KNR 273: Credentialing

Credentialing Process where by the competency of a professional is ensured as a provider of quality services Defines minimum competence to practice What is the difference between credentialing and accreditation?

Credentialing vs. Accreditation Credentialing Individual NCB (CPRP) NCTRC (CTRS) If in community/SRA may need both CTRS and CPRP Accreditation Agency COAPRT CAAHEP Council on Accreditation of Allied Health Education Programs CARTE (adopted in 2010)

Quality in TR Professional (Credentialing) Professional Practice (SofP, Ethics) Education (Accreditation)

Credentialing 3 types: Registration Certification Licensure

Registration The process by which qualified individuals are listed on an official roster maintained by a governmental or non-governmental agency Could be state, national or professional organization Can look at education & professional experience

Certification A governmental or non-governmental agency grants recognition to an individual who has met certain predetermined qualifications set by a credentialing agency or association Education & professional practice Greater weight than registration Restricts use of title, does not restrict practice Title protection

Licensure An agency of government grants permission to an individual to engage in a given occupation upon finding that applicant has attained the minimal degree of competency required to ensure that the public health, safety, and welfare will be reasonably well protected

Licensure Strictest form of credentialing Requires state government to enact legislation that defines the professional practice Practice protection---illegal to practice if not licensed

Why is it important to have professional credentials?

Credentialing Enables: the public (and gov't and 3 rd party payers) to distinguish those who have attained some qualifying level of competency from those who have not Provides: prestige, recognition and earning power

Credentialing Increases the quality and accountability of services to the consumer Increases credibility, respect, and professionalism Increases the minimal qualifications of the professional Increases the likelihood of providing uniform services based on consumer need Encourages education and continuing education

Credentialing in TR Registration 1956: Council for the Advancement of Hospital Recreation created National Voluntary Registration Plan for Hospital Recreation Personnel 1969: National Therapeutic Recreation Society created the NTRS Voluntary Registration Plan

Credentialing in TR Certification---Certified Therapeutic Recreation Specialist (CTRS) 1981: National Council for Therapeutic Recreation Certification (NCTRC) is established by NRPA 1985: NCTRC is legally incorporated 1988: NCTRC conducts initial Job Analysis Study November 1990: 1 st NCTRC exam administered 1994: CTRS credential trademark is registered 1997: 2 nd Job Analysis Study completed November 2001: 1 st computer based exam is offered 2007: 3 rd Job Analysis Study completed  International Job Analysis of CTRS

International CTRS working in 9 countries Braham Great Britain Bermuda Australia Asia 2009 Canadian Therapeutic Recreation Association = CTRS is preferred credential

Credentialing in TR Licensure Few states have licensure for TR Utah (1974) North Carolina (2005) New Hampshire (2006) Oklahoma (2009) Georgia in the past, sunset law Periodically TR has drives toward licensure 7-8 states working on (including New York) 7-8 thinking about starting (including Illinois) CTRS exam = basis of licensure

Credentialing in TR State Registration Texas California

NCTRC National Council for Therapeutic Recreation Certification Independent of NTRS and ATRA Why? Independence provides for a better relationship with regulatory groups like JCAHO and CARF Doesn’t appear to be self serving

NCTRC - Mission To protect the consumer of therapeutic recreation services by promoting the provision of quality therapeutic recreation services by NCTRC certificants

NCTRC - Purpose To establish national (& international) evaluative standards for the certification and recertification of individuals who attest to the competencies of the therapeutic recreation profession To grant recognition to individuals who voluntarily apply and meet established standards for certification in therapeutic recreation; and To monitor adherence to the standards by the certified therapeutic recreation personnel.

General Requirements for CTRS Education Minimum: Bachelor-level degree Experience Documented field placement or work experience in TR Examination Successful completion of NCTRC exam

2 Paths Academic Major in TR or recreation with option in TR Accredited university or college Not program

NCTRC Requirements (Effective 1/1/13) Min. 18 semester hours with 15 in TR and the remainder in recreation 5 courses and each course must be 3 hours Must include: Assessment TR Process Advancement of Profession Not accepted: Specific activity skill course for a specific population Aquatics for People with Intellectual Disabilities Camping for Special Populations

NCTRC Requirements (Effective 1/1/13) 18 semester hours of supportive course work Courses outside of department Minimum of: 3 in anatomy and physiology (1/2) 3 in abnormal psychology 3 in human growth & development across the lifespan Remaining in content areas of social science and humanities Medical terminology

NCTRC Requirements (Effective 1/1/13) Internship Minimum 14 consecutive weeks/560 hours In TR services that use the TR process as defined by the current NCTRC Job Analysis No less than 20 hours/week and no more than 45 hours/week Must be at 1 agency Keep log of hours & duties Supervisor Agency supervisor must be CTRS for 1 year before supervise intern  ISU says must be in field 2 years plus 1 year as CTRS University supervisor must be CTRS Online verification

Internship Cont. Supervisor Must be full time at agency (32 hours/week) 50% of job duties must be in an established TR program in an agency Must be 1 identified primary supervisor Work consistently with student Coordinates all secondary supervision Oversees/signs off all evaluations and reports Ensures exposure to all Job Analysis Task Areas Signs field placement verification form

2 Paths Equivalency – work experience Path A Same courses plus 5 years full time in TR Path B Same courses plus 1 year full time under supervision of CTRS

Internship Cont. Job Analysis Basis of internship Basis of exam content Basis of continuing education Basis of ISU TR curriculum MUST BE exposed to ALL of the job task areas in internship

2007 Job Tasks (Practical Experience/Basis of Internship) Job Task = TR Process Professional roles & responsibilities Assessment Planning interventions/programs Implementation Evaluate outcomes Documentation Work with treatment/service teams Organizing programs Managing TR services Public awareness/advocacy

2007 Job Tasks ( Professional Knowledge Domains - Theoretical Knowledge) Basis of TR exam Foundational knowledge (33%) Practice of TR/RT (47%) Organization of TR/RT service (13%) Advancement of the profession (7%)

Foundational Knowledge Examples Theories of play/rec/leisure Diversity factors Human growth/development Theories of human behavior Leisure thru lifespan Leisure lifestyle Health/human services Societal attitudes Legislation Guidelines & standards Cognition & related impairments Anatomy, physiology Senses & related impairments Psychology & related impairments Normalization & inclusion Accessibility & barriers Group interaction/leadership Behavioral change

Practice of TR/RT Examples Concepts of TR/RT Models Practice settings Standards of practice Code of ethics Impact of impairment Selection of assessment Implementation of assessment Behavior observation Interview techniques Functional testing TR/RT assessments Other sources of assessment data Interpretation of assessment Documentation Activity analysis Leisure education Activity modifications Modalities/interventions Facilitation techniques

Organization of TR/RT Service Examples Program design Goal/behavior objectives Progress notes Evaluation Quality improvement Plan of operation Personnel/volunteer supervision Payment Facility/equipment management Budgeting

Advancement of Profession Examples History Accreditation standards Professionalism Certification Advocacy Legislation Standards Ethics Public relations/marketing Professional association Continuing education

Accommodations for Examination When submit application, include a separate letter describing Candidate’s disability or special need Adaptations being requested Documentation from doctor that confirms disability and prescribes appropriate accommodations (Disability Concerns) If approved must contact Special Conditions Coordinator at the Prometric Candidate Services Contact Center at to schedule appointment for administration

Accommodations for Examination Accommodations available are: Reader Marker/writer Sign language interpreter for instructions Separate room Double test time Extended time by 1.5

CTRS Examination Must meet all eligibility requirements Then pass a written, knowledge-based examination Pass courses, qualify for test, pass test Do ASAP because qualification standards can change and then would not be eligible to sit for examination Offered 3 times a year (5 day period) February 1 for May July 1 for October October 1 for January New: Can take during internship ($25) for locations Prometric

CTRS Examination Mastery testing Some receive more questions Starts with base test everyone takes 90 questions / 86 minutes Pass/fail/unclear Testlets  15 questions / 14 minutes  Maximum of 6 testlets Get preliminary score of if not pass feedback on weak areas Last 3 years, 66-75% passed

CTRS Examination Cost New application: $100 Exam registration fee: $300 Total: $400 If do early = $425 Certification good for 5 years Annual maintenance fee ($80)

CTRS Can’t say certification eligible until receive notification from NCTRC Can’t use CTRS until receive official letter from NCTRC of passing

How Prepare for Exam? STUDY

How Prepare for Exam? Print/review current standards Make sure all areas have been covered in internship Go over requirements with supervisor Complete practice application Review texts & notes Practice tests NCTRC 50 sample questions ~$25 Study guides (Stumbo & Folkerth) Study groups / sessions Flash cards (cost ~$50)

How maintain certification? Annual Renewal Form Fee Recertification to proved continuing professional competence Form Fee Documentation Keep: Original documentation Conference schedule Hours NCTRC areas Audit process

Recertification Must earn 100 credits to renew certification after 5 years Points can be earned Professional Experience (minimum of 480 hours over 5 years…could be volunteer) and Continuing Education (50 hours) or Reexamination (passing score on exam)

Recertification Continuing education Conferences, workshops Publications Presentations (c/b online) Academic courses (take/audit) Webinar/teleconference Thesis or dissertation Guest lecture NCTRC test writing No more than 25 credits from publications/presentations

Continuing Education Points are measured according to the equivalency of an educational contact hour (60 minutes) 1 contact hour = 0.1 CEU = 1 credit Content of the experience must be linked with the knowledge areas of the NCTRC Job Analysis Study ** be careful because some things don’t count

How keep up with NCTRC changes? NCTRC Newsletter NCTRC Web site Meetings at conferences Professional journals/literature

Specialty Certification (2010) Physical Medicine/Rehabilitation Geriatrics Developmental Disabilities Behavioral Health Community Inclusion Services Valid 5 years $100/$20 year

Specialty Certification Path A CTRS active status 5 years FT experience in area (1,000 hours) 75 continuing education hours Min of 3 professional certificate trainings Each training must be min. of 6 CE hours 2 professional references

Specialty Certification Path B CTRS active status Graduate degree in TR/RT 9 graduate-level credit hours in specialty 1 year FT experience in area 2 professional references

Why don’t people seek out continuing education opportunities? Cost Work constraints Lack of benefits Family constraints Disengagement