Guidelines for State APS Systems Administration: Protecting Vulnerable Adults

1. NC Department of Health and Human Services Division of Aging and Adult Services Administration for Community Living: Voluntary Consensus Guidelines for State APS Systems

2. Administration for Community Living The Administration for Community Living (ACL) envisions a comprehensive, multidisciplinary system that effectively supports older adults and adults with disabilities so they can exercise their right to live where they choose, with the people they choose and fully participate in their communities without threat of abuse, neglect, self-neglect, or financial exploitation. • SOURCE: https://acl.gov/

3. Voluntary Consensus Guidelines • The ACL has provided these guidelines to promote effective APS response across the country so that all older adults and adults with disabilities, regardless of state or jurisdiction in which they live, have similar protections and service delivery from APS. • Does not constitute a standard or regulation and does not create a legal obligation nor impose mandates or requirements.

4. Where did the guidelines come from? • Environmental scan/literature review • 1st work group- research/study (Feb & March 2015) • Stakeholder Engagement (July 2015-Feb 2016) • Data Analysis • 2nd work group/Final Draft (July & Aug 2016) • Guidelines updated- February 2019

5. The Recommendations: 7 domains • Program Administration • Time Frames • Receiving Reports • Conducting Investigation • Service Planning • Training • Evaluation and Program Performance

6. 1. Program Administration • A. Ethical Foundation of APS Practice • B. Definitions of Maltreatment • C. Population Served • D. Mandatory Reporters • E. Coordination with other Entities • F. Program Authority, Cooperation, Confidentiality and Immunity • G. Protecting Program Integrity

7. 1. Program Administration • H. Staffing Resources • I. Access to Expert Resources • J. Case Review-Supervisory process • K. Worker Safety and Well-Being • L. Responding during Community Emergency • M. Community Outreach and Engagement • N. Participation in Research

8. 1E. Coordination with other Entities • APS systems should create policies and protocols including the development of: • Memoranda of Understanding • Ensure cross training and co-location of staffs • Promote their collaboration with other entities, as needed, during investigations and interventions to benefit clients.

9. APS should collaborate with… • Law Enforcement • Behavioral health • Medical health • Disability advocates • Substance Abuse providers • Domestic Violence providers • Financial Services/Providers • Legal Services/Providers • Aging Services • Animal Welfare providers

10. North Carolina and Collaboration • Any counties in the room have current MDT’s or other formal relationships? • Our manual encourages collaboration with other service providers- Section III-10 (G.S. 108-A-103b) and VI-5 • Working with other agencies • Assistance with evaluating the report • Assistance with Service Provision • Formal Relationships (MOU/MDT)

11. 1K. Worker Safety and Well-Being • APS involves inherent risk to the worker and can have a marked impact on the ability of the unit to provide services to the adults who need it most • APS systems should create policies and protocols as well as provide adequate resources related to worker safety

12. North Carolina and Worker Safety • No state policy or statutory requirement • Some references in APS manual for best practice • Page III-8, III-14, III-15 • Always encouraged • What are some of the current safety practices used by your agency?

13. 2. Time Frames • A. Responding to the Report/Initiating the Investigation • B. Completing the Investigation • C. Closing the Case *

14. 2C. Closing the Case • We are designed to provide emergency and short term response to urgent situations. • The length of time that services are staying open varies across the nation. • Recommended that APS systems develop and establish case closure criteria and the frequency with which open cases should be reviewed.

15. North Carolina and Case Closure • No State Policy exists • The Requirements for Provision of Services manual requires review and assessment as often as necessary, but at least quarterly, for social services programs- not specific to APS but includes APS • Recommended social work practice • APS cases assessed regularly and closed if need for protection is removed • Assessments based on need of client • “Most cases” should be closed in 90 days • APS Manual III-42 to III-43

16. 3. Receiving Reports of Maltreatment • A. Intake • B. Screening, Prioritizing, and Assignment of Screened in Reports

17. North Carolina and Intake • Statutory requirement to report • State policy states that DSS must accept all reports with A/N/E allegations • Recommended practice and G.S. outlines criteria for APS intake/screening • APS Manual Section III-1 to III-9 outlines both statute, policy, and best practice for intake

18. 4. Conducting the Investigation • A. Determining if Maltreatment has occurred * • B. Conducting an APS client assessment • C. Investigations in Congregate Care settings • D. Completion of Investigation and Substantiation Decision

19. 4A. Determining Maltreatment • Response definition and timeframes are varied and complicated. • Recommended that APS systems establish standardized practices to collect and analyze information when determining whether or not maltreatment has occurred.

20. North Carolina and Case Decisions • No State Policy on collecting and analyzing data • Statute addresses time frames in which to make a decision and notification requirements for the reporter • APS Manual only references “best practices” for making a case decision • 5027 and 5026 required for records • No standardized tools in use • Any counties have a standardized tool they have created?

21. 5. Service Planning • A. Voluntary intervention * • B. Involuntary Intervention * • C. Closing the Case

22. 5A. Voluntary Intervention • Recommended that APS systems develop the client’s APS voluntary service plan using person centered planning principles and monitor that plan until APS case is closed. • Recommended that APS systems establish clear guidelines related to service delivery which incorporates multiple elements related to the adults basic rights.

23. 5B. Involuntary Intervention • Recommended that state APS systems create policies and protocols to respond to situations where there has been a determination of extreme risk and client lacks capacity or cannot consent to services. • The decision for this type of action shouldn’t be taken lightly and APS systems should have clear guidelines related to involuntary interventions.

24. North Carolina and Capacity to Consent • Statute defines “lacks the capacity to consent” • State Policy states evaluation must determine capacity level • Statute requires APS to provide services immediately if the adult consents • Statute allows involuntary intervention by court order for adults lacking capacity • No standardization for determining capacity

25. 6. Training • A. Case Worker and Supervisor Minimum Educational Requirements • B. Case Worker Initial and Ongoing Training* • C. Supervisor Initial and Ongoing Training *

26. 6B. Case Worker Training- Initial/Ongoing • Recommended that APS’ direct service personnel have a worker training process that includes 4 components or phases: • (1) orientation to the job • (2) supervised fieldwork • (3) core competency training, and • (4) advanced or specialized training

27. 6C. Supervisor Training- Initial/Ongoing • Recommended that APS supervisors be qualified by training and experience to deliver APS. • Recommended that all APS supervisors receive initial and ongoing training specific to their job responsibilities and the complex needs of APS clients and managing APS workers. • APS supervisors should have basic supervisor skills training within a year, and then ongoing training in higher level topics such as worker development andspecialized case training.

28. North Carolina and Training • North Carolina has no mandated training for Adult Services • North Carolina has no “minimum” education requirements • Some counties follow the Office of State Personnel/Human Resources to classify positions and the duties those positions perform • Up to counties individually to classify Social Workers into SWI, SWII, SWIII etc

29. 7. Evaluation/Program Performance • Recommended that APS systems develop performance measures, including client outcomes, and collect and analyze data related to those measures on an annual basis. • Data collected should be congruent with the National Adult Maltreatment Reporting System. • APS systems should compile a written report of those performance measures and make that report available to state and federal bodies as well as the public on a regular basis.

30. North Carolina and Performance • Counties complete Annual Survey but no written report published from survey results • NC contributes to NAPSA survey data when requested • Counties evaluate effectiveness differently • How do counties track program performance? • Do any counties publish their county specific data for their community?

31. QUESTIONS?