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Professional Competencies for Recreational Therapists

Puget Sound Therapeutic Recreation Association

Draft - For Comment

Caution: This is a draft document which has not received final approval from PSTRA.

This document is the result of a combined effort of over fifty therapists Certified Therapeutic Recreation Specialists (CTRS) brought together by the Puget Sound Chapter of the American Therapeutic Recreation Association (PSTRA). The intent of this document is to propose a minimum competency for any CTRS practicing within the State of Washington. PSTRA is a professional organization which relies on its members to advance the practice of recreational therapy within the State of Washington. As it does not have an office with a phone number, the following individuals participated in the development of this document and are available for questions: Missy Armstrong (206-713-8126/armstro@u.washington.edu), Mary Ann Keogh Hoss and joan burlingame (360-825-7797/joan@Idyllarbor.com).

This document does not cover the basic competency of understanding activity, leisure and recreation; theories of practice and practice models or material related to advancement of the profession. By definition, an individual holding a CTRS credential through the National Council for Therapeutic Recreation Certification, has passed a national exam which has measured a minimum knowledge base in these three areas.

How to Use This Document

The intent is that therapists and facilities will modify this document to best fit the needs of their location. Modification is expected to take place. However, the group would like to caution that the competencies contained within this document are considered minimum competencies. The two types of modifications anticipated are: 1. increasing minimum competencies and 2. deleting some competencies not required for a specific facility (e.g., knowledge of the later life stages for therapists working in a pediatric setting). This second modification does not imply that the therapist is not expected to hold these deleted competencies. The group feels that every CTRS practicing in the State of Washington is expected to hold all of these competencies by January 1st, 2000. It does mean that the facility/employer is not expected to have these competencies as part of their Level 1 Clinical Competency evaluation. The group advises that facilities include some competencies normally not called upon because of the intent of the Americans with Disabilities Act (ADA). An example might be therapists working in a psychiatric center who still need to hold a basic understanding of adapted equipment. Individuals with psychiatric disorders may also have a physical disability and visa versa.

PSTRA has released its claim on copyright to this document but asks that anyone who uses it, in part or in whole, recognized PSTRA as having developed the original document. Individuals and facilities have permission to modify the document so that it better meets their specific needs. To the best of PSTRA’s knowledge, the information and recommendations contained within this document reflect currently accepted practice. Nevertheless, they cannot be considered absolute and universal. The authors and publisher disclaim responsibility for any adverse effects resulting directly or indirectly from the suggested management practice, from any undetected errors or from the reader’s misunderstanding of the text.

 Definitions

Levels of Competency

Level 1, Beneficence (Do No Harm): Basic and general competencies that a Certified Therapeutic Recreation Specialist (CTRS) can do in any type of setting after a basic orientation to the specific unit and setting assuming successful completion of the facility’s orientation (e.g., fire and safety, hazards, etc.). Supervision is easily attainable (readily available) within the treatment setting whenever the therapist has questions or is in of supervision. Level 1 does not qualify the professional to take clients off of the facility’s campus without supervision. At the Level 1 the therapist is able to provide basic supervision for recreational therapy support personnel (e.g., volunteers, aides).

Level 2, Mastery Level: The therapist successfully demonstrates competencies contained within Level 1. The therapist demonstrates the ability to perform all aspects of the job including knowing when to refer to specialists or to seek assistance. Demonstrates independent clinical judgment to perform all aspects of job. Level 2 indicates that the therapist has demonstrated the competencies required to take clients off of the facility’s campus without supervision.

Level 3, Teacher: Demonstrates specialized skills related to teaching and supervision of others. An individual at Level 3 must be able to successfully demonstrate all competencies from Levels 1 and 2 and must have a minimum of two years experience within the environment or disability group for which s/he will supervise a student intern.

 Primary Methods of Achieving and Measuring Competency:

Workshop/Inservice Attendance: Therapists attends a workshop or inservice whose content is equal to or greater than the knowledge and skill base required. This level of measurement is assuming a great deal: that the therapist was actively listening and participating, and that the content provided the knowledge and skill base adequately and accurately and that the therapist was able to translate the material into knowledge and skills needed for practice.

Self-Education with Written Test: The therapist successfully completes an independent study whose content is equal to or greater than the knowledge and skill base required and whose content has been developed and accepted by a recognized group. Successful completion is defined as having passed a test on the content of the material. "Recognized group" could include professional organizations, institutions of higher education or other recognized groups of professionals, including a facility’s clinical competency or staff education committee.

Verbalize Knowledge Base: The therapist is able to verbally (or otherwise communicate) the content required in adequate detail to demonstrate a clear understanding. The content of the knowledge base may be determined to be meeting standards if it: 1. demonstrates enough understanding for beneficence, 2. contains content with a scope and detail considered adequate when compared to professional literature and standards and 3. satisfies requirements for job performance.

Demonstrated Skill: The therapist is able to demonstrate the skill required with adequate technique to show a clear ability. The level of skill may be determined to meet standards if it: 1. shows enough technique for beneficence, 2. displays proficiency with a scope and detail considered adequate when compared to professional literature and standards and 3. satisfies requirements for job performance.

Credentialing: The therapist holds proof of competence through a recognized credentialing agency achieved through a process of demonstrated knowledge and skill. Recognized credentialing agencies include (but are not limited to) the National Council for Therapeutic Recreation Certification, the American Red Cross, state and federal agencies.

Professional Competency in Recreational Therapy
Background of Practice — Level 1

Competency

Comments and/or Not Applicable

including:
Demonstrate skill related to leadership skills group dynamics, leadership styles, and how to direct, lead, instruct and guide people and processes toward desired outcomes
Holds basic knowledge of life stages stages as outlined by Erikson, Kohlberg, Piaget; preparing clients for medical procedures based on developmental level; and other important milestones presented in literature; death, dying and grieving process
Knowledge of common side effects of general medication groups common side effects and precautions related to the following medication groups: antibiotics, neuroleptic/antipsychotic; antianxiety/anxiolytic drugs; antidepressant drugs; anti-mania/mood stabilizer drugs
Working knowledge of common diagnosis including ability to define physical and emotional ramifications of .. anxiety disorders, birth defects, burns, CD/substance abuse, CVA, dementia, MR/DD, mood disorders, neuro-progressive, neuro-trauma, orthopedic, personality disorders, SCI, TBI, thought disorders; schizophrenia
Holds basic knowledge of other disciplines basic scope of practice to facilitate appropriate referrals and teamwork
Holds basic knowledge of ethics related to practice and can demonstrate understanding in his/her day-to-day practice working knowledge of categories (and their scope) of ethical practice as outlined by national organization(s)
Holds fundamental knowledge of types of legal status and using this knowledge can support the facility’s policies for implementation relating to legal status guardianships; emergency involuntary, temporary involuntary, extended involuntary, voluntary; competency (of fiscal/contractual affairs and of physical person or body/consent for treatment); facility policies related to levels of autonomy within the program
Demonstrates a working knowledge of standards of practice (JCAHO, HCFA, CARF, NCQA, ATRA/NTRS, etc.) scope of each standard setting groups’ standards; key requirements (timing of assessments, level of documentation, standards for quality of treatment, etc.); where to locate standards documents when more information is needed
Knowledge of treatment outcomes a basic knowledge of the types of interventions which have been demonstrated to positively impact the patient’s health status
Knowledge of cognition attention, memory, orientation, reasoning, problem solving, executive function, motor planning and visual spatial, decision making processes
Knowledge of how the neuromuscular system works and impacts function  

 

Professional Competency in Recreational Therapy
Background of Practice, continued — Level 1

Competency

Comments and/or Not Applicable

Knowledge of the cardiovascular system works and impacts function  
Knowledge and ability to avoid dual relationships dual relationships of internship supervisor as counselor/intimate significant other to student; patient as friend/intimate other to therapist; supervisor as intimate other to supervisee
Demonstrates basic knowledge and skills related to assisting patient movement including transfers, bed mobility and (list transfers, list bed mobility areas)
Maintains appropriate credentials CTRS; First Aid; CPR
Holds basic knowledge of common dietary orders and restrictions (list diets including diabetic precautions)
Verbalized knowledge of how to access community resources and how to access scope of continuity of care available  
Verbalizes techniques/therapist behaviors required to implement close observation orders  
Demonstrates understanding of commonly used scales including FIM, ASIA, min/mod/max assist/ weight bearing levels, contact guard, supervision,
Demonstrates ability to accurately measure vital signs  
Demonstrates ability to use task analysis techniques to analyze individual activity consistent with diagnosis, precautions and contraindications include task analysis for specific physical skills listed for L&I

 

Professional Competency in Recreational Therapy
Assessment — Level 1

Competency

Comments and/or Not Applicable

Demonstrated skill Chart Review

 

 
Demonstrated skill interview

 

 
Knowledge of standardized assessments in recreational therapy

 

Some examples of standardized testing tools include the LDB, CERT Psych/R, CIP and TRAA.
Knowledge of how to chose, administer and interpret assessment to develop a treatment plan  
Knowledge related to the assessment and determination of barriers Barriers refers to architectural, attitudinal, cognitive, social and other types of barriers to successful involvement in activity.
Knowledge base adequate to know when and what type of referrals need to be made. This includes knowing when inter-facility or out-of-facility referrals may be clinically indicated. This does not include the knowledge base (to whom the referral should be made) and skills (agency procedures) required to actually make the referral.
Knowledge base adequate to assess when contraindications related to activity exist and to know when to anticipate common contraindications based on diagnosis. An example of anticipating a contraindication based on diagnosis would be the contraindication of sitting for extended periods of time on insensate skin without a pressure release.

 

Professional Competency in Recreational Therapy
Treatment Planning — Level 1

Competency

Comments and/or Not Applicable

Demonstrates ability to incorporate information from assessment (from both the recreational therapy assessment as well as from the other team members)  
Demonstrates basic clinical judgment in establishing the frequency, intensity and duration of treatment interventions  
Demonstrates a working knowledge related to diversity issues to organize and implement therapeutic interventions to meet the patient’s unique needs age, attitude, cultural, educational, financial, geographic, language, social, spiritual
Verbalizes knowledge of how to match patient’s needs with the available resources  
Demonstrates the abilities and attitudes necessary to collaboratively develop the patient treatment plan  

 

Professional Competency in Recreational Therapy
Treatment — Level 1

Competency

Comments and/or Not Applicable

Demonstrates the ability to use a variety of interventions/programs to improve physical, cognitive, social, emotional and behavioral abilities and independence in life activities and leisure functioning.  
Demonstrates basic skills and knowledge to use the following interventions/teach the following techniques (we need to work on this list) advanced activities of daily living, anger management techniques, basic health/fitness, community integration, exercise group, functional skills, leisure counseling, leisure education, pre-community integration skills, relaxation techniques, remotivation, sensory stimulation, social skills, stress management, stress management, time management, validation, value clarification
Demonstrates ability to blend patients with different impairments in a group setting and maintain milieu, appropriateness and safety  
Demonstrates ability to use/adapt existing supplies and facilities to better meet patient needs  

 

Professional Competency in Recreational Therapy
Health and Safety — Level 1

Competency

Comments and/or Not Applicable

Ability to demonstrate skills and knowledge to establish and maintain a safe workplace for staff, patients & the public body mechanics; infection control (universal precautions, hand washing procedure, MRSA); appropriate access and safe use of equipment; violence in the workplace
Is familiar with the basic principles of guarding the public’s, patient’s and staff’s safety related to confidentiality and right to know including working knowledge of confidentiality and Tarasoff I and II; requirements to report abuse
Demonstrates appropriate body mechanics for transferring patients, lifting objects and other back safety techniques  
Demonstrates techniques used to protect a patient during a seizure  
Identifies observable behaviors which may indicate that a patient is considering suicide, elopement or assault  
Demonstrates ability to identify tools/supplies which may be used as a weapon or harm a patient and how to manage this inventory including sharps, potential weapons, patient judgment
Verbally explains pressure lease techniques and states primary causes/situations which lead to skin breakdown power tilt, dependent tilt back, (we need to list the ones we want)

(list causes and situations)

Verbalizes basic knowledge related to understanding and monitoring orthopedic precautions (list specific precautions we want them to know)
Verbalizes how to maintain a safe, clean environment including water temperature, unnecessary obstacles, how to clean supplies, supply inventory, appropriate levels of stimulation
Verbalizes primary concerns/behaviors to monitor with patients on a chemical treatment program  

 

Professional Competency in Recreational Therapy
Documentation — Level 1

Competency

Comments and/or Not Applicable

Demonstrates basic skills related to documenting aspects of patient care  
Demonstrates understanding of documenting units of time including filling out timecards; noting units for purposes of billing or contact hours,  
Understands basic components of and basic principles related to documentation for critical pathways  
Demonstrates basic understanding of how to document using forms including check lists, participation records, billing sheets, time cards  
Demonstrates ability to write measurable objectives  
Understands basic standards/techniques related to updating precautions and coverage information in a timely basis  
Documentation reflects appropriate grammar, spelling and readability. Documentation also includes only approved abbreviations.  

 

Professional Competency in Recreational Therapy
Behavior Management — Level 1

Competency

Comments and/or Not Applicable

Able to perform de-escalation techniques while maintaining a safe and therapeutic environment  
Understands the purposes of different categories of restrains and is able to state negative consequences of each medications., soft, hard
Verbalize techniques/skills used for behavior modification (including token systems, …)

 

Professional Competency in Recreational Therapy
Equipment — Level 1

Competency

Comments and/or Not Applicable

* Note: The group had listed use of safety belts and operating a motor vehicles as a basic competency, but by our definition, level 1 does not take clients out. So I left both out of this document.  
Basic skill in use of safety belts and restraint systems including proper applications and contraindications.  
Basic skill in use of communication equipment including pagers, phones, two-way radios, call lights. PA systems.  
Basic computer skills including the use of word processing equipment; loading and deleting information from disks, e-mail and documents already in files on the system; and knowledge related to the use of a computer.  
Basic Internet skills including receiving and sending e-mail, using the web for obtaining information and knowledge about netiquette.  
Fitness equipment  
Pool equipment  
sports equipment  
personal hygiene equipment  
emergency equipment  
kitchen and craft equipment including microwaves, etc.  
basic skills associated with patient equipment The group said basic knowledge of how to operate a motor vehicle & strap in w/c but level 1 can’t go out
Knowledge of/recognizes and maintains precautions for adaptive devices (including knowing when s/he is not familiar with a piece of equipment and asking for instruction prior to taking responsibility for the patient using that equipment

 

Professional Competency in Recreational Therapy
Quality Evaluation and Utilization Review — Level 1

Competency

Comments and/or Not Applicable

Ability to analyze and evaluate data to modify the individualized treatment/program plan, the intervention/programs or to recommend discharge plans/aftercare  
Verbalizes basic principles and concepts of performance improvement  
 

 

 

 

Professional Competency in Recreational Therapy
Communication — Level 1

Competency

Comments and/or Not Applicable

Demonstrates ability to communicate with others (staff, patients, others) in a clear, concise, professional and timely manner.  

 

 

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