1. Find & print at least 3 definitions of therapeutic recreation.
CAAHEP-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
ATRA-Recreational therapy, also known as therapeutic recreation, is a systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illnesses and/or disabling conditions, as a means to psychological and physical health, recovery and well-being
CAAHEP-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
ATRA-Recreational therapy, also known as therapeutic recreation, is a systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illnesses and/or disabling conditions, as a means to psychological and physical health, recovery and well-being
1982 David Austin- [Therapeutic recreation] is the provision of purposeful intervention designed to help clients grow and to assist them to prevent or relieve problems through recreation and leisure
2. Find & print at least 2 therapeutic recreation philosophies.
canadian TRA-Therapeutic Recreation is a profession which recognizes leisure, recreation and play as integral components of quality of life. Service is provided to individuals who have physical, mental, social or emotional limitations which impact their ability to engage in meaningful leisure experiences.
canadian TRA-Therapeutic Recreation is a profession which recognizes leisure, recreation and play as integral components of quality of life. Service is provided to individuals who have physical, mental, social or emotional limitations which impact their ability to engage in meaningful leisure experiences.
Therapeutic Recreation is directed toward functional interventions, leisure education and participation opportunities. These processes support the goal of assisting the individual to maximize the independence in leisure, optimal health and the highest possible quality of life.
University of vermont- "It is the philosophy of the Therapeutic Recreation program that leisure and recreation are inherent aspects of the human experience. Therapeutic recreation is a process of utilizing recreation activities for intervention in physical, emotional, and/or social behavior to bring about a change which promotes the growth and development of the individual."
3. Find & print at least 2 Codes of Ethics.
4. Find & print at least 2 Standards of practice.
NTRS STANDARDS
Part I Standards of Practice
Introduction
Purpose of Standards of Practice
Developing Standards of Practice for a Continuum of Care in Therapeutic Recreation
Standard One: Therapeutic Recreation Process
Standard Two: Participant Involvement
Standard Three: Intervention and Facilitation Techniques
Standard Four: Documentation
Standard Five: Outcomes
Standard Six: Professional Staffing and Credentials
Standard Seven: Ethics
Standard Eight: Quality Management
Standard One: Therapeutic Recreation (TR) Process
The therapeutic recreation specialist uses a systematic and purposeful process that
consists of assessment, planning, implementation, and evaluation to create therapeutic
recreation programs that benefit the participant’s health, functional status, personal
development and quality of life. The therapeutic recreation assistant contributes to this
process under the supervision of the therapeutic recreation specialist.
A. Assessment
The therapeutic recreation personnel (specialist) follow(s) a written plan for assessing
and reassessing physical, emotional, cognitive, social, spiritual and leisure behaviors;
functional abilities and skills; and lifestyle needs, strengths, preferences, and expectations
of participants to ascertain relevant factors impacting the design of individual and
comprehensive program plans. Assessment findings: 1) provide the foundation for
planning program delivery; 2) provide a method of participant and program evaluation; 3)
provide a tool for quality improvement; and 4) provide a baseline for efficacy research.
•Regular (scheduled) and periodic review of assessment and reassessment
procedures/tools are conducted.
•The assessment process provides information on participant’s functional abilities and
skills, needs, strengths, preferences, and expectations.
•The assessment process uses standardized assessment procedures or accepted practices
appropriate to the program focus and participant’s needs.
•The participant and any identified caregivers; family and significant others participate in
the assessment process.
•The therapeutic recreation specialist obtains pertinent background information about the
participant from relevant others and integrates this information along with the
information collected into the planning process.
•The therapeutic recreation assistant accepts assignments from the therapeutic recreation
specialist commensurate with his/her demonstrated competence. Assessment
responsibilities for the therapeutic recreation assistant may include: record review,
interview, direct observation, and questionnaire administration.
B. Planning
The therapeutic recreation specialist uses assessment information to develop goals and
objectives, content and processes, an evaluation plan and operational guidelines to
manage and implement participant-oriented programs and services. Three types of plans
may exist: operational plans for the management of the department, specific therapeutic
recreation service plans for delivery of services offered, and individual intervention plans
used with each participant. The therapeutic recreation assistant may assist in the planning
process under the supervision of the therapeutic recreation specialist.
The therapeutic recreation specialist develops a written plan of operation for therapeutic
recreation programs/services in accordance with the agency operational plan. This plan
should include: vision, mission, objectives, policies and procedures, personnel criteria
and practices, protocols and service plans, quality improvement monitors, ethical
standards, research and evaluation procedures, safety and risk management directives,
scope of service, and mechanisms for program review and participant feedback. The
therapeutic recreation assistant may contribute to the development of the written plan
under the supervision of the therapeutic recreation specialist.
•The therapeutic recreation specialist prepares specific written therapeutic recreation
service plans, which are recorded in the plan of operation, to guide the delivery of
specific programs and services and the inclusion of participants in the therapeutic
recreation process. Contents of the plan may include: goals, objectives, facilitation
techniques and interventions, leadership and supervision strategies, resources, safety and
risk procedures, quality improvement monitors, formative and summative evaluation
measures and participant feedback mechanisms. The therapeutic recreation assistant may
contribute to the development of the service plans under the supervision of the
therapeutic recreation specialist.
•The therapeutic recreation specialist prepares individual intervention plans that are
documented in agency records when required. The plans may include but are not limited
to: referral information, assessment and progress data, participant diagnosis and needs,
goals, objectives, outcome measures, restrictions, contraindications, limitations and
precautions, facilitation techniques and interventions employed, referral, discharge, aftercare,
and follow-up criteria, quality monitoring and evaluation criteria, and safety and
risk protocols. The therapeutic recreation assistant may contribute to the development of
the individual intervention plan under the supervision of the therapeutic recreation
specialist.
•There are written policies and procedures in the operational manual concerning the
method of: referral, assessment, reassessment, registration, documentation/progress,
billing, reimbursement, and program placement methods or approval necessary for
participant involvement in therapeutic recreation services.
•The plans are developed with interdisciplinary and inter-agency participation, family,
caregivers, and significant others.
•Participant plans accommodate participant’s culture, age, gender, sexual preference,
physical, spiritual, social, educational, and economic backgrounds and any related
diversity need.
•Participant plans recognize and promote inclusion throughout the therapeutic recreation
process.
C. Implementation and Operations
The therapeutic recreation specialist establishes a therapeutic relationship, creates a safe
environment and facilitates and supervises therapeutic recreation programs/services. The
therapeutic recreation assistant shares responsibility for establishing a therapeutic
relationship, creating a safe environment and facilitating therapeutic recreation
programs/services.
•Participants, caregivers, and significant others assist in and/or are encouraged to assist in
program/service implementation.
•Formative evaluation occurs in accordance with the standards of regulatory agencies and
includes effectiveness and quality improvement outcome measures.
Goals and plans are modified based on participant needs, progress, changes in status,
and formative evaluation results.
•Programs and services are scheduled regularly and a comprehensive schedule is
established in cooperation and coordination with agency services.
•As a result of formative evaluations, the therapeutic recreation specialist reports changes
in the participant’s status and, if deemed necessary, reassesses the participant.
D. Evaluation
The therapeutic recreation specialist collects and analyzes summative data to make
subsequent decisions about the individual participant’s plan and specific therapeutic
recreation programs and services according to agency evaluation and program protocols.
The therapeutic recreation assistant may assist in the collection of data; she/he reports
this information to the therapeutic recreation specialist. The therapeutic recreation
assistant may contribute to the analysis and subsequent decision-making process.
•Established agency evaluation and protocols govern documentation and collection of
data.
•Participant and comprehensive summative evaluation demonstrate the effectiveness of
programs/services in accordance with standards of regulatory agencies, including
effectiveness and quality improvement measures to support research and grant initiatives.
•Goals and plans are continued, modified, or discontinued according to evaluation results
and participant response.
•A plan for continuity of care/service (referral, discharge, after-care, follow-up) is
developed with participants, caregivers, and team members and assists participants in
transitioning to appropriate programs/services.
Standard Two: Participant Involvement
The therapeutic recreation (specialist) personnel support(s) participant, caregiver, family,
and significant other involvement in the therapeutic recreation process and create(s)
opportunities to incorporate and empower the participant, caregiver, family and
significant others during the therapeutic recreation process.
•Plans include opportunities for feedback, adaptation and modification to accommodate
participant needs.
•Plans evaluate the improvement or lack of progress, change in participant conditions and
expectations.
•The therapeutic recreation (specialist) personnel create(s) opportunities for participant
input and feedback that may include, but are not limited to, advisory committees,
advocacy networks, patients’ rights groups, caregiver support groups, focus groups,
friends.
•Reactions of the participant to the program/services and input into participant goals are
regularly recorded and reported.
•Plans include referral sources identified by participants, caregivers, family, and
significant others.
•The therapeutic recreation (specialist) personnel recognize(s) and encourages the right
of the participant to make choices regarding the content and process of programs
including the choice of not participating.
Standard Three: Interventions and Facilitation Techniques
The therapeutic recreation (specialist) personnel use(s) interventions and facilitation
techniques to promote changes that empower the individual toward improvement in
his/her functional skills, leisure, health, personal development and quality of life.
•The therapeutic recreation (specialist) personnel use(s) activity and task analyses to
select, modify, design individual and group experiences that enable participants to
achieve their goals and result in measurable outcomes and documented benefits.
•The therapeutic recreation specialist selects interventions and facilitation techniques to
achieve identified and desired outcomes and that comply with protocols developed for
diagnostic groups and activities. The therapeutic recreation assistant may assist in the
selection of interventions and facilitation techniques.
•The therapeutic recreation (specialist) personnel, as member(s) of the team and in
cooperation with the participant, caregivers, family, and significant others selects
interventions and techniques relevant to the participant’s continuity of care/service.
•Based on the participant’s needs, and financial and supportive resources, the therapeutic
recreation (specialist) personnel schedule(s) the frequency, duration, and intensity of the
interventions and techniques in coordination with other disciplines serving the
participant.
Standard Four: Documentation
The therapeutic recreation specialist documents and records information; periodically
reviews and updates documents; and maintains records on the management of programs
and services to ensure accountability, effectiveness and compliance with regulations and
standards. When the therapeutic recreation assistant documents and records information,
the therapeutic recreation specialist conducts periodic reviews of the documentation.
•The assessment and reassessment results are documented in participants’ and/or agency
plans in a timely fashion, in compliance with regulatory standards by therapeutic
recreation personnel (specialist).
•Plans, operational, service, and/or individual, are documented in individual and agency
records.
•Documentation of involvement may occur in the individual intervention plans and/or the
specific therapeutic recreation service plans and is completed by the therapeutic
recreation (specialist) personnel who has(have) provided the service.
•The therapeutic recreation (specialist) personnel who has(have) provided the program or
service documents the frequency, duration, interventions, facilitation techniques and
nature of the participant’s involvement.
•The therapeutic recreation specialist counter signs, reviews and approves documentation
when a therapeutic recreation intern or adjunct therapist provides the programs/services.
•Records are reviewed and updated regularly in accordance with agency and regulatory
bodies and documentation of the review is entered in appropriate records.
•Records and documentation of historical significance are maintained.
•The therapeutic recreation specialist documents occurrences related to risk management;
the therapeutic recreation assistant reports risk management information to the
therapeutic recreation specialist.
•The therapeutic recreation specialist prepares and reports quality improvement data; the
therapeutic recreation assistant may collect data for quality improvement; she/he reports
this information to the therapeutic recreation specialist.
Standard Five: Outcomes
The therapeutic recreation specialist records data on the participant’s response to the
therapeutic recreation process in the behavioral areas, cognitive, physical, social,
emotional, spiritual; leisure functioning; personal development; and, quality of life
variables and uses these results to enhance the therapeutic recreation process. The
therapeutic recreation assistant assists in the recording of data under the supervision of
the therapeutic recreation specialist.
•Outcomes resulting from the use of specific interventions are reflected in systematic and
periodic written evaluations of programs and services.
•Formative evaluation monitors progress and documents timely modifications to better
ensure participant’s needs are addressed through programs and services.
•Summative evaluation documents program effectiveness and accountability of results
directly attributable to programs and services and participant satisfaction with the
outcomes.
•The therapeutic recreation specialist includes the input from the participant, caregivers,
and the interdisciplinary team in the documentation of outcomes.
•The therapeutic recreation assistant provides input to the therapeutic recreation
specialist to assist in the documentation of outcomes.
•The therapeutic recreation specialist uses outcomes in quality improvement and efficacy
research efforts to support and demonstrate effectiveness of the therapeutic recreation
process.
•Participant and program outcomes are used to regularly update programs and services.
•Frequently used data collection methods and devices are recorded in the plan of
operation.
•The therapeutic recreation specialist engages in and disseminates the outcomes of
efficacy research.
Standard Six: Professional Staffing and Credentials
Qualified and properly credentialed personnel conduct and monitor the therapeutic
recreation process and maintain their professional competence through appropriate
professional development activities.
•Credentials from the National Council for Therapeutic Recreation Certification
(NCTRC) qualify the therapeutic recreation specialist.
•Credentials for the TRA follow the JCAHO definition of a “recreational therapist
assistant or technician, qualified: an individual who, at a minimum, is a graduate of an
associates degree program in recreational therapy; [and] meets any current legal
requirements of licensure, registration, or certification . . .” (refer to references).
•The therapeutic recreation (specialist) personnel has(have) a professional development
plan to maintain and expand professional competence and credentials including
knowledge of current therapeutic recreation trends, facilitation techniques and
interventions, issues, and professional and legal standards.
•The therapeutic recreation (specialist) personnel demonstrate(s) appropriate competence
in all interventions and facilitation techniques that are used in programs and services.
•The therapeutic recreation (specialist) personnel is(are) hired, assigned and promoted
based on qualifications specific to therapeutic recreation that are delineated in position
descriptions and/or competency standards with established salary ranges commensurate
with agency practices.
A performance appraisal (competency assessment) evaluates the therapeutic recreation
(specialist’s) personnel job performance(s) on an on-going basis and is(are) founded on
individual professional development goals written in the professional development plan.
•Written personnel policies and procedures interpret expectations and relationships with
supervisors, therapeutic recreation assistants, volunteers, interns, and colleagues.
•The therapeutic recreation (specialist) personnel regularly receive(s) participant input
and feedback that is incorporated into performance appraisals and professional
development plans.
Standard Seven: Ethics
Professionals and paraprofessionals are committed to advancing the use of therapeutic
recreation services in order to ensure protection, quality, and promote the rights of
persons receiving services.
•The therapeutic recreation (specialist) personnel conform(s) and subscribe(s) to the
NTRS professional code of ethics.
•The therapeutic recreation (specialist) personnel conform(s) and subscribe(s) to a
professional participant bill of rights.
•The therapeutic recreation (specialist) personnel conform(s) and subscribe(s) to current
local, state and federal laws, guidelines, and standards established by regulatory bodies.
•The therapeutic recreation (specialist) personnel maintain(s) his/her professionalism by
upholding professional credentialing practices, NTRS standards of practice, agency
conduct codes, competency standards, and privileging policies.
•The therapeutic recreation (specialist) personnel maintain(s) and advocate(s) for
participant integrity, confidentiality, dignity, and autonomy.
Standard Eight: Quality Management
The therapeutic recreation specialist implements management policies and procedures in
order to maintain the quality of therapeutic recreation programs and services. These
protocols comply with governmental, accreditation, professional, and agency standards
and regulations. Evaluation and research are conducted to enhance the therapeutic
recreation process; and, management practices and research initiatives are compatible
with agency protocols and professional standards. The therapeutic recreation assistant
reports information to the therapeutic recreation specialist regarding the quality of TR
programs and services.
•The therapeutic recreation specialist in consultation with management develops a
written plan to monitor and evaluate the delivery and outcomes of programs and services;
the plan identifies significant structure, process, outcome indicators of quality and
standards of productivity for the therapeutic recreation process and for the management
of the resources, areas, facilities, and equipment used during service delivery; the
therapeutic recreation assistant provides input to the therapeutic recreation specialist.
The therapeutic recreation specialist develops a plan to conduct participant and servicerelated
evaluation and research to maintain and improve the quality, effectiveness, and
integrity of the therapeutic recreation process; the therapeutic recreation assistant may
assist in the development of the plan.
•The operating protocols and policies are described in the operational manual and are
compatible with the agency/facility’s general administrative documents and with
governmental, accreditation, professional, and agency standards and regulations.
•A budget for the operation of the therapeutic recreation service is prepared by the
therapeutic recreation specialist or with input from the therapeutic recreation specialist
or assistant and complies with administrative protocols; financial practices are compatible
with other service units and reflect relevant reimbursement procedures.
•The therapeutic recreation specialist maintains records on the management of the
therapeutic recreation service in accordance with agency/facility regulations and external
agents and standards.
•The therapeutic recreation service has a marketing plan that promotes the agency, the
therapeutic recreation service, and the profession; advocates for inclusionary services and
the rights to accessible quality healthcare and leisure services.
•The therapeutic recreation service has a risk management plan that articulates health and
safety standards compatible with agency policies and procedures and external standards.
•The necessary areas, facilities, equipment, and supportive resources are provided,
designed, constructed or modified to permit programs and services to be carried out to the
fullest possible extent and are in compliance with agency regulations, external agents,
laws and regulations, and professional standards.
•A plan for incorporation of therapeutic recreation assistants, support staff, volunteers,
and interns, in the therapeutic recreation process, is in the operational manual and
identifies procedures related to training, supervision, evaluation, and recognition in
accordance with agency/facility policies and professional standards. The therapeutic
recreation assistant contributes to the development of management policies and
procedures under the supervision of the therapeutic recreation specialist.
5. Find & print at least 1 historical time line.
Recreational therapy- 1940 to 2006
complied by Jeffrey A. Mansfield
1940-1959 (26,635 killed by nationwide polio epidemic)
1941 The US enters WWII, ends 1945
1941 Menninger Foundation established by psychiatrist Karl Augustus Menninger (1893-198?). A nonprofit organization dedicated to the furtherance of psychiatric research in Topeka, KS.
1941 AAHPER-News from the Therapeutic Section begins
1942 Karl Menninger "Love Against Hate" chapter 7 about play
1942 American Recreation Society, "recreation worker"
1943 Davis publishes "Principles and Practice of Rehabilitation"
1943 Pending Congressional action, the Red Cross Gray Ladies are cooperating with the Army Medical Corps by providing diversional occupations and recreation to wounded soldiers in Army Hospitals
1943 AAHPER-News from the Therapeutic Section column
"Great nationwide stress is also being placed on rehabilitation of the grossly crippled and handicapped, so that they may be mobilized for constructive service in meeting the manpower shortages in industry and civilian duty, service which is essential to keep our armies in the field." Rehabilitation of war casualties and maximum mobilization of manpower.
"Great nationwide stress is also being placed on rehabilitation of the grossly crippled and handicapped, so that they may be mobilized for constructive service in meeting the manpower shortages in industry and civilian duty, service which is essential to keep our armies in the field." Rehabilitation of war casualties and maximum mobilization of manpower.
1943 Federal Vocational Rehabilitation Act of 6 JUL. 1943 (PL 190)
funds physical and vocational restoration, amendment to Vocational Rehabilitation Act of 1920 (PL113) "remunerative occupation"
funds physical and vocational restoration, amendment to Vocational Rehabilitation Act of 1920 (PL113) "remunerative occupation"
1945 VA Recreation Service established. The objectives are: "to assist the doctor in getting his patients well, and to make life as satisfying and meaningful as possible for those patients who must remain in the hospital."
1945-1960 Increase in nursing homes
1946-1964 Steep increase in the U.S. birthrate following WWII called the "Baby Boom". 76 Million people are born accounting for nearly one-third of the U.S. population in 1980. The resulting uneven age distribution has had a multitude of social effects on educational systems, job markets, urban and suburban economies and so on, including almost every aspect of contemporary life.
1947 "American Physical and Mental Rehabilitation" APMR
1947 AOTA assumes responsibility of publication of its own organ, The American Journal of Occupational Therapy (current)
Occupational Therapy and Rehabilitation continued publishing
Occupational Therapy and Rehabilitation continued publishing
1948 American Recreation Society, Hospital Recreation Section
1948 College Recreation Association founded
194? APA forms Leisure Time Committee
1950 Korean War, ends 1953
1950 Korean War, ends 1953
1950 Dunton and Licht "Occupational Therapy Principles and Practice" ch: 12 Recreational Therapy authored by Davis; Defines RT as: "any free, voluntary and expressive activity; motor, sensory or mental, vitalized by an expansive play spirit, sustained by deep rooted pleasurable attitudes and evoked by wholesome emotional release; prescribed by medical authority as an adjuvant in treatment."
1950 Masters Programs
Springfield College; M.S. PE & Rec. in Rehabilitation
U of MN; M.S. Hospital Recreation (taught at med school)
Columbia U; PE & Rec. in Rehabilitation
Springfield College; M.S. PE & Rec. in Rehabilitation
U of MN; M.S. Hospital Recreation (taught at med school)
Columbia U; PE & Rec. in Rehabilitation
1950 The National Association for Music Therapy is founded
1951 JHPER, v22 p13+ N '51 "We Prescribe Recreation"
1951 Esther Goetz Gillian (Ed.) "Music Therapy"
1951 VA "Recreation Service" VA Manual M6-4
1952 Davis writes book "Clinical Applications of Recreational Therapy"
1952 The Department of Physical Medicine, Graclyn Hospital, Winston Salem, N.C. offers the first 12 month Recreational Therapy internships.
1952 Bernath Eugene Phillips announces the creation of the Recreational Therapy Section of the American Association of Health, Physical Education, and Recreation, a branch of the National Education Association. The RTS replaces the Institutional half of the Industrial and Institutional Section.
1953 National Association of Recreational Therapists (NART) is established Feb. 1953, their official publication is the "Inter-State News"
1953 The Council for the Advancement of Hospital Recreation (CAHR) is formed in Feb. 1953 at a meeting held at NEA offices, and was attended by two representatives each of:
('48) American Recreation Society, Hospital Section (2 representatives)(Annabelle Story-ARC)
('52) AAHPER's Recreational Therapy Section (2) (Jack Anderson)
('53) National Association of Recreational Therapists (2)
('53) National Recreation Association's Hospital Consultant (originally 1, later 2)
('48) American Recreation Society, Hospital Section (2 representatives)(Annabelle Story-ARC)
('52) AAHPER's Recreational Therapy Section (2) (Jack Anderson)
('53) National Association of Recreational Therapists (2)
('53) National Recreation Association's Hospital Consultant (originally 1, later 2)
1953 Sacramento State College offers B.A. in Recreational Therapy
San Francisco State College develops a Hospital Recreation program
New York University starts a Hospital Recreation Graduate program
San Francisco State College develops a Hospital Recreation program
New York University starts a Hospital Recreation Graduate program
1954 U of MN offers Hospital Recreation correspondence course
1954 The Revised 1954 Standards for Psychiatric Hospitals and Clinics, published by the APA, describes Activity Therapy as on of the professional services in the mental hospital, and further indicates that it "may be divided into occupational therapy and recreation."
1955 The first educational film on the therapeutic value of recreation for patients (hospital recreation) in the non-government hospitals "Rx for Recreation" (originally So Much for So Little) is a 28 minute color film produced by the NRA. The script was written by Beatrice Hill and Robert Wald, and was directed by Robert Wald, who produced the radio/TV series "American Inventory." The film premiered at the American Hospital Association convention the week of Sep. 20th, and again at the 37th National Recreation Congress.
1955 CAHR publishes the first hospital recreation personnel standards, separating registration into three sections: Hospital Recreation Director, Hospital Recreation Leader, and Hospital Recreation Aide.
1956 A critical shortage of physical therapists seriously impedes the national rehabilitation program. Over 5,800 jobs for qualified physical therapists are available throughout the US.
1956 The Veterans' Administration begins their Student Affiliate Recreation Trainee Program
1957 Bernath Eugene Phillips becomes CAHR's first registered Hospital Recreation Director at their Mar. 18, 1957 meeting in Chicago.
1957 SUNY Cortland offers a master's degree in Hospital Recreation
San Jose Starts a Hospital Recreation program, and is affiliated with the Palo Alto VA.
Texas Women's University offers Recreational Therapy bachelor's degree
San Jose Starts a Hospital Recreation program, and is affiliated with the Palo Alto VA.
Texas Women's University offers Recreational Therapy bachelor's degree
1958 U of Iowa offers undergraduate and graduate specialization in Hospital Recreation
1958 NRA Hospital Recreation Consultant becomes Consulting Service on Recreation for the Ill and The Handicapped
1961 UNC-Chapel Hill hosts the 5th Regional Institute on Hospital Recreation. The theme was "Expanding Horizons".
1961 Beatrice Hill resigns after seven years as director of the NRA Consulting Service on Recreation for the Ill and the Handicapped to establish Comeback, Inc. Comeback, Inc. implements methods developed by the Homebound Recreation Demonstration Project, which was funded by the Office of Vocational Rehabilitation and conducted by the NRA. Comeback, Inc. is dedicated to serving the social rehabilitation needs of the ill and handicapped.
1965 The US sends troops to Vietnam, withdraws 1973
1965 The US sends troops to Vietnam, withdraws 1973
1965-present: Medicare (Health Insurance for the aged) is added to Social Security benefits, and Medicare starts regulating nursing homes.
1966 The NRA and ARS merge into the National Recreation and Parks Association (NRPA)
1966 On Sunday, October 9, 1966, the NRPA Board of Trustees in session at the Washington-Hilton Hotel, Washington, D.C., approved the Charter and Bylaws of the National Therapeutic Recreation Society and accepted NTRS as a professional branch of NRPA. NTRS takes over the administration of the credentialing program from CAHR.
196? First President's Panel on Mental Retardation
196? Passage of Public Law 90--170, which results in training grants and research for therapeutic recreation
196? PL 90-480 Architectural Barriers Act, tax incentives for barrier removal
196? Creation of Bureau of Education for Handicapped in Office of Education
196? First Special Olympics (Olympics for Retarded)
1967 On January 28, 1967, Hilton Motor Inn, Kansas City, Missouri, the first official meeting of the NTRS Board of Directors was held, and Ira J. Hutchinson was elected president...During the April mid-year meeting, President Hutchinson requested the board accept his resignation as president, so he could accept the NRPA position of "Consultant on Therapeutic Recreation." He also became NTRS Executive Secretary on a part-time basis...First publication of the Therapeutic Recreation Journal.
1969 David C. Park was appointed NRPA Therapeutic Recreation Specialist and NTRS Executive Secretary...The first Registration Board was convened under NTRS.
1969 David C. Park was appointed NRPA Therapeutic Recreation Specialist and NTRS Executive Secretary...The first Registration Board was convened under NTRS.
1971 Dr. Paul Haun, "Recreation: A Medical Viewpoint"
1971 Adoption of "NTRS Standards for Psychiatric Facilities," which were later incorporated into the JCAHO Accreditation Manual for Psychiatric Facilities...NTRS State Section Advisory Council established.
1972 Draft of the first NTRS Code of Ethics was completed...Legislative Action Committee was developed...Competencies for therapeutic recreation specialists were developed.
1973 PL 93-113 Rehabilitation Act of 1973, Section 504
1974 PL 94-142 Education for All Handicapped
1974 NTRS Newsletter was developed.
1975 NTRS Field Placement Guidelines were completed...NTRS 750-Hour Training Program was completed...After David Park’s resignation, Yvonne A. Washington assumed the duties of NTRS Branch Liaison.
1975 Utah Recreation Therapy Licensure Rule goes in effect http://www.rules.utah.gov/publicat/code/r156/r156-40.htm
2006 North Carolina Recreational Therapy Licensure Rule goes in effect http://www.ncbrtl.org
1976 A committee was established to develop a philosophical position statement on therapeutic recreation.
1977 White House conference on Handicapped
1977 NTRS Presidential Commission on Assessment of Critical Issues was established.
1977 Dictionary of Occupational Titles 076.124-014 RECREATIONAL THERAPIST:
Plans, organizes, and directs medically approved recreation program for patients in
hospitals and other institutions: Directs and organizes such activities as adapted sports,
dramatics, social activities, and arts and crafts, regulating content of program in
accordance with patients' capabilities, needs, and interest. Prepares reports for patient's
physician or treatment team, describing patients' reactions, and symptoms indicative of
progress or regression.
Plans, organizes, and directs medically approved recreation program for patients in
hospitals and other institutions: Directs and organizes such activities as adapted sports,
dramatics, social activities, and arts and crafts, regulating content of program in
accordance with patients' capabilities, needs, and interest. Prepares reports for patient's
physician or treatment team, describing patients' reactions, and symptoms indicative of
progress or regression.
197? JCAHO Standards for TR in psychiatric facilities
197? NTRS 750-hour training program
1978 NTRS Registration Program was recognized by NRPA as the sole registering body for therapeutic recreation personnel.
1979 Guidelines for Community-Based Recreation Programs for Special Populations, Standards of Practice for Therapeutic Recreation Services, and Guidelines for Administration of Therapeutic Recreation Service in Clinical and Residential Facilities were developed by NTRS.
1980 NTRS conducted a national survey on the status of recreation as a related service in PL 94-142.
1981 National Council for Therapeutic Recreation Certification (NCTRC), formerly NTRS Board of Registration, became a completely autonomous credentialing body, administratively and financially independent from NRPA/NTRS...NTRS published Quality Assurance: Concerns for Therapeutic Recreation and Guidelines for Third-Party Reimbursement...Philosophical Position Statement on Therapeutic Recreation was accepted and endorsed by the membership and the Board of Directors of NTRS...Model Practice Act was developed by NTRS to assist states in addressing licensure...CARF incorporated therapeutic recreation services into their Standards Manual.
1981 Designated by the United Nations as the International Year of Disabled Persons
Designated by the United Nations as the International Year of Disabled Persons
Designated by the United Nations as the International Year of Disabled Persons
1982-1989 (63,159 killed by AIDS)
1982 NTRS Philosophical Position Statement
1984 NTRS established National Therapeutic Recreation Week.
1984 The American Therapeutic Recreation Association (ATRA)
1985 "ATRA Annual" ATRA
1985 NTRS developed a Strategic Plan—at least 85 percent of the objectives were completed.
1987 NTRS published Philosophy of Therapeutic Recreation...NTRS developed a Marketing Committee...NTRS representative invited to attend the JCAHO PTAC meeting for the first time...Policies and Procedures Manual was revised, approved and disseminated to the NTRS Board of Directors...NTRS Regional Directors began to represent their region on NRPA Regional Councils.
1988 The first NTRS Board Retreat was held in Denton, Texas...The following topic areas were discussed: marketing, communications/publications, public policy, professional standards, and the NTRS committee structure. A work plan was developed to address issues within the topic areas...NTRS unveiled its new "logo" at the NRPA Congress.
1988 NCTRC job analysis establishes a unique and coherent body of knowledge
198? Blocked attempts to remove activity therapy opportunities in nursing homes regulations
198? Development of wellness centers
198? Development of private TR consultant firms
198? IDEA amendments
198? Older Americans Act Reauthorization
198? Older Americans Personal Welfare Education Training Act
1990 NCTRC and ETS (Educational Testing Service) administer first certification exam.
1990 Revised Standards for Internship in Therapeutic Recreation published...NTRS revised Guidelines for the Administration of Therapeutic Recreation Service was published...After Yvonne Washington’s resignation, Rikki S. Epstein assumed the duties of NTRS Program Manager...A revised Code of Ethics was adopted.
1990 Encyclopedia of Careers and Vocational Guidance, volumes 1 & 2.
Volume 2, page 577: As a form of medical treatment: "Recreational therapists plan, organize, and direct medically approved recreation programs for patients in hospitals and other institutions."
Volume 1, page 417: In the recreation and park service: "Therapeutic recreation staff: The development of classes, sites, and opportunities in recreation for the mentally and physically disabled is a relatively new area in research and development."
Volume 2, page 577: As a form of medical treatment: "Recreational therapists plan, organize, and direct medically approved recreation programs for patients in hospitals and other institutions."
Volume 1, page 417: In the recreation and park service: "Therapeutic recreation staff: The development of classes, sites, and opportunities in recreation for the mentally and physically disabled is a relatively new area in research and development."
1991 Dictionary of Occupational Titles 076.124-014 RECREATIONAL THERAPIST: alternate title: therapeutic recreation worker:
"Plans, organizes, and directs medically approved recreation program for patients in hospitals and other institutions: Directs and organizes such activities as sports, dramatics, games, and arts and crafts to assist patients to develop interpersonal relationships, to socialize effectively, and to develop confidence needed to participate in group activities. Regulates content of program in accordance with patients' capabilities, needs and interests. Instructs patients in relaxation techniques, such as deep breathing, concentration, and other activities, to reduce stress and tension. Instructs patients in calisthenics, stretching and limbering exercises, and individual and group sports. Counsels and encourages patients to develop leisure activities. Organizes and coordinates special outings and accompanies patients on outings, such as ball games, sightseeing, or picnics to make patients aware of available recreational resources. Prepares progress charts and periodic reports for medical staff and other members of treatment team, reflecting patients' reactions and evidence of progress or regression. May supervise and conduct in-service training of other staff members, review their assessments and program goals, and consult with them on selected cases. May train groups of volunteers and students in techniques of recreation therapy. May serve as consultant to employers, educational institutions, and community health programs. May prepare and submit requisition for needed supplies."
"Plans, organizes, and directs medically approved recreation program for patients in hospitals and other institutions: Directs and organizes such activities as sports, dramatics, games, and arts and crafts to assist patients to develop interpersonal relationships, to socialize effectively, and to develop confidence needed to participate in group activities. Regulates content of program in accordance with patients' capabilities, needs and interests. Instructs patients in relaxation techniques, such as deep breathing, concentration, and other activities, to reduce stress and tension. Instructs patients in calisthenics, stretching and limbering exercises, and individual and group sports. Counsels and encourages patients to develop leisure activities. Organizes and coordinates special outings and accompanies patients on outings, such as ball games, sightseeing, or picnics to make patients aware of available recreational resources. Prepares progress charts and periodic reports for medical staff and other members of treatment team, reflecting patients' reactions and evidence of progress or regression. May supervise and conduct in-service training of other staff members, review their assessments and program goals, and consult with them on selected cases. May train groups of volunteers and students in techniques of recreation therapy. May serve as consultant to employers, educational institutions, and community health programs. May prepare and submit requisition for needed supplies."
1991 NTRS initiated a move to enhance the therapeutic recreation profession by establishing Ad Hoc Committees with NCTRC and ATRA...A proposed alternate certification plan was developed by NTRS...The NTRS 750-Hour Training Program for Therapeutic Recreation Assistant was revised.
1992 UT Title 58 Recreational Therapy Practice Act, licensure
1992 NTRS became an Associate Member of CARF and joined the JCAHO Coalition of Rehabilitation Therapy Organizations. Revised Preparing for a Career in Therapeutic Recreation... NTRS developed promotional kits to assist agencies in celebrating National Therapeutic Recreation Week, a national observance sponsored by NTRS.
1993 NTRS adopted a comprehensive Strategic Plan to guide the organization's work...A definition of therapeutic recreation was developed...An NTRS Vision Statement was approved...The NTRS Board approved the Research Proposal Guidelines and Criteria developed by the Research Committee, thereby establishing a program to provide partial funding of research projects which investigate the efficacy of therapeutic recreation services.
1994 NTRS approved Interpretive Guidelines for the Code of Ethics...Promoting Therapeutic Recreation—A Marketing Guide was published...NTRS and NRPA held the first annual National Therapeutic Recreation Professional Development Forum...NTRS focused grassroots advocacy efforts on the need for comprehensive health care reform...NTRS established an Ad Hoc Committee on International Affairs...NTRS completed "Therapeutic Recreation Practitioner Analysis Study."
1995 Western Carolina University is the first institution of higher education to offer B.S. in Recreational Therapy, offering a clinical perspective of recreation, rather than just a therapeutic bent to a recreation degree. WCU defines recreational therapy as the prescribed use of recreational and other activities as
treatment interventions to improve the functional living competence of persons with
physical, mental, emotional and/or social disadvantages.
treatment interventions to improve the functional living competence of persons with
physical, mental, emotional and/or social disadvantages.
1995 NTRS established the NTRS Fred Humphrey Internship Program...NTRS revised Standards of Practice for Therapeutic Recreation Services was published...Impacting Public Policy: An Advocacy Manual for Therapeutic Recreation and Manual for Recreation Therapy in Long-Term Care Facilities were published.
1996 CA Assembly Bill 2853-Recreation Therapy title legislation.
1996
NTRS became a National Organization Patron of the 1996 Atlanta Paralympic Games...NTRS revised its Philosophical Position Statement...APRS and NTRS formed a joint committee on community recreation for people with disabilities...Understanding Financing and Reimbursement Issues was published...Philosophy of Therapeutic Recreation: Ideas and Issues, Volume II was published...Preparing for a Career in Therapeutic Recreation was updated...NRPA/NTRS established a Home Page on the Internet...Joint Task Force on Credentialing established by NTRS and ATRA...NTRS invited by the American Medical Association to include its information on "Preparing for a Career in Therapeutic Recreation" in the AMA’s 1997-1998 edition of Allied Health and Rehabilitation Professions Education Directory.
NTRS became a National Organization Patron of the 1996 Atlanta Paralympic Games...NTRS revised its Philosophical Position Statement...APRS and NTRS formed a joint committee on community recreation for people with disabilities...Understanding Financing and Reimbursement Issues was published...Philosophy of Therapeutic Recreation: Ideas and Issues, Volume II was published...Preparing for a Career in Therapeutic Recreation was updated...NRPA/NTRS established a Home Page on the Internet...Joint Task Force on Credentialing established by NTRS and ATRA...NTRS invited by the American Medical Association to include its information on "Preparing for a Career in Therapeutic Recreation" in the AMA’s 1997-1998 edition of Allied Health and Rehabilitation Professions Education Directory.
1997 Revised NTRS Internship Standards and Guidelines for Therapeutic Recreation were published...NTRS invited to participate in the Health Care Financing Administration’s (HCFA) Sharing Innovations in Quality Initiative...First NTRS Edith Ball Scholarship was presented...Revised NTRS Strategic Plan was approved...Position Statement on Inclusion adopted by NTRS...NTRS represented on CARF National Advisory Committee.
1998 NTRS was invited to submit written testimony to the Institute of Medicine’s Committee on Improving Quality in Long Term Care...Revised Manual for Recreation Therapy in Long Term Care and Preparing for a Career in Therapeutic Recreation published...NTRS approved Standards of Practice for Paraprofessinals in Therapeutic Recreation...NTRS and ATRA approved a Resolution and Letter of Agreement to Communicate, Cooperate and Collaborate...NTRS established new committees and task forces in the areas of technology, assistive technology, benefits training, adventure based programming, and therapeutic recreation in the schools...NTRS developed its own website...Consumer At-Large Director position was approved for the NTRS Board of Directors.
1999 NTRS met with the Health Care Financing Administration (HCFA) regarding therapeutic recreation in long term care...NTRS and VSA arts entered into a partnership to collaborate on projects...Joint Task Force on Long Term Care established by NTRS and ATRA...NTRS Resolution on Inclusion was approved by the NRPA National Forum...NTRS received $17,000 in special funds from NRPA for the "Therapeutic Recreation—The Benefits are Endless...™" project.
2000 NTRS developed the "Therapeutic Recreation--The Benefits are Endless...™" training program and materials...Higher Education Work Group established by NTRS and ATRA...NRPA adopts the NTRS Position Statement on Inclusion as an NRPA policy...Revised NTRS Vision Statement was approved...NTRS developed a videotape highlighting the benefits of therapeutic recreation.
2001 State Recognition Options in Therapeutic Recreation: An Educational Resource was published by NTRS and ATRA...NTRS joined the Alliance for Disability Recreation and Sport...Best of Adventure Recreation was published...Joint Task Force on Higher Education was established by NTRS and ATRA.
2003 Nicki Booth was the first person to receive the Edith Ball Scholarship outisde of North America that was also studying therapeutic recreation in a foriegn country.
2005 NTRS testified in formal IDEA hearings across the country.
2006 NTRS celebrated its 40th Anniversary.
6. Find & list at least 4 other TR related web sites.
http://canadian-tr.org/about/ canadian rec therapy
http://www.mtra.memberlodge.org/ minnesota rec therapy
https://marriottschool.byu.edu/bsrecm/majors/therapeuticrecreation by rec therapy
http://montana.networkofcare.org/veterans/services/subcategory.aspx?tax=RP-8000.7400# my pathetic start on searching for a job in Montana.
http://canadian-tr.org/about/ canadian rec therapy
http://www.mtra.memberlodge.org/ minnesota rec therapy
https://marriottschool.byu.edu/bsrecm/majors/therapeuticrecreation by rec therapy
http://montana.networkofcare.org/veterans/services/subcategory.aspx?tax=RP-8000.7400# my pathetic start on searching for a job in Montana.
7. Find & print the application procedures for the National Certification exam
(Same stuff for State Licensure exam ... Plus the law and rules & regs.)
Complete Professional Eligibility Application and submit payment.
Complete Professional Eligibility Application and submit payment.
A complete application including all fees and transcripts must be received within the designated application window in order to be reviewed for a requested exam.
http://nctrc.org/new-applicants/application-deadlines/ has the application form
for the license exam you fill out the aplication and "Upon completion of the online registration form, you will be given the available examination dates and locations for scheduling your examination. Select your desired testing date."
8. Identify exam application deadlines.
| Exam Window | Application Submission Window* |
| Nov 2-14, 2015 | July 16 – Sept 15, 2015 |
| Jan 4-16, 2016 | Sept 16 – Nov 15, 2015 |
| Mar 7-19, 2016 | Nov 16 – Jan 5, 2016 |
| May 2-14, 2016 | Jan 6 – Mar 5, 2016 |
| July 5-16, 2016 | Mar 6 – May 5, 2016 |
| Sept 6-17, 2016 | May 6 – July 5, 2016 |
| Nov 7-19, 2016 | July 6 – Sept 5, 2016 |
exam deadline for application is usually two months before the exam
9. Find & print the National Certification exam Content outline.
Examination Content Outline
I. Assessment of Diabetes and Prediabetes (60)
A. Assess Learning/Self-Care Behaviors (20)
1. Goals and learning needs
2. Learning readiness (attitudes, developmental level,
perceived learning needs, etc.)
3. Learning style (audio, visual, observational,
psychomotor, etc.)
4. Barriers to learning (concrete vs. abstract thinking,
literacy and numeracy levels, language, cultural values,
religious beliefs, health beliefs, psycho-social and
economic issues, family dynamics, etc.)
5. Physical capabilities/limitations (visual acuity, hearing,
functional ability, etc.)
6. Readiness to change behavior (confidence in ability to
change, value of change, etc.)
B. Assess Medical/Health/Psychosocial and Economic Status
(20)
1. Diabetes-specific health history (duration, symptoms,
complications, adherence to standards of care, treatment,
etc.)
2. General health history (family history, allergies, medical
history, nutrition history, etc.)
3. Previous and current medication regimen (medication
dosage, prescription and nonprescription drugs, herbals,
alternative remedies, adverse reactions, etc.)
4. Treatment fears and myths (hypoglycemia,
hyperglycemia, needles, weight gain, etc.)
5. Family/Caregiver dynamics and social supports
6. Substance use (alcohol, tobacco, caffeine, etc.)
7. Developmental transitions and mental health status (age,
life stages, coping ability, adjustment to diagnosis, etc.)
8. Specific barriers to diabetes self-care regimen (cognitive
ability, language, cultural, spiritual, psychosocial,
physical, economic, etc.)
9. Diabetes-specific physical assessment (injection and
blood glucose monitoring sites, blood pressure, weight,
height, body mass index, lower extremities, acanthosis
nigricans, etc.)
10. Laboratory and patient collected data trends (blood
glucose, A1C, lipid profile, renal/liver function, etc.)
C. Assess Current Knowledge and Self-Management Skills
(20)
1. Diabetes (e.g., pathophysiology)
2. Eating patterns (food and beverage preferences, portion
sizes, timing of meals and snacks, eating environment,
disordered eating, etc.)
3. Exercise/Physical activity history and/or level
4. Monitoring techniques and equipment (blood glucose,
ketones, blood pressure, weight, foot examination, etc.)
5. Record keeping activities (blood glucose, food, activity,
etc.)
6. Medication use (oral and injectable medications,
administration technique, delivery systems, timing and
dosage, adherence, etc.)
7. Use of health care resources (health care professionals,
insurance, etc.)
II. Interventions for Diabetes and Prediabetes (89)
A. Collaborate with Patient/Family/Caregiver/Healthcare
Team to Develop: (16)
1. Individualized diabetes education plan based on
assessment (learning objectives, sequence of
information, selection of content, communication, etc.)
2. Instructional methods (discussion, demonstration, role
playing, simulation, technology-based platforms, etc.)
3. Behavioral goals (S.M.A.R.T. goals, AADE-7, etc.)
B. Teach/Counsel Regarding Principles of Care (50)
1. General topics
a. Classifications and diagnosis (ADA Clinical Practice
Recommendations, AACE, etc.)
b. Modifiable risk factors (lifestyle behaviors, etc.)
c. Pathophysiology (auto-immunity, MODY, insulin
resistance, fuel metabolism, secondary diabetes, etc.)
d. Effects and interactions of physical activity, food,
medication, and stress
e. Treatment options (choices, availability, cost,
risk/benefit, etc.)
f. Goals of treatment (blood glucose, A1C, blood
pressure, lipids, quality of life, prevention of
complications, etc.)
g. Purpose of laboratory tests (A1C, lipids, kidney and
liver function tests, etc.)
h. Evidence-based diabetes research
2. Living with diabetes and prediabetes
a. Psychosocial adaptation (new diagnosis,
complications, coping skills, etc.)
b. Psychosocial problems (depression, eating disorders,
divorce, etc.)
c. Role/Responsibilities of care (patient, family
members, team, shared responsibility, etc.)
d. Decision making/Behavior change skills
e. Safety (sharps disposal, medical ID, driving, etc.)
f. Hygiene (dental/skin/feet, etc.)
g. Social/Financial issues (employment, insurance,
disability, discrimination, etc.)
3. Metabolic monitoring
a. Glucose (testing sites, meter selection, sensor, etc.)
b. A1C
c. Blood pressure
d. Regimen and record keeping (blood glucose logs,
food records, etc.)
e. Lipids/Cholesterol
f. Liver/Renal monitoring (liver function studies,
microalbuminuria, serum creatinine, etc.)
g. Ketones
4. Nutrition principles and guidelines
a. ADA and Academy of Nutrition and Dietetics nutrition
recommendations (meal planning,
macro/micronutrients, etc.)
b. Carbohydrates (food source, sugar substitutes, fiber,
carbohydrate counting, etc.)
c. Fats (total, saturated, monounsaturated, etc.)
d. Protein (renal disease, wound care, etc.)
e. Food and medication integration (medication timing,
meal timing, etc.)
f. Food label interpretation (nutrition facts, ingredients,
health claims, etc.)
g. Alcohol (amount, precautions)
h. Weight management (adult and childhood obesity,
failure to thrive, etc.)
i. Special considerations (food allergies, gastroparesis,
celiac disease, bariatric surgery, etc.)
Certification Examination
for Diabetes Educators
Effective 5/2014
© 2013. NCBDE. All rights reserved.
~ 2 ~
5. Physical activity
a. ADA and American College of Sports Medicine
recommendations
b. Benefits, barriers, and precautions (e.g., post exercise
delayed onset hypoglycemia)
c. Exercise/Activity plan (aerobic, resistance training,
etc.)
d. Adjustment of monitoring, food, and/or medication
6. Pharmacologic management
a. ADA/European Association for the Study of Diabetes
(EASD), AACE guidelines
b. Medications (insulin, oral and injectable medications,
administration, side effects, etc.)
c. Delivery systems (pump therapy, devices, etc.)
d. Medication adjustment
e. Interactions (drug-drug, drug-food, etc.)
f. Non-prescription preparations
7. Acute complications: causes, prevention, and treatment
a. Hypoglycemia
b. Hyperglycemia
c. Diabetic ketoacidosis (DKA)
d. Hyperosmolar hyperglycemic state (HHS)
8. Chronic complications and comorbidities: causes,
prevention, and treatment
a. ADA Clinical Practice screening recommendations
b. Eye disease (retinopathy, cataracts, glaucoma, etc.)
c. Sexual dysfunction
d. Neuropathy (autonomic, peripheral, etc.)
e. Nephropathy
f. Vascular disease (cerebral, cardiovascular,
peripheral, etc.)
g. Lower extremity problems (foot ulcers, Charcot foot,
etc.)
h. Dermatological (wounds, yeast infection, ulcers, etc.)
i. Dental and gum disease
j. Co-morbidities (hypertension, depression, cognitive
dysfunction, thyroid disease, celiac disease, obesity,
sleep apnea, polycystic ovarian syndrome, etc.)
9. Other management issues
a. Honeymoon period, dawn phenomenon, Somogyi
effect
b. Hypoglycemia unawareness
c. Sick days
d. Physical capabilities/Limitations (visual acuity,
hearing, functional ability, etc.)
e. Surgery and special procedures
f. Travel and disaster preparedness
g. Transition populations (pediatric, geriatric, care
settings, etc.)
h. Pre-conception planning, pregnancy, post-partum,
and gestational diabetes
i. Changes in usual schedules (shift, religious, cultural,
etc.)
j. Assistive and adaptive devices (talking meter,
magnifier, etc.)
k. Substance use (tobacco, marijuana, illicit drugs, etc.)
l. Pump/Device malfunctions
m. Disparities (economic, access, sex, ethnicity,
geographic, mental capabilities, etc.)
C. Evaluate, Revise, and Document (17)
1. Weight, blood glucose, food intake, medication regimen,
physical activity plan
2. Patient self-reports and/or device downloaded reports
3. Evaluate effectiveness of teaching in the following:
a. Achievement of objectives
b. Progress towards behavioral goals
c. Self-management skills
d. Psychosocial adaptation
4. Ongoing plans for achieving and evaluating objectives
and behavioral goals
D. Referral and Follow-Up (6)
1. Issues requiring referral to other (health care)
professionals
a. Additional diabetes education
b. Medical nutrition therapy
c. Exercise prescription
d. Mental health
e. Medical care (foot care, dilated eye exam,
pre-conception counseling, etc.)
f. Financial and social services
g. Risk reduction (smoking cessation, obesity,
preventative services, etc.)
h. Medication consult
i. Discharge planning, home care, community resources
(visual, hearing, language, etc.)
2. Communication between diabetes educator and provider
3. Diabetes Self-Management Support (DSMS)
(pharmaceutical industry, community resources, and/or
health plan coaches/case managers, etc.)
III. Disease Management (26)
A. Education and Program Standards (8)
1. Translate National Standards for Diabetes Self-
Management Education and Support (NSDSMES)
2. Perform needs assessment (target population, etc.)
3. Develop curriculum (identify program goals, content
outline, lesson plan, teaching materials, etc.)
4. Choose teaching methods and materials for target
populations
5. Evaluate program outcomes (number of people served,
provider satisfaction, patient satisfaction, effectiveness of
diabetes education materials, etc.)
6. Assess patient outcomes (behavior changes, A1C, lipids,
weight, quality of life, ER visits, hospitalizations, work
absences, etc.)
7. Perform continuous quality improvement activities
8. Maintain patient information/demographic database
B. Clinical Practice (16)
1. Apply inpatient standards (AACE, ADA, Endocrine
Society, etc.)
2. Apply outpatient standards (AACE, ADA, Endocrine
Society, etc.)
3. Target high-risk populations for intervention
4. Identify health care professionals in need of education
C. Engage in Diabetes Advocacy (community awareness,
health fairs, work place, legislative efforts, media, etc.) (2)
(better formatting http://www.ncbde.org/certification_info/examination-content-outline/)
9. Find & print the National Certification exam Content outline.
Examination Content Outline
I. Assessment of Diabetes and Prediabetes (60)
A. Assess Learning/Self-Care Behaviors (20)
1. Goals and learning needs
2. Learning readiness (attitudes, developmental level,
perceived learning needs, etc.)
3. Learning style (audio, visual, observational,
psychomotor, etc.)
4. Barriers to learning (concrete vs. abstract thinking,
literacy and numeracy levels, language, cultural values,
religious beliefs, health beliefs, psycho-social and
economic issues, family dynamics, etc.)
5. Physical capabilities/limitations (visual acuity, hearing,
functional ability, etc.)
6. Readiness to change behavior (confidence in ability to
change, value of change, etc.)
B. Assess Medical/Health/Psychosocial and Economic Status
(20)
1. Diabetes-specific health history (duration, symptoms,
complications, adherence to standards of care, treatment,
etc.)
2. General health history (family history, allergies, medical
history, nutrition history, etc.)
3. Previous and current medication regimen (medication
dosage, prescription and nonprescription drugs, herbals,
alternative remedies, adverse reactions, etc.)
4. Treatment fears and myths (hypoglycemia,
hyperglycemia, needles, weight gain, etc.)
5. Family/Caregiver dynamics and social supports
6. Substance use (alcohol, tobacco, caffeine, etc.)
7. Developmental transitions and mental health status (age,
life stages, coping ability, adjustment to diagnosis, etc.)
8. Specific barriers to diabetes self-care regimen (cognitive
ability, language, cultural, spiritual, psychosocial,
physical, economic, etc.)
9. Diabetes-specific physical assessment (injection and
blood glucose monitoring sites, blood pressure, weight,
height, body mass index, lower extremities, acanthosis
nigricans, etc.)
10. Laboratory and patient collected data trends (blood
glucose, A1C, lipid profile, renal/liver function, etc.)
C. Assess Current Knowledge and Self-Management Skills
(20)
1. Diabetes (e.g., pathophysiology)
2. Eating patterns (food and beverage preferences, portion
sizes, timing of meals and snacks, eating environment,
disordered eating, etc.)
3. Exercise/Physical activity history and/or level
4. Monitoring techniques and equipment (blood glucose,
ketones, blood pressure, weight, foot examination, etc.)
5. Record keeping activities (blood glucose, food, activity,
etc.)
6. Medication use (oral and injectable medications,
administration technique, delivery systems, timing and
dosage, adherence, etc.)
7. Use of health care resources (health care professionals,
insurance, etc.)
II. Interventions for Diabetes and Prediabetes (89)
A. Collaborate with Patient/Family/Caregiver/Healthcare
Team to Develop: (16)
1. Individualized diabetes education plan based on
assessment (learning objectives, sequence of
information, selection of content, communication, etc.)
2. Instructional methods (discussion, demonstration, role
playing, simulation, technology-based platforms, etc.)
3. Behavioral goals (S.M.A.R.T. goals, AADE-7, etc.)
B. Teach/Counsel Regarding Principles of Care (50)
1. General topics
a. Classifications and diagnosis (ADA Clinical Practice
Recommendations, AACE, etc.)
b. Modifiable risk factors (lifestyle behaviors, etc.)
c. Pathophysiology (auto-immunity, MODY, insulin
resistance, fuel metabolism, secondary diabetes, etc.)
d. Effects and interactions of physical activity, food,
medication, and stress
e. Treatment options (choices, availability, cost,
risk/benefit, etc.)
f. Goals of treatment (blood glucose, A1C, blood
pressure, lipids, quality of life, prevention of
complications, etc.)
g. Purpose of laboratory tests (A1C, lipids, kidney and
liver function tests, etc.)
h. Evidence-based diabetes research
2. Living with diabetes and prediabetes
a. Psychosocial adaptation (new diagnosis,
complications, coping skills, etc.)
b. Psychosocial problems (depression, eating disorders,
divorce, etc.)
c. Role/Responsibilities of care (patient, family
members, team, shared responsibility, etc.)
d. Decision making/Behavior change skills
e. Safety (sharps disposal, medical ID, driving, etc.)
f. Hygiene (dental/skin/feet, etc.)
g. Social/Financial issues (employment, insurance,
disability, discrimination, etc.)
3. Metabolic monitoring
a. Glucose (testing sites, meter selection, sensor, etc.)
b. A1C
c. Blood pressure
d. Regimen and record keeping (blood glucose logs,
food records, etc.)
e. Lipids/Cholesterol
f. Liver/Renal monitoring (liver function studies,
microalbuminuria, serum creatinine, etc.)
g. Ketones
4. Nutrition principles and guidelines
a. ADA and Academy of Nutrition and Dietetics nutrition
recommendations (meal planning,
macro/micronutrients, etc.)
b. Carbohydrates (food source, sugar substitutes, fiber,
carbohydrate counting, etc.)
c. Fats (total, saturated, monounsaturated, etc.)
d. Protein (renal disease, wound care, etc.)
e. Food and medication integration (medication timing,
meal timing, etc.)
f. Food label interpretation (nutrition facts, ingredients,
health claims, etc.)
g. Alcohol (amount, precautions)
h. Weight management (adult and childhood obesity,
failure to thrive, etc.)
i. Special considerations (food allergies, gastroparesis,
celiac disease, bariatric surgery, etc.)
Certification Examination
for Diabetes Educators
Effective 5/2014
© 2013. NCBDE. All rights reserved.
~ 2 ~
5. Physical activity
a. ADA and American College of Sports Medicine
recommendations
b. Benefits, barriers, and precautions (e.g., post exercise
delayed onset hypoglycemia)
c. Exercise/Activity plan (aerobic, resistance training,
etc.)
d. Adjustment of monitoring, food, and/or medication
6. Pharmacologic management
a. ADA/European Association for the Study of Diabetes
(EASD), AACE guidelines
b. Medications (insulin, oral and injectable medications,
administration, side effects, etc.)
c. Delivery systems (pump therapy, devices, etc.)
d. Medication adjustment
e. Interactions (drug-drug, drug-food, etc.)
f. Non-prescription preparations
7. Acute complications: causes, prevention, and treatment
a. Hypoglycemia
b. Hyperglycemia
c. Diabetic ketoacidosis (DKA)
d. Hyperosmolar hyperglycemic state (HHS)
8. Chronic complications and comorbidities: causes,
prevention, and treatment
a. ADA Clinical Practice screening recommendations
b. Eye disease (retinopathy, cataracts, glaucoma, etc.)
c. Sexual dysfunction
d. Neuropathy (autonomic, peripheral, etc.)
e. Nephropathy
f. Vascular disease (cerebral, cardiovascular,
peripheral, etc.)
g. Lower extremity problems (foot ulcers, Charcot foot,
etc.)
h. Dermatological (wounds, yeast infection, ulcers, etc.)
i. Dental and gum disease
j. Co-morbidities (hypertension, depression, cognitive
dysfunction, thyroid disease, celiac disease, obesity,
sleep apnea, polycystic ovarian syndrome, etc.)
9. Other management issues
a. Honeymoon period, dawn phenomenon, Somogyi
effect
b. Hypoglycemia unawareness
c. Sick days
d. Physical capabilities/Limitations (visual acuity,
hearing, functional ability, etc.)
e. Surgery and special procedures
f. Travel and disaster preparedness
g. Transition populations (pediatric, geriatric, care
settings, etc.)
h. Pre-conception planning, pregnancy, post-partum,
and gestational diabetes
i. Changes in usual schedules (shift, religious, cultural,
etc.)
j. Assistive and adaptive devices (talking meter,
magnifier, etc.)
k. Substance use (tobacco, marijuana, illicit drugs, etc.)
l. Pump/Device malfunctions
m. Disparities (economic, access, sex, ethnicity,
geographic, mental capabilities, etc.)
C. Evaluate, Revise, and Document (17)
1. Weight, blood glucose, food intake, medication regimen,
physical activity plan
2. Patient self-reports and/or device downloaded reports
3. Evaluate effectiveness of teaching in the following:
a. Achievement of objectives
b. Progress towards behavioral goals
c. Self-management skills
d. Psychosocial adaptation
4. Ongoing plans for achieving and evaluating objectives
and behavioral goals
D. Referral and Follow-Up (6)
1. Issues requiring referral to other (health care)
professionals
a. Additional diabetes education
b. Medical nutrition therapy
c. Exercise prescription
d. Mental health
e. Medical care (foot care, dilated eye exam,
pre-conception counseling, etc.)
f. Financial and social services
g. Risk reduction (smoking cessation, obesity,
preventative services, etc.)
h. Medication consult
i. Discharge planning, home care, community resources
(visual, hearing, language, etc.)
2. Communication between diabetes educator and provider
3. Diabetes Self-Management Support (DSMS)
(pharmaceutical industry, community resources, and/or
health plan coaches/case managers, etc.)
III. Disease Management (26)
A. Education and Program Standards (8)
1. Translate National Standards for Diabetes Self-
Management Education and Support (NSDSMES)
2. Perform needs assessment (target population, etc.)
3. Develop curriculum (identify program goals, content
outline, lesson plan, teaching materials, etc.)
4. Choose teaching methods and materials for target
populations
5. Evaluate program outcomes (number of people served,
provider satisfaction, patient satisfaction, effectiveness of
diabetes education materials, etc.)
6. Assess patient outcomes (behavior changes, A1C, lipids,
weight, quality of life, ER visits, hospitalizations, work
absences, etc.)
7. Perform continuous quality improvement activities
8. Maintain patient information/demographic database
B. Clinical Practice (16)
1. Apply inpatient standards (AACE, ADA, Endocrine
Society, etc.)
2. Apply outpatient standards (AACE, ADA, Endocrine
Society, etc.)
3. Target high-risk populations for intervention
4. Identify health care professionals in need of education
C. Engage in Diabetes Advocacy (community awareness,
health fairs, work place, legislative efforts, media, etc.) (2)
(better formatting http://www.ncbde.org/certification_info/examination-content-outline/)
10. Find out if Ramon is currently nationally certified and when his expiration date is if necessary.
Zabriskie is currently certified, but it expires at the end of this year (2015) and he has one year to renew it
Zabriskie is currently certified, but it expires at the end of this year (2015) and he has one year to renew it
11. Identify at least 4 new activity ideas that you can utilize as a TR professional.
Garden Club
Submitted by Dee Maust of Beverly Healthcare on January 29, 2004
Submitted by Dee Maust of Beverly Healthcare on January 29, 2004
Size: 6-10
Equipment: Small scoops, potting soil, pots, planters, watering cans, regular scissors or safety scissors, towels and patience.
Objective: To promote eye hand coordination, a sense of self worth and relaxation.
Description: Before bringing residents into the room and before activity program begins, bring any plants already growing into the room and place them on tables for attractive visual. This will be inviting to residents that are interested in gardening. Give each person a plant to tend and an empty watering can. Fill a large watering can with water if there is no access to water in the activity room. Some may want to just water the plants.(hint, for some people you may want to fill their watering cans with just enough water to water one plant.) Some people like to groom the plants with their scissors. Some residents enjoy putting new cuttings in their new pot with potting soil. Converse with residents about the different plants.
Last spring, we brought flowers from a local nursery. We put long planters on two chairs with one end of planter on one chair and the other end on the other chair. We had a large opened bag of potting soil in a wheelbarrow to make it easy for residents to scoop the dirt from the wheelbarrow into the planter while sitting in their wheel chair. Some of the residents planted Petunias, Geraniums, Marigolds etc...Some just liked scooping the soil, watering or just touching. We have gardening at least once a week in our facility and usually just groom and take care of the plants we already have.
Happy Gardening!!
Happy Gardening!!
Stuffed Animals
submitted by Felecia Kershner of Nursing home on April 23, 2007
Size of Group: as many as you can handle
Equipment: Good scissors, needle, thread, various felt colors, beans, cotton, anything else like pom poms to decorate their favorite animal.
Objective: To have the resident help make their own stuffed animal. Residents can keep the animals, give them to their grand kids or donate to little kids in an orphanage
Description: Determine what animal each participant like best. Download a large clip art image of the animal and trace (or draw) it on to a piece of felt. Make two copies of that animal and cut them out. Hand stitch or sew most of the animal together. To make is so that animal can sit/stand, put beans in the bottom. Stuff the rest of the animal with cotton. Sew/stitch the rest of the animal up and decorate the animal with any tails or noses. We used wobbly eyes for our animals!
submitted by Felecia Kershner of Nursing home on April 23, 2007
Size of Group: as many as you can handle
Equipment: Good scissors, needle, thread, various felt colors, beans, cotton, anything else like pom poms to decorate their favorite animal.
Objective: To have the resident help make their own stuffed animal. Residents can keep the animals, give them to their grand kids or donate to little kids in an orphanage
Description: Determine what animal each participant like best. Download a large clip art image of the animal and trace (or draw) it on to a piece of felt. Make two copies of that animal and cut them out. Hand stitch or sew most of the animal together. To make is so that animal can sit/stand, put beans in the bottom. Stuff the rest of the animal with cotton. Sew/stitch the rest of the animal up and decorate the animal with any tails or noses. We used wobbly eyes for our animals!
Amigurumi (crochet)
Group size: any
Equiptment: crochet hooks, yarn, scissors, patterns
Objectives: To make an object, could be a flower or a cartoon character or an animal (most common). To develop a new skill, and increase relaxation and focus. Residents can keep their creations, gift them, or donate them to a charity organization.
Description: Find a pattern you like, many patterns can be found at http://www.amigurumipatterns.net/patterns/.
Group size: any
Equiptment: crochet hooks, yarn, scissors, patterns
Objectives: To make an object, could be a flower or a cartoon character or an animal (most common). To develop a new skill, and increase relaxation and focus. Residents can keep their creations, gift them, or donate them to a charity organization.
Description: Find a pattern you like, many patterns can be found at http://www.amigurumipatterns.net/patterns/.
Comfort Zone
submitted by Monique Lujan of Sacramento State Therapeutic Recreation Student on December 20, 2006
Size of Group: A group as small as 3, but no larger than 15.
Equipment:
Large area of floor space (activity may be done inside or outside.
Chalk or tape (for making circles, one smaller circle made inside a larger circle.
A list of questions geared toward specific population.
Objective: To demonstrate the ability to recognize personal levels of comfort within self and others.
Description:
1. The staff should have circles ready when group forms. The circle size will vary with group size.
2. The staff will have participants gather around the larger circle.
3. The staff will explain that a serious of questions will be asked. Participants will answer by moving in and out of the circles depending on levels of comfort with the hypothetical scenario. The three levels of comfort are:
A. I am very comfortable with this (inner circle)
B. I need growth in this area(middle circle)
C. This situation makes me panic (outer circle)
submitted by Monique Lujan of Sacramento State Therapeutic Recreation Student on December 20, 2006
Size of Group: A group as small as 3, but no larger than 15.
Equipment:
Large area of floor space (activity may be done inside or outside.
Chalk or tape (for making circles, one smaller circle made inside a larger circle.
A list of questions geared toward specific population.
Objective: To demonstrate the ability to recognize personal levels of comfort within self and others.
Description:
1. The staff should have circles ready when group forms. The circle size will vary with group size.
2. The staff will have participants gather around the larger circle.
3. The staff will explain that a serious of questions will be asked. Participants will answer by moving in and out of the circles depending on levels of comfort with the hypothetical scenario. The three levels of comfort are:
A. I am very comfortable with this (inner circle)
B. I need growth in this area(middle circle)
C. This situation makes me panic (outer circle)
4. When a question is asked the participant feels within their comfort level they will move into the smaller circle. If the participant is somewhat comfortable they will step into the larger circle. If they are not comfortable they will step back off the line outside of the larger circle.
5. Once the participants have chosen their comfort level the staff member will process with participants to discuss why they chose not the move.
6. The facilitator will encourage positive discussion of where participants are within their comfort level and whether these levels have changed during or through their therapy.
7. It is important to start with non-threatening questions first and move into more in-depth questions that will require more processing. You want to frame the questions around the topic you would like to process with the participants.
5. Once the participants have chosen their comfort level the staff member will process with participants to discuss why they chose not the move.
6. The facilitator will encourage positive discussion of where participants are within their comfort level and whether these levels have changed during or through their therapy.
7. It is important to start with non-threatening questions first and move into more in-depth questions that will require more processing. You want to frame the questions around the topic you would like to process with the participants.
12. If you ranked the salaries for TRS’s during 2000, what was the range for the middle 50%? What is the most recent salary info?
average salary of $36,377.85 (could not find middle 50%)
today $45,703-$56,448 average $51,092
average salary of $36,377.85 (could not find middle 50%)
today $45,703-$56,448 average $51,092
13. what is the job outlook for tr professionals
According to the BLS, jobs for recreational therapists are expected to increase by 13% from 2012 to 2022, which is about as fast as the average for all occupations. The BLS reports that the median salary for recreational therapists was $42,280, as of May 2012
14.What is a treatment network?
I believe it is a bunch of different people working in treatment, recreation therapy is just a part of the network, physical therapy, occupational therapy, and family doctors all make up a part of a whole for the treatment network.
but according to google there is only one treatment network and that is the autism treatment network, which is " a ground-breaking network of hospitals, physicians, researchers, and families at 17 locations across the United States and Canada. We are working together to develop the most effective approach to medical care for children and adolescents affected by autism."
According to the BLS, jobs for recreational therapists are expected to increase by 13% from 2012 to 2022, which is about as fast as the average for all occupations. The BLS reports that the median salary for recreational therapists was $42,280, as of May 2012
14.What is a treatment network?
I believe it is a bunch of different people working in treatment, recreation therapy is just a part of the network, physical therapy, occupational therapy, and family doctors all make up a part of a whole for the treatment network.
but according to google there is only one treatment network and that is the autism treatment network, which is " a ground-breaking network of hospitals, physicians, researchers, and families at 17 locations across the United States and Canada. We are working together to develop the most effective approach to medical care for children and adolescents affected by autism."
15. What other resources are available through ATRA and NTRS?
ATRA- also has a page on continuing education units, pretty pictures of RT happening, rallys for recreation therapy legislation, and job oprotunities.
NTRS-website is dead.
ATRA- also has a page on continuing education units, pretty pictures of RT happening, rallys for recreation therapy legislation, and job oprotunities.
NTRS-website is dead.
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