Leisure/Recreation Assessment

I. IDENTIFYING INFORMATION
Name: I****** S****
Admit Date: 03/06/2015
Age:15
Diagnosis:
Major Depressive Disorder
Anxiety, Unspecified
Emerging Borderline Traits
Interview/Observation:
Appearance:
well groomed
Behavior Description:
Student was compliant and displayed a cooperative behavior in
completing assessment.
II. CURRENT
AFFECT
* Bright/congruent
MOOD
* Cheerful/Friendly
* Cooperative
MENTAL STATUS
* Oriented X4
ACTIVITY CAPABILITY
* No Limitations
LEVEL OF ACTIVITY
* Very Active- Physical

RELATIONSHIPS
*
*
*
*

Is able to accept others

Seeks out companionship
Wants to help others
Reacts well to competition

PRECAUTIONS/LIMITATIONS
* dysautonomia
III. RESOURCES (Perceived personal assessment of resources, economic
resources, community resources, etc.)
Student stated that she has the proper resources in order to participate
in her leisure/recreation activities. For the past 5 years, parents would
drive long distances to take her to soccer tournaments every weekend.
Student attends a liberal arts school.
IV. RECREATIONAL/LEISURE INTEREST AND EXPERIENCE INVENTORY
Sports:
Soccer
Football
Volleyball
Gymnastics
Swimming
Jogging
Bowling
Ice Skating
Roller Skating
Outdoor/Adventure/Nature Activities:
Bicycling
Scuba diving
Snorkeling
Hang Gliding
Hiking
Sunbathing
Skiing
Snowmobiling
Surfing
Water skiing
Observing nature
Going for a walk

Camping
Playing in the park
Music/Dance/Drama/Literature:
Dancing
Singing
Listening to music
Reading books
Going to plays/concerts
Visiting museums
Debating issues
Arts/Crafts/Cooking:
Cooking
Painting
Drawing
Ceramics
Pottery
Social Activities/Travel/Hobbies:
Exercising
Boardgames
Visiting friends
Gambling
Attend large social functions or parties
Traveling
Sightseeing
Card games
Playing with kids
Gardening
Environmental groups
Visiting on the phone
Strengths:
Physically strong
Honest
Can handle situations well when girls will test her
Good friend
Caring
Nice
Summary: Leisure/Recreational Profile:
Student expressed the most interest in physical/active activities.
Student enjoys playing soccer and has been on a league for the past 5
years. Student expressed excitement for being on the NH soccer team.

Student is interested in playing and being creative. Student expressed

a high interest for the high ropes course and is open to try new things.
V. LIFESTYLE CHANGES NEEDED
Unhealthy Leisure Values (drugs, crime, etc.) :
Student stated that she has abused substances (weed) and alcohol.
Student also has a history of self harm and isolating. Student
expressed the need of approval from older guys and had a hard time
saying no.
Emotional Needs (self-esteem, impulse control, anxiety, etc.):
Student does not have a preference on group size and student does
prefer to do active activities. Student stated that active activities are
good for her when she dissociates because she tends to do that when
she is not active. Student stated the enjoyment she has in
interactions.
Limitations:
Student has dysautonomia and passes out. Other than that she
doesn't believe she has any other limitations. Student stated, "If we're
doing something, I'm going to do it".
Leisure Skills Needed:
Student stated that she likes to play and would like to try everything.
Student expressed interest in the high ropes course.
VI. GOALS/PLANS:
Std. to participate in social/group/leisure/experiential groups up to 5
times weekly.
Std. to participate in family experiential sessions bi-monthly.
OBJECTIVES/INTERVENTIONS:
Mood Regulation:
Intervention: Std. will be involved in a variety of activities designed to
interact and problem solve with the community.
Objective: Std. will express her feelings and emotions up to 3 times
weekly in RT about the things she has gone through and the effect it is
having on her current behaviors.
Self-Worth:
Intervention: Std. to participate in social/ group/ leisure/ experiential
groups up to 4xs wkly. Std. to participate in bimonthly family
experiential sessions.

Objective: Through experiential tasks with others, Std. will increase

awareness and understanding of her personal strengths and potentials.
Student will voluntarily develop and practice 3x per week.
Relationships
Intervention: Std. will learn and practice healthy relationship skills
during RT by using her leadership skills up to 4x weekly .
Objective: Std. will build relationships with staff and community that
are not based solely upon satisfying the requests of others which will
help her to set healthy boundaries.
VII. SUMMARY:
15 y/o female with hx of depression, anxiety, and dysautonomia
presents for residential treatment secondary to school avoidance and
per recommendation of Silver Hill Transitional Living program. She has
struggled with passive thoughts of suicide and has a hx of cutting
behavior. She avoids processing emotion and will take on the emotions
of other people. She has been impulsive in the past, stole a credit card
and went to visit her brother in Cleveland. She got anxious on the
train and called her parents. She had been hospitalized twice for
psychiatric issues, discharged from SHH ATLP 1/12/15, readmitted
2/21/15 due to declining mood and dissociative events.