Language Matters: Innovations Townhall on APS Language Wrap-up

Introduction

On September 8, 2022, the APS TARC, the Administration for Community Living Office of Elder Justice and Adult Protective Services (ACL OEJAPS), and the National Adult Protective Services Training Center (NATC) facilitated a virtual, interactive townhall discussion with representatives from 34 APS programs (state/local/territory) and other collaborative partners on APS language use.

The goal of the Townhall was to acknowledge the diversity of APS programs and have an open discussion with a variety of APS and APS-tangent professionals to begin building consensus on more person-centered, culturally responsive, and trauma-informed language for use in APS programs acknowledging that both the field and language evolves but laws and statutes may not keep pace.

Questions and Feedback

Discussion questions were developed and sent to all registered participants prior to the Townhall to elicit maximum written and/or verbal responses. Facilitators also encouraged feedback and comments be sent post Townhall to maximize the voices heard. The facilitated discussion questions included:

• As the field and language evolves what terms work and what terms may be problematic?
• What are you hearing from communities or staff and are there feedback mechanisms in place for this feedback?
• How do we negotiate challenges that statute/law may pose to language use/change?

The Townhall discussion provided facilitators valuable comments and feedback which are summarized below.

Townhall Comments, Feedback, and Alternatives

APS Language Comments/Feedback	Alternatives
Alleged Perpetrator/Perpetrator	▪ RISE model “harmer” ▪ Person of interest (POI) ▪ Person alleged responsible for maltreatment ▪ Person responsible for maltreatment
Alleged Victim/Victim ▪ Many do not see themselves as victim, not strengths-based ▪ Definitely have heard "I'm not old" when explaining what APS does ▪ Yes, I'm with intake and I have had some people upset with me when I've asked them if they are the alleged victim. ▪ Electronic records require consistent language to check certain boxes and this can create issues with terms like "alleged victim" which get built into our practice.	▪ Eligible adult ▪ Client, Adult, Adult vulnerable to maltreatment, Older adult or Adult with a disability ▪ We no longer use "Alleged Victim", everybody is a Client. Client/Consumer ▪ Call Joe, Joe or Susan, Susan or Mr. X or Ms. Y
Bedfast/Bedridden/Bedbound or Wheelchair Bound	▪ Mr. Doe was confined to bed unable to xyz. ▪ Ms. Smith used a motorized wheelchair to xyz.
Behavioral ▪ As a person is "having behaviors"; ▪ Behavior is a form of communication and should be honored, acknowledged, and investigated as such	▪ Non-speaking
Case Component, Case Component, Key Indicators ▪ Use social service terminology for consistency with the ACL definition of adult protective services (APS) as a social service program to maximize client safety and independence and for consistency with ACL values for person-centered planning processes. Source: National Adult Maltreatment Reporting System (NAMRS) 60-day Federal Register Notice (FRN) Comments	▪ Investigation: Assessment  ▪ Victim: Client, Adult, Adult vulnerable to maltreatment, Older adult or Adult with a disability  ▪ Perpetrator: Person responsible, or person alleged responsible for maltreatment
Capacity	▪ Decision-making ability ▪ Ability to understand the consequences of their decisions
Elder/Elderly (negative) ▪ Adds to ageism; ▪ Ageist connotations	▪ Older adult, older person
Elder (positive) ▪ There is childhood, adulthood and elderhood ▪ Elder is a sign of respect in my culture ▪ Older would be more offensive ▪ “You calling me old?”	▪ Elder - practice cultural humility and ask and/or learn about the person you are interacting with; this may be their preferred term
Gender-Related language	▪ Ask what the person prefers - formal vs. informal, preferred pronouns, etc. ▪ Gender neutral and/or inclusive language
Homeless	▪ Persons experiencing/experienced homelessness or housing insecurity ▪ Houseless ▪ Unsheltered
Investigation	Assessment
Non-Verbal	▪ Non-speaking ▪ Mrs. Jones uses an augmented communication device to xyz.
Placement ▪ E.G.. “my client needs placement” or “I placed the client” ▪ The elders we serve are not things that we “place”	▪ I helped the client relocate ▪ I assisted the client in locating a care residence ▪ The client moved to a higher level of care ▪ Transitioned to another setting ▪ Ombudsman programs - "admission" to a nursing home or other setting
Person-First Language ▪ Is not preferred by all people with disabilities, ex. Deaf or Autistic Communities	▪ Practice cultural humility and ask and/or learn about the person you are interacting with; this may be their preferred term
Protection/Protective ▪ Could be perceived as paternalistic (“I don't need protection!")	▪ Support is much better than "protection" ▪ Everyone needs support sometimes
Recidivism ▪Client serving will come back in future when it can be excellent customer service and trust vs. negative ▪ Definition from Merriam Webster ▪ Connotation not appropriate for APS clients	▪ Other options reoccurrence, repeat cases or repeat reports ▪ Returning clients, repeat clients
Self-Neglect ▪ Using "substantiated" to refer to confirmed self-neglect cases ▪ Self-neglect seems victim blaming, when it's often societal neglect ▪ Person would not use the language to describe themselves, so could be problematic for APS to use ▪ Outcome of decisions, not decision itself ▪ Outcome of societal neglect; Investigate or access self-neglect	▪ Person experiencing self-neglect ▪ Societal neglect
Social Worker, APS Worker/APS Investigator, Front-Line Worker ▪ Vast majority of APS personnel do not have a social work degree	▪ APS professional ▪ Client-facing (if using client)
Suicidal	▪ They have experienced suicidal thoughts ▪ They have lived through a suicide attempt ▪ They died by suicide ▪ They lost their life to suicide
Vulnerable/Vulnerability ▪ Is the result of socially created processes that determine what resources and power groups have to avoid, resist, cope with, or recover from threats to their well-being ▪ People are not vulnerable; they are made vulnerable ▪ Vulnerable Adults – Our Disability Rights Centers expressed concern with this language in our policy	▪ At-Risk Older Adult  ▪ At-Risk Adult ▪ Person at-risk ▪ Adult vulnerable to maltreatment

 
Around the question of negotiating challenges or barriers to language use or change, the following were shared:
 

• Lack of national standards outside of the Elder Justice Act. ​
• I think it has to start on the national level, and then for example in federal funds and then trickle down to the States.
• Statutory language differences across states will serve as a barrier to language change and consistent language use across the field. Potential solution would be to have language added to statutes that allows states to use the language agreed upon at the national APS level (wishful thinking).
• You may have to update statutes, regulations, and policy guidance also.
• Years of language-habit is difficult to change. Solution- having support to "call in" and remind/refocus and provide context of why.

Conclusion and Next Steps

As Elizabeth Petruy from ACL stated in the beginning of the Townhall, “this is a huge discussion and this Townhall is the start of the conversation, not the end.”

On that note, the APS TARC would like to hear from you on what you would like to see as next steps in this discussion on APS language? What would support you in your APS program around this work? Your feedback will help inform later TARC activities on this topic – please contact us!

Missed the Townhall and want to be a part of the discussion? Watch the recording here.

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