Risk Assessments
When encountering challenging behavior, it is important for clinicians to evaluate the risks presented by each type of problem behavior as part of the process for determining the best course of action. Below is a model of one of three risk assessments for the treatment and management of individuals who exhibit challenging behaviors. For the full model, click here.
Risk Assessment for Problem Behavior
An assessment of the risks and benefits for treating problem behavior must begin with an assessment of the risks of the problem behavior to the individual and to others. This assessment must weigh the risks of problem behavior across multiple dimensions along with the frequency with which the risks are likely to be incurred. The more severe the impact of the problem behavior, and the more frequent it is, the higher the risk. These risks can then be compared to the risks and benefits of treatment.
Dimensions of Risk Assessment for Challenging Behavior
1. What are the dimensions (types) of the risks of the problem behavior? a. Physical risks – physical harm to individuals ranging from tissue damage to death b. Developmental risks – interference to education and/or vocational activities ranging from no interference to no participation c. Social risks – interference with functioning in the family, making friends, participating in community events d. Autonomy risks – interference with the individual’s ability to make decisions regarding their own life e. Economical risks – interference with earning income (e.g., problem behavior interferes with access to work) and risks associated with the problem behavior f. Emotional risks – the stress and trauma caused by the problem behavior and its related risks can have significant impact on the emotional well-being of the individual and others
2. To whom do the risks apply? For each category below, identify the severity of the risk as well as the frequency given no treatment or continuation of current treatment.
a. Individual – the primary focus of this risk assessment is the impact on the individual displaying the problem behavior b. Family – the risks to the family must also be a primary consideration in assessing the risk of the problem behavior c. Peers d. Caregivers e. General public
Assessment for Problem Behavior
The outcomes of the assessment for problem behavior include management, treatment, and crisis management. Although the risks of the problem behavior are critical in determining the next steps, context and culture must also be considered. Context includes an evaluation of the current settings and target settings; culture encompasses setting socially valid goals and using culturally informed assessments.
The three general outcomes include:
- Management – the challenging behavior is “managed” by general protocols (e.g., general school rules and procedures, general guidelines for managing types of challenging behavior such as ignore/redirect, etc.)
- Assessment and Treatment – the function of the challenging behavior is assessed and a function-based treatment is designed and implemented. Typically, an appropriate alternative is taught and reinforced.
- Crisis Management – the challenging behavior requires restrictive procedures to ensure the safety of the client and/or others. Restrictive procedures are defined by their absolute levels of restrictiveness, duration, and efficacy.
