Licensure for Recreation Therapists: Why? Why Now?

November 1, 2015, Department, by Robin Wexler, CTRS, Anthony Martino, CTRS

The current economics of healthcare is driving institutions and patients to seek out insurance reimbursement to pay for quality care. What does this mean for unlicensed recreation therapists?For many years now there has been talk of licensure for recreation therapists, especially for those in the state of New York. What’s driving this talk is the increasing number of complaints that have been filed through the National Council on Therapeutic Recreation Certification (NCTRC Standards Review Committee) about individuals practicing therapeutic recreation services under different titles and without the appropriate professional preparation.

Because recreation therapy is not licensed in the state of New York, anyone can call him- or herself a recreation therapist. This also means that the profession is not represented on the NYS Board of Regents that currently hears complaints for similarly licensed professions. Therefore, there is no state mechanism that offers protection or recourse for malpractice.

Added to this is the fact that in the current economics of health care, institutions as well as patients are looking for insurance reimbursement to fund treatments for quality care with proven beneficial outcomes. Without licensure, recreation therapy is rarely covered by insurance reimbursement, and, more and more, organizations will be mandated to hire only licensed recreation therapists to provide these services. As a result, recreation therapists are finding that their jobs are being replaced by professionals who are licensed and can obtain third-party reimbursement to the facility.

Many recreation professionals, allied health professionals, administrators, consumers and politicians are wondering what this actually means. 

What Is Recreation Therapy?

Recreation therapy, also known as therapeutic recreation or therapeutic recreation services, is defined by the American Therapeutic Recreation Association 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.” 

The ultimate goal of recreation therapy is self-motivated, intrinsically satisfying leisure participation. The recreation therapist works with the client, family and members of the treatment team, and others to design and implement an individualized treatment or program plan, depending on the setting. Treatment interventions might include adapted sports and games, art, music, drama or other creative arts activities, stress management group or use of various relaxation and other techniques such as yoga, community integration outings, activities of daily living such as cooking, leisure education and leisure counselling, as well as other activities that are used to reach treatment goals.

Recreation therapists work in various clinical settings, such as hospitals, psychiatric or skilled nursing facilities, substance abuse programs and rehabilitation centers; in community settings, such as adult care, outpatient clinics, adaptive sports and recreation programs, home health, private consulting, developmental disabilities services, and other health and human services, parks and recreation programs, camps and youth programs; and in long-term, continuing care or residential facilities. They 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.

A minimum of a bachelor’s degree with a major in recreation therapy or therapeutic recreation, or recreation with a specialization in recreation therapy or therapeutic recreation is required for national certification. Specific requirements can be obtained from the National Council for Therapeutic Recreation Certification.

Licensure vs. Certification

Depending on the type of laws enacted, certification and registration may be either voluntary or mandatory. Licensure, however, is a mandatory regulation that prohibits unlicensed persons from practicing a profession. Although laws tend to differ in style, generally, they will restrict the practice of the profession (“practice restriction”), the use of certain descriptions or titles (“title restriction”), or of practice and title use.

Utah, North Carolina, New Hampshire and Oklahoma currently have recreation therapy licensure and are willing to assist New York’s efforts with obtaining licensure through a task force created by the American Therapeutic Recreation Association (ATRA). These states all use the NCTRC exam as the mechanism to become licensed, freeing the state from the cost and validity of developing and administering their own state’s individual licensure tests. Ten other states are currently working toward licensure and are planning to use the NCTRC exam as well. Washington requires state registration and California requires state certification coordinated with the California Title Protection regulations.

Becoming Licensed

Currently, in the state of New York, therapeutic recreation is not being held accountable in the same way as other allied health and human services. Although the profession has similar standards as other allied health professions (e.g., level of education, clinical fieldwork standards and a minimum competency exam), there is no regulating entity to ensure that properly prepared professionals are practicing in the state.

If New York passes a licensure bill for recreation therapy, there will likely be two ways to become licensed: 

1.  New recreation therapists/new graduates — graduating from an accredited college with a major in recreation therapy/therapeutic recreation, passing a certification exam as determined by the licensure board, and applying for licensure and paying a licensing fee.

2.  Certified therapeutic recreation specialists (CTRS) who currently hold a national certification through NCTRC — applying for licensure and paying a fee to become licensed.

The New York bill will include certain defined non-certified individuals who wish to obtain licensure that will likely have to apply for a provisional waiver. This waiver will allow them to continue to practice under the clinical supervision of a CTRS for a specified period of time, during which they will be required to show the licensing board  they are making steady progress toward meeting the necessary requirements to take the national exam. 

The Outlook for Recreation Therapy

Recreation therapy has been designated as one of the fastest growing health care and human service occupations in the United States. According to the U.S. Department of Labor, employment for recreation therapists is projected to grow 13 percent from 2012 to 2022, about as fast as the average for all occupations. Rapid growth is expected in geriatric care facilities, outpatient physical and psychiatric rehabilitation, and services for individuals with disabling conditions. 

As the large baby-boom generation ages, it will need recreation therapists to help treat age-related injuries and illnesses, such as strokes, and hip-and-knee replacement rehabilitation, and dementia. Recreation therapists will also be needed to help manage chronic conditions such as diabetes, dementia and obesity and to play key roles in the treatment of substance abuse, PTSD, head injury and mental illness.

The primary purpose of licensure is to protect consumers, ensuring that they will receive quality recreation therapy services. For therapist, licensure not only will increase professionalism and provide a means of removing unqualified practitioners, but will also meet the growing mandate from organizations to hire only licensed recreation therapist and allow therapists to have their services covered by insurance reimbursement. 

Robin Wexler, CTRS, is a board member of the Long Island Leisure Service Association and a member of the NY State Committee for the Licensure of Recreation Therapists. Anthony Martino, CTRS, is an employee of the North Shore-LIJ Health System Southside, an executive board member of the New York State Recreation and Park Society and member of the LILSA board.