How Structured Decision Making® Came to Texas Adult Protective Services

October 15, 2013 | Beth Engelking, Assistant Commissioner for Adult Protective Services, Texas Department of Family and Protective Services


I am Texas’s state director for adult protective services (APS) and this is the story of how the Structured Decision Making® (SDM) system came to Texas APS. 

I am Texas’s state director for adult protective services (APS) and this is the story of how the Structured Decision Making® (SDM) system came to Texas APS. 

In order to have the full context you have to go back to 2005. At that time, due to a confluence of events, some not so positive, the APS division went through unprecedented changes, many of which were legislatively mandated. The legislation, coupled with recommendations from our parent agency, resulted in 252 changes that the program was to make. Yes, it was as overwhelming as it sounds.

The overarching goal of the changes was to change how the program conducted assessments and provided services to our clients. In Texas APS serves adults over age 65 and adults age 18–64 who have a disability. 

Two of the major changes were the following: 

  • Development and implementation of a risk assessment tool, called the Client Assessment and Risk Evaluation tool (CARE), to be used in all investigations. The goal of the CARE tool was to assist workers in gathering information to assess if the client is in imminent risk of loss of life or safety; in a state of abuse/neglect/exploitation; or in need of protective services. 
  • Requirement for the supervisor to conduct recidivistic case reviews on clients. A recidivistic case is one in which the client has been listed as a victim in two or more previous APS investigations within the previous five years.  

I should note that these have a completely different point of view than SDM® assessments. 

As time moved forward, the program gained experience using the CARE tool and the need for modifications to the tool became apparent. So, some tweaks around the edges were made. The tool met the immediate need; however, there was growing desire and need to make fundamental changes to not only our assessment tool but our casework practice model. As with the majority of APS programs, our caseloads were growing not only in volume but in complexity. However, the assessments and policy were the same regardless of the severity of abuse/neglect/exploitation or the intensity of services needed by individual clients. 

In 2010 we began conducting focus groups with staff from around the state. One of the themes that emerged was overall dissatisfaction with the CARE tool. After much discussion and thought, a decision was made to explore how to change the CARE tool and develop a new casework practice model. 

Now what? We spent several months batting around different ideas but again all the ideas just seemed to make recommendations for changes around the edges. We were stuck!

Fast forward to 2011 at the National Adult Protective Services Association conference in Buffalo, NY. I saw a session on the SDM model given by NCCD and New Hampshire APS that looked interesting. One of my staff who was at the conference attended the session with me. In his words, when he looked at me after the session, “She had stars in her eyes!”. I knew that implementing the SDM model was the way to go for our program and that NCCD could help us get there.

At the time, what intrigued me about the SDM model was that it provided discrete tools for staff, and it helped to guide both information gathering during a case and how to use that information to inform decisions. It also looked at recidivism from a very different point of view and was based on data. (This more clearly states why I was so interested in the SDM model than how I felt, which was giddy with excitement!) 

We began our formal working relationship with NCCD in December 2012. It has been less than a year and we already have the safety and risk assessment tools and the strengths and need tools completed. Which is amazing. 

The journey so far has not always been an easy one. My goal was to not just develop and implement new tools but to take the opportunity to analyze and fundamentally change how we worked cases. By taking a larger view of the changes that the SDM model brings, we challenged ourselves and NCCD with what that process should look like. We appointed a workgroup composed of staff from all over the state whose primary responsibility was to work with NCCD to modify the SDM tools and revamp our casework practice model. It was no small feat. After some negotiations we settled on multiple onsite visits with NCCD and the workgroup as well as follow-up webinars to complete the work. 

I am not sure that either party, NCCD or APS, truly recognized how monumental the work and changes would be. However, I know with certainty that we could not have achieved our goal without NCCD. 

I have learned that the SDM model provides a different way to think about the delivery of protective services. It provides an opportunity to workers, who often have little to no experience, with a way to gather information and assess alleged victims of abuse/neglect or exploitation. This in turn gives supervisors better information when working with their staff to make case decisions. It also focuses on recidivism through research and data so staff can focus on the root cause and work with the client toward lasting solutions. 

Our journey with the SDM system is not over. We are one year away from implementation. In the coming year we will be making changes to our automated case management system and training staff statewide. I look forward to seeing the results of the changes and our continued work with NCCD.

Beth Engelking is the head of the adult protective services program in Texas. She provides leadership and direction to approximately 1,000 employees across the state. She graduated from Texas Tech University and began her state career in 1990 at Department of Family and Protective Services (DFPS) as a child protective services (CPS) worker. While in CPS Beth become a program subject-matter expert, as she worked in several positions both the field and at state office headquarters. After CPS she served in various executive management positions at DFPS until September 2009, when she was named the Assistant Commissioner of Adult Protective Services.