Achieving Equity and Justice By Enhancing Adult Protective Services: Seeking an Evidence-Based Approach to Assessing Risk and Safely for Older Adults

Background and Purpose:  To address the gaps and significant challenges (e.g. high caseloads, lack of efficient practice) faced by state APS systems, the Administration for Community Living (ACL) funded 24 grantees in fiscal years 2015 and 2016 through State Grants to Enhance Adult Protective Services. The state APS program in this study experienced a 57 percent increase in reports of vulnerable adult abuse, neglect, and financial exploitation over four years between state fiscal year (SFY) 2012 and 2015, and historically high caseloads of 139 per APS investigator (70 in rural settings and 172 in urban settings). This paper describes an ACL-funded APS/university research partnership and the process undertaken by one state’s APS program to improve the quality of life and well-being for vulnerable adults and reduce the risk of future maltreatment through the development of safety and risk assessment tools. Additionally, it describes plans to evaluate the fidelity of these tools and maximize their utilization to inform the care planning process.

Methods:  Eleven focus groups were conducted with community stakeholders across the five districts of the state, and four focus groups with family caregivers, to seek input into key questions APS investigators should consider to ascertain risk and safety of vulnerable older adults. Two additional focus groups were conducted with representatives of inter-professional geriatric health professions to gain additional insight into assessing risk and safety and recommended assessment instruments.  Detailed focus group notes taken by APS staff were reviewed by three APS and university research team members to identify themes through open and axial coding, which was then compared with current literature and available risk and safety assessment instruments for vulnerable adults.

Findings: An analysis of meeting notes from focus groups with community stakeholders revealed ten themes related to assessment of risk (support systems, resources/finances, behavioral/mental health, physical health/ADL/IADLs, cognitive ability, medical issues/diagnoses/medications, legal issues to include POA/guardianship, history of maltreatment, physical appearance and environment) and ten themes related to assessment of safety (cognitive functioning/dementia, mental/behavioral health, medical care/physical health, substance abuse, environmental deficiencies/food/clothing/shelter, sexual abuse, domestic violence, insufficient financial resources, frailty, and inadequate caregiving).

Conclusions and Implications: Findings highlight the complex nature of assessing risk and safety in vulnerable adults and the importance of a comprehensive assessment process that gathers detailed information from multiple sources and is sensitive to functional changes and environmental context, including rural versus urban considerations. Evidence-based practice also requires critical thinking and complex, informed decision-making that moves from the collection to the objective analysis of information and connects the assessment process with the subsequent intervention, care plan development, referrals, care coordination, and reassessment process. It is important to educate the APS workforce to effectively use the tools at their disposal in combination with informed, critical thinking. Factors facilitating effective research partnerships between university researchers and APS agencies will also be discussed.