Such an awesome story of inspiration and helping kids find what makes them feel confident!

January 20, 2016

Recreational Therapy for kids and adults with disabilities from a counselor in Chapel Hill.

Today I’m sharing a guest post from a good friend and a phenomenal resource for anyone interested in Recreational Therapy…and even if you don’t know what Recreational Therapy is, trust me, you’re probably interested in it if you have a child with disabilities!

Leah Cox Thomas is a Certified Rehabilitation Counselor and a licensed and certified Recreation Therapist (LRT/CTRS). She works at the University of North Carolina at Chapel Hill in the area of sports injury research.

She’s published academic articles on Accessible Golf for Individuals with Autism Spectrum Disorder and Maximizing Vocational Outcomes Post-Traumatic Brain Injury through Rehabilitation Counseling and Recreation/Leisure Activities.


You’re a parent of a child with special needs.

Your child has been having occupational therapy for months to work on various goals.

Then, one day, your child’s occupational therapist approaches you to tell you that either:

1) your child has ‘plateaued’, meaning they’ve stopped making significant improvements in therapy, and is no longer eligible for services or

2) your child is having a lot of trouble focusing during therapy sessions, making it difficult for the therapist to accomplish goals, and so the therapist is ‘firing’ your child as a client

As a parent, what are you supposed to do?

Sadly, these situations are common for many families that have children with special needs, and can happen in Occupational Therapy, Physical Therapy, or Speech Therapy.

I’ve witnessed it. It’s scary to think about what would happen if your child were to lose a service that is such an important part of their life and soooo important to continue building skills.

Not to mention, entitlements provided through Medicare/Medicaid may be dependent upon your child reaching certain goals over time.

OT, PT, & ST are all extremely beneficial. Sometimes though, despite all the benefits, individuals with disabilities may experience difficulty with a certain skill, task, or activity.

This is where recreational therapy can help. By using fun activities to promote skill building, your child can improve beyond plateaus and stay motivated to engage in traditional therapies.


The American Therapeutic Recreation Association defines Recreational Therapy as:

“a systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illnesses and/or disabling conditions, as a means to psychological and physical health, recovery and well-being… a treatment service designed to restore, remediate and rehabilitate a person’s level of functioning and independence in life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restrictions to participation in life situations caused by an illness or disabling condition.”

Basically, recreational therapy is using recreation and/or leisure activities (RLA’s) to bridge the gap that may exist in OT, PT, or ST by bringing fun to the equation.

The list of what could be used is truly endless, as RLA’s are any activities that are enjoyable or meaningful to the individual and that encourage the person to succeed in a achieving therapeutic goals.

Some commonly used RLA’s include:

Individual physical activities like swimming, trampoline jumping, inline skating, etc.
Team physical activities or sports like basketball, tennis, soccer, etc.
Arts and crafts like painting, drawing, sewing, etc.
Performance arts such as music, dance, drama, or other performance art
Outdoor activities like hiking, boating, rock wall climbing, etc.
Cooking or baking whether for the person to enjoy, to share with a group, or to donate to a cause, such as at a soup kitchen
Animal assisted activities such as horseback riding, dog walking or training, caring for a pet, etc.
Social activities such as clubs, group outings, or classes
Relaxation activities such as mindfulness, deep breathing, or yoga
Individual activities such as reading a book, playing computer games, or listening to music
The important thing is that the activity is meaningful AND enjoyable to the person. This can be tough for parents to accept sometimes, but this means that your RLA’s are going to be different than your child’s!


I imagine you’re thinking, “This is all great but HOW do we find Recreational Therapy services and how much does it cost?”

Unfortunately, recreational therapy is currently not a reimbursable service under Medicaid or Medicare like OT, PT, or ST. Traditionally its part of the “blanket services” that someone receives when they have an inpatient stay in a hospital or rehabilitation facility.

A CTRS (Certified Therapeutic Recreation Specialist) is the qualified provider who can deliver recreational therapy, and most are employed by hospitals and rehabilitation centers, though finding CTRS’s in private practice is becoming more common.

Just because recreational therapy isn’t yet a reimbursable service that can be delivered at home or in an outpatient clinic doesn’t mean you still can’t make it work for you at home!

It’s relatively simple to begin incorporating “fun” into “functional” activities. All it takes is a little bit of creativity!


I once taught an adapted swim class and was paired with a young man with Autism. His mother warned me that he had difficultly paying attention and was easily distracted. He also was more interested in asking questions than swimming.

I realized that I needed to let his interest in asking questions motivate him to improve in swimming!

We set the following structure in place during lessons:

Swim 1 lap = ask 3 questions
Practice 1 new swim move = 3 more questions
Swim another lap = 3 more questions
Put your head underwater 3 times = 3 more questions
At each class I gradually added more tasks to be completed before he could ask questions.

By the end of the class he was able to swim multiple laps successfully. Knowing he would be rewarded with something that motivated him allowed him to complete the task at hand!


Rosellen Reif
MS, LPCA, CRC, QDD/MHP at Reif Psychological Services
Rosellen Reif offers in-home counseling in Cary, Raleigh, and Chapel Hill, North Carolina to kids, adults, and families affected by disabilities like Autism, Intellectual Disabilities, Down Syndrome, Asperger's, Cerebral Palsy, and Prader Willi Syndrome.