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