Evaluation of the relationship between proactive risk assessment and episodes of challenging behavior in community-based behavioral health care settings.

摘要

The move toward deinstitutionalization and community integration for persons with developmental disabilities has focused on how behavior in community-based settings may be viewed differently from the same behavior in institutional settings and how changes occur in behaviors as people move from institutions to the community. Challenging behaviors (defined as dangerous, destructive, harmful, disruptive, or otherwise unacceptable behaviors) are often grounds for exclusion from community-based services and activities and are sometimes associated with social and material deprivation, utilization of medication and restraints, and abuse by care staff. This study evaluated the usefulness of a proactive risk assessment instrument in predicting frequency and severity of incidents of challenging behaviors in a community-based setting serving adults with mental retardation and developmental disabilities. The relationship between level of risk assigned proactively for each consumer and the actual occurrence of incident-related challenging behaviors over a 90-day period for 104 adult consumers was measured using a modified version of the Supports Intensity Scale. The assessment staff specifically rated each individual in five categories of risk: consumer risk, caregiver risk, environment risk, legal risk, and total risk. Key findings indicated that while risk factors did not predict frequency or severity of mild challenging behaviors, they predicted frequency and severity of the moderate and severe challenging behaviors.