hours coursework in the content area of abnormal psychology; and (iii) three (3) semester hours or three (3) quarter hours coursework in the content area of human growth and development across the lifespan. The remaining semester hours or quarter hours of coursework must be fulfilled in the content areas of social sciences and humanities.
3. A minimum of one (1) year full-time, paid work experience in therapeutic recreation services that uses the therapeutic recreation process as defined by the current NCTRC Job Analysis Job Skills, under the supervision of a CTRS.

WORK EXPERIENCE REQUIREMENTS
Equivalency Path B
•Required work experience in therapeutic recreation must occur in the 5 years before application.
•Credit will not be given for administrative or consultant work, which does not include direct client services.
•One-year full-time experience is defined as a minimum of 1500 hours worked (excludes scheduled and unscheduled leave time) within a minimum of a full calendar year (52 weeks). The 1500 hour number is determined from calculating full-time as a minimum of 32 hours per week over 46 weeks. 46 weeks is determined by subtracting potential vacation, holiday and leave time from 52 weeks in a year.
•A minimum of 32 hours per week will be considered full-time status. Part-time employment of no less than 20 hours per week will be pro-rated to full-time equivalent up to the minimum of 1500 hours of employment.
•The supervisor must hold an active CTRS credential throughout the period of supervision and the supervisor may be either: Employed on-site with direct supervisory responsibility for the applicant (direct supervisory responsibilities refer to having primary responsibility for the applicant’s performance evaluation, clinical and/or managerial supervision); or a preceptor or consultant to the agency and applicant. The preceptor/consultant must provide on-site supervision of the applicant for a minimum of one hour for every 10 hours of the applicant’s employment for a minimum of 150 hours within the calendar year of supervision. Supervision must include direct observation of practice as well as supervisory meetings.
•The CTRS supervisor must complete a formal evaluation provided by NCTRC.

Question 19

Certification cycle

Answer 19

Annual renewal and recertification are 2 important processes a TRS must be aware of. The certification cycle is 5 years in length. Each year of that cycle the certified individual must submit an annual maintenance application and fee.

Question 20

2 different options from which a certified person can choose in order to become recertified…

Answer 20

There are 2 different options from which a certified person can choose in order to become recertified. 1st option consists of a combination of professional experience and continuing education; the 2nd option is retaking and passing the national exam. If a person is interested it is possible to obtain a “specialty certification” for their recertification in one of the following areas: physical medicine/rehabilitation, geriatrics, developmental disabilities, behavioral health or community inclusion services.

Question 21

NCTRC Specialty Certification Professional Areas of Recognition

Answer 21

Physical Medicine/Rehabilitation, Geriatrics, Developmental Disabilities, Behavioral Health and Community Inclusion Services. Specialty Certification Part A- CTRS active status;Completion of five (5) years of full-time professional therapeutic recreation experience within a designated specialty area; Completion of 75 continuing education hours within the designated specialty area that include a minimum of three (3) professional certificate trainings. Each professional certificate training must be a minimum of six (6) CE hours. The CE hours must be completed during the five year period prior to application; and Submission of two professional references: one from a peer professional and one from a recent employment supervisor. Specialty Certification Part B- CTRS active status; Graduate Degree in TR/RT; Completion of nine (9) graduate-level credit hours within the designated specialty area; Completion of one (1) year of full-time professional therapeutic recreation experience within the designated specialty area; and Submission of two professional references: one from a peer professional and one from a recent employment supervisor.

Question 22

NCTRC’s Continuing Education Units (CEUs) Policy

Answer 22

NCTRC requires completion of 50 hours of continuing education (it does not have to be awarded in CEU credit) over the five year certification cycle.

Question 23

Licensure

Answer 23

Most restrictive form of credentialing. Requires a governmental agency to enact legislation that defines professional practice. At this time (July 2012) only 4 states have licensure (Utah, North Carolina, New Hampshire and Oklahoma) while several other states are working to enact TR/RT licensure in their state.

Question 24

Advocacy for persons served

Answer 24

A TRS is expected to provide advocacy. To advocate means to recommend or plead for a specific cause or policy and speak on behalf of another. Very often, it is up to the TRS to advocate for recreational services for specific clients/patients especially when they return to they community. They may also advocate for clients’/patients’ specific needs in treatment team meetings to ensure that a client/patient receives the treatment or equipment that he/she requires.

Question 25

Advocacy for the Profession

Answer 25

Whether it is advocating for legislative recognition or recognition by the treatment team regarding the importance of TR, the professional must be willing to speak up in support of his/her profession.

Question 26

Healthy People 2020 & Determinants of Health

Answer 26

One of the focus areas speaks directly to Disability and Health. The Healthy People 2020 initiative is building on Healthy People 2010 by providing a renewed focus on identifying, measuring, tracking and reducing health disparities through a determinants of health approach. Determinants of health- The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. Determinants of health fall under several broad categories: Policymaking, Social factors, Health services, Individual behavior and Biology and genetics. It is the interrelationships among these factors that determine individual and population health. Because of this, interventions that target multiple determinants of health are most likely to be effective. Determinants of health reach beyond the boundaries of traditional health care and public health sectors; sectors such as education, housing, transportation, agriculture, and environment can be important allies in improving population health. Policymaking- Policies at the local, State, and Federal level affect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products. Some policies affect entire populations over extended periods of time while simultaneously helping to change individual behavior. For example, the 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and regulate standards for motor vehicles and highways. This led to an increase in safety standards for cars, including seat belts, which in turn, reduced rates of injuries and deaths from motor vehicle accidents. Social- Social determinants of health reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning and quality of life outcomes. Examples of social determinants include: Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods, Social norms and attitudes, such as discrimination, Exposure to crime, violence, and social disorder, such as the presence of trash, Social support and social interactions, Exposure to mass media and emerging technologies, such as the Internet or cell phones, Socioeconomic conditions, such as concentrated poverty, Quality schools, Transportation options, Public safety and Residential segregation. Examples of physical determinants include: Natural environment, such as plants, weather, or climate change, Built environment, such as buildings or transportation, Worksites, schools, and recreational settings, Housing, homes, and neighborhoods, Exposure to toxic substances and other physical hazards, Physical barriers, especially for people with disabilities and Aesthetic elements, such as good lighting, trees, or benches. Health Services- Both access to health services and the quality of health services can impact health. Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas. Lack of access, or limited access, to health services greatly impacts an individual’s health status. For example, when individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment. Barriers to accessing health services include: Lack of availability, High cost, Lack of insurance coverage and Limited language access. These barriers to accessing health services lead to: Unmet health needs, Delays in receiving appropriate care, Inability to get preventive services and Hospitalizations that could have been prevented. Individual Behavior- Individual behavior also plays a role in health outcomes. For example, if an individual quits smoking, his or her risk of developing heart disease is greatly reduced. Many public health and health care interventions focus on changing individual behaviors such as substance abuse, diet, and physical activity. Positive changes in individual behavior can reduce the rates of chronic disease in this country. Examples of individual behavior determinants of health include: Diet, Physical activity, Alcohol, cigarette, and other drug use and Hand washing. Biology and Genetics- Some biological and genetic factors affect specific populations more than others. For example, older adults are biologically prone to being in poorer health than adolescents due to the physical and cognitive effects of aging. Sickle cell disease is a common example of a genetic determinant of health. Sickle cell is a condition that people inherit when both parents carry the gene for sickle cell. The gene is most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia. Examples of biological and genetic social determinants of health include: Age, Sex, HIV status, Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis, Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer and Family history of heart disease. TRS needs to be aware of this initiative and work within their community to support and assist in the improvement of the health and well-being of persons w/ disabilities.

Question 27

Professional standards and ethical guidelines pertaining to the TR/RT profession

Answer 27

• Important to be aware of the professional standards and ethical guidelines pertain to TR/RT. Need to understand and use the ATRA Standards of Practice and ATRA Codes of Ethics.
• The National Council for Therapeutic Recreation Certification (NCTRC) is responsible for standards for the certification of TR personnel. NCTRC is responsible for placing sanctions on any individual who has violated any NCTRC Certification Standards or any other NCTRC standard, policy or procedure.

Question 28

Public relations, promotion and marketing of the TR/RT profession

Answer 28

Important that every professional be involved in public relations, promotion and marketing of the TR profession. This competency is instrumental in ensuring that TR has a part in the health care arena.
•Important to be able to promote and market TR at the local, state and national level to legislators, health care providers, and 3rd party payers.
•Important to also be able to market TR to other health care providers, especially physicians and members of the treatment team.

Question 29

Public Relations

Answer 29

Way to arouse public attention, education and awareness. Direct and channel information to the public (public education). Promote programs. Develop public support (financial and sales). Serves as a sounding board for new programs. Performance reporting-accountability. Increases prestige and good will towards departments/agency. Types of public relations- advertising, publicity and education. Advertising is for the purpose of directly promoting or creating sales, there may be a fee to do so. Publicity promotes good will and understanding, makes no sales, associated w/ news stories and is usually free includes, press release, news feature, photograph or editorial/letter. Education is a basic instrument by which TRSs can cultivate a desire on the part of the public to conform to stated agency policies, etc.

Question 30

Sources and techniques to do public relations/promotions

Answer 30

newspapers, printed circulars (flyers, pamphlet, newsletter), printed publicity (posters, window cards), novelty items (pens, buttons, shirts), speeches, demonstrations, exhibits, slide presentations/video, T.V., radio, awards/citations, logo/emblem, annual reports, bulletin boards, announcements, word of mouth, calendar and website.

Question 31

A public relations person needs to…

Answer 31

Designated by a superior to take on this role/function. Be knowledgeable of information to be presented, facility policies and where to refer further questions. Provide accurate information and be honest. Be a professional in public image- polite, courteous, friendly, articulate, but don’t speak down to people, use proper phone etiquette and dress appropriately. One person should speak with the media on situations where one attitude is needed.

Question 32

Value Added Approach

Answer 32

Very often TR services can be marketed using the value added approach. The addition of or continued use of TR services will improve quality of care for a health care agency.

Question 33

Methods, resources and references for maintaining and upgrading professional competencies

Answer 33

• This competency expects the entry-level TRS to understand the importance of continuing education.
• In order to maintain certification, the TRS must demonstrate the willingness to participate in continuing education opportunities. NCTRC recognizes a variety of methods that a person can utilize in order to receive continuing education units (CEUs), each method the person chooses must relate to one of the NCTRC Job Analysis Knowledge areas. These methods include: taking courses for academic credit, attending TR continuing education programs at conferences and workshops, writing publications, making presentations at seminars and conferences or presenting guest lectures in courses, and making poster presentations.
• ATRA has developed a series of methods for continuing education, which can be found online. It acknowledges that continuing education is important to all professionals, and formal education through colleges and universities is not the only way to attain educational competencies. It provides a variety of methods to receive CEUs including conferences, webinars, the ATRA newsletter and ATRA’s research journal, the Annual on TR.

Question 34

Professional associations and organizations

Answer 34

• Entry-level TRS needs to be aware of and preferably be a member of ATRA.
• Need to understand about ATRA- under what circumstances it was formed and the purposes/goals of the organization. ATRA VISION STATEMENT-The vision of the American Therapeutic Recreation Association is to be the premiere professional membership association representing recreational therapists, consumers and stakeholders. ATRA MISSION STATEMENT-The mission of the American Therapeutic Recreation Association is to serve as a member-driven association that collectively supports the recreational therapy profession.
• There are state and local organizations that play a role in the profession.
• Entry-level TRS needs to understand the purposes of these important associations and become an active member.
• NCTRC is NOT a professional organization but a certifying body, thus differing from ATRA in goals, purpose, activities and membership. History of these organizations can be found in competency one of this knowledge area. More information on the services our professional organizations and our credentialing organization provide can be found on their websites.

Question 35

Partnership between higher education and direct service providers to provide internships and to produce, understand and interpret research for advancement of the TR/RT profession

Answer 35

The profession expects collaboration between practitioners and educators in internships, research, presentations at conferences, and the authoring of articles and books. Together these professionals can develop and promote a healthy and strong profession.

Question 36

Internships

Answer 36

Practitioners expect educators to provide them with students who have an understanding of TR, understand the population they are about to work with, have leadership ad programming skills and an understanding of a variety of interventions and facilitation techniques. Educators expect practitioners to establish a solid internship program that will take the student to the next level that of entry-level practitioner. It is in the internship that students will put into practice much of what they learned in the classroom.

Question 37

Quality Research

Answer 37

Practitioners and educators also depend on each other to do quality research. Both efficacy and effectiveness research can be done as a partnership. Efficacy research questions how an intervention performs under ideal or more controlled circumstances. Efficacy research usually requires randomization to treatment and control groups, and a specific intervention for the treatment group, which usually has met criteria for a single diagnosis. Effectiveness research evaluates interventions as they are actually practiced with clients. Program evaluation is a form of effectiveness research. Effectiveness research attempts to address the degree to which clients improve under treatment as it is actually practiced in the field (ex., with fewer controls and manipulations than in efficacy research designs). Effectiveness research compares different health care practices or interventions (medical technologies such as drugs, devices or procedures) covering the following areas: mortality, morbidity, symptoms, satisfaction, quality of life, preferences and costs. Very often it is educators who have the research skills and practitioners who have the clients and programs, thus making each valuable to the other.

Question 38

Efficacy research

Answer 38

questions how an intervention performs under ideal or more controlled circumstances. Efficacy research usually requires randomization to treatment and control groups, and a specific intervention for the treatment group, which usually has met criteria for a single diagnosis.

Question 39

Effectiveness research

Answer 39

evaluates interventions as they are actually practiced with clients. Program evaluation is a form of effectiveness research. Effectiveness research attempts to address the degree to which clients improve under treatment as it is actually practiced in the field (ex., with fewer controls and manipulations than in efficacy research designs). Effectiveness research compares different health care practices or interventions (medical technologies such as drugs, devices or procedures) covering the following areas: mortality, morbidity, symptoms, satisfaction, quality of life, preferences and costs.

Question 40

Value of continuing education and in-service training for the advancement of the TR/RT profession

Answer 40

Very often entry-level practitioners can only see that they need continuing education and in-service training to maintain their certification. But it is through continuing education and in-service training that we learn more about our clients, gain new intervention skills, and ultimately improve our practice. We also learn to network with other professionals who also can impact on our knowledge and skills.