The Health Risk Screening Tool (HRST®): Changing Outcomes for People with IDD by Detecting Risks Earlier

Providers supporting people with intellectual and developmental disabilities (IDD) know that health issues rarely appear overnight. In many cases, subtle changes in behavior, energy, mobility, appetite, or routine may signal an emerging medical concern. These changes can be early indicators of illness or even risk of death if not addressed. When these early signs go unnoticed, what begins as a manageable issue can escalate into a behavioral crisis, an emergency department visit, or even a hospitalization.

For organizations responsible for supporting people with complex needs, identifying those early warning signs is one of the greatest challenges in delivering safe, effective support. Staff must interpret behavioral changes, communicate across interdisciplinary teams, and make decisions with limited clinical information. Without structured systems for identifying medical risk, opportunities for early intervention are often missed.

A recent pilot implementation of the Health Risk Screening Tool (HRST) within Threshold Residential Services provides insight into what can happen when those early warning signs are systematically identified and addressed. The HRST gives answers to key health risk questions and supports assessment across different age groups.

A Pilot Focused on Proactive Health Monitoring

Threshold Residential Services implemented HRST screenings for 51 adults with intellectual and developmental disabilities receiving residential services. The screenings were conducted between August 2024 and January 2025, and they were designed to identify potential health risks across multiple areas that commonly contribute to medical instability in people with IDD.

The HRST evaluates 22 areas of health risk, including factors such as eating and nutrition, bowel function, skin integrity, falls, aggression, and self-injury. Each screening generates a Health Care Level (HCL), which reflects a person’s overall level of medical risk and helps guide monitoring and care planning.

To evaluate the impact of HRST implementation, Threshold Residential Services compared outcomes from calendar year 2024, before HRST screening was implemented, with outcomes from calendar year 2025, following implementation.

The results were striking.

Fewer Behavioral Crises Following HRST Implementation

One of the most notable outcomes observed during the pilot was a significant reduction in behavior-related unusual incidents. In 2024, the organization recorded 55 behavior-related unusual incidents involving peer aggression, self-injurious behavior, or destruction of property. In 2025, following HRST implementation, that number dropped to 24.\

This represents a 56% reduction in behavior-related incidents.

Behavioral changes are often among the earliest indicators that something may be medically wrong. Pain, discomfort, infection, or other health concerns can manifest as agitation, withdrawal, or aggression, particularly when someone has difficulty communicating their symptoms.

By helping teams identify potential medical risks earlier, HRST screening supported more proactive responses to emerging health concerns. Addressing those concerns earlier likely prevented situations that might have otherwise escalated into behavioral crises. This highlights the importance of early intervention, ensuring everyone’s health and safety are prioritized.

Reductions in Hospitalizations and Emergency Department Visits

The pilot also demonstrated measurable reductions in acute medical utilization.

Unanticipated hospitalizations declined from 8 in 2024 to 4 in 2025, representing a 50% reduction. Using a conservative estimate of $30,000 per hospital admission, this reduction represents approximately $120,000 in avoided hospital costs.

Emergency department utilization also declined, from 7 visits in 2024 to 4 in 2025. Based on national cost estimates for emergency department visits among people with IDD, this reduction represents approximately $16,290 in avoided costs.

Combined, these reductions represent an estimated $136,290 in direct medical cost avoidance in a single year.

What’s more, these figures do not include additional operational costs associated with hospitalizations and emergency visits, such as staff supervision, transportation, documentation, care coordination, or disruptions to daily programming.

Health Care Access and Quality for People with IDD

Access to high-quality health care is a critical factor in determining health outcomes for people with intellectual and developmental disabilities. Unfortunately, many people with IDD encounter significant barriers, such as limited health insurance coverage, high out-of-pocket costs, and a shortage of providers trained to address their specific needs. These challenges can delay diagnosis and treatment, increasing the risk of health problems and certain diseases.

To deliver effective care, health care providers must consider each person’s intellectual functioning and adaptive behavior when developing individualized health care plans. Tailoring services to the unique needs of people with intellectual and developmental disabilities ensures that preventive measures, such as screening tests, are accessible and meaningful. Early identification of health risks allows for timely intervention, reducing the likelihood of more serious health issues in the future.

Family and supporter involvement is also essential. Parents and supporters often have valuable insights into the person’s needs, preferences, and daily routines, which can inform support planning and improve outcomes. By prioritizing accessible, person-centered health care and involving families and supporters in the process, providers can help people with IDD achieve better health and a higher quality of life.

Stability Matters for People with IDD

While cost savings are an important outcome for health systems and provider organizations, the impact of preventing medical crises extends far beyond financial measures.

Hospitalizations and emergency department visits can be particularly disruptive for people with IDD. Sudden changes in environment, unfamiliar medical settings, and interruptions in daily routines can increase stress and anxiety, sometimes leading to regression in skills or behavioral instability.

Preventing those destabilizing events helps people maintain their routines, remain engaged in their communities, and continue building independence.

For provider organizations, fewer crises also mean more stable environments for both the people they support and the staff delivering care. Expanding proactive health monitoring through a health risk screening tool can help more people access preventive support and ensure that those at risk receive timely interventions to address emerging health concerns.

A Shift from Crisis Response to Prevention

The findings from the Threshold Residential Services pilot reinforce an important shift taking place across disability services and healthcare systems more broadly: moving from reactive crisis management to proactive health monitoring.

Structured health risk screening tools like the HRST give teams a consistent framework for identifying medical concerns earlier and coordinating responses across interdisciplinary care teams. Rather than waiting until a crisis occurs, providers are better equipped to intervene before health conditions escalate.

While additional research across larger populations will further strengthen the evidence base, the results observed in this pilot highlight the potential impact of proactive health risk screening within residential service settings.

For organizations supporting people with intellectual and developmental disabilities, earlier detection of health risks can mean fewer crises, fewer hospitalizations, and better outcomes for the people they serve.

Additional Resources:

• Learn more about the Health Risk Screening Tool.
• Explore products and other case studies regarding IntellectAbility’s services in our Knowledge Hub.
• Watch a brief overview of the Health Risk Screening Tool on the IntellectAbility YouTube channel.