NCTRC Risk Management Protocols 2 — Questions and Answers
Question 1: In therapeutic recreation, 'risk management' primarily involves:
- Avoiding all recreational activities that carry any physical risk
- Systematically identifying, assessing, and minimizing potential hazards while enabling meaningful client participation (Correct answer)
- Requiring all clients to sign liability waivers before any activity
- Limiting TR programs to passive activities only
Correct answer: Systematically identifying, assessing, and minimizing potential hazards while enabling meaningful client participation
TR risk management involves systematic hazard identification, risk assessment, and implementation of controls that minimize risks to an acceptable level while preserving meaningful and therapeutic recreation participation.
Eliminating all risk would eliminate most meaningful recreation — the goal is acceptable risk management, not zero risk. The CTRS systematically identifies potential hazards (environmental, equipment, client-specific), assesses likelihood and severity, and implements controls (supervision, equipment checks, participant screening, emergency protocols) that reduce risk while preserving the therapeutic and recreational value of programs.
Question 2: Before implementing an aquatic therapy program, the CTRS should conduct which of the following safety checks?
- Review client's leisure interest inventory only
- Check pool chemistry, emergency exits, lifeguard certification, client medical screening for contraindications, and emergency action plan (Correct answer)
- Verify that clients enjoy swimming as their primary activity
- Obtain physician permission for every individual session
Correct answer: Check pool chemistry, emergency exits, lifeguard certification, client medical screening for contraindications, and emergency action plan
Aquatic program safety requires comprehensive pre-program checks: water quality and chemistry, facility emergency equipment and exits, lifeguard credentials, medical screening of each client for contraindications, and a current emergency action plan.
Aquatic environments present multiple risk categories requiring systematic pre-program safety review. Water chemistry affects participant health; emergency equipment (AED, rescue equipment) must be present and functional; lifeguards must maintain current certification; each client must be screened for contraindications (open wounds, cardiac conditions, seizure disorders); and staff must know and practice the emergency action plan before the first session.
Question 3: A client falls during a TR group session. After ensuring the client's immediate safety and calling for medical assistance, what should the CTRS do NEXT?
- Continue the group session with remaining participants as if nothing happened
- Complete an incident report documenting the circumstances, time, client condition, and actions taken (Correct answer)
- Apologize to the client and promise no further documentation will occur
- Modify the session activity to increase difficulty for remaining participants
Correct answer: Complete an incident report documenting the circumstances, time, client condition, and actions taken
After securing medical assistance, completing a timely and accurate incident report is the next critical step — creating a legal record of the circumstances, response, and client condition that protects both the client and the organization.
Incident reports are legal and administrative documents that capture the facts surrounding adverse events. They initiate quality improvement processes, notify risk management and insurance departments, and protect the organization in potential litigation. The report must be factual, objective, and completed promptly while details are fresh. The CTRS must also follow up on the client's condition and document any program modifications made in response.
Question 4: Which of the following represents a PROACTIVE risk management strategy in TR?
- Completing an incident report after an injury occurs
- Conducting regular equipment inspection and maintenance checks before program use (Correct answer)
- Referring all clients to the medical team after adverse events
- Increasing supervision ratios only after an incident has occurred
Correct answer: Conducting regular equipment inspection and maintenance checks before program use
Proactive risk management anticipates and prevents hazards before they occur. Regular equipment inspection identifies defects or wear before they cause injury — a preventive measure rather than a reactive response.
Proactive risk management strategies occur before adverse events: pre-session equipment checks, environmental safety audits, staff training in emergency procedures, client screening for contraindications, and regular review of safety protocols. Reactive strategies — incident reports, post-incident supervision increases — are necessary but insufficient. A comprehensive risk management program emphasizes prevention over response.
Question 5: When documenting a client's informed consent for participation in an adventure therapy program, the CTRS must ensure the client understands:
- Only the benefits of the program
- The nature of the program, potential risks, benefits, available alternatives, and the right to withdraw without penalty (Correct answer)
- The CTRS's qualifications and professional certifications only
- The facility's liability insurance coverage
Correct answer: The nature of the program, potential risks, benefits, available alternatives, and the right to withdraw without penalty
Informed consent requires disclosure of all elements necessary for an autonomous decision: what the program involves, its potential risks and benefits, what alternatives exist, and the client's right to refuse or withdraw without negative consequences.
Valid informed consent must be voluntary, informed, and competent. 'Informed' means the client receives complete and honest information about the program, including realistic risk disclosure. Without this, consent is not genuinely voluntary. In adventure therapy, where physical risks are inherent, thorough risk disclosure and acknowledgment of the right to modify participation level are ethically essential.
Question 6: A CTRS notices that a piece of weight-bearing exercise equipment used in TR has a worn cable. The appropriate action is to:
- Continue using the equipment and monitor it closely
- Remove the equipment from service immediately, tag it as out-of-service, and report it for repair or replacement (Correct answer)
- Reduce the weight used with the equipment until it can be repaired
- Only use the equipment with highly functional clients who are unlikely to fall
Correct answer: Remove the equipment from service immediately, tag it as out-of-service, and report it for repair or replacement
Equipment with structural wear that poses injury risk must be immediately removed from service — not used with modifications — until it has been professionally inspected and repaired or replaced.
Using equipment with known structural defects — even under modified conditions — creates ongoing liability and risk of serious client injury. The CTRS's duty of care requires immediately removing hazardous equipment from use, clearly tagging it to prevent accidental reuse by others, and initiating the repair or replacement process. Documenting the finding and action taken also creates a record demonstrating responsible risk management.
NCTRC Risk Management Protocols 2
In therapeutic recreation, 'risk management' primarily involves: