How Did the Updated APS 

Guidelines (2020) Change?
2 How Did the Updated APS Guidelines (2020) Change?

The Voluntary Consensus Guidelines for Adult Protective Services (APS) Systems (Guidelines) were 

recently updated to reflect new research and promising practices. The updated Guidelines are now 

available on the Administration for Community Living (ACL) website at https://acl.gov/programs/

elder-justice/final-voluntary-consensus-guidelines-state-aps-systems. This brief summarizes how 

the 2020 APS Guidelines were updated and what sections of the Guidelines were updated.

I. Why Have Guidelines?

In response to feedback from the APS field and others, ACL believed that it would be helpful 

to states’ APS programs if the federal government facilitated the development of field-driven, 

consensus-informed, national APS guidelines to address the diversity of practice among state APS 

programs. The goal of the Guidelines is to provide a core set of principles and common expectations 

to encourage consistency in the policies and practices of APS programs across the country, and to 

ensure that adults are afforded similar protections and service delivery by APS programs, regardless 

of their state or jurisdiction. 

ACL facilitated the development of the first Guidelines (ACL, 2016), which were published in 2016. 

At that time, ACL committed to facilitating the updating of the Guidelines at regular intervals. The 

updates for the 2020 Guidelines are based on new published research as well as input from APS 

stakeholders and subject matter experts.

II. Process for Updating the Guidelines

To support APS programs, it is more important than ever to demonstrate the effectiveness of APS 

programs and practices in improving client outcomes. In accordance with this goal, a multistep 

approach was implemented for updating the Guidelines, with each step building on the work of 

the previous step. These steps included an updated literature review to identify new research 

evidence; draft revisions and additions to the Guidelines based on new evidence; a stakeholder 

engagement process to obtain feedback for the proposed updates; a comprehensive data analysis 

of the feedback received from stakeholders; and, finally, convening of a technical expert panel to 

refine and build consensus for the updates based on the proposed new research and feedback from 

stakeholders. 

The 2020 and 2016 Guidelines have an identical overall structure, with the content organized by 

seven broad domains (or topics) and a number of specific elements (or subtopics) within each 

domain. For each element, the Guidelines contain a background section followed by the actual 

guidance statements. 

Reviewing New Literature

First, a literature search was conducted to identify new evidence published in peer-reviewed journal 

articles (April 2014 – November 2018) focused on the evaluation of APS programs and practices. 

Twenty-four articles met the inclusion criteria and were included in the literature review. This was a 

significant increase from the eight relevant articles that were identified for the original Guidelines. 
How Did the Updated APS Guidelines (2020) Change? 3

The summary below presents highlights from the new literature. In all cases, the findings from the 

literature were used to enhance the background sections of the Guidelines domains and elements. 

In two instances, the findings were also used to change actual guidance (see bold notes in 

parentheses).

1. Clients are often willing to accept an offer of additional mental health services at the same 

time that they are receiving mistreatment resolution service. Additionally, results support the 

potential for elder abuse service providers to work in tandem with mental health clinicians 

(Sirey et al., 2015). (See changes to Guidance in 5A. Voluntary Service Implementation.)

2. Using a web-based portal and low-cost videophone technology to connect an APS agency and 

its clients to a centralized geriatric and elder mistreatment expert medical team for virtual inhome assessments could serve as a model for fostering state protective agencies and medical 

professional collaborations (Burnett, Dyer, Clark, & Halphen, 2018).

3. Findings highlight the importance of creating a positive and supportive work environment for 

APS workers, and of implementing management strategies for the prevention of burnout among 

APS workers (Ghesquiere, Plichta, McAfee, & Rogers, 2018).

4. A longer-term, relationship-based intervention for entrenched elders who are reluctant to 

receive services may be effective and therefore worth considering (Mariam, McClure, Robinson, 

& Yang, 2015).

5. The Elder Abuse Decision Support System short form can be used to standardize and increase 

efficiency of APS investigations and may also offer researchers new options for brief elder abuse 

assessments (Beach et al., 2017).

6. A list of standardized questions for caseworkers to use during investigation may provide an 

objective and detailed approach for investigation (Conrad, Iris, & Liu, 2017).

7. Elder mistreatment social service programs should aim to promote elder participation in 

supportive community social outlets, such as senior centers (Burnes, Rizzo, & Courtney, 2014). 

When social support from family or friends is unavailable or deficient, policy should direct 

services to compensate or supplement this factor (Acierno, Hernandez-Tejada, Anetzberger, 

Loew, & Muzzy, 2017).

8. Findings highlight the need to identify and intervene in elder mistreatment cases as early as 

possible in the mistreatment trajectory, and the need to develop targeted safety planning for 

clients experiencing different forms of abuse and/or neglect (Burnes, Rizzo, & Courtney, 2014; 

Jackson & Hafemeister, 2014).

9. Findings suggest that goal attainment scaling is a feasible measurement strategy to implement 

in the APS context (Burnes, Connolly, Hamilton, & Lachs, 2018). (See changes to 7B. Evaluating 

Program Performance.)

10. More rigorous means of detecting elder abuse are needed to obtain accurate prevalence data 

and to inform policy decisions; clear definitions and training to standardize the assignment of 

findings for elder abuse/neglect cases should be established (Mosqueda et al., 2016).
4 How Did the Updated APS Guidelines (2020) Change?

Engaging Stakeholders

The goal of the stakeholder engagement and outreach process was to hear from all stakeholders 

about their experiences with APS, ensure all stakeholders understood why and how ACL was 

facilitating the updating of the Guidelines for APS, and provide stakeholders an opportunity to give 

input for the updates to the Guidelines. Stakeholders were able to provide comments via webinars 

and an online request for information. A total of 278 relevant comments were received.

Engaging Subject Matter Experts

The final step in the updating process involved the convening of a nine-member technical expert 

panel (TEP) comprised of APS professionals and researchers. The purpose of the TEP was to serve 

as the voice of the field, i.e., to bring real world experience and wisdom to the updating process. 

TEP members made recommendations for updating based on their experiences, the proposed new 

research, and stakeholder input.

III. How Did the Guidelines Change?

The list below provides a summary of the changes that were made to the Guidelines as a result of 

integrating findings from the literature and feedback from stakeholders and the TEP.

Global changes made to the entire document:

• Created a glossary with definitions of terms used in the Guidelines to assist the reader.

• Changed the word “victim” to “alleged victim” or “client” as appropriate.

• Added National Adult Maltreatment Reporting System data and definitions to the background sections.

• Changed the formatting of the document to enhance the usability.

Changes made to individual domains/elements (in the order they appear in the Guidelines):

1A. Ethical Foundation: Added language recommending that the code of ethics and ethics policies 

be reviewed annually.

1B. Protecting Program Integrity:

• Moved section up to follow 1A. Ethics because the two topics are closely aligned.

• Added language: “APS program policies and standards should be transparent and available 

to the public.”

• Added a section on Providing Information on Rights of Perpetrators.

1E. Mandatory Reporters:

• Added language that makes it clear that Long-term Care Ombudsmen (LTCOs) are not mandatory reporters.

• Added language that clarifies that mandatory reporters are immune from civil as well as 

criminal liability.

1F. Coordination With Other Entities: Added other professional groups to the list, including LTCOs, 

Attorneys General, Protection and Advocacy.
How Did the Updated APS Guidelines (2020) Change? 5

1H. Staffing Resources: Augmented content of Ratio of Supervisor to Direct APS Personnel to 

highlight role of supervisor and risks to clients and workers if a caseload limit is not maintained.

1M. Community Outreach: Added information on Reframing Elder Abuse (how to effectively 

communicate about the topic of adult maltreatment).

2C. Closing the Case: Added language: “Client goals have been achieved to the extent feasible.”

4A. Determining If Maltreatment Has Occurred: Clarified that APS programs screen for decisionmaking ability (but don’t make the final determination on capacity).

4B. Conducting an APS Client Assessment: Moved Trauma-Informed Care to this section (from Ethics 

section) as trauma-informed care is more relevant to this section.

4C. Investigations in Residential Care: Added language that recommends that APS should notify the 

LTCO when APS is investigating allegations of maltreatment in residential facilities.

5. Service Planning and Service Implementation: Changed “Intervention” to “Implementation.”

5A. Voluntary Service Implementation: 

• Added language about how studies show that longer-term interventions are beneficial to 

resistant clients.

• Added language recommending that the services and supports provided be those that have 

been shown to be effective in protecting against negative outcomes, such as social support 

and programs that promote participation in community social outlets.

• Added language about the benefits of working in tandem with mental health practitioners.

5B. Involuntary Service Implementation: Add language about how using a Forensic Center can help 

make the difficult determination as to whether or not APS should petition for a guardianship.

6A. Caseworker and Supervisor Minimum Educational Requirements: Added language about how 

candidates for APS employment should be screened for suitability and capability.

6B. Caseworker Initial and Ongoing Training. Core Competency Training: Added new topics: 

Motivational Interviewing; Cognitive Deficits, including Dementia.

6C. Supervisor Initial and Ongoing Training: Strengthened section on supervisor training, using 

materials from the APS Leadership Development Institute at San Diego State University.

7. APS Program Performance: Divided into two sections: Managing Program Data and Evaluating 

Program Performance.

7A. Managing Program Data: Added language about keeping data long enough to ensure their 

availability for quality assurance needs.

7B. Evaluating Program Performance: Added language about collecting information on client 

outcomes.
6 How Did the Updated APS Guidelines (2020) Change?

IV. Summary

The Guidelines is a living document and, as such, requires updating to reflect the changing landscape 

of APS practice, research, and policies. ACL will continue to facilitate the updating of the Guidelines 

at regular intervals based on new findings and stakeholder input. During the process of updating the 

Guidelines, ACL heard from many stakeholders about how the Guidelines were being used as they 

were originally intended—that is, to improve APS policies and practices and to increase consistency 

of practice across the nation. It is believed that the updates included in the second edition of the 

Guidelines will further that trend by providing new research, new content, and other enhancements to 

continue to build the evidence base for APS practice. 
How Did the Updated APS Guidelines (2020) Change? 7

V. References

Acierno, R., Hernandez-Tejada, M. A., Anetzberger, G. J., Loew, D., & Muzzy, W. (2017). The national elder 

mistreatment study: An 8-year longitudinal study of outcomes. Journal of Elder Abuse & Neglect, 29(4), 254–269. 

Beach, S. R., Liu, P.-J., DeLiema, M., Iris, M., Howe, M. J. K., & Conrad, K. J. (2017). Development of short-form 

measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse 

substantiation decisions. Journal of Elder Abuse & Neglect, 29(4), 229–253.

Burnett, J., Dyer, C. B., Clark, L. E., & Halphen, J. M. (2018). A statewide elder mistreatment virtual assessment 

program: Preliminary data. Journal of the American Geriatrics Society. Advance online publication. doi: 10.1111/ 

jgs.15565 

Burnes, D., Connolly, M. T., Hamilton, R., Lachs, M. S. (2018). The feasibility of goal attainment scaling to measure 

case resolution in elder abuse and neglect adult protective services intervention. Journal of Elder Abuse and 

Neglect, 30(3), 209–222.

Burnes, D. P. R, Rizzo, V. M., & Courtney, E. (2014). Elder abuse and neglect risk alleviation in protective services. 

Journal of Interpersonal Violence, 29(11), 2091–2113.

Conrad, K. J., Iris, M., & Liu, P.-J. (2017). Elder abuse decision support system: Field test outcomes, abuse measure 

validation, and lessons learned. Journal of Elder Abuse & Neglect, 29(2–3), 134–156.

Ghesquiere A., Plichta, S. B., McAfee, C., & Rogers, G. (2018). Professional quality of life of adult protective service 

workers. Journal of Elder Abuse & Neglect, 30(1), 1–19. 

Jackson, S. L., & Hafemeister, T. L. (2014). How case characteristics differ across four types of elder maltreatment: 

Implications for tailoring interventions to increase victim safety. Journal of Applied Gerontology, 33(8), 982–997.

Mariam, L. M., McClure, R., Robinson, J. B., & Yang, J. A. (2015). Eliciting change in at-risk elders (ECARE): Evaluation 

of an elder abuse intervention program. Journal of Elder Abuse & Neglect, 27(1), 19–33. 

Mosqueda, L., Wiglesworth, A., Moore A. A., Nguyen, A., Gironda, M., Gibbs, L. (2016). Variability in findings from 

adult protective services investigations of elder abuse in California. Journal of Evidence-Informed Social Work, 

13(1), 34–44.

Sirey, J. A., Berman, J., Depasquale, A., Halkett, A., Raeifar, E., Banerjee, ... Raue, P. J. (2015). Feasibility of 

integrating mental health screening and services into routine elder abuse practice to improve client outcomes. 

Journal of Elder Abuse & Neglect, 27(3), 254–269.

U.S. Department of Health and Human Services, Administration for Community Living. (2016). Final 

voluntary consensus guidelines for state APS systems. Retrieved from https://acl.gov/sites/default/files/

programs/2017-03/APS-Guidelines-Document-2017.pdf