Department of Family and Protective Services Improving Efficiency of Adult Protective Services in Texas Karl Urban, MA, Director of Performance and Policy Development, Adult Protective Services, Texas Department of Family and Protective Services Kristen Johnson, PhD, Senior Researcher, National Council on Crime and Delinquency October 2014
Agenda
Mission and Context Setting The mission of Texas Adult Protective Services (APS) is to protect older adults and people with disabilities from abuse, neglect, and exploitation. The National Council on Crime and Delinquency (NCCD) promotes just and equitable social systems for individuals, families, and communities through research, public policy, and practice.
In-Home Investigations and Services In-home investigations are conducted in private residences, room and board homes not subject to licensure, and/or adult foster care homes with three or fewer residents. APS may arrange for or provide the following services: Emergency financial assistance for rent and utility restoration Social services Emergency shelter Health services Referral to or collaboration with other community services, including guardianship
FY 2013 Validated APS In-Home Allegations by Type Physical Abuse 2% Mental Health Neglect 9% Medical Neglect 19% Exploitation 2% Emotional- Verbal Abuse 1% Sexual Abuse 0% Suicidal Threat 0% Physical Neglect 67%
Texas Population Age 65 and Over and Population Ages 18 to 64 With a Disability 5 4 Millions 3 2 2.45 2.52 2.58 2.69 2.80 2.91 1 0 1.52 1.56 1.61 1.54 1.68 1.71 2009 2010 Est. 2011 Est. 2012 Est. 2013 Est. 2014 Est. N = 3.97 N = 4.08 N = 4.19 N = 4.23 N = 4.48 N = 4.62 Age 18 to 64 With a Disability Age 65+
APS In-Home Completed Investigations, FY 2006 2012 100,000 90,000 80,000 70,000 74,737 64,459 68,683 72,265 82,802 87,741 87,487 60,000 50,000 40,000 30,000 20,000 10,000 0 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012
HHSC Forecast of APS In-Home Intakes and Caseloads, FY 2011 to FY 2015 Millions 34 33 32 31 30 29 31 108,580 29.6 107,203 31.2 110,508 32.2 112,824 33.2 115,284 120,000 110,000 28 27 FY 2011 FY 2012 FY 2013 est. FY 2014 est. FY 2015 est. 100,000 Caseload Intakes
Key Practice Trends Affecting Need to Change Increasingly difficult-to-serve populations Service gaps in some communities One-size-fits-all and fear-of-the-one-badcase practice approach Casework practice improvement => shrinking durations => declining caseloads Caseworker stress/frustration => turnover => inexperienced staff
What to do? Better target who APS serves Serve them more effectively and efficiently
Changing Who We Serve Target individuals as defined in statute/rule/policy Screen out more intakes at statewide intake through better guidelines Inform and educate (staff and community stakeholders) Staff training and culture change
What changed? Eliminate cases» When APS investigation will not alleviate the root cause» When other entities have clearer responsibility and resources Make distinction between paid and unpaid caretakers Tighten up policy on what it means to be an adult with a substantial impairment
Intakes Initially Dropped by 25% This scared us and caused us to: Review intakes and rapidly close cases to make sure we were not missing anyone Tweak intake guidelines and policy, particularly substantial impairment Stay plugged into feedback from staff and stakeholders
Click to edit Master title style Changing Case Practice Through Use of the Structured Decision Making System
Why change our practice model? Challenges APS target populations are growing The CARE tool does not evaluate safety and risk of recidivism, and it is not an assessment tool specific to the needs of protective services clients APS specialists have to make incredibly difficult decisions in a work environment that encourages independence Opportunities SDM will help target services to those most in need SDM is a risk assessment system that is based on research and insight specific to protective services SDM will provide a response based on safety, risk of recidivism, and strengths-based practice SDM provides decision-making tools that further empower staff Empowered specialists are the APS program s greatest resource
The Assessments Current/immediate harm At case initiation and at initial face-to-face contact Safety Assessment Risk of Recidivism Assessment Likelihood of future harm At end of investigation Focuses service planning At beginning of ICS Strengths and Needs Assessment
Prediction Versus Classification
SHIELD as Part of a Broader, Client-Centered Practice Framework Tools do not make decisions people do. Engagement Research and structured tools can help guide and support decision making to improve outcomes. Clinical Judgment Client Research Tools should be integrated within a context of client engagement strategies and strong social work practice approaches. Structure
Current In-Home Process Intake Proposed Revised In-Home Process Investigation Service Delivery Intake Received by SWI Safety Assessment Valid Findings? Yes Risk Assmt. Med/High Risk Strengths and Needs Assessment Yes Meets Criteria? No Emergency Services No Low Risk Service Plan based on Risk Assessment and Strengths and Needs Assessment No Closure Yes ANE Remediated?
What Are Implications for Casework Practice? Focus on recidivism and root cause Safety vs. risk a change in perspectives Actuarial scored risk Informed decisions reinforcing intuition Real service planning Moving beyond Band-Aid approach
What does it mean for an APS caseworker? Current Practice Model One amorphous assessment tool Duplicate documentation in Faceplates + CARE narrative Risk is about safety Contacts same for all Workload = caseload SHIELD Three tools, as needed, targeted to case decisions Documentation in tools or contact narrative Risk is recidivism Safety is immediate harm Contacts vary Workload = workload
Ensuring Change Happens Phase I: Design Assessment Processes (FY 2013) Business Requirements Risk Fit Data Analysis Design Assessments, Policy and Procedures Phase II: Build in IMPACT/MPS (FY 2014) System Design Build/Code System and UAT Testing Training Phase III: Implement, Monitor, Recalibrate (FY 2015) Statewide Deployment Support Recalibrate (if needed)
What happened? 23
Consequences of the Change in Target Populations in FY 2013 Small drop in older Texas; much bigger drop in adults with disabilities Staff report being happier Caseloads dropped; durations slightly increased But in FY 2014
APS In-Home Completed Investigations, FY 2006 2014 100,000 90,000 80,000 70,000 74,737 64,459 68,683 72,265 82,802 87,741 87,487 69,383 81,707 60,000 50,000 40,000 30,000 20,000 10,000 0 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014
Changing Casework Practice in 2014 and Beyond SHIELD went live on September 1, 2014 So far we are meeting the mission but we are often not using the system correctly» Documentation is inconsistent and wrong» Risk versus safety is difficult change to effectuate» Some of us are not good case managers (yet)
Moving Forward, APS is Answering many day-to-day questions Fixing technical glitches Revamping communication plan Planning new and ongoing training/staff supports
Ensuring Further Change Closely monitor implementation through short-term, ad hoc case reading; weekly scan calls; and ridealongs Adjust long-term, quality improvement processes:» Revise case reading standards» Revise staff performance plans» Create new management reports
What are the implications for the aging network and other community partners? Closure of low-risk client cases More intensive APS involvement with high-risk client cases Community supports as strengths in service planning
Take-Home Points Using data-driven decision making and field input to proactively get ahead of the challenges Finding best practice, then» Study, assess, plan, do, re-assess Measuring and achieving change Implementing for sustainability
QUESTIONS, comments?
Contact Information and Further Discussion Karl Urban: karl.urban@dfps.state.tx.us Kristen Johnson: kjohnson@nccdglobal.org For further discussion about structured decision making, join us