Safety risk assessment

Define the event before rating risk

“Unsafe behavior” is too vague. State what another person could observe, where it occurs, who may be harmed, the exposure window, and the consequence being assessed. Separate injury, elopement, traffic entry, ingestion, fire, self-harm, aggression, property damage, medical deterioration, and abuse concerns.

Different events need different expertise and response. One combined risk score can hide an urgent low-frequency hazard.

Immediate danger uses the emergency route

The SAMHSA crisis-help page says anyone in danger or having a medical emergency in the United States should call 911 or go to the nearest emergency room. Other countries use their local systems.

Do not delay urgent help for a complete assessment, routine approval, payer contact, or data entry. Once immediate safety is addressed, preserve facts and continue the appropriate clinical, medical, protective, or legal review.

Assess severity, likelihood, and exposure

Severity asks what harm could occur. Likelihood asks how often the defined event may occur under the specified conditions. Exposure asks how often the conditions arise. Record confidence and missing information.

A rare event with catastrophic potential may deserve stronger controls than a frequent event with mild impact. Past absence does not prove future safety when the environment or person has changed.

Include vulnerability and protective factors

Health conditions, communication barriers, mobility, age, medication, trauma history, sensory conditions, environment, staffing, and dependence on others can change vulnerability. Protective factors may include reliable communication, trained partners, supervision, environmental controls, medical treatment, safe exits, and effective coping or help-seeking skills.

Confirm that protective factors are actually available in the setting. A written plan cannot protect someone when staff have never seen it or AAC is missing.

Ask the client directly

Invite the person’s account of danger, discomfort, preferred support, and unacceptable responses. Use speech, AAC, sign, gesture, writing, movement, or another reliable form. Protect an accessible way to stop, leave, or ask for help.

Representative input can add history. It should not replace the person’s communication or erase dissent.

Consider medical and interdisciplinary needs

The current BACB Ethics Code addresses medical referral, assessment, intervention risk, competence, data, and continual evaluation. Pain, seizures, sleep, feeding, medication, injury, trauma, mental health, mobility, or communication may require another qualified professional.

Name each question and owner. A behavior analyst can assess behavioral variables within competence without ruling out medical or mental-health risk.

Match controls to the risk

Prioritize prevention and the least restrictive safe support: remove hazards, improve communication, change the environment, clarify roles, train partners, address health, and create usable exit or help routes. Define the threshold for pausing an activity.

Any restrictive response needs its own lawful authority, competence, consent, monitoring, reporting, and review. A risk score alone does not authorize it.

A fictional workshop example

Imani is a fictional adult joining a woodworking workshop. The team predefines five entry gates: eye protection, secured chemicals, AAC or backup, trained partner, and a clear exit. All five are ready in 3 of 6 planned visits. Three visits change location or postpone before entry.

After correcting storage and backup communication, all gates are ready in 5 of 5 later visits. Imani uses a stop message in two eligible situations and partners respond in 2 of 2. These figures measure system readiness and response, not the probability of injury or the workshop’s overall safety.

Reassess when conditions change

Triggers include a new event, injury, near miss, health change, medication, new setting, staff turnover, equipment change, missing support, weak implementation, client withdrawal, or new information. Set a regular review date for ongoing risks.

Document who accepted residual risk and under which authority. Acceptance should follow reasonable safeguards and cannot waive a client’s rights or another party’s legal duty.

A risk matrix supports discussion

A simple likelihood-by-severity matrix can help teams compare hazards and prioritize work. Define each scale, time window, data source, and uncertainty. Keep the underlying event description and evidence beside the rating.

Do not let a color replace judgment. Two “red” risks may require different medical, environmental, legal, or clinical responses. Recalculate after safeguards and record which assumptions changed.

Track overdue controls, unavailable protective factors, near misses, injuries, emergency actions, and client concerns. Report high-priority items even when the denominator is small. Rare exposure can make a percentage unstable while the potential consequence remains serious.