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Detect Health Risk in Vulnerable Populations with the Health Risk Screening Tool

The most widely used, validated health risk screening tool for people with disabilities.

The Health Risk Screening Tool (HRST) offers one of the leading screening tools for intellectual disability risk management and support . This health risk assessment tool is a web-based rating instrument developed to detect health destabilization in vulnerable populations and ensure that proper care and support is provided at all times.

The HRST monitors for health risks associated with developmental and physical disabilities which specifically affect systems of the body and the person’s ability to engage in functional activities. This allows clinicians to make the real-time care decisions that other health screening tools might not support..

Determine the Risk

The most important outcome of the HRST screening is to guide in the provision of health care support and surveillance. The instrument is used to determine the types of further assessment and evaluation required by the person to be safe and healthy in the least restrictive setting.

How it Works

The Health Risk Screening Tool (HRST) is a web-based, HIPAA compliant rating instrument developed to detect health destabilization in vulnerable populations. 

This unique disability screening tool looks for health risks associated with a wide variety of disabilities, including developmental disabilities, physical disabilities, disabilities associated with aging and other conditions, all of which specifically affect systems of the body and the person’s ability to engage in functional activities and which many other health screening tools overlook. 

Part of the instrument examines the health risks associated with psychiatric or behavioral disorders, particularly those that result from medications, self-injurious behavior or restriction of movement.

The HRST is a simple 22-item scale designed to find out who is at the greatest risk of illness and health destabilization. It then responds by producing action steps that empower support staff in the form of special attention and prevention.

Scores for 22 rating items are assigned by the user answering a series of objective Yes/No questions related to each item. The resulting numerical totals of the 22 rating items are assigned Health Care Levels associated with degrees of health risk.

Features & Functions:
  • Detects health destabilization early in vulnerable populations.
  • Field-tested, validated, reliable and user-friendly.
  • Helps meet CMS health and safety requirements.
  • Quantifies level of health risk based on objective criteria.
  • Establishes a health baseline and allows the health status to be monitored.
  • Assists with transition planning and continuity of care.
  • Defines acuity.
  • Identifies health related support needs specific to the person.
  • Determines types of further assessment, evaluation and staff training.
  • Enhances Individual Service Plan development.
  • Enables personalized and less restrictive settings.
  • Assists with budgeting and equitable resource allocation.
  • Provides web-based, real-time data accessibility.
  • Reports can display numerous parameters:
    • State-wide
    • Region
    • County
    • Provider
    • Facility
    • Demographics
    • And more


Three independent studies have been completed using the Health Risk Screening Tool and were conducted on people with intellectual and developmental disabilities
Journal of Nursing Measurement
“An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People With Intellectual Disabilities” Vol. 28, Issue 1 –  April 2020

The HRST can predict mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity.


Independent researchers with the Center for Outcome Analysis and the Georgia Department of Behavioral Health and Developmental Disabilities collaborated to study the ability of the HRST to predict mortality in people with IDD. The study highlights the efficacy of the HRST to predict mortality in a sample of 12,582 people with IDD. The researchers concluded that the “HRST’s Health Care Levels are predictive of mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity for people with IDD.” 

A quote from the study

“All three methods of analysis employed in our study (Kaplan–Meier, Cox regression, and binary logistic regression) indicate that the six-point health risk score (i.e., Healthcare Level) produced by the HRST was prognostic of mortality in a sample of persons with intellectual disability. That is, the instrument is able to identify the degree of vulnerability in such a population.


Merrick and Morad (2011)(2) recommend that an HRA (Health Risk Assessment) become a standard component of the life plan of a person with an intellectual disability because it would allow for the detection of conditions that could compromise longevity, and our results suggest that the HRST can meet this need.”

Click here to read the Research Article >

Additional Studies Validating the HRST

The Center for Outcome Analysis (COA)

Predictive Validity of a Health Risk Screening Tool Designed for People with Developmental Disabilities, Michael J. Roszkowski, Ph.D., and James W. Conroy, Ph.D. Center for Outcome Analysis, 2016.
The study was conducted by Dr. James Conroy of the Center for Outcome Analysis and was done on a sample of over 16,000 people with IDD over a nine-year span and concluded that the HRST’s Health Care Level was prognostic of longevity.


Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD)

A second study is presented by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD). The Annual Mortality Report focuses on mortality, mortality trends, and related information pertaining to the health and care received by individuals with intellectual and developmental disabilities served by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD). The report focuses on an analysis of mortality data and findings from DBHDD’s mortality review process. Reports have been scheduled for publication in August of each year since 2013 and cover the prior calendar year of January 1 through December 31.

The graph below depicts that with each one point increase in Health Care Level, there is a statistically significant increase in the rate of death.

Frequently asked questions

An HRST rater is a person who has permission to conduct a screening using the HRST.  Raters are required to complete a 3-4 hour, self-paced online training course prior to screening.  This online course educates the rater on how to input information into the HRST, conduct accurate screenings, and demonstrates best practices when using the HRST. The ideal choice for a rater is a support person who knows the person well, supports them in various environments, and has access to documents and other support people in the person’s life.  The rater does not have to be a clinician or have a clinical background.  Though clinicians such as nurses can be raters, the HRST was designed to be used by those supporters who do not have clinical training.  Direct Support staff or provider managers make for ideal raters.  Your designated Service Team will assist in choosing the right raters.

 The role of the nurse is very important, even if the nurse is not the designated rater.  Nurses (RNs or LPNs) are trained to complete a process called the Clinical Review.  A Clinical Review is required for all Health Care Levels 3 or higher. The Clinical Review is primarily a quality assurance measure.  Nurses are given additional training to complete this review.  Additionally, nurses can use the screening results to help other non-clinical staff better appreciate identified risks.  Nurses also use the HRST to help them determine who really needs nursing support and to what degree.  The Training Considerations are evaluable to nurses as it informs them on what specific training staff need to support the person around that person’s areas of risk.  The Service Team will help nurses get the full benefit of the HRST.

Screening time depends largely on the medical complexity of the person.  Average screening time of the 22 rating items takes about 30-60 minutes. Updates only take minutes. Ongoing training from our service area will help raters screen more accurately and efficiently over time.

The HRST should be updated at-a-minimum once per year.  Think of it as an annual check-up. An ideal time to complete an annual update of the HRST is when preparing to renew the person’s annual plan. However, it is vital that the HRST be updated anytime the person experiences events that would affect scores, such as falls, injuries, seizure activity, ER visits, etc.  The goal of the HRST is to show an objective progression of health destabilization so the team can take action. This can only happen if the team keeps the HRST updated as the person experiences these changes.  The importance of this cannot be overstated.  The Service Team will assist the client to ensure everyone is receiving timely updates.

While screening is important, it is not the end but rather the beginning.  Screening reveals where there are potential or current health risks and how intense those risks are but if nothing is done about those risks, the person will never benefit.  The HRST is subject to the same outcome of any tool out there in that scores are determined and then just forgotten about.  In the case of the HRST, this could mean life or death.  Once a screening is completed the HRST produces an overall Health Care Level (HCL) which shows overall risk intensity.  Equally important, the HRST will produce Service and Training Considerations. These Considerations give the team direction on how to take action on identified risks. It is the primary job of the client’s Service Team to help users understand the importance of the HCL and proper application of the Considerations.

Studies have validated that the HRST Health Care Levels are predictive of mortality. In fact, a recent study out of the state of Georgia reveals that “similar to previous years, there was a statistical association between HCL and mortality rate in 2018.”  In addition, “each one-unit increase in HCL was associated with an 87% increase in the odds of dying.1”  Knowing each person’s HCL can empower action to prevent unnecessary deaths.  Emphasis on HCL’s will be a major component of our service delivery to the client.


1 2018 Annual Mortality Report, Georgia Department of Behavioral Health and Developmental Disabilities, August 2019.

Every HRST rollout is unique because every client is unique.  HRST rollouts are both flexible and structured.  Flexible in the sense that they adapt to unique client dynamics but structured to include vetted steps and components that have proven to be successful time and time again.  By answering a few questions about the client’s target environment, we can provide a rollout plan that requires very little work on behalf of the client.  The service department strives to make the rollout of the HRST as easy as possible for the client on all levels.  To this end, we provide protocols, orientation webinars, and materials to ensure that those who will use the HRST are prepared and ready. 


Every client has a designated HRST Service Team.  This team consists of an HRST Service Rep and an HRST Clinician (nurse).  The job of this service support team is to work with the client to not only ensure a smooth rollout but to help the client get the most out of the HRST beyond the rollout.  This team will work with the client to identify goals the client wishes to meet as a result of using the HRST. The team also provides support to all levels of the client’s system to promote maximum use of the tool.  This minimally includes state personnel, regional personnel, providers, support staff, case managers, and others. The team remains in close communication with key stakeholders throughout the use of the HRST.



Yes. We offer both technical support and clinical support.  Any user can easily and quickly access our support team to get assistance.  Our support team works in tandem with the HRST Service Team to assist users at all levels.

The number, type, and frequency of HRST trainings are determined during the initial rollout of the HRST.  At the very least, HRST raters are required to complete an online training course that enables them to accurately screen a person using the HRST.  Other trainings can occur in both live and/or webinar formats. Your HRST Service Team will craft a training plan that helps educate all levels of your system or agency about the HRST.  HRST trainings are specifically designed for various support components such as raters, clinical reviewers, case managers, direct support staff, state personnel, and so on.

Yes. We have linked with many data systems to import and export data to and from the HRST. Our development team can work with your current EHR or MAR to provide interoperability between systems. As always, we take HIPAA laws and regulations very seriously and any transfer of data into or out of the HRST follows best practices as it relates to those laws and regulations.

Most definitely. HRS opts to have a 3rd party HIPAA compliance audit performed on a bi-yearly basis. All employees and contractors are required to complete HIPAA training at hiring and throughout their involvement with HRS.

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