MissouriDivisionofDevelopmental DisabilitiesRiskScreeningGuide

Application:

TheRiskScreeningGuidehasbeendevelopedtoassistwithservicesandsupportsplanningforindividualsservedthroughtheMissouriDivisionofDevelopmentalDisabilities(DivisionofDD).DivisionofDDTargetedCaseManagement(TCM),intake,orotherstaffasidentifiedatRegionalOffices,SenateBill40(SB40)Boards,andotherTCMprovideragenciesmayusethisguidetoassistinidentifyingpotentialand/oractualindividualrisksinareasofhealth,personalandenvironmentalsafety,individualrights,socialization,andfinancial.Riskinformationascertainedfromthisguideandadditionalsources,includingbutnotlimitedto,interviews,formalassessments,andrecordreviews,helpsdetermineifthepersonisormaybeexperiencinganyriskissuesthatcanbepreventedormitigatedthroughformaland/orinformalsupports.Ifpotentialand/oractualrisk(s)aredetermined,theindividualandhisorherplanningteamshouldidentifyhowtherisk(s)are/willbeaddressedinthePerson-CenteredPlan,supports,andservices.

The formatandcontentof thisguideisbasedonareview of bestpracticeriskplanningmeasuresutilizedinotherstates.Riskitemsselectedandthresholdsestablishedforthisguidearealsobased on Division of DD qualitysystems datareviews.

TheRiskScreeningGuidecontainsriskitemsthatarearrangedunderoneofthefollowingcategories: Health,Mobility,Environment/Safety,Rights,Socialization,andMoney.

InthisguidethereisaThresholdcolumn.Thesupportcoordinatormayidentifyeachissuethatapplies to the person based on the threshold forthat risk item.

  • Eventhoughthethresholdmaynotbereachedforaparticularriskitem,follow-uptotherisk item maystill be needed.
  • Itmaybedeterminedthat,eventhoughthethresholdwasreachedforariskitem,furtheractionmaynot be neededdueto supports/servicesalreadyin placefor that risk.
  • ForsomeoftheriskitemsthereisanasterisklocatedintheThresholdcolumn.Theasteriskreferstooneormoreoccurrencesoftheriskissuewithinthelast12monthsfortheindividualtomeetthethreshold.However,thisdaterangemayvaryonacase-by-casebasis,anditmaybedeterminedthatalthoughthelastoccurrenceoftheriskmayhavebeenlongerthan12monthsago,theriskitemmaystillneedtobeaddressedinsupport ofthe individual.

TheAssessment/ReferencecolumnidentifiesspecificitemsintheSupportIntensityScale(SIS),HealthInventoryaspartoftheHealthIdentificationandPlanningSystemprocess,and/ortheMissouriCriticalAdaptiveBehaviorInventory,thatarerelatedtovariousitemsintheRiskScreeningGuide.InformationfromtheRiskScreeningGuidecanassisttheServiceCoordinator,forexample,inpreparationforinvolvementininterviewsandotherinformationgatheringprocessesas part ofthe individual’s riskmanagementplanning,asapplicable.

Thelastcolumninthegridbelow,whereapplicable,providesadditionalexplanationand/orexamplesassociated with areas where individuals might be atrisk.

Health/Safety

RiskItem / Threshold / AssessmentReference(SIS,HIPS,MOCABIetc) / Additionalinformationand/orexamples
Personneedssupporttoapplybasicfirstaidifinjured / * / SISQuestion 3, Section C
Personneedssupporttofollow, oris notwillingto follow,healthcareprofessionalinstructions(i.e.,physician’sorders) / * / MOCABI5.6
SISSection E,7;C,7
Personneedssupporttoaccessmaintenance,repairorreplacementofpersonaladaptiveequipment,ifapplicable. / * / SISSectionB7
Personneedssupportsduetoimpulsivelyingestingfoodordrink / 1 or morepermonth / MOCABI1.1
SISSection E,6
Personneedssupportsduetoingestingnon-fooditems / 1 or morepermonth / SISQuestion 5, Section 3B
Personneedssupportsdueto ahistoryof drugor alcoholabuse / SISQuestion 11, Section3B
Personhasexperiencedmultipleunplannedhospitalizations/ERvisits / 2 or morepermonth / #5 HealthInventory
Page 29 HealthReferenceManualSISQuestion, 16, Section3A
Personneedssupportfor aswallowing,choking, or eatingdisorder / 2 or moreperquarter / MOCABI1.1
#4 HealthInventory
Page 43 HealthReferenceManualSISQuestion 4, PartA;SIS
Question 16,Section 3A
Personhasa historyof, oriscurrentlyexperiencingaspiration / 2 or morerespiratoryinfectionsperyear / #29 HealthInventory
Page 43 HealthReferenceManualSISQuestion6/16,Section3A
PersonhasuncontrolledSeizures / 6 or morepermonthHospitalized orto ERforseizureAnticonvulsanttoxicity / #17 a &b HealthInventory
Page 44 HealthReferenceManual
#4 Hospitalizations
SISExceptionalMedical 11 / HIDefinition:Theindividualhasmajorseizureactivitythat interfereswithfunctional activity(school,work,or recreation).Thiswould be someonewithseizuresthat arepoorlycontrolled(three tosixpermonth),uncontrolled, orhasrequiredhospitaladmissionto manageproblems relatedto excessiveseizureactivity, orsomeonewhowastreatedin theEmergencyRoomor hospitalizedforanticonvulsanttoxicityinthepasttwelvemonths.
Personhasa neworrecentlydiagnosedmedicalcondition / * / SISQuestion 16, Section3A
Personhasimplantedmedicaldevices / Havingone ormoredevicesimplanted / #19 VagusNerveStimulator
Page 55 HealthReferenceManual
#28 BaclofenPump HI
Page 8 HealthReferenceManual
*HIdoes notspecificallytrackpacemakers
SISQuestion 16, Section3A / Such asfeedingtube,pacemaker,seizuremanagementdevice
Personexperiencesuncontrolledpain orchronicpain / * / #30 HealthInventory
Page 40 HealthReferenceManualSISQuestion 16, Section3A / Discusschronicvs.uncontrolled…norelief.
Presenceof thisconditionincreasesriskforbehavioralinterventions,overmedication,andmisdiagnosisandrequiresadditionalplanning.
Personusesspecializedmedicalassistivetechnology / * / SISQuestion 16, Section3A / Such as ventilator,dialysis,etc.
Personhasaknownterminalcondition / * / #1 HealthInventoryonlytracksterminalconditionswith a DNRSISQuestion 16, Section3A / DoNotResuscitateOrders(DNR):A medicalorderwritten byaphysician towithholdCardiopulmonaryResuscitation(CPR)includingbreathing/ventilation byanassistive ormechanicalmeansincludingbutnotlimitedto,mouth-to-mouth,mouth-to-mask,bag-valvemask,endotrachealtube,ventilatorand/orchestcompressions,and/ordefibrillation.The orderiswrittenwiththeinformedconsent of acompetentindividualortheirdulyauthorizedhealthcareagentorguardian.
Personhasa communicableDiseaseConcerns: TB/HepatitisA,B, or C/HIV/STD /MRSA / * / #15 HealthInventory
Page 15 HealthReferenceManualSISQuestion10/16,Section 3A / Theindividualhas a knowncommunicabledisease orisacandidateforcontractingorspreadingthedisease.Acommunicablediseaseis adiseasethatmay be passedor becarriedfromone persontoanotherdirectlyorindirectly.
CandidatesforcontractingTBorHepatitisorHIV/STD mayincludethose who havemultiplesexualpartners orthosewhoengage in activitiesresultinginthe exchange orexposureofbodyfluids.
CircleTB foranyindividualwhohasrecentlytestedpositive on skin
testor who hashadexposure to apersonwithactiveTB, orwhohas a diagnosisofTB.
CircleHepatitis Bforanyindividualwho has notbeenvaccinated forHepatitis B orwhois a knownHepatitis B carrier.
CircleMRSA (MethicillinResistantStaph Aureus)forthoseindividualswho arediagnosed assuch.MRSA isa type ofbacteriathatis noteasilykilled byantibiotics.
Personhas allergies / * / SISQuestion 16, Section3A / Requiresadvancedmedical treatmentbeyondOTC whichhaveresultedinhospitalizations,ER,epi-pen.
Persontakesmedications: / MOCABI1.6
  • Requiressedationformedical/dentaltreatment
/ *
  • Takesinjectablemedicationsin thehome
/ * / #23 HealthInventory-insulin onlyPage 33 HealthReferenceManual
#24 anti-coagulants(mayor may notbe injectable)
Page 5 HealthReferenceManualSISQuestion 1,Section E
  • Takes 2or morepsychotropicmedications
/ * / SISQuestion 12, Section3B
  • Receivesmultiplemedicationswithoutbenefitofregularmedicalevaluations(non-placement)
/ *
Personhasdental/oral healthneeds / * / #27 a &b HealthInventory
Page 34 HealthReferenceManualSISQuestion 7, PartA
SISQuestion 16, Section3A / Dental/oralhealthneedsbeyondtypicaloralhygiene,suchasbrokenteeth,ill-fittingdentures,dentaldisease and/ororalcancer.
Otherpotentialhealth/safetyrisk(s): / HealthInventory
#14 Pica
#13 ExcessiveWaterIntake
#20 Falls
#21 2 ormoreinjuriespermonthSISQuestion 16, Section3A SISQuestions2-8, PartE

Mobility

RiskItem / Threshold / AssessmentReference(SIS,HIPS,MOCABIetc) / Additionalinformationand/orexamples
Personhasan unsteadygaitorbalancedisorder / * / SISQuestion 4,Section E
Personexperiencesfalls / 4 or morefallsperquarter / MOCABI4.1
#20 HealthInventory
Page 27 HealthReferenceManualSISQuestion 4 Section E
Personisimmobile / * / #26 HealthInventory
Page 31 HealthReferenceManualSISQuestion4Section E / Non-ambulatory;orrequiresassistancetochangepositions orshiftweight;orwhosedisabilitypreventssittingin anuprightpositionor haslimitedpositioningoptions.
Personexperiences asensoryimpairment / * / MOCABI2.1, 2.5, 3.1, 3.2 / Includingvision,hearing, etc.
Personuses a wheelchairor otherassistivedevice(cane,walker,scooter,braces,etc) / * / SISQuestion4 Section E
Otherpotentialmobilityrisk(s)

Environment/Safety

RiskItem / Threshold / AssessmentReference(SIS,HIPS,MOCABIetc) / Additionalinformationand/orexamples
Personneedsoversightofacaregiverin his orherhome / * / MOCABI6.3SIS / Personcannotstayhomealonesafelyfor anylength of timewithoutsupport/supervisionof a caregiver
Personneedssupportsduetorefusalforservices tosupportindividualin maintainingtheirhealthandsafety / * / SIS PartE;SISSection 2 / Individualmayoptnottotellothers,or refusesupports/services,whenevertheyneed healthand safetyinterventions
Personneedssupporttodevelopand implementanemergencyplanto safelymanage an emergencysituation(appliesto homeandcommunity) / * / SISQuestion5, PartE &Question7, PartC / Examples:
  • Personneedsassistancetodevelop anemergencyplantosafelydealwitheventsand/orevacuatethehome,takingshelter intheeventof a majoremergency
  • Personneedssupportstoimplementan emergencyplansafely. Thiswouldincluderegular practicedrills,evacuationfromthe premises(home orcommunitybuilding)intheeventofanemergency, such as afire.takingshelterduringa storm,tornado,flood,etc.

Personneedssupportstoutilize/managesafetydevices inthe home / 1 or moreincidentsperquarter / SISQuestion 5, PartE / Examples:
  • Changingbatteriesin smokedetector,CO indicator,flashlights,radioforemergencyinformation
  • Managingspecializedsafetydevicessuchas visualfirealarm, etc.

Persondoesnothave acommunicationsource(e.g.,telephone)to contactemergencyservices; and/orneedsassistanceto contactemergencyservicesviaphone orotherwiseaccessassistance; / * / MOCABI2.3
SISQuestion 5, PartE / Examples:
  • Personhasno landline orwirelessphone,pager,LifeAlert,etc.to contactemergencyservicesifneeded
  • Skilldevelopment/supportsneededto use aphone orothersourcetoaccessemergencyassistance

Theperson’sresidenceis unsafeor is inan unsafelocation / * / Homemaybe in significantdisrepair;Person’sprimaryresidenceis in alocationthatpotentiallypresents aconcernregardinghealth andsafety.Examplesincludebutnotlimitedto:
  • Lot on whichhome is locatedor generalareahassoilorairqualityissues;floodplain;etc.
  • Closeto aheavytrafficroadwaywithoutsidewalks(thismay applyif personhasdifficultywithnegotiatingcommunitybywalkingduetophysicalchallenges)
  • Nosidewalks inneighborhood
  • Highcrimeneighborhood

Personneedssupportsto enterand/orsecuretheirownhome;orrepairsneededto securethehome / MOCABI4.7
SISQuestion 5, PartA;Question 8,PartB;Question 4, PartE /
  • Personhasa needtodevelopskillstolock his orher home(security) orusea keyor keypad toenter hisorherhome
  • Home has entrywaysand/orwindowsthatarebroken ordo notlock
  • Person may notunderstandwhenitisappropriate/necessarytosecurethe home(e.g.,whenleavingthehome for anerrandorwork, atnightduringsleep)

Personneedssupportsto safelyaccessorutilizeallareasof thehome / * / MOCABI4.1
SISQuestion 4, PartE / Person may havephysicalchallengesthatlimitssafelynegotiatingareas ofthe home,such asthebathroom, tub,shower,stairs,unlessheorshe hasadaptiveequipmentorhomeaccessibilitymodifications.
Thepersonmay notbe aware ofand/orneedsassistance torespondto potentialhomedangers.Thisincludesbutisnotlimitedtosafeuse ofpotentiallyhazardoushouseholdchemicals,homeappliances,and otherhouseholddevices / *
For potentiallyhazardouschemicals: 2or moretimes in aquarter anindividualdemonstratestheinabilitytosafelyuseforintendedpurposeand/orsafelystoretheproduct / MOCABI3.2
SISQuestion 2, PartE;Questions2/3/5,PartA / Personneedsassistancetorecognizeand/ortosafelymanagepossibleenvironmentalhazards intheirhome.Examples:
  • Safe usehouseholdchemicals(flammable andtoxicchemicals).
  • Safe useofappliancessuchasa mixerortoaster,stove, orothercommon householddevicessuchas lawnmower.

Thepersonneedsassistance tosafelyutilizeitems/instrumentsthatcreateorrequirefire / Oneincidentofuncontrolledfire / MOCABI3.2, 4.5 /
  • Items/instrumentsmayincludelighters,
  • matches,kitchenstoves,oilburninglamps,fireplaces,outdoorgrills,candles,etc.

Personneedssupporttosafelyregulatewatertemperature / 1 or moreincidentperquarter / SISQuestion 7, Part A
Personneedssupporttostoreperishablefoods anddiscardoutdatedfoods ina timelymanner / 1 or moreincidentperquarter / MOCABI6.1
SISQuestion 3, PartA
Personneedssupporttoensureadaptationsor modifications areinstalledproperlyand in goodrepair / Anyreportedneedor anyreportofadaptationsor modifications indisrepair
Personneedssupportsto keephisor herhome and yardclean / 2 or morereportedissuesinaquarter / MOCABI6.1
SISQuestion5,PartA;Question3,Section 2
Personneedssupportsforstablehousing / 2 or moremoves in a year / Examplesincludehistoryof eviction,poorrelationshipwithneighborsand/orlandlord,frequentmoves.
Personneedssupportstoeffectivelymanagestrangers whovisitthe home / 1 or moreincidentspermonth / SISQuestion 7, PartBA2 / Example:Person allows adoortodoor salespersontoenterhis orherhome withoutfirstinquiringaboutpurpose;dealingwith an unwantedacquaintance
Personneedssupportsto accessdesiredresourcesinthecommunity / 1 or moreincidents asa resultofnotsafelynegotiatingthecommunity / MOCABI4.1, 4.2, 4.6
SISQuestions1/2/3/8,Part B / Examples:
  • Person may need to developskillson howtosafelyaccessdesiredresources
  • Recognizeappropriatetimes ofdayfor socializing,business,etc.
  • Negotiatingcrosswalks,trafficlights,roadcurbs
  • Theremay be environmentallimitationsinthecommunitytopreventthe personfromsafelyaccessingresources,suchas nosidewalks, no curbcutsidewalks,no accessiblepublictransportationorparkingplacesifpersonuses own vehicle,etc.

Personneedssupporttocarryanduse personalidentificationwhennecessary / * / MOCABI3.5
SISQuestion 9, PartC
Personneedssupporttorespond inpotentiallyunsafesituations inthecommunity / 1 or moresituationsin aquarter / SISQuestion3,PartC;Question5,PartE / Example:
  • Know whentocontactlawenforcement,ambulance,firedepartment,ifneeded.

Personneedssupportto askforassistance,such asdirections todestinations,if needed / 1 or moresituationsin quarter / MOCABI2.2, 2.3
SISQuestion1/7,PartB
Personneedssupporttoprovidemedicalinformationto firstresponders,if needed / 1 or moresituationsin aquarter / MOCABI2.2, 2.3, 3.5, 5.6
SISQuestion7,PartC;Question3,PartE
Otherpotentialrisk(s) withhome/environmentalsafety / SISQuestion 2, PartE

Rights

Risk Item / Threshold / AssessmentReference(SIS,HIPS,MOCABIetc) / Additionalinformationand/orexamples
Personneedssupportstocommunicateormakeinformeddecisionsin a varietyofareassuchas medical,financial,dayto day,etc. / 1 or moresituationsin aquarter / MOCABI3.3, 5.1, 5.2, 5.6
SISQuestion1/2/4/5/7,Section2
Personneedssupportstounderstandwhento say“no” orrecognize whensomeoneelsehastherightto say“no” / 1 or moresituationsin aquarter / SISQuestion 7, PartB;Question 8,PartC;Questions2/3,Part D;Question3/4/5/6,PartF;Question3/5, Section 2 / Example: Individualdoesnotwantsomeone to hughimbutisunable tovoicethis
Individual’sPlanreflects rightsrestrictions / 1 or morerightsrestrictionsrequiringreview byHumanRightsCommittee / Example: Individual’sPlanstatesthatindividualwillonlyhave accessto hisphoneforonehoureach day
Person needs supports due to current or past engaging in behavior that is injurious to self / Historical, or 1 or more incidents / SIS Question 4, Section 3B / Person needs supports to prevent engaging in self-harm (e.g., slapping self), and safety of others. This may be a means of communicating such emotions as displeasure/anger, or response to such factors as but not limited to: Personal, emotional, and/or environmental stressors, physical ailments; not being supported in a manner which makes sense to the individual.
Person needs supports sue to 1 or more incidents of physical aggression towards others. / Historical, or 1 or more incidents / SIS Question 1 Section 3B / Personneedssupportsto preventengagingin physicalaggressiontowardsothers(e.g.hittingoutatothers,pushingothers),andjeopardizingtheirsafetyandthesafetyof others.
Thismay be a means ofcommunicatingsuchemotions asdispleasure/anger, ora responsetosuchfactors as,butnotlimitedto:Personal,emotional,and/orenvironmentalstressors; physicalailments;notbeingsupported inamannerwhichmakessenseto theindividual,etc.
Personneedssupportsduetocurrent or pastinappropriatebehaviorof sexualnature / Historical, or 1 or moreincidents / SISQuestions7/8,Section3B / Personneedssupportsto preventengagingin inappropriatesexualbehavior(e.g.,makessexuallyexplicitcomments and gesturestoothers) andjeopardizingtheirsafetyand safetyof others.
Thismay beassociatedwith,butnotlimitedto:
  • Has a historyofincestorhasbeen a victimof sexualabuse
  • Has a psychiatricdiagnosisrelated tosexualdisorder

Personneedssupportsduetocurrent or pastunprotectedandunsafesexualbehavior(unprotectedsex,multiplepartners,etc.) / Historical, or1 or moreincidents / SISQuestion 13, Section3B / Personneedssupportsto preventengagingin unprotectedorunsafesexualbehavior(e.g.,Failstopracticeprotectedsexandbirthcontrol;unsafesexualencounterswithstrangers), andjeopardizingtheirsafetyand safetyof others.Factorsto consider may include:
  • Naturalsexualrelationshipsareinhibitedornotpermittedbyguardianand caregivingstaff
  • Failureto provideindividualwithrelationshiptrainingwhichshouldincludeappropriateandhealthysexualexpression

Personneedssupportsduetocurrent or pastbehavioralexpressionresultingin propertydamage / 1 or moreincidents / SISQuestion 2, Section 3B / Personneedssupportstopreventengaginginphysicalaggressionresultinginpropertydamage(e.g.Destructiveofhome,vehiclesandothers’personalproperty),andjeopardizingtheirsafetyandsafetyofothers.
Thismaybeameansofcommunicatingsuchemotionsasdispleasure/anger,oraresponsetosuchfactorsasbutnot limitedto: Personal,emotional,and/orenvironmentalstressors;physicalailments;notbeingsupportedinamannerwhichmakessensetotheindividual,suchasfailuretoprovideinterventionstrategiesandredirectionasoutlinedinthepersonalplaninanefforttoavoidpropertydamagebytheindividual,etc.
Personneedssupportsduetocurrent or pastengagingin verbalaggressiontowardsothers / 1 or moreincidents / SISQuestion 7, PartB;Questions3/4, PartD;Questions3/4/5/6,PartF; Questions9/13,Section3B / Personneedssupportsto preventengagingin verbalaggressiontowardsothers(e.g.,screamingoryellingatothers;makesderogatoryand inappropriatecomments toothers), andjeopardizingtheirsafetyand safetyof others. Thismay be a means ofcommunicatingsuch emotions asdispleasure/anger, orresponsetosuchfactors asbutnotlimitedto:Personal,emotional,and/orenvironmentalstressors; orphysicalailments.The personmay notfeelhe orsheis beingcommunicatedwithorsupportedin amannerwhichmakes sensetotheindividual,e.g.,otherperson’suseofinappropriateand obscenelanguage in thepresence ofindividual;ensureothersarefollowingperson-centeredplanwhencommunicatingwithindividual.
Personneedssupportsduetocurrent or pastelopementwhereabsenceraisesreasonableconcernforsafety / Historicalor 1or moreincidents / SISQuestion10, Section3B / Personneedssupportsto preventengagingin elopement(e.g.,individualrunsfromhome,potentiallyintothestreetwhenupset;individualattemptstoleavehome withoutothers’knowledge),andjeopardizingtheirsafetyandsafetyof others.
Thismay be a means ofcommunicatingsuch emotions asdispleasure/anger, orresponsetosuchfactors asbutnotlimitedto:Personal,emotional,and/orenvironmentalstressors; orphysicalailments.Someconsiderationsmayincludebutnotbelimited to:Thepersonmay notfeelhe orshe isbeingsupportedin a mannerwhichmakes sensetotheindividual,e.g.,needto supporttheindividualto askor notifyothers whentheywouldlike toleave the area in whichtheyare uncomfortable;failureto providelevelofsupervisionasoutlined inthe personcenteredplan;othersleavingthepremises,causingtheindividualto bealone.
Personneedssupportsduetocurrent or pastactivitiesthatareillegal / Historicalor1or moreincidents / SISQuestion4/6,Section 2 / Anyactionexhibited bytheindividualwhichwouldbeconsidered aninfractionof a law orordinance(e.g.,trespassing,abusingemergencysystemsuch as911).Thismay involve anyactionwhichwarrantslaw enforcementtotakecontrol
Otherpotentialriskissues(listall)
Money
RiskIssue / Threshold / AssessmentReference(SIS,HIPS,MOCABIetc) / Additionalinformationand/orexamples
Personneedssupportsto managepersonal fundsindependently(e.g.,employmentincome) / Cannotmaintainbills / MOCABI5.5
SISQuestion2/7,Section2;
Requiresadditionalsupportswhencarryingand/orspendingmoneyfor purchases / 1 or moreincidents or whensituationisrevealed / MOCABI3.3, 5.5
SISQuestion2/7,Section2;Question6, PartB
Requiresassistance inprotectingthemselvesfromfinancialexploitation(e.g.,creditcardoffers,solicitors) / 1 or moreincidents or whensituationisrevealed / MOCABI5.5
SISQuestion 3, Section 2