Assessment Instrument

Assessment Instrument
Zikeya Hickman
Florida International University
LEI 4711 RVC
Dr. Susan Mathieu
10/31/2015

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Table of Contents
I.
II.

Introduction

Assessment Instrument Description 1

III.

Instrument Development and Trial

IV.

Assessment Report Form

V.
VI.

a. Figure 1.1

b. Figure 1.2

c. Figure 1.3

d. Figure 1.4

e. Figure 1.5

Summary and Conclusions

References

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Assessment Instrument

Introduction
The purpose of this assessment instrument is to learn the clients interests and how well
they perform each activity, as well as, what activity they would like to learn in order to give the
client the best experience/capability possible. Knowing the clients strengths and weaknesses will
help the therapist better assist the client in achieving their goal of performing particular leisure
interests. This assessment will inform the therapist of the clients emotional, cognitive, mental,
and physical needs, so that the therapist will know what to pay attention to specifically in order
to build the clients confidence and independence based on what the client feels he or she needs
to improve on or learn.
Assessment Instrument Description
This is an initial assessment to be performed in rehabilitation facilities/units with young
to older adults, ages eighteen and older. It is suggested that the clients being assessed are able to
respond, but may or may not be able to physically achieve all leisure interests. Therefore, this
instrument should be used with clients who have experienced a stroke, traumatic brain injury, a
sudden physical impairment, or any other injury that prevents them from participating in usual
leisure activities.
This assessment requires a significant amount of communication, so therapists are only
allowed to used this instrument when the client is coherent and able to communicate effectively.
Examples of minimal communication required would be a simple head nod for yes or no
questions, audible words, or hand gestures. Clients are not required to move in order to answer
the questions being asked during the assessment.
Only Certified Therapeutic Recreation Specialists (CTRS) should administer this
assessment instrument, with the exception of the CTRS assistant who has completed a bachelors

Assessment Instrument

degree in Recreational Therapy or Therapeutic Recreation and interns who are currently
completing a bachelors degree in Recreational Therapy or Therapeutic Recreation from
colleges/universities. Interns may only administer this assessment under the supervision of the
CTRS or CTRS assistant. If a CTRS assistant is not available, then the CTRS must be present at
all times when an intern is conducting an assessment with a client.
When administering this assessment, the CTRS is to complete the Demographics and
Disability Information section before letting the assistant or intern administer the remainder of
the assessment. Once, the Demographics section is completed, the remainder of the assessment
may be completed by asking the client the questions provided and circling their specific interests,
known as the Leisure Interests section. After, the Psycho-Social Leisure Lifestyle Client
Questionnaire is to be given to the client to be filled out. The client will fill out the
questionnaire on their own or with the assistance of the administer. Once, all of the sections of
the assessment is filled out completed, then the assessment is concluded and to be kept in a safeguarded environment in order to stay within HIPPA guidelines.
Instrument Development and Trial
This assessment instrument is criterion-referenced, meaning that information from this
assessment is designed to measure the clients performance based upon what specific stage the
client should be at considering their treatment plan created by their occupational or physical
therapist.
In order to make sure that the client is comfortable during this assessment and to ensure
that they are giving open and honest answers, the client and administer need to be in a closed
room that only the administer and client occupy.

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Assessment Report Form

Below are images of the assessment instrument:

(Figure 1.1)

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(Figure 1.2)

(Figure 1.3)

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(Figure 1.4)

(Figure 1.5)

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Summary and Conclusions

This assessment instrument is to help individuals gain knowledge about themselves, as
well as, improve themselves. The CTRS should work alongside the clients Physical Therapist
and/or Occupational Therapist to ensure an effective delivery of treatment through therapeutic
activities. Using this assessment in a rehabilitation facility helps the CTRS and the client to work
together and be on the same page. This assessment, if used properly, will help guide the client to
during their rehabilitation while also boosting their confidence and maintaining their leisure
interests.

Assessment Instrument
References
Burlingame, J., & Blaschko, T. (1990). Assessment tools for recreational
therapy and related fields (4th ed.). Ravensdale, WA: Idyll Arbor.
Therapeutic Recreation Forms and Formats. (n.d.). Retrieved November 2,
2015, from http://www.recreationtherapy.com/forms.htm