Recreational Therapists
Nature of the Work
Recreational therapists provide services to people who are mentally, physically, or
emotionally disabled. These workers are also known as therapeutic recreation specialists,
a job title that draws attention to the fact that theirs is a health profession. The work of the
recreational therapist should not be confused with that of the recreation worker, who
provides recreational activities for the sole purpose of enjoyment.
Recreational therapists employ recreational and leisure activities as a form of
treatment--much as other practitioners use surgery, drugs, nutrition, exercise, or
physiotherapy. Therapists strive to minimize patients' symptoms and to improve their
physical, mental, and emotional well-being. Enhancing the patient's ability to function in
everyday life is the primary goal of recreational therapy; enjoyable and rewarding activities
provide the means for working toward that goal.
Activities employed by recreational therapists are as varied as the interests and
abilities of the people they serve. They might, for example, organize athletic events,
dances, arts and crafts or musical activities, attendance at movies, field trips, or poetry
readings. Apart from sheer enjoyment, activities such as these provide opportunities for
exercise and social participation. Other goals that the therapist might have in mind when
planning an activity include relieving anxiety, building confidence, or promoting
independence.
Recreational therapy is a relatively new field. Closely related to occupational
therapy, it shares with that profession a view that activities that seem ordinary to most of
us can put disabled persons on the road to recovery--or lead to improvement, at any rate.
Together with the "expressive" therapies--art, music, drama, and dance--recreational
therapy owes much to the discovery that soldiers suffering from battle fatigue, shock, and
emotional trauma responded favorably to organized treatment programs. During World War
II, for example, the Veterans Administration (VA) organized medical recreational activities
in VA hospitals.
Recreational therapists are found in a variety of settings, including mental hospitals,
psychiatric "day hospital," community mental health centers, nursing homes, adult day care
programs, residential facilities for the mentally retarded, school systems, and prisons. They
are often located in the activities department or therapy department of an organization.
These departments are staffed by therapists and their assistants from several disciplines--
occupational therapy, music, dance, and art therapy, to name a few. Together with other
health professionals, they assess the patient's functioning, develop a treatment plan, and
monitor progress as the plan is carried out. Job responsibilities also include directing the
support staff. At times, it is the therapeutic assistant who actually conducts recreational
programs and spends the most time with the patients.
The specifics of the recreational therapist's job vary with the employment setting and
capacities of the patients or clients served. In a hospital setting, for example, the
recreational therapist usually works as a member of a team that may include a physician,
nurse, clinical psychologist, social worker, and other rehabilitation professionals. Team
members evaluate the patient from the perspective of their various specialties and then
develop a coordinated treatment plan.
During the initial session in a hospital therapy department, the recreational therapists
might chat with the patient and family to put then at ease before directing the conversation
toward the patient's interests, enthusiasms, or hobbies--anything that offers a clue to
activities that could be incorporated into a treatment program.
The therapists needs information about the patient's physical, mental, and emotional
status in order to set realistic goals and recommend suitable activities. To obtain this
information, the therapist pores through medical records, talks with other members of the
staff, and observes the patient's behavior. Next, the therapist prepares a list of activities
that capitalize on the patient's strengths and interests.
Progress is likely to be slow; sometimes, there is no progress at all. Recreational
therapists understand this, and set goals accordingly. A patient who has trouble socializing,
for example, may express interest in chess but be overwhelmed by the prospect of actually
playing since that involves interaction with another person. The therapist would proceed
slowly, first letting the patient observe a game and then assigning a therapeutic assistant
to serve as a chess partner for weeks or even months--as long as it took for the patient to
gain the confidence to seek out other patients as partners.
Recreational therapists are careful to observe patients' reactions to the activities in
which they are involved. The therapist might note, for example, that one patient participates
in outdoor activities more enthusiastically than before; another is ready for activities that
require teamwork; still another patient, formerly cooperative, has become combative and
disruptive. Observations such as these provide the basis for the therapist's periodic review
of each patient's condition changes.
Documentation is an important part of the recreational therapist's job. Among the
records the therapist must keep are the initial evaluation, progress notes, reports to the
physician, internal staff notes, Medicare records, and discharge notes. These records are
used to keep track of the patient's condition, document treatment programs, and monitor
progress.
In nursing homes, recreational therapists evaluate residents' capabilities much as
they do in hospitals. They look at medical records, talk with residents to learn about their
interests, and discuss their condition with other members of the staff. Often, the therapist
groups residents according to common or shared interests and similar ability levels, and
plans field trips, entertainment events, baking, exercise, dancing activities, and the like for
the group. The therapist documents residents' responses to the activities and continually
searches for ways of heightening residents' enjoyment of recreational and leisure activities,
not just in the facility, but in the surrounding community as well.
Because nursing home residents are likely to remain in the facility for months or even
years, the activities program makes a big difference in the quality of their lives. Without the
stimulation of interesting events, the daily routine of a nursing home can be monotonous
and depressing, and residents are apt to deteriorate. In some nursing homes, recreational
therapists direct the activities program. In other facilities, activities coordinators plan and
carry out the program under the part-time supervision of a consultant who is either a
recreational therapist or an occupational therapist.
The recreational therapist in a community setting might work in a day care center for
the elderly, for example, or in a program for mentally retarded adults operated by a country
recreation department. No matter what the disability, recreational therapists in community
settings have a challenging job in pulling together the resources to provide recreational
opportunities for disabled persons. Organizational ability, flexibility, and ingenuity are
essential.
Before an activity such as wheelchair basketball can take place, for example,
space must be secured and equipment rented; prospective participants interviewed; and
clients, staff, and volunteers advised of timetables and logistics. Because clients generally
live at home with their families or in group residential facilities such as halfway houses,
transportation to and from the activity site is an important concern. In institutional settings
such as hospitals and nursing homes, transportation requires less planning and
coordination.
Therapeutic goals are identified before the event takes place. Once the program has
been planned and publicized, the therapist interviews each individual who sign up, and may
also discuss the upcoming event with the client's physician to be sure that the event is
suitable for the client's condition. For example, if the physician indicates that an individual
would get very upset in a competitive situation, the therapist may suggest a team event
rather than a chess match: Less intense competition may help clients learn how to deal
with losing and eventually to gain enough control of their impulses to participate in more
competitive activities. In addition, the therapist acts as the leader of these events and many
times supervises assistants as well.
Working Conditions
Working conditions vary according to the employment setting, facilities available, and
the activity being implemented. In a clinical setting, for example, recreational therapists
might work directly in a hospital ward or a spacious activity room. In a nursing home, the
recreational therapist might work in a room equipped with arts and crafts materials.
In a community setting, the recreational therapist is likely to be in several different
places in the course of a day or a week. Interviewing clients and planning events take
place in an office, but when leading activities, the therapist might be in a gymnasium,
outdoors on a nature walk, or in a swimming pool.
In general, recreational therapists work in well-lighted, well-ventilated areas. The job
may be physically tiring because therapists often are on their feet all day. Recreational
therapists generally work a standard 40-hour week, although weekend and evening hours
occasionally are required. Therapists holding supervisory positions may be required to
work overtime depending upon the workload.
Employment
Recreational therapists held about 28,000 jobs in 1990. Nursing homes and
hospitals each employed more than one-third of recreational therapists. Other employers
of recreational therapists include community mental health centers, adult day care
programs, school systems, residential facilities for the mentally retarded, and a variety of
community programs for people with disabilities.
A small number of therapists are self-employed, providing recreational therapy
services on a contract basis, for the most part. A self-employed therapist might develop
and oversee activities programs for several small nursing homes or community programs,
for example.
Training, Other Qualifications, and Advancement
A degree in therapeutic recreation, or in recreation with an emphasis on therapeutic
recreation, is the usual requirement for professional positions in this field. An associate
degree satisfies hiring requirements in many nursing homes, while a bachelor's degree
ordinarily is necessary in community and clinical settings.
Hiring requirements are changing. In the past, individual with degrees in psychology,
sociology, social work, and other human service field found jobs as recreation therapists.
Increasingly, however, formal preparation in therapeutic recreation is expected. Individuals
without such preparation are likely to be hired as therapeutic assistants rather than as
therapists.
Three States--Georgia, Maryland, and Utah--regulate the practice of recreational
therapy. Georgia and Utah have licensure requirements, while Maryland requires
recreational therapists in long-term care facilities to be certified (or eligible for certification).
Certification is available through the National Council for Therapeutic Recreation
Certification (NCTRC), which awards credentials for therapeutic recreation specialists and
therapeutic recreation assistants. Many employers prefer to hire certified recreational
therapists; some insist on the NCTRC credential.
More than 160 accredited programs in recreational therapy are offered at the college
or university level. Most of these are bachelor's degree programs, although some are
associate or master's degree programs. There are a few doctoral programs in therapeutic
recreation.
Entry level preparation for a job as a recreational therapist is available at both the
bachelor's and master's level. Associated degree programs do not ordinarily lead to
therapist jobs. Instead, graduates qualify for hospital jobs as therapeutic assistants, or for
nursing home jobs as activities specialists. A graduate degree is generally required for
teaching, research, and administrative positions in this field.
Academic programs in therapeutic recreation emphasize coursework in the physical,
biological, and behavioral sciences and require 360 hours of internship under the
supervision of a certified therapeutic recreation specialist.
To put disabling and handicapping conditions into context, these programs provide
a solid foundation in human anatomy and physiology. They deal with society's response
to disability as well as biological, psychological, and social consequences for the disabled
individual. In the realm of professional practice, courses deal with programming for special
populations; assessment and referral procedures; assistive techniques including self-help
skills, signing, and orientation and mobility; adaptive devices and medical equipment;
current treatment approaches; legal issues in delivering services to special populations; and
professional ethics.
Persons considering this career must be able to work with people of all ages,
temperaments, and personalities. To gain patients' confidence, it is necessary to have a
warm, friendly personality that inspires both trust and respect. In addition to these qualities,
it is necessary to have ingenuity and imagination in adapting activities to individual needs.
The potential therapist must be skilled, patient, and resourceful in teaching and dealing with
patients.
Newly graduated recreational therapists generally begin as staff therapists.
Advancement is chiefly to supervisory or administrative positions. Some therapists teach,
conduct research, or do consulting work on a contract basis.
Job Outlook
Employment of recreational therapists is expected to grow much faster than the
average for all occupations through the year 2000, chiefly because of anticipated growth
in the need for long-term care, physical and psychiatric rehabilitation, and services for the
mentally and emotionally disabled.
Hospitals will provide a large number of recreational therapy jobs through the year
2000. A growing number of these will be in hospital-based adult day care programs, or in
units offering short-term mental health services to individuals suffering from alcohol or drug
abuse, eating disorders, depression and similar conditions. Long-term rehabilitation and
psychiatric hospitals will provide additional jobs.
Future changes in the size and age structure of the population mean that there will
be many more people with disabilities in 1995 than there are today.
Substantial growth is
expected for the population age 85 and above, an age group that suffers a very high
incidence of disabling conditions. Because of better health care, people with developmental
disabilities such as Down's syndrome are living longer than they used to, so the number of
mentally retarded persons is expected to grow. Significant growth is also projected for the
mentally ill, in part because of the very large number of young adults who have reached the
age of peak risk for schizophrenia and other chronic mental illnesses.
Public and private response to the needs of older people is expected to spur rapid
employment growth in nursing homes, retirement and life care communities, adult day care
programs, and social service agencies. In the areas of mental health and mental
retardation, continued support for deinstitutionalizing residents of large public facilities is
expected to create strong and sustained pressure, at State and local levels, for community
residences and programs for the physically and mentally disabled.
Community programs for special populations are expected to expand significantly
in the years ahead. Locating a job may require persistence, however, in view of the small
scale and developmental nature of community-based programs. Internships may prove
especially valuable for students interested in community practice. In recreational therapy,
as in other human service fields, internships and volunteer work provide contacts that may
prove invaluable in finding a job.
Job prospects are expected to be favorable for graduates of accredited programs in
therapeutic recreation. Currently, there are reports of a shortage of qualified recreational
therapists in some areas, rural areas in particular. In metropolitan areas and localities
where training programs abound, competition for jobs is keener.
Earnings
Salaries of recreational therapists vary according to employment setting, educational
background, work experience, and region of the country. According to a Radford University
survey, however, the median annual salary of full-time recreational therapists in 1990 as
$24,900. The middle 50 percent earned between $21,700 and $30,700.
In nursing homes, recreational therapists are often classified as activities directors.
According to limited data from a survey conducted by the National Association of Activity
Professionals the average salary of activities directors in nursing homes was between
$15,900 and $26,500 a year in 1990.
Recreational Therapists employed by hospitals had a median starting salary of about
$21,500 a year in 1990. The middle 50 percent earned between $19,000 and $24,200.
The median salary for experienced therapists was about $28,200.
Related Occupations
Recreational therapists design activities to help people with disabilities lead more
fulfilling and independent lives. Other workers who have similar jobs are orientation
therapists for the blind, art therapists, drama therapists, dance therapists, music therapists,
occupational therapists, and rehabilitation counselors.
Sources of Additional Information
For information about careers in recreational therapy, contact:
National Therapeutic Recreation Society, 3101 Park Center Dr., Alexandria,
VA 22302.
Certification information may be obtained from:
National Council for Therapeutic Recreation Certification, P.O. Box 16126,
Alexandria, VA 22302.
Academic programs in therapeutic recreation are listed in the National Recreation
and Park Associations' Directory of College/University Programs in Recreation, Leisure
Services and Resources. The latest edition may be purchased from:
NRPA, 3101 Par Center Dr., Alexandria, VA 22302.
The American Association of Health, Physical Education, Recreation, and Dance
also publishes a directory listing academic programs in therapeutic recreation. For price
and ordering information, contact:
AAHPERD, P.O. Box 704, Waldorf, MD 20601.
For a pamphlet on careers in mental health, write:
Public Inquiries, National Institute of Mental Health, 5600 Fishers Lane,
Rockville, MD 20857.
For a pamphlet on careers in nursing homes, write:
American Health Care Association, 1200 15th St. NW., Washington, D.C.
20005.
Information about employment opportunities in Veterans Administration medical
centers is available from local VA medical centers.
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