Assessment tools in TR

Any assessment on a client involves gathering data from many sources. Sources for assessment info can include but are not limited to:

- The client - The client's family - The client's environment - The client's history and background info such as age, diagnosis, educational level - Contributions by other members of the treatment team (verbal and written) - The client's medical record - Observation methods

CERT- Psych involves three areas of observation:

1) general observation of the client 2) the client's individual performance 3) the client's performance within a group

The Five Dimensions of Life Satisfaction as defined by Lohmann are:

1) pleasure vs. apathy 2) determination 3) difference between desired and achieved goals 4) mood at time of assessment 5) self -concept

Leisurescope helps the client/therapist identify:

1. Areas of leisure that are of high interest to the client 2. Emotional motivation for participation in each of these areas of interest 3. A patient's need for high arousal experiences (desire and need to take risks)

Some common assessment tools that the CTRS may use include:

CERT-Psych (Comprehensive Evaluation in Recreation Therapy - Psych)*

An assessment is completed to:

to gather and analyze data in order to best determine the client's needs and interests as well as strengths and abilities. (Remember that TR is ability oriented).

The four subscales of this assessment are:

1. Intellectual - measures the extent to which the client is motivated to engage in leisure activities that involve mental activities such as learning, exploring, discovering, creating or imagining 2. Social -measures the extent to which the client engages in leisure activities because of the need for friendship and interpersonal relationships and the need to be valued by others 3. Competency/mastery - measures the extent to which the client engages in leisure activities in order to achieve, master, challenge and compete 4. Stimulus/avoidance - measures the extent that a client needs to escape and get away from over-stimulating life situations.

Culturally Sensitive/ competent

Assessments need to be culturally sensitive. Therefore the TR needs to be culturally competent.

What is CERT?

Comprehensive Evaluation in Recreation Therapy - CERT Psych is a 25 item assessment that is one of the most widely used assessments in the field of recreation therapy.

The affective component of leisure attitude is designed to take into account the individual's:

Evaluation of his/her leisure experiences and activities Liking of those experiences and activities, and Immediate and direct feelings toward leisure experiences and activities. This component generally reflects the respondent's like or dislike of leisure activities.

FACTR/R

FACTR/R is a 33 item screening tool used to determine a client's needs related to his/her basic functional skills and behaviors. It helps to prioritize the client's treatment objectives. Once the therapist has review the client's chart and has observed the client in a few activities, he or she should be able to fill out the FACTR-R score sheet. Doing so helps pinpoint the functional domain (physical, cognitive, social/emotional) with the greatest need and ability to be improved. It helps the therapist identify the areas most likely to improve through the services of recreation therapy.

What is FACTR?

Functional Assessment of Characteristics for TR.) * Note: There is also a revised edition, hence the FACTR/R.

What does FIM stand for?

Functional Independence Measure

The cognitive component of leisure attitude gathers info on the following areas:

General knowledge and beliefs about leisure Beliefs about leisure's relation to other concepts such as health, happiness and work and Beliefs about the qualities, virtues, characteristics and benefits of leisure to individuals such as : developing friendship, renewing energy, helping one to relax, meeting needs and self-improvement

What does GCS stand for?

Glasgow Coma Scale

What does GAF stand for?

Global Assessment of Functioning

This 50 item assessment uses an observational check list and helps the recreational therapist determine the patient's functional ability in eight areas:

Gross motor function, e.g. weight bearing, neck control, lower extremity movement ability, etc. Fine motor function, e.g. manual movement ability, manual movement endurance, etc. Locomotion, e.g. ambulation ability, wheelchair maneuverability, transfer ability, etc. Motor skills, e.g. gross motor coordination, fine motor coordination, reaction time, etc. Sensory, e.g. visual acuity, depth perception, ocular pursuit, auditory acuity, etc. Cognition, e.g. attention span, memory, orientation, judgment, decision-making ability, etc. Communication, e.g. verbal receptive skills, verbal expressive skills, reading receptive skills, written expressive skills, etc. Behavior, e.g. social interaction skills, adjustment to disability, frustration tolerance level, displays of emotion, etc. *Each assessment sheet can be used up to four times with a single patient.

What is FIM?

In a nutshell the FIM is a standardized seven-point scale used to document a client's degree of independence in performing any observable skill. The CTRS can use the FIM to determine at which of seven levels* a client initially functions in 18 areas of daily living activities, from completely independent at the highest level down to being unable to perform an activity at the lowest level. Each level in between represents progressively greater amounts of assistance that the client needs to perform each activity. Through intervention the client's degree of disability is expected to decrease and functional performance will increase in some or all areas. The CTRS can re-evaluate the client's functional performance periodically using the FIM to document client's progress over time. The TRS can also use the FIM scores to predict how much assistance a client will need at home.

What does IRF-PAI Stand for?

Inpatient Rehabilitation Facility-Patient Assessment Instrument

What is CERT- PD?

Intended for evaluating adult clients in rehab programs. Its purpose is to establish baseline levels of client functional skills needed for leisure activities. This tool is able to provide the TR'S with a good measurement of the client's functional abilities as they relate to leisure involvement. One of its strengths is that each sub-scale may be used independent of the others. One of the drawback to this assessment is that administering the entire assessment takes a full hour or more to administer and frequently clients in physical rehab get too tired before finishing the full assessment.

What does LAM stand for?

Leisure Attitude Measure

What does LCM stand for?

Leisure Competence Measure

What does LDB stand for?

Leisure Diagnostic Battery

What does LIM stand for?

Leisure Interest Measure

What does LMS stand for?

Leisure Motivation Scale

What does LSM stand for?

Leisure Satisfaction Measure

For what common sense reasons would we do a leisure assessment on our clients?

Leisure assessments help us to determine the following sorts of things for our clients. Potential leisure barriers Leisure interests Leisure attitudes Current leisure skills Whether or not they have a well-rounded leisure lifestyle Are they able to get their leisure needs met Do they know about leisure (benefits, opportunities, etc?)

social interaction scale of the FIM

Level 7 = Client interacts appropriately with others 100% of the time; 6= Occasional inappropriate behavior but self-corrects or it is noted that medication corrects the situation; 5= Client only needs supervision under unfamiliar or stressful conditions less than 10% of the time; 4= Client interacts appropriately 75-90% of the time; 3=Client interacts appropriately 50-74% of the time; 2=Client interacts appropriately 25-49% of the time; 1= Client interacts appropriately less than 25% of the time; 0=Client never interacts appropriately or does not interact

physical functioning scale of the FIM

Level 7 = complete independence; 6=modified independence; 5= client requires supervision or set up; 4= minimal contact assistance, client performs 75% or more of the task; 3= moderate assistance, client performs 50-74% of task; 2=maximum assistance, client performs 25-49% of task; 1= dependent/total assistance, client performs less than 25% of task; 0=no activity occurs

8 Levels of Rancho Los Amigos Scale:

Level One No response to stimuli (coma) Level Two Generalized response to stimuli (inconsistent and non-purposeful) Level Three Localized response (specific but inconsistent response to stimuli) Level Four Confused - agitated (heightened state of activity with decreased ability to process information) Level Five Confused - inappropriate, non-agitated Level Six Confused - appropriate Level Seven Automatic - appropriate Level Eight Purposeful and appropriate (normal)

What does LSS stand for?

Life Satisfaction Scale

What is MMPI?

MMPI - 2 Minnesota Multiphasic Personality Inventory

What does MDS stand for?

Minimum Data Set Also referred to as the Long-Term Care Minimum Data Set

Does the TRS want to know about the clients sensory functioning?

Obviously the answer is yes. The TRS will need to know such things as the client's Level of vision and any visual concerns Tactile abilities Level of hearing and any hearing related concerns Responses to various sensory stimuli In summary, as TRS's we are interested in assessing our client's level of leisure functioning AS WELL AS their sensory, social, physical, cognitive, and affective functioning. We use multiple assessment sources and tools, depending on the individual circumstances.

8 domains or categories for LIM include:

Physical Outdoor Mechanical Artistic Service Social Cultural Reading

The FACTR/R measures functional skills for leisure involvement in eleven areas within three domains:

Physical, ambulation general coordination, vision, hearing, etc. Cognitive, e.g. attention, orientation, concentration, long-term memory, receptive language, etc. Social/Emotional, e.g. functioning in pairs, in small groups, in competitive situations, when involved in conflicts or arguments, etc.

What setting is CERT used in?

Psychiatric setting

To help the therapist pinpoint the specific areas that need intervention the assessment divides leisure satisfaction into six subscales:

Psychological (sense of freedom, enjoyment, involvement and intellectual challenge). Educational (intellectual stimulation to learn about one's self and the world Social (rewarding relationships with other people). Relaxation (relief from stress and strain of life) Physiological (means to develop physical fitness, stay healthy, control weight and otherwise promote well-being) Aesthetic (perceives that his/her leisure activities are pleasing, interesting, beautiful and generally well designed)

What does the LAM do?

The LAM helps the therapist identify attitudinal barriers to the client's healthy involvement in leisure activities.

Things to remember when selecting an assessment tool:

Select the most appropriate assessment tool for what you are trying to assess Consider the usability and practicability of the assessment tool you are using. Is it do-able in terms of time constraints, ease of use, cost of use, availability, and staff knowledge to administer appropriately? Is there evidence of assessment tool reliability and validity?

What does STILAP stand for?

State Technical Institute Leisure Activities Project

What does IRF- PAI do?

The Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) is assessment data collected on all Medicare Part A fee-for-service patients who receive services under Part A from an inpatient rehabilitation facility (IRF) at admission and upon discharge. IRF-PAI items address the physical, cognitive, functional, and psychosocial status of the IRF patients. The data collected for IRF-PAI is used for quality of care purposes and items were developed primarily for IRF prospective payment system (PPS).

What is LDB?

The LDB helps the therapist measure the client's perceived freedom as it relates to leisure and other factors that may be barriers to this freedom. It's available in paper and computer format with an accompanying manual that provides extensive information on the tools validity and reliability.

What does the LMS measure?

The LMS measures motivation relative to leisure involvement.

What does LSM do?

The LSM helps the therapist determine the extent to which a client perceives his/her general 'needs' are being met through leisure.

LSM and Idyll Arbor Leisure Battery

The LSM is one of four separate instruments that are under the umbrella of the 'Idyll Arbor Leisure Battery'. These four instruments are all used to measure how a client relates to leisure. Other instruments included under the umbrella of the 'Idyll Arbor Leisure Battery' are the Leisure Attitude Measure (LAM) [see below], the Leisure Motivation Scale (LMS) [see below] and the Leisure Interest Measure (LIM) [see below]. All are included in this document. These measures can be administered together or independently.

What does LSS do?

The LSS is a 32 item scale with a reliability coefficient of .89 (.80 is considered acceptable). It was developed by Nancy Lohmann (1976) as a result of her research on life satisfaction. The LSS measures five dimensions of life satisfaction which provides the therapist with a single sore when they are combined

What is the LCM?

The Leisure Competence Measure (LCM) is a testing tool with a 201-page manual that can be used with most patient populations served by the recreational therapist.

What is STILAP?

The STILAP is a leisure interest inventory that was developed in 1974 and updated in 1990. The client is presented with a check list of more than 120 activities and responds with one of four answers: M (much for those activities he/she participates regularly during the appropriate seasons); S (sometimes for those activities that he/she has done but not on a regular basis); I (interested for those activities he/she would like to learn) and no answer (left blank) for activities where none of the other three answers apply.

What does CERT allows the therapist to evaluate?

The clients demonstrated functional level in the following areas: attendance, appearance, attitude toward rec therapy, coordination, posture, response to therapist (one to one), decision making ability, judgement ability, ability to form individual relationships, expression of hostility, performance in organized activities, performance in free activities, attention span, frustration tolerance level, strength/endurance, memory for group activities, response to group structure, leadership ability in groups, group conversation, display of sexual role in group, style of group interaction, handling of conflict in group when indirectly involved, handling of conflict in group when directly involved, competition in group, attitude toward group decisions.

What is the purpose of STILAP?

The purpose of this assessment is to help the client achieve a balanced leisure lifestyle through: assessing the client's leisure skill and participation patterns; categorizing these patterns into leisure competency areas; providing a systematic way for the therapist to measure the degree to which the client's lifestyle is balanced.

This tool is divided into two sections with a total of seven subscales.

The subscales measure the following: 1) perceived leisure competence 2) perceived leisure control 3) leisure needs 4) depth of involvement 5) playfulness 6) barriers to leisure experiences 7) leisure preferences

What is LIM?

Therapists often complain about the common problem of using activity interest lists in which the client just checks off activities that he/she likes. Results of such checklists are often questionable. Ragheb and Beard developed a 29 item assessment that is more rigorous and measures how much interest the client has in each of eight domains of leisure interest.

How long does STILAP assessment usually take?

This assessment takes about 30 minutes for the clients to fill out and an additional 15 minutes for the therapist to score.

What is GCS?

This is a measure used to describe the severity of a coma and subsequent injury by grading eye, motor and verbal responses. The numerical values of the scale range from 3 (low) to 15 (normal). The total score of a client's GCS means: 3-8 sever coma, 9-12 moderate coma and 13-15 mild coma. A newer Glasgow type scale has been developed for children which allows more accurate measurement of the early recovery in young children who are under the age of 3. This is called the Children's Coma Sale (CCS).

MMPI

This is a personality assessment. It has 500 statements such as "I sometimes tease animals." The client responds with a True or False or I Cannot Say response. The MMPI-2 helps identify such things as the following: Defensiveness Potential issues of illiteracy or confusion Levels of anxiety Tendency to engage in denial Ego strength (extent to which client is able to function at work and in social situations) Proneness to addictions

Leisurescope (for adults) Teenscope (for adolescents)

This is a quick test to administer, Clients make 45 visual comparisons (pictures on slides or cards...which do they like better?). Results are categorized into ten leisure categories (games, sports, nature, collection, crafts, art & music, entertainment, helping others/volunteerism, social affiliation, and adventure) along with the emotional motivations for participation in activities.

What does MDS do?

This is a standardized, interdisciplinary tool designed for long-term healthcare facilities whose residents receive Medicare or Medicaid benefits (basically every client admitted to a nursing home in the US. The MDS is also sometimes referred to as the Resident Assessment Instrument. It is used to conduct primary screenings and assessments of resident health status and includes a section for TR/RT responses.

Mini Mental State Exam

This is an easy tool to utilize. It measures cognitive functioning.

Rancho Los Amigos Scale of Cognitive Functioning

This is an eight-point scale that is used to indicate the degree to which cognitive functioning is impaired, usually in adults with brain injury.

What is GAF?

This is considered one of the most often used scales for assessing impairment in clients with psychiatric disorders. Mental health and social work practitioners use it during patient or caregiver interviews. It is a helpful tool for tracking individual patient's clinical progress.

The behavioral component of leisure attitude is based on the individual's:

Verbalized behavioral intentions toward leisure choices and activities, and on self-reports of current and past participation.

What are some common affective domain related functional abilities the TRS would assess?

When assessing affective functioning the TRS would be interested in such things as: The client's emotional skills (e.g. emotional control, level of emotional maturity, how they express emotions, can they express anger appropriately, level of assertiveness vs. passiveness or aggressiveness, etc.) The client's attitude toward his/herself (e.g. self-concept, self-esteem, etc.).

What are some common cognitive domain related functional abilities the TRS would assess?

When assessing cognitive functioning, the TRS would be interested in the clients functioning as it relates to such things as Short and long term memory Problem solving capabilities Attention span Orientation to person, place and time The client's level of safety awareness

What are some common physical domain related functional abilities the TRS would assess?

When assessing physical functioning the TRS would be interested in such things as: The client's level of fitness/endurance The client's gross motor skills The client's fine motor skills The client's level of eye-hand coordination Plus many other physical functioning skills

Examples of inappropriate behavior could include:

non-interactive/withdrawn, excessive crying/laughing, loud, abusive, foul language, temper tantrums, physical attacks, and needing restraints for safety of self and/or others

What are some common social domain related functional abilities the TRS would assess?

When assessing social functioning the TRS would be interested in the client's interaction and communication skills such as: Can/does the client initiate conversations? Does the client respond appropriately to questions? Does the client maintain friendships? Does the client have a support network?

What are the 3 subcomponents of attitude:

cognitive, affective and behavioral.

LCM consists of eight sub-scales:

leisure awareness, leisure attitude, leisure skills, cultural/social behaviors, interpersonal skills, community integration skills, social contact, and community participation.

How long does FACTR/R take to administer and score a client?

less than 20 minutes per client to administer and score.