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Department of Family and Protective Services. Increasing Efficiency and Effectiveness in Adult Protective Services: Implications for the Aging Network Kez Wold and Karl Urban June 17, 2013 . Presentation Objective. - PowerPoint PPT Presentation
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1
Department of Family and Protective Services
Increasing Efficiency and Effectiveness in Adult Protective
Services:
Implications for the Aging Network
Kez Wold and Karl Urban
June 17, 2013
2
Presentation Objective
The Texas Adult Protective Services (APS) program is having to do more with less. We are taking a hard look at who we serve and how we serve them. This presentation describes one critical
change already implemented and one being developed.
To have a dialogue with the Aging Network about these changes.
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Overview of Presentation
Brief overview of APSCurrent trends in APSRecent changes in who APS servesUpcoming changes in how we
conduct casework Questions and Answers
4
Mission
The mission of Adult Protective Services (APS) is to protect the older adults and people with disabilities from abuse, neglect, and exploitation.
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APS Programs
APS Program has two primary components:
In-Home Investigations and Service Delivery
Facility Investigations
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Statutory AuthorityChapter 48 of the Texas Human Resources Code authorizes APS to investigate reports of abuse, neglect, and exploitation of: elderly persons (age 65 and older); adults with disabilities; and persons receiving mental health and/or IID
services in a state supported living center, state hospital, community center, state center, licensed ICF/IDD), or via Home and Community-based Services (HCS) and Texas Home Living Medicaid waiver programs.
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In-Home Investigations and Services
In-Home investigations are conducted in private residences, room and board homes not subject to licensure, and/or adult foster care homes with three or fewer residents.
APS may arrange for or provide the following services: emergency financial assistance for rent and utility
restoration social services emergency shelter health services referral to or collaborate with other community
services, including guardianship
Current In-Home Process
Intake Received by SWI
Meets Criteria
?
Case Initiation Emergency Services
Client Assessment: Risk + CARE
ANE Valid?
Closure
Service Plan based on Outcome Matrix
from CARE Tool
ANE Remediated
?
Investigation Service DeliveryIntake
Yes
Yes
YesNoNo
No
Current APS In-Home Process
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Current APS In-Home Trends
Target populations are increasing rapidly resulting, in the long-term, in rising intakes
But durations are shrinking because… APS has implemented casework practice changes that
have improved efficiency Mobile caseworkers “As You Go” documentation using tablet-PCs Management attention on pending cases and
improved practice Resulting in, for now, falling caseloads
2009 2010 Est. 2011 Est. 2012 Est. 2013 Est. 2014 Est.
Population (Millions) 3.97 4.08 4.19 4.23 4.48 4.63
Age 18 to 64 with a Disabil ity 2.45 2.52 2.58 2.69 2.80 2.91
Age 65+ 1.52 1.56 1.61 1.54 1.68 1.71
0
1
2
3
4
5M
illio
ns
Texas Population Age 65 and over and Population Age 18 to 64 with a Disability
Age 65+ Age 18 to 64 with a Disability
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FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012Intakes 82,029 77,223 83,601 89,489 103,401 108,580 107,203
70,000
75,000
80,000
85,000
90,000
95,000
100,000
105,000
110,000
APS In-Home Intakes
12
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FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012Service Delivery Stages 35,350 35,547 36,691 38,095 42,940 43,611 46,101
30,000
35,000
40,000
45,000
50,000
APS In-Home Service Delivery Stages
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FY2006 FY2007 FY2008 FY2009 FY2010. FY2011 FY2012Total Duration 124.6 122.5 102.9 99.0 95.9 84.3 76.9Service Delivery Stage 57.8 51.8 48.9 48.0 45.0 41.4 37.7Investigation Stage 66.8 70.7 54.0 51.0 50.9 42.9 39.2
0
20
40
60
80
100
120
140
APS In-Home Durations
Investigation Stage Service Delivery Stage
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FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
Ave. Daily Caseload 51.2 36.4 30 30.1 33.1 31 29.6
20
30
40
50
60
APS In-Home Average Daily Caseloads
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FY2011 FY2012 FY2013 est. FY2014 est. FY2015 est.Caseload 31 29.6 31.2 32.2 33.2 Intakes 108,580 107,203 110,508 112,824 115,284
100,000
110,000
120,000
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29
30
31
32
33
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HHSC Forecast of APS In-Home Intakes and Caseloads FY2011 to FY2015
Caseload Intakes
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Key Casework Challenges Caseworkers are:
Decreasing (in FY 12-13 biennium) Leaving (turnover is a problem) Lacking life experience/skills (new ones, especially) Practicing defensive casework practice – “fear of the one bad
case” Managing a mobile workforce Uniform practice for all types of allegations and levels of
client risk Limited ability to address needs of some clients (especially
mentally ill, chronically poor) leading to less than optimal outcomes and frustrated (at best) or burned-out staff
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Background on Changing Who We Serve
SB221 (82nd R) granted HHSC the authority to define In-Home ANE in APS investigations by rule in the Texas Administrative Code.
Changes to definitions have allowed APS to: Focus on providing the most effective protection
possible Make distinctions in the definitions between paid
and unpaid caretakers
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Types of Change Target who we serve as defined in rule and
policy:Two types of changes definitions of target
populations and definitions of ANEFor APS to investigate, must be in target
population and then must meet definition of ANE Screen more intakes out at Statewide Intake
through better guideline Staff training and culture change
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What Changed? Generally…
Eliminate cases when the APS investigation will not alleviate the root cause
Eliminate duplication of cases in which other entities have clearer responsibility and resources
Streamline cases in which an expedited investigation would be more efficient
What Changed? Specifically….
Not investigate “suicidal threat” when there is no ANE Define “Substantial impairment” in TAC and clarify in policy
(SSDI will no longer be an automatic qualifier) Must be “emotional harm” or “physical injury” to be abuse or
neglect For unpaid caretakers, there must “threat” of harm for
emotional/verbal abuse For paid caretaker, theft and “may have caused” Self neglect and caretaker neglect are separately defined Definition of sexual abuse based on consent; clearly define
when consent cannot be given
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Definition of Person with a Disability
A person with a mental, physical, or developmental disability that substantially impairs the person’s ability to provide adequately for the person’s care or protection.”
Proposed change is to define “substantial impairment” in rule: “grossly and chronically diminishes an adult’s physical or mental
ability to live independently or provide self-care”
Current APS policy defines "substantially impairs" as "requires assistance" with one or more ADL or qualifies for SSDI/SSI – Put in place a better way of determining disability.
So What Happened?
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The Drop in Intakes….
Scared us…. Caused us to go back and review intakes
and rapidly closed cases to make sure we were not missing anyone
So we tweakedSWI GuidelinesPolicy
26
What’s the Aging Network’s Experience and Feedback?
27
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Changing Casework Practice
Currently APS treats all cases the same regardless of the allegation type or the potential “risk” to the client
Moving forward, APS is: Implementing new tools to assess safety, risk of
recidivism, and strengths and needs. Further targeting resources to address the most “risky”
cases. Providing Caseworkers with tools to support decisions in
the field. Each tool will help determine our response.
Current In-Home Process
Intake Received by SWI
Meets Criteria
?
Case Initiation Emergency Services
Client Assessment: Risk + CARE
ANE Valid?
Closure
Service Plan based on Outcome Matrix
from CARE Tool
ANE Remediated
?
Investigation Service DeliveryIntake
Yes
Yes
YesNoNo
No
Current APS In-Home Process
Revised In-Home Process
Intake Received by SWI
Meets Criteria
?
Safety Assessment
Emergency Services
Risk Assmt
.
Closure
Service Plan based on Risk Assessment and Strengths and Needs Assessment
ANE Remediated
?
InvestigationIntake
Yes
Yes
Yes
No
No
No
Proposed Revised In-Home Process
Valid Findings
?
Strengths and Needs Assessment
Low Risk
Service Delivery
Med/High Risk
Project Drivers
Review of ANE definitions and the assessment processes revealed that new processes are needed to more effectively assess client safety and risk
Practice relies on legacy tool – Client Assessment Risk Evaluation (CARE) and does not evaluate safety and risk
Inefficiencies in policy divert APS resources from clients in most need
National Council on Crime and Delinquency (NCCD)
Mission: NCCD promotes just and equitable social systems for individual, families, and communities through research, public policy, and practice.
Non-Profit; with focus areas in Adult Protective Services, Child Welfare, Adult Criminal Justice, Juvenile Justice
Operates 2 Centers: Children’s Research Center (CRC) Center for Girls and Young Women
40 State & Local and 10 international SDM Implementations
APS CredentialsCalifornia•Riverside County•San Diego County•Orange County•Yolo County
New Hampshire, National Institute of Justice Grant
Minnesota County Collaborative
National Adult Protective Services Resource Center partner
Norfolk, VA
Safety Assessment
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Risk Assessment and redefining Risk in APS
What is actuarial research?• A simple statistical procedure for estimating the probability that
a “critical” event will occur at some future time.
• In the auto insurance industry, the critical event is a car accident involving a driver insured by the agency. Among breast cancer patients, the critical event is recurrence of cancer, and risk informs treatment determination.
• In this case, the critical event is the likelihood of future self-neglect or abuse/neglect by another person.
Risk Assessment
Strengths and Needs Assessment
What are Implications for Casework Practice? Focus on recidivism and root cause. Safety vs. Risk, change in
perspectives. Actuarial scored risk Informed decisions reinforcing intuition “Real” service planning Moving beyond bandaid approach
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What are the Implications for the Aging Network? Closure of low risk client cases More intensive APS involvement with
high risk client cases Community supports as strengths in
service planning
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Next Steps
Business requirements are completed and tools are finalizing.
System requirements for IT and policy for field is being developed
In FY 2014, we willMake IT system changesTrain on the new policy and practice
In FY 2015, we implement
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Questions and Answers