Attention Providers of Adult Behavioral Health Services: Updated Critical Incidents Definitions

The Office of Behavioral Health (OBH), in coordination with Kepro, have updated the definitions of a Critical Incident to better clarify when it must to be reported through the Kepro Atrezzo system.  

Level One (1) Critical Incident

A Level One (1) Critical Incident are those that result in death or serious injury and/or significantly jeopardize clients, public safety, or program integrity. Such incidents involving clients must be reported to OBH regardless of the location of the incident. A client’s death is always reported as a Level 1, regardless of whether the death was attended or not, and regardless of the cause of death.

Examples of Level 1 Critical Incidents include:

  • Suicide, homicide, other causes of death
  • Clinical or medication error resulting in emergency medical care for client 
  • Lost, missing client or client that left the facility Against Medical Advice (AMA) in a residential/Crisis Stabilization Unit (CSU) placement which would rise to the level of Silver Alert and/or who are under guardianship, in the Care and Custody of the Commissioner, and/or in violation of conditions of release/court order
  • Alleged abuse: physical/sexual, emotional abuse, neglect, and financial exploitation of client by a staff
  • Alleged serious crime (e.g., arson, assault, hostage) by client with extreme risk of harm to client, staff, or public
  • Other serious events (fire, flood, motor vehicle accident in company vehicle with clients that requires medical attention for staff and/or client(s)
  • Natural disaster, building becomes uninhabitable, incidents that require client evacuation from the building
  • Medical outbreak   

Level Two (2) Critical Incident

A Level Two (2) Critical Incident are those where significant errors or undesirable events that compromise quality of care or client safety occur.

Examples of Level 2 Critical Incidents include:

  • Alleged abuse: physical/sexual, emotional abuse, neglect, and financial exploitation of client by someone other than a provider staff
  • Suicide attempt that requires medical intervention
  • Self-harm that requires medical intervention
  • Lost or missing client or client that left the facility AMA in facility (Private Non-Medical Institution (PNMI) residential/ CSU placement client (for greater than 24 hours)
  • medication/drug diversion
  • Duty to Warn 
  • Neglect- is a pattern of conduct, engaged in without the patient's informed consent, resulting in deprivation of food, water, medication, medical services, shelter, cooling, heating, or other services necessary to maintain minimum physical or mental health. (Examples: Malnutrition, dehydration, pressure sores, unsafe, dangerous, or unsanitary living conditions, untreated medical problems) 

Provider Training

A provider training will be held on Wednesday, June 1, 2022, at 2:00 pm to review these changes. To participate in the training please register online. If you are unable to make the training, you can view the pre-recorded training video or view the instructional guide

For questions regarding this change or the upcoming training please contact Kepro Provider Relations at 1-866-521-0027, Option 3, or via email at

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