An Assessment and Disposition (A&D) assessment is a specialized, time-sensitive evaluation used in acute care and behavioral health settings to determine an individual’s immediate needs and the safest, most appropriate next steps for their care. The A&D is fundamentally a structured inquiry that synthesizes medical and psychosocial data to answer two overarching questions: Is the person medically stable, and are they safe to be outside of a supervised environment. This ensures that individuals experiencing a crisis are quickly directed to the correct level of support.
The Assessment Phase: Gathering Information
History and Medical Clearance
The initial phase of the A&D process centers on comprehensive data collection, which must be completed efficiently. This begins with a thorough history of the present illness, focusing on the precipitating events that led to the current evaluation and any recent changes in functioning. Clinicians systematically gather information about the patient’s psychiatric history, including prior hospitalizations, suicide attempts, and current medications, as past behavior is a significant predictor of future risk.
A fundamental step is the medical clearance evaluation, which seeks to rule out any underlying physiological conditions that may be causing or contributing to the psychiatric symptoms, such as metabolic imbalances or substance intoxication. The team utilizes laboratory tests and physical examinations to ensure medical stability before proceeding with purely behavioral health planning.
Mental Status and Risk Assessment
Simultaneously, a Mental Status Examination (MSE) is conducted to observe and document the patient’s current cognitive and emotional state, including their appearance, speech, mood, thought processes, and orientation. Risk assessment is an ongoing component of the information gathering, involving direct questioning about any current ideation, intent, or plan for self-harm or violence toward others.
Clinicians actively search for protective factors, such as family support or reasons for living, that can help mitigate the identified risks. Gathering collateral information from family members, first responders, or previous providers is also essential, as the patient’s own account may be incomplete or distorted due to their acute state.
The Disposition Phase: Determining Next Steps
The disposition phase uses the collected assessment data to determine the most fitting level of care. This outcome is directly proportional to the assessed level of risk and the individual’s ability to maintain safety. For instance, a patient with acute suicidal intent and a concrete plan will likely require the highest level of restrictive care.
A finding of imminent danger to self or others typically results in a recommendation for Inpatient Psychiatric Hospitalization, offering 24-hour supervision and stabilization in a secure facility. If the patient is medically stable but requires a highly structured environment, the disposition may be Residential Treatment. Individuals who are not an immediate danger but are unable to function safely in their daily lives may be referred to a Partial Hospitalization Program (PHP) or Intensive Outpatient Program (IOP), which offer structured treatment during the day.
If the patient is deemed safe and stable, with adequate protective factors and community support, the disposition will be a discharge with a specific safety plan and referral to Outpatient Therapy. This plan includes clear follow-up instructions, appointments, and crisis resources, ensuring a smooth transition back to the community. The final disposition balances the need for safety with the principle of providing care in the least restrictive environment possible.
Common Clinical Settings and Professional Roles
Clinical Settings
A&D assessments are most frequently conducted in settings designed to manage acute crises and function as points of entry into the behavioral health system. The Emergency Department (ED) remains the most common site, as it provides immediate access to medical clearance and is legally mandated to evaluate all patients presenting in crisis. Specialized Psychiatric Emergency Services (PES) or Crisis Stabilization Units (CSU) also perform A&D assessments, offering dedicated spaces and staff separate from the general medical environment. Mobile crisis teams often perform these assessments in the community to determine if transport to a facility is necessary.
Professional Roles
The evaluation process relies on an interdisciplinary team, with each member contributing a unique perspective. The Emergency Physician or Psychiatrist provides medical clearance and determines the need for psychiatric medication or involuntary hold based on state laws. Psychiatric Registered Nurses (RNs) perform initial triage, monitor the patient’s physical and mental status, and manage any immediate de-escalation needs.
The Psychiatric Social Worker or Crisis Counselor is often responsible for the comprehensive psychosocial interview, assessing social determinants of health, such as housing and financial stability, and coordinating the discharge plan. This coordination includes linking the patient to the appropriate next level of care and arranging community resources. Collectively, this team synthesizes the medical, psychiatric, and social data to produce a holistic A&D decision that manages the immediate crisis and establishes a pathway for ongoing recovery.