# | Behavioral supports needed | No support needed | Some support Needed | Extensive support needed |
1. | Prevention of emotional outbursts | 0 | 1 | 2 |
2. | Prevention of assault or injury to others | 0 | 1 | 2 |
3. | Prevention of property destruction (e.g. fire setting, breaking furniture) | 0 | 1 | 2 |
4. | Prevention of stealing | 0 | 1 | 2 |
5. | Prevention of self-injury | 0 | 1 | 2 |
6. | Prevention of suicide attempts | 0 | 1 | 2 |
7. | Prevention of PICA (ingestion of inedible substances) | 0 | 1 | 2 |
8. | Prevention of nonaggressive but inappropriate behavior (e.g., exposes self in public, exhibitionism, inappropriate touching or gesturing) | 0 | 1 | 2 |
9. | Prevention of sexual aggression | 0 | 1 | 2 |
10. | Prevention of substance abuse | 0 | 1 | 2 |
11. | Prevention of wandering | 0 | 1 | 2 |
12. | Maintenance of mental health treatments | 0 | 1 | 2 |
13. | Managing attention-seeking behavior* | 0 | 1 | 2 |
14. | Managing uncooperative behavior* | 0 | 1 | 2 |
15. | Managing agitated/over reactive behavior* | 0 | 1 | 2 |
16. | Managing obsessive/repetitive behavior* | 0 | 1 | 2 |
17. | Prevention of other serious behavior problem(s) - Specify: | 0 | 1 | 2 |
Subtotal scores of 1s and 2s: | | |
Add subtotals scores for 1s and 2s for total exceptional behavioral support needs scores: | |
* #13-16 are questions added by DDA. They are used as part of the DDA behavior acuity scale and are not used to calculate SIS percentiles. |
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 19-02-020, § 388-828-4380, filed 12/21/18, effective 2/1/19. Statutory Authority: RCW
71A.12.030 and Title
71A RCW. WSR 07-10-029, § 388-828-4380, filed 4/23/07, effective 6/1/07.]