HISTORY OF THE HRST

Developed in 1992

The Health Risk Screening Tool (also known as the HRST) was originally developed in 1992 at the behest of a Federal Judge overseeing the welfare of nearly 1100 individuals in Oklahoma who were members of the Homeward Bound class and who were moved into less restrictive settings all over the state of Oklahoma. Included in this group were a number of individuals with complex needs, including tracheotomies, ventilators and all sorts of high tech supports. Most of these persons were being served in the Tulsa area, but about 25% were scattered all over the state, which is primarily rural and quite isolated in some areas. Judge James Ellison wanted assurances that these folks would have mechanisms to assure their health and safety and asked Karen Green-McGowan, a registered nurse and one of the members of his appointed review panel, to develop a mechanism to assure their safety.

Field Tested on 6000 Persons

Over the next several years, Ms. McGowan worked with nurses in Oklahoma to develop an instrument known there as the Physical Status Review (PSR). This instrument was field tested on some 6000 individuals in the state, and a scoring system was added to allow the level of health risk to be quantified. The state now uses this process to drive health care supports, and every person in the state is rated on this version of the tool.

Use in Other States

A number of other states, including Tennessee, Florida, Louisiana and Georgia, and numerous private providers began implementing the tool, now renamed the Health Risk Screening Tool (HRST), to monitor the health and safety of thousands of individuals. The HRST is used in several states (Tennessee, Oklahoma, Florida) to determine the type and extent of professional support and training and its use is mandated by policy. In Tennessee, for instance, the Division of Mental Retardation Services (DMRS) requires that all recipients of residential services in the department receive a health care level determination using the Health Risk Screening Tool.

The state of Georgia first used the tool in 1997 when a group of developmentally disabled individuals were being transitioned from a congregate care setting into the community. The HRST was used to indicate the level of nursing needs, services and supervision required. Similarly, in Illinois persons are re-rated within 3 - 6 months to determine if their health care status is stable.

Web-based HRST

In 1998, an electronic version of the instrument was developed. This allowed groups of individuals, as well as a specific person to be tracked over time to determine if they were stable or if their health status was deteriorating.

In 2003 work began on a Web-based version of the HRST and in 2007 this was released and thoroughly field tested. The Web-based HRST utilized all the health screening aspects of the paper tool along with the dynamic aspects of the electronic version, and combined these with a consolidated, on-line database with a myriad of data analysis and reporting capabilities.

The State of Georgia implemented the Web-based HRST on a state-wide level in 2007. Over the last two years the state has used the HRST to monitor the health and safety of approximately 13,000 individuals. Georgia has now written the Web-based HRST into its state policy and its use is mandated. The state has made the HRST a requirement for all developmentally disabled individuals transitioning from the hospital into the community and requires the HRST to be included in the Individual Service Plan (ISP) of every individual.