Would You Rather Report an Incident or Prevent One? Using IDD Health Data to Reduce Harm and Improve Outcomes
From the IDD Perspectives Webinar, partnering with ANCOR; featuring Craig Escudé, MD, FAAFP, FAADM, FAAIDD, and Daleigh Tallent, MSN, RN, CDDN
Which would you rather do, report an incident or prevent one from even happening? Ask most support teams how they handle incidents, and you’ll hear a familiar sequence: when something goes wrong, an incident report gets completed, the event is reviewed, corrective action may follow — and then attention shifts to the next event. It’s a cycle nearly every organization in the intellectual and developmental disability (IDD) field recognizes, because it’s the one most of us were trained to run.
For provider agencies, group homes, support coordinators, clinicians, and frontline teams supporting people with intellectual and developmental disabilities, the choice matters every time a fall, choking incident, or behavioral crisis turns into harm that might have been identified earlier.
During a recent IDD Perspectives webinar, Dr. Craig Escudé and Daleigh Tallent, MSN, RN, CDDN of IntellectAbility made the case that this traditional cycle, while well-intentioned, keeps organizations perpetually one step behind. This article looks at what a prevention cycle does differently: using baseline health knowledge and ongoing data to spot risk sooner, applying tools such as the Health Risk Screening Tool (HRST®), training supporters to act on what the data shows, and measuring outcomes that can reduce crises, control costs, and improve quality of life for people with IDD.
The Traditional Cycle vs. The Prevention Cycle
The traditional, reactive cycle is built entirely around response: an incident happens, it gets documented, it gets reviewed, and maybe something changes before the next one occurs. Incident reporting systems also need to address reporting biases because they affect data quality. The problem, as Escudé and Tallent laid out, is that this cycle only starts moving after someone has already been harmed.
A prevention cycle runs in parallel with daily support rather than waiting for a crisis: you notice a change, gather information, identify patterns and risks, act early, measure whether the action worked, adjust the support plan, and educate the person and their supporters. A stronger reporting culture is also supported by confidentiality, feedback, and ease of use. Each stage feeds the next, creating an ongoing loop rather than a one-time fix.
Most Incidents Have History and Incident Trends
One of the most important points made during the webinar is that incidents rarely come out of nowhere. They usually have a lead-up — a history of smaller signals that, in hindsight, pointed to what was coming, so teams should describe small changes clearly so patterns can be recognized sooner.
- Falls may follow sedation, weakness, dehydration, or infection.
- Choking may follow changes in swallowing, posture, pace, or alertness, and choking events often first appear as recognizable patterns rather than isolated surprises.
- Behavioral changes may reflect pain, constipation, reflux, infection, or medication side effects, so teams should treat them as early warning signs to watch for.
The early signs are almost always there in daily observations. The challenge for most organizations isn’t that the data doesn’t exist — it’s that early detection depends on reviewing the data and doing analysis before the incident happens.
Know the Baseline, Know the Person
Prevention starts with knowing what “normal” looks like for each individual, so that changes are easier to catch. Tools like a Health Passport — a single place to capture baseline information, medical history, and other essential details — help support staff, nurses, and clinicians create a shared reference point and support completion of a more complete and reliable record in one place instead of relying on memory or scattered notes. A free downloadable version of the HRST Health Passport can be found here: HRST Health Passport – IntellectAbility.
With that knowledge helping organizations in establishing clearer preventive practices and guidelines, organizations need to know:
- Person-specific risks — things like aspiration, bowel obstruction or constipation, dehydration, and seizures that are more likely for a given individual.
- Person-specific preventive measures — for example, diet modification and mealtime monitoring for aspiration risk, bowel tracking and dietary consultation for constipation risk, reviewing meds when side effects may be contributing to risk and other medication concerns, or assistive devices, pharmacy consultation, and environmental evaluation for fall risk.
- The person’s level of acuity — a measure of health needs and medical complexity that helps determine how much healthcare oversight, monitoring, and support someone requires, and that helps guide care planning and allocate resources appropriately.
Yet, when Escudé and Tallent posed the question to webinar attendees — how your organization identifies people at increased health risk and which preventive actions and training to implement — a striking number of respondents pointed to informal methods: team experience and discussion, or simply no formal process at all.
Early Risk Identification Changes Everything
The difference between organizations that stratify acuity and those that don’t is striking. Without acuity stratification, organizations tend to see delayed recognition of health changes, care focused on crisis response, frequent emergency room visits and hospitalizations, and higher, less predictable costs. With acuity stratification in place, the picture shifts toward early recognition of risk, care focused on prevention and stability, fewer preventable emergencies, and better outcomes at a lower cost. Organizations should measure the time spent on incident care, not just the individual incidents, to evaluate whether prevention is working. A post-incident review and debrief documents can help educate teams and refine preventive actions.
That’s the essence of the message: move from reaction to prevention to reduce adverse outcomes by identifying risks earlier.
How the Health Risk Screening Tool (HRST) Works
To operationalize that shift, Escudé and Tallent walked through IntellectAbility’s Health Risk Screening Tool (HRST) — described as the only validated predictive risk engine built specifically for people with IDD and other at-risk populations. Since 1992, it has been used to screen more than 130,000 lives annually, with over 30 years of validated use across the field. It is designed to be implemented in real-world provider settings.
The HRST works in four stages:
- Objective Screening across 22 areas of risk, spanning items like functional status, behavior, physiological conditions, safety, and frequency of services.
- Acuity Scoring, where a numerical risk score is assigned per Rating Item, typically ranging from 0 (no issues within the past 12 months) to 4 (a potentially life-altering or life-defining issue, or hospitalization, within the past 12 months).
- Risk Tiering sorts results into Health Care Levels 1 through 6 — from low risk to high risk — providing providers with a defensible, evidence-based acuity classification.
- Targeted Action, which translates the score into concrete considerations for planning, training, and immediate intervention, helping define the scope of risks that need attention for each person.
The result: every person screened receives an evidence-based acuity level and a person-centered action plan to match — data that flows directly into Service Considerations (what kind of support and equipment a person needs) and Training Considerations (what staff need to know, such as how to manage bowel issues, aspiration risk, or seizures).
Turning Training Into Action
Data alone doesn’t prevent incidents — employees trained to act on it do, especially when that training is supported by reliable processes and technology. That’s where IntellectAbility’s Academy comes in, offering person-centered eLearn courses including the Fatal Five, as well as various health & safety, behavior, and Trauma-Informed Support courses that help teams provide better answers under pressure, learn from brief debrief-style follow-up after incidents, and manage risk more consistently.
Prevention Works — and the Numbers Show It
Escudé and Tallent closed with outcomes data from organizations that have put this approach into practice:
- Threshold Residential Services screened 51 people using the HRST. In the following year, behavior-related unusual incidents declined by 56%, unanticipated hospitalizations declined by 50%, and emergency department utilization declined by 43%.
- Discovery Living, Inc., which trained 230 staff members supporting 150 adults in Fatal Five Fundamentals, saw a 37% reduction in emergency department and urgent care visits within one year, along with an estimated $274,410 saved in medical costs and $15,237 saved in staff overtime.
As the presenters put it simply: prevention improves outcomes, reduces staff burden, reduces reportable events, and improves lives.
The Bottom Line
Reporting an incident will always have its place — organizations need to understand what happened in each instance, respond appropriately, and recognize that poor reporting can lead to significant regulatory penalties, including in the case of a near-miss. But Escudé and Tallent’s message was clear: the goal isn’t to get better at reporting, because prevention is a strategy for managing risk before a failure escalates. It’s to build systems that catch the signs early enough that there’s less to report in the first place, while also strengthening investigation and recovery when incidents do occur. That requires knowing each person’s baseline, their specific risks, their level of acuity, and having staff trained to act on that information before a crisis, not after.
Additional Resources:
- Watch the full webinar recording on our webinar hub: Would You Rather Report an Incident or Prevent One? Using Health Data to Reduce Harm and Improve Outcomes
- Learn more about the Health Risk Screening Tool
- Explore Academy eLearn courses, including the Fatal Five training series
- Explore upcoming IDD Perspectives Webinars for participants seeking more insights and shared learning