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The Structured Decision Making® Model in Adult Protection in Minnesota

October 31, 2013 | Jennifer Kirchen, Adult Protection Program Administrator, Minnesota Department of Human Services

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Adult protection (AP) is charged with promoting the safety of vulnerable adults while respecting choice where appropriate. In Minnesota, adult protective services (APS) are delivered through a county-based service system with state oversight. For years, county AP staff struggled with difficult multifaceted case decisions amidst rising demands. As cases were processed, a need to establish consistency between cases while reinforcing clinical judgment surfaced.

Adult protection (AP) is charged with promoting the safety of vulnerable adults while respecting choice where appropriate. In Minnesota, adult protective services (APS) are delivered through a county-based service system with state oversight. For years, county AP staff struggled with difficult multifaceted case decisions amidst rising demands. As cases were processed, a need to establish consistency between cases while reinforcing clinical judgment surfaced. Validating decisions and reducing rates of maltreatment were identified as overarching goals; thus, when counties examined their service delivery system, a need for assistance surfaced.
 
In 2009, a six-county collaborative made up of AP staff from Dakota, Hennepin, Olmsted, Ramsey, Steele, and Washington counties began working with the NCCD Children’s Research Center (CRC) to create Structured Decision Making® (SDM) assessments for AP workers that could be used to inform decision making in in Minnesota. The goal was to create assessments that would help workers improve the consistency of their decision making and allow flexibility for differences in county practice. The result was three SDM® assessments: intake, safety, and strengths and needs. The National Council on Crime and Delinquency (NCCD) hosts the assessments, structuring the data in a cloud environment for easy county and state access. Workers in the six counties began using these assessments in 2010.

From the initial stages of the SDM project in 2009, the Department of Human Services (DHS) AP staff saw the value of the SDM system, but acknowledge numerous barriers.

  • Financial support was a major barrier to making the SDM assessments available to all of the counties statewide in 2009. The initial six counties had budgeted funds to commence the project with NCCD. Analyzing potential funding sources to make the assessments into sustainable, statewide resources involved extensive research. In 2012, AP applied for and received an ongoing grant from the Minnesota Board on Aging to implement them.
  • The 2013 Minnesota Legislature made revisions to the Vulnerable Adult Act (VAA), requiring that counties use a standardized tool in carrying out duties under the VAA, effective August 1, 2013. This legislation supported the state’s policy of requiring that reports of suspected maltreatment be investigated and protective services be provided in appropriate cases. Assessment information will be accessible to DHS, and assessment data will be available for service planning, program management, and evaluation. Research demonstrates that the use of structured frameworks results in more reliable, accurate, and consistent decisions than professional judgment alone.
  • DHS made the assessments available to counties on a voluntary basis on January 1, 2013. Education on their use was provided by DHS in 2012 and 2013 using regional training-for-trainers sessions, webinars, a conference presentation, an online forum, a training website, and regional calls for policy and practice integration in preparation for implementation.

APS is a safety net for vulnerable adults. SDM assessment development not only brought consistency to Minnesota jurisdictions, but also increased the strength of our safety net. Budgets may be tight and worker turnover a reality, but the population continues to age. Preparing workers and using items such as the SDM assessments will increase protection to those who are vulnerable and need protective services.

Jennifer Kirchen, Minnesota DHS AP program administrator, is a graduate of Mankato State University with a BS in social work. She is licensed by the Minnesota Board of Social Work as a licensed social worker (LSW) and has worked in facilities serving persons with mental illness and developmental disabilities and the elderly. She has 17 years of experience working with vulnerable adults and was employed with Rice County Social Services for seven years as an adult protection social worker prior to coming to DHS in November 2006.