Leisure Interest Inventory (Recreational Therapy)

Note Type: Leisure Interest Inventory (Recreational Therapy)

Date/Time: [Date and time]

Location: [Care setting and unit/clinic]

Author: [Name, credentials]

Encounter Type: [initial assessment / re-assessment / discharge planning update]

Referral Source: [Referring discipline/name and requested focus] (Include if applicable; otherwise state Not applicable.)

Information Sources: [patient interview / caregiver interview / chart review / observation] (List all sources used. If patient unable to self-report, specify limitation and alternative sources.)

Communication Accommodations: [Interpreter / AAC / hearing supports / vision supports / other] (Include only if applicable; otherwise omit this line.)

Reason for Assessment

[Primary reason for assessment, relevant time horizon, and key constraints framing the assessment] (2–5 sentences. Open with the patient's own framing and a direct quote if meaningful.)

Clinical Context Relevant to Leisure

(Include only health conditions, impairments, precautions, and environmental factors that directly affect leisure feasibility, adaptation needs, or safety. Label each item with information source. Omit this entire section if completing a preference screener in a stable outpatient setting where functional constraints are documented elsewhere and unchanged.)

• [Mobility, balance, endurance, and fatigue considerations] ([chart-based / patient-reported])
• [Cognitive factors: attention, memory, processing, executive function] ([chart-based / patient-reported])
• [Mood, anxiety, or behavioral health considerations] ([chart-based / patient-reported])
• [Sensory changes: vision, hearing, sensory sensitivity] ([chart-based / patient-reported])
• [Safety precautions: fall risk, behavioral precautions, activity restrictions] ([chart-based / patient-reported])
• [Environmental context: living situation, caregiving supports, transportation, financial constraints] ([chart-based / patient-reported])

Leisure Profile

Leisure Identity and Meaning

[Patient's self-described leisure identity, roles connected to leisure, and what leisure provides them] (Include 1–2 direct quotes reflecting values/meaning when available.)

Participation History

Past participation (pre-illness/injury baseline): [Top activities, typical frequency, settings, companions, and what "good leisure" looked like]

Current participation:

• Continues: [Activities continuing and current frequency]
• Reduced: [Activities reduced and extent of change]
• Stopped: [Activities stopped and reasons]
• New: [New activities since illness/injury]

Interest Inventory

(List current and potential interests organized by priority level and domain. Separate interest from feasibility—do not exclude items solely due to barriers.)

• High interest: [Activities by domain: physical, outdoor/nature, creative/artistic, social, service/volunteer, intellectual/reading, spiritual, mechanical/DIY/tech]
• Medium interest: [Activities by domain]
• Low interest: [Activities by domain]

Willingness to trial new activities: [yes / no / conditional] (If conditional, specify conditions.)

Values, Preferences, and Non-Negotiables

• Core values: [Values such as independence, privacy, spirituality, competitiveness, creativity, helping others]
• Environmental preferences: [Noise level, group size, indoor/outdoor, structured vs open-ended, pacing, sensory needs]
• Cultural practices shaping leisure: [Practices/beliefs relevant to leisure participation]
• Non-negotiables/refusals: [Activities refused with stated reasons] (Use direct quotes when available.)

Motivation and Readiness

• Readiness to engage: [low / moderate / high] — [Brief justification]
• Self-efficacy/confidence: [Description of confidence level and contributing factors]
• Motivating factors: [Social connection, mastery, mood improvement, discharge goals, etc.]
• Demotivating factors: [Fear of failure, pain, embarrassment, cognitive fatigue, etc.]

Social Participation Preferences

• Preferred format: [solo / 1:1 / small group / large group]
• Interaction style: [cooperative / competitive / leadership / participant / structured / open-ended]
• Social comfort level and triggers: [Description]
• Inclusion needs: [Communication supports, pacing, breaks, peer matching, etc.]

(If patient cannot self-report due to aphasia, delirium, or similar limitations, document the limitation and alternative information sources, and mark preferences as provisional pending reassessment.)

Barriers and Facilitators

Barriers

(Categorize barriers and specify modifiability for each.)

• Intrapersonal: [Mood, anxiety, confidence, fear of falling, fatigue, pain, perceived competence] — [modifiable now / modifiable later / non-modifiable (workarounds)]
• Interpersonal: [Social network, caregiver burden, leisure partners, communication barriers] — [modifiable now / modifiable later / non-modifiable (workarounds)]
• Structural/Environmental: [Transportation, cost, accessibility, program availability, schedule, technology access] — [modifiable now / modifiable later / non-modifiable (workarounds)]

Facilitators

• Strengths and supports: [Family involvement, community ties, prior routines, adaptive skills, motivation anchors]
• Available resources: [Equipment, accessible venues, financial supports, transportation options, technology/apps]
• Effective strategies to date: [Strategies that have worked previously]

Clinical Impression

(Provide a concise synthesis translating collected data into an actionable summary for the interdisciplinary team.)

• [Most meaningful interests and values to target]
• [Highest-impact barriers limiting participation]
• [Feasibility considerations: supervision needs, adaptation/equipment, precautions]
• [Leverageable strengths and resources]
• [Priority leisure goal themes: rebuild social connection / re-establish mastery / increase community access / develop sustainable coping routine / other]

Leisure Goals

(Include when inventory informs treatment planning. Omit this entire section for screening-only inventories and instead state: "Screening only—no RT goals established; recommendations provided.")

• Goal 1: [Patient-centered goal linked to stated values] — Priority: [#], Context: [inpatient / home / community]
• Goal 2: [Patient-centered goal] — Priority: [#], Context: [inpatient / home / community]
• Goal 3: [Patient-centered goal] (Include as needed.)

Patient collaboration: [agrees with goals / chose goals / goals provisional (reason)]

RT Recommendations and Plan

• Recommended service type: [1:1 sessions / group participation with accommodations / leisure education / community reintegration planning]
• Intervention focus areas: [Graded activity trials, leisure skill building, adaptive strategies, barrier negotiation, coping/relaxation routines]
• Interdisciplinary coordination: [Disciplines and focus areas for coordination]
• Safety plan integration: [Supervision level, contraindications, triggers and mitigation] (Include if applicable.)
• Link to inventory findings: [Brief statement tying recommendations to key interests/barriers]
• Contingencies: [Plan contingent upon pending data] (Include if applicable.)

Education Provided

[Education topics covered and patient response] (Note any handouts or referrals provided and teach-back results when obtained.)

Follow-Up Plan

[Planned next contact and reassessment triggers] (Specify what will be measured at follow-up: participation frequency, barrier reduction, satisfaction/enjoyment.)

Authentication

Signature: [Electronic signature]

Credentials: [Credentials]

Date/Time: [Date and time of authentication]