Risk Assessment Tool for Behavioral Crisis

Utilize risk assessments applicable to the general population. Take into account how the patient’s developmental disabilities affect both risks and protective factors. Note whether recent changes have occurred in any risk or protective factors.

Flag all areas where there are risk issues – also consider factors that may protect from harm.

RISK AREA Patient – Risk factors Caregivers / environment
(includes possible protective factors)
HARM TO SELF Is the patient verbalizing suicidal thoughts or intent?Is there evidence of suicidal behaviors, poor judgment or mental illness?Is there a history of suicidal or para-suicidal behavior?Is the patient unable to identify reasons to keep on living?Is the patient engaging in, or is there evidence of, self harm?Is the patient verbalizing intent to self harm?

Does the patient have a history of self harm?

Is the patient unable to care for self?

Is the patient unwilling to accept support from others?

Is there evidence of neglect and behaviors that put the patient at risk?

Is a means available for the person to commit suicide?Are means available for the person to harm self?Are caregivers able to supervise and protect the person?Are others available and able to assist in the person’s care?
Is the patient being victimized or exploited?Has the patient been victimized or exploited in the past?Is the patient unable to protect self?Does the patient lack insight into possible dangers of the situation?Has the patient failed to show evidence that he/she would ask for help?

Has the patient been unable to get help or protection from others in the past?

Are caregivers able to supervise and protect the person?
HARM TO OTHERS Is the patient verbalizing intent to harm others?Is the patient making physical gestures about hurting others?Has the patient caused physical harm to others?Does the patient have sufficient mobility and strength to potentially harm others?Does the patient’s aggression/harmful behavior tend to escalate quickly and/or unpredictably? Are there vulnerable individuals in the setting who cannot protect themselves?Can caregivers recognize cues and intervene safely?Can the person be supervised safely in current setting without caregivers being at risk of harm while trying to prevent harm to others?
RISK TO ENVIRONMENT Has the patient damaged or attempted to damage property in recent past?If yes, what was the nature and extent of damage?Does the patient have sufficient mobility and strength to be able to cause damage?Does the patient escalate rapidly and/or unpredictably? Are caregivers able to recognize the escalation and intervene effectively?Do caregivers feel comfortable about being able to predict and prevent it?

Original tool: © 2011 Surrey Place Centre.
Developed by Bradley, E, Lunsky Y & Developmental Disabilities Primary Care Initiative Co-editors.
Modified with permission of Surrey Place Centre. This tool was reviewed and adapted for U.S. use by physicians on the Toolkit’s Advisory Committee; for list, view here.

Stein W. Modified Sainsbury tool: An initial risk assessment tool for primary care mental health and learning disability services. J Psychiatr Ment Health Nurs. 2005; Oct.;12(5):620-33.