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Recreation Therapy Assessments & Models

CIP used to measure function in a community setting.
What is the Community Integration Program (CIP)? One of the oldest standardized test; Measures cognitive awareness & demonstrated abilities related to use of community resources & leisure time. Purpose: To measure different aspects of client’s knowledge & skills in accessing community resources
What are the Modules of the CIP? -Community environment (environmental safety, basic survival skills, and emergency preparedness), - Cultural activities (theatre, restaurant ) - Community activities (shopping mall, grocery store) - Transportation - Physical activity
What are good populations for the the Community Integration Program? Any population that needs to regain ability to use community resources including physical disabilities, DD, psychiatric disorders, head injuries, and at risk youth
FOX Assessment Purpose To evaluate skills in social/affective domain. Has 6 sections that measures a client's reaction & interaction with objects & others.
How many areas are tested in the Fox assessment and what are they? 6 areas: 1. Client’s reaction to others 2. Client’s reaction to objects 3. Client’s seeking attention from others to manipulate the environment 4. Client’s interaction with objects 5. Client’s concept of self 6. Client’s interactions with others.
What population is the FOX used on? Primary for youth/adults w/ severe profound MR or developmental disabilities. Now includes youth/adults with dementia, severe MI, psychological disorders, or brain injury. Basically low functioning clients.
What is the STILAP? State Technical Institute's Leisure Assessment Process - lengthy checklist of activities based on 14 competencies
What is the State Technical Institute Leisure Assessment Process (STILAP) purpose? To achieve a balanced lifestyle. Assessing the client's leisure skill participation patterns; categorizing these patterns into leisure competency areas; & providing guidelines for further leisure decision-making & future program development
What population is the STILAP used on? Adolescents and adults with physical or psychological disabilities or MR/DD Purpose: Interests in various activities New activities interested in learning Degree to which leisure lifestyle is balanced
What is the Leisure Scope Assessment? Develop to identify need for high arousal teens and adults. This can be done in a group or individually. ID areas of high leisure interests ID emotional motivation for participation ID individuals need higher arousal experiences
Leisure Scope assessment Clientele Adults and teens with little to no cognitive impairment Psychiatric setting/ adjudicated youth/ CD Mental age 6 or above Rancho 6 or above
Leisure Scope assessment description This can be done in a group or individually. There are 10 activity categories. There is forced choice between 2 pictures shown at a time. Highest interest is scored on a grid and emotions are checked.
What is FACTR-R? Functional Assessment of Characteristics for Therapeutic Recreation - Revised. Originally devised for recreation specialist w/ no formal training before it was revised.
What is the FACTR-R (Functional Assessment of Characteristics for Therapeutic Recreation - Revised) Determine client's needs related to their basic functional skills and behaviors. Examines functional skills for leisure involvement 1) Physical 2) Social/emotional 3) Cognitive
What is the FACTR-R Clientele? All person developmentally over 10 years
FACTR-R Description Not administered- fill out after observation of client in a variety of activities and reviewing medical chart. Measures 11 areas in each of 3 domains Physical, cognitive, Social/emotional
What is the IALB Purpose? provides the therapist with a broad, accurate measure of an individual's leisure aptitudes Measuring 4 specific leisure attributes- total scores 2nd page: affect and mannerisms
What is the IALB (Idyll Arbor Leisure Battery) Clientele? IQ 80 or above Mental age 12 Mild to no cognitive impairments Rancho 7 or above
Idyll Arbor Leisure Battery (IALB) Description 4 areas: The LAM is part of this battery Leisure Attitude Measurement Leisure Interest Measure Leisure Motivation Scale Leisure Satisfaction Measure
What is the MDS? clinical assessment tool used to assess multiple areas of care for residents in LTC facilities; Used in SNF that are certified by CMS (Center for Medicare and Medicaid Services) Just updated in OCT 2013 by the CMS
When does a CTRS in a LTC perform a MDS assessment? Admission Annually Change of condition
How does the MDS work? Each section contains specific questions. For each answer there is a numerical value or "code" assigned to each answer then they are calculated a RUG (Resource Utilization Guideline) score is given, which determines the CMS reimbursement rate of services
What is a "trigger" in the MDS? A trigger is a score that indicates a need for further assessments (CAA) Care Assessment Area, the professional must complete a more in depth explanation of plan of action, to correct or minimize the possibility of the issue occurring
What is the LCM (Leisure Competency Model)? Measures change in client functioning over time ID patterns of leisure dysfunction Provide a basis for evidence-based decision making Program evaluation Guide client-centered goal setting & RT intervention Compliance w/ CARF, JCAHO & CCHSA
LCM (Leisure Competency Measure) description 7 sub-scales: FIMS; Based on Leisure ability model: 1. Leisure Awareness 2. Leisure Attitude 3. Leisure skills 4. Cultural/Social Behaviors 5. Interpersonal Skills 6. Community Integration Skills 7. Social Contact 8. Community Participation
Leisure Competency Measure (LCM) Clientele Geriatric or rehabilitation setting
What is the LDB? Leisure Diagnostic Battery *Has the most research Assess leisure functioning Determine areas for improvement Impact of offered services Facilitate research on structure of leisure
What is PFL Perceived Freedom in Leisure? Perceived freedom in leisure is a set of beliefs the individuals have of their ability to participate and derive personal benefits from participation in recreation activities.
LDB (Leisure Diagnostic Battery) description 8 Scales (Short&Long Forms) 1 Perceived Leisure Competency 2 Perceived Leisure Control 3 Leisure Needs 4 Depth of Involvement in Leisure 5. Playfulness 6. Barriers to Leisure Involvement 7. Knowledge of Leisure Opportunities 8. Leisure Preference
LDB Clientele Recreation services for special education students Version A: ID/DD with higher functioning skills Version B: Adults with or without disabilities Rancho 7 or above Mild to no cognitive impairment
What is the CERT? Comprehensive Evaluation in Recreation Therapy - two types of assessment, one for psych & one for physical rehab this 25-question test takes just 5 minutes to score after observing a patient in a group activity
CERT - Psych (Comprehensive Evaluation in Recreation Therapy) Clientele, Purpose, & Description Psych/Behavioral- youth & adults; Rancho 5+; cognitive severe+ ID behaviors relevant to successfully integrating into society using social interaction skills Acute intake assessment, document change in RTC, perform before & after medication changes
CERT - Physical Rehab (Comprensive Evaluation In Recreation Therapy) Clients: physical rehab, Rancho 1-8 Develop 5 yrs +, Cognition severe or above Purpose: est. functional skills related to leisure Description: 8 areas: gm, fm, locomotion, motor skills, sensory, cognition, communication, behavior
What is RAI? Fully computerized interdisciplinary assessment to determine the most appropriate level of care for residents
RAI (Resident Assessment Instrument) Clientele Geriatric, NH, SNF, SNU, ALL, LTC, Medicare/Medicaid
Resident Assessment Instrument (RAI) Purpose Fully computerized interdisciplinary assessment to determine the most appropriate level of care for residents MDS + TRIGGERS + RAPS = COMPREHENSIVE ASSESSMENT GUIDELINES
RAI Description 3 Basic components 1. Minimum Data Set (MDS)- test questions interdisciplinary – SET OF SCREENING OF CLINCIAL AND FUNCTIONAL STATUS -TR is section N and T 2. Triggers- scores that indicate a need for further assessment 3. RAPS
What are RAPS Resident Assessment Protocols 18 areas Provides guidelines for further assessment as indicated by triggers. For new residents or when significant change in health status or annual MDS review.
SCORING the RAI Resource Utilization Guidelines (RUGS) Prospective Payment System (PPS)- govt. reimbursement for NH-based on avg. cost of resident
What is POMR? Problem Oriented Medical Record Organized around the client’s problems rather than source of data: (is a comprehensive evaluation)
What are the 4 parts of the POMR? 1) data base: data collected 2) problem list: analysis of data base establishes a problem list 3) initial plan: outlines an approach to be used to meet each of the identified problems 4) progress notes: record the results of interventions/ct. progress
What is SOAP? Subjective data, Objective data, Assessment, Plan (POMR Progress Note)
Subjective data Statements client makes about problem or course of treatment Could also be family or friend statements S: “I want to stay in my room. Leave me alone.” S: “I feel like I am making better decisions.”
Objective data Gathered by observation of client’s actions or behaviors Must be stated in overt behavioral terms Does not include opinions Must only reflect behaviors that relate to the client’s problems or the initial treatment plan
Analysis (Assessment) (Based on S&O) Can indicate progression, regression, or no change in patient’s condition related to problem A: Pt. has adequate social interaction abilities and can interact with peers for sustained periods of time.
Plan (Based on A) Updates treatment plan Indicates additional info that may need to be collected Notes: specific programs intervention techniques frequency and duration when plan will be reevaluated any new goals & objectives Indicates referrals to other services
SOAP(IER) Intervention, Evaluation, Revision Intervention: Stress Management Evaluation: effectiveness of intervention Includes patient’s response to intervention Notes if goals or objectives were achieved Revision to plan R: Move from intermediate to advanced leisure skills class.
What is DARP? Data, Action, Response, Plan (Progress Note, focus replaces problem from SOAP)
D=Data Subjective and/or objective information
A=Action Description of actions taken by RT in form of interventions or programs
R=Response Client’s response to interventions Goals/objectives attained Client outcomes FIMS
P=Plan Next interventions
What is PERRLA? Pupils, Equal, Round, RL (react to light), A (accommodating) the abbreviation used when noting that an individual's eye and pupil reaction are within normal limits. Sign used to measure pupil dilation.
If eyes are not PERRLA Eyes and pupils that don't react within normal limits may be sign of many possible problems including neurological damage, eye infection, glaucoma, or the effects of certain classes of drugs.
What scale is used to measure SCI? AIS - American Spinal Injury Association Impairment Scale - has five levels of completeness (A through E) and describes the degree of motor & sensory function lost.
Levels of SCI A: Complete - No motor or sensory function is perserved in the sacral segments S4-45 B. Incomplete - Sensory but not motor function is preserved below the neurological level & includes the sacral S4-S5
Levels of SCI cont. C. Incomplete. Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.
Levels of SCI cont. D. Incomplete - Motor function is preserved below the neurological level, & at least half of key muscles below neurological level have a muscle grade of 3 or more E. Normal - Motor & sensory function is normal
Spinal Cord Cervical C1-C8 Thoracic T1-T12 Lumbar L1-L5 Sacral C2-C5 Coccyx
What scale is used to measure skin breakdown ? Braden Scale for Predicting pressure ulcer sores risk and stages of skin breakdown (decubitus ulcer) Graded on a 4 pt. scale
Why do recreational therapist need to know about pressure sores? Because inactivity, or the wrong type of activity, can cause skin integrity problems; in turn become barriers to involvement in leisure and potentially, increased disability or death.
What are risks of a skin breakdown? Inactivity, poor circulation, poor health, diminished sensations, and cognitive impairment
FIMS is a seven -level scale that helps measure performance; developed to measure outcome of rehab for SCI pt. ; Scale of 1 - 7 that measures the degree of assistance an individual requires to complete a task.
FIMS Scale 1 -Total Assistance 2- Maximal Assistance 3 - Moderate Assistance 4- Minimal Contact Assistance 5- Supervision or Set up 6 - Modified Independence 7 - Complete independence
What scale is used to assess level of coma? Glasgow Coma Scale or Children's Coma Scale (CCS) (2YRS-) - measures depth of coma for individuals who have sustained brain trauma. 3 sections: eye response, motor response & verbal response
Scoring the GCS (Glasgow Coma Scale) & CCS (Children Coma Scale) Each sub-scales are added together. 3 - 8: Severe coma 9 - 12: Moderate coma 13 - 15: Mild to absent coma To record GCS or CCS: EMV (eyes,motor,voice) with subsection score (dropped half a line) i.e. E4M4VS
What is the GAF? ranges from 1 (death) to 100 (total absence of mental or physical problems) used to describe a person's combined psychological, social, and occupational well-being. Multi-axial V.
What is the GDS ? seven-level scale used w. ct. w/ dementia; individuals in stages 1 - 4 are able to live in the community w/o assistance; GDS should only be used as a quick description of the ct. current level of functioning.
Muti-axial Assessment is a 5 category reporting system used by psychiatrist and clinical psychologist. Axis 1: Clinical disorders Axis 2: Personality disorders Axis 3: General Medical conditions Axis 4: Psychosocial & environmental problems Axis 5: GAF Score
IQ measure one's ability to take in factual information, recall events, apply reason in a logical way, manipulate concepts (numbers or words), think abstractly, analyze or summarize ideas or info, problem solve, & prioritize.
IQ description (IQ = Mental Age / Chronological Age; 10 levels) IQ Range / Classif. Below 20 or 25 - Profound ID 20-25 - 35-40 Severe ID 35-40 - 50-55 Moderate ID 50-55 - 70 Mild ID 70-79 Borderline Intelligence 80-90 Dull Normal 90 -110 Normal 110-120 Bright Normal 120-130 Superior 130-200 Very Superior
What is the MMSE ? standardized test to measure cognitive impairment; A total score of 30 pts. possible, A score below 20 usually indicates cognitive impairment.
The process to measure the quality of the theory or idea? Validity
The term that describes how well the test is written and administered? Reliability
Criterion referenced objective is to see if the student has learned the material , NCTRC
Norm - referenced identifies if test taker performs better/worst than someone else,
Psychometric measures of behaviors and thought processes
Biometric measures of organism
Clinical Evaluation: value placed on clients characteristics and willingness to change (change of behavior)
Clinical opinion: client status based on your experience
Non standardized tests No rigorous validity or reliability
Functional Data Facts on non-standardized tests that refer to skill and resources
Standardized tests Defined psychometric properties
Triangulation Checking 3 ways for validity
What is RAI? Rapid Assessment Instrument – based on research, screening tool, help people qualify for services
Signs Measure 1 thing and its norm referenced (vital signs) to tell you something is wrong
Scales Classify traits and states, measures “how much”
MMSE= Mini-Mental State Examination
GDS= Global Deterioration Scale
GAF= Global Assessment of Functioning
FIMS= Functional Independence Measure Scale
CERT= Comprehensive Evaluation of Recreation Therapy
LCM= Leisure Competency Measure
LDB= Leisure Diagnostic Battery
IALB= Idyll Arbor Leisure Battery
Created by: oteroadaniel
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