ASSESSING AN ADULT’S CAPACITY TO CONSENT

1. ASSESSING AN ADULT’S CAPACITY TO CONSENT

2. LEARNING OBJECTIVES • Define autonomy, capacity, and incapacity. • Be empowered to make the capacity decision • Become familiar with factors that may influence capacity. • Be able to access other professionals to assist with gathering information to make a capacity decision

3. APS Process & Capacity Exercise Using numbers 1-6, take a few minutes to order the steps in the APS process

4. FAMILYASSESSMENT AND CHANGE PROCESS AS USED IN ADULT PROTECTIVE SERVICES Receive and Screen Referral Evaluate the Need for Protective Services • Obtain Service Authorization Plan and Mobilize Essential Services Close Protective Services Case

5. APS Process & Capacity Making the capacity decision is the first step in obtaining service authorization. The capacity decision is not made at intake. Repeat referrals must be accepted if they meet the screening criteria. An alleged disabled adult cannot refuse an evaluation.

6. Key Terms of Capacity Assessment WHAT IS AUTONOMY? • Autonomy is the highest principle in legal, psychological and medical issues. • “Autonomy” means the right to make one’s own decisions.

7. Capacity APS Manual III-29 Being aware of the limitations or deficiencies in one’s surroundings Being aware of one’s own mental or physical limitations Being aware of resources available to assist in meeting one’s needs Being aware of the consequences to oneself if nothing is done to improve or remedy one’s situation

8. Capacity to Consent to Protective Services Refers to an adult’s ability to fully comprehend his/her situation and exercise judgment regarding the particular services that are protective in nature.

9. Capacity Evaluation A complete capacity evaluation can include: • A physical examination • A neurological examination • Short and long term memory assessment • Assessment of executive function • Exam for existing psychological disorders

10. Capacity May Vary… • As a result of physical or mental stress. • According to the complexity of the decision • From day to day. • From morning to evening.

11. Factors that influence Capacity • Substance Abuse • Depression • Social Setting • Nutrition

12. Lacks the Capacity to ConsentAPS Manual III-28 108A-101(l) Lacks sufficient understanding or capacity to make or communicate responsible decisions concerning his person, including, but not limited to, provisions for: health or mental health care, food, clothing or shelter, because of physical or mental incapacity.

13. Incapacitated due to a disability Is part of the definition of a disabled adult. It is related to the person’s functioning and ability to care for himself/herself or arrange for care to be provided.

14. Capacity vs. Competency Capacity • Functional/Clinical Term • Mental/Cognitive ability to understand the nature and effects of decisions Competency • Legal Term • Having sufficient capacity, ability, or authority to make decisions

15. CAPACITY VS. COMPETENCY CapacityCompetency Decision used for Provision of Decision used for Protective Services Appointment of Guardian Often temporary Usually long term Decision made by DSS or Decision made by Clerk District Court Judge of Superior Court or Jury

16. IMPLICATIONS OF A JUDGEMENT OF INCAPACITY • Make decisions about medical treatment • Personal Care • Testify in court • Choose where to live

17. Common Mental Health Problems of Older Adults Delirium Dementia Depression Personality Disorders

18. Assessing Capacity and Interviewing Tips Use a strength-based approach Assess capacity throughout the evaluation Interview the adult alone Interview the adult more than once Judge capacity in the best of circumstances

19. Interviewing Tips cont’d…. • Be aware that strangers are perceived as outsiders • Take the time to establish rapport • Speak Clearly, avoid professional jargon/slang • Be Respectful

20. What do I Say??? Ask Questions That Focus On: • The client’s understanding of relevant information • The quality of the client’s thinking process • The client’s ability to demonstrate and communicate a choice • The client’s understanding of his/her own situation

21. G.S. 108A-103(B) The staff and physicians of local health departments, area mental health, developmental disabilities, and substance abuse authorities, and other public or private agencies shall cooperate fully with the director in the performance of his duties. These duties include immediate accessible evaluations and in-home evaluations where the director deems this necessary.

22. When to Access Another Professional Adult has a known history of psychosis. Adult exhibits psychotic symptoms. Adult actively receives treatment for mental health problems. Adult has fluctuating capacity. Adult is Non-Verbal

23. Information of Interest to Other Professionals Mood or Attitude of Adult Orientation of Adult Memory Deficits Treatment History Thought Content and/or Process Sleep and/or Appetite Changes General Medical Conditions

24. Capacity Dismantled Intensity: refers to the severity of the symptoms and the impact on capacity Duration: refers to how long a symptom or symptoms have been present and the impact on capacity Frequency: refers to how often a symptom or symptoms occur and the impact on capacity Capacity may be situation specific Capacity may be time limited

25. Mental Status Tools All assessment tools: • Have limitations • Cannot measure all variables in assessing capacity • Should never be used exclusively to assess a client’s capacity

26. Mental Status Tools Mini Mental Status Exam (MMSE) Does Not: address decision making for specific tasks elicit the client’s desires, wishes, or fears detect mild dementia or advanced cognitive disorders Short Portable Mental Status Questionnaire Briefly assesses Orientation, Long Term Memory One of the easier tools to administer

27. Questions/Comments?