Behavior Risk Assessment

Aggression

Change in body language, argumentative or defensive, verbal or physical escalation.

Elopement

Verbal request to leave, movement towards exit, physical attempt to leave.

Actively Suicidal/Self Harm Behavior

Expressed thought to harm self/others, present injurious behaviors or plan, intent during appointment.

Threat to Harm Others

Expressed thought to harm others, present plan or intent during appointment.

• Integrate Risks and Protective Factors
  • Target of behavior and physical, social/emotional, environmental considerations

• Immediate Safety Actions
  • R.A.C.E. Response
  • Ensure safe room/location
  • Remove weaponized items
  • Staff access to door
  • Reduce visit time, as possible

• Risk Based Response
  • Risks and protective factors may impact the response level and resources needed for support
  • In the boxes below, strategies and resources occur in order of suggested priority

• De-escalation Strategies
• Staff Position, Proximity, Posture Safety

• De-escalation Strategies
• Staff Position, Proximity, Posture Safety
• Assess room safety
  • Relocate to safe space
  • Remove potential weaponized items

• Alert Team Safe
  • Response initiator alerts team, remains with escalated person
  • Team lead mobilizes response and resources
• Contact 911, Security immediately
• Staff Position, Proximity, Posture Safety

• Behavior Specific Response
  • Aggression
    • Lower demands
    • Offer choices
  • Elopement
    • Position staff in front of door
    • Close door
  • Actively Suicidal/Self Harm Behavior
    • Notify care team
    • Review Care of the Suicidal Patient in Ambulatory Care Locations Procedure
  • Threat to Harm
    • Notify Care Team
    • Consider Additional Supports

• Behavior Specific Response
  • Aggression
    • Relocate escalating person
    • Provide clear expectations
    • Offer choice of ending visit
  • Elopement
    • Close door
    • Comfort hold (parent/staff)
    • Offer a break
  • Actively Suicidal/Self Harm Behavior
    • Remain with person
    • Alert BH provider
    • Consider referral to ED or Crisis Center
    • Review Care of the Suicidal Patient in Ambulatory Care Locations Procedure
  • Threat to Harm
    • Alert BH provider
    • Consider Duty to Warn

• Behavior Specific Response
  • Aggression
    • Remove other patients, visitors and unnecessary staff from space
  • Elopement
    • Monitor building doors
  • Actively Suicidal/Self Harm Behavior
    • Monitor safety
    • Re-evaluate the EOC for hazards and risks for items that could be weaponized
    • Referral to ED or Crisis Center, or dispositions in coordination with authorities (adults)
  • Threat to Harm
    • Evaluate EOC for Hazards or
      Weaponized Items
    • Consider Duty to Warn

• Contact for Additional Supports, as needed
• Child Life, HMHK
• Proceed with visit

• Alert Team Safe
  • Response initiator alerts team lead of potential need for support
  • Child Life, HMHK
• Contact for Additional Supports
  • Security, Child Life, HMHK

• Ongoing Escalation
  • Terminate Visit
  • Contact for Additional Supports
  • Consider transfer to higher level of care
  • Navigating Difficult Conversations with Family

Disposition

• Team safe alert activated
  • Cancel alert
  • Staff Debrief and Documentation
  • Behavior safety alert
• Consider Duty to Warn
• Consider consults to Child Life, HMHK, Social Work, or Psychology for future appointments
• If patient escalation, team lead or physician should consider follow-up call to patient/ caregiver in 1-3 days.
• KAPS Report

• Optional
  • Care for colleagues
  • Threat assessment team (proactive, and post-assessment)