A RESEARCH APPROACH TO THE REDESIGN OF A TR ASSESSMENT
PROCESS
Adrienne Gilbert, MA
Leeann Ferries, RN, BA
University of Waterloo Waterloo, Ontario, Canada
Homewood Health Centre Guelph, Ontario, Canada
Bryan Smale, PhD
Laurene Rehman, MA
University of Waterloo Waterloo, Ontario, Canada
University of Waterloo Waterloo, Ontario, Canada
Introduction
The assessment process is the cornerstone of all therapeutic recreation (TR) programs. The perfect
process puts the client's needs first while fulfilling the requirements of all of the other stakeholders at the
same time (i.e., practitioner, agency, treatment team, caregivers, TR professionals). Assessment and research
have often been viewed as two separate processes, but the purpose of each is arguably similar. Even though
the uses of the accumulated information may vary between the two, each process purports to ask incisive
questions that generate valid information that can ultimately be used to take action.
This paper describes the assessment process in the eating disorders program at the Homewood Health
Centre in Guelph, Ontario, and how it is evolving through a partnership between Homewood and the
Department of Recreation and Leisure Studies at the University of Waterloo. In particular, the recognition of
leisure as an integral component to the process is described, as well as the ways in which both quantitative
and qualitative data gathered during the initial (i.e., entry) and discharge assessments serve to better
understand the nature of each individual's experience with an eating disorder and how leisure helps in the
recovery process.
A Brief Overview of Eating Disorders
Eating disorders are not merely about food and weight. They are the result of an attempt to use food
intake and weight manipulation as a means of coping with psychological, familial,
and/or social distress in one's life within a culture that is obsessed with thinness.
Two general types of eating disorder can be distinguished. Anorexia Nervosa can be defined as a
syndrome involving self-starvation to avoid becoming "fat". There is a refusal to maintain body weight at or
above minimal normal weight for age and height (85% or less than expected). It is most often accompanied
by an intense fear of weight gain and a distorted body image. There exists an obsession with one's
appearance and food. Bulimia Nervosa consists of constant changes in weight with recurring episodes of
binge eating (large amount of food in discrete time with loss of control) followed by self-induced vomiting
or purging with laxatives, diuretics, compulsive exercise and/or periods of fasting. These two destructive and
potentially fatal eating disorders represent the extremes on a continuum of unhealthy weight and size
preoccupation in today's society. In Canada, 1% of all women have Anorexia Nervosa and 2% to 4% have
Bulimia Nervosa. In Ontario this translates to 80,000 women.
When exploring the causes of eating disorders, it is essential to recognize that eating disorders are
brought about by a multitude of precipitating factors. For example, low self-esteem; fear of
maturity/separation; loss of control; lack of identity; physical, emotional and/or sexual abuse; an enmeshed
family relationship; peer factors; and difficulty expressing emotions in a direct manner, are all factors that
may result in the emergence of an eating disorder. However, it is not typically the presence of just one
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precipitating factor that may lead to an eating disorder. Indeed, many women today face these factors and
are repeatedly subjected to society's image of the ideal body, yet they do not go on to develop eating
disorders. It is how the individual responds to his or her environment that determines whether or not that
person will develop an eating disorder.
Figure 1 summarizes the etiology and progression of eating disorders. Three principal types of factors
exist that predispose an individual to the development of an eating disorder. When exposed to a precipitating
event, such as a stressful life event, and there are also deficits in the individual's ability to cope effectively,
he or she may attempt to manage the situation by engaging in eating disorder behaviors. The individual uses
food intake and weight control to solve the emotional conflicts. Then, several other factors serve to
perpetuate the maladaptive thoughts and behaviors, and these ultimately result in some type of perceived
secondary gain. The dividends or secondary gains, whether they are a sense of control, power over others,
and/or the means of defining identity or uniqueness, serve to reinforce the eating disorder as an effective
coping strategy. Consequently, a critical step is to explore the adaptive context of eating disorders with
individuals in order to assist them in discovering healthier ways of meeting their needs and increasing their
awareness of the underlying issues that perpetuate the eating disorder.
Figure 1
Etiologic Factors of Eating Disorders
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The Eating Disorders Program at Homewood Health Centre
The eating disorders program of Homewood Health Centre, Guelph, Ontario is the largest inpatient
treatment unit in Canada with 18 beds dedicated to the treatment of both females and males, aged 16 and up,
who have been diagnosed with anorexia or bulimia. The program uses a multidisciplinary treatment milieu
to help patients achieve the following goals:
•
to restore healthy attitudes and eating habits
•
to learn about proper nutrition, exercise and other aspects of eating disorders,
•
to cope with emotional difficulties without self-defeating food and weight manipulation,
•
to increase self-awareness, and
•
to explore and participate in the development of healthier coping techniques.
The Homewood Eating Disorders Program advocates a client-centred approach to healing by
integrating emotional, spiritual, physical, sexual and social components of well-being within a holistic
treatment process. Recovery from an eating disorder involves three core processes -those of healing,
education and socio-political change.
Adjustment to an Eating Disorder
People with eating disorders will find themselves, at some point, in crisis due to the maladaptiveness
of their behaviors. It is helpful to explore the "Adjustment to a Crisis" model (Luckmann & Sorensen, 1980)
to understand this phenomenon and what impact it can have on their participation in the recovery process.
If they are overtly displaying signs of unhealthy behavior, and receive this feedback from outside
sources (e.g., peers, parents, partner, and/or health professional), they may experience shock, anger, fear and
guilt which in turn leads to a defensive retreat. When they experience denial, this further perpetuates the
eating disorder behavior, thereby immobilizing their adjustment process. If they are able to continue with
acknowledgment and a willingness to change, they can voluntarily elect to begin treatment.
Acknowledgment is essential to help work through any feelings of ambivalence. This is where reviewing the
adaptive and maladaptive context of eating disorders is crucial. They continue to learn healthier coping
techniques and manage their environment more effectively so that growth and change can occur. Individuals
may move back and forth between these phases based on their recovery work and willingness to explore and
work through underlying issues. There are extra challenges when they are still experiencing denial and have
little insight into the severity of their illness. It is critical to have a willingness to change and be an active
participant in the treatment process. Family members also experience these phases of adjustment and may
find themselves moving through the phases at times that are different from the client's progression.
The Leisure Assessment Process in the Eating Disorders Program
Assessment is a critical component of recreation therapy and mental health, and certainly within the
Homewood's Eating Disorders program. It is helpful to explore all the resources that are available to
generate the information that will identify patient/client needs, even if it means creating your own
assessment tool. As the knowledge base about the client population increases, one has a better sense of the
appropriate questions to include in the assessment in order to generate the necessary information, and
thereby enable collaborative goal setting. At Homewood, an original assessment tool had to be designed and
incorporated with the available standardized assessments in order to meet the unique needs of people with
eating disorders. With the development of any new instrument, one also has to be prepared to review the
suitability and practicality of the tool, and be prepared to make any necessary revisions. Many people are
hesitant to evaluate, explore, and develop assessments due to the time commitment involved, and that is why
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it is crucial to find or design a tool that is both client and practitioner friendly. There is a wealth of
information available, however it is up to the practitioner to determine how he or she is going to access it.
Individuals with eating disorders have special needs especially within the area of leisure. It became
apparent during this process that the existing assessments did not adequately reflect these needs, and
consequently, the ability of the team to set appropriate treatment goals was compromised. By exploring the
history of their leisure pursuits, the nature of the impact that an eating disorder has had on their leisure
lifestyle can be better determined. An individual's leisure lifestyle is increasingly neglected, especially when
the symptoms of an eating disorder increase, because the eating disorder becomes the primary focus in the
person's life. A preoccupation with food and weight ensues, and leisure time may be replaced with counting
calories, restricting food intake, bingeing and purging, isolating oneself, focusing on weight and body image,
and often, compulsive exercise. In addition, the presence of particular personality traits in people with
anorexia and bulimia (e.g., perfectionism and high need for achievement; competitiveness; eagerness to
please; low tolerance to anxiety; difficulty with decision making; responsible to others; obsessivecompulsiveness; all or none thinking) can have an impact on their concept of leisure and ultimately on their
development of a healthy leisure lifestyle.
By virtue of being in the protective setting of the treatment program and through the initiation of
healthier coping techniques, leisure time becomes increasingly available to the program participants. As the
healthier coping strategies develop, the eating disorder symptomatology begins to decrease and then leisure
education becomes of vital importance. A healthy leisure lifestyle is an essential component of the recovery
process and aids in the prevention of relapse.
When the individual feels at risk (e.g., strong emotions, uncomfortable situations), leisure activities
can assist him or her to refrain from previously employed maladaptive coping
strategies. Leisure activities assist in the delay of, distraction from, and coping with the urges to re-engage in
eating disorder behavior. In a broader context, a healthy leisure lifestyle is encouraged because it provides many
benefits that lead to overall well-being. The types of benefits incurred include the following:
•
self-determination
•
autonomy
•
control over decisions
•
freedom of choice
•
intrinsic motivation
•
increased self-esteem
•
increased self-fulfilment
•
uniquely individual
•
chosen for its own sake
Leisure empowers the individual in all areas of life, especially in recovery. The development of a healthy
leisure lifestyle serves to replace the lack of structure, the boredom, and the loneliness which may act as triggers
for many individuals with eating disorders.
An activity that is typically associated with an eating disorder is excessive exercise, but it is unclear to
what extent. The role of exercise as it relates to the eating disorder needs to be better understood. The frequency,
intensity, duration, and purpose of exercise are essential components to include in the assessment process. For
example, determining that the patient exercises 3 hours a day, 7 days a week is useful information, but on its
own, it does not begin to explain the reasoning behind it. Information related to the role of exercise is necessary
in order to prepare treatment goals because people with eating disorders exercise for a variety of reasons.
Individuals with anorexia may exercise:
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•
•
•
•
•
•
•
as a means of allowing themselves to eat and then to burn calories;
to avoid, or as a way to deal with, feelings of anxiety, fear, guilt, etc.
despite having other obligations and/or other factors to deal with (e.g., time, energy, weather)
compulsively, and are preoccupied with exercise and will not miss an opportunity to do so
to form an identity (one dimensional)
very secretively; and/or
to cope with and change a negative body image
Individuals with bulimia may exercise:
•
as a means of weight loss (i.e., as a form of purging to undo the effects of a binge)
•
to deal with fear and anxiety;
•
to punish themselves for being "bad"; and/or
•
less compulsively than individuals with anorexia and may even create opportunities to miss it.
By understanding the individual's exercise profile, it becomes clearer how to begin to manage his or
her maladaptive behavior (Prussin, 1992). The individual has to temporarily refrain from the behavior and
develop a greater awareness of how exercise relates to his or her eating disorder until it is no longer used as
an unhealthy coping technique. Hence, education around exercise, healthy leisure lifestyle choices, and
effective coping techniques is of paramount importance.
Assessment and Research
The development of assessment procedures and decisions about information needed for the
assessment process in any agency should be an ongoing process and ultimately should be designed based on
what approach best meets the needs of the client group. The experience of the Recreation Therapist at the
Homewood Health Centre certainly demonstrates how the content of the assessment has changed as her role
evolved and knowledge about the needs of the client group became clearer.
Dunn (1984) defines assessment as "a systematic procedure for gathering select information about an
individual for the purpose of making decisions regarding that individual's program or treatment plan"
(p.268). Many factors are considered in determining the type and depth of information required for an
assessment. The most important factor is the needs of the client; then, the needs of the agency, practitioner,
caregivers, and TR profession are considered. "The key element... is the ability to accurately assess leisure
interests and needs as well as identify leisure deficits and strengths to facilitate freedom, choice, opportunity
and intrinsic motivation" (Olsson, Shearer, & Halberg, 1988, p. 35).
Burlingame and Blaschko (1997) suggest that the best assessments have the positive attributes both
from clinical practice and from those designed for research purposes. However, it should be acknowledged
that it is often difficult to develop assessments that meet the needs of both clinical practice and research
because the goals for generating information may be different. This has been evident throughout the
partnership between the University of Waterloo and the Homewood Health Centre - the research team
examined the initial assessment form through a different "set of glasses". The initial assessment form
included both open-ended and closed-ended questions that provided basic demographic information,
previous and current leisure participation patterns, descriptions of the social context within which leisure
occurred, patterns of exercise behavior and attitudes, and measures of leisure motivation and leisure
satisfaction. It is administered both upon entry to the program and upon discharge with the intention of
examining change. The research team undertook a review of the form and began the process of coding and
analyzing the quantitative and qualitative data generated. From this process, the research team made some
preliminary recommendations to the recreation therapist on the assessment process and the way in which the
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data were treated.
The researchers suggested a modified assessment process whereby the initial assessment was selfadministered and focused on easily quantifiable data. It was designed primarily to get background
information. The recreation therapist would then follow up by interviewing the patient to confirm some of
the information obtained on the self-administered assessment and also to request more qualitative
information. While this would be the ideal from a research perspective, time constraints on the recreation
therapist do not allow for a full interview with the patient. Therefore, the team decided to develop a separate
self-administered, open-ended questionnaire that would provide qualitative, individualized information
about each patient's personal experience. Essentially, the researchers were able to determine that the
qualitative data provided the essence of the assessment for individuals in the client group while the
quantitative data provided an effective means of monitoring change in the group in the treatment program.
Falling from the broader changes noted above, some of the specific recommendations made were: (1)
the development of a new activities participation form which would provide a broader array of activities,
specific favorites, the frequency of participation in each, and a simple classification of activities into broader
interest categories, thereby providing a closer look into the leisure repertoire of the individuals; (2) a reordering of the questions both on the initial self-administered part and on the follow up interview because
the timing and presentation of some of the qualitative questions after some of the quantitative ones may
influence responses; and (3) reducing the number of items on both the leisure motivation and the leisure
satisfaction scales used in the initial assessment and discharge assessment in order to reduce problems due to
respondent recall, particularly for those patients who are shorter term. However, even before these changes
may be implemented, a number of instructive results - both in terms of the assessment process and for the
treatment program itself- emerged from the analyses of both the quantitative and the qualitative data.
Quantitative Data Issues and Findings
The processes of assessment and of social-psychological research have both typically relied on the
collection and analysis of quantitative data to answer questions about the characteristics
and behavioral patterns of groups of individuals. Practitioners want to know who their clients are and what
they are like in order to provide them with appropriate treatment programs and to evaluate their progress.
They also want to know if their treatment programs are effective for the target groups and in what ways.
Quantitative data and the statistical indicators they generate are most suited to describing groups in this way
and also for individuals if the data are gathered over time.
With respect to the current project, some of the basic findings about the participants in the eating
disorders treatment program at Homewood are shown in Tables 1 and 2. On average, the individuals were
just under 18 years of age when the eating disorder began, and now, as participants in the program, they
averaged just under 28 years of age - almost 10 years with the disorder (see Table 1). All the participants
were well-educated and were typically students or working full-time (see Table 2), and for the most part,
there were few real differences between those individuals diagnosed with anorexia and those with bulimia.
These data provide an overview of the types of individuals with whom the practitioner is most likely to work
and help to identify those individuals who fall outside of the general profile and may therefore need special
consideration.
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Group
Anorexia
Bulimia
Overall
Table 1
Present Age and Age at Onset for Individuals with Anorexia and Bulimia
Age at Onset
Present Age
n
Mean
Std.dev.
n
Mean
48
18.4
7.7
50
26.5
41
17.3
5.8
41
28.9
89
27.5
17.9
6.9
91
Std.dev.
9.9
9.3
9.7
Table 2
Level of Education and Vocation of Individuals with Anorexia and Bulimia
Bulimia
Overall
Pct.
Pct.
n
n
n
Anorexia
Characteristic
Education level
High school
College
University
Post graduate
Vocation
Student
Working full-time
Working part-time
Not working
Work in home
23
7
13
7
46.0
14.0
26.0
14.0
19
9
10
3
46.3
22.0
24.4
28
15
1
4
2
56.0
30.0
13
22
1
5
0
31.7
53.7
2.0
8.0
4.0
7.3
2.4
12.2
0.0
Pct.
42
16
23
10
46.3
17.6
25.3
11.0
41
37
2
9
2
45.1
40.7
2.2
9.9
2.2
When initial, mid-point, and discharge assessments are done, they are very much like the pre and posttests associated with quasi-experimental research. Consequently, the assessments should adhere to the same
principles used in the design and administration of the questionnaires used in classic pre and post-test studies. In
this way, an effective examination of change in selected characteristics of the participants can be done with the
confidence that no other factors contributed to any measurable change other than the treatment that was provided
between the entry (pre-test) assessment and the discharge (post-test) assessment. Hence, in order to track changes
in the group over time, the same characteristics must be measured at each assessment.
This is, in effect, what was done at Homewood. Of the 91 individuals who completed entry assessments,
29 also completed discharge assessments upon completion of the treatment, program. Both forms included
measures of leisure motivation (comprised of four underlying dimensions) and leisure satisfaction (comprised of
six underlying dimensions), and the average scores on the measures were calculated for both points in time. As
can be seen in Figures 2 and 3, several of the underlying dimensions showed significant, positive changes for the
group as a whole. These changes suggest that the leisure component of the treatment program had, indeed, made
an important contribution to the recovery of the participants, and in areas previously lacking due to their eating
disorder.
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Figure 2
Change in Mean Score on Components of Leisure Motivation Scale
Figure 3
Change in Mean Score on Components of Leisure Satisfaction Scale
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As with all statistical indicators, the results report overall, group averages and these results are not
necessarily true for every individual. With repeated assessments over a period of time, each participant's progress
can be monitored for individual patterns and how these compare to the group as a whole. Then, individualized
needs for the program may be more readily seen and understood, so that adaptations could be incorporated.
There are some specific concerns that may arise when using this approach. First, because data are needed
from both the initial and the discharge assessments (as well as any other follow-up or intermediate
assessments), analyses of the final data will not include those individuals who do not complete the program,
drop out early, or simply decline to participate in any subsequent assessments. Consequently, the results
must be interpreted with this limitation in mind; that is, they do not necessarily represent all of the program's
participants. Second, it may not always be appropriate to use the same instrument to measure, for example,
psycho-social indicators such as leisure satisfaction and motivation, because it is necessary to avoid
participant recall from one assessment to the next. One way to ensure this is through the use of "equivalent
forms" - scales which measure the same concept, but are based on a different set of items. Finally, in the
case of individuals in an eating disorders treatment program, additional psycho-social indicators directly
related to the participants' experiences might also be useful to include, such as measures of self-esteem, egodevelopment, and body image.
Qualitative Data Issues and Findings
With such an emphasis in the past on quantifying the results of programs, the presence of qualitative
data can often prove troubling to practitioners unfamiliar with recently emerging strategies for their analysis.
Concerns arise about what to do with the words, phrases, and slogans that result from interviews and openended questions on self-administered surveys. Yet, throughout the process of this project, it was clear that
the qualitative data helped to provide a better sense of each individual's unique experience with his or her
eating disorder. When a treatment program is client-centred, such insights into individual needs are perhaps
the most valuable contributions that qualitative data can provide. In this section, some of the benefits of
utilizing qualitative data are described using direct examples from the assessment process, the problems that
arose during the process are examined, and finally, suggestions for a revised qualitative research tool are
outlined.
The Benefits of Qualitative Data
Henderson (1991) and Patton (1990) have documented the benefits of qualitative research both in terms
of obtaining a richer understanding of the research topic and in its utility for evaluating programs, and these were
just two of the benefits that could be found within this study. The qualitative data supplemented the quantitative
information, and indeed, provided a more complete picture of each individual. Among the benefits that were
realized from looking closely at the qualitative data were participant-defined data and clarifying words and
phrases. These are described below.
Participant-defined data essentially means having the participants describe in their own words what terms
such as "leisure" and "fitness" mean to them. The self-defined meanings described by the participants provided
more detailed information that would not otherwise have been obtained
through the use of quantitative measures alone. This level of detail revealed those aspects of, for example, the
terms "leisure" and "fitness", that showed similarities between the participants' meanings as well as their
individual differences. For example, many of the participants regarded "relaxation" and "time for one's self to be
important parts of leisure, and "exercising" and "losing weight" were closely associated with fitness. Such
overlaps in responses by participants provided verification that many of them had similar views of leisure and
fitness. At the same time, there were a number of specific differences among participants. For example, in the
definitions of leisure, a few participants talked about "activities" as being the most important aspects of leisure,
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while others emphasized "relaxation" or "rest" as most important, In terms of the fitness definitions, although
many of the participants related fitness to exercise, there were also a few participants who tied fitness to being
"strong" and "healthy". These subtle distinctions can readily assist in the development of more appropriate,
individualized treatment programs.
A second major benefit of including qualitative data is that it provides clarifying words and phrases on
the assessment form. For example, a question asking participants to indicate what barriers to leisure time they
perceived also provided space for their comments. On almost every form the participants outlined exactly how
each barrier actually influenced them. The researchers could then understand not only which barriers affected
participants, but also how they were affected by them. One barrier that was highlighted by the participants on
both the entry and discharge assessment forms was "decision making". They frequently commented on the
problems that they had making decisions and on their need to rely upon support networks for assistance. The
researchers would not have fully understood the nature of this barrier or the importance of social support if the
qualitative data had not been included.
The inclusion of qualitative data of these types in the research process also provided an additional benefit
associated with the impacts of the treatment program. As noted in the previous section, overall changes in
components of both leisure motivation and satisfaction were revealed, but those measures do not explain where
the changes were rooted for the individual participants. By examining the participant-defined definitions of
"leisure" and "fitness", the researchers noted notable changes in the participants' views of these concepts. They
no longer commented as often on the need to lose weight or to exercise when describing "fitness", but instead
adopted a more holistic view that included the need to "enjoy oneself", "not push one's self", and "to feel better".
Their definitions of "leisure" did not change as much; however, they did place greater emphasis on "time with
friends and family" than they had on their entry assessments. Once again, the inclusion of the qualitative data
provided insights into the impacts of the participants' experiences with eating disorders that went well beyond the
information derived solely from the quantitative measures.
Areas for Improvement within the Qualitative Data
As with any research process, modifications to the ways in which data are collected and organized are
inevitable and necessary. This section, therefore, contains some of the suggested improvements that could be
made and describes a modified questionnaire for the collection of qualitative data in the assessment process.
Apart from ensuring that any assessment form is well laid out, easy to complete, and focuses on relevant
issues, there were a couple of specific suggestions that arose during this process. First, participants should
periodically be asked if there were any questions that they might not have entirely understood. Often, nonresponse to open-ended questions may be attributed to the lack of clarity in what information is being requested,
so re-wording may be necessary. Second, the order in which the questions appeared on the assessment form may
have influenced how the respondents answered them. For example, an open-ended question on the meaning of
fitness to the participants was placed immediately after a series of questions concerning the positive and negative
aspects of exercise. The introduction of these ideas about exercise may have predisposed the participants to draw
on them as they described their feelings about fitness.
The few open-ended questions included on the original assessment form revealed the potential that
qualitative responses gathered during the assessment process provided many more insights into the experience of
the individuals than had originally been anticipated. By including a broader array of questions soliciting
reflective, qualitative responses from the participants, the assessment can be enriched even more. To that end - as
well as to help avoid some other concerns - an example of an alternative set of questions to gather qualitative
data is provided in Figure 4. If the questionnaire must be self-administered when personal interviews are not
possible, participants should be encouraged to provide complete responses to the questions.
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Figure 4
An Example of a Modified Self-Administered Questionnaire for Collecting Qualitative Data on Leisure and Fitness
The following questions are about your participation in leisure and fitness. The information will be used to better
understand your present leisure and fitness activities. Please read each question carefully and respond in the space
provided.
1)
What does leisure mean to you?
2)
How has your leisure changed over the last few months (e.g., the activities you do; the people you spend time
with; where you go)?
3)
Which of the following barriers do you face in your leisure? Please check the box beside those barriers that you
experience and explain how each one affects your leisure.
Barrier to leisure:
[]
poor health/physical functioning
[]
poor motivational levels
[]
inadequate leisure knowledge
[]
inadequate skill level
[]
lack of transportation
[]
financial constraints
[]
poor time management skills
[]
lack of social support
[]
inadequate decision making skills
[]
other barriers? Please specify:
__________________________
4)
What does fitness mean to you?
5)
What are your goals for this program?
6)
What are your goals for when you leave the program?
If yes, how does it affect your leisure?
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in a manner which competes with or substitutes for the distribution of the database by the Leisure Information Network (LIN). http://www.lin.ca
Recommendations for Recreation Practitioners
All recreation therapists should routinely examine their assessment process to determine if it is still
meeting the clients' needs, agency needs, therapist's needs, and the needs of other stakeholders such as
caregivers. In particular, the population with which practitioners work should be carefully examined and
ensure that the assessment process includes aspects of the psychological and/or behavioral characteristics of
the clients.
All practitioners should ask themselves what happens to the information after it has been collected
during the assessment process. Is it filed, charted, presented to the team, reviewed with patients, discussed
with family, and/or used to set goals and objectives? Take a close look at what information is actually being
gathered, then consider this question: how much of the information is actually being used and how much of
it is just "nice to know"?
Assessment forms should be carefully examined to determine if there are gaps in the information
gathered. Indicators that there are problems with an assessment process include: (1) questions that are not
completed by a significant proportion of the participants; (2) participants' inability to answer or understand
any of the questions; and (3) a lack of real action taken based on the information obtained by the assessment.
To help in identifying these and other problems, practitioners should always empower the clients to be a part
of the assessment process whenever possible. Through their involvement, innovative approaches to
gathering information from clients, such as journal writing, may result.
Conclusions
Essentially, the assessment process should be designed to meet the needs of the client, provide
guidelines for the development of program goals and objectives, and serve as a basis for evaluation of
achievement of the client's objectives. The findings based on the quantitative data have demonstrated the
importance of including both entry and discharge assessments in order to determine the efficacy of the
therapeutic recreation program. Clearly, the additional data gathered at two points in time produced much
more information about the effect of the program than would simple discharge summaries.
Practitioners have access to a large amount of information about specific client groups and by
including a research perspective into the process of compiling, organizing, and analyzing that data, they can
contribute a great deal to the therapeutic recreation profession. Practitioners need not do this alone; indeed,
there are other people, often within their facility, who are able to collaborate and assist in setting up and
administering the research process.
The partnership between Homewood Health Centre and the University of Waterloo has been a
tremendous learning experience for everyone involved. We found that our interests were not exclusive, but
in fact very mutual. With time and considerable brainstorming, we feel we have made some changes that
fulfill the needs of both clinicians and researchers.
Appropriate Use of Documents: Documents may be downloaded or printed (single copy only). You are free to edit the documents you download
and use them for your own projects, but you should show your appreciation by providing credit to the originator of the document. You must not sell the
document or make a profit from reproducing it. You must not copy, extract, summarize or distribute downloaded documents outside of your own organization
in a manner which competes with or substitutes for the distribution of the database by the Leisure Information Network (LIN). http://www.lin.ca
References
burlingame, J., & Blaschko, T. (1997). Assessment tools for recreational therapy (2nd ed.) Ravensdale, WA:
Idyll Arbor.
Dunn, J. (1984) Assessment. In C.A. Peterson & S.L. Gunn (Eds.). Therapeutic recreation program design:
Principles and procedures (2nd ed., pp. 267-318). Englewood Cliffs, NJ: Prentice-Hall.
Henderson, KA. (1991). Dimensions of choice: A qualitative approach to recreation, parks, and leisure
research. Stage College, PA: Venture.
Luckmann, J., & Sorenson, K.(Eds.). (1980). Medical-surgical nursing: A psychophysiologic approach (2nd
ed). Philadelphia: WB Saunders.
Olsson, R.H., Shearer, T.W., & Halberg, K.J. (1988). The effectiveness of a computerized leisure assessment
system for individuals with spinal cord injuries. Journal of Expanding Horizons in Therapeutic
Recreation. 3 (3), 35-40.
Patton, M.Q. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage.
Prussin, R. (1992). How to understand and manage exercise addiction: Hooked on exercise. New York:
Simon and Schuster.
Appropriate Use of Documents: Documents may be downloaded or printed (single copy only). You are free to edit the documents you download
and use them for your own projects, but you should show your appreciation by providing credit to the originator of the document. You must not sell the
document or make a profit from reproducing it. You must not copy, extract, summarize or distribute downloaded documents outside of your own organization
in a manner which competes with or substitutes for the distribution of the database by the Leisure Information Network (LIN). http://www.lin.ca