The American Therapeutic Recreation Association, the largest national organization representing recreational therapy professionals, has prepared this statement to facilitate the understanding of the critical role recreational therapists play in comprehensive healthcare and to facilitate the recognition of the cost-effective nature of utilizing recreational therapy services to ensure the total rehabilitation and quality of life for persons with disabilities.

What is recreational therapy?

Recreational therapy, also referred to as therapeutic recreation, is defined by the United States Department of Labor as a profession of specialists who utilize activities as a form of treatment for persons who are physically, mentally or emotionally disabled (Paraphrased, Occupational Outlook Handbook, U.S. Department of Labor, Bureau of Labor Statistics, April 1991). Differing from diversional or recreation services, recreational therapy utilizes various activities as a form of active treatment 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.

Who delivers recreational therapy services?

Recreational therapy services are delivered by qualified professionals with training and education in therapeutic recreation/recreational therapy service delivery and professionally certified by the National Council for Therapeutic Recreation Certification (NCTRC).

The professional certification designation is Certified Therapeutic Recreation Specialist (CTRS). The credential requires a bachelor's degree or higher from an accredited institution of higher education in the area of therapeutic recreation (recreational therapy), an approved internship under the supervision of a professionally credentialed CTRS, and the passing of a national certification examination administered for the NCTRC by the Educational Testing Service (ETS).

What is the projected demand for recreational therapy?

According to the United States Department of Labor's 1994 Occupational Outlook Handbook, "Employment of recreational therapists is expected to grow faster than the average for all occupations through the year 2005, because of the anticipated expansion in long-term care, physical and psychiatric rehabilitation, and services for the disabled." There are over 30,000 employment positions in the United States and the growth rate is projected at 40% through the year 2005. It is important to note that employment is available in a wide variety of settings, working with individuals with varying types of disabilities and illnesses.

Where are recreational therapy services delivered?

Recreational therapy services are delivered in a variety of settings depending on the needs of the consumer. Settings in which services are traditionally delivered include freestanding rehabilitation hospitals, rehabilitation units in general hospitals, long-term care, subacute care, or skilled nursing facilities, substance abuse rehabilitation facilities, home healthcare services, and residential facilities for persons with disabilities.

What are the benefits of recreational therapy services?

Research indicates that recreational therapy services, provided by qualified professionals, offer a diversity of rehabilitation benefits addressing the needs of individuals with a range of disabling conditions. A recent conference, sponsored by Temple University and funded through the National Institute on Disability and Rehabilitation Research (NIDRR), evaluated the efficacy of therapeutic recreation services as a treatment modality on rehabilitation outcomes. Research has demonstrated the value of recreational therapy services for individuals with a range of diagnoses.

Recreational therapy is a component of comprehensive rehabilitation. Such comprehensive rehabilitation services have proven to be cost-effective. A survey conducted by the Health Insurance Association of America indicated a savings of $11 for every $1 spent on rehabilitation. In addition, other studies have indicated that quality comprehensive rehabilitation services reduce long-term hospitalization and nursing home stays for stroke patients and thus save the American economy $17,000 per year per patient. Recreational therapy services play a significant role in comprehensive efficient healthcare systems.

• Recreational therapy services are an effective means for improving the functioning, independence, and quality of life of persons with illness or disability. The provision of recreational therapy services, in concert with related disciplines such as occupational therapy, physical therapy and speech therapy, offer the client or patient comprehensive rehabilitation services. The proper mix of services and the therapist-client relationship proves to be of maximum benefit to the consumer.
• Well managed and cost effective services are an investment in human potential. Recreational therapy services utilize both individual and small group intervention strategies, therefore, staff/patient ratios are cost-effective. More patient treatment hours per therapist can be generated through the use of such small group interventions. Furthermore, recreational therapy services for older Americans are equally cost-effective. Recreational therapists play a significant role in assisting older adults to maintain current skills and re-establish previous levels of functioning in the least restrictive environment possible. Recreational therapists work in concert with and provide complement to other treatment modalities.
• Recreational therapy plays a primary role in enhancing the quality of life and productivity of the consumer. Enjoyable activities and social relations are significant in promoting he quality of life and productivity of the individual with a disability. Recreational therapists offer individuals with disabilities the opportunity to resume normal life activities and to establish/re-establish skills for successful social integration. In addition, the therapist will employ treatment modalities which promote physical skill development, enhance feelings of well-being, foster successful experiences, facilitate continued involvement in the rehabilitation process, and establish new life activities for continued growth.

Utilization of Recreation Therapy Services as a Standard Service in Managed Healthcare Systems

Recreational therapy as a member of the core rehabilitation treatment team

Recreational therapy is listed as one of the physical rehabilitation services in the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. Recreational therapists are standard treatment team members in psychiatric rehabilitation, substance abuse treatment, and physical rehabilitation services. In addition, recreational therapists are designated as members of the comprehensive core treatment team in the acute brain injury, the post-acute brain injury, and the inpatient rehabilitation standards of the Commission on Accreditation of Rehabilitation Facilities (CARF).

Since the 1940's, recreational therapists have served as active members of the interdisciplinary treatment team addressing the psychosocial and physical rehabilitation needs of the consumer. Recreational therapy will certainly have an active role in a managed care and managed competition system with emphasis on providing opportunities for meeting rehabilitation goals, accessing life skills and opportunities, and providing quality services in the most cost-efficient manner. These functions must be performed on an on-going basis in concert with other allied health fields such as physical therapy, occupational therapy, and speech therapy and audiology. Although some overlap occurs between all disciplines in area such as activities of daily living, vocational and avocational adjustment, and application of motor performance skills in the natural environment, the disciplines mutually complement each other in the rehabilitation environment. For instance, each discipline may work on the development of physical skills and activities of daily living. Much of the responsibility for community adjustment and integration efforts in the rehabilitation setting, however, has become the charge of the recreational therapist. In addition, recreational therapists assist the consumer in developing or re-developing social skills, discretionary time skills, decision making skills, coping abilities, self-advocacy, discharge planning for re-integration, and skills to enhance general quality of life. As with each allied health discipline, treatment goals are based upon individual needs. The ability to meet the physical and psychosocial needs of the person affected by a disability is critical to the pursuit of independent productivity in vocational and avocational endeavors.

Recommendations in Healthcare Allocations

The American Therapeutic Recreation Association is in support of a healthcare allocations package which ensures coverage for all Americans. This package should include cooperative efforts between public and private health insurance programs. The healthcare package should also include standard coverage of a range of rehabilitative services including recreational therapy services. Current practices restrict the range of rehabilitation services that are identified as standard reimbursable services under Part A of the Medicare and Medicaid Guidelines (e.g. physical therapy, occupational therapy, speech therapy and respiratory care.) Through inclusion and utilization of recreational therapy services under Part A and Part B of the Medicare and Medicaid Guidelines, the healthcare provider will have access to additional options to meet the treatment needs of the consumer. The availability of a broader base of outcome oriented therapies and the application of a proper combination of therapeutic modalities will offer several dramatic benefits:

•  The specific needs of the consumer can be better met with the greater availability of disciplines.
• Proper mixes of therapies in a managed care and managed competition system offers a more cost-effective means to meet consumer needs.
• This approach responds in the most effective and efficient manner to the critical shortage of healthcare practitioners by expanding the pool of available professionals.

The utilization of recreational therapy offers an opportunity for accessing these treatment options to meet the "personal assistance services" of the healthcare consumer. This approach would provide expanded options and service mixes which will prove more cost-effective. For instance: At the current time, if an individual is receiving rehabilitation services for a cerebral vascular accident (stroke), the individual will likely be involved in 1:1 (one on one) physical therapy services to improve range of motion. Should there be an option of inclusion of recreational therapy services (frequently prescribed in group format), the person could receive 60% physical therapy 1:1 services and 40% recreational therapy services in aquatic therapy groups. The result is a mix that is in the best interest of the consumer and will prove to be more cost-effective

Conclusion

In conclusion, the American Therapeutic Recreation Association is in support of cost-effective healthcare opportunities for all citizens. The growing need to ensure basic services to all of America's citizens is evident. 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. The need to access a broad range of services, therefore is crucial. The intent should be the utilization of effective treatment options as standard services within a healthcare program. Recreational therapy should be included as a viable option to meet the needs of consumers with disabilities. Ultimately, the availability of managed healthcare options which respond to the unique treatment needs of individuals with disabilities will prove cost-effective. Inclusion of a comprehensive system that responds to individual healthcare consumer needs will reduce the length of hospital stay, reduce hospital recidivism, and maximize on the productivity of the individual. Recreational therapy has been and should continue to be included as an effective treatment discipline in the provision of quality, cost-effective healthcare services.