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A Best-practice Model for New Hampshire’s Adult Protective Services (APS) Program The Structured Decision Making® (SDM) System Presented by: Rachel Lakin.

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Presentation on theme: "A Best-practice Model for New Hampshire’s Adult Protective Services (APS) Program The Structured Decision Making® (SDM) System Presented by: Rachel Lakin."— Presentation transcript:

1 A Best-practice Model for New Hampshire’s Adult Protective Services (APS) Program The Structured Decision Making® (SDM) System Presented by: Rachel Lakin Administrator of Adult Protective Services Program Sally Varney Director of Quality Improvement

2 Overview of Presentation
Describing adult and elder maltreatment and the role of NH Bureau of Elderly and Adult Services (BEAS), Adult Protective Services (APS) Program Describing APS’ decision support system known as Structured Decision Making® or SDM® 3. Current Status, Challenges and Opportunities Structured Decision Making® and SDM® are Registered in the U.S. Patent and Trademark Office by the National Council on Crime and Delinquency

3 Adult Protective Services
APS programs were created by states to protect vulnerable adults and the elderly with trained staff responding to and investigating allegations of self-neglect and maltreatment by others. Per an AARP Public Policy Institute publication, March 2011, “calls for APS have increased during the recent recession which began in Dec However, funding for these services either remained flat or decreased in many states” in recent years. APS programs are generally under-funded and exist with no federal funding. The current hope is that Congress will appropriate funds for the Elder Justice Act passed as part of the Affordable Care Act.

4 Adult Protective Services
Per a March 2011 GAO Report, Elder Justice, Stronger Federal Leadership Could Enhance National Response to Elder Abuse: “The Adult Protective Services (APS) program in each state is generally responsible for identifying, investigating, resolving and preventing abuse of adults” “In addition, given state governments’ current fiscal crises, there is concern that potential cuts in funding for APS will threaten these programs’ ability to effectively respond to the needs of a rapidly growing older adult population and the increased incidence of elder abuse that can come with it.” NH’s APS Structured Decision Making® system is designed to assist in the prioritization of cases based on severity of the incident(s), vulnerability of the identified victim(s), and potential risk of future harm. In light of limited and possibly reduced resources, SDM® information assists staff, supervisors and administrators to direct resources to where they are the most needed.

5 NH APS Program The APS Program in NH serves adults and elderly that are determined to be incapacitated (see definition below). Many states’ APS programs serve just the elderly. NH’s APS Program is charged with providing protection for incapacitated adults who are abused, neglected, or exploited (RSA 161-F:42). Incapacitated means that the physical, mental, or emotional ability of a person is such that he is unable to manage personal, home, or financial affairs in his own best interest, or he is unable to act or unable to delegate responsibility to a responsible caretaker or caregiver (RSA 161-F:43, VII)

6 NH APS Program The following are the types of maltreatment of incapacitated adults that NH APS addresses: Self-neglect: The failure of an adult to meet his/her own basic needs of food, housing, clothing and medical care. Neglect: The failure to meet an adult’s basic needs of food, housing, clothing and medical care. Emotional Abuse: Behaviors that harm an adult’s emotional well-being and/or self-worth, e.g., name calling, scaring, embarrassing, destroying property, not allowing a person to see friends and family. Physical Abuse: Injuries such as hitting, kicking, pushing, slapping, burning or other show of force or physical harm Sexual Abuse: Forcing an adult to take part in sexual behavior when he/she did not or could not consent Exploitation: Illegal use of an adult’s money, property or other assets

7 NH APS Structured Decision Making® System
Newness: Implemented in 2008. Creativity: Innovative use of research to support APS practices. Effectiveness: Supports decision making at the case, supervisory and administrative levels. Transferability: Other state and county APS agencies have implemented components of the system; others have expressed interest in the system. Significance: Represents an evidence-based approach to practice improvement.

8 NH APS Structured Decision Making® System
Why did NH APS design and implement an SDM® system? To systematically assess adults’ safety, risk of future harm, and service needs to determine the best response(s); To establish consistency and accuracy in decision-making throughout the life of APS cases; To obtain quantitative information to measure and monitor outcomes; to determine: immediacy of initial responses, safety (immediate harm)status, risk (future harm)status, and access to needed services. To expand the APS information system for program planning, evaluation, budgeting, workload allocation, staffing needs, and quality improvement

9 NH APS Structured Decision Making® System

10 NH APS Structured Decision Making® System
Development of the actuarial SDM® Risk Assessment Goals were to: classify adults by the likelihood of experiencing future maltreatment (abuse, neglect, self-neglect, or exploitation) inform case opening decisions and level of engagement low risk: services not provided/not offered moderate risk: services provided/offered with frequent contact high risk: services provided/offered with very frequent contact The research was made possible by the National Institute of Justice grant 2008 IJ-CX-0025, “Developing an Actuarial Risk Assessment for Adult Protective Services.”

11 NH APS Structured Decision Making® System
Explanation for Actuarial Risk Assessment chart on next slide: The individual and case characteristics of a sample of 763 clients investigated by APS were examined and compared to subsequent reports involving the same clients during a period of six months (March-Sept. 2009). Among the March – Sept. sample of clients, 5.2% classified as low risk had a subsequent APS investigation 9.4% classified as moderate risk had a subsequent APS investigation 23.9 % classified as high risk had a subsequent APS investigation To continue: only 2.0% classified as low risk had subsequent APS investigations substantiate the allegation(s) 4.7% classified as moderate risk had subsequent APS investigations substantiate the allegation(s) 14.7% classified as high risk had subsequent APS investigations substantiate the allegation(s) Conclusion: these risk groups (low, moderate, high) demonstrate significantly different rates of future maltreatment thus allowing APS to respond accordingly to resolve problems, mitigate risk and reduce the likelihood of repeat maltreatment.

12 NH APS Structured Decision Making® System
N = 763; base rate, investigation = 10.1%; base rate, substantiation = 5.2%. National Institute of Justice grant 2008-IJ-CX-0025

13 NH APS Structured Decision Making® System

14 Current Status, Challenges, Opportunities
With the four SDM® assessments in NH’s electronic case management system, NH’s APS supervisors, administrators and quality improvement staff have more easily accessible data to not only manage APS work but also to monitor implementation of the SDM® program. For instance, the table below illustrates the rate of Level 1 (response within 24 hours of receipt of report to APS) and Level 2 (response within 72 hours) for the first four months of CY 2011.

15 Current Status, Challenges, Opportunities
In reviewing this data with supervisors, we believe all staff may not be consistent in their review of the comprehensive definitions and policies established to gain consistency and accuracy in decision-making at critical points in the life of a report to APS and, in doing so, the trend is to identify intakes more as Level 2 than Level 1.

16 Current Status, Challenges, Opportunities
A review of Safety outcomes reveals a similar concern as with Intake data that there is some misunderstanding of how and when to complete a Safety Assessment leading to a trend of a higher percentage of Safe outcomes. In speaking with supervisors, we believe it is more likely that a higher percentage of alleged victims are initially conditionally safe or unsafe and quickly become safe due to the diligence of the APS staff.

17 Current Status, Challenges, Opportunities
The SDM® risk assessment data for the same time period is more reliable due to the fact that the risk assessment outcomes are established by an algorithm and, thus, less subjective than the other assessments. This data can be compared with the rate of case openings and will eventually be compared with recitivism data. Since the Risk Assessment was implemented August 1, 2010, the rate of victims experiencing repeat maltreatment will begin to be evaluated after August of this year.

18 Current Status, Challenges, Opportunities
The APS SDM® Program has been successfully implemented with all assessments in the electronic case management system. This was accomplished over three years with staff having to initially complete assessmsents as Word documents: a time-consuming process that did not provide easy and timely access to comprehensive data. APS administration is committed to ongoing dialogue with supervisors and staff to ensure consistency of implementation through adherence to definitions and policy and review of data. APS administration promotes the program with its internal and external stakeholders thus building confidence in APS and providing opportunities for dialogue regarding ongoing and prevention-focused service needs.

19 Thank you Thank you for your attention and the opportunity to highlight New Hampshire’s Adult Protective Services Structured Decision Making® Program. We invite you to contact us should you have any questions. Rachel Lakin Administrator of Adult Protective Services Sally Varney Director of Quality Improvement


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