Part I: APS Research 

Agenda

Part II: Report on the 

Development 

of the APS 

Research 

Agenda

Building the Evidence Base 

for Adult Protective Services

August 13, 2020
Acknowledgment 

This publication is provided in support by the Office of Elder Justice and Adult 

Protective Services (OEJAPS), Administration for Community Living (ACL), U.S. 

Department of Health and Human Services (HHS), by New Editions Consulting, Inc., 

under contract number HHSP233201500113I/HHSP23337002T. The contents of this 

brief do not necessarily represent the policy of OEJAPS, ACL, or HHS, and readers 

should not assume endorsement by the Federal Government.

Disclaimer 

The views, opinions, and content of this publication are those of the authors and do 

not necessarily reflect the views, opinions, or policies of OPE, ACL, or HHS. Nothing 

in this document constitutes a direct or indi¬rect endorsement by ACL of any nonfederal entity’s products, services, or policies, and any reference to non-federal entity’s 

products, services, or policies should not be construed as such.
Part I APS Research 

Agenda

Contents — Part I

ABBREVIATIONS I-2

INTRODUCTION I-3

OVERVIEW OF THE DEVELOPMENT PROCESS I-4

RESEARCH AGENDA STRUCTURE I-5

APS RESEARCH THEMES I-6

1. Definitions I-6

2. Quality Assurance and Program Improvement I-6

3. Cost Impact of APS I-7

4. Caseload Size I-8

5. Worker Safety & Well-Being I-9

6. Timeframes I-10

7. Intake I-10

8. Tools (for Screening, Assessment, and Decision-Making) I-11

9. Collaboration I-13

10. Investigations and Findings I-14

11. Perpetrators I-15

12. Service Planning and Delivery I-16

13. Client Goals I-17

14. “Underserved” Populations I-18

15. Specialized Interventions I-19

16. Access to Expert Resources I-21

17. Involuntary Interventions I-21

18. Client Outcomes I-23

CONCLUSION I-24

REFERENCES I-26

APPENDIX A. TECHNICAL EXPERT PANEL I-33

APPENDIX B. LIST OF HIGH-PRIORITY RESEARCH QUESTIONS I-35
I-2 Part I | APS Research Agenda

Abbreviations

ACL Administration for Community Living

APS Adult protective services

Guidelines National Voluntary Consensus Guidelines for State APS Systems

NAPSA National Adult Protective Services Association

TEP Technical expert panel
Part I | APS Research Agenda I-3

Introduction

The Administration for Community Living (ACL)1, as the federal home for programs 

addressing the unique needs of older Americans and adults with disabilities across 

the lifespan, is leading several initiatives to help advance and support the critically 

important work of the adult protective services (APS) field. One of these initiatives is 

the development and dissemination of an APS Research Agenda.

APS is a social services program provided by state and local governments across the 

nation that serve older adults and adults with disabilities who are in need of services 

because of abuse, neglect, self-neglect, or financial exploitation (adult maltreatment). 

In all states, APS is charged with receiving and responding to reports of maltreatment 

and working closely with their clients and a wide variety of allied professionals to 

maximize the client’s safety and independence.

APS programs are not subject to federal rules and regulations, and thus each state has 

designed its own unique system. In addition, while there is some consistency in the 

types of practices APS programs have adopted, the evidence base concerning which 

practices are most effective, and how state characteristics (e.g., rurality, access to 

resources, state- versus county-administered APS programs) are associated with the 

effectiveness of specific practices, is largely lacking. These gaps point to the need for 

research focused on APS practices and policies to ensure APS leaders and workers 

have the tools and resources to respond efficiently and effectively. 

While the field of adult maltreatment has identified some research priorities and 

created several research agendas over the past 3 decades (Stahl, 2015; Stein, 1991; 

University of New Hampshire, 1968; U.S. Department of Justice, 2014; Wolf, n.d.), 

there has never been a research agenda focused exclusively on the practice of APS. 

An APS research agenda is needed to provide guidance to funders, researchers, and 

APS programs to help move the field forward and create an evidence base for APS 

programs. 

This APS Research Agenda is the first step in helping to meet this need. Specifically, 

the goal of the agenda is to highlight research gaps to help inform the APS field and, 

ultimately, help build a cohesive body of evidence in the field.

1 ACL brings together the efforts and achievements of the Administration on Aging, the Office of 

Intellectual and Developmental Disability Programs, and the Department of Health and Human 

Services Office on Disability to serve as the federal agency responsible for increasing access 

to community supports, while focusing attention and resources on the unique needs of older 

Americans and adults with disabilities across the lifespan. 
I-4 Part I | APS Research Agenda

This APS Research Agenda is intended for information purposes only. The information 

in this agenda does not constitute any standard or regulation, and does not create any 

new legal obligations nor impose any mandates or requirements. The agenda also does 

not create nor confer any rights for, or on, any person or agency.

Overview of the Development Process

The research agenda was developed in conjunction with updating ACL’s Voluntary 

Consensus Guidelines for State APS Systems (Guidelines). The Guidelines are designed 

to assist states in developing efficient, effective APS systems and to provide APS 

administrators with recommendations from the field about quality practice. The 

Guidelines were first developed in 2016. In 2018–2019, ACL facilitated the updating 

of the Guidelines through incorporating information from new research and feedback 

from the field. 

As part of this process, ACL also facilitated the development of the APS Research 

Agenda, supporting the implementation of a multistep approach, including a review 

of the literature and engagement of stakeholders and experts to identify APS research 

questions, engagement of experts from research and APS practice fields to prioritize 

the identified research questions, and “translation” of high priority research questions 

into the APS Research Agenda. 

1. Review of the literature: To update the Guidelines, a literature search and review 

were conducted to identify new evidence published in peer-reviewed journal 

articles focused on the evaluation of APS programs and practices. The identified 

literature was also reviewed to identify recommendations from the authors for 

additional APS research questions. 

2. Identification of research questions: Research questions were also identified 

through a series of stakeholder engagement activities, including webinars, 

a public comment period, a meeting at the 2019 National Adult Protective 

Services Association (NAPSA) conference, and feedback from a technical expert 

panel (TEP). 

3. Prioritization of research questions: A modified Delphi process (Brown, 1968; 

Hsu & Sandford, 2007)2

 was used to prioritize the research questions. As part 

of the process, a final list of 153 research questions was presented to the TEP, 

2 For publications referencing the Delphi process see: https://www.rand.org/topics/delphimethod.html?content-type=research.
Part I | APS Research Agenda I-5

which was asked to rate the level of priority for each question on a 9-point scale 

(1=lowest priority; 9=highest priority). TEP members completed three rounds of 

rating of the same questions until consensus was reached. For a list of the TEP 

members, see Appendix A.

This process resulted in a list of 61 high-priority APS research questions (see 

Appendix B for the research questions listed in priority order), which were 

categorized into 18 themes (e.g., caseload size, tools, intake) for the APS 

Research Agenda. The themes were developed through an analysis of the words 

used (e.g., word repetition and word count) and a review of key words in context 

(i.e., how is the word or term used). For a detailed summary on the process 

for developing the APS Research Agenda, including the results from the Delphi 

process, see Part II of this report.

Research Agenda Structure

This research agenda is organized into 18 themes. For each theme, three sections are 

provided:

1. Importance presents a brief summary of how the theme is significant to APS 

practice and policies.

2. Existing Knowledge presents an overview of what is already known about the 

theme based on existing literature.

3. Research Questions presents the research questions that were identified by the 

field and experts for this theme. The number in front of each question indicates 

its ranking by level of importance (out of all 61 questions) based on the mean. 

For example, the number 5 in front of a question indicates that the question was 

ranked to be the fifth most important question out of the 61 questions. 

While Existing Knowledge highlights what is known about each theme, the associated 

Research Questions section in turn reveals some of the knowledge gaps (things not yet 

known) for each theme.

The 18 themes are listed in the next section. General themes are listed first, followed by 

themes that are related to specific APS practice components. Those themes are listed 

to approximate the flow of APS practice, from the start of APS casework to case closure.
I-6 Part I | APS Research Agenda

1

2

APS Research Themes 

1. Definitions

Importance: Without a common definition and understanding of terms, it is difficult to 

ensure accuracy and consistency in APS practice and data about APS, both of which 

are necessary to study APS and apply findings of APS research to improve practice. 

Definitions of adult maltreatment vary from state to state, as do terms used specifically 

in APS practice. 

Existing Knowledge: Daly and Jogerst (2003) analyzed elder abuse3

 definitions in the 

state statutes for the 50 state and District of Columbia laws addressing protective 

services for elder abuse. The authors found that no single term describing elder 

abuse was used uniformly across all statutes. Jirik and Sanders (2014) followed up 

with an analysis of elder abuse statutes across the United States and the District of 

Columbia during 2011–2012. These authors concluded that differences remain in how 

states respond to elder abuse at the community level. They include differences in the 

inclusion and types of definitions. 

Common definitions are important for all types of maltreatment, but especially for 

self-neglect, which is still poorly understood and is not always included in definitions 

of elder abuse. Yet, among the elderly, self-neglect is the most common form of nonfinancial maltreatment encountered (Boothroyd, n.d.).

Research questions identified by the field (1 question):

50. How does APS define self-neglect?

2. Quality Assurance and Program Improvement

Importance: Performance management in public organizations requires systematic data 

collection, analysis, and use for program needs assessment, planning, monitoring, 

quality assurance, evaluation, decision making, and implementation of change.

3 Although the authors of this report use the term “adult maltreatment” to refer to abuse, 

neglect, self-neglect, and financial exploitation of older adults and adults with disabilities, 

authors of works cited herein may use other terms (e.g., elder abuse). For the sake of accuracy, 

when conveying information from those cited works, the authors of this report will use 

whatever terms are used in those studies.
Part I | APS Research Agenda I-7

3

The process of evaluating APS programs’ performance has several goals. First, it 

provides information on how the program helps APS clients. Second, it provides 

information that helps workers and supervisors do their best work. Third, it provides 

the APS program with information it can use to tell a compelling story about the 

program and its effectiveness to decision-makers, other providers, and the community 

as a whole.

Existing Knowledge: At its core, performance management is evidence based, using 

information to guide management (Carrilio, 2003; Kopczynski & Lombardo, 1999; 

McDavid & Hawthorn 2006). For human services fields, using performance information 

to manage for outcomes is often strained by the organizational culture of human 

services (Carrilio, 2003; Wulczyn, 2005). For instance, social workers (including 

APS workers) may see data entry as an annoyance rather than an activity integral to 

collecting program information (Carrilio, 2003). In addition, while social services can 

use information as a means of quality management, organizations may be hampered 

by their own technological naiveté (i.e., lack of knowledge about the use of existing 

tools) or lack of access to technology. Understandably, human services, including 

APS, historically present a reactive culture of dealing urgently with the emergencies 

confronting them, with less focus on planning and evaluating the results of actions 

taken or looking for ways to best improve future service delivery (Carrilio, 2003; 

Wulczyn, 2005).

Research questions identified by the field (3 questions):

27. What are effective strategies for using data to improve program 

performance and practices for APS workers?

52. What data elements are used for effective quality assurance (QA)?

53. What are recommended processes and strategies for QA for APS 

programs?

3. Cost Impact of APS

Importance: Understanding costs and cost savings related to APS programs and 

services is an important part of explaining the impact of APS. APS programs are part 

of a larger community and system of services to populations, and sometimes to the 

same individuals. The presence and impact of APS intervention will interact with the 

impact of other services, either upstream or downstream from the APS intervention. 

Quantifiable data on reduction in costs of other services for the same individuals or 

groups that have been served by APS is highly valued, but typically not available. 
I-8 Part I | APS Research Agenda

4

Existing Knowledge: Several studies and reports have highlighted the financial costs 

related to adult maltreatment. For example, financial exploitation has been shown 

to cause large economic losses for businesses, families, elders, and government 

programs, and to increase reliance on federal health care programs such as Medicaid 

(U.S. Department of Justice, 2014). While likely underreported, estimates of elder 

financial abuse and fraud costs to older Americans range from $2.9 billion to $36.5 

billion annually (National Council on Aging, n.d.). In addition, the direct medical costs 

of injuries related to adult maltreatment are estimated to contribute more than $5.3 

billion to the nation’s annual health expenditures (Dong, 2005). In nursing homes, 

most adverse events lead to preventable harm and $2.8 billion per year in Medicare 

hospital costs alone (Office of the Inspector General, 2014).

Whereas these findings point to the financial costs of adult maltreatment, research 

has not examined the link between APS specifically and cost, including potential cost 

savings.

Research questions identified by the field (1 question):

40. Does APS save state governments money? If so, how and how much?

4. Caseload Size

Importance: Caseload size is an important element in the working conditions of 

those delivering public social services, such as APS. The literature on these working 

conditions argues that when caseloads exceed some manageable level, there are 

considerable negative consequences for workers’ performance in terms of the 

quality of services they provide and the outcomes they can achieve for their clients. 

In addition, a client’s safety, well-being, and even life may depend on a prompt and 

effective APS response. The relationship of both caseload size and client outcomes to 

workforce stability and quality is a major concern for APS agencies.

Existing Knowledge: In the late 1990s, NAPSA conducted a survey of state programs to 

help identify effective caseload sizes. Based on information from 11 states, the District 

of Columbia, and two counties, NAPSA recommended that caseloads that focused only 

on investigations be limited to 15.7 cases per month, ongoing caseloads be limited to 

26.5 cases per month, and mixed caseloads of both investigation and ongoing cases 

be limited to 24.6 cases per month. Even though the survey helped inform practices, it 

should be noted that the study was based on a small sample of state programs and did 

not conform to accepted research standards (Otto, 2014).
Part I | APS Research Agenda I-9

5

Data from state APS agencies show that reports of maltreatment and caseloads for APS 

workers have increased over time (AARP Public Policy Institute, 2011; Teaster et al., 

2006). The 2012 survey of APS agencies conducted by NAPSA and National Association 

of States United for Aging and Disabilities (NASUAD] found that APS worker caseloads 

vary from 0–25 per worker, in 13 states, to 100+ per worker, in four states (NAPSA & 

NASUAD, 2012). In the majority of states (21), the caseload per worker was 26–50. The 

ratio of supervisor to investigators varied from 1:1 to 1:14. 

Research questions identified by the field (2 questions): 

1. What is the impact of caseload size on the quality of investigations and 

interventions?

2. What is the impact of caseload size on case worker performance, 

retention, satisfaction?

5. Worker Safety & Well-Being

Importance: APS work can involve personal physical and emotional risk to the APS 

worker. Ensuring that workers have the tools they need to respond skillfully and safely 

can affect worker health and well-being as well as worker retention. Addressing issues 

of worker safety and well-being also increases the ability of APS systems to provide 

services to the adults who need them most.

Existing Knowledge: A 2018 study (Ghesquiere, Plichta, McAfee, & Rogers, 2018) 

revealed that APS workers reported experiencing an average of 3.42 different hazard 

exposures per month, with the most common exposures being dangerously cluttered 

living spaces, garbage or spoiled food, insect infestations, and being yelled at, cursed 

at, or belittled by a client or the client’s family. The authors note that the findings 

highlight the importance of building a positive and supportive work environment 

for APS workers, and that results can help inform management strategies for the 

prevention of burnout among APS workers. 

Research questions identified by the field (2 questions):

12. What is the incidence and prevalence of hazards (threats and assaults) for 

APS workers?

31. What is the incidence of burnout, compassion fatigue, and secondary 

traumatic stress among APS workers?
I-10 Part I | APS Research Agenda

6

7

6. Timeframes

Importance: Timeliness of response and service delivery is one element of effective 

intervention on behalf of APS clients. Typically, APS programs have required or target 

timeframes for initiating and completing investigations, seeing the alleged victim faceto-face for the first time, implementing ongoing safety contacts, and closing cases. 

Existing Knowledge: National Adult Maltreatment Reporting System (NAMRS) Agency 

Component data provide information on timeliness of APS practice regarding initiating 

the investigation and completing the investigation (Aurelien et al., 2018). A 2015 study 

(Mariam, McClure, Robinson, & Yang, 2015) examined an elder abuse intervention 

and prevention program, assessing its effectiveness for building alliances between 

APS and elders with suspected abuse. Results showed that risk factors of elder abuse 

decreased over the course of the intervention. In addition, nearly 75% of participants 

made progress on their treatment goals. The authors note that, for other agencies 

serving at-risk elders, the project’s findings suggest that a longer-term, relationshipbased intervention for entrenched elders who are reluctant to receive services may be 

effective and therefore worth considering. 

Research questions identified by the field (2 questions):

46. What is the impact of different time frames for completing investigations 

on case outcomes?

51. What is the impact of different time frames for initiating investigations on 

case outcomes?

7. Intake

Importance: Intake serves several critical functions for APS, some personal, others 

technical. It is the front door of APS for individuals who are concerned about suspected 

adult maltreatment. It is also the first step in the process of collecting information 

needed for determining eligibility, routing eligible matters to the correct staff, and 

prioritizing by severity of suspected adult maltreatment so that highest risk matters can 

be given the fastest possible attention. Finally, the intake process opens the APS case 

file, collecting the initial data needed by investigators to determine their immediate 

next steps. The intake process must be easy and fully accessible to those needing 

to make a report, give those individuals the opportunity to express their concerns or 

needs, and collect all essential data to facilitate an appropriate, timely, and helpful 

response to the reporter and the alleged victim.
Part I | APS Research Agenda I-11

8

Existing Knowledge: Recent data (2017) from the National Adult Maltreatment 

Reporting System indicate that 51.9% of states provide a centralized statewide hotline 

or call-in number as a single point of entry for reports of maltreatment. Approximately 

a quarter of the states (24.1%) provide a combination of both statewide and local 

hotlines or call-in numbers, and 20.4% of states provide decentralized regional or 

county hotlines or call-in numbers only (Aurelien et al., 2018).

Research questions identified by the field (5 questions):

9. What are best practices for identifying cases that require an investigation?

10. What are best practices for effectively prioritizing cases?

13. What are the most important questions needed to screen in/out cases?

23. What are best practices for taking/conducting an intake report (i.e., who 

should take/conduct an intake report, level of competency of worker 

needed, time to create report, types of information to collect in order to 

make a screening decision/determine if investigation is needed)?

34. What practices lead to an intake report with clear, specific information 

related to the maltreatment and the alleged victim and his/her 

circumstances (e.g., phone vs internet/email, structured interview vs free 

form, training provided to intake staff)?

8. Tools (for Screening, Assessment, and Decision-Making)

Importance: Decisions that occur at several points in the APS service process require 

thorough information, precise evaluation, and clear decision-making criteria to ensure 

alleged victims are protected as well as to promote safety after APS case closure. 

Systematic assessments are most critical at the time of intake, when screening for 

abuse is done and decisions to open and triage a case are made; at the time of the 

initial evaluation of safety of the alleged victim, as well as subsequent safety checks; 

and at the conclusion of the investigation to evaluate allegation validity and close the 

investigation. APS programs that provide or arrange for services post-investigation 

additionally make critical assessment-based decisions to shape service plans and, 

later, to determine eligibility for case closure.

While APS values the expertise and “clinical judgment” of APS workers, APS programs 

typically provide structures and tools for collecting and evaluating information and 

making decisions at these critical points in the APS process. This facilitates optimal 

decisions in an environment of high caseloads and increasingly complex case 

management. Quality data collected from and about these assessment and decision-
I-12 Part I | APS Research Agenda

making points have become critical to measuring APS outcomes, improving APS, and 

demonstrating effectiveness to policymakers. 

Existing Knowledge: There are several categories of tools typically used by APS, 

including tools to identify elder abuse and its sub-types, decisional ability screening 

tools, and tools to screen for memory, depression, alcohol use, activities of daily 

living (ADLs) and instrumental activities of daily living (IADLs), and functional ability. 

Another tool used by APS is a comprehensive assessment of the adult’s strengths 

and needs. According to the 2018 NAMRS data, 78% of states report that they use a 

common instrument or tool throughout the state to conduct client strengths and needs 

assessments. For other states (22%), assessment instruments are determined by each 

county or left to the worker’s discretion.

A number of instruments have been developed to screen for adult maltreatment. 

According to Fulmer, Guadagno, Dyer, and Connolly (2004),“although all share similar 

content and are directed toward assisting with the identification of various forms of 

elder mistreatment, there are key differences in the focus, format, structure, and type 

of data gathered by each instrument.” Currently there is no gold standard for screening 

for adult maltreatment. A positive screen does not unequivocally mean that adult 

maltreatment is occurring, but it does indicate that further information should be 

gathered (National Center on Elder Abuse, 2016). 

As noted, a number of screening instruments exist, and many articles on those 

instruments are available. As an example, Ernst et al. (2014) identified three screening 

tools or rating scales designed using APS data. Two of the tools assessed different 

types of abuse and were tested with APS workers. Kemp and Mosqueda (2005) 

developed a structured “framework” for understanding financial exploitation. They 

found strong consensus among APS specialists, attorneys, and law enforcement, 

supporting their model of exploitation.

Some APS programs use a structured decision-making tool to standardize the 

collection of information and guide the investigator in evaluating collected evidence 

through an objective and more detailed approach. Examining the effectiveness of 

a standardized approach to guide caseworkers’ decision-making processes, Liu, 

Stratton, Hass, and Conrad (2020) found reliability and validity for a short selfneglect assessment. In addition, the authors found that standardized measures 

promote consistency in substantiation decisions. Other research has shown higher 

substantiation rates with the use of the technology-based Elder Abuse Decision 

Support System (EADSS) full interview guide and short form, compared to APS 

protocols (Beach et al., 2017; Conrad, Iris, & Liu, 2017).
Part I | APS Research Agenda I-13

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Research questions identified by the field (7 questions):

3. What is the validity and effectiveness of existing screening and 

assessment tools and tools that are used by APS to measure intervention 

outcomes?

17. What are barriers and potential harms of screening adults for 

maltreatment?

19. What is the impact of APS using standardized vs. non-standardized 

assessment tools?

21. What is the impact of using standardized tools on APS service delivery and 

client outcomes?

42. What valid and reliable screening methods and tools are used by APS? 

49. What tools exist to measure intervention outcomes (e.g., change in client 

or case status in response to the intervention)?

54. What is the impact of standardized and non-standardized intake screening 

tools?

9. Collaboration

Importance: APS programs often work with other professionals for the benefit of 

their clients. The goal of these intentional and specific collaborations is to provide 

comprehensive services to alleged victims by building on the strengths, and 

compensating for the weaknesses, of the service delivery system available in the 

community, and by avoiding working at cross-purposes (NAPSA, 2013).

Existing Knowledge: Formal multidisciplinary teams (MDTs) that convene in order 

to review complex maltreatment cases have been shown to increase effectiveness, 

satisfaction of workers, and rates of prosecution, and to be associated with a reduction 

in future mistreatment risk (Navarro, Gassoumis, & Wilber, 2013; Rizzo, Burnes, & 

Chalfy, 2015; Wiglesworth, Mosqueda, Burnight, Younglove, & Jeske, 2006). 

Findings from Rizzo et al. (2015) showed a significant reduction in future mistreatment 

risk for adults who received services through an MDT model consisting of APS workers 

and lawyers under the same roof (co-located), compared to adults receiving APS 

services only. Additional research has shown that another MDT model—the elder abuse 

forensic center model—is an effective approach for determining whether cases should 

be referred to a public guardian or whether guardianship should be established, to 

ultimately ensure the safety of adult maltreatment victims who require the highest level 

of protection (Gassoumis, Navarro, & Wilber, 2015). 
I-14 Part I | APS Research Agenda

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Research focusing on coordination with other entities, including mental health and 

substance use services, has also shown positive outcomes, including increased 

willingness of adults to accept treatment (He & Phillips, 2017; Sirey et al., 2015; 

Susman, Lees, & Fulmer, 2015). The 2012 NAPSA/NASUAD survey of APS agencies 

found that most APS systems participate in some kind of MDT (NAPSA & NASUAD, 

2012). About 50% of the states that do so have formal agreements to facilitate 

interagency cooperation.

Research questions identified by the field (4 questions):

22. What are best practices and effective models for collaboration between 

APS and criminal justice and law enforcement?

28. How does the use of MDTs effect the safety and well-being outcomes of 

clients?

44. What is the impact of collaboration between APS and other professions 

(for example, law enforcement, emergency department staff)?

45. What are best practices and tools for MDTs?

10. Investigations and Findings

Importance: Case findings are the investigation results which indicate whether the 

reported adult maltreatment has or has not occurred in a particular case. Although 

there is some variation across APS jurisdictions in standards of evidence that are used, 

there are typically three types of case findings:

■ Confirmed (substantiated): Evidence supports that adult maltreatment is more 

likely than not to have occurred.

■ Inconclusive: There is some evidence that adult maltreatment may have 

occurred but not sufficient evidence for a substantiated finding.

■ Unfounded (unsubstantiated): There is little or no evidence that adult 

maltreatment occurred. 

Determining a case finding involves gathering information through interviews with 

the client, the alleged perpetrator, and other involved parties; review of relevant 

information; and evaluation of the living environment (if applicable). APS caseworkers 

then must evaluate this information to determine whether maltreatment is more likely 

than not to have occurred. A finding in an APS case may determine whether or not 

someone can receive services from an APS program in some states. The finding may 

also play a role in the eventual involvement of the criminal justice system. 
Part I | APS Research Agenda I-15

11

Existing Knowledge: A 2016 study on variability of APS findings in California concluded 

that differing interpretations of definitions of confirmed, inconclusive, and unfounded 

case findings, along with differences in worker expertise and practices, were the 

major contributors to a wide range of the percentage of confirmed, inconclusive, and 

unfounded cases. The authors suggest establishing clear definitions and training to 

standardize the determination of findings for elder abuse/neglect cases (Mosqueda et 

al., 2016).

Some programs use structured decision-making to standardize the collection of 

information and guide the investigator in evaluating collected evidence through an 

objective and systematic approach. For instance, substantiation rates have been 

shown to be higher with the use of the technology-based Elder Abuse Decision Support 

System (EADSS) full interview guide and short-form, compared to APS protocols (Beach 

et al., 2017; Conrad et al., 2017). 

Research questions identified by the field (4 questions):

5. What are effective processes for investigating allegations and making 

decisions regarding substantiation? 

11. What are effective decision-making strategies to determine case findings?

14. What are effective processes for making a finding based on the evidence?

57. What are best practices/procedures (e.g., structured decision-making) for 

recognizing and differentiating abuse and neglect sub-types in the APS 

client population?

11. Perpetrators

Importance: Understanding who perpetrates adult maltreatment is critical to 

crafting appropriate and effective interventions for clients as well as for preventing 

maltreatment. 

Existing Knowledge: Elder abuse research has for decades examined who perpetrates 

adult maltreatment, and some characteristics of perpetrators are widely recognized. 

For instance, substance abuse, mental health problems, abuser dependency (in 

particular financial dependency), caregiver burden or stress, and certain personality 

characteristics such as “hot temper” are perpetrator characteristics that have been 

shown to be associated with higher probability of emotional/psychological abuse 

(Conrad, Liu, & Iris, 2016; Jackson & Hafemeister, 2011; Johannesen and LoGiudice, 

2013; Liu, Conrad, Beach, Iris, & Schiamberg, 2019).
I-16 Part I | APS Research Agenda

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Research has also focused on important differences of perpetrators across types of 

abuse and studied how APS and other response systems can intervene effectively, 

depending on the type of perpetrator (Amstadter et al., 2011; Jackson, 2014). The APS 

Guidelines suggest that information about suspected maltreatment be collected from 

the alleged victim, alleged perpetrator, and other involved parties. The APS Guidelines 

also recommend that an assessment of the alleged perpetrator and/or caregiver be 

conducted to ascertain the risk to the safety and independence of the alleged victim of 

adult maltreatment.

Research questions identified by the field (2 questions):

4. What is the impact of interventions for perpetrators on client outcomes?

35. What is the impact of perpetrator investigations and services for client 

with family member perpetrators on client safety?

12. Service Planning and Delivery

Importance: After APS has completed the investigation and the client assessment, in 

many states a service plan is created with the adult. The goal of the service plan is to 

improve safety, prevent maltreatment from occurring, and improve the adult’s quality 

of life. Service plans are monitored, and changes can be made, with the adult’s (and/

or the adult’s designated representative’s) involvement, to facilitate services that 

address any identified shortfalls or newly identified needs and risks. The service plan 

will include the arrangement of any essential services required by statute or policy 

as well as capitalize on services and resources available in the particular community. 

(Note: Programs may use various terms to refer to the plan, e.g., case plan, service 

plan, safety plan, action plan.) Frequently, consultation with other service providers is 

needed to develop and implement the plan. 

Existing Knowledge: Several studies of adult maltreatment have yielded findings that 

may inform current APS practice. For example, a study by Jackson & Hafemeister (2011) 

indicates that interventions tailored to meet the unique characteristics associated with 

each type of mistreatment may lead to greater safety. In addition, specific services or 

supports, such as social support and participation in supportive community social 

outlets, may be effective for mitigating negative outcomes of elder mistreatment, 

such as depression, generalized anxiety, and poor health (Acierno, Hernandez-Tejada, 

Anetzberger, Loew, & Muzzy, 2017) as well as future risk of mistreatment (Burnes, 

Rizzo, & Courtney, 2014). It has also been shown that adults with mental health needs 

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

time that they are receiving mistreatment resolution services (Sirey et al., 2015). 
Part I | APS Research Agenda I-17

13

Research on mental health highlights the importance of also addressing mental health 

issues, such as depression, as it affects individuals’ perception of their need for 

care and their motivation, initiative, and energy to seek help and engage in services 

(DiMatteo, Lepper, & Croghan, 2000; Sirey, Bruce, & Alexopoulos, 2005). 

The 2012 NAPSA/NASUAD survey of APS agencies found that once a case is initiated 

through APS, 63% of the programs reporting require regular communication with the 

adult, either by phone or in person (NAPSA & NASUAD, 2012). Close to 90% of the 

states stated that, once a month, an in-person visit is required while a case is open, 

although most also indicated that ongoing investigations may require more frequent 

contact. Once-a-month phone calls are required in 64% of the states. Research 

indicates that longer-term, relationship-based interventions may be effective for 

entrenched elders who are reluctant to receive services (Mariam et al., 2015).

Research questions identified by the field (7 questions):

15. What are best practices for conducting investigations in cases of domestic 

violence involving older adults (i.e., practices that do not increase the risk 

for the alleged victim)?

24. What are strategies for effective collaboration between clients and APS 

workers?

26. What are best practices for effective service planning (i.e., time needed to 

create and implement effective service plan; services planning for adults 

with capacity vs those with limited/lacking capacity; service planning for 

older adults vs. adult with disabilities; degree of involvement)?

32. What are best practices for identifying clients with service needs?

39. What factors are associated with service refusal and strategies for 

enhancing acceptance of service supports?

59. What types/kinds of referral services (e.g., legal services, transportation 

services) are effective for each maltreatment type?

60. What are current APS practices, from the time cases are reported to APS to 

the time they are closed?

13. Client Goals

Importance: Ethical principles in APS practice focus on supporting the adult’s wishes 

and goals; however, determining what those goals are and measuring progress towards 

them is challenging. In addition, the level of involvement of the adult in developing his 

or her own safety plan is believed to have a significant impact on the feasibility and 

likelihood of success of that safety plan. 
I-18 Part I | APS Research Agenda

14

Existing Knowledge: Burnes et al. have proposed that APS use goal attainment scaling 

(GAS) with adults in order to help them set goals. GAS is a client-centered outcome 

measurement approach that has the potential to address existing measurement 

challenges constraining progress in elder abuse intervention research. Goals toward 

case closure should be specific to each adult, and goal attainment should be 

contingent on the adults meeting their specific goals (Burnes, Connolly, Hamilton, & 

Lachs, 2018). 

Research questions identified by the field (1 question):

61. What do APS clients report as their goals/needs with regard to APS 

services?

14. “Underserved” Populations

Importance: In order to craft effective APS responses, it is important to understand and 

adequately address the needs of the general population as well as those groups who 

traditionally represent underserved populations. Understanding which groups present 

underserved groups in the context of adult maltreatment and how being underserved 

relates to APS is key for eliminating barriers to APS utilization and service access. 

Existing Knowledge: The term “underserved” generally refers to groups believed to be 

insufficiently served by the health care system, including racial and ethnic minorities, 

uninsured persons, immigrants, elders, rural populations, persons living in primary 

care health professional shortage areas, and/or those with various communitywide 

vulnerabilities (Jervis et al., 2016).

In the area of adult maltreatment, research has focused on understanding how 

different groups define, experience, and seek to remedy adult maltreatment. For 

example, Dong et al. (2011) examined the perception, knowledge, and help-seeking 

tendency toward elder mistreatment among Chinese older adults. The authors found 

that Chinese older adults mostly characterized elder mistreatment in terms of caregiver 

neglect and identified psychological mistreatment as the most serious form of 

mistreatment. In addition, they found that Chinese older adults had limited knowledge 

of resources for seeking help, other than seeking assistance from local community 

service centers. Findings from focus group discussions also suggest that perceptions/

beliefs about maltreatment are determined by culture and degree of acculturation in 

addition to race/ethnicity (Enguidanos, DeLiema, Aguilar, Lambrinos, & Wilber, 2014). 

These findings may point toward the need for APS to develop person-centered 
Part I | APS Research Agenda I-19

15

intervention and prevention models that integrate the cultural background, care needs, 

and individual preferences of older adults.

Research has also focused on other populations, including those with mental health 

needs. Specifically, research has shown that adults with mental health needs are 

often willing to accept an offer of additional mental health services at the same time 

that they are receiving mistreatment resolution services from APS (Sirey et al., 2015). 

Research on mental health highlights the importance of also addressing mental health 

issues, such as depression, as it affects individuals’ perception of their need for 

care and their motivation, initiative, and energy to seek help and engage in services 

(DiMatteo et al., 2000; Sirey et al., 2005).

Research questions identified by the field (4 questions):

41. What are best practices to address the needs of clients from minority 

populations (e.g., race/ethnicity, gender, sexual orientation, language, 

etc.)?

55. How do APS client goals/needs differ by APS population (older adults/

adults with disabilities, by ethnicity, by maltreatment type, etc.)?

56. What are different socio-cultural conceptualizations of abuse; to what 

extent do they create barriers for reporting maltreatment, help-seeking 

behaviors, and service utilization?

58. What are best practices for working with clients who experienced severe 

vs. less severe maltreatment?

15. Specialized Interventions

Importance: Knowledge of specialized interventions, their costs, and their impact on 

client outcomes is essential to efficiently allocate scare resources for APS programs. 

Evidence-based practices4

 for prevention and/or remediation of adult maltreatment are 

essential for improving the well-being of clients and for potentially reducing recidivism 

in the APS system.

Existing Knowledge: Though there is a paucity of research about evidence-based 

practices specific to APS, several studies have examined the effectiveness of 

specific interventions with those who have experienced adult maltreatment. These 

4 Evidence-based practices are policies and/or processes that are scientifically proven, through 

quantitative research, to be effective and beneficial in preventing or changing a targeted 

outcome and effective across a wide range of settings and populations.
I-20 Part I | APS Research Agenda

interventions could be integrated into APS practice. For example, specific services 

or supports, such as social support and participation in supportive community 

social outlets, may be effective for mitigating against negative outcomes of elder 

mistreatment, such as depression, generalized anxiety, and poor health (Acierno et 

al., 2017) as well as future risk of mistreatment (Burnes et al., 2014). It has also been 

shown that adults who have experienced maltreatment are often willing to accept an 

offer of mental health services at the same time that they are receiving mistreatment 

resolution services (Sirey et al., 2015). Research on mental health highlights the 

importance of also addressing mental health issues, such as depression, as it affects 

individuals’ perception of their need for care and their motivation, initiative, and 

energy to seek help and engage in services (DiMatteo et al., 2000; Sirey et al., 2005).

A 2015 study (Mariam et al., 2015) examined an elder abuse intervention and 

prevention program and assessed its effectiveness for building alliances between APS 

and elders with suspected maltreatment. In this program, outreach specialists met with 

elders in person and used different strategies, including motivational interviewing, 

to build an alliance and connect elders to resources in the community based on their 

readiness to change, preferences, and needs. Results showed that risk factors of 

elder abuse decreased over the course of the intervention. In addition, nearly 75% of 

participants made progress on their treatment goals. The authors note that, for other 

agencies serving “at-risk” elders, the project’s findings suggest that a longer-term, 

relationship-based intervention for entrenched elders who are reluctant to receive 

services may be effective.

Programs that facilitate bidirectional support in the form of education, volunteerism, or 

socialization may be most effective (e.g., Experience Corps, congregate meal program) 

(Anetzberger, 2018).

Research questions identified by the field (3 questions):

8. What is the effectiveness of specialized/focused interventions (e.g., 

relationship-based intervention, longer-term interventions, client 

navigators, peer support services), including impact on different 

populations/types of clients? 

16. What is the impact of specialized APS units (e.g., financial exploitation, 

self-neglect) on investigation outcomes?

43. What are best practices to address the needs of clients with mental health 

issues?
Part I | APS Research Agenda I-21

16

17

16. Access to Expert Resources

Importance: It is often helpful or necessary for APS programs to consult with content or 

clinical experts in order to investigate allegations of adult maltreatment or to provide 

services to their clients.

Existing Knowledge: Nearly every state APS system reported, in a 2012 survey 

conducted by the NAPSA and NASUAD, that they had some access to legal consultation. 

Over half of the states surveyed reported that they had access to physicians, while over 

60% indicated that they had access to mental health professionals as well as nurses 

and physician assistants. The survey also noted that, although financial exploitation is 

one of the most frequent and complex types of mistreatment handled by APS, access 

to forensic specialists and accountants was not available in over 60% of the states. 

Several states, but not all, indicated that they could consult with law enforcement, 

faith-based groups, the attorney general’s office, and domestic violence agencies 

(NAPSA & NASUAD, 2012). 

Recently, technology has been used to address the scarcity of expert resources for 

APS client assessments (Burnett, Dyer, Clark, & Halphen, 2019). Researchers in Texas 

created a Forensic Assessment Center Network that uses a Web-based portal and lowcost videophone technology to connect an APS agency and its clients to a centralized 

geriatric and elder mistreatment expert medical team for virtual in-home assessments. 

Research questions identified by the field (1 question):

29. What is the impact of access to financial experts on rates and outcomes of 

successful intervention in financial exploitation cases?

17. Involuntary Interventions

Importance: APS systems are sometimes called upon to provide services in cases 

where there has been a determination of extreme risk and the adult lacks capacity for 

self-protection or cannot consent to services (e.g., for clients with advanced dementia). 

These can be difficult decision points for APS staff, often not well understood by APS 

partners. APS values and practice standards emphasize choosing courses of action 

and services which are the least restrictive possible, pose the least risk of harm to the 

adult, maximize the adult’s independence and choice to the extent possible based on 

the adult’s capacity, and are in the best interests of the adult unable to make decisions 

for him- or herself (NAPSA, n.d.). 
I-22 Part I | APS Research Agenda

Carrying out the necessary processes and gaining cooperation of partners for 

involuntary intervention can be difficult. In order to provide an involuntary intervention, 

APS must first secure a capacity assessment, then obtain legal standing, either 

by going to court with legal counsel or by involving another agency that has legal 

jurisdiction. APS programs follow the particular laws and policies in their jurisdictions 

regarding involuntary services to vulnerable adults who lack the capacity to protect 

themselves from maltreatment. However, APS practice standards emphasize that 

principles of supportive decision-making should be utilized in involuntary service 

planning with an adult who lacks capacity in some areas (NAPSA, 2013). 

Often, at the time of APS entry into the situation, a lack of capacity has not yet been 

identified or addressed, and lack of other options puts APS is in the position of 

initiating a guardianship or conservatorship process in order to keep the client from 

returning to a state of maltreatment.

Existing Knowledge: Little is known about the long-term consequences of involuntary 

interventions such as guardianships on clients. In addition, although APS practice 

standards emphasize the need to explore all other options to preserve choice and 

independence to the maximum degree, research has not identified best practices for 

alternatives to legal guardianship. Supported decision-making is at times presented 

as a potential alternative that has the potential to avoid many of the legal and social 

pitfalls that guardianship presents (Blank & Martinis, 2015), but more research is 

needed to determine the effectiveness in the context of APS. Other research has 

shown that the elder abuse forensic center model, with its multiple disciplines and 

perspectives, can be an effective approach for determining whether or not cases 

should be referred for guardianship (Gassoumis et al., 2015).

Research questions identified by the field (3 questions):

25. What are effective alternatives to guardianship?

30. What is the impact of involuntary interventions (e.g., facility placement) 

on clients, and what is the impact of alternative strategies?

47. What is the impact of supported decision-making/limited guardianship on 

outcomes?
Part I | APS Research Agenda I-23

18

18. Client Outcomes

Importance: According to the U.S. Government Accountability Office, challenges faced 

by APS programs nationwide include an increased number of cases reported, shrinking 

state and local revenues used to fund APS programs, inadequate staffing levels, limited 

information on how to resolve complex cases, and difficult-to-use or inadequate data 

systems (U.S. Government Accountability Office, 2011). All these challenges point to 

a need for quality research on APS, including research on APS outcomes. Building the 

evidence base for APS programs and practices is key for determining if and how APS 

programs make a difference in the lives of their clients. Despite clarity on the need 

for protective services, it can be difficult for APS agencies to define specific client 

outcomes that are achievable and measurable so that they can evaluate their own 

effectiveness.

Existing Knowledge: There are few existing studies of APS client outcomes (e.g., 

Booker, Breaux, Abada, Xia, & Burnett, 2018; Burnes et al., 2014; Kurrle, Sadler, 

Lockwood, & Cameron, 1997; Neale, Hwalek, Goodrich, & Quinn, 1996; Teaster & 

Roberto, 2004). Among those identified, most had one or more characteristics of a 

new or underdeveloped body of literature. In particular, most of the articles used 

small sample sizes selected from small geographic areas, relied on case record 

review methods using state/local administrative data sources, and/or used simple, 

descriptive statistical approaches to address research questions. These limitations 

may be explained in part by the decentralized nature of APS and the wide variation in 

APS programs across states and counties. They may also be explained by a lack of data 

collection about APS in national surveys or surveillance systems.

Studies on client outcomes tend to focus on examining the influence of APS on 

subsequent maltreatment or recurrence of maltreatment. These outcomes appear to 

have strong support as common and important ones across APS programs. Specific 

findings from these studies suggest that there are multiple levels of influence on 

adults’ risk of subsequent maltreatment and recurrence of maltreatment. These 

influences include adult characteristics (e.g., gender, age, race/ethnicity, community 

engagement, type of maltreatment), victim–perpetrator relationship characteristics 

(e.g., cohabitation, relationship, history of abuse), and APS characteristics (e.g., MDT 

versus individual social worker).5

 The existing knowledge highlights that there does not 

seem to be consensus in the field about key outcomes for APS and what constitutes a 

“good” outcome. 

5 The following articles examine the relationship between one or more of these characteristics 

and risk of subsequent maltreatment or recurrence of maltreatment: Burnes et al. (2014); 

Dong, Simon, and Evans (2013); Ernst & Smith (2012); Lithwick, Beaulieu, Gravel, & Straka 

(2000); Roberto, Teaster, and Duke (2004); Vladescu, Eveleigh, Ploeg, & Patterson (2000). 
I-24 Part I | APS Research Agenda

Research questions identified by the field (9 questions):

6. What are relevant and meaningful outcomes at case closure, and the 

means to quantify those outcomes, that will provide helpful information 

about the effectiveness of services in the lives of clients? 

7. What are longitudinal adult outcomes (e.g., from case initiation to 1 

year+ after case closure) and what are effective strategies for measuring 

longitudinal outcomes?

18. What are best practices for measuring client safety and wellbeing 

outcomes?

20. How do limits to APS authority (ability to acquire evidence, compel 

interviews, request a mental health hold, etc.) impact client outcomes?

33. What are effective strategies for maintaining client safety (i.e., future 

reports to APS)?

36. How are immediate and long-term client safety and wellbeing outcomes 

measured?

37. How should APS determine/define positive outcomes (do they look 

different for older adults vs. younger adults with disabilities)?

38. What is a successful APS outcome? Who decides and why? 

48. Does the achievement of a successful outcome vary by elder maltreatment 

form or other factors, and if so how?

Conclusion

This APS Research Agenda is an important step for helping to advance the evidence base 

of practices and policies adopted by APS programs. APS programs provide essential 

services and supports for older adults and adults with disabilities who are in need of 

assistance due to maltreatment. Even though every state has its own distinct APS system 

and programs, the field has seen great advances over the years, resulting in a move 

toward a core set of principles and more consistent practices across states. However, to 

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

of APS programs and practices in improving client outcomes and provide states with 

tools to support effective and timely responses to adult maltreatment. As evidenced 

by the number and range of research questions submitted by APS stakeholders for the 

development of this agenda, there is a lot we still do not know about APS as whole, 

effective standards and practices, and program and client outcomes. 
Part I | APS Research Agenda I-25

This first APS Research Agenda summarizes some of the top priority research questions 

for the APS field at this point in time. The research questions address virtually all 

APS policy and program areas, from definitions of maltreatment types and quality 

assurance to investigations and client outcomes. Of special note, all 61 questions were 

deemed to be of high priority. Each question was rated for level of priority on a 9-point 

scale, organized by thirds: 1–3=low priority; 4–6=medium priority; 7–9=high priority. 

Within this list, questions focused on caseload sizes were rated to be of highest 

priority, and no question received lower than a mean score of 6.6. (see Appendix B)

Regardless of which questions are taken up for study, it is essential that challenges 

faced by practitioners are translated into research questions and that findings 

of researchers are translated into practical implications for practitioners. Thus, 

researchers and practitioners need to work together in all phases of research, 

including formulating the research question, designing research, collecting data, 

interpreting and using results to generate knowledge, and making changes that 

can improve APS. All research about APS should, by necessity and in the interest of 

integrity and collegiality, begin in consultation with APS leaders and workers. The 

Voluntary Consensus Guidelines for State APS Systems include a recommendation 

for APS to participate in research in order to identify best practices, evaluate program 

performance, and determine client outcomes. The Guidelines state that while abiding 

by all applicable regulations related to privacy and confidentiality, it is recommended 

that state APS programs: 

■ support collaborative research between and among APS programs and 

researchers from academic institutions, research organizations, and consultants 

at the local, state, national, and international levels;

■ support research-based evaluation of APS programs, initiatives, policy, and 

practice;

■ conduct analyses of APS program outcomes;

■ participate in national APS data collection efforts; and

■ disseminate findings from research to other state and county APS programs, 

policymakers, and other researchers.

As noted, this APS Research Agenda is a key step forward in providing guidance 

to funders, researchers, and APS programs on issue areas both in need of more 

understanding and deemed important to APS. Concentrated efforts in these areas 

will help move the field forward and create an evidence base for APS programs. This 

agenda is intended to identify gaps in evidence-based and professional knowledge 

regarding APS policies and practices, stimulate thinking and increase awareness, and 

encourage collaboration between APS professionals and researchers. ACL is committed 

to being part of this effort by using the agenda to help guide the agency’s funding.
I-26 Part I | APS Research Agenda

In addition, ACL envisions that the agenda provides guidance for other agencies and 

organizations that fund APS research, researchers, and APS leaders and workers who 

deliver these important services and can benefit from evidence-based information for 

the conduct of their professions.

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adult protective services data. Journals of Gerontology: Social Sciences, 74(5), 897–907.

Liu, P.-J., Stratton, S. K., Hass, Z., & Conrad, K. J. (2020). Can standardized measures provide 

helpful feedback about adult protective services substantiation? Pilot data from a short 

self-neglect assessment. Journal of Elder Abuse & Neglect. Advance online publication. doi: 

10.1080/08946566.2020.1742837. 

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. 

McDavid, J. C., & Hawthorn, L. R. L. (2006). Program evaluation and performance measurement: 

An introduction to practice. Sage Publications, Inc.

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.

National Adult Protective Services Association. (n.d.). NAPSA (or APS) Code of Ethics. Retrieved 

from http://www.napsa-now.org/about-napsa/code-of-ethics/

National Adult Protective Services Association. (2013). Adult protective services recommended 

minimum program standards. Retrieved from http://www.napsa-now.org/wp-content/

uploads/2014/04/Recommended-Program-Standards.pdf

National Adult Protective Services Association & National Association of State Units on Aging. 

(2012). Adult protective services in 2012: Increasingly vulnerable. Retrieved from http://www.

napsa-now.org/wp-content/uploads/2012/06/BaselineSurveyFinal.pdf

National Center on Elder Abuse. (2016). Elder abuse screening tools for healthcare professionals. 

Retrieved from http://eldermistreatment.usc.edu/wp-content/uploads/2016/10/Elder-AbuseScreening-Tools-for-Healthcare-Professionals.pdf

National Council on Aging. (n.d.). Elder abuse facts. Retrieved from https://www.ncoa.org/publicpolicy-action/elder-justice/elder-abuse-facts/

Navarro, A. E., Gassoumis, Z. D., & Wilber, K. H. (2013). Holding abusers accountable: An 

elder abuse forensic center increases criminal prosecution of financial exploitation. The 

Gerontologist, 53(2), 303–312. 

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Program description and administrative findings. The Gerontologist, 36(4),502–511.
I-30 Part I | APS Research Agenda

Office of Inspector General, Department of Health and Human Services. (2014). Adverse events 

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https://oig.hhs.gov/oei/reports/oei-06-11-00370.pdf

Otto, J. M. (2014). Adult protective services caseload management [Technical assistance brief]. 

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Department of Justice. Retrieved from https://www.justice.gov/file/852846/download

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Susman, A., Lees, K. E., & Fulmer, T. (2015). Understanding repeated visits to adult protective 

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Teaster, P. B., Dugar, T., Mendiondo, M., Abner, E. L., Cecil, K. A., & Otto, J. M. (2006). The 2004 

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Teaster, P. B., & Roberto, K. A. (2004). Sexual abuse of older adults: APS cases and outcomes. 

Gerontologist, 44(6), 788–796.

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Research Conference on Elder Abuse and Neglect. Durham, NH: Author. 

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to an emerging health, justice, financial and social crisis. Retrieved from https://www.justice.

gov/file/852856/download. 

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enhance national response to elder abuse (GAO-11-208). Washington, DC: Government Printing 

Office.
Part I | APS Research Agenda I-31

Vladescu, D., Eveleigh, K., Ploeg, J., & Patterson, C. (2000). An evaluation of a client-centered 

case management program for elder abuse. Journal of Elder Abuse & Neglect, 11(4), 5–22.

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elder abuse forensic center. The Gerontologist, 46(2), 277–283. 

Wolf, R. S. (n.d.). Research agenda on abuse of Older persons and adults with disabilities. 

Retrieved from https://ncea.acl.gov/NCEA/media/docs/Research_Agenda_on_Abuse_of_

Older_Persons.pdf

Wulczyn, F. 2005. Beyond common sense: Child welfare, child well-being, and the evidence for 

policy reform. New Brunswick, Canada: Aldine-Transaction.
I-32 Part I | APS Research Agenda
Part I | APS Research Agenda I-33

Appendix A. Technical Expert Panel

Georgia Anetzberger, PhD, ACSW

Consultant in private practice

Fellow, Gerontological Society of America

Adjunct Assistant Professor, 

Department of Medicine at Case Western 

Reserve University

Cleveland, OH

Catherine Bingle, MPA

Research Specialist, 

Adult Protective Services, 

Texas Department of Family and Protective 

Services

Austin, TX

Julie Bobitt, PhD

Director, 

Interdisciplinary Health Sciences, College 

of Applied Health Sciences, 

University of Illinois at Urbana Champaign

Champaign, IL

Akiles Ceron, MSW

Director, 

Adult Protective Services, 

Department of Disability and Aging 

Services, 

City and County of San Francisco 

San Francisco, CA

Michael Hagenlock, LCSW, LAC

APS Bureau Chief, 

Montana Department of Public Health & 

Human Services

Helena, MT

Rachel Lakin, MSW

Adult Protection Program Administrator, 

New Hampshire Department of Health and 

Human Services

Concord, NH

Geoffrey Rogers

Director of Learning and Development, 

Brookdale Center for Healthy Aging of 

Hunter College

Peggy Rogers

Manager, 

Adult Mistreatment Prevention and 

Response Section, Adult Protective 

Services and Colorado Adult Protective 

Services data system (CAPS) Check Unit, 

Colorado Department of Human Services

Denver, CO

Sidney Stahl, PhD

Consultant

Chief, 

Individual Behavioral Processes Branch, 

National Institute on Aging (NIA), 

National Institutes of Health (NIH) (Ret.)
I-34 Part I | APS Research Agenda
Part I | APS Research Agenda I-35

Appendix B. List of High-Priority Research Questions

The list shows the 61 APS research questions that the technical expert panel (TEP) 

agreed to be of high priority. Questions are listed in order of importance based on the 

mean (average of all scores). TEP members rated the level of priority on a 9-point scale, 

organized by thirds: 1–3=low priority; 4–6=medium priority; 7–9=high priority.

Research Question Mean Standard 

Deviation

1. What is the impact of caseload size on the quality of 

investigations and interventions?

8.6 0.7

2. What is the impact of caseload size on case worker 

performance, retention, satisfaction?

8.3 1

3. What is the validity and effectiveness of existing 

screening and assessment tools and tools that are used 

by APS to measure intervention outcomes?

8.1 0.9

4. What is the impact of interventions for perpetrators on 

client outcomes?

8 0.7

5. What are effective processes for investigating allegations 

and making decisions regarding substantiation? 

8 0.9

6. What are relevant and meaningful outcomes at case 

closure, and the means to quantify those outcomes, 

that will provide meaningful information about the 

effectiveness of services in the lives of clients? 

8 0.9

7. What are longitudinal client outcomes (e.g., from case 

initiation to 1 year+ after case closure) and what are 

effective strategies for measuring longitudinal client 

outcomes?

8 0.9

8. What is the effectiveness of specialized/focused 

interventions (e.g., relationship-based intervention, 

longer-term interventions, client navigators, peer support 

services), including impact on different populations/

types of clients? 

7.8 0.7

9. What are best practices for identifying cases that require 

an investigation?

7.8 0.8

10. What are best practices for effectively prioritizing cases? 7.8 0.8
I-36 Part I | APS Research Agenda

Research Question Mean Standard 

Deviation

11. What are effective decision-making strategies to 

determine case findings?

7.8 0.8

12. What is the incidence and prevalence of hazards (threats 

and assaults) for APS workers?

7.8 1.0

13. What are the most important questions needed to screen 

in/out cases?

7.8 1.1

14. What are effective processes for making a finding based 

on the evidence?

7.8 1.1

15. What are best practices for conducting investigations in 

cases of domestic violence involving older adults (i.e., 

practices that do not increase the risk for the alleged 

victim)?

7.7 0.5

16. What is the impact of specialized APS units (e.g., financial 

exploitation, self-neglect) on investigation outcomes?

7.7 0.5

17. What are barriers and potential harms of screening adults 

for maltreatment?

7.7 0.9

18. What are best practices for measuring client safety and 

wellbeing outcomes?

7.7 0.9

19. What is the impact of APS using standardized vs. nonstandardized assessment tools?7.7 1

20.How do limits to APS authority (ability to acquire 

evidence, compel interviews, request a mental health 

hold, etc.) impact client outcomes?

7.7 1

21. What is the impact of using standardized tools on APS 

service delivery and client outcomes?

7.7 1.3

22.What are best practices and effective models for 

collaboration between APS and criminal justice and law 

enforcement?

7.6 0.7

23. What are best practices for taking/conducting an intake 

reports (i.e., who should take/conduct an intake report, 

level of competency of worker needed, time to create 

report, types of information to collect in order to make a 

screening decision/determine if investigation is needed)?

7.6 0.7
Part I | APS Research Agenda I-37

Research Question Mean Standard 

Deviation

24.What are strategies for effective collaboration between 

clients and APS workers?

7.6 0.7

25. What are effective alternatives to guardianship? 7.6 0.7

26.What are best practices for effective service planning 

(i.e., time needed to create and implement effective 

service plan; services planning for clients with capacity 

vs those with limited/lacking capacity; service planning 

for older adults vs. adult with disabilities; degree of client 

involvement)?

7.6 1

27. What are effective strategies for using data to improve 

program performance and practices for APS case workers?

7.6 1

28.How does the use of MDTs effect the safety and well-being 

outcomes of clients?

7.6 1.1

29.What is the impact of access to financial experts on rates 

and outcomes of successful intervention in financial 

exploitation cases?

7.4 0.7

30.What is the impact of involuntary interventions (e.g., 

facility placement) on clients, and what is the impact of 

alternative strategies?

7.4 0.7

31. What is the incidence of burnout, compassion fatigue, 

and secondary traumatic stress among APS workers?

7.4 0.9

32. What are best practices for identifying clients with service 

needs?

7.4 0.9

33. What are effective strategies for maintaining client safety 

(i.e., future reports to APS)?

7.4 0.9

34. What practices lead to an intake report with clear, 

specific information related to the maltreatment and the 

alleged victim and his/her circumstances (e.g., phone vs 

internet/email, structured interview vs free form, training 

provided to intake staff)? 

7.4 1

35. What is the impact of perpetrator investigations and 

services for clients with family member perpetrators on 

client safety?

7.4 1
I-38 Part I | APS Research Agenda

Research Question Mean Standard 

Deviation

36.How are immediate and long-term client safety and 

wellbeing outcomes measured?

7.4 1

37. How should APS determine/define positive outcomes (do 

they look different for older adults vs. younger adults with 

disabilities)?

7.4 1.4

38.What is a successful APS outcome? Who decides and 

why? 

7.4 2.6

39.What factors are associated with service refusal and 

strategies for enhancing acceptance of service supports?

7.3 1

40.Does APS save state governments money? If so, how and 

how much? 

7.3 1.1

41. What are best practices to address the needs of clients 

from minority populations (e.g., race/ethnicity, gender, 

sexual orientation, language, etc.?

7.3 1.3

42.What valid and reliable screening methods and tools are 

used by APS? 

7.3 2.5

43. What are best practices to address the needs of clients 

with mental health issues?

7.2 0.7

44.What is the impact of collaboration between APS and 

other professions (for example, law enforcement, 

emergency department staff)?

7.2 0.8

45. What are best practices and tools for MDTs? 7.2 1.3

46.What is the impact of different time frames for completing 

investigations on case outcomes?

7.1 0.6

47. What is the impact of supported decision-making/limited 

guardianship on client outcomes? 

7.1 1.2

48.Does the determination of a successful outcome vary by 

elder maltreatment form or other factors, and if so how?

7.1 1.4

49.What tools exist to measure intervention outcomes 

(e.g., change in client or case status in response to the 

intervention)?

7.1 2.4

50.How does APS define self-neglect? 7.1 3.1
Part I | APS Research Agenda I-39

Research Question Mean Standard 

Deviation

51. What is the impact of different time frames for initiating 

investigations on case outcomes?

7 0.9

52. What data elements are used for effective quality 

assurance (QA)?

7 0.9

53. What are recommended processes and strategies for QA 

for APS programs? 

7 1.1

54. What is the impact of standardized and non-standardized 

intake screening tools?

7 1.2

55. How do APS client goals/needs differ by APS population 

(older adults/adults with disabilities, by ethnicity, by 

maltreatment type, etc.)?

7 1.2

56. What are different socio-cultural conceptualizations of 

abuse; to what extent do they create barriers for reporting 

maltreatment, help-seeking behaviors, and service 

utilization?

6.9 0.9

57. What are best practices/procedures (e.g., structured 

decision-making) for recognizing and differentiating 

abuse and neglect sub-types in the APS client 

population?

6.9 2.3

58. What are best practices for working with clients who 

experienced severe vs. less severe maltreatment?

6.8 0.4

59. What types/kinds of referral services (e.g., legal 

services, transportation services) are effective for each 

maltreatment type?

6.7 1.7

60.What are current APS practices, from the time cases are 

reported to APS to the time they are closed?

6.6 2.4

61. What do APS clients report as their goals/needs with 

regard to APS services? 

6.6 2.5
I-40 Part I | APS Research Agenda
Part II Report on the 

Development of 

the APS Research 

Agenda

ABBREVIATIONS II-2

INTRODUCTION II-3

DEVELOPMENT PROCESS II-4

Review of the literature II-5

Identification of research topics by APS stakeholders II-5

Prioritization of research topics II-6

Methods II-6

Analysis II-7

Rating results II-8

Table 1. Aggregate Results from the First Round of Rating. II-9

“Translation” of high priority research questions into the APS Research Agenda II-9

CONCLUSION II-10

REFERENCES II-12

APPENDIX A. TECHNICAL EXPERT PANEL II-13

APPENDIX B. RESULTS PRESENTED TO TEP MEMBERS AFTER 3RD AND FINAL RATING II-14

Instructions for Reading the Results II-14

Overall Results II-15

INDIVIDUAL RATING RESULTS II-16

Foundational Topics II-16

1. Contact with APS and Other First Responder Systems II-16

2. Placement in State II-17

3. Cost-Benefit and Cost Efficiency of APS System II-18

4. APS Process Evaluation II-20

5. Screening and Assessment Tools II-20

Domain 1: Program Administration II-21

1C. Definitions of Maltreatment II-21

1D. Population Served II-21

1E. Mandatory Reporting II-22

1F. Coordination with Other Entities II-23

1G. Program Authority, Cooperation, Confidentiality and Immunity II-25

1H. Staffing Resources II-26

1I. Access to Expert Resources II-27

1K. Worker Safety and Well-Being II-27

1L. Responding During Community Emergencies II-29

Domain 2: Time Frames II-30

2A. Responding to the Report/Initiating the Investigation II-30

2B. Completing the Investigation II-30

2C. Closing the Case II-30

Domain 3: Receiving Reports of Maltreatment II-31

3A. Intake II-31

3B. Screening, Prioritizing, and Assignment of Screened-In Report II-34

Domain 4: Conducting the Investigation II-35

4A. Determining If Maltreatment Has Occurred II-35

4B. Conducting an APS Client Assessment II-37

4C. Investigations in Residential Care Facilities II-39

Contents — Part II
II-2 Part II | Report on the Development of the APS Research Agenda

4D. Completion of Investigation and Finding II-40

Domain 5: Service Planning and Service Implementation II-42

5A. Voluntary Service Implementation II-42

5B. Involuntary Service Implementation II-48

5C. Closing the Case II-50

Domain 6: Training II-51

6A. Case Worker and Supervisor Minimum Educational Requirements II-51

6B. Case Worker Initial and Ongoing Training II-52

Domain 7: APS Program Performance II-54

7A. Managing Program Data II-54

7B. Evaluating Program Performance II-55

Other Topics II-58

Perpetrators II-58

Culture II-59

Causes/Tools of Maltreatment II-60

Homeless Populations and APS II-61

Guidelines II-62

Undue Influence II-62

Additional Topics Suggested by TEP Members and Added to the Survey II-63

Abbreviations

ACL Administration for Community Living

APS Adult protective services

Guidelines National Voluntary Consensus Guidelines for State APS Systems

NAPSA National Adult Protective Services Association

RFI Request for Information

STDV Standard deviation

TEP Technical expert panel
Part II | Report on the Development of the APS Research Agenda II-3

Introduction

The Administration for Community Living (ACL)6, as the federal home for programs 

addressing the unique needs of older Americans and adults with disabilities across 

the lifespan, is leading several initiatives to help advance and support the critically 

important work of the adult protective services (APS) field. One of these initiatives is 

the development and dissemination of an APS Research Agenda.

APS is a social services program provided by state and local governments across the 

nation that serve older adults and adults with disabilities who are in need of services 

because of abuse, neglect, self-neglect, or financial exploitation (adult maltreatment). 

In all states, APS is charged with receiving and responding to reports of maltreatment 

and working closely with older adults and adults with disabilities and a wide variety of 

allied professionals to maximize clients’ safety and independence.

APS programs are not subject to federal rules and regulations, and thus each state has 

designed its own unique system. In addition, while there is some consistency in the 

types of practices APS programs have adopted, the evidence base concerning which 

practices are most effective, and how states’ characteristics (e.g., rurality, access to 

resources, state- versus county-administered APS programs) are associated with the 

effectiveness of specific practices, is largely lacking. These gaps point to the need for 

research focused on APS practices and policies to ensure APS leaders and workers 

have the tools and resources to respond efficiently and effectively. 

While the field of adult maltreatment has identified some research priorities and 

created several research agendas over the past 3 decades (Stahl, 2015; Stein, 1991; 

University of New Hampshire, 1968; U.S. Department of Justice, 2014; Wolf, n.d.), 

there has never been a research agenda focused exclusively on the practice of APS. An 

APS research agenda is needed to provide guidance to funders, researchers, and APS 

programs to help move the field forward and to guide in the creations of an evidencebase for APS programs. 

To address this need, ACL supported the development of the first APS Research 

Agenda. The goal for this agenda is to highlight research gaps to help inform the APS 

field and ultimately, help build a cohesive body of evidence in the field. 

6 ACL brings together the efforts and achievements of the Administration on Aging, the Office of 

Intellectual and Developmental Disability Programs, and the Department of Health and Human 

Services Office on Disability to serve as the federal agency responsible for increasing access 

to community supports, while focusing attention and resources on the unique needs of older 

Americans and adults with disabilities across the lifespan. 
II-4 Part II | Report on the Development of the APS Research Agenda

This report describes in detail how the APS Research Agenda was developed, including 

the activities that were completed, the stakeholders and subject matter experts who 

contributed, and the results for each milestone in its development. 

This report is intended for information purposes only. The information in this report 

does not constitute any standard or regulation, and does not create any new legal 

obligations nor impose any mandates or requirements. The report also does not create 

nor confer any rights for, or on, any person or agency.

Development Process

The research agenda was developed in conjunction with updating ACL’s Voluntary 

Consensus Guidelines for State APS Systems (Guidelines). The Guidelines are 

designed to assist states in developing efficient, effective APS systems and to provide 

APS administrators with recommendations from the field and findings from relevant 

research about quality practice. There are several ways that states may choose to use 

the Guidelines: to serve as a model of comparison to existing APS systems offered, 

to identify new areas of interest, or to identify areas for improvement in current state 

statutes or policies. The Guidelines further inform ACL about priority APS issues that 

ACL can then focus on through other programs and efforts, including the National APS 

Technical Assistance Resource Center and the National Adult Maltreatment Reporting 

System.

The Guidelines were first developed in 2016. In 2018–2019, ACL facilitated the 

updating of the Guidelines through incorporating information from new research and 

feedback from the field about effective APS practices and policies. To access the full 

report on the process for updating the Guidelines, use this link: https://acl.gov/sites/

default/files/programs/2020-05/ACL-Appendix_3.fin_508.pdf

As part of this process, ACL also facilitated the development of the APS Research 

Agenda, supporting the implementation of a multistep approach. This effort included 

a review of the literature and engagement of stakeholders to identify APS research 

questions, engagement of experts from research and APS practice fields to prioritize 

the identified research questions, and “translation” of high priority research questions 

into the APS Research Agenda. 
Part II | Report on the Development of the APS Research Agenda II-5

Review of the literature

To update the Guidelines, a literature search and review were conducted first, to 

identify new evidence published in peer-reviewed journal articles focused on the 

evaluation of APS programs and practices. The literature search focused on articles 

published between April 20147

 and November 2018. A final group of 24 articles met 

the inclusion criteria8

 and were included in the literature review. The findings in these 

articles were reviewed and cross-walked with the topics addressed by the Guidelines to 

understand which articles provided support for current guidelines and which provided 

support for new recommendations or guidelines. The literature was also reviewed to 

identify recommendations from the authors for further research questions and topics 

related to APS. 

Identification of research topics by APS stakeholders

Findings from the literature were used to draft updates to the Guidelines. In the next 

step, APS stakeholders (including staff from APS, aging, long-term care, disability, 

domestic violence, sexual assault, and victim services networks; legal services; 

researchers; and the public) were invited to comment on the draft updates to the 

Guidelines. Stakeholders had the opportunity to provide feedback during webinars 

and/or on ACL’s request for information (RFI) website. The stakeholder webinars 

and the RFI were also used to invite stakeholders to submit research questions or 

topics that they thought should be addressed to advance the APS field. Specifically, 

stakeholders were invited to respond to the following question: 

■ What are some of most important topic areas for which research on APS 

practices is lacking? 

In addition, researchers attending the 2019 National Adult Protective Services 

Association (NAPSA) conference were invited to join an APS research brainstorming 

session. The session was used to identify additional topics that may be included in the 

APS Research Agenda.

All suggestions provided by stakeholders were reviewed and consolidated by 

combining duplicative suggestions and removing suggestions that were not directly 

7 A literature search and review focused on earlier years (January 2004 – March 2014) was 

conducted for the development of the first Guidelines.

8 Inclusion criteria: Published in English; contains quantitative data analysis or presents 

literature review; related to or applicable to APS programs, operations, practices, and 

processes
II-6 Part II | Report on the Development of the APS Research Agenda

related to APS. Finally, suggestions were reframed as needed to present research 

questions, resulting in a list of 139 research questions. To ensure the APS Research 

Agenda reflects field-generated priorities, every attempt was made to keep as much of 

the original wording as possible. Sample questions from the list include:

■ What are effective processes for making an APS finding based on the evidence?

■ What is the impact of caseload size on case worker performance, retention, 

satisfaction?

■ How should APS determine/define positive outcomes (do they look different for 

older adults vs. younger adults with disabilities)?

■ What are strategies for effective collaboration between at-risk adults and APS 

workers?

■ What are effective alternatives to guardianship?

The questions were then organized by the Guidelines topics. Additional topics 

were created for questions that did not fit with the Guidelines topics. All questions, 

organized by topic, were imported into SurveyMonkey to prepare for the next stage of 

the project. 

Prioritization of research topics 

A technical expert panel (TEP) consisting of nine APS and adult maltreatment experts 

(researchers and APS professionals) was then engaged to finalize the list of questions 

and to prioritize the questions. For a list of the TEP members, see Appendix A.

Methods

A modified Delphi process (Brown, 1968; Hsu & Sandford, 2007)9 was used with the 

TEP for this stage of the project. The Delphi process was developed by Dalkey and 

Helmer at the Rand Corporation in the 1950s as a means to build consensus among 

experts. As part of the process, data are gathered from experts through a feedback 

process. Specifically, experts complete multiple iterations of a questionnaire/survey 

on a specific topic. After their first response, they receive feedback about how their 

responses/ratings compare to the group as a whole. Experts are then allowed and 

encouraged to reassess their responses and make changes. Again, they are provided 

their results compared to the group as a whole. Experts may also have the chance 

to meet in person to discuss the results and make changes to their responses. 

9 For publications referencing the Delphi process see: https://www.rand.org/topics/delphimethod.html?content-type=research.
Part II | Report on the Development of the APS Research Agenda II-7

Theoretically, the feedback process continues until consensus is determined to have 

been achieved.

For this project, a virtual orientation meeting was first held with the TEP members 

to provide an overview of the project, describe the modified Delphi process to be 

implemented for this project, review examples of rating the research questions, and 

show how the results would be presented after each iteration of the rating process.

After the meeting, TEP members received an individual link to the first online survey 

listing the 139 research questions. TEP members were asked to rate the level of priority 

for each question individually and to add research questions as needed. Specifically, 

TEP members were provided the following instructions:

■ Rating Instructions: Please rate each topic on a 9-point scale, organized by 

thirds: 1–3=low priority; 4–6=medium priority; 7–9=high priority. A rating of 1 

would equal lowest priority, whereas a rating of 9 would equal highest priority. 

Please indicate if you think topics are “out of scope,” meaning that they are 

beyond the scope of APS practices and policies, and add comments as needed. 

After you have rated all topics, you can also list additional topics you think the 

TEP should consider. (They will be added to the rating in the second round.) 

Please be judicious when adding topics and consider whether new items may 

be addressed by topics already listed.

After the first round of rating, some research questions were consolidated, and some 

were further broken down into several questions, or refined. In addition, research 

questions from the TEP members were added to the list as appropriate, resulting in 

final list of 153 research questions for all subsequent ratings. TEP members completed 

three iterations of the ratings process. For the second and third iterations, TEP 

members were asked to consider the results from the previous rating to determine 

whether or not they wanted to change their ratings.

Analysis

Results for each round of ratings were analyzed using the SPSS statistical software 

package. For each research question, the following descriptive statistics were 

calculated from the ratings assigned by the nine TEP members: mean, median, mode, 

and standard deviation. The results were used to describe the ratings and to determine 

the priority level and agreement status between the TEP members for each round of 

rating. 
II-8 Part II | Report on the Development of the APS Research Agenda

■ Priority Level for each research question was determined by the mean (e.g., 7.6 

= high priority).

■ Agreement Status showed to what extent the group as a whole agreed on the 

priority level of each research question; agreement was defined as ratings that 

were in the same third of the ratings (1–3; 4–6; 7–9), whatever the median. All 

topics where three or more TEP members rated the topics outside the 3-point 

region containing the median (e.g., 7–9) were classified as “in disagreement.”

Rating results

Once the first survey was completed by all TEP members, results were analyzed and 

summarized. Each TEP member received an individual summary, showing aggregate 

results, their own rating for each research question, descriptive statistics for each 

question, and de-identified comments from all TEP members regarding research 

questions. See Appendix B for the results for each research question from the third 

round of rating.

The three tables below show the aggregate result from all three rounds of ratings. The 

tables show the numbers of research questions that were rated as high, medium, and 

low priority. In addition, they show the numbers of research questions for which the 

TEP members agreed about the priority level. 

For example, during the third and final round of rating, 74 questions were rated as high 

priority, 77 were rated as medium priority, and two were rated as low priority. Of the 

74 research questions that were rated as high priority, the TEP was in agreement on 61 

of them (82.4%). Of those that were rated as medium priority (n=77), the TEP was in 

agreement on 12 of them (15.6%). Finally, for the two questions that were rated as low 

priority, the TEP was in agreement on both of them. 

Overall, the TEP members were in agreement about the priority level for 49% 

of research questions and in disagreement for 51% of research questions. This 

represented a 17% increase in agreement from the first round and a 10% increase in 

agreement from the second round.
Part II | Report on the Development of the APS Research Agenda II-9

Table 1. Aggregate Results from the First Round of Rating.

Agreement Status

Priority level Agreement Disagreement Total

High 43 (58%) 31 74 (53%)

Medium 0 63 63 (45%)

Low 1 1 2 (1%)

Total 44 (32%) 95 (68%) 139

Table 2. Aggregate Results from the Second Round of Rating.

Agreement Status

Priority level Agreement Disagreement Total

High 55 (79%) 15 70 (46%)

Medium 4 77 81 (53%)

Low 1 1 2 (1%)

Total 60 (39%) 93 (61%) 153

Table 3. Aggregate Results from the Third and Final Round of Rating.

Agreement Status

Priority level Agreement Disagreement Total

High 61 (82%) 13 74 (48%)

Medium 12 65 77 (50%)

Low 2 0 2 (1%)

Total 75 (49%) 78 (51%) 153

“Translation” of high priority research questions into the APS Research Agenda

The implementation of the modified Delphi process resulted in a list of 61 APS 

research questions that the TEP agreed to be of high priority. These questions present 

the building blocks of the research agenda. Based on the content of the research 

questions, 19 themes were identified (e.g., caseload size, tools, intake). All 61 

questions were then grouped into these themes.

For each theme, three sections were drafted to compose the content of the APS 

Research Agenda:
II-10 Part II | Report on the Development of the APS Research Agenda

1. Importance presents a brief summary of how the theme is significant to APS 

practice and policies.

2. Existing Knowledge presents an overview of what is already known about the 

theme based on existing literature.

3. Research Questions presents the research questions that were identified by the 

field and experts for this theme. The number in front of each question indicates 

its ranking by level of importance (out of all 61 questions) based on the mean.

For example, the number 5 in front of a question means that its mean ranking was the 

fifth highest out of the 61 items.

While Existing Knowledge highlights what is known about each theme, the associated 

Research Questions sections in turn reveals some of the knowledge gaps (things not 

yet known) for each theme.

The draft APS Research Agenda was shared with the TEP members via email for review 

and feedback (i.e., revisions and comments for content changes). The TEP members’ 

feedback was incorporated as feasible. The updated draft was then provided to ACL 

subject matter experts who reviewed the draft and provided feedback. This feedback 

was incorporated into this final draft.

Conclusion

This first-ever Research Agenda for APS demonstrates ACL’s ongoing commitment to 

building the evidence base for APS. The field-generated development process has 

resulted in the agenda reflecting some of most important questions for which APS 

practitioners and APS researchers seek answers.  

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

effectiveness of APS programs and practices in improving client outcomes and provide 

states with tools to support effective and timely responses to adult maltreatment. 

As evidenced by the number and range of research questions submitted by APS 

stakeholders for the development of this agenda, there is a lot we still do not know 

about APS as whole, effective standards and practices, and program and client 

outcomes. 

The research questions address virtually all APS policy and program areas, from 

definitions of maltreatment types and quality assurance to investigations and client 

outcomes. Regardless of which questions are taken up for study, it is essential that 
Part II | Report on the Development of the APS Research Agenda II-11

challenges faced by practitioners are translated into research questions and that 

findings of researchers are translated into practical implications for practitioners. Thus, 

researchers and practitioners need to work together in all phases of research, including 

formulating the research question, designing research, collecting data, interpreting 

and using results to generate knowledge, and making changes that can improve 

APS. All research about APS should, by necessity and in the interest of integrity and 

collegiality, begin in consultation with APS leaders and workers.

This agenda is intended to identify gaps in evidence-based and professional 

knowledge regarding APS policies and practices, stimulate thinking and increase 

awareness, and encourage collaboration between APS professionals and researchers. 

ACL is committed to being part of this effort by using the agenda to help guide the 

agency’s funding.

In addition, ACL envisions that the agenda provides guidance for other agencies and 

organizations that fund APS research, researchers, and APS leaders and workers who 

deliver these important services and can benefit from evidence-based information for 

the conduct of their professions.
II-12 Part II | Report on the Development of the APS Research Agenda

References

Brown, B. B. (1968). Delphi process: A methodology used for the elicitation of opinion of experts. 

Santa Monica, CA: Rand Corporation. Retrieved from https://www.rand.org/pubs/papers/

P3925.html

Hsu, C.-C., & Sandford, B. A. (2007) The Delphi technique: Making sense of consensus. Practical 

Assessment, Research & Evaluation, 12(10), 1-8. 

Stahl, S. M. (2015). Building consensus on research priorities in elder mistreatment. U.S. 

Department of Justice. Retrieved from https://www.justice.gov/file/852846/download

Stein, K. (1991). A national Agenda for Elder Abuse and Neglect Research: Issues and 

Recommendations. Journal of Elder Abuse & Neglect, 3(3), 91–108.

University of New Hampshire. (1986). Elder abuse and neglect: Recommendations from the 

Research Conference on Elder Abuse and Neglect. Durham, NH: Author. 

U.S. Department of Justice. (2014). The elder justice roadmap: A stakeholder initiative to respond 

to an emerging health, justice, financial and social crisis. Retrieved from https://www.justice.

gov/file/852856/download.

Wolf, R. S. (n.d.). Research agenda on abuse of Older persons and adults with disabilities. 

Retrieved from https://ncea.acl.gov/NCEA/media/docs/Research_Agenda_on_Abuse_of_

Older_Persons.pdf
Part II | Report on the Development of the APS Research Agenda II-13

Georgia Anetzberger, PhD, ACSW

Consultant in private practice

Fellow, Gerontological Society of America

Adjunct Assistant Professor, 

Department of Medicine at Case Western 

Reserve University

Cleveland, OH

Catherine Bingle, MPA

Research Specialist, Adult Protective 

Services, Texas Department of Family and 

Protective Services

Austin, TX

Julie Bobitt, PhD

Director, Interdisciplinary Health Sciences, 

College of Applied Health Sciences, 

University of Illinois at Urbana Champaign

Champaign, IL

Akiles Ceron, MSW

Director, Adult Protective Services, 

Department of Disability and Aging 

Services, 

City and County of San Francisco 

San Francisco, CA

Michael Hagenlock, LCSW, LAC

APS Bureau Chief, Montana Department of 

Public Health & Human Services

Helena, MT

Appendix A. Technical Expert Panel

Rachel Lakin, MSW

Adult Protection Program Administrator, 

New Hampshire Department of Health and 

Human Services

Concord, NH

Geoffrey Rogers

Director of Learning and Development, 

Brookdale Center for Healthy Aging of 

Hunter College

Peggy Rogers

Manager, Adult Mistreatment Prevention 

and Response Section, Adult Protective 

Services and Colorado Adult Protective 

Services data system (CAPS) Check Unit, 

Colorado Department of Human Services

Denver, CO

Sidney Stahl, PhD

Consultant

Chief, Individual Behavioral Processes 

Branch, National Institute on Aging (NIA), 

National Institutes of Health (NIH) (Ret.) 
II-14 Part II | Report on the Development of the APS Research Agenda Appendix B. Results Presented to TEP Members after 3rd and Final Rating Instructions for Reading the Results The rating results for each topic is presented in tables in the subsequent pages. Topics are listed in the same order as they were presented in on the survey, with the same category headings. Below are example results and instructions for how to interpret the results. Each topic was rated on a 9-point scale, organized by thirds: 1-3=low priority; 4-6=medium priority; 7-9=high priority; or out of scope (os) ■ The topic is listed on the left. ■ The Rating shows how every TEP member rated the topic; in the first example one TEP member rate the topic a ‘6’, four rated it a ‘7’, three rated it a ‘9’, and one rated it ‘out of scope (os)’. ■ The mean shows the average for how the group as a whole rated the topic (e.g., 7.6). ■ The priority level shows how the group as a whole rated the priority level of the topic based on the mean (e.g., high). ■ Agreement status shows to what extend the group as a whole agreed on the priority level of each topic; agreement is 

defined as ratings that are in the same third of the ratings (1-3; 4-6; 7-9), whatever the median. All topics where three or more TEP members rated the topics outside the 3-point region containing the median (e.g., 7-9) are classified as “in disagreement.”

■ The last column shows your individual rating (i.e., 6; 4).■ When reviewing the results, the key items to look at are the ‘Priority Level’ and the ‘Agreement Status’. It may also be 

useful to look at the range of scores to see how spread out the rating was and whether your rating seems close to that of the rest of the group. 
Part II | Report on the Development of the APS Research Agenda II-15

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status

a. Does APS save state 

governments money? If so

Example

, 

how and how much?

1 2 3 4 5 6 7 8 9 os

1 4 3 1 7.6 7 7 1.2 High Agreement

b. What are APS inputs/resources 

and how are they used for APS implementation/ operations?

1 2 3 4 5 6 7 8 9

1 1 2 1 1 3 6.4 6 9 2.4 Medium Disagreement

Overall ResultsTEP members rated a total of 153 research topics/questions. During this third and last round of rating, 74 topics were rated being high priority, 77 were rated being medium priority, and 2 were rated being low priority. Of the 74 research topics/questions that were rated being of high priority, the TEP was in agreement on 61 of them (82.4%). Of those that were rated as having medium priority (n=77), the TEP was in agreement on 12 of them (15.6%). Finally, for the two topics/questions that were rated as having a low priority, the TEP was in agreement on both of them.Overall, the TEP members rated 49% of topics with agreement and 51% of topics with disagreement. This is an almost 17% increase in agreement from rating round 1 and a 9% increase in agreement from rating round 2.

Agreement Status

Priority level Agreement Disagreement Total

High 61 13 74

Medium 12 65 77

Low 2 0 2

Total 75 (49%) 78 (51%) 153
II-16 Part II | Report on the Development of the APS Research Agenda Individual Rating Results Foundational Topics 1. Contact with APS and Other First Responder Systems Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What percentage of adult maltreatment victims ever interact with APS? 1 2 3 4 5 6 7 8 9 os 1 1 2 2 2 1 5.9 6 6,7,9 2.8 Medium Disagreement b. What percentage of adult maltreatment victims interact with APS prior to interaction with any other responders? 1 2 3 4 5 6 7 8 9 1 2 2 3 1 5 5 6 1.5 Medium Agreement

c. What is the percentage of 

victims who are screened in and receive services from multiple response systems (e.g., law enforcement, domestic violence)?

1 2 3 4 5 6 7 8 9 os

2 1 2 1 2 1 4.4 5 3,5,7 2.2 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-17

2. Placement in State

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. In what way and to 

what degree does APS placement in state government (e.g., aging agency, other agency) impact its performance (e.g., sufficiency of funding, sufficient qualified APS staff to do APS work, the number and types of clients, client outcomes)?

1 2 3 4 5 6 7 8 91 1 2 4 1

6.1 7 7 2.2 Medium Disagreement
II-18 Part II | Report on the Development of the APS Research Agenda 3. Cost-Benefit and Cost Efficiency of APS System Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. Does APS save state governments money? If so, how and how much? 1 2 3 4 5 6 7 8 9 2 4 1 2 7.3 7 7 1.1 High Agreement b. Does APS save the federal government money? If so, how and how much? 1 2 3 4 5 6 7 8 9 2 1 3 1 2 7 7 7 1.5 High Disagreement c. What is the relationship between programs costs and savings? For example, if APS budgets are funded through social service budget lines but 

the savings accrue to criminal justice or health care budget lines, do social service programs see any benefit from those savings? What incentives are there for cost savings if the savings do not accrue to the program itself?

1 2 3 4 5 6 7 8 9

2 2 2 2 1 5.7 6 3,5,6,7 1.9 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-19

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

d. What are the 

characteristics (e.g. structure, placement, populations served, staffing configurations, service types/approaches) of the most cost-effective APS programs?

1 2 3 4 5 6 7 8 9

1 4 1 1 2 6.4 6 6 2.4 Medium Disagreement

e. What are reasons for 

Child Protective Services receiving many more resources than APS, are there approaches that could be replicated for APS?

1 2 3 4 5 6 7 8 9 os

3 1 2 1 1 1

2.2 2 1 1.6 Low Agreement
II-20 Part II | Report on the Development of the APS Research Agenda 4. APS Process Evaluation Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What are current APS practices, from the time cases are reported to APS to the time they are closed? 1 2 3 4 5 6 7 8 9 1 1 4 2 1 6.6 7 7 2.4 High Agreement b. What are APS inputs/ resources and how are they used for APS implementation/ operations? 1 2 3 4 5 6 7 8 9 1 2 4 1 1 5.6 6 6 1.9 Medium Disagreement 5. Screening and Assessment Tools

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What is the validity 

and effectiveness of existing screening and assessment tools and tools that are used by APS to measure intervention outcomes?

1 2 3 4 5 6 7 8 9

3 2 4

8.1 8 9 0.9 High Agreement
Part II | Report on the Development of the APS Research Agenda II-21

Domain 1: Program Administration1C. Definitions of Maltreatment

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. How does APS define 

self-neglect?

1 2 3 4 5 6 7 8 9 os

1 3 4 1 7.1 8 9 3.1 High Agreement

1D. Population Served

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What strategies ensure 

that APS programs are appropriate for all people (age, language, culture, preferences, potential historical trauma, literacy levels, etc.)?

1 2 3 4 5 6 7 8 9

1 1 3 4

6.1 6 7 1.1 Medium Disagreement
II-22 Part II | Report on the Development of the APS Research Agenda 1E. Mandatory Reporting Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. How effective is mandated reporting in increasing rates of reporting and substantiation rates in general, by specific professions?

1 2

3

4

5

6

7

8

9

3

2

3 1

6.2

6 5,7 1.1 Medium Disagreement

b. Is mandatory reporting 

differentially effective for different reporter groups or different client populations/subpopulations?

1 2

3

4

5

6

7

8

9

3 1 5

6.2

7

7 1.0 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-23

1F. Coordination with Other EntitiesImpact/Outcomes

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. How are outcomes 

different in localities that have mandated vs. “permissive” multidisciplinary teams (MDTs)?

1 2 3 4 5 6 7 8 9

2 1 4 2

6.2 7 7 1.9 Medium Disagreement

b. What is the impact 

of collaboration between APS and other professions (for example, law enforcement, emergency department staff)?

1 2 3 4 5 6 7 8 9

2 3 4 7.2 7 8 0.8 High Agreement

c. What is the impact of 

follow-up of APS with other entities (i.e., Emergency Departments and Primary Care Physicians)?

1 2 3 4 5 6 7 8 9

4 3 2

6.8 7 6 0.8 High Disagreement
II-24 Part II | Report on the Development of the APS Research Agenda Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating d. How do rates of criminal prosecution differ for states and counties that have adopted statutes that provide explicit criminal penalties for elder abuse vs. those where perpetrators are prosecuted under a given jurisdiction’s general criminal code (e.g., assault, battery, fraud, theft, rape)? 1 2 3 4 5 6 7 8 9 os 1 2 1 3 1 1 5.3 6 7 2.5 Medium Disagreement e. How does the use of MDTs effect the safety 

and well-being outcomes of clients?

1 2 3 4 5 6 7 8 9

1 2 5 1 7.6 8 8 1.1 High Agreement
Part II | Report on the Development of the APS Research Agenda II-25

Best Practices

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

f. What are best practices 

and effective models for collaboration between APS and criminal justice and law enforcement?

1 2 3 4 5 6 7 8 9

5 3 1 7.6 7 7 0.7 High Agreement

g. What are best practices 

and tools for MDTs?

1 2 3 4 5 6 7 8 9

2 1 6 7.2 8 8 1.3 High Agreement

h. What is the most effective 

make up of an MDT? 

1 2 3 4 5 6 7 8 9

2 1 3 3

6.8 7 7,8 1.2 High Disagreement

1G. Program Authority, Cooperation, Confidentiality and Immunity

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. In what ways and 

to what degree are there differences in effectiveness between APS programs that conduct investigations and provide social services vs. APS programs that separate those functions?

1 2 3 4 5 6 7 8 9

1 2 3 3 6.9 7 7,8 1.1 High Disagreement
II-26 Part II | Report on the Development of the APS Research Agenda 1H. Staffing Resources Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What is the impact of caseload size on the quality of investigations and interventions? 1 2 3 4 5 6 7 8 9 1 2 6 8.6 9 9 0.7 High Agreement b. What is the impact of caseload size on case worker performance, retention, satisfaction? 1 2 3 4 5 6 7 8 9 1 3 5 8.3 9 9 1 High Agreement c. What is the relationship between funding for the APS program and caseload sizes? 1 2 3 4 5 6 7 8 9 1 1 2 2 1 2 6.2 7 6,7,9 2.7 Medium Disagreement d. What is a recommended 

caseload size for APS caseworkers and APS supervisors?

1 2 3 4 5 6 7 8 9

1 1 2 2 2 1 6.7 7 6,7,8 1.6 High Disagreement
Part II | Report on the Development of the APS Research Agenda II-27

1I. Access to Expert Resources

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What is the impact 

of access to financial experts on rates and outcomes of successful intervention in financial exploitation cases?

1 2 3 4 5 6 7 8 9

1 3 5 7.4 8 8 0.7 High Agreement

1K. Worker Safety and Well-BeingIncidence/Prevalence/Descriptives

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What is the incidence and 

prevalence of hazards (threats and assaults) for APS workers?

1 2 3 4 5 6 7 8 9

1 2 4 2 7.8 8 8 1.0 High Agreement

b. What is the incidence 

of burnout, compassion fatigue, and secondary traumatic stress among APS workers?

1 2 3 4 5 6 7 8 9

1 4 3 1 7.4 7 7 0.9 High Agreement
II-28 Part II | Report on the Development of the APS Research Agenda Impact/Outcomes Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating c. What is the association, if any, between APS work stress and attitudes about working for APS? 1 2 3 4 5 6 7 8 9 3 2 2 1 1 5.2 5 3 2.0 Medium Disagreement d. What is the impact of negative bias (e.g., from the community and/or the client) toward APS workers on the ability of APS workers to do their job? 1 2 3 4 5 6 7 8 9 5 1 1 1 1 4.2 3 3 1.8 Medium Disagreement Best PracticesTopic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

e. What are effective 

quantitative approaches to examine the combination of work stressors, compassion fatigue, or secondary traumatic stress experienced by APS workers?

1 2 3 4 5 6 7 8 9

1 3 2 2 1 5.9 6 5 1.3 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-29

f. What are best practices 

for APS managers and administrators to address APS worker safety and well-being?

1 2 3 4 5 6 7 8 9

1 2 5 1

6.8 7 7 1.1 High Disagreement

1L. Responding During Community Emergencies

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. How do community 

emergencies effect later rates of APS reporting?

1 2 3 4 5 6 7 8 91 5 1 1 1 3.6 3 3 1.7 Medium Disagreement

b. How do community 

emergencies effect APS case progress?

1 2 3 4 5 6 7 8 91 5 1 2 3.3 3 3 1.2 Medium Disagreement
II-30 Part II | Report on the Development of the APS Research Agenda Domain 2: Time Frames 2A. Responding to the Report/Initiating the Investigation Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What is the impact of different time frames for initiating investigations on case outcomes? 1 2 3 4 5 6 7 8 9 1 6 2 7 7 7 0.9 High Agreement 2B. Completing the Investigation Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What is the impact of different time frames for completing investigations 

on case outcomes?

1 2 3 4 5 6 7 8 9

1 6 2 7.1 7 7 0.6 High Agreement

2C. Closing the Case

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What is the impact of 

different time frames for closing cases on case outcomes?

1 2 3 4 5 6 7 8 9

1 1 1 4 1 1 6.4 7 7 2 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-31

Domain 3: Receiving Reports of Maltreatment3A. IntakeImpact/Outcomes

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What is the association 

between the quality of the intake and the number of screened in reports?

1 2 3 4 5 6 7 8 9

1 3 4 1 6.7 7 7 1.1 High Disagreement

b. What is the impact of 

explicit permission for APS workers to notify the reporter of case outcomes (e.g., does this practice increase reporting)?

1 2 3 4 5 6 7 8 9

1 2 1 2 2 1 4.9 5 3,5,7 2.1 Medium Disagreement
II-32 Part II | Report on the Development of the APS Research Agenda Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating c. What is the impact of different reporting standards on maltreatment discovery (i.e., some states allow reporting of suspicions of abuse, but others require the reporter to know that abuse is actually occurring)?

1 2

3

4

5

6

7

8

9

6

3 5.3

5

5 0.5 Medium Agreement

d. What is the impact of 

standardized and nonstandardized intake screening tools?

1 2

3

4

5

6

7

8

9

2

3

4

7

7

8 1.2 High Agreement
Part II | Report on the Development of the APS Research Agenda II-33

Best Practices

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

e. What practices lead 

to an intake report with clear, specific information related to the maltreatment and the alleged victim and his/her circumstances (e.g., phone vs internet/email, structured interview vs free form, training provided to intake staff)? 

1 2

3

4

5

6

7

8

9

2

2

4 1 7.4

8

8 1 High Agreement

f. What are best practices 

for taking/conducting an intake reports (i.e., who should take/conduct an intake report, level of competency of worker needed, time to create report, types of information to collect in order to make a screening decision/determine if investigation is needed)?

1 2

3

4

5

6

7

8

9

5

3 1 7.6

7

7 0.7 High Agreement
II-34 Part II | Report on the Development of the APS Research Agenda 3B. Screening, Prioritizing, and Assignment of Screened-In Report Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What percent of screened out cases return to APS? 1 2 3 4 5 6 7 8 9 1 1 6 1 6.2 7 7 2.3 Medium Agreement b. What are the most important questions needed to screen in/out cases? 1 2 3 4 5 6 7 8 9 1 3 2 3 7.8 8 7,9 1.1 High Agreement c. What are best practices for identifying cases that require an investigation? 1 2 3 4 5 6 7 8 9 4 3 2 7.8 8 7 0.8 High Agreement d. What are best practices for effectively prioritizing cases? 1 2 3 4 5 6 7 8 9 4 3 2 7.8 8 7 0.8 High Agreement
Part II | Report on the Development of the APS Research Agenda II-35

Domain 4: Conducting the Investigation4A. Determining If Maltreatment Has OccurredIncidence/Prevalence/Descriptives

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What types of contacts 

(e.g., telephone calls, home visits, other) are made with and on behalf of the APS client (e.g., what happens during those contacts)?

1 2 3 4 5 6 7 8 9

1 1 4 2 1 5.9 6 6 2.1 Medium Disagreement

Impact/Outcomes

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

b. What is the impact of 

conducting criminal background checks/obtaining police reports from alleged perpetrators before an APS worker meets with the alleged victim?

1 2 3 4 5 6 7 8 9

1 4 3 1 4.9 4 4 1.4 Medium Agreement
II-36 Part II | Report on the Development of the APS Research Agenda Best PracticesTopic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating c. What are effective decision-making strategies to determine case findings? 1 2 3 4 5 6 7 8 9 4 3 2 7.8 8 7 0.8 High Agreement d. What are effective strategies for engaging clients who were referred to APS by a community agency without the client’s knowledge (in contrast to self or family referrals)? 1 2 3 4 5 6 7 8 9 3 3 1 2 7.2 7 6,7 1.2 High Disagreement e. What are best practices for conducting 

investigations in cases of domestic violence involving older adults (i.e., practices that do not increase the risk for the alleged victim)?

1 2 3 4 5 6 7 8 9

3 6 7.7 8 8 0.5 High Agreement
Part II | Report on the Development of the APS Research Agenda II-37

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

f. What are best practices/

procedures (e.g., structured decisionmaking) for recognizing and differentiating abuse and neglect subtypes in the APS client population?

1 2 3 4 5 6 7 8 9

1 3 5 6.9 8 8 2.3 High Agreement

4B. Conducting an APS Client AssessmentIncidence/Prevalence/Descriptives

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What valid and reliable 

screening methods and tools are used by APS? 

1 2 3 4 5 6 7 8 9

1 2 3 3 7.3 8 8,9 2.5 High Agreement

b. Who has developed 

these methods and tools?

1 2 3 4 5 6 7 8 9

1 5 2 1 4.3 3 3 2.6 Medium Disagreement

c. What are the 

characteristics of the APS populations for whom certain methods and tools are used most?

1 2 3 4 5 6 7 8 9

1 2 4 2

6.1 7 7 2.2 Medium Disagreement
II-38 Part II | Report on the Development of the APS Research Agenda Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating d. What tools exist to measure intervention outcomes (e.g., change in client or case status in response to the intervention)? 1 2 3 4 5 6 7 8 9 1 2 5 1 7.1 8 8 2.4 High Agreement Impact/Outcomes Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating e. What is the impact of APS using standardized vs. non-standardized assessment tools? 1 2 3 4 5 6 7 8 9 1 3 3 2 7.7 8 7,8 1 High Agreement f. What are barriers and 

potential harms of screening adults for maltreatment?

1 2 3 4 5 6 7 8 9

1 2 5 1 7.7 8 8 0.9 High Agreement

g. What are effective 

processes for investigating allegations and making decisions regarding substantiation? 

1 2 3 4 5 6 7 8 9

3 3 3

8 8 7,8,9 0.9f High Agreement
Part II | Report on the Development of the APS Research Agenda II-39

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

h. What are best practices 

for identifying clients with service needs?

1 2 3 4 5 6 7 8 9

1 4 3 1 7.4 7 7 0.9 High Agreement

4C. Investigations in Residential Care Facilities

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What percentage of 

investigations are conducted in residential care facilities? 

1 2 3 4 5 6 7 8 9

2 1 1 2 1 1 1 3.8 4 1,4 2.3 Medium Disagreement

b. How are investigations 

related to clients in residential care facilities the same as or different from those with clients in the community?

1 2 3 4 5 6 7 8 9

1 4 2 1 1 5.7 5 5 1.2 Medium Agreement

c. Are cases with clients in 

residential care facilities more or less effective than cases with clients in the community?

1 2 3 4 5 6 7 8 9

1 1 5 1 1 4.9 5 5 1.8 Medium Agreement
II-40 Part II | Report on the Development of the APS Research Agenda 4D. Completion of Investigation and Finding Incidence/Prevalence/Descriptives Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What percentage of APS investigations lead to criminal prosecution and what is result of the prosecutions? 1 2 3 4 5 6 7 8 9 os 2 4 1 2 5.1 7 7 3.1 Medium Disagreement Impact/Outcomes Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating b. What is the impact of specialized APS units (e.g., financial exploitation, selfneglect) on investigation 

outcomes?

1 2 3 4 5 6 7 8 9

3 6 7.7 8 8 0.5 High Agreement

c. What is the impact of law 

enforcement practices on APS case outcomes (i.e., differences between jurisdictions where county attorney/

1 2 3 4 5 6 7 8 9 os

1 3 2 1 1 1 5.1 5 5 2.3 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-41

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

law enforcement reviews every case vs. jurisdictions where only “likely crimes” are submitted to law enforcement)?

d. What is the impact, if 

any, of different criminal penalties for perpetrators (e.g., jail, probation, restorative models) on outcomes for APS victims? 

1 2 3 4 5 6 7 8 9 os

1 1 4 2 1 5.4 6 6 2.4 Medium Disagreement

Best Practices

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

e. What are effective 

processes for making a finding based on the evidence?

1 2 3 4 5 6 7 8 9

1 3 2 3 7.8 8 7,9 1.1 High Agreement
II-42 Part II | Report on the Development of the APS Research Agenda Domain 5: Service Planning and Service Implementation 5A. Voluntary Service Implementation Incidence/Prevalence/Descriptives Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What do APS clients report as their goals/ needs with regard to APS services? 1 2 3 4 5 6 7 8 9 1 1 3 3 1 6.6 7 7,8 2.5 High Agreement b. How do APS client goals/needs differ by APS population (older adults/adults with disabilities, by ethnicity, by maltreatment type, etc.)? 1 2 3 4 5 6 7 8 9 2 3 4 7 7 8 1.2 High Agreement

c. What are clients’ service 

needs and service level needs by type of maltreatment and clientperpetrator relationship? 

1 2 3 4 5 6 7 8 9

3 2 4

6.8 7 8 1.4 High Disagreement

d. What are current APS 

practices/processes for service delivery?

1 2 3 4 5 6 7 8 9

1 1 2 2 3

6.1 7 8 2.3 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-43

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

e. What are the types and 

number of services directly provided by APS (driving a client to the doctor) vs. the types and number of services that APS refers clients to (calling and setting up transportation services)?

1 2 3 4 5 6 7 8 9

1 2 4 1 1 5.8 7 7 2.7 Medium Disagreement

f. What are client service 

needs and gaps?

1 2 3 4 5 6 7 8 9

1 3 1 4 6.4 7 8 2.2 Medium Disagreement

g. What are the differences 

between states in terms of service availability and gaps?

1 2 3 4 5 6 7 8 9

1 1 2 3 2 5.1 6 6 2 Medium Disagreement

h. What is the role and 

benefit of nurses employed by APS (also other professionals)?

1 2 3 4 5 6 7 8 9

1 3 2 3 5.8 6 5,7 1.1 Medium Disagreement
II-44 Part II | Report on the Development of the APS Research Agenda Impact/Outcomes Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating i. What is the impact of direct APS services vs. indirect services (referral only) on client outcomes?

1 2

3

4

5

6

7

8

9

2

2

3

2

6.6

7

7 1.1 High Disagreement

j. What is the impact of 

services on outcomes of older adults vs. adults with disabilities?

1 2

3

4

5

6

7

8

9

2

2

5 6.3

7

7 0.9 Medium Disagreement

k. What factors are 

associated with service refusal and strategies for enhancing acceptance of service supports?

1 2

3

4

5

6

7

8

9

1 6

2 7.3

7

7 1 High Agreement

l. To what extent are 

APS clients affected by ‘resource deserts’ (e.g., areas with limited resources)? 

1 2

3

4

5

6

7

8

9

1 3

2 1 2

5

5

4 1.4 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-45

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

m. What is the effectiveness 

of specialized/focused interventions (e.g., relationship-based intervention, longer-term interventions, client navigators, peer support services), including impact on different populations/types of clients? 

1 2 3 4 5 6 7 8 9

3 5 1 7.8 8 8 0.7 High Agreement

n. What is the impact of 

using standardized tools on APS service delivery and client outcomes?

1 2 3 4 5 6 7 8 9

1 3 2 3 7.7 8 7,9 1.3 High Agreement

Best Practices

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

o. What types/kinds 

of referral services (e.g., legal services, transportation services) are effective for each maltreatment type?

1 2 3 4 5 6 7 8 9

1 1 5 1 1 6.7 7 7 1.7 High Agreement
II-46 Part II | Report on the Development of the APS Research Agenda Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating p. What is the optimal level of services needed based on type of population (are there populations that would benefit most from expanded services)? 1 2 3 4 5 6 7 8 9 1 6 2 6 6 6 0.9 Medium Agreement q. What are strategies for effective collaboration between clients and APS workers? 1 2 3 4 5 6 7 8 9 5 3 1 7.6 7 7 0.7 High Agreement r. What are effective strategies for maintaining client safety (i.e., future reports to APS)? 1 2 3 4 5 6 7 8 9 1 4 3 1 7.4 7 7 0.9 High Agreement s. What are best practices 

to address hoarding?

1 2 3 4 5 6 7 8 9

1 1 3 4 5.8 6 7 1.9 Medium Disagreement

t. What are best practices 

to recognize changes in capacity of clients with hoarding issues?

1 2 3 4 5 6 7 8 9 os

1 1 1 3 2 1 4.7 6 6 2.5 Medium Disagreement

u. What are best practices 

to address the needs of clients with mental health issues?

1 2 3 4 5 6 7 8 9

1 5 3 7.2 7 7 0.7 High Agreement
Part II | Report on the Development of the APS Research Agenda II-47

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

v. What are best practices 

to address the needs of clients from minority populations (e.g., race/ethnicity, gender, sexual orientation, language, etc.?

1 2 3 4 5 6 7 8 9

1 1 3 2 2 7.3 7 7 1.3 High Agreement

w. What are best practices 

for effective service planning (i.e., time needed to create and implement effective service plan; services planning for clients with capacity vs those with limited/lacking capacity; service planning for older adults vs. adult with disabilities; degree of client involvement)?

1 2 3 4 5 6 7 8 9

1 4 2 2 7.6 7 7 1 High Agreement
II-48 Part II | Report on the Development of the APS Research Agenda 5B. Involuntary Service Implementation Incidence/Prevalence/Descriptives Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What is the role of APS in assessing and identifying decline in cognitive capacity? 1 2 3 4 5 6 7 8 9 os 4 1 2 1 1 5.7 5 5 2.6 Medium Disagreement b. What are the type and number of restrictive interventions initiated by APS? 1 2 3 4 5 6 7 8 9 1 3 2 1 2 6.2 7 5 2.5 Medium Disagreement c. What are the characteristics of programs and locations with access to 

professionals who are qualified to conduct full capacity assessments; identification of needs for an APS agency/program to access professional capacity assessments? 

1 2 3 4 5 6 7 8 9

1 3 3 2 5.7 6 5,6 1 Medium Agreement
Part II | Report on the Development of the APS Research Agenda II-49

Impact/Outcomes

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

d. What is the impact of 

MDTs on APS access to professional-level capacity assessments?

1 2 3 4 5 6 7 8 9

1 1 1 5 1

6 7 7 2.2 Medium Disagreement

e. What is the association 

between APS worker competency in screening for decisional ability and number of professionallevel capacity assessments?

1 2 3 4 5 6 7 8 9

1 1 4 2 1 5.3 5 5 2.2 Medium Disagreement

f. What is the impact of 

supported decisionmaking/limited guardianship on client outcomes? 

1 2 3 4 5 6 7 8 9

1 1 4 2 1 7.1 7 7 1.2 High Agreement

g. What is the impact of 

involuntary interventions (e.g., facility placement) on clients, and what is the impact of alternative strategies?

1 2 3 4 5 6 7 8 9

6 2 1 7.4 7 7 0.7 High Agreement
II-50 Part II | Report on the Development of the APS Research Agenda Best PracticesTopic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating h. What are effective alternatives to guardianship? 1 2 3 4 5 6 7 8 9 5 3 1 7.6 7 7 0.7 High Agreement 5C. Closing the Case Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What are relevant and meaningful outcomes at case closure, and the means to quantify those outcomes, that will provide meaningful information about the 

effectiveness of services in the lives of clients? 

1 2 3 4 5 6 7 8 9

3 3 3

8 8 7,8,9 0.9 High Agreement
Part II | Report on the Development of the APS Research Agenda II-51

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

b. What is the impact of 

different standards for case substantiations (e.g., preponderance, credible cause) on case closure results (e.g., number of confirmed cases, client outcomes)?

1 2 3 4 5 6 7 8 9

1 2 3 1 2 6.4 7 7 2.5 High Disagreement

Domain 6: Training

6A. Case Worker and Supervisor Minimum Educational Requirements

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What is the impact of 

educational background (e.g., type of degree, area of study) on APS program staff turnover?

1 2 3 4 5 6 7 8 9 os

6 1 1 1 3.9 4 4 1.6 Medium Agreement

b. What are the 

characteristics of high performing case workers?

1 2 3 4 5 6 7 8 9

4 2 1 2

6.1 6 5 1.3 Medium Disagreement
II-52 Part II | Report on the Development of the APS Research Agenda Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating c. What is the impact of educational background of APS workers on client outcomes? 1 2 3 4 5 6 7 8 9 1 4 4 5.3 5 5,6 0.7 Medium Agreement 6B. Case Worker Initial and Ongoing Training Incidence/Prevalence/Descriptives Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What are the training needs for newly hired military veteran case workers (vs. civilian case workers)? 1 2 3 4 5 6 7 8 9 2 2 3 1 1 2.7 3 3 1.3 Low Agreement

b. How is training quality 

assessed?

1 2 3 4 5 6 7 8 9

1 1 3 2 1 1 4.9 4 4 2.3 Medium Disagreement

Impact/Outcomes

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

c. What is the impact of 

training on the quality of case work?

1 2 3 4 5 6 7 8 9

2 1 3 1 2 7 7 7 1.5 High Disagreement
Part II | Report on the Development of the APS Research Agenda II-53

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

d. What is the impact 

of different training modalities? 

1 2 3 4 5 6 7 8 9

1 1 3 1 1 1 1 5.8 5 5 1.9 Medium Disagreement

e. What is the impact of 

mentorship programs within APS?

1 2 3 4 5 6 7 8 9

1 2 3 1 1 1

6.2 6 6 1.6 Medium Disagreement

f. What is the impact of 

increased training in using capacity screening tools on client outcomes?

1 2 3 4 5 6 7 8 9

1 3 3 1 1

6.2 7 5,7 1.9 Medium Disagreement

Best Practices

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

g. What is the optimal 

timing/schedule and number each year for ongoing and additional/specialized training for APS workers (and supervisors)?

1 2 3 4 5 6 7 8 9

1 2 3 1 1 1 5.4 5 5 1.9 Medium Disagreement
II-54 Part II | Report on the Development of the APS Research Agenda Domain 7: APS Program Performance 7A. Managing Program Data Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What are effective strategies for using data to improve program performance and practices for APS case workers? 1 2 3 4 5 6 7 8 9 1 4 2 2 7.6 7 7 1 High Agreement b. To what data do program have routine access? 1 2 3 4 5 6 7 8 9 1 3 3 2 5.8 6 5,6 2.4 Medium Disagreement c. What are data quality issues that affect data usage? 1 2 3 4 5 6 7 8 9 os 1 2 1 2 2 1 5.8 6 5,7,9 2.8 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-55

7B. Evaluating Program PerformanceIncidence/Prevalence/Descriptives

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What are longitudinal 

client outcomes (e.g., from case initiation to 1 year+ after case closure) and what are effective strategies for measuring longitudinal client outcomes?

1 2 3 4 5 6 7 8 9

1 6 2 8 8 8 0.9 High Agreement

Impact/Outcomes

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

b. What is the correlation 

between client outcomes and case worker outcomes?

1 2 3 4 5 6 7 8 9 os

2 1 3 1 2 3.6 5 6 3 Medium Disagreement

c. How satisfied are clients 

with their experience working with APS? 

1 2 3 4 5 6 7 8 9

2 1 5 1 5.3 6 6 1.7 Medium Disagreement
II-56 Part II | Report on the Development of the APS Research Agenda Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating d. How are immediate and long-term client safety and wellbeing outcomes measured? 1 2 3 4 5 6 7 8 9 1 5 1 2 7.4 7 7 1 High Agreement e. What is the relationship between client satisfaction and client safety and wellbeing outcomes? 1 2 3 4 5 6 7 8 9 1 1 1 2 3 1 5.9 6 7 1.6 Medium Disagreement f. How do program performance outcomes differ by level of funding? 1 2 3 4 5 6 7 8 9 1 1 4 1 1 1 6.3 6 6 1.5 Medium Disagreement Best PracticesTopic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

g. How should APS 

determine/define positive outcomes (do they look different for older adults vs. younger adults with disabilities)?

1 2 3 4 5 6 7 8 9

1 1 3 1 3 7.4 7 7,9 1.4 High Agreement
Part II | Report on the Development of the APS Research Agenda II-57

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

h. What are recommended 

processes and strategies for quality assurance (QA) for APS programs? 

1 2 3 4 5 6 7 8 9

1 1 5 1 1 7 7 7 1.1 High Agreement

i. What data elements are 

used for effective QA?

1 2 3 4 5 6 7 8 9

2 6 1 7 7 7 0.9 High Agreement

j. What tools are used for 

effective QA?

1 2 3 4 5 6 7 8 9

1 3 4 1

6.2 7 7 2.2 Medium Disagreement

k. What are best practices 

for assessing client satisfaction (when should it be assessed and how)?

1 2 3 4 5 6 7 8 9

1 1 2 3 1 1 5.6 6 6 1.5 Medium Disagreement

l. What are best practices 

for measuring client safety and wellbeing outcomes?

1 2 3 4 5 6 7 8 9

5 2 2 7.7 7 7 0.9 High Agreement
II-58 Part II | Report on the Development of the APS Research Agenda Other Topics Perpetrators Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. What is the impact of perpetrator investigations and services for clients with family member perpetrators on client safety? 1 2 3 4 5 6 7 8 9 1 2 6 7.4 8 8 1 High Agreement b. What is the impact of interventions for perpetrators on client outcomes? 1 2 3 4 5 6 7 8 9 2 5 2 8 8 8 0.7 High Agreement c. What is the impact of 

perpetrator registries (where perpetrator is a family member) on APS clients and vulnerable adults?

1 2 3 4 5 6 7 8 9

1 3 1 2 2

6.1 6 5 1.4 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-59

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

d. What is the impact of 

perpetrator registries (where perpetrator is a non-family member) on APS clients and vulnerable adults?

1 2 3 4 5 6 7 8 9 os

2 3 1 2 1 5.7 6 6 2.4 Medium Disagreement

Culture

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. In what way and to what 

degree does a victim’s culture (e.g., sexual orientation, country of origin, disability status) affect their perception of APS?

1 2 3 4 5 6 7 8 9

1 2 1 3 1 1 5.4 6 6 1.6 Medium Disagreement
II-60 Part II | Report on the Development of the APS Research Agenda Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating b. What are different socio-cultural conceptualizations of abuse; to what extent do they create barriers for reporting maltreatment, help-seeking behaviors, and service utilization? 1 2 3 4 5 6 7 8 9 1 1 5 2 6.9 7 7 0.9 High Agreement c. What is the impact of tribal vs. nontribal APS on services and outcomes for American Indian, Alaska Native, Native Hawaiian, and Other Pacific Islander clients? 1 2 3 4 5 6 7 8 9 1 3 2 3 5.4 6 5,7 1.9 Medium Disagreement

Causes/Tools of Maltreatment

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What is the percentage of 

clients experiencing selfneglect as result of being a victim of a crime?

1 2 3 4 5 6 7 8 9

1 6 1 1 6 6 6 1.3 Medium Disagreement
Part II | Report on the Development of the APS Research Agenda II-61

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

b. How are pets used as 

tools for perpetuating abuse and to engender trust?

1 2 3 4 5 6 7 8 9

1 2 5 1 4.4 5 5 1.4 Medium Agreement

Homeless Populations and APS

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. Is there a role for 

APS in addressing homelessness; if so, what is that role?

1 2 3 4 5 6 7 8 9 os

4 2 2 1 3.8 3 3 2.2 Medium Disagreement
II-62 Part II | Report on the Development of the APS Research Agenda Guidelines Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating a. How are ACL’s APS Guidelines being implemented, and what similarities and differences are there in implementation between states (National Core Indicators data type information)? 1 2 3 4 5 6 7 8 9 1 1 3 1 1 2 6.3 6 6 2.4 Medium Disagreement Undue Influence Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. What are effective 

boundaries for/scope of APS to intervene in cases involving undue influence?

1 2 3 4 5 6 7 8 9

1 3 3 2 5.7 6 5,6 1 Medium Agreement
Part II | Report on the Development of the APS Research Agenda II-63

Additional Topics Suggested by TEP Members and Added to the Survey

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

a. Which CPS program 

services and interventions, shown to be effective to improve long-term health and safety of victims and the well-being of the family unit, have possible application to APS? Are they being used and how could they be applied? 

1 2 3 4 5 6 7 8 9 os1 2 3 2 1 3.8 5 5 2.2 Medium Disagreement

b. Presuming sufficient 

evidence on effectiveness of APS interventions, what is the cost-effectiveness of different types of APS interventions and alternative interventions?

1 2 3 4 5 6 7 8 91 3 3 1 1 6.3 7 6,7 2.3 Medium Disagreement

c. What are best practices 

for the use of technology for case management?

1 2 3 4 5 6 7 8 91 1 2 3 2

6 7 7 2.2 Medium Disagreement
II-64 Part II | Report on the Development of the APS Research Agenda Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating d. What are best practices for the use of technology to support worker health?

1 2

3

4

5

6

7

8

9 os

2

2

2

2 1 5.3

6 3,6,7,8 2.7 Medium Disagreement

e. How do profiles differ for 

cases that are reported to APS vs. cases that are not reported?

1 2

3

4

5

6

7

8

9 os

1 3

2 1 1 1 6

6

6 2.5 Medium Disagreement

f. How do limits to APS 

authority (ability to acquire evidence, compel interviews, request a mental health hold, etc.) impact client outcomes?

1 2

3

4

5

6

7

8

9

1 3

3

2 7.7

8 7,8 1 High Agreement

g. What are best practices 

working with client who experienced severe vs. less severe maltreatment?

1 2

3

4

5

6

7

8

9

2

7

6.8

7

7 0.4 High Agreement

h. What is a successful APS 

outcome? Who decides and why? 

1 2

3

4

5

6

7

8

9

1 3

5 7.4

9

9 2.6 High Agreement
Part II | Report on the Development of the APS Research Agenda II-65

Topic Ratings Mean Median Mode STDV Priority Level Agreement Status Your Rating

i. Does the determination 

of a successful outcome vary by elder maltreatment form or other factors, and if so how?

1 2 3 4 5 6 7 8 9

2 3 3 1 7.1 7 7,8 1.4 High Agreement

j. What is the association of 

APS with client mortality?

1 2 3 4 5 6 7 8 9

1 2 3 3

6.8 7 7,8 1.3 High Disagreement