Frequently Asked Questions

In 1982, people were moved out of institutions into the community at six separate sites around Florida. A high death rate was experienced within the first few months at the Hodges site. This was not explained by a higher rate of medical fragility or medical complexity in those supported.

Instead, Hodges had a smaller, less well-trained, more unstable workforce with higher staff turnover and fewer staff on any given shift than other similar entities. From this study, the following key principles were deemed essential in the successful oversight and support of people with various types of developmental disabilities. Among them are:

•  Always know if a person’s condition is getting better or worse.
•  Have an early warning system to detect destabilization.
•  Do not let chronic health issues become routine or invisible.
•  Records must provide useful data about trends.
•  Ensure continuity of care across providers.
•  Monitor residential settings to help ensure health and safety

This study and its outcomes would give way to what is today known as the HRST, which was specifically designed and developed to meet these support principles.

The HRST is uniquely designed to identify subtle signs of health destabilization in people with intellectual/developmental disabilities (IDD) and other at-risk populations, such as people with physical disabilities, traumatic brain injuries, and disabilities associated with aging.

HRST Raters are designated by the state or agency utilizing the HRST. There are no minimum requirements for this role outside of completing IntellectAbility’s Online Rater Training and, eventually, Advanced Rater Training. The best Raters are those who know the person being screened well and supports them frequently in various environments. The Rater does not have to have a clinical background. In fact, the HRST was developed mainly to be administered by non-clinical supporters.

Examples of Raters include House Managers, Program Managers, Case Managers, Nurses, DSPs, etc. The designated Rater should include as much input from the person in support and their current supporters as possible when conducting the screening.

Screening is a process for evaluating the possible presence of a particular problem and typically involves questions that elicit a yes or no response. Screenings are often completed by personnel who are trained in the use of a particular tool.

Assessment is a process for defining the nature of a problem, determining a diagnosis, and developing specific treatment recommendations. Assessments are typically completed by physicians, nurses, or other clinicians with specialized training.

Both screening and assessment tools are useful in certain situations. The goal of the HRST is to quickly and uniformly identify and quantify risk and determine if a trained clinician needs to administer a further, more in-depth assessment.

Consider the following example to help provide a better understanding of the difference between screening and assessment.

One day while visiting your local pharmacy or drug store, you notice an unmanned machine used to capture health information. You sit down, place your arm through a cuff, and press start. Within moments the machine produces health-related values for you to review, such as weight, BMI, blood pressure, etc. It notes that in a few areas, you are outside of the “normal” range. At this point, you would not go to the pharmacist and ask for medications or a treatment plan, rather, you might decide to schedule an appointment with your primary doctor to investigate further why certain areas of your health are out of range. After further, more in-depth assessment, your doctor may place you on medications or engage a specific health care plan with you.

In this example, the HRST can be seen as the machine used to screen you to note areas where further assessment or analysis may be needed.

Independent researchers with the Center for Outcome Analysis conducted a study focused on life expectancy trends over about a 9-year span of time on a large population screened using the HRST.

In addition, the Georgia Department of Behavioral Health and Developmental Disabilities has used the HRST in its annual mortality study for nearly a decade. This study repeatedly reveals a robust statistical association between the HRST Health Care Level (HCL) and mortality rates. 

GA annual mortality reports can be found at: https://dbhdd.georgia.gov/organization/be-informed/reports-performance/mortality-reports

Study results can be found in the article entitled “An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People With Intellectual Disabilities”  in the Journal of Nursing Measurement, Volume 28, Issue 1 –  April 2020.

Two key conclusions from the study of over 12,000 people with IDD:

“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.”

“Moreover, the HRST can serve as one basis for objectively determining nursing staffing allocations in facilities serving individuals with intellectual disability.”

Currently, the HRST is used on over 100,000 people across 2,400 provider agencies and 26 states. 

In addition to serving as a 24/7 source of web-based information about a person’s health risk, data from the HRST has been leveraged to provide information to:

• Complement state incident management and sentinel event reporting processes
• Provide context for state mortality reporting processes
• Assign Case Management support levels, provide data for initial and annual Level of Care (LOC) determinations
• Inform prioritization for individuals on IDD HCBS Waiver waiting lists
• Measure healthcare acuity to inform direct support and nursing staffing needs
• Provide an electronic platform for nursing assessment data, healthcare plans, and person-centered plans
• Address continuity of care concerns related to direct support and case management staffing turnover
• Inform state Medicaid IDD program on individualized budget and rate-setting activities
• Address CMS Home and Community Based Services (HCBS) Waiver Health and Safety Performance Measures (PMs) and provide data for valid and reliable reporting on PMs
• Inform state and provider direct support staff training initiatives
• Inform support needs in the person-centered plan
• Determine appropriateness for IDD Medical Health Homes
• Provide direct access to health risk information during selected IDD-specific telemedicine encounters

Most importantly, it can improve the quality and quantity of life for at-risk populations

The HRST is a unique and proprietary screening tool and the intellectual property of IntellectAbility. It has been approved for sole source purchase in 7 states and qualifies for a Medicaid match in multiple states.

Yes – the overall Health Care Level (HCL), a score of 1-6, as assigned by the HRST, can be used in conjunction with other tools (such as the Supports Intensity Scale (SIS-AÒ and SIS-CÒ) and the Inventory for Client and Agency Planning (ICAP) to inform the rate setting process. Georgia and Illinois both use it for these purposes. 

The cost of the HRST is based on a “per person per month” model. By “person,” we mean the person in support who is screened. That monthly fee ranges from $3.50-$3.75 per person per month. There is no additional fee for the number of times the screening is updated or for how many users have access to the screening/results.

Many states draw down the Medicaid Match for HRST-related activities, making it even more affordable.

For more pricing information, visit our pricing page or reach out to us at 727-437-3201 or Inquiries (at) ReplacingRisk.com.

Yes – we can integrate the system with other electronic record-keeping systems and platforms to whatever degree is necessary.