A national study of therapeutic recreation field work and internships.
The internship has played a vital role in therapeutic recreation education for decades (Goldstein, 1977), and is generally considered to be the culminating or capstone event in the undergraduate educational experience. The influence of an effective internship process goes well beyond students' educational requirements and is likely to affect their initial entry into the field, the population and setting in which they choose to work, and perhaps their entire professional career. Internships also provide significant services that extend beyond the students, which are critical to professionals in the field, to clinical and community based agencies of all kinds, to universities and colleges, as well as to the profession as a whole. The internship is of such consequence that a national curriculum study (Stumbo & Carter, 1999) found that 94% of the responding therapeutic recreation curricula required a full-time internship in order to graduate, both professional organizations (American Therapeutic Recreation Association & National Therapeutic Recreation Society) have established internship standards and guidelines, and the internship process is actually linked to the credentialing process provided by the National Council for Therapeutic Recreation Certification[R] (1) (NCTRC[R]). Notwithstanding the significance of the internship, however, there is limited empirical understanding of the similarities, differences, and challenges related to the internship process among therapeutic recreation undergraduate degree programs.
The internship is defined as "academic credit awarded to students for supervised work obtained outside the standard classroom environment" (Wentz & Trapido Lurie, 2001, p. 140). Inkster and Ross (1995) added that the experience must take place at an approved agency. Although some definitions are much more detailed, this combination seems to be a commonly accepted definition of an internship for most disciplines. The primary purpose of the internship experience is to enrich and solidify the educational experience by providing practical experiences which help students to apply theoretical knowledge and problem solving in professional practice as well as to develop the critical skills necessary for occupational performance (Elkins, 2002; Jarvis, 2000; Messmer, 1999). The internship also has secondary purposes, which is to provide benefits to both the agency where the internship is completed, as well as to the educational program requiring the internship.
In a discussion about theories of learning and development applied to internships and cooperative learning experiences, Linn (2004) reviewed three theories that fit particularly well when focusing on specific work experiences and that have consistently guided empirical work examining the efficacy of experiential learning in higher education. The first suggests that there are different learning styles (Kolb, 1984) and that all effective learning experience are comprised of four stages including concrete experience, reflective observation, abstract conceptualization, and active experimentation. The theory suggests that the most effective learning occurs as a learner moves through all four phases of the learning cycle. Linn (2004) concludes that interns completing tasks in the work place are typically required to move through all four phases thus facilitating significant learning experiences. Bandura's (1986) self-efficacy theory is another approach often used when examining cooperative learning and refers to a general sense of competence for successful performance in new situations and challenges that may be similar to past successes such as those found cooperative internships. Self-efficacy has been found to be a better predictor of future performance than measures of ability. Finally, the theory of practical intelligence (Sternberg & Wagner, 1986) explains that cooperative learning can enable students to acquire practical skills which is "knowing how" verses "knowing that" which is typically the focus of learning in the classroom. Williams, Sternberg, Rashotte, and Wagner (1993) reported significant differences in practical intelligence between student involved in cooperative learning experiences and control groups without such experiences. Each of these theories support and clearly explain the specific theoretical and empirical benefits claimed to be outcomes of the internship process.
Coco (2000) called internships a "rite of passage" that provides a natural bridge for students between college and the work world. He suggested that there are numerous benefits for students which include the following: a) the application of theories learned in the classroom, b) the opportunity to take on professional responsibilities, c) the development of individual skills and abilities, d) the opportunity to gain a greater knowledge of the field as it relates to career paths, e) the crystallization of personal interests and career ambitions, f) the reduction of shock when entering the workplace after graduation, and g) the possibility of faster job placement and advancement. Falvo and Parker (2000) emphasized the fact that interns not only learn the ethical standards of their profession through the internship experience, but are frequently faced with situations that call for the exercise of ethical behavior which is an important part of their professional growth. Finally, Farnsworth, Holsinger and Mehrhoff (2001) noted that "students learn concepts most successfully through a combination of hands-on experience, cooperative problem solving, and independent study" (p. 874). These are precisely the types of activities that good internship experiences are comprised of.
The benefits of the internship experience extend well beyond the individual student and provide a significant contribution to the host agency and supervising professional as well. Internship partnerships provide a source of competent assistance and access to highly motivated and productive individuals (Coco, 2000). The supervision and mentorship of student interns releases current employees from routine tasks (Coco, 2000) and prevents burnout by allowing seasoned practitioners to work with new professionals who are full of energy, excitement, and new state of the art ideas. Interns are also likely to ask challenging questions, and are capable of helping supervisors look at things from a new or different perspective. Internships also provides an opportunity to evaluate and cultivate new potential employees and allow employers to "try out" the intern before hiring them as a full-time employee (Pianko, 1996). This advantage can save a company up to $15,000 in training costs alone (Watson, 1995). The number of companies hiring former interns has been rising steadily in the past few years (Filipczak, 1998). Recently, 70% of new hires at Hewlett Packard had served as interns for the company prior to employment (Watson, 1995).
Academic institutions also enjoy benefits from the three way partnership of internships. The most significant benefits revolve around providing the students with a cooperative learning experience that solidifies knowledge learned in the classroom and provides a tangible transition from academic preparation to professional practice. In this manner, a successful internship experience is often related to the quality of the education provided by the university. There are other benefits for academic institutions, however, that extend beyond the students themselves. A cooperative internship program provides a valuable feedback loop with professionals in the field which can help validate and refine curricula and specific course work. In addition, cooperative relationships between faculty and internship supervisors often result in guest lectures, class field trips, and funding opportunities, as well as community service, support, and awareness. Universities also benefit by having full-time students who are paying full-time tuitions but are not currently on campus, thus providing space for other students to be on campus.
Therapeutic Recreation Internships
In therapeutic recreation, the value of a quality internship has been recognized for decades (Goldstein, 1977). More recently, however, Holmes-Layman and Pommier (2001) have said that "the internship in therapeutic recreation is a pivotal learning experience for students" (p. 105). The NCTRC (2003) indicated that "Universities and agencies are recognizing the critical value of a structured learning experience under the direct supervision of a qualified, practicing professional" (p. 15). Higher education institutions have increasingly emphasized the importance of experiential learning in therapeutic recreation with 94% of the universities that offer therapeutic recreation programs requiring students to complete an internship (Stumbo & Carter, 1999). Often schools require multiple internships (Stumbo & Carter, 1999) as well as a number of other supervised experiential learning hours in the field. Such emphasis on experiential learning in general and on the internship experience in particular may be an outgrowth of the dilemma described by Austin and Crawford (1991) of trying to train entry level professionals in a discipline where the required entry level knowledge base is expanding beyond what can be absorbed in a university curriculum. In today's world, says Austin (2002) "therapeutic recreation/recreation therapy can be concerned not only with health protection but illness prevention and health promotion as well" (p. 216). It may also be reflective of the fact that interns are expected to accept increasingly higher degrees of responsibility (Carter, Van Andel, & Robb, 2003).
Although the NCTRC has recently increased their required field placement hours from 360 to 480, some authors have recommended an even greater standard of 600 clock hours of experience (Kinney, Witman, Sable, & Kinney, 2001). To date, however, no one seems to have empirically studied the internship experience to determine the most effective length of internship needed to become fully competent as a recreation therapist, and the variance in required clock hours by universities is quite substantial (Stumbo & Carter, 1999). In spite of this fact Kim, Stumbo and Carter (2004) recently reported that the average length of internship has increased from 12.6 weeks in 1996 to 13.5 weeks in 2003. This is a very significant increase in such a short period. One reasonable explanation could be the new standard for certification of a 12 week internship but the extra week is only accounted for if it is considered "insurance" against non-acceptance by NCTRC. A second explanation might be that most schools are converting from term systems to semester systems and perhaps there is a longer length of time available. Unless it is researched, however, the increase will remain unexplained.
Internships play such a significant role in the therapeutic recreation educational process that they have been addressed in both internal and external standards for the field as a whole. Both the American Therapeutic Recreation Association (Grote & Hasl, 1998) and the National Therapeutic Recreation Society (NTRS, 1997) have developed internship guidelines and standards for internships (see Table 1). Both sets of standards are quite similar, are fairly consistent with NCTRC standards (discussed later), and start with a definition and purpose of an internship. They include guidelines for the sequencing of the internship experience within the academic program; the length of the internship; qualifications of the agency supervisor and the university supervisor; roles and responsibilities of the university, the agency, and the student; and suggested guidelines for written materials including internship manuals, assignments, and contracts. Overall, the professional internship guidelines have been developed at the request of educators and practitioners (Grote & Hasl, 1998) to help provide direction to those who are preparing for a degree in therapeutic recreation and to those who provide academic or agency supervision.
External Standards and Professional Credentialing
The internship also plays a significant role among external standards that impact our field. For a therapeutic recreation option at a university to be accredited through the National Recreation & Park Association/ American Association of Leisure & Recreation (NRPA/AALR) Council on Accreditation (COA) the curriculum must require field experience prior to the internship, as well as a full time internship for at least 10 weeks (NRPA/AALR Council On Accreditation, 2000). Perhaps of even greater significance is the fact that the completion of a therapeutic recreation internship is not only a graduation requirement, but that it is linked to the professional credentialing process including national certification and state licensure where required.
In 1981, the National Council for Therapeutic Recreation Certification replaced the NTRS registration program with a new national certification program that has evolved into the primary credentialing process in the field today. Similar to many national certification processes, an individual is required pass a computerized competency exam in order to become certified. Prior to becoming eligible to sit for the exam, those meeting academic requirements in therapeutic recreation must also complete a qualifying internship (NCTRC, 2003). Thus, the internship experience has become virtually universal in the training of all Certified Therapeutic Recreation Specialist's who obtain their credential through the normal academic path. Furthermore, individuals who wish to be licensed in the state of Utah, which is the only state that currently has a therapeutic recreation licensure law, must also meet all requirements for NCTRC certification. This includes the completion of a qualifying internship and passing the NCTRC exam in order to be eligible to sit for the state law and rules exam (Utah Department of Commerce, Division of Occupational and Professional Licensing, 1998). Following the successful completion of the state exam an individual can apply for state licensure. Therefore, the completion of a NCTRC qualifying internship appears to be an essential step in acquiring professional credentials in therapeutic recreation on the national level and within the only state with licensure.
The NCTRC (2003) definition for a therapeutic recreation internship states that the internship (NCTRC uses the term "field placement" rather than internship) refers to:
A highly structured, field centered and professionally supervised requirement that is completed after the majority of required therapeutic recreation and general recreation coursework is completed... The field placement experience requires an extensive, full-time involvement and is a shared responsibility between the academic unit and the internship agency. (p. 15)
The minimum number of hours (480 hours) and weeks (12 weeks) must be completed at one agency over a consecutive period of time. The full time, onsite supervisor must be currently certified by NCTRC as a Certified Therapeutic Recreation Specialist (CTRS[R]) and the student must receive academic credit.
Purpose of the Study
The internship process clearly plays a vital role in the field whether measured in terms of primary benefits in the educational process of young professionals, by secondary benefits to practicing professionals, agencies, and educational programs, or by the role it serves in assessing competency and quality through the credentialing process. Providing a successful internship experience for students, however, comes with a unique set of challenges. Questions regarding length, structure, risk management, timing in the education process, assignments, communication, clinical supervision, university supervision, visitations, evaluation, and funding are common among therapeutic recreation educators. Although most examinations of therapeutic recreation curricula (Kim, Stumbo, & Carter, 2004; Stumbo & Carter, 1999) have included a section addressing internships, there have been no comprehensive studies to date that have focused exclusively on the internship experience. Nor have any attempted to examine or define other forms of experiential learning such as practicum and field work. Therefore, the purpose of this study was to gain a clear picture of the current practices and characteristics of therapeutic recreation internships, practicum, and field work among undergraduate curricula.
As part of the Higher Education Institute held in conjunction with the 2001 American Therapeutic Recreation Association Annual Conference, therapeutic recreation educators gathered to discuss the findings of a pilot study (Ferguson & Zabriskie, 2001) that examined the current state of therapeutic recreation internships. Findings were presented, trends noted, and continued concerns were discussed. As a result, the authors were asked to conduct a more in depth descriptive examination that included new questions and concerns identified at the institute, which could be discussed further by educators and practitioners during the 2002 Higher Education Institute (Zabriskie & Ferguson, 2002). As a result, the current study was conducted.
The sample was accessed via an email sent by the National Council of Therapeutic Recreation Certification to their list of 100 academic institutions that provided an undergraduate therapeutic recreation education in 2002. Attached to the announcement of the study was a cover letter from the researchers that acknowledged the pilot study and its discussion at the 2001 ATRA Higher Education Institute. The letter also introduced the current study, and requested participation by completing the online survey and submitting it via the internet. Surveys were collected for a period of 30 days and no follow-up requests were made.
Of the 100 academic institutions on the original mailing list, 60 usable responses were collected yielding a response rate of 60% (n = 60). Although one of the responding institutions was located in Canada, it was determined to include them in the sample due to smiliarities in professional and credentialing internship standards as well as to the lack of differences in responses. A slight majority (23 or 39.7%) of the responding institutions provided an emphasis in therapeutic recreation while 20 or 34.5% provided an option in therapeutic recreation and 15 or 25.9% defined their therapeutic recreation program as a major. Most of the programs were relatively small with one (22 or 39.3%) or two (21 or 37.5%) full time therapeutic recreation faculty members. Other programs had 3 (11 or 19.6%), 4 (1 or 1.8%), or 5 (1 or 1.8%) full time faculty members. Current enrollment ranged from 0 students in one program to 130 in another, with a mean of 40.3 (SD = 23.9). The number of students who were expected to graduate during the academic year ranged form 0 to 45 with a mean of 14.1 (SD = 8.7).
The survey utilized in this study was originally developed for the pilot study (Ferguson & Zabriskie, 2001) which was presented and discussed at the 2001 ATRA Higher Education Institute. Following this discussion, the original instrument was refined to require mutually exclusive forced responses that would be more conducive to an online administration. Based on input from those attending the 2001 Institute, seventeen new items were also added to the original survey which changed the total items from 42 to 59. Additional items included questions addressing the following: funding of intern visits; academic advisors and faculty teaching load; provision of an internship preparation course; pre-internship requirements related to universal precautions, background checks, hepatitis shots & TB tests; approaches to internship evaluation; additional requirements of field work beyond course work; and descriptive questions about the therapeutic recreation program such as the number of faculty, students, and projected graduates. The first 40 items on the survey pertained to the capstone or fulltime internship experience, the next nine items addressed practicum experiences, followed by five items that addressed field work experience and five demographic questions.
All data were collected online via the Perseus Survey Solutions software which downloads all responses into a database (in this case SPSS) for analysis. Descriptive statistics were first computed for the demographic information in order to examine the characteristics of the responding academic institutions. Based on the exploratory nature of the study and the structure of the survey questions, descriptive statistics were then calculated for all research variables in an effort to present an accurate description of the current state of therapeutic recreation internships.
Findings will be presented from each of the three sections of the questionnaire which were entitled internships, practicum, and field work experience. In an effort to increase clarity and consistency, the following definitions were provided and each respondent was asked to utilize them as they completed the questionnaire regardless of the terminology that they use at their institutions. An internship was defined as the full time, capstone experience, taken for credit, which is usually completed at the end of a student's education and generally used to qualify for the NCTRC exam. A practicum was defined as an experiential learning activity, taken for credit, which may be of shorter duration or have a lower expectation in terms of assignments and hours required, and which is not designed to be the capstone experience of a student's education. Field work was defined as non-credit bearing activities, volunteer or paid, that are done individually or as part of a class and which are completed prior to the internship as defined above.
All of the responding institutions except for one (98.3%) required their TR students to complete a capstone internship experience. The majority (52 or 86.7%) required only one internship, while some required two (6 or 10%) or even three (1 or 1.7%). The length of the internship ranged from 8 to 16 weeks (see Table 2) and the credits awarded for the internship ranged from 1 to 16 with a mode of 12 (see Table 3). Very few (2 or 3.3%) institutions had geographic limitations as to where students could complete their internships. Of those that did have geographic limitations, one school limited students to within 500 miles if they wanted a site visit, and the other limited students to within the state or within 250 miles unless they had a high GPA.
Most institutions (52 or 88.1%) required students to complete their internships under the agency supervision of a CTRS. The majority (39 or 65%) also required the supervising CTRS to have a certain amount of experience before taking one of their students as an intern. Of those that required experience 1 or 2.6% required a minimum of 1 month, 1 or 2.6% required a minimum of 6 months, 19 or 48.7% required a minimum of 1 year, 15 or 38.5% required a minimum of 2 years, and 3 or 7.7% required a minimum of 3 years. About half (31 or 51.7%) of the responding institutions required the supervising CTRS to have been in their current position for a certain amount of time before taking a student intern. Of those that did require time in their current position, 1 or 3.2% required at least 1 month, 8 or 25.8% required at least 6 months, 20 or 64.5% required at least 1 year, and 2 or 6.5% required at least 2 years.
The majority (44 or 74.6%) of university supervisors were also CTRS's[R] and felt that it is important that the university supervisor be a CTRS. Almost all (57 or 95%) of the university supervisors were full time faculty members with only 2 or 3.3% being part time, and 1 or 1.7% other. None of the university supervisors were adjunct faculty or graduate students. Internship supervision was calculated as part of the faculty member's teaching load at 47 or 78.3% of the responding institutions. When asked how many interns were equal to a 3 credit course on a faculty member's teaching load 15 or 25% responded "not applicable, 20 or 33.3% reported 2 or less interns, and the rest varied from 3 to 9 or more (see Table 4). The primary means for communication with interns was e-mail (22 or 36.7%) followed by telephone (12 or 20%), site visit (11 or 18.3%), mail (7 or 11.7%), all of the above (6 or 10%), and other (2 or 3.3%). The majority of university supervisors (33 or 55%) required weekly contact from students, while others required contact every 2 weeks (18 or 30%), monthly (6 or 10%), as needed (2 or 3.3%), or even daily (1 or 1.7%).
In regards to site visits, only 16 or 26.7% visited all of their interns during their internship, with 41 or 68.3% visiting some of their interns, and 3 or 5% visiting none of their interns. Of those that do visits, most (46 or 80.7%) attempted to make one visit during the internship, while 10 or 17.5% made two visits, and 1 or 1.8% makes three or more visits. Of those who only visit some of their interns, the criteria for receiving a visit varied and were as follows: only those who are in state (9 or 22.5%); those within 0 to 50 miles from the university (4 or 10%); 51 to 100 miles (5 or 12.5%); 101 to 150 miles (4 or 10%); 151 to 200 miles (5 or 12.5%); 201 to 300 miles (10 or 25%); 301 to 400 miles (1 or 2.5%); and other was 2 or 5%. When asked if they had a budget for visiting interns only 35 or 59.3% reported that they did have a budget, and of all 60 respondents 34 or 56.7% reported that it was sufficient to meet internship visit needs. Only one institution (1.7%) charged the student additional fees for the internship. Most (52 or 88.1%) reported that they had no "other means" for funding internship supervision. Of those that did have "other means", three reported "department funds, university funds for emergencies, and personal resources"; one reported "each year we exceed our budget and no one complains. It seems to be working"; one reported "We charge a bit extra for the internship manuals to help offset the costs of visits"; and one reported "University Cooperative Education monies." When asked about personal resources, 25 or 41.7% stated that they spend personal monies to help pay for internship visits.
In terms of preparation for the internship a majority of institutions (46 or 76.7%) required students to complete all of their therapeutic recreation courses before their internship, while only 23 or 38.3% were required to complete all of their other classes prior to their internship as well. A slight majority (37 or 61.7%) provided a pre-internship or an internship preparation class, and more (45 or 77.6%) reported that such a class was needed. Just over half (34 or 56.7%) of the responding institutions provided training in universal precautions (e.g. blood-born pathogens) prior to the internship. Only 15 or 25% required students to have immunizations and health screenings such as Hepatitis shots and TB tests, and 6 or 10% completed background checks on students prior to the internship.
A majority of institutions (42 or 70%) provide a letter grade for the completion of the internship, while 16 or 26.7% give a pass/fail grade, and 2 or 3.3% use some other grading method. When asked if students were permitted to have outside work during their internships the responses were mixed (yes = 33 or 57.9%, no = 24 or 42.1%). Most institutions stated that they encouraged students not to work another job but recognized that individual circumstances of the students may require it. Responses were also mixed (yes = 29 or 48.3%, no = 31 or 51.7%) when asked if students were allowed to take other classes during their internship. Most institutions (48 or 80%) allowed their students to complete their internship during any semester, while some (4 or 6.7%) required the internship during the summer semester only, some (5 or 8.3%) during the winter/spring semester only, some (3 or 5%) during the fall or winter/spring semester. There were none that limited the internship to the fall semester only.
The academic assignments that students were required to complete during their internship beyond their intern duties varied (see Table 5). However, most were required to complete mid-term (59 or 98.7%) and final evaluations (59 or 98.7%), a significant project (57 or 95%), a research project or experience (56 or 93%), and a regularly kept journal (51 or 85%). When asked if internship assignments should be the same for all TR interns from all institutions only 9 or 15.5% agreed, 39 or 67.2% disagreed, and 10 or 17.2% were not sure. When asked about the mid-term and final evaluation format, 46 or 79.3% reported that they use a specific TR evaluation form. Only half (29 or 50.9%), however, stated that their TR internship evaluation form documented the students progress based on the National Job Analysis Skills. A majority (46 or 80.7%) reported that it would be useful to have a standardized TR internship evaluation form available.
All of the responding institutions reported that they offered a practicum experience of some type. A slight majority (37 or 66.1%) of the responding institutions required students to complete a practicum in addition to the full time capstone internship. An optional practicum experience was available for students at 22 or 42.3% of the responding institutions. Most (27 or 62.8%) of those that offered a practicum awarded 3 credits for the practicum while others gave 1 credit (8 or 18.6%), 2 credits (4 or 9.3%), 4 credits (1 or 2.3%), or said that the number of credits varied (3 or 7%). The duration of the practicum also varied for 21 or 48.8% of the respondents with others having a specific length of 2-6 weeks (7 or 16.3%), 8-10 weeks (10 or 23.2%), or 12-16 weeks (5 or 11.7%). The number of hours required per week during the practicum varied for 28 or 63.6%, while others required 5 (4 or 9.1%), 10 (4 or 9.1%), 20 (5 or 11.4%), or 40 hours per week (3 or 6.8%) for the practicum. Only 20 or 41.7% of respondents required the practicum to be completed in a TR setting and only 6 or 12.5% required the practicum to be completed under the supervision of a CTRS[R]. The majority of institutions (32 or 66.7%) did not make a site visit to their students completing a practicum. In terms of sequencing the practicum, a slight majority (22 or 45.8%) preferred it be completed midway through a students academic program, while others allowed it to be completed anytime (19 or 39.6%), near the beginning (4 or 8.3%), or near the end (3 or 6.3%).
A majority (42 or 75%) of the responding institutions required students to complete non-credit field work prior to their internship. The amount of field work required varied from 10 to 1500 hours with a mean of 225 hours, median of 150 hours, and a mode of 500 hours. The majority of institutions (38 or 71.7%) included some of this field work as part of their TR courses. A slight majority (28 or 52.7%) also required field work completely separate from any course work. A slight majority (30 or 55.6%) did not require field work to be in a TR setting and most (43 or 78.2%) did not require field work to be completed under CTRS supervision.
The purpose of this study was to examine the current practices and characteristics of therapeutic recreation internships, practicum, and field work among undergraduate therapeutic recreation curricula. As a result, findings provide a descriptive picture of the current state of internship provision and other forms of experiential learning among institutions that provide undergraduate therapeutic recreation programs. They also provide a basis for identification of current trends, continued questions, and concerns about the provision and supervision of the internship and related experiences.
Of the most notable findings, two major points demonstrate the high degree of support for a capstone internship for therapeutic recreation students. First, all but one (59 or 98.3%) of the responding institutions required their therapeutic recreation students to complete a fulltime capstone internship experience. This finding, together with the NCTRC requirement, supports previous literature in their arguments about the value and necessity of undergraduate internship experiences and is a clear indication that therapeutic recreation educators consider the internship experience to be an essential component of their curricula. Second, most (57 or 95%) of the university internship supervisors were full time faculty members. This suggests that even though there are many issues related to the assignment of faculty to internship supervision when graduate students, part time faculty, or adjunct faculty could complete the supervision, the full time faculty either still make student internships a priority or they consider it important enough to accept supervision responsibilities on top of their existing duties.
Another notable finding concerns the length of the internships. These data were collected just prior to NCTRC's increase in the length requirement from 10 to 12 consecutive weeks (effective December 31, 2002). In this sample, 88.3% already met or exceeded the new standard which appears to be consistent with the Kim, Stumbo, and Carter (2004) finding that the average length of internships is already longer than the NCTRC standard. This is not as long, however, as some authors have strongly recommended (Kinney, Witman, Sable, & Kinney, 2003). Internal standards from both professional organizations (Grote & Hasl, 1998; NTRS, 1997) suggest that an internship be a 15 week full time experience. Findings indicate that only 28.3% went beyond the NCTRC[R] requirement of 12 weeks and met or exceeded the internal standard of 15 weeks (see Table 2).
Such inconsistencies raise a very important question. What is the optimal length of an internship? Is there a point at which it can be said that the overwhelming majority of students will have mastered the basic skills and knowledge required to be a competent recreation therapist and is capable of passing the national certification exam? The NCTRC has set the standard at 12 weeks based upon what is common practice and expert opinion. This standard represents what has been deemed to be a minimum criteria for taking the certification exam but has not been held out as an optimum standard. Our internal standards and guidelines, on the other hand, do tend to represent more of an optimal experience and suggest a 15 week experience for all students (Grote & Hasl, 1998; Kinney & Witman, 1997; NTRS, 1997). These standards have also been established based upon years of practical experience, common practice, and an intuitive feeling about the length of an optimal internship experience for most students. Yet no theories of how critical skills are developed have ever been tested in the internship context. There has been no investigation of how the theories taught in the classroom have related to the application of those theories in the internship experience. Nor has anyone attempted to empirically determine if students completing a 15 week internship are likely to develop better skills or perform better on the certification exam than students completing a 12 week internship. With the rapidly rising cost of both education and healthcare, this is an important issue that begs examination. Furthermore, considering the costs to agencies, student interns, faculty advisors, and universities to provide internship experiences, these questions about internship duration are too great to be ignored.
Other findings indicated that 96.7% of responding TR programs had no geographical limitations for internship placements. Nevertheless, there were significant limitations when it came to on-site visitation and supervision by academic supervisors. The profession's internal standards suggest that all interns should have a site visit from their academic supervisor during their internship (Grote & Hasl, 1998; NTRS, 1997). Findings, however, indicated that about 74% of the university supervisors either visit only some of their interns or don't visit any of them at all. Of those who visit some of their interns, only one institution visited interns if they were more than 300 miles from campus, and those still had to be less than 400 miles away to be visited. Most of these limitations to intern visits are likely to be a response to the financial burdens associated with internship placements. Only 35 or 59% of the responding institutions had a budget for on-site supervision of interns with even fewer reporting that their budgets were sufficient. Most (52 or 88%) had no other means to fund visits and perhaps the most disturbing finding was that 25 or 42% reported that their faculty members spend personal monies on internship visits.
The findings related to intern visits are clearly a concern that must be addressed. Perhaps one of the first steps is to begin identifying those institutions at which faculty consistently visit all of their interns (26.7%) and assess the ways in which they have been able to overcome the financial and/or other challenges related to conducting internship site visits. These strategies or modifications are likely to be possible solutions for other programs as well. It is clear that many have resorted to simply not visiting all of their interns. However, it is also clear, as evidenced by those who make visits without a budget and those who utilize personal monies, that the majority of educators feel that the site visit is essential, at least in most cases. This again points to the continued need for empirical evidence as to the impact of the site visit on student performance. Does the faculty member's presence at the internship site fulfill anything more than a public relations objective or does it actually contribute to student learning? Anecdotal evidence suggests that both students and site supervisors generally encourage and highly value a faculty supervisors' visit. It provides an opportunity for all three parties to discuss progress and successes, resolve problems, address challenges, and set goals for the remainder of the experience. In fact, these may be the contributing factors of the site visit, but empirical evidence as to the value and necessity of the university supervisors' site visit remains unknown.
The skill and competence of the internship site supervisor is also paramount to the mentoring of student interns. In an effort to insure a high level of competence, NCTRC standards require internship site supervisors to be certified (NCTRC, 2003). The field's internal standards (Grote & Hasl, 1998; NTRS, 1997) suggest that agency supervisors should not only be certified but they should have at least 2 years of full time experience in the field with 6 months to 1 year in their current position prior to accepting a student intern. Findings from this study indicate that most institutions (52 or 88%) do require the internship site supervisor to be currently certified as a CTRS. Those that don't indicated that they left the choice up to the student. Only 39 or 65% of respondents, however, indicated any sort of experience requirement. Of those, 19 or 48.7% required a minimum of 1 year and 18 or 46.2% met the standard and required a minimum of 2 or more years of experience. Of the 31 or 51.7% of responding institutions that required the site supervisor to have been in their current position for a certain amount of time, all but one (97%) met the standard of being in their current position for 6 months or more.
Although experience in the field is only one way to measure likely competence, there is a considerable concern abut the possible qualifications of some internship site supervisors. According to current findings, 35% of all therapeutic recreation programs do not require their clinical internship supervisors to have any experience in the field whatsoever. Therefore, it is possible, although not likely, that an intern could have a NCTRC certified site supervisor with no professional experience at all other than their own internship, and who may have actually been one of their own classmates a couple of months earlier. In theory, such lack of professional experience on the part of the supervisor could clearly undermine the premise of completing an internship under an experienced mentor. With little experience of their own, there is a question as to how such a site supervisor could effectively mentor the intern in skill development, professional acclimation, and transition into professional practice. This is a serious issue in a field where there is a scarcity of CTRS' in many states in which unsuspecting or ill advised students are not likely to consider the experience factor of their supervisor before committing to an internship site. Clearly, this is another area in serious need of additional systematic investigation. Furthermore, the fact that 48% have no requirements concerning the length of time the internship supervisor has been in their current position suggests that it is possible that they may have been recently hired and are still becoming acclimated to or even designing the TR program for the facility in which the intern will be placed. Under such circumstance it is less likely that a supervisor could provide the level of mentorship and supervision that would best serve the student intern. It is recommended that these internal standards developed by our professional organizations be adhered to or that they be included among NCTRC standards in an effort to increase the likelihood that the internship site supervisors will be qualified and able to provide a quality capstone experience for student interns.
There are several other general findings that do warrant brief discussion. Findings indicated that only 62% required and provided a pre internship or internship preparation class in an effort to prepare students for a successful internship experience, while 78% responded that such a class was definitely needed. This discrepancy suggested that it may be valuable for those who do not provide an internship preparation course to consider adding one to their curriculum. In a related area, findings indicated that about 57% of institutions provided training in universal precautions (blood-borne pathogens, etc.), 25% required Hepatitis shots, and 10% completed background checks prior to intern placement. Such findings suggest that therapeutic recreation interns are likely to be ill prepared to work in most healthcare settings in which such requirements are commonplace. It is likely that the demand for such preparation will continue to increase but that it may not arrive at the forefront of future TR curricula discussions unless they are included in internal and external standards.
Another notable finding was that 81% of responding institutions felt that it would be useful to have a standardized TR internship evaluation instrument. Professional members of the Cincinnati-Dayton Area Recreation Therapy Association (CDARTA) in conjunction with ATRA have developed such a tool in response to an expressed need of two Ohio educators. The Therapeutic Recreation Intern Evaluation (TRIE) (CDARTA, 1997) states that it is a comprehensive evaluation tool based on the Standards for the Practice of Therapeutic Recreation and Self Assessment, Guidelines for Curriculum Planning in Therapeutic Recreation for Colleges and Universities and Individual Self-Assessment on Competencies for Professional Practice and Career-Long Learning (CDARTA, 1997). All copyright restrictions have been released in an effort to permit and promote the use of this standardized TR evaluation form in the education and evaluation of all TR internship students. It is recommended that those programs interested in utilizing a specific standardized TR internship evaluation tool should examine the TRIE. It should be noted, however, that validity and reliability information on the TRIE are limited. Bearing in mind that 81% of the institutions in this study recommended such an instrument, the relative utility and success of this tool is an additional area of needed research.
The last finding that merits discussion concerns the other practical experiences required prior to the fulltime internship. A majority of institutions required a practicum (66%) and non-credit bearing field work (75%) prior to placement in an internship. Yet, that the amount of required non-credit bearing field work varied from 10 to 1500 hours. This wide gap represents enormous inconsistency when considering the amount of experience required for students prior to their internship. Some students would have practically no experience at all while others may have more accumulated hours in different settings than they would be required to complete in three internships of 12 weeks each. Findings indicated that the mean of responding institutions for field work hours was 225. When the outlier that required 1500 hours was eliminated from the pool the mean was 176 hours and the median and mode remained the 150 and 500 hours respectively. Currently, there are no standards that address the amount of field experience hours that are necessary or recommended prior to the capstone internship. This is an area of future research that could provide some guidance for TR curricula and some consistency among student preparation.
Overall, findings from this study provide a current description of internship and field work practices among therapeutic recreation curricula. They also provide empirical support and clarification of several issues related to internship provision that have been identified and debated in recent professional forums. It appears that the concern about graduate students and adjunct faculty supervising interns is unfounded as most academic supervisors in this study were full time faculty members. Although most institutions adhered to NCTRC standards, it is clear that many institutions in this sample either are not aware of or do not utilize the internal standards (Grote & Hasl, 1998; NTRS, 1997) that have been developed in an effort to provide quality and consistency among therapeutic recreation internship experiences. The results also highlight discrepancies and significant concerns about internship duration, site visits, funding for such visits, experience among agency supervisors, and the inconsistency in the amount of pre internship field experience required. Universal precaution training, Hepatitis shots, and background checks are beginning to be addressed in some programs but will need to be a continued concern in the future. Specific recommendations were made for future research that must empirically examine the optimal length of the internship, the value and necessity of the university site visit, competency and experience among site supervisors, and the utility and success of a standardized intern evaluation tool.
Although there are several pressing concerns related to internship provision, it also appears that some institutions have successfully addressed those concerns. Universities that provide undergraduate therapeutic recreation curricula are encouraged to carefully consider the findings identified in this study as they evaluate issues related to internship provision. It is recommended that those who have effectively negotiated internship concerns openly discuss solutions and network with professional colleagues in an effort to improve the internship provision process, provide better and more consistent experiences for therapeutic recreation students, and therefore, continue to fortify and strengthen the profession.
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(1) The trademarks 'CTRS[R]' and 'Certified Therapeutic Recreation Specialist[TM]' are the property of the National Council for Therapeutic Recreation Certification[R], all rights reserved.
Ramon B. Zabriskie, Ph. D., CTRS
Brigham Young University
Daniel D. Ferguson, Ph. D., CTRS
Pittsburg State University
The authors wish to express their gratitude to Dr. Peg Connolly and the NCTRC staff as well as to those involved in the ATRA Higher Education Institute for their support and collaboration on this study.
Ramon B. Zabriskie, Ph.D., CTRS, is an Assistant Professor of therapeutic recreation in the Department of Recreation Management and Youth Leadership at Brigham Young University. Daniel D. Ferguson is an Associate Professor of therapeutic recreation in the Department of Health, Physical Education, & Recreation at Pittsburg State University.
* Address correspondence to Ramon B. Zabriskie, Department of Recreation Management and Youth Leadership, Brigham Young University, 273 RB, Provo, UT 846022033. Phone: (801) 422-1667, email: email@example.com
Table 1 Comparison of NTRS, ATRA, and NCTRC Internship Standards Characteristic NTRS Definition or An active learning experience to develop purpose of internship TR competencies in the service delivery process. Sequence in Completed all required coursework and the curriculum acquired necessary skills Length of experience 15 weeks full time, 35 hrs per week minimum. On site supervision CTRS, state credential if applicable. Full time employee of agency. 2 years experience. Academic Supervision CTRS and state credential if applicable. Goals for students Student goals based on personal needs and career aspirations; Opportunity for students to augment or improve present TR programs Characteristic ATRA Definition or To apply academic knowledge of TR; develop purpose of internship clinical practice skills; assess, expand student competencies; acquire in-depth understanding; practice ethical behaviors; understand critical issues. Sequence in Completed all or most academic coursework the curriculum in TR. Length of experience 15 weeks full time, 600 total hours recommended. On site supervision CTRS, state credential if applicable and any required agency credentials. Full time employee of agency. 2 years in the field with 6 mo. to 1 year in current job. Supervisory experience. Academic Supervision CTRS recommended. Goals for students Establish goals consistent with agency/university requirements, NCTRC job analysis and field placement guidelines, self assessment. Characteristic NCTRC Definition or Highly structured, field centered, purpose of internship professionally supervised, credit given. Sequence in Completed majority of TR and general the curriculum rec. coursework Length of experience 12 consecutive weeks, full time 40-45 hrs/week at 1 site, total 480 hours or its equivalency On site supervision CTRS is current when the internship begins, full time employee of the agency, on site and working in TR. Academic Supervision No requirement or recommendation Goals for students No requirement or recommendation Table 2 Duration of Internship Experience Duration Freq. % Accum % 16 weeks 2 3.3 % 3.3 % 15 weeks 15 25 % 28.3 % 14 weeks 13 21.7 % 50 % 13 weeks 5 8.3 % 58.3 % 12 weeks 18 30 % 88.3 % * 10 weeks 6 10 % 98.3 % 8 weeks 1 1.7 % 100 % Note. * 88.3% met or exceeded new NCTRC standard; n = 60. Table 3 Credit Awarded for Internship Experience # of Credits Freq. % 16 1 1.7 % 15 4 6.7 % 14 1 1.7 % 12 33 55 % 10 1 1.7 % 9 4 6.7 % 8 4 6.7 % 6 9 15 % 4 1 1.7 % 3 1 1.7 % 1 1 1.7 % Note. n = 60. Table 4 Number of Students on Internship Equal to a 3 Credit Course on Supervising Faculty Load Number of students Freq. % Responded "not applicable" 15 25% 2 or less 20 33.3% 4 3 5% 5 2 3.3% 6 3 5% 7 7 11.7% 8 5 8.3% 9 1 1.7% Varies 4 6.7% Note. n = 60. Table 5 Assignments Required During Internships Assignment Freq. % Mid-term evaluation 59 98.7 % Final evaluation 59 98.7 % Significant project 57 95 % Research project or experience 56 93 % Journal 51 85 % Final paper 43 71.7 % Site visits to other TR programs 22 36.7 % Case study/practice perspective 17 28.3 % Written personal philosophy 10 16.7 % Final exam 2 3 % Other (Notebook, agency in-service, agency 26 43.3 % assessment, bi-weekly report) Note. n = 60.
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|Author:||Zabriskie, Ramon B.; Ferguson, Daniel D.|
|Publication:||Annual in Therapeutic Recreation|
|Date:||Jan 1, 2004|
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