1. State Licensure for Recreational Therapy: How Minnesota is Keeping Up
MTRA Annual Conference 2018
Bonus Session
November 8, 2018
Kathy Davis, MA,CTRS, CDP, CDCS
MN State Licensure Coordinator, current
Kaitlin Lewis, CTRS
MTRA past-president
MN State Licensure Coordinator

2. Objectives Participants will be able to:
describe rationale for RT state licensure
describe the methodology for achieving state licensure
describe the current status of RT state licensure within the US
demonstrate an understanding of how NCTRC certification compliments the establishment of RT state licensure within the US
articulate several issues challenging the movement for state licensure
demonstrate understanding of Minnesota’s current progress and goals toward obtaining state licensure

3. LEARNING OUTCOMES
Upon completion of this session, participants will be able to:
Describe the difference between state licensure and national certification.
Identify 3 steps in the state licensure process.
Explain 3 reasons for pursuing licensure for recreational therapists at the state level.

4. SESSION OVERVIEW Credentialing Basics
Current Standards for TR practice
Purpose of expanding Licensure
NCTRC Recommendations (with ATRA endorsement)
How to get there
Current Status of State Licensure
Considerations
How does this affect us?
Questions and follow-up
Introduction
Quiz
What is state licensure?
Why is state licensure important?
What is process of becoming licensed?
What happened once there is licensure in a state?
Assessment of interest
Q & A

5. 3 TERMS TO BE AWARE OF…
Registration- process to verify possession of a specific credential relevant to perform tasks & responsibilities in a field.
Certification- Voluntary process by which organization grants recognition to individuals who met certain predetermined qualifications/standards.
Licensures-mandatory credentialing process by which a state grants permission for a in a specific occupation to practice in a stae by ensuring that the person has a minimum level of knowledge and skill to protect the public.
From the NCTRC Position Paper on Legal Regulation of the Practice of Recreational Therapy (2006)

6. Professional Credentialing
Credentialing: the process by which an agency grants recognition of compliance to recognized standards to individuals who have met stated qualifications Credentialing programs develop when there is a need to define entry standards and assure compliance with these standards to protect the public, assist employers and increase the credibility of the discipline
(Riley, 2012)

7. Certification vs. Licensure
Certification (NCTRC)
Licensure
National perspective
Voluntary (standards)
Peer Review & sanction
Broad Scope and SOP
Less Restrictive
Protects the public
Recognized indirectly by funding source
Recognized by most regulators
State perspective
Legal Mandate
Legal Prosecution
Specific scope and SOP
More restrictive
Protects the public
Recognized by state as precondition for fund
Recognized by all regulators
(Riley, 2012)

8. Development of Licensure
Certification developed prior to licensure
NCTRS very protective of intellectual property and trademarks (CTRS, etc.)
Status Quo for many years: “licensure wasn’t necessary in TR”
Not a top priority for professional organizations
Times have changed…
NCTRC & ATRA have no control or mandate over states participation. Only able to guide the advancement and recommend what may be best for the profession among states. States have control. This is per the 10th Amendment in our constitution leaving regulation to the states.
(Riley, 2012)

9. States Recognition Project
Joint Task form comprised of ATRA, NTRS & NCTRC
Goal in 1998 upon creation of task force to advance the profession via state regulation
Time spent defining, determining terminology & scope
“What needs to be regulated?” “What is at risk?”
Scope of Service developed
State Recognition guidelines formed
NCTRC position paper produced
Which settings or populations are at most risk? License may not be necessary for full scope.

10. Scope (of Practice Act)
The purpose of regulation is public protection not professional self-interest
Changes in scope of practice are inherent and related to change in the HC system
Collaboration between HC providers should be the norm and not the exception
Overlap among professions is necessary and acceptable
Practice acts should require that licensees demonstrate that they have the required training and competence to provide a service
Discusses how we are recognized by not only state, but peers and colleagues.
Discusses the perception and recognition by employers, hospital admin., etc.
What discipline do you think most overlaps with TR? Why?
(Riley, 2012)

11. Scope of Practice of Recreation Therapy
The primary purpose of recreation therapy practice is to improve health and quality of life by reducing impairments of body function and structure, reducing activity limitations, participation restrictions, and environmental barriers of the clients served. The ultimate goal of recreation therapy is to facilitate full and optimal involvement in community life. The scope of recreation therapy practice includes all patient/client services of assessments, planning, design, implementation, evaluation and documentation of specific therapeutic interventions, management, consultation, research, and education, for either individuals or groups that require specific therapeutic recreation or recreation therapy intervention. This scope of practice represents, at a minimum, the process and knowledge base delineated in the most recent National Council for Therapeutic Recreation Certification (NCTRC) Job Analysis Study (Job Tasks and Knowledge Areas for the Certified Therapeutic Recreation Specialist) and delivered by a CTRS consistent with professional standards of practice, and codes of ethics with the intent of enhancing consumer safety.
(Developed via State Recognition Project and accepted by the Boards of Directors of ATRA, NTRS, and NCTRC, 2004)
Most recent SOP revision, 2015

12. NCTRC Certification (CTRS) provides…
NCTRC is recognized as the benchmark of safety
Recognized standards ensure qualified practitioners
Provides online verification services of all active CTRSs
NCTRC has an effective peer disciplinary process
NCTRC serves as clearinghouse for disciplinary cases
NCTRC is accredited by the National Commission for Certifying Agencies (NCCA)
(Riley, 2012)

13. Unify under a Common Approach
TR/RT needs to be operationally defined by practice not philosophy…
NCTRC Job Analysis
Standards of Practice
Competency Guidelines
(Riley, 2012)
Affects:
CE requirements
Who uses the title or description of their position or dept. TR or RT?
The entire profession affected by different ‘philosophies’ that do not unify us

14. Job Analysis “…delineates the important tasks and knowledge deemed necessary for competent practice.”
The results of the Job Analysis Study reinforce the elements of the TR/RT Process:
Assessment
Planning
Implementation
Evaluation
Documentation

15. Current Expansion of Credentialing
Supports and promotes National Certification and State Licensure
States Recognition Project
ATRA & NCTRC Joint Task Force
NCTRC Position Paper
State Initiatives completed (UT,OK,NC&NH)
46 State Coordinators designated
Additional States and Provinces (N=8)
NCTRC Position Paper
(It is hereby acknowledged and accepted that the National Council for Therapeutic Recreation Certification (NCTRC) supports the purpose and intent of the legal regulation of recreation therapy practice, including, but not limited to, professional registry, practice acts, and licensure. NCTRC maintains that the primary purpose and intent of regulation is the protection of public welfare through the establishment and monitoring of competent and ethical professional practice of recreation therapy. Furthermore, it is the intent of NCTRC to work with professional organizations and recognized leaders in a collaborative manner in the pursuit to establish the legal regulation of the practice of recreation therapy.”
(NCTRC, 2007; revisions 2017)

16. NCTRC Position Paper Rationale for the regulation of RT
Protection of the public
Regulated Practice
Qualified Professionals
Continued Competence
Professional Advancement and Recognition
skip

17. NCTRC Recommendations
Recognition of existing Professional Standards
Collaborate with NCTRC
CTRS as basis for legal recognition
NCTRC as a Resource
Portability
Reciprocity
Scope of Practice
Terminology and Definitions
Recognition of Existing RT Legislation
NCTRC Position Paper on Legal Recognition

18. Steps in a nutshell Recognition and Pre-credentialing efforts
Determine the Status Quo
Conceptualize the Law and Process
Establish a Work Plan
Prepare a Bill
Legislative Process
Monitor Process…repeat
The Rules
Prepare for opposition. Who might Oppose this? (our own TR’s, overlapping disciplines)

19. History Jan. 2006-Bill is submitted July 2007-Licensure enacted
North Carolina
Utah
Name: Recreational Therapy Practice Act
1987-passed as the Therapeutic Recreation Certification Act
2005-amended as the Recreational Therapy Practice Act
Enacted 1975
Name: Therapeutic Recreation Practice Act
2006-TRAO passed motion
Sp Draft Bill developed
Sp Statewide vote to continue
Won 63-0
ID sponsor, Senate Bill died
New Sponsor; Bill signed and passed
Implemented Nov. 2010
Jan Bill is submitted
July 2007-Licensure enacted
History
Oklahoma
New Hampshire

20. Levels LRT LRTA TRT TRS Master TRS Same: TR, TRS and CTRS
North Carolina
Utah
LRT
LRTA
TRT
TRS
Master TRS
Same: TRS/L or CTRS/L
Same: TR, TRS and CTRS
Levels
Important to recognize that the assistant and masters levels are not required
Oklahoma
New Hampshire

21. Requirements North Carolina Utah Oklahoma New Hampshire LRT LRTA
Bachelors Degree in RT/TR or option
(5 3cr.hr.RT,3ABPSY,3A&P,3DevPsy,9H&Hsrv, internship)
LRTA
Associates Degree in TR or RT
(9TR,10INT,15SUP,380 hr. FW)
Measured in semester hours
TRT:dip/GED,6or9hrs edu,practicum) TRS:BorM Degree in TR or emphasis OR BorM Degree with approved add’l edu + approved practicum Master TRS:Master Degree in TR or with emphasis hrs. paid experience as lic. TR or CTRS Note: No equivalency path as
approved by NCTRC
Exam completion with success, per NCTRC
Fieldwork completion under CTRS or otherwise approved
Fieldwork completion, per NCTRC
*note: initial licenses may only req. CTRS
Requirements
Oklahoma
New Hampshire

22. Renewal (every 2) Fees & Renewals Renewal (every 2) $110
North Carolina
Utah
Application
LRT-$100
LRTA-$50 Renewal/Maintenance (annual)
LRT-$75
LRTA-$35
2.0 CEUs every 2 years
Renewal (every 2)
$47
Proposed: 2.0 CEU
*Note: maintaining CTRS is optional
Renewal (every 2) $110
100 work hours
2.0 CEUs
Application LRTS-$110 Renewal/Maintenance (every 2)
Maintain CTRS
3.0 CEUs (higher than PT/OT/ST!)
Fees & Renewals
Oklahoma
New Hampshire

23. Department of Professional Licensing
North Carolina
Utah
Licensing Boards are all independent of each other
NCBRTL is responsible for administration and costs of implementing law
Department of Professional Licensing
State Board of Medical Licensure and Supervision
NH Office of Licensed Allied Health Professions
Includes: PT,OT,ST,RT,AT,RCP
Legal Organization
Oklahoma
New Hampshire

24. North Carolina Utah Oklahoma New Hampshire
Board includes LRTs, LRTA, 2 public members, physician appt’d by the governor, speaker of the house and Pres Pro Tem.
Initially challenged financially due to independent licensing board
Do not recognize NCTRC’s equivalency path due to lack of sufficient education
No activity directors in the state of Utah-they use TRT’s
Utilizes TRS/L or CTRS/L (if CTRS is maintained, however no reciprocity)
Initiation of TR services to person with medical condition req. physician order-edu., adp. Sports, prevention, etc. do not.
Practice of TR , claiming title or advertising TR services without license is forbidden
Legislation was an amendment of an existing statute
Fees and forms consistent among professions
Deregulation attempts (Tea Party) aimed at RT, barbers, landscape architects, reflexologists, etc…
Unique Aspects
NOT IN HANDOUTS
Oklahoma
New Hampshire

25. Pros (Riley, 2012) Protects the public from harm
Unifying experience for TR professionals in the state
Assures that all practitioners have the same education, training, practicum experiences and continuing education
Elevates the profession to the same level as other allied health professions
Adds validity and credibility to the profession
Increased recognition of the overall value of the profession
Supports a higher level of professionalism and commitment to the profession
Prevents non-qualifying persons from practicing and calling themselves something for which they are not qualified
Requires that a person be an active CTRS and uses NCTRC as credentialing standards
Attorney General’s office is legal arm of the licensing board and serves as prosecutor in disciplinary cases when necessary
(Riley, 2012)

26. Others? Hiring opportunities based on recognition Value of services
Acceptance of TR services in therapy workflow
Greater chance to meet the literal narrative requirements for coverage (example: CMS language changes within past 5 years)
Gives the public access to competent providers
Higher quality
Accountability

27. Speedbumps Educating Minnesota TR’s
Gaining support from other associations and allied health professions
TRS’s initial concerns for costs, time, etc.
Fear of something new
Energy and attention to legislative and governing body needs (ie: rule making, disciplinary process, etc.)
(Riley, 2012)

28. Mood of Minnesota
WHO- is on our side? (CTRS’s, state reps, other professions)
WHAT-do we need help with?
WHEN- is best to take action?
WHERE- does Licensure fit into MN’s government (DOH vs. State Board)
WHY- is Licensure important in our state? –do we have examples of harm or ‘near misses’ within the profession?
HOW- can this be accomplished? –how do we acquire the resources, support, finances, time?

29. MN Representatives We Have Reached Out For Support
Michael Frieberg (Rep from Golden Valley, Crystal, Robbinsdale)
He met with us in July and set us up with Elisabeth Klarqvist, legal analyst who has drafted our bill!
Tina Liebling-District 26A
Roz Peterson- District 56B
Peggy Flannagan- District 46A
Dave Baker- District 17B
At the nudge of the ATRA/NCTRC task force to gain support and network, letters were sent to many state representatives, selected based on their disctrict having known employers of TR’s. Mike Freiberg was willing to meet and initiated a sponsorship to have bill drafted during our meeting. This was much sooner than ever anticipated!
*Some have been supportive and asked for more information; others have warned strongly against regulation due to time commitment worry that too many professions are seeking regulation, unnecessarily?

30. Our Progress for 2018 Licensure Emails to MN Representatives
Meeting with Representative Mike Freiberg on July 30, 2018
Tentative MN TR Licensure Bill has been drafted by Elisabeth Klarqvist
The Bill reflects the other 4 states language, uses standards for reciprocity, uses current CTRS as the main pre-requisite for application
The Bill can be reviewed as a group at the next designated Task Force meeting
Met to review and propose edits to the drafted licensure bill
NCTRC sent out the MN TR Licensure Survey on October 10, 2018
After-Hours Licensure Education Session at MTRA Annual Conference 2018
*indicate this has all rolled out within past 4 months
*Not to disperse the bill widely at this time; review in small group and discuss rationale for current decisions and language first

31. Progress of Other States
California- Title Protection
Washington Registration
Washington DC Registration
States in Process
New York
Pennsylvania
Georgia
Kentucky- Licensure Bill Made it all the Way to the Governors Table and was vetoed
New Mexico
New Jersey
Michigan

32. Action Forward
Educate Minnesota TR’s on the importance, implications, responsibilities and national efforts, continue
Develop MN Task Force to discuss details of establishing licensure
Task Force to obtain valuable information regarding MN state’s supporters, barriers, processes, etc.
Gain letters of support from state organizations, allied health professions, others
Develop continued timeline
Continue to edit Bill
Strategize when to propose the Bill

33. Questions Submitted
Survey questions and answers

34. Involvement
Interested in more information? Want to be involved in the next steps of the national movement to move state regulation forward? We need you! Please contact either: Kathy Davis at Kaitlin Lewis at

35. References NCTRC position paper Scope of practice Jab task analysis
American Therapeutic Recreation Association. (2000). Standards for the practice of therapeutic recreation. Alexandria, VA: ATRA.
National Council for Therapeutic Recreation Certification. (2004). NCTRC Scope of Practice for the Practice of Recreation Therapy. New City, NY: ATRA, NCTRC, NTRS.
National Council for Therapeutic Recreation Certification. (2007). NCTRC Position Paper on the Legal Regulation of the Practice of Recreation Therapy. New City, NY.
National Council for Therapeutic Recreation Certification. (2011). NCTRC National Job Analysis. New City, NY.
National Council for Therapeutic Recreation Certification website. Online at
National Therapeutic Recreation Society. (1995). Standards of practice for therapeutic recreation services and annotated bibliography. Ashburn, VA: NRPA/NTRS.
Riley, B. (2012). NCTRC Perspective on RT State Licensure[PowerPoint slides].
NCTRC position paper
Scope of practice
Jab task analysis