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 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.
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.
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.
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.
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.