Measuring Success in Adult Protective Services

Background and Purpose: Elder mistreatment is a pervasive social and public health problem with major individual consequences, such as pre-mature mortality, and societal costs. Adult protective services (APS) is the principal authority in the United States responsible for intervening on substantiated elder mistreatment cases. Our knowledge about effective APS practices is scant. APS intervention research is constrained by an unavailability of intervention outcomes tools that measure change on the key intervention outcome of case resolution. Case resolution is difficult to measure because it is defined differently across older adult clients who have a right to self-determination and the factors indicating re-victimization risk vary across cases. Standardized case resolution outcome measures that apply the same set of items to all cases may not align with the expectations of a given older adult or may miss client-specific circumstantial factors indicating re-victimization risk.

The current study sought to examine the feasibility of goal attainment scaling (GAS) as a strategy to measure APS case resolution. GAS is a client-centered measurement strategy capable of tracking change on an individualized set of re-victimization risk indicators and accommodating varying standards of problem resolution across older adult clients. To enhance GAS feasibility in the busy APS clinical context, this study used an adapted version of GAS involving a pre-worded menu of goals/goal scales and GAS implementation through web-based application (app) software.

Methods: Data were collected across three sites within the State of Maine APS. A series of qualitative focus groups were conducted with APS investigators, case managers, and supervisors to identify common client goals and to construct a menu of pre-worded GAS goal scales. APS caseworkers implemented GAS procedures, using the web-based GAS app, with a prospective sample (n = 25) of consenting, incoming elder mistreatment victim clients. Eligible participants were community-dwelling, cognitively intact victims of elder physical/emotional/sexual/financial abuse, neglect, or self-neglect.

Results: The constructed menu of pre-worded GAS goals/scales targeted several key domains of re-victimization risk, including social isolation, disconnection to community services, functional impairment, victim-perpetrator shared living, lack of safety plan, and dependence upon perpetrator. Across cases, caseworkers spent 5 to 60 minutes (mean = 17 minutes) to discuss goals with clients, 1 to 5 minutes (mean = 1.7 minutes) to establish goals in the GAS app, and 0.2 to 5 minutes (mean = 2 minutes) to score goals.

Conclusions and Implications: This study represents one of only a few pieces of prospective intervention research in the elder mistreatment literature. Findings suggest that GAS is a feasible strategy to measure level of elder mistreatment case resolution in the APS context. Establishing a feasible intervention outcome measure of APS case resolution will provide necessary research infrastructure to begin comparing the effectiveness of different APS practices/models toward the development of an evidence-based elder mistreatment response system.