Frequently Asked Questions

The Health Risk Screening Tool (HRST®) is a web-based, HIPAA-compliant, validated health risk screening and stratification instrument designed to detect health destabilization in at-risk populations.

The HRST uses a simple 22-item rating scale designed to determine which people are at the highest risk of illness and health destabilization.

Each of the 22 Rating Items is scored by answering basic yes/no, objective questions about the person receiving supports. Each Rating Item can receive a score of 0 to 4. Once all Rating Items have been scored, the HRST will produce an overall Health Care Level (HCL) ranging from 1-6. Lower Health Care Levels correlate with lower health risk, while higher levels correlate with higher risk.

Based on the scores of the 22 Rating Items, the HRST produces action steps called Service and Training Considerations and Clinical Briefs. These provide important next steps and helpful information for the team to consider, promoting a response to the identified areas of risk.

The HRST was developed to meet the essential support principles derived from the 1984 "Hodges Report" by the Brehon Institute for Human Services. 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

The Hodges Report helped identify the need for an instrument like the HRST and laid some early groundwork for its development.

A brief summary of the Hodges Report:

In 1982, people were moved out of institutions and into the community at six separate sites around Florida. A high death rate was experienced within the first year at the Hodges site. This was not explained by a higher rate of medical fragility or medical complexity of those who lived there. Instead, Hodges had a smaller, less well-trained, and more unstable workforce, with higher staff turnover and fewer staff per shift than other similar entities. As a result of this, several vital steps to the successful oversight and support of people with various types of developmental disabilities were identified.

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 complete the screening process and 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 frequently support them across various environments. The Rater does not need a clinical background. In fact, the HRST was developed primarily for non-clinical supporters to administer.

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

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 whether a trained clinician needs to administer a more in-depth assessment.

Independent researchers at the Center for Outcome Analysis conducted a study focused on life expectancy trends over a 9-year period in a large population screened using the HRST.

The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) 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.”

More information about our validation studies can be found here.

Currently, the HRST is used on over 135,000 people across 5,500 provider agencies and 26 states.

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-A® and SIS-C®) 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 $4.50-$4.75 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 Inquiries@IntellectAbility.com.

Yes, we can integrate the HRST with other electronic health record systems and platforms to whatever degree is necessary.