The American Therapeutic Recreation Association (ATRA) is the largest, national membership organization representing the interests and need of recreational therapists. Recreational therapists are health care providers using recreational therapy interventions for improved functioning of individuals with illness or disabling conditions. ATRA was incorporated in the District of Columbia in 1984 as a non-profit, grassroots organization in response to growing concern about the dramatic changes in the health care industry. As a result of this response, ATRA has grown from a membership of 60 individuals in June 1984 to 4,500 in 1999.

According to the U.S. Department of Labor, Bureau of Labor Statistics, in 1996 there were approximately 38,000 recreational therapists. "Employment of recreational therapists is expected to grow faster than the average for all occupations through the year 2006 because of anticipated expansion in long term care, physical and psychiatric rehabilitation and services for people with disabilities" (Occupational Outlook Handbook, 1998).

Roots of the Profession

The recreational therapy profession can be traced back to the 1850's when Florence Nightingale decried the conditions of military hospitals during the Crimean War. Nightingale protested that hospital conditions were counter productive to the recovery of patients and that recreation experiences could be drawn upon to improve the human condition (James, 1997/98, p. 84). In 1917, the American Red Cross developed convalescent houses in military hospitals and in 1931 began hiring recreation hospital workers. The term "recreational therapy" was first coined by the Menninger brothers who were enthusiastic for the inclusion of recreational therapy as a treatment of persons with mental health disorders (James, 1998).

The formative years of the recreational therapy profession occurred from 1945-1953 following World War II with the development of formal undergraduate education programs, and the establishment of three professional organizations for hospital recreation workers. Hospital recreation was viewed as "a means toward patient recovery rather than as an end in itself. This dictates the selection of activities primarily on the basis of needs and capability, and secondarily on the basis of interests" (Phillips, 1952, p.29).

The Organization

ATRA was formed in response to recreational therapistís demand for an independent organization solely representing the needs and issues of the therapeutic recreation profession within health care delivery system. The association is directed by an elected board of directors with over 35 volunteer committees, focused on areas such as public policy, coverage and reimbursement, diagnostic specialty groups, education and research. The association hosts two offices, a national office in Alexandria, Virginia led by an executive director and an administrative office in Hattiesburg, Mississippi led by an administrative contractor with additional contractual services provided by a conference coordinator and legislative counsel.

Since the inception of ATRA, the organization has emphasized the importance of grassroots involvement with the membership. As such, the formation of chapter affiliates is a very important feature within the association, relying on the individual chapter affiliates to provide constant feedback and information on the issues facing the profession to the board of directors. In addition, the organization places significant emphasis on consumer input into the professional direction of the organization and relies on a consumer advisory network for information related to the consumerís perspective. As a result, in 1995 the board of directors added two ad hoc positions to the board, one representing the Chapter Affiliate Council (chair elected by the chapters) and an appointed consumer advisor. These two ad hoc positions have created a meaningful exchange between constituency groups for the organizationís response and future direction.

The association provides a vast array of membership services focusing on professional practice, professional development, external affairs, advocacy, treatment networking and educational services. Specifically, ATRA leads the profession with nationally recognized professional standards of practice, code of ethics and competency guidelines. ATRA provides one mid year professional issues forum and one annual conference each year at different locations across the country. Additionally, in 1998, the ATRA Academy was developed to provide quality, competency training and skill based continuing education through regional workshops to the professional recreational therapists.

In 1992, the American Therapeutic Recreation Foundation was formed as the 501 (c) (3) non-profit organization affiliated with ATRA. This foundation supports annual research and education projects for the association, membership and profession and is administered independently by a board of trustees.

The Practice of Recreational Therapy

Recreational Therapy plays a critical role in the comprehensive rehabilitation of individuals with disabling conditions by contributing to the broad spectrum of health care through delivery of treatment services and through the provision of physical and recreational activities - each of which is instrumental in improving and maintaining physical and psycho-social functioning, preventing secondary health conditions, enhancing independent living skills and overall quality of life.

Recreational Therapy services utilize various methods to promote the independent physical, cognitive, emotional and social functioning of persons disabled as a result of trauma or disease, by enhancing current skills and facilitating the establishment of new skills for daily living and community functioning (ATRA, 1998).

Recreational therapy also includes components that enable individuals to become more informed and active partners in their health care. Prescribed activity assists individuals in coping with the stress of illness and disability and prepares them for managing their disabling so they may achieve and maintain optimal levels of independence, productivity, and well being. Quality services include the provision of recreational opportunity and physical activity (e.g. wheelchair sports, exercise and swimming programs) which allow individuals with disabling mechanisms to prevent declines in physical, cognitive, social, and emotional health status, and therefore reduce the need for medical services.

A degree in therapeutic recreation (or recreational therapy) is required to be considered for jobs in most health care settings providing treatment or rehabilitation services. National certification is provided by the National Council for Therapeutic Recreation Certification (NCTRC). Many employers insist on hiring individuals with the professional certification designation, Certified Therapeutic Recreation Specialist (CTRS). A few states regulate this profession through licensure, certification, registration or regulation of titles.

With a degree in therapeutic recreation or recreational therapy, a qualified provider may work in a variety of organizations and settings such as:

• free-standing rehabilitation hospitals
• rehabilitation units in general hospitals
• long-term care or skilled nursing facilities
• comprehensive outpatient rehabilitation facilities
• inpatient and outpatient mental health/psychiatric facilities
• substance abuse rehabilitation facilities
• home health care agencies
• residential facilities for persons with disabilities
• adult day medical care centers
• centers for independent living
• non-profit disability/recreational agencies

As an active member in five Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Professional and Technical Advisory Committees, ATRA has been a strong advocate for the inclusion of recreational therapy as a rehabilitation service. The recreational therapist is recognized as one of the physical rehabilitation services in the JCAHO standards. Recreational therapists are standard treatment team members in psychiatric rehabilitation, substance abuse treatment, physical rehabilitation and long term care services in both in-patient and out-patient settings. Since 1988, ATRA has maintained sponsoring membership with the Commission on Accreditation of Rehabilitation Facilities (CARF). CARF identifies recreational therapists as members of the comprehensive core treatment team in the acute brain injury, the post-acute brain injury, and the inpatient rehabilitation standards. The Health Care Financing Administration (HCFA) includes recreational therapy in the mix of treatment and rehabilitation services used to determine compliance with the federal government's commitment to quality care in rehabilitation, skilled nursing and long term care facilities.

Legislative Advocacy

ATRA actively participates in the national legislative arena as a strong advocate for quality and affordable health care services. In the Washington, D.C. area, ATRA maintains a national office to coordinate advocacy efforts with a variety of disability and health services related alliances and coalitions, including the National Rehabilitation Caucus, the Washington Rehabilitation Caucus and the Consortium for Citizens with Disabilities. The addition of a legislative counsel to the organization in 1994 catapulted ATRAís legislative activity during the health care reform debates. As a result of this legislative representation the membership increased their emphasis during initial debate and final implementation of the BBAí97 and the continuing dialogue on patientís rights. With the continuing shift of funding and services to the states, the association has a vibrant state initiatives program with many chapter affiliates and other members not represented by chapters, participating in public policy efforts at the state level. This state level initiatives has seen dramatic results in the advocacy for recreational therapy services to consumers and government officials alike within individual states.

Recreational Therapy as a Viable Option

The therapeutic recreation profession is in support of cost-effective health care services for individuals with disabilities. The number of Americans requiring health and rehabilitation services continues to increase due to an aging population, disabling conditions, improved treatment services, and greater survival rates. Therefore, the need to access a broad range of available services is crucial.

The provision of quality services that lead to expected outcomes while reducing overall health care costs is the bottom line in therapeutic recreation services. Recreational therapy should be included as a viable option to meet the needs of consumers with disabilities. Ultimately, the ability to choose the most appropriate mix of health care options will afford the provider the most cost-effective approach to meet the unique needs of individuals with illnesses and disabilities. Reducing the length of stay and hospital or system recidivism, promoting independent community living, and maximizing individual productivity in society are all positive outcomes of recreational therapy services.

For more information about recreational therapy or the American Therapeutic Recreation Association please visit the ATRA website for a complete listing of officers and staff or contact the ATRA national office in Alexandria, VA at (703) 683-9420.

References

US Department of Labor. (1998). Occupational outlook handbook 1998 edition. Washington, DC: U.S. Department of Labor.

James, A. (1997/98). Recreation therapy: A history of concern, part I 1855-1946. Annual in Therapeutic Recreation, 7, 83-90.

James, A. (1998). The conceptual development of recreational therapy. In F. M. Brasile, T. K. Skalko & j. burlingame (Eds.), Perspectives in recreational therapy (pp. 7-38). Ravensdale, WA: Idyll Arbor, Inc.

Phillips, B.E. (1952). Hospital recreation is unique. Journal of the American Association for Health, Physical Education and Recreation. 23(6), 23-24.

American Therapeutic Recreation Association. (1998). Recreational therapy: A viable option in rehabilitation services [Brochure]. Alexandria, VA: Author.