B Staff Intensity Scale

TITLE 89: SOCIAL SERVICES CHAPTER IV: DEPARTMENT OF HUMAN SERVICES SUBCHAPTER d: MEDICAL PROGRAMS PART 144 DEVELOPMENTAL DISABILITIES SERVICES SECTION 144.TABLE B STAFF INTENSITY SCALE Section 144.TABLE B   Staff Intensity Scale Client Name Client Identification Residential Facility Client Birthdate Day Program Assessment Date Assessor Once or More Per: Day Week Month Year a) Coercive Sexual Behavior 1) Touches or grabs others' genitals without their consent and/or is aggressively affectionate but will cease engaging in behavior(s) upon request. 2) Intimidates (without injuring) another to engage in sexual behaviors not including penetration of bodily orifices. 3) Intimidates (without injuring) another to engage in sexual behaviors including penetration of bodily orifices. 4) Injures victim in the course of a sexual attack which may or may not include penetration of bodily orifices. Once or More Per: Day Week Month Year b) Offensive Bodily Exposure 1) Engages in partial or full nudity or genital exposure in view of others in inappropriate locations within the treatment setting only. 2) Exposes self (not including genitals) in a manner offensive to others when outside the treatment setting. 3) Exposes self (including genitals) in a manner offensive to others when outside the treatment setting. Once or More Per: Day Week Month Year c) Suicide Threats and Attempts (These behaviors imply purposeful suicidal action as opposed to self-injurious actions or pica behavior devoid of conscious suicidal intent.) 1) Threatens to commit suicide, may or may not be specific how and does not attempt to injure self (e.g., states, "I'm going to kill myself," but does not follow statement with action). 2) Purposefully engages in behavior that could be fatal, with or without precursory threats, but discontinues behavior upon verbal intervention without injuring self. 3) Purposefully engages in behavior that could be fatal, with or without precursory threats. Injures self, or is prevented from self-injury only by physical staff intervention. Once or More Per: Hr. 4 Hrs. Day Week Month d) Pica 1) Mouthing and licking of non-food objects or compulsive and excessive eating and/or drinking of food and liquids. 2) Consumption of non-food objects in volume small enough to be not life-threatening, e.g., small pieces of rubber, plastic or fabric, soil, small nuts and bolts, grass, etc. 3) Consumption of life-threatening materials such as paint, cleaning compounds, soap, boiling liquids, sharp objects, large objects that may cause alimentary blockages, or small objects (as in subsection (d)(2) above) in large enough volume to be life-threatening. Once or More Per: Day Week Month e) Verbal Abuse 1) Uses mocking and teasing language. 2) Uses language hostile in tone (e.g., sarcastic or intimidating) or content, whether obscene or not; may yell or scream threats of violence without designating a specific person as a target. 3) Directly and explicitly threatens specific others with physical harm or violence. Once or More Per: Day Month 6 Mo. f) Mania Engages in constant activity marked by bizarre behavior, incoherent speech and a nasty response if ignored or crossed. Once or More Per: Day Month 6 Mo. g) Inappropriate Affect Displays emotional tone that is incongruent in general form or degree, with the idea, object or thought accompanying it.  Lack of emotional tone ("flat" affect) or incongruent and changing emotional tone ("labile" affect). Once or More Per: Day Week Month h) Manipulative Behavior 1) Circumvents authority by asking successive individuals in authority the same question/request until receiving the desired answer or permission. 2) Exchanges items of unequal values to own benefit, e.g., trading a candy bar to get a coat. 3) Lies about others to get them into trouble or to obtain a self-serving goal; or uses another person as an agent to perform unlawful, unacceptable or dangerous acts. Once or More Per: 4 Hrs. Day Week Month i) Physical Assault 1) Light striking, kicking, pushing of others that is purposeful, but does not appear to cause pain to the target person. 2) Purposeful attack of others that causes reddening of the skin of the target person. 3) Purposeful attack of others that causes superficial injury or injuries requiring medical attention. 4) Attacks with intent to cause severe injury (e.g., broken bones) using potentially lethal force with or without use of weapon. Once or More Per: Day Week Month 6 Mo. j) Property Theft 1) Takes others' belongings of little or no monetary value or importance – may be indicative of hoarding. 2) Steals for personal use; or steals belongings of moderate or greater monetary value or importance (advance planning is involved); may barter or sell goods taken. Once or More Per: Day Week Month k) Substance Abuse 1) Uses alcohol or non-addictive substances to become intoxicated. 2) Has an alcohol dependency. 3) Is addicted to a controlled substance. Persons who use tobacco products or alcohol at levels that do not produce intoxication should not be scored on this item. Check box if condition is present regardless of frequency. Once or More Per: Day Week l) Extreme Irritability 1) Acts fretful or annoyed in an overly reactive manner to an extent that interferes with own social functioning and/or upsets others. 2) Displays anger in an overly reactive manner that staff perceive as potentially resulting in physical aggression. Once or More Per: Min. Hour 4 Hrs. Day m) Hyperactivity 1) Moves about area continuously in a somewhat predictable and moderately-paced manner. 2) Moves around area continuously in a seemingly random and very rapid manner. 3) Bounces up and down or is in and out of chair/ place/work station continuously. Once or More Per: Day Week Month n) Temper Tantrums 1) Makes inconsequential verbal threats and/or cries loudly, jumps up and down or stamps feet when angered. 2) Threatens others physically when upset and/or curses and kicks or hits objects briefly. 3) Yells loudly, thrashes about, kicks, cries and presents what appears to be an imminent danger to others. Once or More Per: Day Week Month 6 Mo. o) Wanders, Roams, Runs Away 1) Wanders away from immediate supervision but returns when called. 2) Runs away or wanders out of sight and does not return when called even though still within hearing distance. 3) Sneaks away for hours or longer. Once or More Per: Week p) Depression or Excessive Withdrawal 1) Is under-responsive to normal social interactions; inactive; may be quiet and unusually passive. 2) Rejects contact with others; refuses formerly preferred reinforcers; may be inactive, quiet and passive; refuses to eat. Once or More Per: Day Month 6 Mo. Year q) Hallucinations Talks or acts as if experiencing sensory events that others do not (e.g., hearing voices) at various times and places and to an extent that it disrupts or interferes with socially adaptive responses. Once or More Per: Day Month 6 Mo. Year r) Delusions Talks about ideas and events that have no basis in fact and, in spite of evidence to the contrary, to an extent that it disrupts or interferes with his or her socially adaptive responses. Once or More Per: Day Week Month 6 Mo. Year s) Fire-Setting 1) Plays with matches, open flames and/or cigarette lighters.  May have accidentally set objects on fire; potential small danger to self or others. 2) Collects or locates flammable materials, such as paper or leaves, to use in setting small fire; or starts fires in contained vessels, such as waste-baskets, garbage cans. Overall potential moderate danger to others. 3) Sets a large fire, such as a bed or draperies, which has the potential for burning a room or a building; may or may not use an accelerant. Once or More Per: Min. 4 Hrs. Day t) Self-Injurious Actions 1) Purposefully inflicts a blow or bite to self that causes reddening of the skin. 2) Purposefully inflicts a blow or bite to self that causes superficial injury requiring medical attention. 2) Purposefully inflicts on oneself a blow that causes severe injury (e.g., broken bone) or a bite that removes a large amount of tissue. Once or More Per: 4 Hrs. Day Week u) Handles/Plays With Bodily Wastes 1) Plays or touches rectum or genitals; small amount of fecal materials or urine found on hands. 2) Smears feces or urine on own clothing and body; hoards feces on person or in room. 3) Smears feces or urine on others or on nearby objects. 4) Eats feces or urine. Once or More Per: Day Week Month 6 Mo. v) Property Destruction (excluding firesetting). (Please note that the primary maladaption here is property destruction rather than self-injurious actions or assaults that may also cause property destruction.) 1) Purposefully damages own or others' property resulting in a projected negligible or minor repair/replacement cost. 2) Purposefully damages own or others' property with a projected major repair/replacement cost. Once or More Per: Day Week Month w) Resists Supervision 1) Will not comply with staff request to act in a considerate manner (e.g., plays radio too loud, cuts in line) or refuses to comply with staff instructions to correct behaviors or engage in behaviors affecting self in a minor way (e.g., with not bathe regularly, will not brush teeth). 2) Refuses to comply with demands to cease behavior or to cooperate, thus significantly disrupting ongoing activities or the living unit in general. 3) Refuses to cease behavior constituting imminent and significant danger to self or others. Once or More Per: Min. Hour 4 Hrs. Day v) Stereotypical Behavior Repetitive motor or verbal activity, including self-stimulation, which does not serve meaningful purposes (e.g., string twirling, bizarre limb or body movements, rocking, repeated verbalizations; DOES NOT INCLUDE self injurious behavior or masturbation.