The Waypoint Elopement Risk Scale (WERS) is a specialized assessment tool developed by the Waypoint Centre for Mental Health Care to systematically evaluate a patient's risk of absconding or elopement. Unlike relying solely on unstructured clinical judgment, the WERS offers a structured, evidence-based framework to guide decision-making, ensuring greater transparency and consistency in risk management across patients. The tool is not a single measure but a set of three distinct sub-scales that capture different aspects of a patient's risk profile: historical factors, stable or modifiable factors, and acute, short-term indicators.
The three core components of the WERS
WERS-Historical (WERS-H)
This sub-scale assesses a patient's past behavior and static risk factors that do not change over time. It is typically scored upon admission and updated annually or following an elopement incident. The WERS-H looks at:
- History of Successful Elopements: Any past instances of unauthorized departures from a facility.
- History of Elope Attempts: Unsuccessful attempts to leave a supervised area.
- History of Failures to Return or AWOLs: Past failures to return from authorized leave or being Absent Without Authorized Leave.
- History of Wandering: Aimless wandering due to a compromised mental state, which can indicate confusion or potential for elopement.
- History of Self-Harm: Past self-harm behaviors, which can sometimes be linked to elopement motivations.
- History of Harm to Others: Any past physical or mental harm inflicted on others.
- Nicotine Use: An extensive history of nicotine use.
- Substance Abuse: A history of drug or alcohol abuse.
WERS-Stable (WERS-S)
This scale focuses on dynamic, potentially modifiable risk factors that change over weeks or months. It is designed for re-evaluation on an approximate monthly basis. The WERS-S includes factors such as recent substance use, medication non-adherence, active symptoms of mental illness, and stress. By regularly assessing these factors, clinicians can adjust care plans and interventions in response to a patient's changing condition.
WERS-Acute (WERS-A)
Designed for short-term risk assessment, the WERS-Acute helps with decision-making regarding immediate, off-unit activities and assesses imminent elopement risk (within the next few hours). This five-item scale documents recent, sudden changes in behavior, personal appearance, anxiety levels, and any other acute destabilizers. Scoring the WERS-A is recommended within 30 minutes of a patient's authorized leave.
How the WERS guides risk management
Once a patient is assessed using the WERS sub-scales, the scores are combined to determine an overall risk category: low, moderate, or high. This categorization directly informs the appropriate risk mitigation strategies. This tiered approach allows facilities to tailor interventions to individual patient needs, moving from less restrictive to more intensive measures as the assessed risk increases.
Comparison of elopement risk assessment tools
| Feature | Waypoint Elopement Risk Scale (WERS) | Algase Wandering Scale (AWS) | Booth Evaluation of Absconding Tool (BEAT) |
|---|---|---|---|
| Application | Inpatient psychiatric facilities, forensic and non-forensic. | Primarily for individuals with dementia. | Canadian forensic inpatient populations. |
| Focus | Multi-faceted assessment (historical, stable, acute) for absconding risk. | Measures specific wandering behaviors like spatial disorientation. | Structured professional judgment tool for absconding, including contextual factors. |
| Format | Three separate, multi-item scales with categorical risk scoring. | Scale assessing the frequency and severity of wandering behaviors. | Multi-item scale with five sections, leading to a professional judgment. |
| Timing | Different sub-scales scored at different intervals (admission, monthly, acutely). | Can be used regularly to monitor behavior changes. | Typically used on a regular, ongoing basis to inform decisions. |
| Mitigation Guidance | Direct guidance on mitigation strategies based on risk category. | Provides information for developing individualized care plans. | Guides the formulation of risk management strategies. |
The importance of a standardized approach
Elopement incidents in healthcare can have severe consequences, including serious injury or death, and often lead to significant institutional scrutiny. Historically, the assessment of elopement risk often relied on inconsistent and unstructured clinical judgment. This approach was problematic because it could lead to variances in how patients with similar risk profiles were managed.
The WERS, by providing a standardized, structured framework, helps address these issues. It encourages a more consistent and transparent process for assessing risk and implementing safety measures. The tool prompts clinicians to consider a comprehensive set of factors, from a patient's historical behavior to their immediate mental and emotional state, allowing for more informed decisions. Furthermore, the tool's focus on both static and dynamic factors ensures that risk is regularly reassessed and managed as a patient's condition changes, promoting a proactive rather than reactive safety culture.
Conclusion
The Waypoint Elopement Risk Scale (WERS) is a sophisticated, multi-component assessment tool vital for mental health facilities. By segmenting risk into historical, stable, and acute categories, it provides a comprehensive and standardized method for evaluating a patient's likelihood of elopement. This structured approach helps clinicians move beyond subjective judgments, allowing for consistent, evidence-based decision-making that enhances patient safety. Ultimately, the WERS enables healthcare providers to implement targeted, proportional risk mitigation strategies, protecting vulnerable patients while supporting their treatment and recovery. The continuous assessment framework ensures that interventions remain relevant and responsive to a patient’s evolving clinical needs.
