Ill. Admin. Code tit. 89, pt. 144, tbl. B

Current through Register Vol. 48, No. 38, September 20, 2024

Table B - Staff Intensity Scale

Client Name	_________________	Client Identification	_______
Residential Facility	_________________	Client Birthdate	_______
Day Program	_________________	Assessment Date	_______
Assessor	_________________

a)

Once or More Per:
Day	Week	Month	Year
Coercive Sexual Behavior
1) Touches or grabs others' genitals without their consent and/or is aggressively affectionate but will cease engaging in behavior(s) upon request.	______	______	______	______
2) Intimidates (without injuring) another to engage in sexual behaviors not including penetration of bodily orifices.	______	______	______	______
3) Intimidates (without injuring) another to engage in sexual behaviors including penetration of bodily orifices.	______	______	______	______
4) Injures victim in the course of a sexual attack which may or may not include penetration of bodily orifices.	______	______	______	______

b)

Once or More Per:
Day	Week	Month	Year
Offensive Bodily Exposure
1) Engages in partial or full nudity or genital exposure in view of others in inappropriate locations within the treatment setting only.	______	______	______	______
2) Exposes self (not including genitals) in a manner offensive to others when outside the treatment setting.	______	______	______	______
3) Exposes self (including genitals) in a manner offensive to others when outside the treatment setting.	______	______	______	______

c)

Once or More Per:
Day	Week	Month	Year
Suicide Threats and Attempts
(These behaviors imply purposeful suicidal action as opposed to self-injurious actions or pica behavior devoid of conscious suicidal intent.)
1) Threatens to commit suicide, may or may not be specific how and does not attempt to injure self (e.g., states, "I'm going to kill myself," but does not follow statement with action).	______	______	______	______
2) Purposefully engages in behavior that could be fatal, with or without precursory threats, but discontinues behavior upon verbal intervention without injuring self.	______	______	______	______
3) Purposefully engages in behavior that could be fatal, with or without precursory threats. Injures self, or is prevented from self-injury only by physical staff intervention.	______	______	______	______

d)

Once or More Per:
Hr.	4 Hrs.	Day	Week	Month
Pica
1) Mouthing and licking of non-food objects or compulsive and excessive eating and/or drinking of food and liquids.	______	______	______	______	______
2) Consumption of non-food objects in volume small enough to be not life-threatening, e.g., small pieces of rubber, plastic or fabric, soil, small nuts and bolts, grass, etc.	______	______	______	______	______
3) Consumption of life-threatening materials such as paint, cleaning compounds, soap, boiling liquids, sharp objects, large objects that may cause alimentary blockages, or small objects (as in subsection (d)(2) above) in large enough volume to be life-threatening.	______	______	______	______	______

e)

Once or More Per:
Day	Week	Month
Verbal Abuse
1) Uses mocking and teasing language.	______	______	______
2) Uses language hostile in tone (e.g., sarcastic or intimidating) or content, whether obscene or not; may yell or scream threats of violence without designating a specific person as a target.	______	______	______
3) Directly and explicitly threatens specific others with physical harm or violence.	______	______	______

f)

Once or More Per:
Day	Month	6 Mo.
Mania
Engages in constant activity marked by bizarre behavior, incoherent speech and a nasty response if ignored or crossed.	______	______	______

g)

Once or More Per:
Day	Month	6 Mo.
Inappropriate Affect
Displays emotional tone that is incongruent in general form or degree, with the idea, object or thought accompanying it. Lack of emotional tone ("flat" affect) or incongruent and changing emotional tone ("labile" affect).	______	______	______

h)

Once or More Per:
Day	Week	Month
Manipulative Behavior
1) Circumvents authority by asking successive individuals in authority the same question/request until receiving the desired answer or permission.	______	______	______
2) Exchanges items of unequal values to own benefit, e.g., trading a candy bar to get a coat.	______	______	______
3) Lies about others to get them into trouble or to obtain a self-serving goal; or uses another person as an agent to perform unlawful, unacceptable or dangerous acts.	______	______	______

i)

Once or More Per:
4 Hrs.	Day	Week	Month
Physical Assault
1) Light striking, kicking, pushing of others that is purposeful, but does not appear to cause pain to the target person.	______	______	______	______
2) Purposeful attack of others that causes reddening of the skin of the target person.	______	______	______	______
3) Purposeful attack of others that causes superficial injury or injuries requiring medical attention.	______	______	______	______
4) Attacks with intent to cause severe injury (e.g., broken bones) using potentially lethal force with or without use of weapon.	______	______	______	______

j)

Once or More Per:
Day	Week	Month	6 Mo.
Property Theft
1) Takes others' belongings of little or no monetary value or importance - may be indicative of hoarding.	______	______	______	______
2) Steals for personal use; or steals belongings of moderate or greater monetary value or importance (advance planning is involved); may barter or sell goods taken.	______	______	______	______

k)

Once or More Per:
Day	Week	Month
Substance Abuse
1) Uses alcohol or non-addictive substances to become intoxicated.	______	______	______
2) Has an alcohol dependency.	______	______	______	______
3) Is addicted to a controlled substance.	______	______	______	______
Persons who use tobacco products or alcohol at levels that do not produce intoxication should not be scored on this item. Check box if condition is present regardless of frequency.

l)

Once or More Per:
Day	Week
Extreme Irritability
1) Acts fretful or annoyed in an overly reactive manner to an extent that interferes with own social functioning and/or upsets others.	______	______
2) Displays anger in an overly reactive manner that staff perceive as potentially resulting in physical aggression.	______	______

m)

Once or More Per:
Min.	Hour	4 Hrs.	Day
Hyperactivity
1) Moves about area continuously in a somewhat predictable and moderately-paced manner.	______	______	______	______
2) Moves around area continuously in a seemingly random and very rapid manner.	______	______	______	______
3) Bounces up and down or is in and out of chair/ place/work station continuously.	______	______	______	______

n)

Once or More Per:
Day	Week	Month
Temper Tantrums
1) Makes inconsequential verbal threats and/or cries loudly, jumps up and down or stamps feet when angered.	______	______	______
2) Threatens others physically when upset and/or curses and kicks or hits objects briefly.	______	______	______
3) Yells loudly, thrashes about, kicks, cries and presents what appears to be an imminent danger to others.	______	______	______

o)

Once or More Per:
Day	Week	Month	6 Mo.
Wanders, Roams, Runs Away
1) Wanders away from immediate supervision but returns when called.	______	______	______	______
2) Runs away or wanders out of sight and does not return when called even though still within hearing distance.	______	______	______	______
3) Sneaks away for hours or longer.	______	______	______	______

p)

Once or More Per:
Week
Depression or Excessive Withdrawal
1) Is under-responsive to normal social interactions; inactive; may be quiet and unusually passive.	______
2) Rejects contact with others; refuses formerly preferred reinforcers; may be inactive, quiet and passive; refuses to eat.	______

q)

Once or More Per:
Day	Month	6 Mo.	Year
Hallucinations
Talks or acts as if experiencing sensory events that others do not (e.g., hearing voices) at various times and places and to an extent that it disrupts or interferes with socially adaptive responses.	______	______	______	______

r)

Once or More Per:
Day	Month	6 Mo.	Year
Delusions
Talks about ideas and events that have no basis in fact and, in spite of evidence to the contrary, to an extent that it disrupts or interferes with his or her socially adaptive responses.	______	______	______	______

s)

Once or More Per:
Day	Week	Month	6 Mo.	Year
Fire-Setting
1) Plays with matches, open flames and/or cigarette lighters. May have accidentally set objects on fire; potential small danger to self or others.	______	______	______	______	______
2) Collects or locates flammable materials, such as paper or leaves, to use in setting small fire; or starts fires in contained vessels, such as waste-baskets, garbage cans. Overall potential moderate danger to others.	______	______	______	______	______
3) Sets a large fire, such as a bed or draperies, which has the potential for burning a room or a building; may or may not use an accelerant.	______	______	______	______	______

t)

Once or More Per:
Min.	4 Hrs.	Day
Self-Injurious Actions
1) Purposefully inflicts a blow or bite to self that causes reddening of the skin.	______	______	______
2) Purposefully inflicts a blow or bite to self that causes superficial injury requiring medical attention.	______	______	______
3) Purposefully inflicts on oneself a blow that causes severe injury (e.g., broken bone) or a bite that removes a large amount of tissue.	______	______	______

u)

Once or More Per:
4 Hrs.	Day	Week
Handles/Plays With Bodily Wastes
1) Plays or touches rectum or genitals; small amount of fecal materials or urine found on hands.	______	______	______
2) Smears feces or urine on own clothing and body; hoards feces on person or in room.	______	______	______
3) Smears feces or urine on others or on nearby objects.	______	______	______
4) Eats feces or urine.	______	______	______

v)

Once or More Per:
Day	Week	Month	6 Mo.
Property Destruction (excluding firesetting).
(Please note that the primary maladaption here is property destruction rather than self-injurious actions or assaults that may also cause property destruction.)
1) Purposefully damages own or others' property resulting in a projected negligible or minor repair/replacement cost.	______	______	______	______
2) Purposefully damages own or others' property with a projected major repair/replacement cost.	______	______	______	______

w)

Once or More Per:
Day	Week	Month
Resists Supervision
1) Will not comply with staff request to act in a considerate manner (e.g., plays radio too loud, cuts in line) or refuses to comply with staff instructions to correct behaviors or engage in behaviors affecting self in a minor way (e.g., with not bathe regularly, will not brush teeth).	______	______	______
2) Refuses to comply with demands to cease behavior or to cooperate, thus significantly disrupting ongoing activities or the living unit in general.	______	______	______
3) Refuses to cease behavior constituting imminent and significant danger to self or others.	______	______	______

x)

Once or More Per:
Min.	Hour	4 Hrs.	Day
Stereotypical Behavior
Repetitive motor or verbal activity, including self-stimulation, which does not serve meaningful purposes (e.g., string twirling, bizarre limb or body movements, rocking, repeated verbalizations; DOES NOT INCLUDE self injurious behavior or masturbation.	______	______	______	______

Ill. Admin. Code tit. 89, pt. 144, tbl. B

Amended at 19 Ill. Reg. 2890, effective February 22, 1995