DIVISION OF SENIOR AND DISABILITY SERVICES
Adult Protective Services Policy Manual
Abuse, Neglect, and ExploitationReports
1703.10

Statute requires a prompt and thorough response be made to determine whether the eligible adult is facing a likelihood of serious physical harm and is in need of protective services (192.2415, RSMo). The Bureau of Adult Protective Services (APS) staff conducta systematic and methodicalassessment when responding to Abuse/Neglect/Exploitation (ANE) Class I/II/III Reports and Information Detailed Requests (IDR). All necessary informationmust be collected to address theallegations, determinewhether reported concerns are valid,andwhether further intervention is necessary.

The ANE report is assigned toAPS to conductnumerous interrelated tasks and document such efforts in order to accurately reflect the eligible adult’s circumstances. The role of APS is to determine whether services are needed to reduce or eliminate the risk of ANE and remediate concerns while preserving self-determination.

  1. Acknowledging and Initiating the Report

ANE Reports must be initiated and completed in a timely and efficient manner to ensure the eligible adult’s safety and wellbeing. The ANE Report shall be initiated and completed within required policy timeframes on all ANE Class I/II reports.

  1. Acknowledging the Report

In order to acknowledge the report, staff must open the ANE Report (referenced as “DA” in Case Compass) from the Dashboard, using the link in the DA # column. Case Compass will automatically place a checkmark in the “Ackw” box, indicating the report is acknowledged.

  1. Initiating the Report

APS staff shall contact the reporter, if identified, to ensure all pertinent information has been collected. The reporter may be informed that staff cannot share information as it is kept confidential. Staff shall also complete a face-to-face visit with the reported adult on Class I and II reports. Timeframe requirements for reporter contact and the face-to-face visit differentiate based on the classification of report.

  1. Class IReports shall be:
  1. Initiated within one hour of the report being routed by attempting to contactthe reporter, if identified.
  2. Initial face-to-face visit with the eligible adult must be made as soon as possible within twenty-four hours. Face-to-face visits refer to an in-person contact with the eligible adult.
  1. Class II Reports shall be:
  1. Initiated within forty-eight hours of the report being routed by attempting to contact the reporter, if identified.Prior to this contact, staff shall attempt to coordinate with the assigned investigator on dual response reports.

NOTE: If the report is routed after business hours, the identified reporter shall be contacted by close of business the next business day or the first working day after a weekend or holiday.

  1. Initial face-to-face visit with the eligible adult must be made as soon as possible within a period not to exceed seven calendar days from receipt of the report by the division.
  1. Class III Reports:

Class III reports do not necessarily require a face-to-face visit. Staff shall contact the reporter within seven calendar days from receipt of the report by the division. These reports consist of additional information to an open Class I or II report that does not contain new allegations or new alleged perpetrator. The report shall be reviewed as soon as possible for pertinent information.

  1. Information Detailed Requests (IDR)

An IDR is a request for resources or information that cannot be provided by staff duringintake. There is no requirement for a face-to-face visit.

  1. Examples of IDRs
  • Questions related to regional housing resources, energy assistance, and nursing home/institution placement.
  • Reported concerns that do not meet the criteria of ANE, but the eligible adult has case history.
  • Another state requesting assistance with interviewing an adult located in Missouri.

NOTE: When the request is for someone other than the eligible adult to be interviewed, the Central Registry Unit will refer the caller directly to the respective county office for assistance.

  1. Process for responding to an IDR
  • APS staff shall respond to an IDR as soon as possible but no later than seven calendar days after receipt by the division to ensure appropriate resources are provided in a timely manner.
  • Response may involve a phone call and/or mailing pertinent information. If more assistance is necessary, APS staff should consider field generating an ANE report.
  1. Face-To-Face Postponements and Waivers

Depending on information gathered following receipt of the report and the allegations, it may be appropriate to postpone or waive the face-to-face visit. The needs of the eligible adult shall be the first consideration in any decision to postpone or waive the face-to-face visit. The exception or waiver requires APCS approval and must be requested through Case Compass with the reason for the waiver/exception documented.

Examples:

  • Recurring reports with similar allegations in which there is another open report or an open Protective Service Case.
  • The eligible adult has died, cannot be located or has moved out of state. For unable to locate, all efforts to locate the eligible adult must be documented.
  • Current needs are being met and/or addressed (hospitalization or institutionalization).
  • The eligible adult refuses to talk with staff after attempt(s) to contact have been made.

NOTE:There are circumstances when a phone contact may be made in lieu of a face-to-face visit, after supervisor consultation and approval. The determination is made on a case-by-case basis.

  1. Preparing for the Face-to-Face Visit

Adequate preparation for the ANE Report is necessary to ensure a thorough process that addresses the eligible adult’s needs holistically.

  1. Analysis of ANE Report Content:

Staffshall review the report to understand as much as possible about the situation prior to initial contact. This is also the first opportunity staff have to assess safety concerns for the eligible adult.

If safety concerns are identified, they should be discussedwith the APCS to formulate a plan. This may include contacting law enforcement to assist or the APCS accompanying staff to the home for the face-to-face. The initial face-to-face may also be delayed with supervisor approval until arrangements can be made to ensure safety. If the face-to-face is delayed, staff shall continue to make other contacts or collect other information.

Additional searches should be made regarding safety while preparing for the visit.

Related Policy 1705.05: Worker Safety

  1. Prior Record Review

Prior ANE reports and Protective Services Cases contain history on the eligible adult as well as potential sources of collateral information. This may help detect previous patterns of maltreatment and behaviors of the eligible adult, caregiver(s) and relatives. Such review assists with identifying potential strengths the eligible adult has to help mitigate maltreatment and/or safety concerns.

  1. Develop a Plan

The plan outlines the actions to be taken in accordance with the reported information. This is not necessarily a written document, but a thought process that includes:

  1. Assessing the need to involve medical and/or mental health professionals.
  2. Determining the order of interviews. Typically, the eligible adult is interviewed prior to other collateral/witness contacts being made. However, there may be times when this is not the most effective approach and the plan must be modified based on staff’s judgement.
  3. Determining whether the face-to-face will be announced or unannounced. Staff shall determine, on a case-by-case basis, what type of visit is appropriate to ascertain the risk and ensure the safety of the eligible adult. There may be times when the initial decision does not prove to be effective and the plan needs to be modified.
  • Unannounced Visit

This is often believed to reveal the most accurate portrayal of the home situation. There is little opportunity to prepare stories, cover-up situations, build anxiety or alert the alleged perpetrator.

  • Announced Visit

There are times when this type of visit may be more effective. Many individuals may become irritated with an unannounced visit and refuse to answer questions/participate.

  1. Determining what records or documents, if any, will need to be obtained to determine validity of the allegation(s).
  2. Identifying agencies that may need to be involved and/or service referrals needed.
  3. Modification of Plan due to Location of Adult

There may be times when staff is unable to locate the adult or the adult is located in a different area of the state. In this circumstance, staff will need to work with his/her supervisor to modify the plan.

  • If the eligible adult cannot be located after numerous and comprehensive efforts have been made, the report may be concluded with all efforts clearly documented. Staff shall discuss efforts made with the APCS to ensure all options have been explored.
  • If the adult is located in another area/zip code,staff may coordinate face-to-face visits with the staff responsible for that area/zip code. The APCS must approve the arrangement and re-assign the task to another staff.
  • If the eligible adult does not have plans to return to the area/zip code the initial report was routed to, it may be appropriate to re-assign the report through appropriate supervisory channels.
  1. Conducting the Face-To-Face
  1. Gaining Access

Gaining access to the home and/or the eligible adult may be difficult in certain circumstances. Staff shall approach the home visit/interview with a goal to be helpful and to provide resources and/or services. Each staffperson over time develops his/her own approach. None of these approaches are wrong and some may work better than others depending on circumstances. The key to any approach is that staff is professional and the approach is consistent with ethical practices.

Related Policy: 1705.00: Ethics and Expectations of APS Staff

If entry is barred by the eligible adult or a third party, staff may need to get assistance from law enforcement and/or legal assistance. If a third party interferes with the delivery of protective services, or the eligible adult is being held against his/her will, as a last resort, law enforcement may need to assist with a temporary restraining order. It may be possible to secure an Entry Warrant either by law enforcement or an Administrative Entry Warrant arranged through the Office of General Counsel.

Related Policy: 1704.40: Judicial Proceedings

  1. Face-To-Face Interview/Assessing PS Need

The face-to-face interview of the eligible adult is a critical component of the response. This allows staff to not only verbally determine what needs might exist but also to observe the eligible adult and his/her environment to aid with formulating referrals and/or service needs.

Staff shall determine whether the eligible adult requires immediate medical attention, which could involve a physical illness/injury, a mental/emotional need, or both. Examples of mental/emotional needs requiring immediate attention include but are not limited to threats of self-harm or harm to others and behavior that could result in serious harm/injury due to what appears to be a mental illness. Staff shall consider the possible impact of ANE on the eligible adult. The eligible adult may have suffered a traumatic event and be in need of services in order to cope.

  1. Assessing Safety and Developinga Safety Plan

Assessing safety is a critical component of the intervention. Safety refers to the likelihood of current and/or immediate harm whereas risk refers to the likelihood of future harm. Staff shall complete the Safety Plan in addition to the Risk Assessment upon initial contact and as needed to address changes in the eligible adult’s circumstances.

NOTE: This task may be postponed or waived with APCS approval depending on the circumstances.

  1. The primary goal of the Safety Plan is to determine if there is a current threat of serious harm to the eligible adult and to engage the eligible adult and/or caregiver in developing interventions to mitigate the safety threat based on their acceptance of the plan.
  2. The Safety Plan shall consist of specific action steps to be taken to mitigate safety concerns. Examples include but are not limited to:
  • Staying temporarily with a friend/family member if there are serious concerns with the home’s structure and or the environment.
  • For situations where the eligible adult is afraid of someone or there has/have been physical abuse/threats of physical abuse by a caretaker, discuss arrangements for someone else to assist the eligible adult to limit the alleged perpetrator’s access.
  1. Part of the Safety Plan process is to identify formal or informal supports which may be temporarily modified until other more permanent arrangements can be made to assist the adult, which may take multiple home visits and/or referrals for services.
  2. Staff shall listen to the eligible adult throughout this process, ensuring he/she has a voice and is as involved as possible. If the eligible adult completely refuses to participate, document the attempt in recordings.
  3. Staff shall respect the eligible adult’s right to self-determination in making the final decision regarding any safety plan. Staff shall thoroughly document all efforts and whether the eligible adult accepts or declines in recordings.
  4. Staff shall upload the Safety Plan to Case Compass.

NOTE: The following circumstances may result in the need to waive the completion of the safety plan:

  • Eligible adult is deceased
  • Eligible adult is in the hospital and no safety concerns
  • Eligible adult is incarcerated
  • Eligible adult is incapacitated
  • Circumstances of the home are volatile and unsafe, requiring the immediate contact of law enforcement

Staff shall document details for not completing the safety plan in case recordings.

Related Policy: Safety PlanForm and 1707.00: Safety Plan Instructions

  1. Assessing Risk

Risk refers to the likelihood or probability that maltreatment will occur in the future. Assessing risk could help reduce the likelihood of future harm.Staff shall assess the eligible adult’s level of risk by completing aRisk Assessment and a Perpetrator Access Assessment (for reports where there is an alleged perpetrator) in Case Compass.

The Risk Assessment shall be completed at initial contact, prior to closing the report, and when there are changes in circumstance. The firstRisk Assessment should be completed within seven days of the date the report was received. If staff is unable to complete the Risk Assessment within seven days of the date that the report was received by DSDS, staff shall notify the APCS to request an exception and document the reason within the Exception Request.

Related Policy 1706.20: Protective Service Documentation, 1703.64: Assessment of Risk

  1. Assessing Capacity

Staff shall administer the Decisional Capacity Assessment and the St. Louis University Mental Status (SLUMS) Exam if capacity issues are suspected. SLUMS is a screening tool for assessing dementia and mild cognitive decline.

Related Policy SLUMS/SLUMS Instructions (Section VII of APS manual) & 1703.60: Decisional Capacity

  1. Conducting Collateral/Witness Interviews

Staffshall conduct witness and/or collateral interviews of those pertinent to the report or who have knowledge of the adult’s circumstances/condition. The interviews shall be conducted in a professional manner utilizing effective communication techniques.

  1. Collecting Reports/Documentation

Obtain all information necessary to determine if maltreatment occurred or is occurring such as medical records, financial records, police reports and/or legal records (durable power of attorney, guardianship, wills, etc.).

Related Policy: 1706.20: Documentation

  1. Dual Response Reports: Coordinating with Special Investigations Unit (SIU)

When anINV/EDL report is generated with allegations of Caregiver Neglect - Medical, Physical Abuse, and/or Sexual Abuse, a second report is routed to APS staff.APS staffare responsible for assessing the health, safety, and/or wellbeing of the eligible adult and working with the adult to mitigate concerns with referrals and/or services.

  1. Conducting Interviews

APS staffwill coordinate efforts with SIU when necessaryto determine if one or both staff are going to conduct interviews with specific parties involved. An exception to this is reporter and initial contact on Class I ANE reports.

  1. Field Generating an Investigative (INV) report

When it is discovered in the field that there are allegations criminal in nature, staff shall use the New Intake Screen to create an INV report if it is determined there is not currently an INV report assigned to SIU regarding the allegation(s) and/or alleged perpetrator.

Related Policy 1702.00: Intake and Classification

  1. Service Intervention

When responding to an ANE report, staff must determine if the eligible adult is in need of services. Staff shall focus on the eligible adult’s overall situationto determine the services or actions needed for the eligible adult to remain safe and independent.

  1. Concluding the ANE Report

Information collected throughout the ANE Report must be analyzed when determining whether maltreatment (including self-neglect) occurred and whether further intervention and/or services are needed. Staff’s role is to provide resources or service referrals to keep the adult safe, mitigate the risk of further harm/potential harm, and assist the adult with being as independent as possible.

  1. Determining the Validity of Allegations

Validity refers to facts that support or do not support the allegation(s). All information must be considered when making this determination. After making the determination, the Statement of Evidence for each allegation and the Investigative Summary shall be completed to reflect the decision.

  1. Valid

The weight of the facts supports that maltreatment did occur. To select this finding, facts must suggest a chance that injury, harm, loss or damage may have occurred.

NOTE: For all allegations that are referred to SIU for investigation, staff shall use the status of “Valid”.

  1. Invalid

The weight of facts supports that maltreatment did not occur. To select this finding, facts must suggest that injury, harm, loss or damage likely did not occur.