Updates to the APS Guidelines 2020

by Mary Twomey, MSW, Consultant

The National Voluntary Consensus Guidelines for Adult Protective Services (Guidelines) were recently updated. This blog addresses the purposes of the Guidelines, the process for updating them, and key highlights to revisions.

Why Have APS Guidelines?

The Administration for Community Living (ACL) published the first Guidelines in 2016. The goal of the Guidelines is to provide a core set of principles and common expectations to encourage consistency in the policies and practices of APS programs across the country and to ensure that adults are afforded similar protections and service delivery by APS programs, regardless of which state or jurisdiction they are in. When the original Guidelines were published, ACL committed to update the Guidelines at regular intervals.

The Process for Updating the Guidelines

To support APS programs, it is more important than ever to demonstrate the effectiveness of APS programs and practices in achieving positive client outcomes. To accomplish this goal, ACL applied a multi-step approach for updating the Guidelines, with each step building on the work of the previous step. These steps are outlined below.

The 2020 and 2016 Guidelines have an identical overall structure, with the content organized by seven broad domains (or topics) and several specific elements (or subtopics) within each domain. For each element, the Guidelines contain a background section followed by the actual guidance statements.

Step 1: Reviewing New Literature

Twenty-four articles met the inclusion criteria and were included in the updated literature review. This was a significant increase in the number of relevant articles that were identified for the original Guidelines (n=8).

Below are highlights from some of the new research that was found to be relevant to APS practice.

1. Clients are often willing to accept an offer of additional mental health services at the same time that they are receiving maltreatment resolution service. Additionally, results support the potential for elder abuse service providers to work in tandem with mental health clinicians. (Sirey et al, 2015)

2. Findings highlight the importance of creating a positive and supportive work environment for APS workers, and of implementing management strategies for the prevention of burnout among APS workers. (Ghesquiere, Plichta, McAfee, & Rogers, 2018)

3. A longer-term, relationship-based intervention for entrenched elders who are reluctant to receive services may be effective and therefore worth considering. (Mariam, McClure, Robinson, & Yan, 2015)

4. The Elder Abuse Decision Support System short form can be used to standardize and increase efficiency of APS investigations and may also offer researchers new options for brief elder abuse assessments. (Beach et al., 2017).

5. A list of standardized questions for caseworkers to use during investigation may provide an objective and detailed approach for investigation. (Conrad, Iris, & Liu, 2017)

6. Elder mistreatment social service programs should aim to promote elder participation in supportive community social outlets (e.g., senior centers) (Burnes, Rizzo, & Courtney, 2014). When social support from family or friends is unavailable or deficient, policy should direct services to compensate or supplement this factor. (Acierno, Hernandez-Tejada, Anetzberger, Loew, & Muzzy, 2017)

7. Findings highlight the need to identify and intervene in elder mistreatment cases as early as possible in the maltreatment trajectory, and the need to develop targeted safety planning for clients experiencing different forms of abuse and/or neglect. (Burnes, Rizzo, & Courtney, 2014; Jackson & Hafemeister, 2014)

Note: For full reference citations noted above, please see the full Guidelines document.

Step 2: Stakeholder Engagement

The goal of the stakeholder engagement and outreach process was to hear from all stakeholders about their experiences with APS and to provide interested parties an opportunity to give input into the process and content of the Guidelines.  Five outreach webinars were held with approximately 190 stakeholders representing 39 states and the District of Columbia participating. Over 250 comments were collected. 

Step 3: Engaging Subject Matter Experts

The final step in the updating process involved the convening of a 9-member technical expert panel (TEP) comprised of APS professionals and researchers.  The purpose of the TEP was to serve as the voice of the field, i.e., to bring real world experience and wisdom to the updating process. 

How Did the Guidelines Change?

Changes to the Guidelines were made as a result of integrating findings from the research, from stakeholder comments, and from TEP feedback.

Changes made to individual domains/elements (in order of how they appear in the Guidelines) are shown below.

1A. Ethical Foundation:  Recommended the code of ethics and ethics policies be reviewed annually.

1B. Protecting Program Integrity:

     • Added “APS program policies and standards should be transparent and available to the public”

     • Added a section on Providing Information on Rights of Perpetrators

1E. Mandatory Reporters:

     • Made it clear that Long-term Care Ombudsmen (LTCO) are not mandatory reporters

     • Added language that clarifies that mandatory reporters should be immune from civil as well as criminal liability

1F. Coordination with Other Entities:  Added dementia services providers to the list.

1H. Staffing Resources:  Augmented content of Ratio of Supervisor to Direct APS Personnel to highlight role of supervisor and risks to clients and workers if limit is not maintained.

1M. Community Outreach:  Added information on Reframing Elder Abuse. Reframing Elder Abuse is a communications strategy and toolkit that reimagines our cultural dialogue on elder abuse. The Talking Elder Abuse Toolkit provides resources and tips to improve the public’s awareness of elder abuse, enhance understanding of the underpinning issues, and elevate public exchange on the topic. See: Reframing Elder Abuse Project.

2C. Closing the Case:  Added “Client goals have been achieved to the extent feasible”

4A. Determining if Maltreatment Has Occurred:  Clarified that APS programs screen for decision-making ability (but do not determine capacity)

4C. Investigations in Residential Care:  Added language that recommends that APS should notify the Long-Term Care Ombudsman (LTCO) when APS is investigating in residential facilities.

5A. Voluntary Service Implementation:

     • Added language about how studies show that longer-term interventions are beneficial to entrenched clients.
     • Added language about how APS should emphasize social support and programs that promote participation in community social outlets.
     • Added language about working in tandem with mental health practitioners.

5B. Involuntary Service Implementation:  Added language about how using a Forensic Center can help make the difficult determination whether or not APS should petition for a guardianship.

6A. Caseworker and Supervisor Minimum Educational Requirement:  Added language that candidates for APS employment should be screened for suitability and capability.

6B. Caseworker Initial and Ongoing Training:  Added additional training topics of cognitive deficits and motivational interviewing.

6C. Supervisor Initial and Ongoing Training:  Strengthened section on supervisor training, using materials from the APS Leadership Development Framework Report developed by Adult Protective Services Workforce Innovations, Academy for Professional Excellence.

7A. Managing Program Data:  Added language about keeping data long enough to ensure their availability for quality assurance needs.

7B. Evaluating Program Performance:  Added language about collecting information on client outcomes

Looking Ahead

The Guidelines is a living document and, as such, requires regular updating to reflect the changing landscape of APS practice, research, and policies. ACL will continue to update the Guidelines with new findings and stakeholder input at regular intervals.

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