Domain 9 of 12·PRIORITY-ELIGIBLE

Behaviour

Challenging behaviour that poses risk to self, others, or property.

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What this domain measures

The Behaviour domain captures challenging behaviour that creates risk — aggression, severe disinhibition, resistance to care, intractable restlessness, self-harm, or inappropriate interference with others. It is one of four Priority-eligible domains: a single Priority score in Behaviour can secure CHC eligibility on its own.

How it's scored (Annex C wording)

DST scoring levels for the Behaviour domain, with verbatim Annex C descriptors.
Level	DST descriptor
No needs	No evidence of 'challenging' behaviour.
Low	Some incidents of 'challenging' behaviour. A risk assessment indicates that the behaviour does not pose a risk to self, others or property or create a barrier to intervention. The individual is compliant with all aspects of their care.
Moderate	'Challenging' behaviour that follows a predictable pattern. The risk assessment indicates a pattern of behaviour that can be managed by skilled carers or care workers who are able to maintain a level of behaviour that does not pose a risk to self, others or property. The individual is nearly always compliant with care.
High	'Challenging' behaviour of type and/or frequency that poses a predictable risk to self, others or property. The risk assessment indicates that planned interventions are effective in minimising but not always eliminating risks. Compliance is variable but usually responsive to planned interventions.
Severe	'Challenging' behaviour of severity and/or frequency that poses a significant risk to self, others or property. The risk assessment identifies that the behaviour(s) require(s) a prompt and skilled response that might be outside the range of planned interventions.
Priority	'Challenging' behaviour of a severity and/or frequency and/or unpredictability that presents an immediate and serious risk to self, others or property. The risks are so serious that they require access to an immediate and skilled response at all times for safe care.

Evidence that moves the score up

Incident logs covering the last 12 weeks with dates, times, triggers, duration, and staff response
PRN (as-needed) medication administration records, especially for behaviour-related drugs (lorazepam, haloperidol, risperidone)
Risk assessments — both general and behaviour-specific (e.g. ABC charts, STAR analysis)
Specialist behaviour assessments (psychology, community LD nurse, psychiatry)
Care plan sections that describe planned interventions and skilled response requirements
DoLS authorisation if in place — evidences the level of restriction needed for safe care
Body-map records of injuries (to self or staff) arising from behaviour
Staff training records showing what specialist skills are required to manage the behaviour

How ICBs commonly under-score this domain

Pattern: Assessor scored Moderate because incidents have reduced since the behaviour management plan was introduced.

Rebuttal: Reduction in incidents is evidence the plan is working — not evidence the underlying need has reduced. Per the well-managed needs principle, the level should reflect the present-day need if support were withdrawn or no longer available.

Source: para 162-166 + DST user notes para 31

Pattern: Assessor scored Low/Moderate because the individual is 'compliant with care' when carers are skilled.

Rebuttal: Skilled carer involvement is the intervention, not the absence of need. The descriptor 'can be managed by skilled carers' is itself Moderate-level wording — it does not de-escalate to Low.

Source: DST Annex C Behaviour Moderate descriptor

Pattern: Assessor scored High instead of Severe because 'planned interventions are effective' some of the time.

Rebuttal: Severe descriptor explicitly contemplates risks 'that might be outside the range of planned interventions'. If any incidents required prompt skilled response outside the planned interventions, Severe is the correct level — not High.

Source: DST Annex C Behaviour Severe descriptor

4-line rebuttal template

I disagree with the [LEVEL] score for Behaviour. The evidence shows [SPECIFIC INCIDENT/PATTERN] which meets the [HIGHER LEVEL] descriptor. On [DATE/PERIOD], [DESCRIBE INCIDENT — who, what, frequency, response required, duration]. Per the well-managed needs principle (National Framework paras 162–166), the current management is the intervention, not the absence of need. If the [SUPPORT/MEDICATION/STAFFING] were withdrawn, the present-day need would be [DESCRIBE]. I therefore request the Behaviour domain be re-scored to [HIGHER LEVEL] with reference to the [SPECIFIC EVIDENCE: incident log dates / PRN records / risk assessment].

Behaviour is one of four Priority-eligible domains

A single Priority score in Behaviour can secure CHC eligibility on this domain alone. The MDT Preparation Pack (£799) walks through exactly how to prepare your Behaviour evidence for the MDT.

View MDT Preparation Pack →