10224 Assessment of Involved Adult

 

Within thirty (30) or sixty (60) working days of receiving a report, the APS Protection Specialist shall complete a thorough investigation and assessment. The goal of the investigation and assessment is to determine the safety of the Involved Adult (IA) and to recommend services required to address any needs identified through the assessment.

If conducting the investigation and assessment within thirty (30) or sixty (60) working days would interfere with an ongoing criminal investigation, the time period for the investigation and assessment shall be extended, but the investigation and assessment shall be completed within ninety (90) working days.

Assessment is an ongoing process. The assessment is based on the APS Protection Specialist’s observations, interviews with the Involved Adult and the Alleged Perpetrator, and information obtained from collateral contacts.

  1. Components of the assessment

The following areas may be considered in the assessment for each Involved Adult as part of the APS investigation.

1. Environment

    1. Assess whether the daily living environment contributes to the Involved Adult's risk, including:
      1. The Involved Adult is sufficiently mobile to exit the home in case of an emergency or has an assistance plan for exiting in case of an emergency.
      2. The living quarters are adequately heated or cooled.
      3. Toilet facilities are available and in working condition.
      4. There is refrigeration and or other adequate storage for food.
      5. There is ready availability of a telephone or other communication device to contact help.
      6. There is no animal, rodent, or insect infestation.
      7. Utilities are working.
      8. There are no other endangering housing deficiencies.

The assessment of the physical environment should include identification of type and feasibility of needed improvements or changes to the Involved Adult’s environment, and whether the adult is isolated in his or her environment.

2. Functional Ability

There is a direct relationship between an Involved Adult’s risk of being abused, neglected, or exploited and his or her dependence on others for performance of activities of daily living (ADL’s). An assessment of the Involved Adult’s ability to manage these activities of daily living is one consideration in assessing his or her need for protective services. Examples of ADL’s include:

a. Bathing

b. Dressing

c. Toileting

d. Transferring

e. Eating

f. Using the telephone

g. Shopping for essential supplies

h. Preparing food

i. Performing housekeeping and laundry tasks

j. Travelling independently

k. Assuming responsibility for medication

l. Managing his/her own finances.

3. Physical/Health

The assessment of the Involved Adult’s physical health may be based on reports of illness, disabilities, and symptoms by the individual or by friends, relatives, or other contacts, or by the APS Protection Specialist’s observation of apparent medical problems. Additional areas to consider when assessing physical health include:

    1. Current medical condition, including any diagnosis or prognosis available, and any services being used.
    2. Symptoms observed by the APS Protection Specialist or reported by the Involved Adult or other observers that may not have been diagnosed or treated.
    3. The number and types of medication(s) the Involved Adult is currently taking (prescription and non-prescription) and whether medication is being prescribed by multiple physicians.
    4. Eating habits (nutrition and hydration).
    5. Need for assistive devices (eyeglasses, hearing aids, dentures, and mobility aids to compensate for physical impairments, etc.)

4. Mental/psychosocial health

While an APS Protection Specialist’s assessment of an Involved Adult’s psychological functioning cannot take the place of a formal clinical evaluation, it can suggest a psychiatric condition is present and is contributing to the Involved Adult’s endangerment. This assessment can provide the APS Protection Specialist with reason for recommending a more complete assessment by mental health professionals. Areas to consider when assessing psychosocial status include:

    1. General appearance is appropriate and consistent with age, social, and economic status. This includes, but is not limited to, an evaluation of appropriateness of dress and personal hygiene
    2. Perceived emotional or behavioral problem(s)
    3. Orientation to person, place and time as well as memory and judgment capacity
    4. Manifestations of emotional or behavioral problems (e.g., insomnia, nightmares, crying spells, depression, agitation, unusual fears, thoughts, perceptions, delusions, hallucinations, etc.)
    5. Major life changes in the past year (e.g., death of a significant person, loss of income, a move, an illness, divorce, institutional placement, etc.)
    6. Ability to follow simple one-step instructions
    7. Ability to manage financial affairs
    8. Appropriate responses to questions
    9. Self-endangering behavior of the adult (e.g., suicidal behavior, refusal of medical treatment, gross self-neglect, wandering, aggressive acts that are likely to precipitate retaliation, etc.)
    10. The APS Protection Specialist’s evaluation regarding the Involved Adult’s ability to make responsible, rational, and informed decisions as well as the ability to understand the probable consequences of his or her decisions.

B. Guidelines for determining ability to consent

Mental illness, intellectual disability, physical illness, memory impairment, developmental disability, alcoholism, substance abuse, and other conditions may be reasons why an Involved Adult is unable to make, communicate, or carry out responsible decisions concerning his or her well-being.

A review of the following abilities will help the APS Protection Specialist differentiate between those who are and those who are not able to make, communicate, or carry out responsible decisions concerning his or her well-being.

1. Ability to communicate a choice:

 

Assess the Involved Adult’s ability to make and communicate a choice from the realistic choices available. Assess the Involved Adult’s ability to maintain the choice made until it can be implemented.

 

2. Ability to understand relevant information:

 

Assess the Involved Adult’s ability to understand information that is relevant to the choice that is to be made (e.g., without treatment gangrene will likely cause death).

 

3. Ability to compare risks and benefits of available options:

 

Assess the Involved Adult’s ability to compare risks and benefits of available options. This requires weighing risks and benefits of a single option and weighing more than one option at the same time. Can the Involved Adult give a logical explanation for the decision he or she reached in terms of risks and benefits?

 

4. Ability to comprehend and appreciate the situation:

 

Assess the Involved Adult’s ability to comprehend and appreciate the situation. An Involved Adult may be able to understand relevant information (e.g., without treatment gangrene will likely cause death) and yet be unable to appreciate his or her own situation (e.g., believes his or her own gangrenous foot will not cause his or her death or disregards medical opinion and denies the foot is gangrenous). An Involved Adult who comprehends and appreciates the situation will acknowledge illness when it is shown to be present and acknowledge the risks and benefits of available treatment options for him or herself.

 

C. Guidelines for determining decisional ability  

APS Protection Specialist shall use the Cornell-Penn Interview for Decisional Abilities (IDA) to determine decisional ability of the Involved Adult. IDA is an evidence-based, semi-structured interview tool, utilized to gather information about a client’s decision-making abilities.

IDA is designed to accurately capture an individual’s general understanding and personal appreciation of risk as well as their ability to make reasoned decisions about service options. IDA helps navigate a vulnerable adult’s right to refuse protective services, specifically the right to self-determination.

IDA will be used by APS Protection Specialists that have been fully trained and received their IDA Practitioner badges.  

  1. IDA Steps:

    1. APS Protection Specialist will complete the pre-IDA. APS Protection Specialist may consult with a supervisor or designee if guidance is needed.
    2. APS Protection Specialist will choose and reword the risk that poses the highest level of endangerment to the Involved Adult. 
    3. APS Protection Specialist will use the same identified reworded risk for each step of IDA to ensure consistency.
    4. APS Protection Specialist will document the Involved Adult’s responses using direct quotes on IDA.
    5. APS Protection Specialist will complete IDA in its entirety.
    6. If APS Protection Specialist marks a “maybe” or “no” on the judgment section of IDA, then APS Protection Specialist shall consult with the APS supervisor or designee within 24 hours to determine next steps. Otherwise, the post-IDA can be completed during the staffing for case finding with the APS supervisor or designee.
    7. APS Protection Specialist will upload a copy of the completed IDA into KIPS.
    8. APS Supervisor/Designee will document IDA results in the case finding note in KIPS.  

  1. There may be events when IDA is not applicable.

These events will need to be staffed with the supervisor or designee and documented within the case file. The supervisor or designee may request the APS Protection Specialist to attempt IDA. These events may include but are not limited to:

  1. The Involved Adult has a guardian or an active DPOA.
  2. The Involved Adult is unable to actively participate in the interview due to mental, physical, or severe cognitive concerns.
  3. The Involved Adult appears to be under the influence of illicit drugs/intoxicated and is unable to actively participate in the interview. 
  4. The Involved Adult refuses to participate during initial face to face assessment or refuses to patriciate in IDA.  
  5. If there are safety concerns for the APS Protection Specialist or Involved Adult while attempting IDA.
  6. If the APS Protection Specialist believes completing IDA would cause harm to the Involved Adult, then staff with a supervisor or designee and document in the case notes in KIPS.
  7. If law enforcement requests APS to not proceed, staff with a supervisor or designee for next steps and document in the case notes in KIPS.

D. Support System

To assess the Involved Adult’s support system, the APS Protection Specialist’s shall first identify those family, friends, neighbors, religious and other voluntary groups, and any formal supports that comprise the adult’s social network. To assess the support of these persons or groups, it may be helpful to answer the following questions:

    1. Does the Involved Adult have family, friends, neighbors, and organizations available to assist him or her?
    2. Are these persons and organizations able to provide effective and reliable assistance?
    3. What is the frequency and quality of assistance available to the Involved Adult from informal and formal support systems?

E. Income and resources

Assess the Involved Adult’s knowledge of his or her income and resources and his or her ability to manage his or her financial affairs. Dementia, disorientation, and short-term memory loss leaves an individual vulnerable to financial exploitation by others or can lead to self-neglecting circumstances such as utility cut-offs or the inability to purchase needed medication. If the Involved Adult is unable to discuss his or her income and financial management ability, the APS Protection Specialist should contact family members, supportive friends, substitute decision makers or financial institutions who have knowledge of an Involved Adult’s income and resources.

Obtaining this information will not only address the issue of exploitation but also be useful for service planning and assistance with benefit program eligibility determinations.