Global Behavioral Service Need Matrix Instructions

Global Behavioral Service Need Matrix Instructions

V6.1

1.  Recipient’s name: Enter the name of the person you are assessing.

2.  Area: Enter the Area that is responsible for the person’s placement in IB.

3.  Assessor’s Name: Enter your name.

4.  Date: Enter the date you completed the assessment.

5.  Score: This will be automatically calculated in the electronic version, you do not enter anything here.

6.  Level: This will be automatically calculated in the electronic version, you do not enter anything here.

7.  Scoring level: This is the number associated with a particular level of need (1-6) or service in each of the columns. Each column is rated independent of the other columns. This is the number (1-6) you will enter at the bottom of each column once you have determined the level of need or service for a particular column. If the person’s behavior does not meet the at least the Level 1 criteria a “0” should be entered for that column.

In the shaded Score row enter the score that addresses the person’s highest level of need during the identified evaluation period. The initial length of the evaluation period will be 12 months. Once the person has been assigned a initial or baseline level of need, the length of the evaluation period will be determined based on the person’s level. People with a level of need of 6 will be re-evaluated more frequently than people with a level of need of 1.

8.  Behavior Frequency: Determine how often the behavior occurs during a one month period. Score the most frequent of the targeted/problematic behaviors that are directly related to the person residing in an Intensive Behavioral program. The behavior that is most frequent may or may not be the behavior with the highest impact. Each column is rated independently. Enter the score (1-6) entered at the bottom of the Behavior Frequency column:

a.  If the behavior occurs less than 2x per month, score it as a “0”

b.  Level 1- If the behavior occurs equal to or more than 2x per month but less than 3 times per month, score it as a “1”.

c.  Level 2- If the behavior occurs equal to or more than 3x per month but less than 1 time per week, score it as a “2”.

d.  Level 3- If the behavior occurs equal to or more than 1 x per week (4times per month) but less than 4x per week (16 times per month), score it as a “3”.

e.  Level 4- If the behavior occurs equal to or more than 4x per week (16 times per month) but less than 1x per day (30 times per month), score it as a “4”.

f.  Level 5- If the behavior occurs equal to or more than 1x per day (30 times per month) but less than 4x per day (120 times per month), score it as a “5”.

g.  Level 6- If the behavior occurs equal to or more than 4x per day (120 times per month) , score it as a “6”.

Note: When scoring interval data use each interval as one occurrence of the behavior. If percentages of occurrence are the only data available ask for the number of intervals used to make the calculations for that particular individual and use this to determine the frequency.

9.  Behavioral impact: Score the targeted/problematic behaviors directly related to the person residing in an Intensive Behavioral program that has the highest level of severity. Find a description of a behavior and the intensity level that most closely fits the targeted behavior you are evaluating. Read the descriptors carefully as there are fine distinctions between each level. Start from level one and work up until you have determined the highest level of impact that has occurred in the past 12 months and in the past 30 days. Once you have determined the level enter that number at the bottom of the behavioral impact column.

a.  Physical aggression to self: This is any behavior done by the individual that causes harm to themselves. This category includes SIB, SAB, substance abuse and ingestion/inhalation of toxic chemicals. The severity rating for this category is based on the relative level of tissue damage done by the aggression to self.

i.  Level 2- This is aggression to self that results in no detectible damage.

1.  Example: Slapping ones face that results in NO discoloration of the skin.

2.  Example: Occasional ingestion of substances(i.e. dugs, alcohol) in small amounts that are unlikely to produce long term damage

ii.  Level 3- This is aggression that results in minor tissue damage that requires no medical attention.

1.  Example: Slapping ones face that results in reddening or minor bruising

2.  Example: Ingestion of substances frequently or in large quantities such that medical literature would suggest significant increased risk of long term tissue damage.

iii.  Level 4- This is aggression to self that results in damage that can be treated using procedures that the Redcross identifies as first aid that does not need additional care from a medical professional.

1.  Example: Biting oneself on the arm with sufficient force to break the skin requiring cleansing of the area and application of a band aide

2.  Example: Kicking a wall that results in bruising and swelling in the great toe requiring the application of an ice pack.

iv.  Level 5- This is aggression to self that requires some level of attention by a medical professional but can be provided on an outpatient basis. This can include medical care provided by on site program nurses and/or doctors. The determining factor is the severity of the injury requiring this level of care NOT program policies that require every wound to be reviewed by a medical professional.

1.  Example: Hitting oneself in the head hard enough to cause bruising and requiring evaluation/monitoring for possible concussion

2.  Example: Ingestion of enough alcohol to become intoxicated requiring medical personnel to regularly monitor vital signs to assure that the person will not need additional care

3.  Example: Hitting ones hand on a hard object causing a laceration deep enough that the Redcross recommend treatment by a medical professional, but not deep enough to require stitches or staples.

v.  Level 6- This is aggression to self that causes sufficient tissue dame to require the person receive medical care at an emergency room or requires emergent care by the facility medical staff that would usually be provided in an ER. It also includes self injury severe enough to result in an admission to the hospital.

1.  Example: Banging ones head against an object resulting in a loss of consciousness or a laceration deep enough to require staples or stitches to close the wound

2.  Example: Ingestion of sufficient drugs or alcohol requiring the person to be transported to the hospital for emergency measures to remove the substances from their body or administer medications to counteract the effects of the substances

3.  Example: Targeted behavior that resulted in a broken bone, detached body part or eye injury requiring a trip to the emergency room and/or inpatient medical intervention to correct the damage.

b.  Physical aggression to Others –This is a physical act done by the individual that results in physical harm to another person.

i.  Level 2- This is aggression to others that results in no detectible damage.

1.  Example: Slapping someone else’s face that results in NO discoloration of the skin

2.  Example: Pushing another person with sufficient force to cause the other person to move

ii.  Level 3- This is aggression to another person that results in minor tissue damage that requires no medical attention.

1.  Example: Slapping someone else’s face that results only in temporary discoloration of the skin without bruising

iii.  Level 4- This is aggression to another person that results in damage that can be treated using procedures that the Redcross identifies as first aid that does not need additional care from a medical professional

1.  Example: Scratching another person with enough force to break the skin.

2.  Example: Striking another person with enough force to cause minor bruising

iv.  Level 5- This is aggression to another person that requires some level of attention by a medical professional but can be provided on an outpatient basis. This can include medical care provided by on site program nurses and/or doctors. The determining factor is the severity of the injury requiring this level of care NOT program policies that require every wound to be reviewed by a medical professional

1.  Example: Hitting another person with enough force to cause a laceration deep enough that the Redcross recommends treatment by a medical professional, but not deep enough to require stitches or staples.

2.  Example: Hitting another person in the head with enough force to cause bruising and evaluation of potential concussion.

v.  Level 6- This is aggression to another person that causes sufficient tissue dame to require the person receive medical care at an emergency room or requires emergent care by the facility medical staff that would usually be provided in an ER. It also includes self injury severe enough to result in an admission to the hospital.

1.  Example: Hitting another person with enough force to cause a loss of consciousness or a laceration deep enough to require staples or stitches to close the wound

2.  Example: Physical aggression that resulted in a broken bone, detached body part or eye injury requiring a trip to the emergency room and/or inpatient medical intervention to correct the damage.

c.  Police involvement- Behavior produced by an individual that results in Law enforcement responding to the event. This can be initiated by the program or by others in the community. This INCLUDES police involvement or Baker Act that is initiated by the individual. (eg. individual is kept from engaging in a required activity, calls the police and says, "I'm going to kill myself," police respond)

i.  Level 5- without arrest or detainment. This is the police have responded but the event is resolved without the officer arresting the person and without the person being detained under the Baker act

ii.  Level 6- with arrest or detainment/Baker act detainment. This is police have responded and the person is either arrested or they have been detained under the provisions in the Baker Act

d.  Property destruction- This is the total value of all property destruction done by this individual in any one calendar month. Add the value of the items destroyed and match the number to the levels below. Use the actual replacement cost of the destroyed items.

i.  Level 1- Property destruction ≤$100- Total is more than $0 but less than or equal to $100

ii.  Level 2- Property destruction ≤$250- Total is more than $100 but less than or equal to $250

iii.  Level 3- Property destruction ≤$500- Total is more than $250 but less than or equal to $500

iv.  Level 4- Property destruction ≤$750- Total is more than $500 but less than or equal to $750

v.  Level 5- Property destruction < $1000- Total is more than $750 but less than or equal to $1000

vi.  Level 6- Property destruction ≥ $1000- Total is more than $1000

e.  Elopement/Wandering- This category refers to the behavior of leaving a facility or program without the programs knowledge or authorization. It does NOT include simply leaving one room to go to another or moving away from a group/area but staying in the same general location. There is a distinction between focused movement to a particular location and movement that is random.

i.  Level 1- Elopement/Wandering, going to a specific location, has community safety skills – This is for the person who leaves the facility and has a specific location they are trying to get to and they have demonstrated the community mobility/safety skills that will allow them to safely make it to that location.

1.  Example: John slips out of the facility unnoticed, goes to the bus stop and safely waits for the bus to come, pays his fare and takes the bus to his girlfriends house. He has a nice visit and returns to the facility 10 hours later.

ii.  Level 2- Elopement/Wandering, going to a specific location, no community safety skills- This is for the person who leaves the facility and has a specific location they are trying to get to but they have NOT demonstrated the community mobility/safety skills that will allow them to safely make it to that location.

1.  Example: Fred slips out of the facility unnoticed and begins walking to his girlfriends hose 12 miles away. He walks out in traffic and narrowly avoids being struck by cars several times. He is eventually returned by the staff at his girlfriends home.

iii.  Level 3- Elopement/Wandering, no specific location, no community safety skills- This is for the person who leaves the facility WITHOUT a specific location they are trying to get to and they have NOT demonstrated the community mobility/safety skills that will allow them to safely make it to that location

1.  Example: Rasputin is at the movies with a group of people. He gets up as if he is going to use the restroom but just keeps walking, out of the facility, across a 6 lane road, sees a butterfly and follows it down to a river, he is eventually found by a sheriffs officer.

iv.  Level 4- Elopement/Wandering, no specific location, enhanced supervision- This is for the person who leaves the facility WITHOUT a specific location they are trying to get to and they have NOT demonstrated the community mobility/safety skills that will allow them to safely make it to that location. The problem is of sufficient frequency that the individual has an enhanced level of supervision as a means to prevent this behavior.