Standardizing Risk Assessment in Adult Protective Services
Henderson, Linda, Policy & Practice
Adult protective services programs are at a critical juncture. While the elderly population is increasing rapidly, APS programs remain at a disadvantage for stable funding and growth without a standardized approach to risk assessment and intervention that leads to measurable outcomes. Armed with objective data, adult protective services will be poised to meet the complex needs of a growing population. Recognizing the need for greater consistency in identifying risk among vulnerable adults, Ventura County has designed a risk assessment instrument. The RAI standardizes the approach to assessing risk, correlates the assessment with interventions, and measures outcomes in the areas of health, safety and the elimination or reduction of harm.
A team of Ventura County's APS program managers and social workers designed the RAI based on the theory that elder/dependent abuse/neglect may follow a path of progression similar to the disease process. This parallel structure was first suggested in the keystone work, Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America edited by Richard J. Bonnie and Robert B. Wallace and published by the National Research Council and National Academies Press in 2003. Models from the fields of alcoholism and chronic pain are the foundation for the design of the RAI. In these, assessment and intervention are not discrete functions but integrated and correlated to anticipated or expected outcomes and prognosis for recurrence.
The RAI is built on the premise that elder abuse/neglect does not occur spontaneously. Rather, it occurs subtly over time in a deteriorating nature punctuated by periods of stability. Recurrence is a normal stage in the process of many diseases and is common in abuse/neglect, particularly in self-neglect cases. Tracking recurrence and prognosis are methods used in the RAI to measure not only program effectiveness but also client response to interventions. More importantly, these outcomes provide valuable information to managers and social workers about trends in the population and gaps in the service delivery system.
Precursors are those risk factors that play a crucial role in the onset and course of a disease and increase susceptibility to a particular illness. Medical practitioners consider both risk factors and active symptoms when diagnosing illness. This assessment model is standardized within the RAI. The RAI incorporates a set of biological, psychological and social precursors that appear to predispose a person to harm. The instrument also standardizes a set of factors that indicate actual occurrence of abuse/neglect. …