TR Past, Present, and Future: A
Historical Analysis of Issues in
TR
Chapter 2
HPR 453
ATRA Definition 1988
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...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).
ATRA Definition 2009
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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).
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.
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 wellbeing. Therapeutic recreation is provided by professionals who are
trained, certified, registered, or licensed to provide therapeutic
recreation (ATRA, 1988).
Old questions about TR/RT
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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?
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
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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:
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Professional organizations
Scholarly journals and textbooks
Academic programs
Certification
Code of Ethics
Standards of Practice
Best Practices
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?
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Professional Organizations
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1948 - Hospital Recreation Section (HRS)
of the American Recreation Society (ARS)
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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)
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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
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
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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
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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
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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
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ATRA’s Vision for the profession
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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
Develop & promote networking with other
healthcare agencies and professional
organizations
 Focus on promoting the value of the TR
Process within the healthcare delivery
system
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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
Philosophical Differences
“Is Recreation Therapy?”
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1950s & 60s –
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“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
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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?”
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
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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)
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What is TR?
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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)
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
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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
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
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NCTRC
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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?