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The SDM® System Helps Address Complexity of Adult Protective Services

May 8, 2018 | Debra Illingworth Greene

Older Man

An 80-year-old woman with progressive dementia lives with her son and attends an adult day center twice a week. She shows up one day with bruising around her wrists.

A 64-year-old man, who uses a wheelchair and lives with his sister, has a hard time getting around their apartment due to the amount of clutter. His sister is not around much to help him because she works a lot. While refusing to move to a nursing home, as suggested by his VA social worker, the man agrees to home health services. However, the home health worker says he cannot provide services in such a cluttered apartment.

A 20-year-old man who has cerebral palsy and a developmental disability arrives at school with a busted lip. He lives with family members, who provide care. He tells the school social worker that he fell off the toilet that morning while trying to be more independent.

What do these scenarios have in common? They illustrate the types of situations faced by adult protective services (APS) workers every day—situations that require difficult decision making that balances individual safety and capacity with independence and freedom.

APS is a state or local social services program that responds to and investigates reported abuse or neglect of older adults or adults with disabilities. Each US state has its own APS system, so programs vary from state to state. Generally, APS workers investigate abuse, neglect, self-neglect, or financial exploitation; and work with clients to determine what services are needed to maximize safety while allowing for independence.

Deciding how (or whether) to move forward with an APS investigation can be complicated. Meanwhile, APS agencies chronically lack resources, and the demand for services is growing due to mandated reporting laws. All of these factors create stress on workers, which can increase the difficulty of making good decisions with clients.

The Structured Decision Making®(SDM) system helps address the complexity of APS work by breaking down—or structuring—decisions. The SDM® system for APS consists of multiple assessment tools that help guide decision making at key points in the life of a case.

The intake assessment helps assess whether the referral should be investigated; and if so, how quick the response time should be. This is completed during the first phone call received that reports abuse or neglect of an individual.

The safety assessment helps assess whether the adult is safe in the current environment; and if not, whether any interventions can help mitigate the danger and allow the adult to safely remain in the environment throughout the investigation. This is completed during the initial in-person contact and at various points throughout the life of a case.

The risk assessment uses actuarial data to help determine the likelihood of future APS recurrence for a client, which helps determine the intensity of services and level of engagement needed.

The strengths and needs assessment helps to identify specific client needs that should be addressed on a service plan.

Each of these tools includes definitions, which help manage personal interpretations and enable everyone to operate from the same meanings of assessment items. Other benefits of the SDM system for APS include improved transparency and greater consistency in decision making. The SDM system provides guidance for new workers and verification or pointed questioning for experienced workers.

When decision making is structured, workers can focus on just the information needed to make the decision at hand. While the SDM system does not take the complexity out of making decisions, it helps to break down the decisions into manageable pieces. And better decisions lead to better outcomes for those who need protective services.

Debra Illingworth GreeneDebra Illingworth Greene is the communications manager for NCCD.