Adult Protective Services Policy Manual
Assessment of Risk
1703.64
The assessments of risk include the Risk Assessment, the Perpetrator Access Assessment and the Financial Exploitation Assessment, all of which can be found in the Assessments Tab in Case Compass. The Risk Assessmentshall be completed on all Adult Protective Services (APS) investigations. The intent of the Risk Assessment is to direct the Adult Protective Service Worker’s (APCW) attention to all aspects of the Reported Adult’s (RA’s) life that may place he/she at risk, rather than just focusing on the original reported allegations. If additional issues are identified, the APCW shall:
- add any new allegations to the Case Compass report;
- investigate the new allegations;
- complete any associated Case Compass allegation “activities” during the course of the investigation.
The Perpetrator Access Assessment shall be completed whenever there is an alleged perpetrator involved. The Financial Exploitation Assessment is to be completed when there is an allegation of exploitation or when the Risk Assessment indicates possible exploitation.
The assessment of risk shall be an ongoing process throughout the investigation meaning that the APCW should remain aware of the RA’s circumstances on every visit. The Risk Assessment is the formal documentation of the APCW’s observations and information gathered, and completion of data entry in Case Compass shall occur as often as needed. A Risk Assessment is required on every APS hotline report. However, more than one Risk Assessment may be needed during the course of an investigation when not all categories can be assessed during the initial visit or if there is a change in circumstances. In every APS hotline report, there is a potential for change in the level of risk, as the RA’s risk may escalate during the investigation. For example, a decline in the RA’s physical or mental health during an investigation may impact the RA’s level of risk, thus necessitating the APCW to re-assess the situation.
The only exceptions to not completing the Risk Assessment are situations in which the RA has moved out of state, the RA is deceased, or the APCW is unable to locate the RA. An exception request shall be submitted to the Adult Protective Community Supervisor (APCS) if these circumstances exist so that the Risk Assessment requirement can be waived.
Determining Risk:
The assessment of risk shall include asking specific questions, engaging in discussion with the RA, making observations, and analyzing information gathered.
The APCW shall assess several factors/categories to determine if any other element of risk exists in each particular area. The categories to examine include the RA’s:
- functional and mental abilities,
- living environment,
- financial resources,
- self-neglect and caregiver neglect,
- caregiver strengths/weaknesses
- support system,
- medical history,
- abuse and financial exploitation.
Discerning Risk guidelines:
When assessing the RA’s Support System, the APCW shall determine by discussion and/or observation if the RA has formal and/or informal supports, make note of who the supports are, and ask questions in order to determine whether the support system is reliable and adequate. If the RA has an inadequate support system, due to being estranged from family/friends, refusing available support, or having no supports, the level of risk associated with any support system concerns shall be noted and allegations added to the report if appropriate.
When assessing for Financial Exploitation, the APCW shall address reported or observed signs of exploitation such as unexplained depletion of funds, transfer of assets and/or property, or the mention of visitors that coincide with the arrival of RA’s monthly income. The APCW shall also attempt to determine whether Undue Influence has been used to gain control of the RA’s assets and/or decision making. Undue Influence (570.145 RSMo) may be identified by asking specific questions if a recent financial transaction or decision did occur such as:
- Didthe RA have the opportunity to consult with a neutral third party prior to the transaction?
- Does the RA understand the transaction? Was the transaction fully explained?
- What events preceded the discussion about the transaction?
- What are the relative benefits to the RA and suspect? Who stands to gain the most?
When assessingFunctional Ability, the APCW shall address the RA’s abilities with mobility, hygiene, toileting, household chores, transportation, dietary needs, and communication. The APCW shall assess whether the RA is independent, needs occasional or moderate assistance, or is totally dependent upon others in these areas.
Policy 1704.40 on Judicial Proceedings provides definitions for Payee, Conservator, Guardian, Financial Durable Power of Attorney (DPOA), and Medical DPOA. The Mental Abilities section of the Risk Assessment addresses whether or not the RA needs, has or doesn’t have each of these legal directives.
NOTE: Case Compass “Help Text” has been implemented for several of the risk categories and the APCW may access the text by clicking on the help text question mark next to the question or category needing further clarification or definition.
Conducting the Assessment:
I. Initial Contact
During a Class I or Class II investigation, the initial Risk Assessment shall coincide with the initial face-to-face visit (See Policy 1703.40). When completing the Risk Assessment in Case Compass, the actual date the RA was seen shall be given as the assessment date. This may be different from the date the assessment data is entered in Case Compass. Policy 1703.40 states the APCW must determine the type of initial visit that will ascertain the risks to the RA.
Certain circumstances may prevent the APCW from determining the level of risk in all categories at the time of the initial visit and initial assessment with the RA. For example, an APCW in receipt of a Class I hotline involving physical abuse may be busy addressing the emergency and providing immediate intervention. The risk to the RA involving the abuse would be addressed but the APCW may not be able to address any other category. The initial Risk Assessment in Case Compass would reflect just the category addressed and a subsequent assessment would be completed as soon as the APCW is able, in order to address the remaining categories.
Once documentation of the Risk Assessment has been initiated in Case Compass, the assessment should not be left in a “pending” status. The documentation of the assessment should be completed and closed within the same day, regardless of whether all categories were able to be addressed.
II. During the Investigation
In situations in which the APCW is not able to address all categories of risk during the initial visit, those categories of risk shall be completed as the situation permits and until all categories have been addressed. The Risk Assessment in Case Compass should reflect that the APCW was unable to assess a particular category and the APCW shall provide a brief explanation as to the circumstances that prevented gathering the information. Because assessing risk to the RA is an on-going process throughout the investigation, the APCW may observe the RA’s level of risk escalate during the investigation due to a change of circumstances. The APCW shall complete a subsequent assessment to address those categories of risk affected by the change.
When re-assessing the RA during an investigation, the APCW shall create a duplicate copy of the most recently completed Risk Assessment in Case Compass. The APCW shall identify which categories need to be updated. The APCW will only need to update the category or categories that changed or were unable to be addressed previously. The APCW shall note the date of the subsequent assessment and describe the updates that were made.
III. Completion of the Investigation
At the conclusion of the investigation, the APCW shall re-evaluate each risk category to be sure no risk remains. If the APCW finds that RA has needs that have not been resolved, the APCW shall determine the need for continued monitoring of the RA as a protective service client by completing the PS Assessment (see Policy 1704.20).
Documenting the Risk Assessment in Case Compass:
When completing the Risk Assessment in Case Compass, the APCW shall respond as to whether the risk category was discussed or observed. If a category was discussed/observed, the APCW shall select specified check-boxes for any observed and/reported issues and provide any additional detail necessary in the description and explanation text box. If the APCW was not able to assess risk in a particular category, no detail is needed except a brief explanation as to why the category was not assessed.
Each category of risk in the assessment shall be given an overall rating of:
- (0) No Risk;
- (3) Minimum non immediate, minimal risk;
- (6) Moderate serious but non immediate risk;
- (9) Maximum serious and immediate risk.
The Abuse, Neglect and Exploitation (ANE) score is determined by considering the RA’s overall situation and highest level of risk experienced by the RA during the course of the investigation (see Policy 1703.70, Appendix A). The Risk, Perpetrator Access and Financial Exploitation assessments will influence the ANE score within Case Compass.
Page 1 of 4
Effective: 05/13