Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 144 - DEVELOPMENTAL DISABILITIES SERVICES › Table B - Staff Intensity Scale

Current through Register Vol. 48, No. 28, July 12, 2024
Client Name
_________________
Client Identification
_______
Residential Facility
_________________
Client Birthdate
_______
Day Program
_________________
Assessment Date
_______
Assessor
_________________
a)
Once or More Per:
Day
Week
Month
Year
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.
______
______
______
______
b)
Once or More Per:
Day
Week
Month
Year
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.
______
______
______
______
c)
Once or More Per:
Day
Week
Month
Year
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.
______
______
______
______
d)
Once or More Per:
Hr.
4 Hrs.
Day
Week
Month
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.
______
______
______
______
______
e)
Once or More Per:
Day
Week
Month
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.
______
______
______
f)
Once or More Per:
Day
Month
6 Mo.
Mania
Engages in constant activity marked by bizarre
						  behavior, incoherent speech and a nasty response if ignored or
						  crossed.
______
______
______
g)
Once or More Per:
Day
Month
6 Mo.
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).
______
______
______
h)
Once or More Per:
Day
Week
Month
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.
______
______
______
i)
Once or More Per:
4 Hrs.
Day
Week
Month
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.
______
______
______
______
j)
Once or More Per:
Day
Week
Month
6 Mo.
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.
______
______
______
______
k)
Once or More Per:
Day
Week
Month
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.
l)
Once or More Per:
Day
Week
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.
______
______
m)
Once or More Per:
Min.
Hour
4 Hrs.
Day
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.
______
______
______
______
n)
Once or More Per:
Day
Week
Month
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.
______
______
______
o)
Once or More Per:
Day
Week
Month
6 Mo.
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.
______
______
______
______
p)
Once or More Per:
Week
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.
______
q)
Once or More Per:
Day
Month
6 Mo.
Year
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.
______
______
______
______
r)
Once or More Per:
Day
Month
6 Mo.
Year
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.
______
______
______
______
s)
Once or More Per:
Day
Week
Month
6 Mo.
Year
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.
______
______
______
______
______
t)
Once or More Per:
Min.
4 Hrs.
Day
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.
______
______
______
3) Purposefully inflicts on oneself a blow that causes
						  severe injury (e.g., broken bone) or a bite that removes a large amount of
						  tissue.
______
______
______
u)
Once or More Per:
4 Hrs.
Day
Week
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.
______
______
______
v)
Once or More Per:
Day
Week
Month
6 Mo.
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.
______
______
______
______
w)
Once or More Per:
Day
Week
Month
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.
______
______
______
x)
Once or More Per:
Min.
Hour
4 Hrs.
Day
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.
______
______
______
______