Research indicates that the prevalence of loneliness and boredom may be higher for older adults living in residential facilities compared to adults who are community-dwelling. Leisure engagement plays a critical role in addressing these public health concerns, and recreational therapists are well positioned to facilitate interventions aimed at reducing these issues. This pilot study examined the relationship between leisure engagement, loneliness, and boredom among 65 older adults living in two residential communities with very different environmental resources (high vs low). Although adults residing in the lower resource facility reported higher levels of loneliness, no significant difference in loneliness mean values was found between communities. However, levels of boredom were significantly higher in the lower resource community, and overall boredom levels were strongly associated with levels of loneliness regardless of environmental resources. Adults in the lower resource community reported less participation in leisure activity and more barriers to physical and outdoor leisure activities. The findings of the study are discussed in terms of implications for recreational therapy practice and directions for future research.
With the increasing number of older adults living in nursing and assisted living homes, Certified Therapeutic Recreation Specialists (CTRSs) proactively address issues that impact well-being, such as decreased autonomy. CTRSs serving older adults in the United States utilize a skill set that is uniquely positioned to promote autonomy through therapeutic relationship development and a person-centered care ideology. This conceptual paper proposes the Empowering Language Framework (ELF), an applied practice model that integrates established empowering language principles with a therapeutic recreation theoretical foundation to strengthen autonomy in older adults. ELF integrates self-determination theory, person-centered care, and the Flourishing Through Leisure Model with communication research that demonstrates the impact language has on autonomy. The framework identifies evidence-based language choices that reduce autonomy, such as stereotyping, elderspeak, or a paternalistic style. Empowering language approaches are recommended, such as person-first language, strength-based, and respectful dialogue. This language framework provides CTRSs with a tool that fosters autonomy in older adults. This framework offers application for practice and provides a foundation for the investigation of language based-interventions to improve autonomy and quality of life in older adults.
Surf therapy offers an innovative, nature-based approach to address complex health needs in children and youth. This scoping review synthesizes recent evidence of surf therapy’s physical, psychological, social, cognitive, functional, and spiritual benefits within a Whole Person Health framework. Findings indicate that surf therapy enhances cardiorespiratory fitness, muscular strength, flexibility, and balance while reducing fatigue and improving functional mobility. Participants also show reduced depression, anxiety, and stress alongside improved self-esteem, emotional regulation, and social connectedness. Notably, youth with disabilities often experience equal or greater gains compared to their peers. The review further discusses how decentralized, community-driven implementation—aligned with emerging social prescribing models—can integrate surf therapy into complementary and integrative health services. Relevance to holistic wellness, health equity, and interprofessional practice is highlighted. Implications for therapeutic recreation practice and policy include embracing surf therapy as a Whole Person Health intervention and integrating it into social prescribing and community behavioral health programs.
This paper, based on a presentation delivered at the American Therapeutic Recreation Association (ATRA) annual conference on October 20, 2025, in San Antonio, Texas (Purrington, 2025), examines the integration of Generative AI (GenAI) technologies within recreational therapy’s process of assessment, planning, implementation, evaluation, and documentation (APIED or TR/RT process). The paper defines two forms of AI relevant to current practice: Generative AI and Agentic AI. Drawing from informal conversations with professionals and related literature, the article illustrates specific applications where AI can enhance each phase of the APIED process while emphasizing that clinical decision-making must remain with the professional. Example cases are provided within each aspect of the TR/RT process. Challenges discussed include confidentiality protections, critical evaluation of AI-generated content, and equity in access to AI technologies. The paper concludes with a series of questions to address future practice and research as AI is integrated into the APIED process.
Lesbian, gay, bisexual, transgender, queer, and additional sexually and gender diverse (LGBTQ+) populations experience persistent inequities in the realms of health and recreation. These inequities pose significant barriers to accessing services that uphold the standards and principles of whole person health. Despite its philosophical alignment with holistic, person-centered care, the field of therapeutic recreation (TR) has yet to meaningfully engage with LGBTQ+ populations in ways that recognize the complexity of these identities in research and practice. This conceptual paper addresses this gap by proposing a practice model informed by intersectionality and anti-oppression to advance whole person health in equitable and justice-oriented directions. The model acknowledges how structural factors influence individual experiences in health and recreation and provides detailed guidance on integrating intersectionality and anti-oppression into everyday TR practice. In turn, it lays the groundwork for future TR research, policy, and practice implications that promote whole person health. By presenting an empirically and theoretically informed model, this paper makes a unique contribution to the literature on TR, LGBTQ+ populations, and whole person health.
Despite recreation therapy’s commitment to person-centered care, current assessment practices operate within conventional boundaries that may limit recognition of clients' authentic leisure interests. This conceptual analysis addresses how therapist bias could systematically filter client leisure identities during assessment, potentially creating barriers to culturally responsive interventions and perpetuating health disparities. The proposed framework aligns with whole person health principles that address interconnected biological, behavioral, social, and environmental factors influencing health outcomes, recognizing that authentic wellness emerges from individuals' capacity to express complete identities rather than treating isolated symptoms. The purpose of this paper is to develop a theoretical framework illuminating how practitioner filtering mechanisms operate and propose systematic approaches for inclusive assessment environments. Through theoretical analysis integrating stigma research, cultural competency literature, and leisure studies scholarship, this study develops the Bias-Aware Assessment Framework (BAAF). The framework synthesizes the Assessment Paradox—the tension between person-centered ideals and institutional realities. The Bias-Aware Assessment Framework (BAAF) model identifies four interconnected layers influencing assessment outcomes: societal context, institutional filters, therapist lens, and client experience. It reveals how practitioners' cultural assumptions and personal perspectives create systemic gaps between clients' actual leisure identities and activities deemed appropriate within therapeutic frameworks. The BAAF provides practical guidance through bias recognition strategies, cultural humility approaches, and client-centered exploration techniques. Long-term implications include transforming professional education, supervision practices, and organizational policies. The field stands at a critical juncture where person-centered care commitments must evolve beyond theoretical ideals toward systematic bias-aware practices advancing health equity through authentic recognition of diverse leisure identities.
The purpose of this scoping review was to comprehensively summarize research documenting the therapeutic benefits of labyrinth-based interventions and to provide practical, evidence-informed recommendations for how recreational therapists can integrate this intervention into professional practice. A systematic search strategy across multiple databases identified 25 research articles, published between 2000 and 2025, that examine labyrinths as an intervention. The review synthesizes evidence describing the use of labyrinth walking and its documented effects across mental, cognitive, physical, and spiritual domains of health. Taken together, the findings indicate that labyrinth walking represents a multidimensional, nonpharmacological intervention that aligns with the NCCIH Whole Person Health framework by simultaneously engaging biological, psychological, social, and spiritual dimensions of health. Findings indicate that labyrinths are increasingly used as a therapeutic modality across diverse health and human service settings. Although the evidence base remains limited, studies consistently report positive outcomes. No research specific to recreational therapy practice was identified. To support translation into practice, the therapeutic recreation process—Assessment, Planning, Implementation, Evaluation and Documentation (APIE-D)—is applied to labyrinth walking to guide the development of a preliminary protocol. As the emerging evidence continues to expand, further research may establish the labyrinth as a therapeutic intervention that contributes to evidence-based practice in recreational therapy.
National health priorities increasingly emphasize whole person health and integrative approaches to chronic pain management. The National Center for Complementary and Integrative Health (NCCIH) Strategic Plan (2021–2025) reframes complementary health into a broader whole person health paradigm that integrates nutritional, psychological, and physical therapeutic inputs across interconnected biological, behavioral, social, and environmental domains. Recreational therapy (RT) aligns closely with this reframing through its biopsychosocial, strengths-based, and participation-centered foundations. This practice perspective case report integrates NCCIH’s whole person health framework with a Community-Based Recreational Therapy (C-BRT) program to illustrate how acceptance and commitment therapy (ACT), motivational interviewing (MI), and trauma-informed care (TIC) can be operationalized within community-based RT for individuals with chronic pain. A case example demonstrates how RT contributes to psychological flexibility, resilience, symptom management, and community reintegration. Authors note recommendations for practice and research supporting the tenets of their practice perspective.
Recreational therapists work in behavioral health settings, including forensic and correctional settings, providing treatment to individuals with serious mental illness (SMI). Limited literature exists regarding the role of recreational therapy (RT) in these settings. Using hermeneutic phenomenology, semi-structured interviews (n=10) explored the lived experiences of recreational therapists working with adults with SMI in forensic and correctional settings. Qualitative findings yielded three main themes: 1) RT roles and responsibilities, 2) Facilitators for recreational therapists in these settings, and 3) Constraints for recreational therapists in these settings. Across the three main themes, 11 subthemes were identified. Study findings were compared to the American Therapeutic Recreation Association Standards of Practice (2019) and the National Council for Therapeutic Recreation Certification Professional Knowledge Areas and Job Domains (2021) to determine (a) whether practitioners working in forensic and correctional settings were meeting professional competencies; and (b) if there were any competencies specific to RT and forensic and correctional settings that needed to be better represented in professional RT documents. Study findings, limitations, and implications for RT practice, education, and research are shared.
Siblings of individuals with intellectual and developmental disabilities (IDD) may experience stress as they navigate relations with their sibling with IDD. Bibliotherapy has been shown to help youth learn stress-coping strategies, however, minimal research has focused on bibliotherapy for stress-coping among sibling groups. The purpose of this mixed methods study was to examine the impact of a bibliotherapy program on perceived stress and coping among siblings (n=6), aged 7-12, of individuals with IDD, and to identify what program components participants and their parents (n=5) felt were important for a bibliotherapy program focused on stress-coping. Pre-post surveys assessed changes in stress-coping following the seven-week biblio-therapy program. Participants and parents completed an importance-performance analysis (IPA) to evaluate the bibliotherapy program. Qualitative interviews were conducted to better understand participants' perceptions of the program's impact on their perceived stress-coping. There were no statistically significant changes in par-ticipants perceived stress-coping, except for one parent sub-scale. Participants' qualita-tive stress-coping data resulted in two themes: peer interaction and coping strategies; parents' stress-coping data resulted in five themes: peer interaction, identification and appropriate expression of feelings, coping strategies, considerations for siblings with IDD, and no change in stress. Participants' IPA data resulted in four themes: enjoy-able program activities, book selection, peer mentorship, and involvement of family members. Parents' IPA data indicated four themes: use of books, program logistics, peer mentorship, and involvement of family members. A discussion of study findings, implications for recreational therapy practice and future research, and study limita-tions are provided.
Literature in recreational therapy (RT), highlights employee and organizational benefits associated with organizational culture, climate, and job satisfaction yet limited research examines employee perceptions of the relationships among these factors. An e-survey distributed through the National Council for Therapeutic Recreation Certification (NCTRC) examined Certified Therapeutic Recreation Specialists' (N=260) perceptions of how the culture and climate of RT organizations impacted job satisfaction. Results indicated that culture and climate in RT organizations were positively associated with job satisfaction which was linked to the nature of work, the relationships in the workplace, communications, and supervisory-employee relationships. No significant differences were found by sector nor number of years in the profession. Findings noted that the workplace culture and climate were good predictors of one's job satisfaction and sense of thriving was tied to on-the-job-learning. Study limitations, direction for future research, and practice implications are presented.
Medical specialty camps provide short-term positive psychosocial benefits for participants (McAuliffe-Fogarty et al., 2007), while more long-term benefits appear to be fleeting (Dawson, 2017). In studies of participation in life after spinal cord injury (SCI), a commonality among responses emphasized the importance of finding a support network post injury (Amsters et al., 2021). Medical specialty camps may be one way to provide support, yet criticism on diminishing effects after camp participation ends remains a concern (Plante et al., 2001). Few studies have utilized qualitative means to examine possible reasons for lack of carry over psychosocial impact. This study utilized a general inductive qualitative analysis of 11 adults with SCI 2-5 years post camp participation. Interviews were conducted with individuals with differing levels of spinal cord injury. Qualitative analyses yielded 3 major themes from campers with SCI: 1) Nuances of the Camp Social Inoculation Experience, 2) Facilitators to a Successful SCI Specific Camp, and 3) Challenges of Returning Home After Camp Ends. Discussion focuses on perceived benefits of camp participation, positive structure of camp, and issues related to lack of carry over impact after camp ends. It is recommended that future practices and research focus on improving access to the SCI community social networks made at camp after returning to home communities.
Certified Therapeutic Recreation Specialists (CTRSs) are increasingly turning to emerging technologies to enhance personalized care for individuals with disabilities and chronic conditions. This paper presents a conceptual outline for integrating Ecological Momentary Assessment (EMA) philosophy utilizing machine learning (ML) and deep learning (DL) predictive modeling to refine the APIE process (Assessment, Planning, Implementation, and Evaluation) in Recreational Therapy (RT). We discuss how real-time data from wearables, mobile apps, and passive sensing tools could allow CTRSs to better understand clients' moment-to-moment emotional and behavioral responses, enhancing the precision and responsiveness of care. We introduce Synthetic Minority Oversampling Technique-Few Shot Learning (SMOTE-FSL), a ML method optimized for small-sample, personalized predictions. Practical applications across each APIE stage are illustrated through clinical examples, highlighting how digital tools could improve decision-making and streamline documentation. The described methods are not yet ubiquitous as their implementation remains limited due to cost, access, and privacy concerns, as well as the need for practitioner training. We advocate for foundational exposure to EMA and ML/DL in higher education, followed by ongoing, practice-based training to ensure ethical, informed use. Future research must focus on validating and standardizing these approaches, with interdisciplinary collaboration being the key in developing clinically relevant, ethically sound systems. CTRSs are well-positioned to lead this evolution in care, using EMA and ML/DL not only to improve outcomes but to model inclusive, person-centered, and data-informed practice in a rapidly evolving digital health landscape.
Swimming and spending time outdoors near lakes, rivers, and oceans provides therapeutic benefits for children with autism spectrum disorders (ASD). However, engaging in aquatic environments is not without risks for children with ASD. Drowning is a top cause of mortality for children with ASD. We investigated the experiences of parents of children with ASD around aquatic environments to understand: the benefits of swimming and being in aquatic environments for children with ASD and their families, features of aquatic environments that serve as facilitators to access, and the barriers to accessing aquatic environments. Guided by phenomenology, semi-structured interviews were conducted with parents of children with ASD (N=12). Four themes emerged from the findings of this study: safety is the priority, attraction to water, acceptance of children with ASD in aquatic environments, and therapeutic benefits of water. While there are many positives to children with ASD engaging in water activities, families with ASD experience several barriers that limit access to water environments. Recommendations for therapeutic recreation practice and future research are provided. These findings support stakeholders of aquatic environments, therapeutic recreation professionals, and others seeking to increase safety for children with ASD to create reduced-risk aquatic environments.
The purpose of this pilot study was to explore the benefits of a bibliotherapy technique called shared reading on older adults with a diagnosis of dementia. The study evaluated the impact of shared reading on the mood, cognition, social engagement, and quality of life of six older adults with dementia who lived in a memory care assisted living unit. Fifteen forty-five minute sessions occurred over eight weeks and demonstrated a positive impact on social engagement and quality of life, changes observed in mood and behavior, and mixed results on cognition. The results in this study affirmed research done by others on shared reading with older adults who have dementia. Additionally, this study utilized a previously published protocol on shared reading, which provided a usable structure and format for each session. Implications for practice and recommendations for future studies will assist recreational therapists in using shared reading as an effective intervention for older adults living with dementia.
The primary aim of this pilot study was to determine the optimal length of time to engage older adults with moderate dementia in preferred therapeutic recreation interventions (TRIs). By elucidating the patterns of engagement within and between TRIs, this study offers valuable insights for recreation therapists (RTs), enabling them to more adeptly address the needs of this demographic. Key findings from the study indicate that TRIs with a duration of 35 minutes or less are more effective in promoting engagement among older adults with moderate dementia, compared to longer sessions. Higher engagement levels were also observed in programs that support independent participation, suggesting that autonomy plays a critical role in sustaining involvement. Moreover, TRIs designed for continuous participation, rather than those requiring invited or turn-based engagement, were associated with more favorable engagement outcomes. When examining patterns of social interaction, programs characterized by aggregate interactional formats yielded higher levels of engagement than those with more competitive or cooperative approaches. These findings contribute to a deeper understanding of the mechanisms underlying engagement in recreation settings and underscore the importance of program structure and delivery. The results inform practical recommendations for RTs, providing an evidence-informed rationale for selecting specific intervention types and optimizing program duration for individuals with moderate dementia. Suggestions are presented for future research projects.
Therapeutic dyads offer an innovative recreational therapy approach to support community-dwelling individuals with dementia and their caregivers. This report presents two case studies from Taiwan, demonstrating a dyadic recreational therapy intervention tailored to individual family units. Each unit included one older adult with mild to moderate cognitive impairment and their primary family caregiver. Over six months, both members of each dyad participated in 16 two-hour home-based sessions designed around their shared leisure interests. Data were collected from each participant—care recipient and caregiver—before and after the intervention using accelerometers, standardized assessments, and qualitative interviews. Observations suggested potential improvements in physical activity, functional fitness, and sleep quality for individuals with dementia, while caregivers reported a reduced sense of caregiver burden. Qualitative findings highlighted enhanced social interaction, positive shifts in leisure attitudes, and increased joint participation in meaningful activities. These case studies underscore the potential of dyadic recreational therapy as a culturally sensitive, family-centered approach to dementia care in Taiwan.
Following the repercussions of refining the equine-assisted services (EAS) terminology by the consensus groups, the work of ATRA's EAS taskforce emphasized the need to further define and guide recreational therapy incorporating equines. The research questions of this study focus on practicing CTRS (R)'s report on the scope of their practice with humans and equines. Findings shed light on the use of mounted and groundwork, the domain areas of goals, the populations, settings, ages, frequency, duration, and payment mechanisms. Based on these findings, specific suggestions for evidence-based protocol development, research, and professional development are described.
