NCTRC Certification

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National Council for Therapeutic Recreation Certification (NCTRC)


Established in 1981, the National Council for Therapeutic Recreation Certification (NCTRC) is an accredited, internationally recognized non-profit organization responsible for assessing and certifying professional competency in the field of recreational therapy.[1] Early credentialing programs for therapeutic recreation specialists began in 1959, when the Commission for Advancement of Hospital Recreation (CAHR) began a voluntary registration program for professionals in the field. In this first year, 68 specialists were credentialed. In 1967, the National Therapeutic Recreation Society (NTRS) was formed and took over the registration and credentialing process. When the NCTRC was formed in 1981, there were about 3,000 active credential holders. The standards-based credentialing exam was established in 1990, and continues to evolve to meet the changing demands of the profession using a data-driven approach, incorporating job task analyses to insure that the exam remains relevant to current practice. Since 1990, NCTRC has certified over 20,000 therapeutic recreation specialists.[2]

Function of the Test

NCTRC Study Guide

Becoming a Certified Therapeutic Recreation Specialist (CTRS) demonstrates to potential employers, referring health care providers and the public that an individual meets a rigorous standard of knowledge, skills and experience in the field of recreational therapy.[3] To be eligible for initial certification by the NCTRC, an individual must hold a minimum of a bachelor’s degree from an accredited institution, must complete an appropriate supervised internship, and must pass the CTRS exam. Certified individuals are sought after for employment in community-based mental health and wellness centers, inpatient facilities, geriatric facilities and programs, drug and alcohol rehabilitation programs, and school systems.[4] Candidates whose degrees are in major subjects other than recreation or therapeutic recreation may be eligible under an equivalency given the appropriate coursework and full-time, paid work experience.[5] Once an individual achieves CTRS certification and gains further specialty experience and education in the field, they can apply for additional specialty certification.[6] Specialty certification is available in the areas of physical medicine and rehabilitation, geriatrics, developmental disabilities, behavioral health, and community inclusion services.[7]

Test Administration

NCTRC Flashcards

The NCTRC exam is given during 6, one-week testing windows each year at Prometric testing centers across the United states. The cost to take the exam is $300.[8] Special accommodations are available at test sites for individuals with disabilities covered under the Americans with Disabilities Act (ADA). Requests for accommodations such as readers or sign language interpreters, writers, and extensions to the normal time allotted for the exam must be requested at the time of application, and requests must be accompanied by documentation from an appropriate health care provider.[9]

Test Format

Sections of the NCTRC Test
NCTRC Test Subject Areas Percentage
Foundational Knowledge 33.3%
Practice of TR/RT 46.7%
Organization of TR/RT 13.3%
Advancement of the Profession 6.7%
Total 100.0%

Test Structure

The NCTRC is made up of 90 questions that have to do with four main topics: Foundational Knowledge; Practice of TR/RT; Organization of TR/RT; and Advancement of the Profession. The time allowed to complete all 90 questions is 86 minutes. After that testing period is complete, candidates will receive a pass score, fail score, or neither. If the candidate has neither passed nor failed the exam, they will be moved on to testlet sections. Each testlet contains 15 questions lasts up to 14 minutes. At the end of each testlet, another pass, fail, or "neither" score will be reported. The combined testlets and base test lasts three hours, and consists of 180 questions.[10]

Test Environment

On the day of the exam, candidates are expected to arrive 30 minutes early to their exam site to allow enough time to check in. A valid, government issued identification is required. Once in the exam room, no personal items are allowed. The NCTRC is a computer based exam, and scratch paper will be provided by the testing center.[11]

Test Content

  • Sample NCTRC Questions
  • Sample Foundational Knowledge Questions
  1. According to Piaget's and similar theories of cognititve development, when can most people typically think abstractly enough to perform mental operations without using concrete objects?
    A. Right from infancy
    B. In early adulthood
    C. Pre-teens to teens
    D. Middle adulthood
  2. For a patient who has had a stroke to the left hemisphere of the brain, which is a better TR practice?
    A. To do more leisure education than reality orientation
    B. To keep any distractions out of the TR environment
    C. To use more verbal directions instead of gestures
    D. To use mroe physical gestures instead of words
  3. The literature from leisure research has established which of these?
    A. People pursue more stability than novelty in their leisure experiences.
    B. People pursue more novelty than stability in their leisure experiences.
    C. people seek equal amounts of stability and novelty in leisure activities.
    D. People seek novelty in leisure when young and stability at older ages.
  • Sample Practice of Therapeutic Recreation/Recreation Therapy questions
  1. Of the following concepts, which would be most related to enabling people with disabilities to participate in the same activities as the non-disabled in the same school class or community group?
    A. TR/RT as inclusive recreation
    B. TR/RT as treatment modality
    C. TR/RT as recreative process
    D. TR/RT from holistic approach
  2. A client finds leisure activity a way to escape from a stressful job. Which of the four primary leisure motivations does this reflect?
    A. Competence mastery
    B. Intellectual motivation
    C. Stimulus avoidance
    D. Social motivation
  3. Relative to the nature and diversity of recreation and leisure activites, what should RTs include in their programs to promote their advocacy for all kinds of people?
    A. Activities that make us examine biases
    B. Activities that make us examine phobias
    C. Activities that make us examine prejudices
    D. Activities that make us examine all of these
  • Sample Organization of Therapeutic Recreation/Recreation Therapy Service Questions
  1. What is accurate about utilization review as a part of quality improvement?
    A. Utilization review concentrates on over-utilization, not under-utilization
    B. Utilization review concentrates on under-utilization, not over-utilization
    C. Utilization review targets department inefficiency but not effectiveness
    D. Utilization review should be included in written agency operations plans
  2. Which of the following is true about Medicare and Medicaid?
    A. Both Medicare and Medicaid provide health insurance only for those aged 65 and over.
    B. Medicare is a federal program and Medicaid is a combined federal and state program.
    C. Medicare Part A provides for hospital care, home health, and outpatient services.
    D. Medicare Part B provides for hospital care, home health care, and outpatient services.
  • Sample Advancement of the Profession questions
  1. What is one way the NCTRC ensures that the continuing education pursued by CTRSs contributes value to the advancement of the TR/RT profession?
    A. By giving CTRSs CEUs or credits for every continuing education experience they complete
    B. By requiring their CE experiences to be connected to knowledge areas in the Job Analysis
    C. By offering its own series of continuing education courses online in which CTRSs can enroll
    D. By providing continuing education via home study courses and professional journal review

More free NCTRC practice test questions.


The exam format is unique in that it consists of a base exam of 90 questions, and up to 6 additional “testlets” of 15 questions each in an adaptive format. A candidate may definitively pass or fail the base exam, or may achieve a score that requires further testing. If further testing is required, the candidate will move through as many of the 6 testlets as necessary to determine a definitive pass/fail status.[12] Scoring is based on the number of correct answers, and candidates are encouraged to answer each question on the exam.[13] Raw scores are converted to scaled scores to determine a candidate’s pass/fail status. Candidates who achieve a scaled score of 55 or higher pass the exam, while those who receive a scaled score between 20 and 54 do not pass. Passing scores are not revealed for security reasons.[14] Because the number of questions answered may vary among candidates (depending on the number of testlets administered), the scaled score is based on the total number of correct answers and the total number of questions, but does not convert directly into a percentage score.[15] Those candidates who fail the exam may reapply for a slot during any subsequent testing window.[16]

Recent/Future Developments

The NCTRC’s 2014 job analysis has been completed, and results will be incorporated into test forms beginning in July, 2015. Exams given up until that point will continue to be based on the 2007 job task analysis.[17]

Answers to Sample Questions

Foundational Knowledge 1;C 2;D 3;C Practice of Therapeutic Recreation/Recreation Therapy 1;A 2;C 3;D Organization of Therapeutic Recreation/Recreation Therapy Service 1;D 2;B Advancement of the Profession 1;B


  1. ^ National Council for Therapeutic Recreation Certification (NCTRC) April 11, 2015
  2. ^ About NCTRC April 14, 2015
  3. ^ National Council for Therapeutic Recreation Certification (NCTRC) April 11, 2015
  4. ^ FAQ About RT/TR April 11, 2015
  5. ^ Certification Standards Part I: Information for New Applicants April 14, 2015
  6. ^ About NCTRC April 14, 2015
  7. ^ CTRS Specialty Certification April 14, 2015
  8. ^ FAQS April 14, 2015
  9. ^ Certification Standards Part II: NCTRC Exam Information April 14, 2015
  10. ^ NCTRC Exam Content Outline 22 April 2015
  11. ^ NCTRC Exam Information 22 April 2015
  12. ^ NCTRC Certification Exam April 14, 2015
  13. ^ Taking The Exam April 14, 2015
  14. ^ Certification Standards Part II: NCTRC Exam Information April 14, 2015
  15. ^ Certification Standards Part I: Information for New Applicants April 14, 2015
  16. ^ Certification Standards Part II: NCTRC Exam Information April 14, 2015
  17. ^ Recent News April 14, 2015

External Links