Re-Creative Resources
By Kimberly Grandal, BA, CTRS, ACC, Executive Director
Kimberly Grandal,

Kimberly Grandal, Founder
and Executive Director of Re-
Creative Resources, Inc., is a
strong advocate for the field
of Therapeutic Recreation
and Activities, with over fifteen
years of experience working
with the elderly in numerous
management and consultant
positions.  She is an Activity
Consultant Certified and a
Certified Therapeutic
Recreation Specialist. Kim is
a member of the New Jersey
Activity Professionals
Association and the New
Jersey/Eastern Pennsylvania
Therapeutic Recreation

In 1990, Kim graduated from
William Paterson University
with a BA in Sociology and
later studied gerontology
courses at Union County
College and Therapeutic
Recreation courses at Kean
University. Throughout her
career, Kim has been the
Director of Therapeutic
Recreation for several long-
term care facilities, including
one of NJ’s largest.

In 2006, Kim founded Re-
Creative Resources Inc. She
is a speaker for various state
and local activity associations
such as NJAPA, MOCAP, and
NJACA, as well as the Society
of Licensed Nursing Home
Administrators of NJ. She
also offers lectures for Re-
Creative Resources Inc.,
local colleges, and
community groups, and
provides consultation and
support to numerous
facilities in the state.

Kim is the editor and writer
for the “The Rec-Room", a
monthly newsletter published
by her company. In addition,
she writes monthly articles
for the Activity Directors Office
newsletter, and has
contributed articles to
Creative Forecasting
Magazine, and The
Continuing Care Insite

Kim is a recipient of the
Kessler Institute of
Rehabilitation 1997 Triumph
of the Human Spirit Award.  
Her passion is to promote
the field of Therapeutic
Recreation and Activities and
to unite Recreation
Therapists and Activity
Professionals. Kim currently
serves on the NJAPA board
as the Chairperson for the
Legislation Committee.
Providing Internet Resources
for Activity Professionals
in Long Term Care Settings

Copyright 2004-Present
The Activity Director's Office
All Rights Reserved

Resources Inc.

Re-Creative Resources, Inc.
is committed to enhancing
the lives of long-term care
residents through the use of
Therapeutic Recreation. We
provide a variety of services
such as Therapeutic
Recreation seminars,
in-services, resources, form
development, program
analysis and development,
consultation, and support for
activity professionals and
recreational therapists. A
selection of downloadable
training materials and forms
are available for your
convenience as well as a free
job posting site.
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Community is a gathering
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Activity Professionals.
Feel free to express yourself
and respond to submissions
from other AD's.
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This site is moderated by
Robert & Linda Lucas, Owners of
The Activity Director website.
Top 10 Questions About the CTRS
By Kimberly Grandal, CTRS, ACC
Executive Director, Re-Creative Resources Inc.

Many professionals ask me about the CTRS, how to get certified, and the role of the CTRS in long-term care. The
following are some commonly asked questions:

1. What is a CTRS?

CTRS stands for Certified Therapeutic Recreation Specialist.

2. What type of education is required to become a CTRS?

Required education includes a BA in TR or recreation with specific coursework or a BA accredited school with
specific coursework.

3. Is an internship required?

Yes, the academic path requires an internship of 480 hours.

4. Do I have to take a national exam?

Yes, all CTRS candidates must pass the national exam.

5.        Is there an alternate path to becoming a CTRS?

Yes, there is an equivalency path which requires varying years of paid full-time experience in TR, education,
additional TR coursework, and exam.  

6.  Are there continuing education requirements for the CTRS?

Yes, all CTRS candidates must complete 50 hours of continuing education every 5 years to maintain certification
(plus experience or re-take the exam).

7. What is the name of the certifying body for the CTRS?

NCTRC (National Council for Therapeutic Recreation Certification)

8.   Where does a CTRS work?

The CTRS is qualified to work in long-term care, sub-acute, adult day care, assisted living, residential, CCRC’s,
group homes, rehabilitation facilities, hospitals, school systems, behavioral health centers, substance abuse
facilities, jails, and vocational facilities. The CTRS can work with any special population.

9. What is the difference between a CTRS and an Activity Professional?

Many leisure professionals feel that there is controversy in defining the differences between the CTRS and an
Activity Professional, especially in long-term care.  There are those who feel that the line is clearly drawn
between the two while others state that the roles are very similar.  It is my belief that Recreation Therapists and
Activity Professionals can and should work together in the provision of Recreation Therapy and Activity Therapy
services to enhance and support the physical, emotional, behavioral, and cognitive well-being of the individuals
they serve. Both are equally important, especially in long-term care, and greatly compliment and enhance each
other. With that being said, here are some general differences. Please note: These differences are not endorsed
by ATRA, NTRS, NCTRC, NAAP, NCCAP, or any other organization.

  • Education and Training  The CTRS is required to a have a bachelor’s degree. He/she receives extensive
    education and training in therapeutic recreation services, clinical/diagnostic information, treatment
    modalities, working with special populations, leisure education and much more. The curriculum includes
    taking challenging courses such as Anatomy and Physiology. Recreation Therapy students can choose
    various areas of studies such as geriatrics, pediatrics, individuals with developmental disabilities,
    behavioral health, rehabilitation, etc. Training consists of a 480 hour internship, under the direction of a
    CTRS and can be done in a variety of settings as well.

  • As of January 2007, all Activity Professionals who wish to become certified through the National
    Certification Council of Activity Professionals (NCCAP) as an Activity Director or Activity Consultant are
    required to take the Modular Education Program for Activity Professionals, 2nd Edition (MEPAP 2nd
    Edition) which includes 180 hours of classroom time plus 180 hours practicum working with the elderly.
    The MEPAP course has really evolved over the years and is specially designed to educate individuals
    who work with the elderly. The course has an extensive curriculum which includes the aging process, the
    assessment process, planning, facilitation techniques, care planning, evaluation, as well as
    management issues specifically related to working in geriatric facilities.

  • Populations Served  The CTRS can work with any special population whereas Activity Professionals
    generally work with the elderly in various health care settings.

  • Services Rendered  Throughout my career in Therapeutic Recreation, I have followed The National
    Therapeutic Recreation Society’s (NTRS) definition of Therapeutic Recreation which states: “Therapeutic
    recreation uses treatment, education and recreation services to help people with illnesses, disabilities
    and other conditions to develop and use their leisure in ways that enhance their health, functional
    abilities, independence and quality of life.” This definition is based on Peterson and Gunn’s Therapeutic
    Recreation Service Model. The three components consist of: treatment, leisure education and recreation
    participation (Peterson & Gunn, 1984)      

  • Activity Professionals and CTRSs provide the recreation participation component of this model, providing
    activities for fun and enjoyment.  It’s not to say that these activities are not therapeutic, because we know
    that they most certainly are.  Activity Professionals and CTRSs provide a variety of therapeutic activities
    that are designed to meet the needs and interests of the individuals they serve.  Activity Professionals
    and CTRSs utilize the APIE process of assessment, planning, implementation and evaluation. Both
    professionals specialize in breaking down the barriers to leisure pursuits to provide opportunity for
    residents and patients to participate in their favorite past times at their highest practical level.  Activity
    interventions are present in the resident’s comprehensive care plan and play a significant role in the
    quality of life and care of each resident.

  • According to the Manual for Recreation Therapy in Long Term Care Facilities, 2nd Edition by NTRS, the
    leisure education and treatment components of the Therapeutic Recreation Service Model are provided
    by the CTRS.  Peterson and Gunn define leisure education as: “A broad category of services that focuses
    on the development and acquisition of various leisure-related skills, attitudes, and knowledge.”  
    (Peterson and Gunn, 1984). Peterson and Gunn’s Leisure Education Content Model consists of: leisure
    awareness, social interaction skills, leisure resources, and leisure activity skills. The CTRS receives a lot
    of training in this area and play an important role in enhancing current skills, assisting with the
    development of daily living skills and community integration.

  • The third component of The Therapeutic Recreation Service Model is recreation therapy which is
    designed to restore or rehabilitate. It is a specific, prescriptive, medically ordered, planned treatment
    process, which is provided by a CTRS and is recognized by CMS, JCAHO, and CARF. In July 1998, CMS
    (formerly HCFA) added section T1a Special Treatments, to the MDS 2.0. The CMS RAI Version 2.0
    Manual defines recreation therapy as: “Therapy ordered by a physician that provides therapeutic
    stimulation beyond the general activity program in a facility. The physician’s order must include a
    statement of frequency, duration, and scope of the treatment.  Such therapy must be provided by a state
    licensed or nationally certified Therapeutic Recreation Specialist or Therapeutic Recreation Assistant.  
    The Therapeutic Recreation Assistant must work under the direction of a Therapeutic Recreation
    Specialist”. The scope of treatment includes: social, physical, affective and cognitive.  

10.  What is the role of the CTRS in long-term care?

The CTRS utilizes his/her clinical, assessment, facilitation, and evaluation skills to provide services that
includes recreation therapy, leisure education and recreation participation. It has been my experience, however
that many CTRSs do not take full advantage of the MDS 2.0 Section T1a, recreation therapy. Facilities that have a
CTRS on staff should revisit this opportunity to increase chances for reimbursement, professionalism, purpose
and validity. Consider offering these treatment-oriented recreation therapy services, beyond the general activity
program. To download a free sample Physician Order Form by Re-Creative Resources Inc. please click here.  If
you are providing recreation therapy or are considering doing so, Re-Creative Resources Inc. has also
developed a one-page form that tracks the recreational therapy services provided and includes: the purpose, the
scope of service, treatment time, TR Services by category, and a space for weekly progress notes. To purchase
the Recreation Therapy Daily Treatment Log click here.

The CTRS plays a significant role working with specialized populations in long-term care and sub-acute
facilities. For example, sub-acute patients may greatly benefit from recreation therapy services and leisure
education to ensure the patient develops and retains a healthy leisure lifestyle when he/she returns to the
community. Specialized leisure education programs, support groups, and community integration programs are
critical for short term patients. Other specialized units may include: dementia units respirators/ventilator units,
HIV/Aids, pediatric LTC, etc.

To find out more about becoming a Certified Recreation Therapist Specialist, please visit NCTRC or call NCTRC
at 845-639-1439 and talk with a Credentialing Specialist.

Recommended Reading

Therapeutic Recreation Specialists, a great article about Recreational Therapists written by Karen C. Wenzel,

Recreational Therapy Handbook of Practice: ICF-Based Diagnosis and Treatment Heather R. Porter, Joan
Burlingame available through Idyll Arbor.

Long Term Care for Activity Professionals, Recreational Therapists and Social Services Professionals, Fourth
Edition by Elizabeth Best Martini, Mary Anne Weeks, Priscilla Wirth. This is a great book for individuals working in
long-term care. The new edition expands the information on MDS version 2.0 (including Section T) and
information on the Prospective Payment System.

Innovations: A Recreation Therapy Approach to Restorative Programs by Dawn R. De Vries and Julie M. Lake.
Innovations integrates recreation therapy and restorative nursing to make a significant improvement in the
residents' lives.

Centers for Medicare and Medicaid Services. (December 2002). CMS’s RAI version   
2.0 manual, pp 3-314 & 3-215.

National Therapeutic Recreation Society. (1998). Manual for Recreation therapy in long term care facilities, (2nd
ed.). Ashburn, Virginia: NTRS.

National Therapeutic Recreation Society. (October 14, 2000). Definition of therapeutic recreation.  Retrieved June
9, 2007, from

National Therapeutic Recreation Society. (2007). National Therapeutic Recreation Week. Retrieved June 9,
2007, from

Peterson, C.A. and S.L. Gunn. Therapeutic recreation program design: Principles and procedures. 2nd ed.
Englewood Cliff: Prentice-Hall, 1984

Copyright Kimberly Grandal, 2007.  All rights reserved.
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