Adult Protective Services Basic Skills Training Presented by: North Carolina Department of Health and Human Services Division of Aging and Adult Services Module II Day One

Family Assessment & Change Process Receive and Screen Referral  Evaluate the Need for Protective Services Obtain Service Authorization Plan and Mobilize Essential Services Close Protective Services Case

o Evaluation of reports involving a danger of death must be initiated immediately. o Evaluation of reports involving irreparable harm must be initiated within 24 hours. o All other allegations within 72 hours. APS Manual Section 6510 pg. III-10 Prompt Evaluations All reports must be evaluated promptly:

Definition of Emergency Disabled adult in substantial danger of death or irreparable harm.

Evaluate Need for Protective Services Conduct Evaluation: ▪ Assess six functional areas ▪ Complete three steps in evaluation Make Case Decision: Substantiated Unsubstantiated ▪ Send required ▪ Send required notices notices ▪ Obtain authorization for service ▪ Make appropriate referrals

 Whether the adult is disabled.  Whether the adult is abused, neglected, or exploited.  Whether the adult is in need of protective services.  Whether the adult has or lacks the capacity to consent to protective services. Focus of Evaluation The focus of the evaluation is to determine:

Steps in Evaluation A complete evaluation includes: 1.A visit to the disabled adult 2.Medical, psychological and/or psychiatric evaluations, when needed. 3.Consultation with others. APS Manual Section 6510 pg III-12

Practice Issues: Pre-Evaluation  Prior history of mistreatment Check any old records (income maintenance, as well as services )  Prior knowledge to APS Review the case record  Prior/present law enforcement involvement If violence is indicated check to see if individuals are known to law enforcement  Existing court orders  Public records

Practice Issues: Pre Evaluation cont……  Discuss the report with your supervisor Safety Concerns (who should accompany you on the initial visit) Report involves an emergency requiring quick action  Evaluations in Adult Care Homes Discuss with AHS (adult homes specialist) Fear of Reprisal by staff/residents

Involving Law Enforcement at Initial Visit APS Manual III-16 When is it recommended Worker feels unsafe Weapons in home Crime committed Danger to self or others Recommended by law enforcement Recommended by supervisor or agency attorney Disadvantages Fear and suspicion of client Difficult for trust-building with client and/or alleged perpetrator Black/white/shades of gray: language difference between APS and Law Enforcement

Hmmmm????? What might be some of the challenges to accessing the adult?????????

Gaining Access: Rapport at the Door The first visit should be unannounced Non threatening Identify yourself and make introductions Be prepared to show ID Use respect when addressing the adult Be careful not to patronize or infantilize Use non-verbals Confidence, Warmth, Non-judgmental, Calm, Sensitivity

Gaining Access: Rapport at the Door cont..  Build rapport Having prepared communication statements may be helpful: “We frequently find that people aren’t aware of the many services that are available” “I understand your reluctance and realize that it must not be easy allowing a stranger into your home”

I’m at the Door….Now What?????? How do you introduce yourself? What do you say?

Gaining Access: The Do’s →Take your time →Start slowly →Use engagement techniques →Start where the client is →Watch your verbal language →Speak Clearly →Open Ended Questions →Do not yell or bombard with questions →Watch your body language

Gaining Access: The Do’s Your eyes Your nose Your earsYour touch Bring “sense-ability” to the door

Dealing with Resistance Be aware of possible causes Allow client to vent Manage your own feelings Use communication skills: listen with your body and your heart Clarify concerns Be as flexible as possible Remember, you are in the client’s home

Dealing with Resistance cont….. If your authority to conduct a private interview is challenged, explain that you have a legal responsibility to evaluate reports of abuse, neglect, and exploitation Administrative Search and Inspection Warrant APS manual III-76-78

Adult Protective Services Community Evaluation A thorough evaluation of the protective service reports shall include identifying indicators of abuse, neglect or exploitation and the disabled adult’s strengths and limitations by assessing the following functional areas  Physical Health  ADLs/IADLs  Mental Health/Emotional Functioning  Social Support  Environmental Situation  Economic Functioning APS Manual Section 6510 pg III-12

Major health problems Essential medical services Medications Sensory impairments Indicators of abuse or neglect Physical Health

Major Health Problems Identify any major health problems Be alert for problems that are the result of mistreatment Consider whether or not any of the problems incapacitate the adult Try to determine if any of the adult’s problems impair his/her decision making ability

Essential Medical Services Determine whether the adult is receiving the services to maintain their health Does the adult have a physician Identify any barriers which are preventing the adult from obtaining the necessary services

Sensory Impairments Identify strengths and weaknesses in the adult’s vision, hearing or speech Be alert for sensory problems which might impair the adult’s ability to communicate decisions

Medications Is the client receiving the medications needed to maintain their health Assess medication compliance Side effects of medications

Indicators of Abuse or Neglect Physical Indicators of abuse and neglect Bruising Skin Tears/Breakdown Bed Sores

Ambulation Bathing Dressing Eating Grooming Toileting Transfer Activities of Daily Living

 Home Maintenance  Housework  Laundry  Meal Preparation  Money Management  Shopping/Errands  Telephone Use  Transportation Instrumental Activities to Daily Living

↔ Adult’s living arrangement ↔ Type of residence ↔ Environmental risk factors ( Safety, adequacy, and accessibility of essential features of home) ↔ Level of endangerment ↔ How does the client feel about the environment? Environmental Situation

 Orientation  Memory  Judgment  Mental/Emotional Assessment (Diagnostic and symptom elements) Mental Status/Emotional Functioning Level of Functioning in Different Domains

Purpose of Mental Health Assessment ↗ Determine whether the adult is disabled due to mental health problems ↗ Determine whether the adult is receiving services necessary to maintain mental health ↗ Baseline to help the worker determine whether the adult has/lacks capacity

How finances are managed. (by whom?) Monthly income/expenses Assets Any financial problems in meeting basic needs Indicators of exploitation. Economic Functioning

Social Support  Helps the worker determine if the adult has a caretaker, who the caretaker is, and the support the caretaker is providing  Identifies the adult’s formal and informal support network  Include family, friends, neighbors, etc.

The adult is determined to be disabled; The adult is determined to be abused, neglected, or exploited; and The adult is determined to be in need of protective services A report is not substantiated if any one of these three conditions is not met. APS Manual III-23 Case Decision An APS report is substantiated if:

Capacity to Consent The decision about the client’s CAPACITY TO CONSENT should be made AFTER the case decision is made.

 Oral  In Writing Immediately upon completing the evaluation and making the case decision APS Manual III Required Notices Notices to the Complainant:

! Evidence of abuse, neglect or exploitation is found; or, ! The evaluation was conducted on a patient or resident of a nursing or combination facility, mental health residential facility, or adult care home; or, ! Financial exploitation is found in a Medicaid funded facility. APS manual III-23 Written Report A Written Report of the Evaluation must be completed when:

 The name, address, age and condition of the adult;  The allegations (but the reporter’s identity should not be revealed);  The evaluation, including the agency’s findings and supporting documents;  The conclusions; and  Recommendations for action. APS Manual III-23 Written Report Contents The Written Report must include:

The District Attorney The Division of Health Service Regulation The Division of Medical Assistance Other Governmental Agencies Distribution of Written Report The Written Report should be sent to: