Debbie Rivera

Nancy Perla
Jennifer Santizo

Assessment Analysis Assignment- CERT PSYCH R

History of assessment

Comprehensive Evaluation in Recreational Therapy- Psych/ Behavioral Revised, by authors

Robert A. Parker, Curtis H. Ellison, Thomas F. Kirby, and M.J Short, MD, is by far the most useful and

practical assessment tool in rehabilitation settings.The Therapeutic Recreation Journal first published the

CERT -Psych/ R in 1975 and demonstrated initial validity and reliability data. At first the CERT- Psych

was outlined to only be used for a short time. The scale was first created at Pickens Hospital, where

clients typically stay no longer than 11 days. Therapists observe the clients attitudes and if it is in any way

related to recreational activity.

Primary purpose

The primary purpose of Comprehensive Evaluation in Recreational Therapy – Psych/ Behavior,

revised is to identify, define, and evaluate the client’s social behaviors. General, Individual and Group

Performances are the three main assessment measures. The measurable outcomes in using this assessment

is that it provides a very practical way to decide the course of action regarding a client’s intervention.

During the process of this therapy the assessment score sheet measures if the client skills are expanding or

worsening. Therapists take about 20 minutes to evaluate 15 to 20 clients who have all participated in the

same activity. The main goal of the scale is to provide feedback of client’s progression. This assessment is

taken in a critical stage to decide the most suitable treatment goal. For the most part, clients are evaluated

regularly to document the amount of change. This assessment is one of the most widely used assessment

tools in the field of Recreation Therapy.

Primary population and how to administer the assessment

 The CERT-Psych/R was created for clients with the development age of ten years or older, and

works well with the psychiatric and rehabilitation community. It is also recommended for the use of

individuals with a Rancho Los Amigos level of 5 and above and reality orientation level of severe and

above. In order to administer the CERT, the therapist will have to observe the client in various leisure

activities and fill out the CERT-Psych/R from #A116. Due to the main purpose of CERT, to evaluate a

client’s social interaction ability, the therapist will benefit most when conducting group activities. Group

activities will also allow the therapist to evaluate more than one client at a time. The assessment form will

require about twenty minutes to assess approximately fifteen to twenty clients, all of which will have been

in the same group activity.

The CERT-Psych/R has associated twenty-five behaviors that are categorized in three main

domains of a client’s performance, General, Individual, and Group Performance. The general category has

five behaviors such as, attendance, appearance, attitude toward recreational therapy, coordination, and

posture. Individual Performance is composed of ten behaviors, responses to therapist’s structure: one to

one, decision making ability, judgement ability, ability to form individual relationships, expression of

hostility, performance in organized activities, performance in free activities, attention span, frustration

tolerance level, and strength/ endurance. Lastly, ten behaviors are on Group Performance, memory of group

activities, response to group structure, leadership ability in groups, group conversation, sexual role in group,

style of group interaction, and handling conflict in group when indirectly involved. The ranking scale goes

from zero to four, zero being acceptable behavior and four indicates there is a severe problem presented.

All twenty-five behaviors are marked with a number and later the therapist adds the overall score from all

three categories which takes little time to score. Scores range from as small as zero to as high as one

hundred. The Adyll Arbor, Inc version has been designed to be used up to ten times for each client.

How assessment is analyzed and scored

Starting off with the general category, which is information on the client’s general lifestyle,

attendance. Attendance gives indications on how the client manages responsibility when following these
norms. Appearance gives information on how the client cares for themselves. If a person is disheveled it

could be a sign that the person may not care about their lifestyle or may be too depressed to keep up with

self-care grooming. For attitude towards recreational therapy category, it gives an indication to the

client’s adaptability to whether circumstances may be problematic for his/her coping skills. A client could

dislike recreation therapy because they feel as if they are endangered, or the complete opposite, they like

recreation therapy because it may be the only thing they are good at. Posture category reflects the client’s

attitude and feelings, this gives an indication on how the client might behave during intervention or

during the moment.

The categories in individual and group performance have been separated because of the different

behaviors clients display in one-to-one and group settings. Having these two categories separated can give

a more accurate representation of the client’s performances. Beginning with individual performance,

response to therapist’s structure, using one-to-one therapy, can indicate how well a client responds to just

the therapist and what type of therapy is suitable for the individual. Decision-making ability is vital

because it looks at the process of deciding if they are capable to make their own decisions, if the client is

unable to make decisions then the therapist then needs to address the problem on why they can’t make

decisions independently. Judgement ability looks at the quality of a decision, for instance how the client

utilizes their decisions in order to succeed within a society. Ability to form individual relationships

indicates the performance of a client in social settings, this observation is done usually over a three-day

period for the client to adjust to an unfamiliar setting. Expression of hostility reflects how the person

handles anger, this can be in attitudes such as isolating self or overexpressing his/herself, this gives

indications as to types and attitude to therapy. Performance in organized activities indicates whether an

individual can handle working in organized or unorganized activities. If an individual is incapable of

working in an unorganized activity it indicates that the individual may not be able to perform

independently and needs routine or structure in order to function. Performance in free activities is an

indicator to the client’s autonomy and how sure they are of his/her own resources. Attention span is an
indicator on the client’s ability to direct him/herself to a task, in addition to being able to sustain

interactions during the task. Problems in this area may signify struggle, boredom, concern, or

misperception. Frustration tolerance level indicates how a client endures a situation and what type of

impulse control they have. Strength and endurance indicate the type of behavior the client conveys

through with activities of daily living, for instance if a client is depressed, they may not have the strength

to get out of bed.

In group performance categories, memory for group activities indicates how well the client can

remember from one day to the next, it reveals how the client functions at his/her job or home as well as an

indicator of confusion and how well the client memories things. Response to group structure reflects

whether a client can relate to a group and follow group instructions in addition to how they respond to

authority. Leadership ability in groups or absence of it tells the therapist about the client’s lifestyle and his

or her problem, if they are a leader or not what are the reasonings behind this title. Group conversations

identifies self-expression problems and identifies whether feelings are expressed internally or externally,

the client should be given time to accommodate before this behavior can be evaluated adequality. Sexual

role in the group indicates how the client expresses his or her sexuality and how it fits into the rest of

society, inappropriate or appropriate sexual behavior, proper expression of sexuality is vital. Style of

group interaction is measured based on an inward or outward scale and tells how the client interacts in a

group which can indicate about their standard of living in group situations. Handling conflict in group

settings when indirectly involved shows the client’s understanding of his/her personal boundaries,

capability to differentiate between self and others, and composure in dealing with unpleasant situations.

Competition in group replicates what a person will do to get their desired need, the therapist determines

how appropriate the client’s competitive behavior is during the moment. Lastly, attitude towards group

decisions mirrors a client’s attitude towards group decisions and whether they can follow a decision made

by the group, this can indicate how the client responds in community or family decision making.
 The rating scales allows for the therapist to use it as an initial assessment and progress notes since

it is focused on observing the client’s behavior during intervention, thus creating more time for the

therapist to write adequate detailed notes.

Where to obtain the assessment

You can purchase this assessment online at the Idyll Arbor Incorporation which is both a

publishing house and a consulting firm, known as a company that carries practical products in which

professionals can use in his/her daily practice. Online research also offers other resources and information

about the assessment. The Assessment Tools for Recreational Therapy and Related fields by Thomas M

Blaschko and Joan Burlingame as well includes a sample copy of the assessment and detailed

information.

References

Burlingame, J., & Blaschko, T. M. (1991). Assessment Tools for Recreational Therapy. Seattle, Wash:

Frontier Pub.