Strengthening APS and Informing Implementation of the Elder Justice Act: A Nationwide Survey of APS Administrators. Preliminary Results January 2011

Transcription

1 Strengthening APS and Informing Implementation of the Elder Justice Act: A Nationwide Survey of APS Administrators Preliminary Results January 2011

2 Contact Information Betsy Cavendish; Executive Director, Appleseed Marie-Therese Connolly; Director, th Street, N.W., Suite 1100 Washington, DC

3 Appleseed and Appleseed, a network of public interest justice centers in the U.S. and Mexico, tackles tough policy and legal challenges at a systemic level. We leverage the skills of pro bono partners and other professionals to research and advocate for long-lasting reforms that advance opportunity and justice. : Strategic advocacy for elder justice informed by evidence, experience, expertise and evaluation. (LLJ), Appleseed, seeks to empower the nascent elder justice field by developing resources (like this) that inform the national dialogue, furthers recognition of elder abuse, neglect and financial exploitation as a growing social justice issue, and promotes reform of law, policy and practice to enhance justice and dignity for older people.

4 Edgeworth Economics is a boutique economic consulting firm that combines attentive, quality client service with vigorous thought leadership in economic analysis and data management. We are professional economists who enjoy solving the practical problems that our clients face. We stay at the leading edge of economic analysis by engaging in scholarship, teaching, and research. Our team is made up of consulting economists, academics, business specialists, human resource professionals, statisticians, and engineers with strong backgrounds in statistical analysis. At Edgeworth, we know that even the highest quality analysis is useless if it can't be explained in a simple, straightforward manner. We take pride in our ability to teach clients, judges, and juries about our research.

5 Acknowledgements Special thanks to: Linda Lannom Leah Flamm Ariel Trilling John Johnson Chuck Fields Kim Dusebout Katie Gofus Justin Henderson Jun Liang Phil Winsor APS experts and survey respondents (too numerous to name) Thank you to Edgeworth Economics for its pro bono support of Appleseed s initiative.

6 Adult Protective Services (APS) Responds to and investigates allegations of elder abuse, neglect & exploitation and intervenes to help protect victims Exists in all states under state laws and is administered at the state or county level Most programs serve adults with disabilities age 18 and older; a few programs only serve seniors APS programs in about 50% of states have jurisdiction for abuse investigations in at least some facilities

7 Elder Justice Act (EJA) Enacted March 23, 2010 with the Affordable Care Act (Health Care Reform) First federal law to take a comprehensive approach to promoting elder justice and addressing elder abuse, neglect and exploitation Section 2042 of EJA authorizes funding, data collection, demonstration projects, and other support for Adult Protective Services (APS) (No funds appropriated to date) This survey focuses on EJA, Section 2042

8 Survey Instrument and Process Survey instrument development: APS experts (practitioners and academics) and survey research experts provided input A pilot was conducted to test and revise the instrument The Survey Responses were collected via phone interviews with APS administrators from June through August 2010 The response rate was 87% APS Administrators from 46 states, DC, the Virgin Islands, and Guam are represented in the survey results

9 The Survey: Topics Covered 1.Sufficiency of Current APS Resources 2.Priority Uses for EJA Funds Designated for APS 3.Types of assistance APS programs most need from HHS 4.Types of Data APS Programs Collect 5.How APS Measures its Effectiveness 6.Priority Areas for APS Demonstration Projects 7.Top Legal and Policy Challenges Facing APS 8.APS Participation in Multidisciplinary Forensic Teams 9.APS Administrators Duties and Activities

10 Does your APS program have enough resources to address the needs of the population you serve? Yes 9% RESULTS & TAKEAWAYS The majority of APS administrators do not have enough resources No 91% Do you have enough resources? Notes and Sources: Analysis excludes those participants who did not respond to this particular question. No.no Absolutely not Laughs for seconds

11 On a scale of 1 to 5 where 1 is not at all important and 5 is very important, Importance of using EJA state and local funding for: Hiring new staff 4.7 APS-procured direct client services, such as guardianship Enhanced APS investigation and response Training for APS 4.3 Training for others who encounter or work in the field of elder abuse 4.1 Information Technology 4.1 RESULTS & TAKEAWAYS Top priority is new or additional staff Notes and Sources: Analysis excludes those participants who did not respond to this particular question.

12 The top 2 needs of APS administrators OTHER 25% EXAMPLES: FINANCIAL EXPLOITATION EXPERTISE LEGAL ASSISTANCE STAFF 36% RESOURCES FOR DATA COLLECTION/ ANALYSIS 5% MORE MULTIDISCIPLINARY COORDINATION / COLLABORATION 6% TRAINING FOR APS, LE, ETC. 11% RESULTS & TAKEAWAYS Over 50% of APS administrators believe that staff (36%) and funding (17%) are the most important resources FUNDING 17% Our resources are being depleted since we are 100% state funded and our state is [facing] a budget crunch. Notes and Sources: Analysis excludes those participants who did not respond to this particular question.

13 Types of Support that HHS should ensure are provided to APS: On a scale of 1 to 5 where 1 is not at all important and 5 is very important, the most important types of support that the US Department of Health and Human Services (HHS) should ensure are provided to APS [either by HHS or another entity]: Develop best practice guidelines 4.5 Increase public awareness 4.5 Provide input by APS experts into law reform and policy development 4.5 Coordinate initiatives with critical partners, such as DOJ, etc 4.4 Compile and analyze uniform national APS data Notes and Sources: Analysis excludes those participants who did not respond to this particular question. 4.4

14 Types of Support that HHS should ensure are provided to APS: On a scale of 1 to 5 where 1 is not at all important and 5 is very important, the most important types of support that the US Department of Health and Human Services (HHS) should ensure are provided to APS [either by HHS or another entity]: Disseminate research findings 4.1 Develop national training for APS personnel 4.1 Provide technical assistance to APS programs 3.9 Develop national training for other professions regarding the role of APS RESULTS & TAKEAWAYS Broad APS support for HHS assistance in developing APS best practices increasing public awareness, and assuring APS input into law reform and policy Notes and Sources: Analysis excludes those participants who did not respond to this particular question. 3.8 There is a huge difference between APS across the country, not just because of training, but because of statutes and I think more uniform laws surrounding abuse would be very helpful.

15 Can all of the data your APS program currently collects be retrieved and used to generate report tables? No 21% RESULTS & TAKEAWAYS Most APS programs use the data that is collected to create reports But 21% of APS programs do not effectively use the data they collect Notes and Sources: Analysis excludes those participants who did not respond to this particular question. Yes 79%

16 Percent Client information currently collected by APS Programs 100% 90% 96% 93% 88% 83% 80% 70% 60% 55% 54% 50% 40% 30% 20% 10% 0% Client's gender Client's age Client's setting Setting where the abuse occurred Client's functional capacity, such as ADLs Client's cognitive capacity Notes and Sources: Analysis excludes those participants who did not respond to this particular question.

17 Percent Alleged perpetrator information (where relevant) collected by APS 100% 90% 89% 80% 70% 69% 60% 50% 45% 40% 30% 20% 21% 10% 0% Perpetrator's relationship to the client Notes and Sources: Analysis excludes those participants who did not respond to this particular question. Perpetrator's gender Perpetrator's age Perpetrator's cognitive capacity RESULTS & TAKEAWAYS Client specific data are more likely to be collected than perpetrator specific data Cognitive capacity and function data are collected less frequently

18 Percent Information collected re: number of cases and substantiated cases 100% 90% 80% 98% 96% 96% 94% 90% 81% 77% 73% 71% 70% 60% 50% 47% 40% 30% 20% 10% 0% # of reports made to APS per year # of substantiated financiancial exploitation cases # of substantiated cases of neglect by another person # of substantiated reports # of substanatiated self-neglect cases # of substantiated physical abuse cases Notes and Sources: Analysis excludes those participants who did not respond to this particular question. # of substantiated sexual abuse cases Resolution of substantiated reports # of substantiated psychological, emotional or verbal abuse cases Reasons why reports were not substantiated RESULTS & TAKEAWAYS Current case data collection trends more towards case volume than outcomes or resolutions

19 Percent Factors that would make it more feasible for APS programs to collect or retrieve data 100% 90% 80% 70% 60% 94% 77% 68% 56% 50% 40% 30% 28% 20% 10% 0% Additional funding for staff time to support data collection Change in current data collection procedures Assistance setting up computer programs or other IT support Change in the forms on which data are collected Change in state laws or rules governing data collection RESULTS & TAKEAWAYS Funding and staff critical to building robust data systems State laws or regulations typically not barriers to collecting data Notes and Sources: Analysis excludes those participants who did not respond to this particular question.

20 Percent of respondents that routinely measure program effectiveness by collecting: Recidivism rates Client outcomes No 40% Yes 60% No 52% Yes 48% n =35 n =33 No 65% Risk reduction data Yes 35% Arrest and prosecution data No 86% Yes 14% n =37 n =36 RESULTS & TAKEAWAYS Recidivism rates are the most common way APS programs measure effectiveness Improved data management capability could allow for collection of critical client outcome data Additional study is needed to determine how to define and measure success Notes and Sources: Analysis excludes those participants who did not respond to this particular question.

21 The EJA authorizes $25 million for APS-related demonstration projects. Respondents were asked what one topic they would most like to explore in such a project. OTHER 33% EXAMPLES: -EDUCATION AND PUBLIC AWARENESS -TRAINING FINANCIAL EXPLOITATION ISSUES 28% RISK ASSESSMENT / PREVENTION SERVICES FOR AT RISK ADULTS 8% SELF NEGLECT AND HOARDING PREVENTION AND SERVICES 9% what one topic would you most like to explore? MEASURING EFFECTIVENESS AND OUTCOMES OF INVESTIGATIONS/INTERVEN TIONS 9% COLLABORATION WITH LAW ENFORCEMENT AND OTHER AREAS 13% One of the biggest challenges for us is really detecting financial abuse RESULTS & TAKEAWAYS Financial exploitation most common response Notes and Sources: Analysis excludes those participants who did not respond to this particular question.

22 Top legal or policy challenges APS administrators face OTHER 49% EXAMPLES: - CHANGE LAWS TO INCREASE ACCESS TO FINANCIAL RECORDS - INCREASED FUNDING - LACK OF STAFF - NEED ASSISTANCE FROM FEDERAL GOVERNMENT GUARDIANSHIP ISSUES 12% STANDARDIZE, UPDATE, AND CONSOLIDATE LAWS AND POLICIES 10% BETTER COLLABORATION WITH POLICY MAKERS, LAW ENFORCEMENT, AND OTHER AGENCIES 10% MORE PROSECUTION NEEDED 10% INCONSISTENCY OF INTERPRETATION OF LAWS 4% STANDARDS FOR DATA AND RESEARCH SYSTEMS 5% RESULTS & TAKEAWAYS Most common challenge cited is Guardianship Issues (12%) Standardizing laws (10%) + inconsistent interpretation of laws (4%) also rank highly Better collaborations with myriad others next priority (10%) Notes and Sources: Analysis excludes those participants who did not respond to this particular question. Actual question asked was What are the top 3 legal or policy challenges that you face that are not being met?

23 Does your APS program participate in an Elder Forensic Center, Elder Fatality Review Team, or any other type of multidisciplinary forensic team or program? No 43% Yes 57% RESULTS & TAKEAWAYS The majority of APS programs participate in a multidisciplinary forensic program Opportunity for more APS programs to collaborate with other multidisciplinary teams Notes and Sources: Analysis excludes those participants who did not respond or who did not know the answer to this particular question.

24 Percent APS Administrators Duties and Activities 100% 90% 80% 70% 60% 50% 95% 85% 91% 91% 82% 71% 86% 76% 85% 50% 82% 81% 76% 56% 72% 54% 67% 62% 57% 44% 52% 40% 30% 20% 24% 10% 0% Developing rules and regulations Program evaluation Quality Assurance Technical assistance Data Collection Responsible For Training Personally Handle Community collaboration RESULTS & TAKEAWAYS APS administrators are busy! Personally handle or oversee numerous duties Illustrates the value of increased funding and staff Budget and Finance Notes and Sources: Analysis excludes those participants who did not respond to this particular question. The percent of administrators who personally handles the job duty is based on the total number of administrators that responded to the question, even if they responded that they are not responsible for the duty. Personnel Oversight of management agencies providing direct client services Case Supervision

25 Conclusions and Recommendations Conclusion: Most APS programs lack sufficient resources Most APS programs report severe staff and funding shortages Majority of programs need funding, staff, training, resources for data collection, more collaboration, research, technical assistance APS wants and needs assistance from HHS (the types of assistance cited could be provided by a robust resource center) Frequently cited challenges include financial exploitation, guardianship issues, inconsistent laws, and rare justice system action Recommendation: Appropriate funds to implement the Elder Justice Act and allocate funds and other types of support to APS, to research relating to APS, and to efforts to strengthen it

26 Next Steps for APS Data Collection Progress in last 5 years: APS has made progress in collecting data, identifying certain types of outcomes, and participating in multidisciplinary forensic groups Next steps and EJA requirements: We can and should immediately begin to identify common data points that all APS programs nationwide can and should collect Uniform national data collection will allow valuable and revealing data comparisons of apples-to-apples among jurisdictions APS data collection and evaluation are required by law: The Elder Justice Act requires evaluation of all programs funded under the Act (Section 2044) and the APS provision (section 2042) requires the collection of data

27 Critical Next Step: Defining Success We have not yet defined what a successful APS intervention is We urgently need to develop definitions for what constitute successful interventions (and whose views should be considered in making that determination) Without a definition of success, we cannot measure true efficacy A thoughtful, well-contemplated and validated definition of success, is critical to the development of outcome measures to assess the effectiveness of current APS interventions

28 Next Step for this Project We are in the process of drafting a report to provide additional detail about: Methodology and process Survey results Next steps and recommendations

29 Feedback? Questions? We d love to hear your feedback, questions or suggestions. How are you using these slides? What additional information relating to this project would you like to know? Anything else? Please contact MT Connolly at mtconnolly@appleseednetwork.org Thank You