Using the DST-PH

When using the tool you can reveal more information about each risk factor and options by clicking the cell with your mouse.

To change the risk score, click the down arrow to the side of the risk score you would like to change and select the number from the drop down menu. This will automatically update the overall score and risk rating for the section.

Risk rating and final risk stratification will be automatically calculated and updated as you fill the tool in.

An intellectual disability (ID) affects the way a person learns new things throughout their lifetime, based on an Intellectual Quotient (IQ) of 70 and below and is generally diagnosed in childhood. This is often referred to as a learning Disability.

A formal diagnosis of learning disability is needed to complete this decision support tool.

In, some cases the formal diagnosis has either not been given or determined within childhood or a person is referred to as having learning difficulties but is considered to have a learning disability. In these occasions a referral to Specialist Learning Disability Service for diagnosis is only needed if there are concerns regarding a person’s physical and mental well-being or significant behavioural issues

• “Moderate/Severe/Profound ID”

If the person has a moderate, severe or profound Learning Disability and a score of 3 should be given.

• “Mild ID”

If the person has a mild learning disability and a score of 1 should be given.

• “No ID”

If the person has no formal learning disability diagnosis then a score of 0 should be given.

The formal diagnosis of Neurodevelopmental Condition is not always necessary to be present when scoring this section.

If a person is suspected of having a neurodevelopmental condition such as Autism then an AQ10 assessment could be undertaken to help identify if formal diagnosis would be appropriate.

• “Yes”
  If the person has a formal diagnosis with clear evidence of a suspected Neurodevelopmental Condition, then a score of 2 should be given
• “No”
  If the person has no formal diagnosis or evidence of a Neurodevelopmental Condition, then a score of 0 should be given

Behavioural Problems are often referred to as Challenging Behaviour and defined as ‘culturally abnormal behaviour of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities".

• “Yes”
  If behavioural presentation is impacting on the person accessing and receiving health services, then a score of 3 should be given.
• “No”
  If there are no significant behavioural problems displayed, or behavioural difficulties are well managed, then a score of 0 should be given.

Score in this section to be based on number of medication groups a person is prescribed.If the person is prescribed ‘As required’ medication such as pain relief then this is not to be included as a medication group unless is taking on a frequent/regular basis.

• “Two or more groups of medications”
  If the person is prescribed two or more groups of medication, then a score of 2 should be given
• “One group of medication”
  If the person is prescribed one group of medication, then a score of 1 should be given
• “No medication”
  If the person is not prescribed any medication, then a score of 0 should be given

The scoring in this section is to be based on the person’s current mental health state and the impact this is having on the person accessing healthcare. Do not score based on diagnosis of mental illness, only if mental health condition is impacting on the person engaging with Primary and Secondary Care to maintain their physical health. All Eating Disorders including Avoidant/Restrictive food intake Disorder (ARFID) are to be scored in this section.

• “Yes”

If the person has a diagnosis of a mental illness that is not well managed or actively being treated, and it impacting on access to health care, then a score of 3 should be given.

If the person has no diagnosis of mental illness but there are significant concerns regarding mental health presentation, then a score of 3 should be given.

• “No”

If there are no concerns regarding mental health presentation, or if the person has a diagnosis of mental illness but it is well managed and not impacting on access to healthcare, then a score of 0 should be given.

The score in this section is to be based on any recent transition from children’s service, education or changes to the home and level of care the person has received in the last 6 months which has had a negative impact on their presentation.

• “Yes”
  If the person has recently moved home or changes have been made to their support and/or package of care which have had a negative impact on the person, then a score of 3 should be given
• “No”
  If the person has no recent changes to care and support or transition or recent changes which have not impacted the individual

The score in this section to be based on person current or history (within the last 5 years) of alcohol and drug problems.

Evidence for this could be a person has previously received support from drug and alcohol services or self, family or carers reporting issues.

• “Yes”
  If the person has a history of substance or alcohol abuse (within the last 5 years) or current issues of substance abuse, then a score of 1 should be given.
• “No”
  If the person has no alcohol or drug problems, then a score of 0 should be given.

The score should be based on difficulty engaging the person to attend the GP surgery routinely for annual health checks or attending and accessing primary and secondary healthcare services. This could include physical health monitoring tools for people with more severe levels of disability such as health passports, health action plans, or condition specific health monitoring documents.

• “No”
  If there is limited and poor information regarding the person’s physical health with no evidence of the person receiving annual health check or any regular monitoring of physical health or review of needs, then a score of 3 should be given.
• “Yes”
  If the person is actively accessing GP surgery and attending annual health checks with plans and actions in place for physical health needs, then a score of 0 should be given.

This score to be mainly based on an individual having a diagnosis of epilepsy. Do NOT score any other neurological condition in this section.

• “Yes- significant problems”
  If the person has a diagnosis of epilepsy that is not managed effectively and is causing significant problems to physical health, or does not have a diagnosis of epilepsy but significant concerns are raised regarding suspected epilepsy that requires interventions, then a score of 3 should be given.
• “No”
  If the person is diagnosed with epilepsy which is well managed, regularly reviewed by primary care or Neurology, with no recorded seizures in the last 12 months, then a score of 0 should be given.

Scores in this section are to be based on the diagnosis of an acquired brain injury or other neurological condition. 
Include; Dementia and Alzheimer disease both early and late onset. 

• “Yes- (progressive or degenerative including dementia)”
  Is there is a diagnosis of neurological condition or an acquired brain injury that is progressive or degenerative, then a score of 3 should be given.
• “No”
  ​​​​​​​If there is no evidence of an acquired brain injury or any neurological condition, then a score of 0 should be given.

Score in this section based on infection affecting a major system/organ including respiratory tract infections.

Acute kidney injury caused by urinary tract infection included in this section.

Rate ALL infections of the body in this section only. 

• “Yes”
  If the person has a diagnosed infection or recurrent infection affecting a major system/organ including respiratory tract infections, then a score of 3 should be given.
• “No”
  If the person does not have a diagnosed infection, then a score of 0 should be given.

The score in this section is to be based on diagnosis of respiratory conditions and/or difficulties a person is currently experiencing.
Do not score lung cancers, respiratory infection or dysphagia related conditions in this section.  

• “Yes”
  If the person has a diagnosis of a respiratory condition or is having difficulties with their breathing, then a score of 2 should be given.
• “No”
  If the person has no respiratory difficulties or conditions, then a score of 0 should be given.

Score based on diagnosis for all forms of cancers/malignancies or where cancer is suspected and investigations are required to identify.

• “Yes”
  If the person is diagnosed with cancer /malignancy or suspected cancer, then a score of 3 should be given.
• “No”
  If the person has no diagnosis or suspected cancer or malignancy or where the person has successfully received treatment and has been cancer free for 2 years and above, then a score of 0 should be given.

Score based on individual with a diagnosis of chronic dysphagia, or history of dysphagia or swallowing difficulties.
Respiratory infections are NOT to be scored in this section.

• “Yes”
  If the person has a diagnosis of dysphagia and/or modified diet due to swallowing difficulties, or if the person has recently has a Percutaneous Endoscopic Gastrostomy [PEG] due to swallowing difficulties/aspiration within last 6 months, then a score of 3 should be given.
• “No”
  If the person has no diagnosis of dysphagia or swallowing difficulties, or have had 6 months with no issues with PEG, then a score of 0 should be given.

The Score in this section is to be based on the person’s current Body Mass Index.

• “Yes - significant (BMI under 15 or over 30)”
  If the person has a Body mass index under 15 or over 30 in obese or underweight category, then a score of 3 should be given.
• “Yes - minor (BMI 15-18.5 or 25-30)”
  If the person has a Body mass index 15 -18.5 or 25 – 30 in overweight range, then a score of 1 should be given.
• “No”
  If there are no concerns regarding person’s nutritional intake and Body Mass Index in healthy range, then a score of 0 should be given.

Score in this section based on diagnosed gastrointestinal problems and constipation.

• “Yes”
  If the person has gastrointestinal problems or constipation, or where a persons bowel management plan is not effective then a score of 1 should be given. People with Iron deficiency, crohn’s disease, coeliac disease and colitis
• “No”
  If there are no concerns regarding gastrointestinal problems or constipation, or where the person has a bowel management plan surrounding constipation which is effective, then a score of 0 should be given.

Score in this section based on diagnosed endocrine conditions. 
Include nutritional deficiencies and kidney disease/failure in this section. 
Score should be given in this section only for any other major system conditions which cannot be explained and not covered anywhere else in the tool.

• “Yes”
  If the person has a diagnosed endocrine condition, then a score of 2 should be given.
• “No”
  If the person has no diagnosis of any endocrine condition, then a score of 0 should be given.

This section should be scored if the person has a diagnosed cardiovascular or circulatory condition.

• “Yes”
  If the person has diagnosed cardiovascular condition or circulatory condition, or if person has difficulties managing blood pressure or cholesterol levels with difficult compliance to treatment plan, then a score of 2 should be given.
• “No”
  If the person has no cardiovascular or circulatory conditions, or if person has high blood pressure and/or high cholesterol but is well managed with medication with regular review, then a score of 0 should be given.

Score in this section to be based on a person’s mobility and posture.
Do NOT score in this section if swelling is related to another condition and already rated in another section such as cardiovascular disease.

• “Yes- significant problem”
  If the person has difficulties with their mobility, posture and positioning requiring support and intervention, or if person has swelling to feet and legs caused by fluid retention, then a score of 3 should be given.
• “No”
  If the person is fully mobile and there are no concerns regarding mobility, posture or positioning, then a score of 0 should be given.