NABITA membership has more than doubled over the last year. To help new members implement the NABITA Standards for Behavioral Intervention Teams (BITs), and to provide continuing members with a refresher, NABITA is launching a Tip of the Week series specifically focused on the BIT Standards. Twenty standards, twenty Tips of the Week (maybe more) aimed specifically at the practical application of the BIT Standards (Note: the twenty Tips may not be published consecutively so that NABITA can bring you timely updates regarding other topics).
Standard 11. Objective Risk Rubric: Teams have an evidence-based, objective risk rubric that is used for each case that comes to the attention of the team.
The use of objective risk assessments is a crucial component of the BIT process. Assigning a risk level to each individual of concern each time they are referred creates consistency and allows the team to engage in an objective decision-making process and use a shared language. The NABITA Risk Rubric is a research-based, expert system useful for the initial triaging of emotional health concerns, life stressors, and/or the potential for violence. The tool should be used in conjunction with further training and study. A starting place for this would be to read the NABITA Risk Rubric white paper.
One component of an objective risk rubric is establishing a baseline. A baseline is a set of behavioral data that serves as a reference for establishing normal activities for the individual referred, making it easier to identify deviations that indicate the presence of distress or a threat. When evaluated with relevant detail, baselines make detecting changes faster and more accurate.
Practical tip – Teams should apply a standardized tool to each referral, regardless of how severe or how insignificant the referral seems. If subjective opinions, such as “this referral is not that big of a deal,” drive the assessment and intervention phases of the BIT process, BITs run the risk of either over- or under-reacting or missing key risk indicators. By using an objective risk rubric, teams can mitigate potential bias, manage their own risk or liability, and streamline the process. Assessing the level of risk is critical to identifying any safety concerns and deploying appropriate interventions to address those concerns. The NABITA Risk Rubric is designed to be the initial assessment applied to every referral. Following the initial assessment and risk rating, BITs can (and often should) utilize additional assessments to gather further data to assess risk most effectively.
NABITA often receives questions related to the risk rubric similar to, “How do we effectively assess and assign a risk level if we do not have much information about the individual of concern?” As highlighted in the tip for Standard 6 , “The BIT’s effectiveness is only as good as the information it has available to it regarding individuals of concern. BIT members must gather information before arriving at the BIT meeting so that they are ready to report out. To ensure members arrive at meetings with the necessary information, chairs or case managers should distribute the agenda before the meeting and clearly outline which individuals of concern will be discussed so that members can arrive prepared.” When more information is gathered, a more accurate baseline and risk level can be assigned. Remember, the lack of information is also information. For example, consider a referral that indicates a student had an outburst of anger in class that resulted in a disruption to the educational environment for other students. If during the data gathering phase, it is shared that the referred student has no previous conduct history or referrals for outburst of anger, the lack of a previous referral often indicates that the newly referred behavior is a deviation from the student’s norm (e.g., baseline) and they may be experiencing a triggering event or life stressor. Remember, using the NABITA Risk Rubric is an iterative process. Regularly assessing individuals throughout the intervention phase aids the team in ensuring they are best meeting the students’ needs in the moment.