Assessment Flashcards
Conduct the assessment process
Client Assessment
Tool to gather baseline information for program placement, monitoring progress, and evaluating involvement of client.
It may also be used to determine the most effective and efficient interventions for clients or groups of clients.
Assessment Principle 1
Assessment is a systematic process of deciding what information is important to gather, how to collect the information, how to analyze results and what kinds of decisions are appropriate from the data gathered.
Assessment Principle 2
There must be a logical connection between the assessment and programs delivered to clients.
Assessment Principle 3
The assessment process must yield dependable and consistent results in order to be useful.
Assessment Principle 4
Client placement into programs should be based on assessment results, not just opinions or judgements of the specialist
Assessment Principle 5
The assessment process should provide baseline information from which a client’s progression or regression as the result of participation in programs can be judged.
Cultural Orientation
A person’s cultural orientation can be categorized by traditional, marginal, bicultural, and assimilation. A person’s cultural orientation will impact how he/she reacts to the assessment and programming process.
Assessment properties as a measurement tool
Validity, reliability, fairness, practicability and usability.
Validity
Extent to which it meets its intended purpose. It concerns what the test measurements and how well it does so.
Reliability
Estimate of consistency of the assessment results
Fairness
Reduction or elimination of undue bias or stereotypes
Practicability and Usability
Nonstatistical concept that is concerned with reasonableness of the assessment
Assessment Domains
Sensory, Cognitive, Social, Physical, Affective, Leisure, Functional Skills
Social Assessment
Assessing the social impacts of planned interventions or events and for developing strategies for the ongoing monitoring and management of those impacts.
It is concerned with the patient’s communication/interactive skills: such as initiating a conversation, responding appropriately to questions, and developing a support network.
Physical Assessment
Assessing a patient’s fitness, gross motor, and fine motor skills. Eye-hand coordination and other physical functioning skills.
Affective Assessment
Functioning skills in the affective emotional domain: patient’s attitude towards self, when expressing emotions, etc.
Cognitive Assessment
Assessing patient’s long/short term memory, ability to solve problems, attention span. Also concerned with patient’s orientation (person, place and time) and safety awareness.
Sensory Assessment
Evaluating patient’s ability to see and hear, tactile abilities
Leisure Assessment
Assessment of patient’s leisure functioning, barriers, leisure interests and attitudes, as well as patient’s knowledge and understanding of leisure.
Functional Skills Assessment
Assessing the patient’s understanding of the world he/she will be returning. Such as, utilizing recreational/leisure skills to re-integrate to community, level of skill in specific tasks upon discharge. (i.e. Does the patient know how to use public transportation? Will the patient have access to his/her community upon discharge?)
Assessment implementation process
Seven steps:
1. reviewing the assessment protocol
2. Preparing for assessment
3. Administering assessment to the patient
4. Analyzing or scoring the assessment results
5. Interpreting results for placement into programs
6. Documenting results of assessment
7. Reassessing the patient as necessary/monitoring the progress
Secondary sources of assessment data
Sometimes it is not possible for the patient to provide all the information necessary information for a complete assessment. The therapist should use other sources of assessment information:
-medical records
-educational records
-interviews with family and friends
-interviews with members of treatment team
-background information of patient
-patient’s diagnosis
-patient’s cultural belief system
Assessment as a Systematic Process
-Must be selected/developed based on specific purpose
-Must be able to gather necessary information in logical/straightforward way
-Must meet the needs of the clients and intent of agency
-Must produce results that are valid and reliable to the greatest degree possible
Assessment Planning Process
1)Analyze environment
2)Define parameters
3)Select commercial assessment or develop agency-specific assessment
4) Establish Assessment Protocols
5)Train staff and interns on assessment protocols
Analyze Environment: Agency considerations
Evaluate agency considerations (i.e. agency’s mission, services delivered, clients served).
Analyze Environment: Client considerations
Client considerations (i.e. client needs, typical limitations of client population served),reviewing client characteristics helps therapist know the level of content appropriate of assessment and how to implement it.
Analyze Environment: Therapeutic Recreation Program Considerations
TR program considerations: content of program (functional intervention, leisure education or recreation participation), level of program (beginner, intermediate, advanced) and purpose of program (i.e. creative expressions, functional improvement). These factors are important because they may affect the type and depth of questions asked during assessment.
Analyze Environment: Staff and Resources Considerations
Consider the availability of staff and other recreational sources. Staff talents, strengths, and weaknesses.
Defining Parameters of Assessment
Function, content and implementation strategy of assessment. These three areas can help provide foundation for decisions whether to select a commercially assessment or develop an agency-specific assessment.
Define Parameters: Function
What function will assessment serve? 1. basic screening 2. identifying problems 3. narrowing the problems 4. reassessing or monitoring client progress
Define Parameters: Content
The content of assessment must align with content of the programs offered. For example, if the major programs offered include functional intervention, the assessment must ask the specific questions related to this area and whether client should/should not be placed in program. Additionally, level of assessment questions should be determined during this step.
Define Parameters: Implementation Strategy
Four basic strategies for gaining client assessment information: interviews, observations, self-administered questionnaires and record reviews
Systematic observation
-The most frequently used type of observation in the field today.
-Standardizes procedures used: identifying targeted behavior, developing specific recording techniques for the observations of targeted behaviors, scoring and interpreting the observation.
Types of recording methods/techniques in TR
-checklists
-rating scales
-anecdotal records along with frequency or tally methods
-duration, interval and instantaneous time sampling techniques
Assessment interview
Gather information about a client.
-Most CTRSs use directive approach, which involves a series of questions targeted for a specific end result. (open-ended questions)
-Interview questions should directly relate to purpose of interview/assessment
-Interview consists of opening, body of interview and closing
-TR depts. should develop an interview protocol to use in assessment, this ensures everyone is collecting the necessary information the same way.
Record Review
Another form of assessment. It is information from a secondary source and ranges from medical test to social histories. Examples:
medical chart, case file, education file.
Self-administered surveys/questionnaires
Used to gather information a quick fashion for specialist. Often used with for individuals who are cognitively intact and can process information without assistance of specialist.
Questions are usually closed-ended (checklists, rating scales, or ranking).
Aspects of therapeutic relationship with clients
-Establishing rapport
-Fostering empathy
-Facilitating effective communication
-Promote collaborative decision-making processes
-Upholding professional boundaries
self-disclosure
Consists of the therapist sharing their thoughts, ideas, experiences and feelings with clients, allowing the client to see the therapist as a person, not just a working professional.
Selecting commercial assessment or develop agency-specific assessment.
A systematic evaluation must occur to make sure that selected assessment fist the intended purpose and can produce reliable results for the client/s.
Steps when developing agency specific assessments
- Planning the assessment: agency, client, program and resource factors must be noted, along with assessment function, content and implementation strategy.
- Item writing: content of assessment (and item) matched the content of program/s and items produce results that can be used to determine placement of patient in program. Examples of types of items: closed ended questions with yes/no answers, checklists, rating scales, and rankings.
- Item analysis and testing: assessment must meet quality measurement standards, including testing for validity and reliability.
Standardized Assessment
- The consistent administration and reporting of participant data using formal and informal processes accepted by professionals at the particular agency.
- Including: MDS, LCM, LDM and agency developed instruments use to identify participants behavior’s, abilities, strengths, skills and expectations.
Assessment Protocols
Document that provides clear information on the standardized procedures for preparing for, administering, scoring, interpreting and reporting assessment information.
-It is important whether assessment is commercially available, or agency developed.
Train Staff and Interns on Assessment Protocols
The purpose of this step in to ensure all specialists are fully able to complete and adhere to the protocol as written.
-This increases the likelihood of specialist delivering assessment in similar fashion
-Increases reliability of assessment results
-Reduces unwanted error
-Promotes the quality improvement process
Strength based approach
-A strengths-based approach entails developing an ethic of care that honors the individual for the person they are rather than their disease.
-A strengths-based approach through service delivery models such as the Leisure Well-being and Flourishing Through Leisure Model identifies an individual’s strengths to increase capabilities related to living well while simultaneously addressing problems and barriers.
- Instead of searching
for problems, issues, deficits, and the like, assessment becomes a search for the dreams,
goals, and strengths in participants and the
environments in which they live, work, and
play to support outcomes.
Barriers to leisure particpation
-social
-physical
-cognitive/psychological
-environmental
Client outcomes
Documentable changes in client behavior, skills and/or attitudes which can be attributed to active participation in a therapeutic recreational intervention program.
-Client outcomes need to be clarified and targeted before any intervention/service is conceptualized or designed.
Important characteristics of outcomes
-identifiable
-measurable
-achievable
-demonstratable or documented
-predictable or casual
-meaningful
Goals and Objectives
-Goals are broad and objectives are specific
-Objectives are used as a mean to measure whether goals are met
-Objectives contain a behavior, condition and criteria and are SMART: Specific, Measurable, Achievable, Realistic, and Time related.
Domains of functional interventions
-physical
-mental
-emotional
-social behavioral
Functional intervention services
Outcome is to eliminate, significantly improve, or to teach a client to adapt to existing functional limitations that hamper efforts to engage fully in leisure pursuits.
Communicate assessment data to interdisciplinary team/ other service providers and client
-TR contributes to general treatment goals and addresses specific leisure-related goals
-Therapist interprets and educates the entire team regarding the leisure area of rehabilitation and treatment
-Therapist integrates the significance of therapeutic recreation into the total rehabilitation concept and approach
Assessing client eligibility for therapeutic recreation services
-traditional systems (DSM IV)
-newer systems based on body functions and structure, and activity and participation (WHO International Classification of Functioning, Disability and Health-known as ICF )
Recipients of therapeutic recreation services
Individuals diagnosed with:
Developmental disabilities
Mental and emotional illnesses
Dementia
Physical and sensory impairments
Acute and chronic illnesses
Substance abuse
Additionally:
Legal offenders in detention and rehabilitation centers
At-risk youth
