Developing Goals for Adult Protective Services

Developing Goals for Adult Protective Services

October 29, 2013 | Shannon Flasch, Associate Director, NCCD

flaschpic

Each year, a growing number of older and disabled adults are reported to adult protective services (APS) agencies as alleged victims of abuse or neglect, including self-neglect. As contact between APS and vulnerable adults increases, it is critically important to define successful outcomes.

Each year, a growing number of older and disabled adults are reported to adult protective services (APS) agencies as alleged victims of abuse or neglect, including self-neglect. As contact between APS and vulnerable adults increases, it is critically important to define successful outcomes.

Setting goals in APS is challenging because of the competing values in the field. How should an agency balance a client’s need for safety against his or her right to self-determination? When the intervention that would best preserve the client’s health is contrary to the client’s wishes, what should be done? Every day, APS workers make difficult decisions, trying to improve clients’ safety while fully respecting their right to make their own decisions. Depending on the balance, making a good decision may mean that a client chooses to remain in an unsafe situation, or it may mean that a client is safer, but unhappy about the outcome.

Defining success would help agencies and workers gain clarity around their mission and responsibilities. For many APS agencies, this may be a call to do more for clients; in others, an affirmation of their current practice. For example, many jurisdictions across the country provide investigation and stabilization services only, because this is the extent of their agency’s capacity. Other agencies investigate the allegation and also provide a limited period of ongoing services to address the needs that may have led to the current incident, or that may result in further harm.

This different understanding of the role of APS services stems from a lack of agreements on success (sometimes within agencies; sometimes between agencies and their funders), and has real consequences for the quality of life for vulnerable adults:

  • State (and sometimes county) agencies set varying standards, leading to disparate treatment. For example, an agency in one jurisdiction may choose to define success as maintaining vulnerable adults in the community, while another may prioritize physical safety above all else. This may result in clients with similar situations being treated differently, depending on which side of a state or county line they live on.
  • Without a clear way to define success, stakeholders cannot hold agencies accountable. There is currently a low level of public awareness of the work of APS agencies. However, as the population ages, this is likely to change and agencies may come under increased scrutiny.
  • Substantial federal funding for child protective services has been tied to states’ efforts to meet Child and Family Services Review (CFSR) standards. Without similar standards for APS, it has been difficult for the field to advocate for additional federal funding, limiting the availability of services in most areas.

The influence of CFSR standards on child protection practice is a reason for urgency in setting goals for APS. The CFSR standards have been criticized for distorting child protection practice by encouraging agencies to focus on measure that, taken in isolation, may not be best practice. APS has the opportunity to learn from these experiences and to have a thoughtful conversation about setting goals that acknowledge the tensions in the field and avoid unintended consequences. I believe that a discussion about goals and successful outcomes is vitally important to the field of APS. Common goals will provide guidance and support to workers facing difficult decisions and will provide agencies a means of measuring their success and advocating for necessary resources.

Shannon Flasch is an Associate Director at NCCD.