Download A. APS Basic Skills Module II Day One

Adult Protective Services
Basic Skills Training
Module II
Day One
Presented by:
North Carolina Department of Health and Human Services
Division of Aging and Adult Services
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
Prompt Evaluations
All reports must be evaluated promptly:
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
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
notices
▪ Send required notices
▪ Obtain authorization for service
▪ Make appropriate referrals
Focus of Evaluation
The focus of the evaluation is to determine:

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.
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
Bring “sense-ability” to the door
Your eyes
Your nose
Your ears
Your touch
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
Physical Health
• Major health problems
• Essential medical services
• Medications
• Sensory impairments
• Indicators of abuse or neglect
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
Activities of Daily Living
• Ambulation
• Bathing
• Dressing
• Eating
• Grooming
• Toileting
• Transfer
Instrumental Activities to Daily Living
 Home Maintenance
 Housework
 Laundry
 Meal Preparation
 Money Management
 Shopping/Errands
 Telephone Use
 Transportation
Environmental Situation
↔ 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?
Mental Status/Emotional Functioning
Level of Functioning in Different Domains
 Orientation
 Memory
 Judgment
 Mental/Emotional Assessment
(Diagnostic and symptom elements)
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
Economic Functioning
• How finances are managed.
(by whom?)
• Monthly income/expenses
• Assets
• Any financial problems in meeting
basic needs
• Indicators of exploitation.
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.
Case Decision
An APS report is substantiated if:
• 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
Capacity to Consent
The decision about the client’s
CAPACITY TO CONSENT
should be made
AFTER
the case decision is made.
Required Notices
Notices to the Complainant:
 Oral
 In Writing
Immediately upon completing the evaluation
and making the case decision
APS Manual III-23-24
Written Report
A Written Report of the Evaluation must be
completed when:
! 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 Contents
The Written Report must include:
 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
Distribution of Written Report
The Written Report should be sent to:
• The District Attorney
• The Division of Health Service Regulation
• The Division of Medical Assistance
• Other Governmental Agencies