Assessment Flashcards
Erikson’s Stages of Psychosocial Development
- Infancy (0-1 year): Trust v. mistrust (trust or mistrust that basic needs, such as nourishment and affection, will be met) [hope]
- Early childhood (1-3 yrs): Autonomy vs. shame/doubt (develop a sense of independence in many tasks) [will]
- Play age (3-6 yrs): Initiative vs. guilt (take initiative on some activities-may develop guilt when unsuccessful or boundaries overstepped) [purpose]
- School age (7-11 yrs): industry vs. inferiority (develop self-confidence in abilities when competent or sense of inferiority when not) [competence]
- Adolescence (12-18 yrs): identity vs. confusion (experiment with and develop identity and roles) [fidelity]
- Early adulthood (19-29 yrs): intimacy vs. isolation (establish intimacy and relationships with others) [love]
- Middle age (30-64 yrs): generatively vs. stagnation (contribute to society and be part of a family) [care]
- Old age (65+): integrity vs. despair (assess and make sense of life and meaning of contributions [wisdom]
Interaction Patterns
- Intra-individual: action taking place within the mind or action involving the mind and a part of the body; requires no contact with another person or external object (yoga, meditation)
- Extra-individual: action directed by a person toward an object; requires not contact with another person (reading, solitaire, listening to music, exercycle, puzzles, toys)
- Aggregate: action directed toward an object while in the company of other directing action towards objects; no interaction among participants required (crafts, watching TV)
- Inter-individual: action of a competitive nature directed by one person toward another person (checkers, cards, billiards, ping-pong)
- Unilateral: action of a competitive nature among three of more person, one of whom is an antagonist or “it”; interaction is in simultaneous competitive relationship (tag)
- Multilateral: action of a competitive nature among three or more persons with no one person as an antagonist (table games, poker, horse, cards)
- Intra-group: action of a cooperative nature by two or more persons intent upon reaching a mutual goal; action requires positive verbal or nonverbal interaction (plays, building a birdhouse, choirs)
- Inter-group: action of a competitive nature between two or more inter-groups (team sports)
Parten’s Stages of Play
- Unoccupied play (0-3mo): watching and responding to things in the environment that catches one’s attention, such as sounds, colors, movements, and sensations
- Solitary play (0-2ys): occupying oneself by playing alone and independently in purposeful, sustained engagement in activities with objects, toys, materials, or games
- Spectator/onlooker play (2-2.5 yrs): occupying oneself by purposeful observation of the activities of others with objects, toys, materials, or games, but not joining in their activities
- Parallel play (2.5-3yrs): engaging in purposeful, sustained activities with objects, toys, materials, or games in presence of other persons also engaged inlay, but not joining in on their activities
- Associative play (3-4yrs): engaging in play with others who are doing the same or similar activity (following one another with trains) and takes, lends, or borrows objects, toys, materials, and games from others; each child acts as they wish and do not subordinate their individual interests to that of the group
- Cooperative play (4+yrs): engaging in play with others with a shared goal or purpose
Group session structure
- Opening of the session: CTRS helps clients relax, get to know each other, and understand what will occur
- Body of the session: focus-game, arts and crafts, leisure awareness, etc.
- Closing of the session: process the activity-debrief, outcomes of the activity meet goals (CTRS focuses, redirects, blocks, links and summarizes in order to summarize and bring closure to the session)
Centers for Medicare and Medicaid Services
CMS: establishes regulations for both programs; important for CTRS to understand regulations if patients are receiving funding from these
The Joint Commission
-accredits hospitals and facilities that provide health care services that meet essential standards
-identifiers=client name and DOB
Commission for the Accreditation of Rehabilitation Facilities (CARF)
establishes standards for organizations that might offer TR service; standards developed address programming issues that CTRSs must meet and relate directly to TR services
Occupational Safety and Health Administration (OSHA)
provides regulations to reduce workplace hazards and dangerous conditions
Accreditation Canada
provides standards and accreditation programs for many healthcare services across Canada
Views on leisure
- Leisure as time
- Leisure as activity
- Leisure as a state of mind
- Leisure as a symbol of social status
- Leisure as an anti-utilitarian concept
- Leisure as a holistic concept
*CTRS should determine client’s view to meet them where they are at
Perceived freedom
people think they have a choice when related to leisure; people do not really have leisure unless they at least believe they have the freedom to choose what they do during leisure
Intrinsic motivation
motivation for leisure must come from within rather than from external factors
Locus of Control
amount of control a person feels they have over the events that occur in their life; internal=person believes they have control of outcome of events; external=person believes outcome of events is due to luck, environment, or others
Quality of Life
person’s physical, psychological, social, occupational, and leisure functioning as well as sense of well-being
Boundary Violations
-romantic/sexual relationship
-receiving gift of money
-favoring a client at expense of another
-telling client personal things to make an impression
Professional Boundaries
-invisible structures imposed by legal and ethical standards
-focus of relationship is on clients’ needs with purpose and health goals and concludes when they are met
Cognitive/Developmental Disorder
-Developmental=”severe and chronic disorder involving mental and/or physical impairment that originates before age 22”; causes substantial functional limitations in 3 of 7 areas of major life activity (self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency”
-Intellectual=”deficits in general mental abilities such as reasoning, problem solving, planning abstract thinking, judgement, academic learning, and learning from experience that cause impairment in adaptive functioning such as communication, socializing, academic or occupational functioning, and person independence”; mild, moderate, severe, and profound based on functioning not IQ scores
-Most people who have intellectual disability are developmentally disabled but opposite is not always true
Autism Spectrum Disorder
-3 out of 4 diagnosed thought to have intellectual disability
-3 levels: requiring support, requiring substantial support, and requiring very substantial support”
-Features:
1. impairment in social communication and interaction
2. Restricted, repetitive patterns of behavior, interests, or activities
3. Sensory issues
4. Eating issues
5. Sleeping issues
6. No emotional reaction
7. Excessive fear
8. Speech issues (echolalia)
9. Poor eye contact
10. Resistance to change
11. Sustained odd play
Traumatic Brain Injury (TBI)
-involved in an accident and may have other complications that involve their physical abilities
-Glasgow Scale: predicts degree of recovery and severity of a TBI
-Rancho Scale: identifies eight levels of cognitive functioning organized into 4 intervention stages
Cardiovascular Accident (CVA)
-stroke (interruption of the blow-flow to the brain)
-Hemiplegia (paralysis)
-damage to right side of brain: left hemiplegia, problems with depth perception, visual neglect, problems orienting to environment, and estimating abilities
-damage to left side of brain: right hemiplegia, aphasia (problem speaking), understanding, reading, writing, and judgement
Dementia (major neurocognitive disorder)
-decline in mental ability severe enough to interfere with independence and daily life
-Alzheimer’s Disease, Vascular Dementia, Dementia with Lewy Bodies, Parkinson’s, Alcohol-related Dementia, and Frontal-Temporal Dementia
-2 sets of symptoms:
1. Behavioral (apathy, physical aggression or nonaggression, verbal nonaggression or aggression, or refusal of care or medication [causes most issues for caregivers])
2. Cognitive (loss of skills and memory)
-Other symptoms: depression, paranoia, social withdrawal, or suicidal ideation
Alzheimer’s Disease (AD)
-most common form of dementia
-3 stages
Stage 1/Mild: lasts between 2-4 years
Stage 2/Moderate: lasts from 2-7 years
Stage 3/Severe: lasts from 1-3 years
Epilepsy
-chronic brain disorder characterized by recurring attacks of abnormal sensory, motor, and psychological activity
-Primary=no identifiable etiology
-Secondary=after an impact to the brain that causes seizures
-Partial=only one cerebral hemisphere
-Generalized=both hemispheres
-Simple=no loss of consciousness
-complex=loses consciousness
Physical/Medical Disorders and Related Impairments
-largest group in Diagnostic Groupings listing any impairment that is not under cognitive, sensory, or psychiatric
-may cause adjust in person’s activities but not complete change of lifestyle
Cerebral Palsy (CP)
-developmental disorder characterized by problems controlling movement
-non-progressive
-Described by….
1. Limb involvement (quadriplegia, paraplegia, diplegia, hemiplegia, triplegia, or monoplegia)
2. Exhibited symptoms (spasticity, athetosis, or ataxia)
Muscular Dystrophy (MD)
-group of related diseases that affect the muscoskeletal system
-Duchenne or childhood MD: most severe and common, affects male children who show symptoms by 2-3, progressive, use wheelchair by adolescence, confined to bed by adult, most die in early 20s
-Facio-scapulo-humeral MD
-Limb-girdle MD
Spinal Cord Injury (SCI)
-paraplegia or quadriplegia
-usually acquired through trauma
Mutiple Sclerosis (MS)
-impacts nervous system
-diagnosed in individuals between 20 and 50
-causes deterioration of the myelin sheath
-no set patten of symptoms, but common are speech disturbances, balance problems, vertigo, blurred vision, walking difficulties, and tremors
-exacerbation and remission pattern, but never complete recovery to original functioning level
Diseases of the circulatory system
-myocardial infraction or specific heart condition that may impact treatment
-Class I (no limitation of physical activity) to Class IV (inability to carry on any physical activity without discomfort)
Endocrine and metabolic system diseases
-Diabetes mellitus (large amounts of sugar in the blood and urine)
-Type 1: immune mediated before age 30; difficult to regulate and person usually on insulin
-Type 2: more common and appears when over 40; managed by diet and some require insulin
-DM is often a secondary condition
Cancer
-Symptoms=tumors growing in specific area of the body; can be benign or malignant (invasive, grows rapidly, can metastasize through circulatory or lymph system)
-tumors graded on 1-4 and TNM system (T=size and extent, N=number of area lymph nodes involved, M=any metastasis)
Autoimmune Deficiency syndrome (AIDS)
-viral infection associated with HIV
-sexually transmitted or by blood
-spectrum of symptoms
-CTRS must help client cope with an incurable disease and continue quality of life that is appealing to them
Visual impairments/blind
-legally blind=20/200 or less
-CTRS help them in community, meet rec needs through adaptive equipment, and sports
-knowing etiology and teaching/learning techniques is important
Hearing impairments
-measured by the degree of speech heard per decibel level
-CTRS needs to be aware of residual hearing ability, use of hearing aids, which ear can hear better, type of communication method preferred, and understanding of deaf culture
Speech impairments
-understand types of aphasia
-effects from CVA or brain injury
-People with CP can have speech problems
-CTRS should demonstrate patience, listening skills, and speech-facilitated technology
Psychiatric Disorders and Related Impairments
-impairments of mental health, behavior, and addictions
Schizophrenia
-Two or more of following for at least a month:
1. Hallucinations: involves senses and feels real but is not, auditory is most common where people report hearing voices
2. Delusions: fixed beliefs that won’t change despite practical evidence (persecutory=most common where person thinks someone or group is trying to hurt them; grandiose=one has special powers, wealth, mission, or identity; referential=song on radio is taking about me)
3. Disorganized thinking/speech: switch quickly from one topic to another and an answer to a question may be only marginally related or not related at all
4. Grossly disorganized or abnormal motor behavior (includes catatonic): silliness to agitation
5. Negative symptoms=anhedonia or motivation (lack of interest of drive to engage in social and rec activities), flat affect, and alogia (reduced speech)
-Impairment in one area of function (social, occupational, educational, self-care) for significant amount of time
-Continued sign of illness for at least 6 months
-always a change in functioning level
-manifests at the time of transition from adolescence to adulthood
Schizophrenia Disorder
Same as schizophrenia but last at least a month but less than 6 months
Schizoaffective Disorder
-both schizophrenic symptoms and either major depression or manic episode
-delusions or hallucinations for at least 2 weeks when not having a depressive or manic episode
-depressive or manic symptoms are present for over half of illness duration
Delusional Disorder
-the presence of at least 1 delusion for at least half a month
-never met schizophrenic criteria
-function is not impaired outside of impact of delusion
-duration of any depressive or manic episode is brief relative to delusion
Brief Psychotic Disorder
One of more symptoms for at least one day but less than a month: delusions, hallucinations, disorganized speech, grossly disordered or catatonic behavior
Attenuated Psychotic Disorder
-One or more of following symptoms in “attenuated”/lessened form: delusions, hallucination, or disorganized speech
-Symptoms must have occurred at least once a week for the past month and have started or gotten worse in the past year
-symptoms must be severe enough to distress or disable the individual or to suggest to others that the person needs clinical help
-person has never met diagnostic criteria for psychotic disorder and symptoms are not better attributed to another disorder
Bipolar and related disorders
-strong impact on emotions
-moods swing from lows of depression to mania
-manic=3 or more of these: inflated self-esteem, seems not to need sleep, very talkative, highly distractible, thoughts seem to be racing, increase in goal-directed activity to accomplish anything, and overly involved in activities that have high possibility for a painful outcome
3 types:
1. Bipolar I: single manic episode while depressive episode is not necessary
2. Bipolar II: single or recurrent hypomanic episode and depressive episode
3. Cyclothymic disorder: numerous and alternative periods of hypomania and depression
Major Depressive Disorder
Personality Disorders
-an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture
-pervasive and inflexible
-has an onset in adolescence or early adulthood
-stable over time
-leads to distress or impairment
-10 PDs: paranoid, schizoid, schizotypical, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive
Borderline Personality Disorder
Eating Disorders
-Anorexia nervosa: habits that cause starvation
-Bulimia nervosa: cycle of binging and purging
-important to understand family interactions as this disorder is thought to have direct relationship with family system
Behavioral Impairments
-victims or perpetrators of violence, abuse, or neglect
-abuse=act of commission or inflicting injury or allowing injury to a child, while neglect refer to an act of omission or failure to act on behalf of a child
-physical abuse, sexual abuse, and emotional abuse
-can be developmentally delayed because of emotional problems, passivity, overly aggressiveness, or other problems
-CTRS can help them gain coping skills, self-awareness, and healthy emotional expression
Addictions
-start out as harmless pastimes
-10 classes of drug abuse: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics and anxiolytics, stimulants, tobacco, prescribed and OTC drugs
-Substance abuse occurs when individual repeatedly uses a substance to that it causes serious problems in life, whether on job, role obligations, legal problems, health, etc.
-also be addicted to gambling, exercise, work, etc.
-addiction represents a powerful kind of attraction, for what may initially appear to be harmless pleasure or personal release but ultimately control individual and leads to shattering life consequences
-persons addicted can use goal-oriented treatment, leisure education, and understanding of their behavior and how it affects others esp. family
-leisure is first of 5 major life areas to be affected from use of substances
Post-traumatic Stress Disorder (PTSD)
-could have experienced war, threaten or actual physical assault, threatened or actual sexual violence, being kidnapped, being taken hostage, terrorist attack, torture, incarceration, prisoner of war, natural or human-made disasters, and severe motor vehicle accidents
-veterans it is associated with poor social and family relationships, absenteeism from work, lower income, and lower educational and occupational success
Comprehensive Evaluation in Recreation Therapy-Psych (CERT-Psych)
-functional
-determines behaviors related to a person’s ability to successful integrate into society using his/her interaction skills
BANDI-RT
Functional Assessment of Characteristics for Therapeutic Recreation (FACTR-R)
-measures prerequisite skills related to leisure participation
Leisure Diagnostic Battery
-LDB
Leisure Competence Measure
-LCM
American Spinal Cord Injury Association Scale
-ASIA
Rancho Los Amigos Scale of Cognitive Functioning
Glasgow Coma Scale
Children’s Coma Scale
Inpatient Rehabilitation Facility-Patient Assessment Instrument
-IRF-PAI
-inpatient rehabilitation hospitals and units are required to use this scale in order to receive Medicare reimbursement
Global Deterioration Scale
-GDS
-used in many long-term care facilities
Mini-Mental State Examination
-used in many long-term care facilities
Minimum Data Set Resident Assessment and Care Screening (MDS)
-must be used in long-term care facilities to receive Medicare reimbursement
Multiaxial Assessment System
-used in psychiatric settings
Cross Cutting Symptom Measures
-used in psychiatric settings
-helps clinicians identify additional areas of inquiry that may have significant impact on the individual’s treatment and prognosis
World Health Organization Disability Assessment Schedule 2.0
-WHODAS 2.0
Functional Independence Measure (FIM)
-developed as a measure of disability in general and not specific to any diagnoses
-measures level of independence for self-care, including sphincter control, transfers, locomotion, communication, and social cognition
-Self-care (eating, grooming, bathing, dressing, toileting)
-Sphincter control (bladder, bowel)
-Transfers (bed, chair, wheelchair, toilet, tub, shower)
-Locomotion (walk/wheelchair, stairs)
-Communication (comprehension, expression)
-Social cognition (social interaction, problem solving, memory)
-uses level of assistance to measure from 1-7:
1=Total assistance (client 0-24% of work)
2=maximal assistance (client 25-49% of work)
3=moderate assistance (client 50-74% of work)
4=minimal assistance (client 75-99% of work)
5=supervision (client 100% of work but distant: within a few yards, close: within a few feet; general: no hands-on assistance and may require all but tactile cues)
6=modified independence (client 100% of work but requires increase time of device)
7=complete independence (client 100% of work in timely and safe way)
Secondary Sources of Assessment Data
-background info: age, educational level, diagnosis, family
-medical history
-multicultural considerations
-records: medical, educational
-interviews: family, friends, other members of treatment team, caretakers
Selecting/Developing Assessment
-reliability=estimate of consistency of measurement
-validity=extent to which the assessment meets its intended purpose
-practicality=doable as far as time, ease of use, cost, and staff knowledge and ability
-availability=accessible
7 step assessment implementation process
- Reviewing assessment protocols
- preparing for assessment
- administering assessment to the patient
- analyzing or scoring the assessment results
- interpreting results for placement into programs
- documenting results of assessment
- reassessing patient as necessary/monitoring progress
Systematic observation
-most frequently used type of observation in RT
-standardizes procedures used: identifying target behavior, developing specific recording techniques for observation of target behavior, and scoring/interpreting the observation
Recording methods
-checklists
-rating scales
-anecdotal records
-frequency or tally methods
-duration
-interval
-instantaneous time sampling
Directive interviewing approach
-series of questions targeted for a specific end result
-open or closed-ended questions
-questions should directly relate to the purpose of the interview/assessment
-every interview should have an opening, body of the interview, and closing
-interview protocol created by TR department should be used in assessment
Assessment domains
- Sensory: ability to see and hear, tactile abilities,
- Cognitive: memory (long and short term), problem solving, attention span, orientationx3, safety awareness
- Social: communication, interactive skills, conversation skills, friendships, support network
- Physical: fitness, gross and fine motor, eye-hand coordination
- Affective: emotional skils, attitude towards self, how express emotions (anger)
- Leisure: barriers, facilitators, interests, attitudes, skills, what do they know/able to get needs met
- Functional: consider where they will be using leisure skills and what skills they need to participate; transportation, community access, social media/internet use, must assess person’s understanding of the world they will be returning or are in
Making goals
-must be measurable
-based on client’s strengths and weaknesses found from assessment
-goals flow directly from the needs list and are statements that reflect what the client is going to be able to do at the completion of the treatment plan
Making objectives
-written based on goal statement that indicate the goal has been acheived
3 components:
1. Condition (when or where outcome behavior should occur)
2. Observable behavior (action verb that describes the behavior; what you are looking for)
3. Criteria (describes how well/often the client must perform the behavior; degree to which it will be considered successful
Example: When asked a question by staff, the client will respond politely within 30 seconds (conditions=when asked/behavior=will respond/criteria=politely within 30 seconds)
Bloom’s Taxonomy
in order…
1. knowledge (lowest level)
2. comprehension
3. application
4. analysis
5. synthesis
6. evaluation (highest level)
Krathwohl Taxonomy
-Referred to for affective domain
-based on internalization=process whereby a person’s affect toward an object passes from a general awareness level to a point where the affect is “internalized” and consistently guides or control the person’s behavior
1. receiving
2. responding
3. valuing
4. organizing
5. characterization by value set
SMART goals
Specific
Measurable
Achievable
Relevant
Time-bound
Distal Goal
-Long-term
-Example: Client will increase her participation engagement to improve the quality of her leisure experiences
Proximal Goal
-Short-term
-Example: Client will actively engage in the Special Olympics Maryland Kayaking Sports Programming
Focus Charting
-targets both client’s problems and assets
-holistic approach to identify patient issues and concerns in progress notes
Fox Activity Therapy Social Skills Baseline Assessment
-used for adults with developmental disabilities
-evaluates level of skills in social/affective domains
-appropriate for clients with developmental level of 6 months-4 years
Leisureoscope
-determines client’s leisure options
Chapters in DSM-5
20
Mental Health Parity and Addiction Equity Act
federal legislation attempting to equalize mental health services with other medical services
