National Voluntary Consensus

Guidelines for State Adult 

Protective Services Systems

Updated | March 2020

Contents

Preface	 	 2

Abbreviations and Acronyms	 2

Rationale	 3

Background	 4

Development and Updates of the Guidelines and Content	 6

1.	 PROGRAM ADMINISTRATION	 9

1A.	 Ethical Foundation of APS Practice	 10

1B.	 Protecting Program Integrity	 11

1C. 	 Definitions of Maltreatment	 13

1D. 	 Population Served	 13

1E. 	 Mandatory Reporters	 14

1F. 	 Coordination with Other Entities	 15

1G. 	 Program Authority, Cooperation, Confidentiality, and Immunity	 17

1H. 	 Staffing Resources	 18

1I. 	 Access to Expert Resources	 20

1J. 	 Case Review—Supervisory Process	 21

1K. 	 Worker Safety and Well-being	 22

1L. 	 Responding During Community Emergencies	 23

1M. 	 Community Outreach and Engagement	 24

1N. 	 Participation in Research	 25

2.	 TIME FRAMES	 27

2A. 	 Responding to the Report/Initiating the Investigation	 28

2B. 	 Completing the Investigation	 29

2C. 	 Closing the Case	 30

3.	 RECEIVING REPORTS OF MALTREATMENT	 33

3A. 	 Intake	 34

3B. 	 Screening, Prioritizing, and Assignment of Screened-in Reports	 35

4.	 CONDUCTING THE INVESTIGATION	 37

4A. 	 Determining if Maltreatment has Occurred	 38

4B. 	 Conducting an APS Client Assessment	 40

4C. 	 Investigations in Residential Care Facilities	 42

4D. 	 Completion of Investigation and Finding	 43

5.	 SERVICE PLANNING AND SERVICE IMPLEMENTATION	 45

5A. 	 Voluntary Service Implementation	 46

5B. 	 Involuntary Service Implementation	 49

5C. 	 Closing the Case	 51

6.	 TRAINING	 53

6A. 	 Caseworker and Supervisor Minimum Educational Requirements	 54

6B. 	 Caseworker Initial and Ongoing Training	 55

6C. 	 Supervisor Initial and Ongoing Training	 59

7.	 APS PROGRAM PERFORMANCE	 61

7A. 	 Managing Program Data	 62

7B. 	 Evaluating Program Performance	 63

References	 64

Endnotes	 70
2 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

Preface

The	Administration	for	Community	Living	(ACL)	is	providing	these	2020	Voluntary	Consensus	Guidelines	

for	State	Adult	Protective	Services	Systems	(Guidelines)	to	promote	an	effective	adult	protective	services	

(APS)	response	across	the	country	so	that	all	older	adults	and	adults	with	disabilities,	regardless	of	the	

state	or	jurisdiction	in	which	they	live,	have	similar	protections	and	service	delivery	from	APS	systems.	

The	Guidelines	also	provide	a	core	set	of	principles	and	common	expectations	to	encourage	consistency	

in	the	policies	and	practices	of	APS	programs	across	the	country.	To	develop	the	Guidelines,	ACL	served	as	

facilitator	and	applied	the	Office	of	Management	and	Budget	(2016)	and	National	Institute	of	Standards	

and	Technology	(2001)	process	for	creating	field-developed,	consensus-driven	guidelines.	To	eliminate	

unnecessary	duplication	and	complexity	in	the	development	and	promulgation	of	the	Guidelines,	ACL’s	

process	remains	consistent	with	the	guidance	provided	by	the	National	Institutes	of	Standards	and	

Technology	15	CFR	Part	287	(2020).

These	Guidelines	are	informational	in	content	and	are	intended	to	assist	states	in	developing	efficient	and	

effective	APS	systems.	They	do	not	constitute	a	standard	nor	a	regulation,	and	they	do	not	create	any	new	

legal	obligations	nor	impose	any	mandates	or	requirements.	They	also	do	not	create	nor	confer	any	rights	

for,	or	on,	any	person.

Abbreviations and Acronyms

ACL		 Administration	for	Community	Living

APS		 Adult Protective Services

CAPTA	 Child Abuse Prevention and Treatment Act

CFR		 Code of Federal Regulations

CPS		 Child Protective Services

MDT	 Multidisciplinary Team

NAMRS	 National Adult Maltreatment Reporting System

NAPSA	 National Adult Protective Services Association

NASUAD	 National Association of States United for Aging and Disabilities

NASW	 National Association of Social Workers
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 3

Rationale

The Administration for Community Living (ACL)1 envisions a comprehensive, multidisciplinary system that

effectively supports older adults and adults with disabilities so they can exercise their right to live where

they choose, with the people they choose, and fully participate in their communities without threat of

abuse, neglect, self-neglect, or financial exploitation.

Adult protective services (APS) agencies are a critically important component of this comprehensive

system to address abuse, neglect, self-neglect or financial exploitation of older adults and adults with

disabilities (hereinafter referred to as “adult maltreatment”). APS is a social services program provided

by state and local governments across the nation serving older adults and adults with disabilities who

are in need of assistance because of adult maltreatment. In all states, APS is charged with receiving

and responding to reports of maltreatment and working closely with clients and a wide variety of allied

professionals to maximize clients’ safety and independence.

APS programs are not subject to federal rules and regulations. As a result, each state has designed its

own unique system. In addition, there is no single funding stream for APS, forcing states to look to multiple

sources for funding and often leaving states with inadequate resources for their APS programs. Yet data

from state APS agencies show an increasing trend in reports of maltreatment and increasing caseloads

for APS workers (AARP Public Policy Institute, 2011; Teaster et al., 2006). These challenges can present

significant obstacles to responding in an effective and timely way to reports of adult maltreatment.

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. To address this need, ACL facilitated the development of the National

Voluntary Consensus Guidelines for State APS Systems in 2016 (original Guidelines) and the update of

the Guidelines to provide the APS field with guidance about effective APS practices. The updates for these

2020 Guidelines are based on new published research and input from APS stakeholders and subject

matter experts. For a glossary of terms used throughout the Guidelines, see Appendix 1; for an annotated

bibliography of the research literature, see Appendix 2; and for feedback from stakeholders and experts

upon which the update is based, see Appendix 3.
4 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

Background

Governments have long recognized the principle of individual dignity and rights. These basic rights

are found in both national and international human rights doctrines, advocating the values of selfdetermination in decision making, equal access to resources, full participation in all aspects of society, and

the value of a dignified quality of life. Adult maltreatment violates these inherent rights.2

Data suggest that at least 10% of older adults experience maltreatment each year (Beach, Schulz, Castle, &

Rosen, 2010). However, the prevalence of elder maltreatment (also referred to as “mistreatment”) is likely

underreported. For instance, a large study conducted in New York State found that the incidence rate of

elder abuse was nearly 24 times greater than the actual number of cases referred or reported to authorities

(Lifespan of Greater Rochester, 2011). Findings from a literature review conducted by Horner-Johnson and

Drum (2006) showed increased prevalence of maltreatment among adults with disabilities, and Petersilia

(2001) found that adults with developmental disabilities are 4 to 10 times more likely to become victims

of maltreatment than persons without disabilities. Among adults with disabilities who use personal

assistance services, 30% report one or more types of mistreatment (National Center on Elder Abuse, n.d.).

Adult maltreatment, including abuse (i.e., physical, sexual, emotional), neglect, self-neglect, and financial

exploitation, is associated with significant and serious health consequences. For instance, older adults

who experience even modest forms of maltreatment have dramatically higher (300%) morbidity and

mortality rates (Lachs, Williams, O’Brien, Pillemer, & Charlson, 1998) and higher rates of emergency

department use, hospitalization, readmission, skilled nursing placement, and hospice use compared to

those who have not experienced maltreatment (Dong, 2015). For adults with a disability, maltreatment

impacts the person’s health, safety, and emotional well-being, but also greatly impacts their ability to

engage in activities of daily living (National Center on Elder Abuse, n.d.).
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 5

According to the Elder Justice Roadmap (2014), it is clear that

Adult maltreatment triggers a downward spiral for many victims, eroding their health, financial

stability, and well-being. In addition, it causes untold suffering for millions of people of all ages. That

suffering, in turn, needlessly depletes scarce resources of individuals, families, businesses, charities,

and public programs (like Medicare and Medicaid). The cumulative toll of [adult maltreatment] has

not yet been quantified but is estimated to afflict more than 5 million people and cost many billions of

dollars a year.

Considering these factors together—the threat to human dignity and safety, higher rates of chronic

conditions for victims of abuse, and higher costs of trauma associated with adult maltreatment—we are

faced with a human rights, public health, and economic imperative to prevent and intervene in these cases.

The Guidelines present a critical building block in this effort by helping to provide states with tools to

support the implementation of effective and evidence-based strategies and practices for adult protective

services (APS) programs. Specifically, it is ACL’s mission with these Guidelines to

■ provide a core set of principles and common expectations to encourage consistency;

■ help ensure that adults are afforded similar protections and service delivery regardless of locale;

■ support interdisciplinary and interagency coordination; and

■ enhance effective, efficient, and culturally competent delivery.
6 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

Development and Updates of the Guidelines and Content

Development of the Guidelines and Updates

ACL first facilitated the development of the Guidelines in 2016. As part of the development, ACL applied

the Office of Management and Budget (2016) and National Institute of Standards and Technology (2001)

process for creating field-developed, consensus-driven guidelines. To eliminate unnecessary duplication

and complexity in the development and promulgation of the Guidelines, ACL’s process remains consistent

with the guidance provided by the National Institutes of Standards and Technology 15 CFR Part 287 (2020).

The development of both the Guidelines and its updates consisted of multiple steps, including a review of

research available on what works in APS agencies and in other analogous systems throughout the United

States, and an extensive and wide-reaching stakeholder engagement and outreach process.

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

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

development of Guidelines for APS, and provide interested parties an opportunity to give input into the

process and content of the Guidelines. Throughout the process, ACL’s stakeholder engagement and

outreach endeavored to

■ respect people’s history and experience with APS and their other life experiences;

■ empower the public and stakeholders to contribute to the development of national

APS guidelines in a meaningful way;

■ understand the public’s vision for APS and for ACL’s role in APS;

■ build consensus on proposed guidelines by including representatives from materially affected

and interested parties, to the extent possible; and

■ incorporate a civil rights/personal rights perspective in developing the system guidelines.

For a detailed description of the development of the 2016 ACL APS Guidelines, see the 2016 ACL APS 

Guidelines. For a detailed report on the methods for updating the Guidelines, see Appendix 3.

Updating the Original Guidelines

ACL used a similar multistep approach to update the original Guidelines, with each step building on

the work from the previous step. These steps included: an updated literature review to identify new

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

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

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

consensus for the updates based on the proposed new research and feedback from stakeholders. For a

detailed report on the method for the updates and feedback from stakeholders and the technical expert

panel, see Appendix 3.
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 7

Content and Structure

ACL drew intentionally from published research to help the Guidelines reflect the most recent evidence

and best practices. ACL did not draw from current state laws or regulation to avoid limiting the Guidelines

to practices currently in use. References to the child welfare system or child protective services are also

included in the Guidelines to illustrate federal guidance for other analogous social services systems. These

references are not intended to serve as guidance to the APS system, but rather, they serve as justification

for providing federal-level guidance for APS programs, and they provide stakeholders with direct access

to examples from child welfare system or child protective services for topics similar to those in APS

(e.g., response times).

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

broad domains (or topics) and a number of specific elements (or subtopics) within each domain. For each

element, the Guidelines contain a background section followed by the actual guidance statements. The

background and guidance are informed by the research identified through the literature search. For an

annotated bibliography of the literature, see Appendix 2.

The following section presents a list of domains and elements within each domain.

List of Guidelines Domains and Elements3

1.	 Program Administration

2.	

1A.	 Ethical Foundation of APS Practice

1B.	 Protecting Program Integrity

1C.	 Definitions	of	Maltreatment

1D.	 Population	Served	

1E.	 Mandatory	Reporters

1F.	 Coordination With Other Entities

1G.	 Program Authority, Cooperation, Confidentiality, and Immunity

1H.	 Staffing Resources

1I.	 Access to Expert Resources

1J.	 Case Review–Supervisory Process

1K.	 Worker Safety and Well-being

1L.	 Responding During Community Emergencies

1M.	Community Outreach and Engagement

1N.	 Participating in Research

Time Frames

2A.	Responding to the Report/Initiating the Investigation

2B.	Completing the Investigation

2C.	Closing the Case

continued on page 8
8 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

3.	 Receiving Reports of Maltreatment

3A.	Intake

3B.	Screening, Triaging, and Assignment of Screened-in Reports

4.	 Conducting the Investigation

4A.	Determining If Maltreatment Has Occurred

4B.	Conducting a Psychosocial Assessment

4C.	Investigations in Residential Care Facilities

4D.	Completion of Investigation and Finding

5.	 Service Planning and Service Implementation

5A.	Voluntary Service Implementation

5B.	Involuntary Service Implementation

5C.	Closing the Case

6.	 Training

6A.	Case Worker and Supervisor Minimum Educational Requirements

6B.	Case Worker Initial and Ongoing Training

6C.	Supervisor Initial and Ongoing Training

7.	 APS Program Performance

7A.		Managing Program Data

7B. 	Evaluating Program Performance

The next section contains the updated 2020 APS Guidelines.

Guidelines Domains and Elements continued
9 9

1 | Program Administration
10 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

1A

1A. Ethical Foundation of APS Practice

Background

A code of ethics provides a conceptual framework and practical guidance that workers can use when they

are challenged by conflicting ethical duties and obligations. Most professions have developed their own

codes of ethics, including social work (National Association of Social Workers, 2015) and adult protective

services (APS; National Adult Protective Services Association [NAPSA], n.d.). APS practice is rife with

situations that require workers to navigate complicated ethical situations. Key concepts in the ethical

foundation for APS practice include, but are not limited to:

■ Least restrictive alternative

Least restrictive alternative means a setting, a program, or a course of action that puts as few limits as

possible on a person’s rights and individual freedoms while, at the same time, meeting the person’s

care and support needs.

■ Person-centered service

Person-centered service refers to an orientation to the delivery of services that considers an adult’s

needs, goals, preferences, cultural traditions, family situation, and values. Services and supports are

delivered from the perspective of the individual receiving the care, and, when appropriate, his or her

family.

■ Supported decision-making

Supported decision-making is a series of relationships, practices, arrangements, and agreements, of

more or less formality and intensity, designed to assist an individual with a disability to make, and

communicate to others, decisions about the individual’s life (Dinerstein, 2012).

It is recommended that APS systems establish

and adopt a set of ethical principles and codify

these in their policies and program manuals.

It is recommended that APS systems require

all employees to sign a code of ethics that

includes, at a minimum, those key concepts

described above (i.e., least restrictive

alternative, person-centered service, and

supported decision-making). The system’s

code of ethics would be signed at the time

of employment with APS. In addition, it is

recommended that training on ethics be

covered during preservice training and ongoing

staff education. Finally, it is recommended that

the code of ethics be reviewed with all staff on

an annual basis.

Guideline
11

1B

March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

1B. Protecting Program Integrity

Background

Policies related to program integrity build on the APS commitment to ethical practice (see 1A. Ethical

Foundation of APS Practice) and help ensure compliance with laws and regulations, increase accountability

within APS systems, and foster the public’s trust in the program’s actions.

1B

continued on page 12

It is recommended that APS systems create

and implement policies to ensure that the APS

program is held to high standards of integrity.

APS program policies and standards should be

transparent and available to the public. Policies

are needed to address the issues below:

■ Conflicts of interest

APS programs should have a process for

handling the APS case investigation when

the APS program itself, its contractors, staff

members, or those with whom they have a

close relationship have a conflict of interest

or the potential for perceived conflict of

interest.

■ Dual relationships

The National Association of Social Workers

(NASW) defines dual relationships as “when

professionals assume two or more roles at

the same time or sequentially with a client,

such as: assuming more than one professional role or blending of professional and

nonprofessional relationship” (NASW, n.d.).

In instances when dual relationships are

unavoidable, APS workers should make the

client’s protection their priority. The worker,

not the client, is responsible for setting

clear, appropriate, and culturally sensitive

boundaries.

■ Receiving and handling complaints

APS programs should have a process for

addressing complaints made about case

findings or actions of APS employees.

■ Screening APS personnel

APS programs should have a process for

screening potential APS employees for

suitability.

■ Consistency of practice

APS programs should establish policy

and standards regarding the process for

handling a case from the point of intake

through case closure. This should include

APS workers as well as those with supervisory responsibilities (e.g., receiving,

screening, and prioritizing maltreatment

reports; identifying investigation procedures to be implemented; determining the

validity of reports; defining findings; providing services to maltreated adults; and

providing casework supervision) with the

goal of consistent casework practice within

the program.

■ Providing information on the APS

program and process:

At the time of the initial investigation,

APS programs should provide an explanation of the APS program and its goals,

Guideline
12 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

1B

1B continued

in terms that are reasonably understandable, to those involved in the case.

■ Providing information on rights

of alleged victims

At the time of the initiation of the investigation, APS programs should provide to

alleged victims an explanation of their

rights under state law. It is recommended

that the explanation include information

about their rights to:

•	 Have confidentiality and privacy,

explaining relevant exceptions;

•	 Participate in the development of their

service or treatment plan;

•	 Refuse services and the possible

consequence; and

•	 Be informed of and to appeal a finding

by the APS program.

■ Providing information on rights

of perpetrators

When an APS program has made a finding

that adult maltreatment has occurred, and

if that maltreatment involves a perpetrator,

APS should provide an explanation to the

alleged perpetrator of any rights under

state law that apply. It is recommended that

the explanation include information about:

•	 Their right to be informed of and to

appeal a finding by the APS program;

•	 Their placement on a registry for

perpetrators, if a registry exists in

that state.
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 13

1C

1C. Definitions of Maltreatment

Background

The APS Survey (NAPSA & National Association

of States United for Aging and Disabilities

[NASUAD], 2012) reveals that the vast

majority of APS systems respond to reports

of physical, emotional, and sexual abuse;

financial exploitation; neglect; and self-neglect.

Recent data (2017)4 from the National Adult

Maltreatment Reporting System (NAMRS) shows

all states investigate or assess neglect,596.

of states investigate or assess physical abuse,6

92.6% investigate or assess self-neglect,7 90.7% investigate or assess sexual abuse83.3% investiga

or assess financial exploitation,9 and 75.9% investigate or assess emotional abuse.10 In addition, states

also reported investigating or assessing nonspecific exploitation11 (50%), abandonment (42.6%), other

exploitation12 (40.7%), other type13 (35.2%), and suspicious death14 (16.7%; Aurelien et al., 2018a). It

should be noted that definitions of adult maltreatment vary from state to state.

The child welfare system, including child protective services (CPS), specifies a minimum federal definition

of what constitutes child abuse and who is eligible for services under various child welfare provisions

(Children’s Bureau, n.d.-a).15

Guideline

It	is	recommended	that	APS	systems	define	

and	respond	to,	at	a	minimum,	reports	of		

the following categories of maltreatment:

physical, emotional, and sexual abuse;

financial exploitation; neglect; and

self-neglect.

Guideline

It	is	recommended	that	APS	systems	develop	

criteria	for	determining	the	eligibility	for	APS	

services	of	adults	(18+	years)	who	are	vulnerable	

to	maltreatment	and	who	are	the	alleged	victims	

of	maltreatment.	It	is	recommended	that	APS	

serve	those	who	are	eligible	for	their	services	

regardless	of	their	settings.

1D

1D. Population Served

Background

The APS Survey (NAPSA & NASUAD, 2012)

reveals that the vast majority of APS systems

serve adults (18+ years) who are the subject of

an APS report and who also meet the state’s

eligibility criteria for being vulnerable or at

risk (terms and definitions vary from state to

state). Most elders and adults with disabilities

successfully manage their own lives and are

capable of providing for their own care without

assistance. They are not automatically defined

as “vulnerable adults” simply because of age or

disability. Many states also serve the older adult population (usually starting at either

60 or 65 years) without requiring an additional finding of vulnerability.
14 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

1E. Mandatory Reporters

Background

According to the APS Survey, 49 states currently have mandatory reporting statutes (NAPSA & NASUAD,

2012). Some states require all citizens to report suspected adult maltreatment. Most identify professionals

required by law to report. The federal system provides guidance and examples on establishing mandated

reporting, as well as the role of various professions as mandated reporters (Children’s Bureau, n.d.-b). In

addition, states are required to identify in a state plan laws identifying categories of mandated reporters

(Children’s Bureau, n.d.-c).15

Researchers in one study found that reports made by mandated reporters to APS were more likely to be

substantiated and less likely to result in service refusal than reports made by nonmandated reporters

(Lees, 2018).

1E

It is recommended that states require

mandatory reporting to APS by members

of certain professions and industries who,

because of the nature of their roles, are

more likely to be aware of maltreatment. It is

recommended that employees, contractors,

paraprofessionals, and volunteers be

mandated to report. It is recommended

that states mandate reporting from groups,

including, but not limited to,

■ county, state, and federal law enforcement

■ first responders;

■ medical, behavioral health services, and

social service providers;

■ educational organizations;

■ disability organizations;

■ victim service providers;

■ long-term care providers, including home

health providers;

■ financial services providers;

■ aging services providers; and

■ anyone engaged in the care of or

providing services to a vulnerable adult.

Clear	guidelines	and	mechanisms	for	taking	

reports	from	both	mandatory	and	nonmandatory	reporters	should	be	established.	

Exemptions	to	mandatory	reporting	requirements	should	be	consistent	with	professional	

licensing	requirements	and	state	and	federal	

laws.	For	example,	representatives	of	the	

office	of	the	state	long-term	care	ombudsman	

are	exempt	from	mandatory	reporting	under	

the	Code	of	Federal	Regulations	(CFR),	per	

45	CFR	1324.19(b)(3)(iii).	

It	is	further	recommended	that	mandated		

reporters	be	immune	from	civil	and	criminal		

liability	when	reports	of	suspected	adult	

maltreatment	are	made	in	good	faith,	unless	

the	reporter	is	later	determined	to	be	the	

perpetrator.

It	is	recommended	that	APS	be	mandated	to		

report	to	law	enforcement	suspected	crimes		

related	to	adult	maltreatment.

Guideline
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 15

1F. Coordination with Other Entities

Background

According to the NAPSA Minimum Standards, APS systems should

Work with other agencies and community partners.... 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).

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 be associated

with a reduction in future mistreatment risk (Navarro, Gassoumis, & Wilber, 2013; Rizzo, Burnes, & Chalfy,

1F

continued on page 16

To improve communities’ responses to

adult maltreatment, it is recommended that

APS systems create policies and protocols,

including the development of memoranda

of understanding, (including contracts and

other types of agreements), cross-training,

and colocation of staffs (when permitted)

to promote their collaboration with other

entities, as needed, during investigations and

service implementation to benefit clients. It

is recommended that APS collaborate with

organizations or agencies, including, but not

limited to,

■ county, state, and federal law enforcement;

■ state offices that handle scams and frauds;

■ medical providers;

■ social service providers;

■ disability service organizations (including

the state office responsible for disability

issues);

■ alcohol and drug abuse service providers;

■ domestic violence, sexual assault, and

victim services providers;

■ financial services providers;

■ legal service providers;

■ aging services providers (including

the state offices responsible for older

adult issues);

■ dementia service providers;

■ long-term care ombudsman;

■ licensing and certification agencies;

■ animal welfare organizations; and

■ universities and other research

institutions.

It is further recommended that states establish

policies and protocols to facilitate APS

participation in formal interdisciplinary adult

maltreatment teams, while protecting client

confidentiality and other rights.

Additionally, it is recommended that APS

systems develop policies and protocols that

allow them to share information with APS

and law enforcement systems in other states

and jurisdictions, including tribes, in order

to detect, prevent, and remedy adult

maltreatment.

Guideline
16 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

2015; Wiglesworth, Mosqueda, Burnight, Younglove, & Jeske, 2006). Findings from Rizzo et al. (2015)

showed a significant reduction in future mistreatment risk for clients who received services through an

MDT model consisting of social workers and lawyers under the same roof (co-located), compared to clients

receiving social work 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 clients

who require the highest level of protection (Gassoumis, Navarro, & Wilber, 2015).

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

have also shown positive outcomes, including increased willingness of clients to accept treatment (Sirey et

al., 2015; He & Phillips, 2017; Susman, Lees, & Fulmer, 2015).

The APS Survey revealed 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.

1F continued
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 17

1G

1G. Program Authority, Cooperation, Confidentiality, and Immunity

Background

APS systems regularly deal with legal issues such as its authority, confidentiality of its records, and

immunity of its workers. APS systems require the services of legal counsel to provide guidance on these

issues. The APS Survey shows that many APS systems receive legal counsel from their county or state’s

attorney, though some have attorneys on staff (NAPSA & NASUAD, 2012).

It is recommended that APS systems have

access to legal counsel with expertise in the

legal issues the APS systems may face. In

addition, it is recommended that states provide

APS systems with the following authority:

■ Access to alleged victims

It is recommended that APS systems be given the authority to access alleged victims of

maltreatment and the authority to prevent

another’s interference in an APS case. That

access includes the authority to conduct

a private, face-to-face interview with the

alleged victim.

■ Access to information

This includes the ability of APS to access

records, by subpoena if necessary, for the

investigation of the alleged maltreatment

and for the protection of the APS client.

■ Communication and cooperation

In order to detect, prevent, and remedy

adult maltreatment, it is recommended that

APS systems be given the authority to cooperate with and share information related

to an APS case with:

•	 other APS and/or law enforcement

programs outside of the jurisdiction in

which the report was made; and

•	 non-APS members of MDTs convened

within the jurisdiction in which the

report was received, provided that all

members of the MDT have agreed to

keep the information confidential.

■ Further, it is recommended that APS be given the authority to provide the reporter of

the alleged maltreatment with the following

information, at a minimum:

•	 whether APS has or has not opened an

investigation as a result of the report;

•	 that APS has not opened an investigation as a result of the report; and

•	 whether an APS investigation has been

closed.

■ Immunity

It is recommended that legal protections

from liability be created for APS staff who

are acting in good faith and within the

scope of their employment.

■ Confidentiality

It is recommended that the confidentiality

of APS records and exceptions to

confidentiality be delineated, including

what shall be the APS system’s response to

subpoenas seeking those records.

Guideline
18 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

1H

1H. Staffing Resources

Background

The APS Survey indicates that APS worker caseloads vary from 0 to 25 per worker (13 states) to 100+ per

worker (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. NAPSA minimum standards and

federal child welfare guidelines recommend that states establish ratios but do not specify those ratios.

The child welfare system has dealt with the issue of staffing for decades and lessons from that system

may inform the creation of caseload studies for APS.15 For example, in a nationwide survey, state child

welfare system administrators identified reducing caseloads, workloads, and supervisory ratios as the

most important action for child welfare agencies to take to retain qualified frontline staff (Cyphers, 2001).

Research in child welfare also points to supportive supervision as a critical factor in reducing turnover

(Zlotnick, DePanfilis, Daining, & Lane, 2005).

Research shows that investigators who handle reports of alleged abuse of children and vulnerable adults

had lower investigation and substantiation rates than those who handled one or the other type of abuse

report (Jogerst et al., 2004).

continued on page 19

It	is	recommended	that	APS	systems	be	provided	with	sufficient	resources	to	ensure	that	

staffing	is	adequate	to	serve	the	target	population	and	fulfill	mandates.	To	reach	that	goal,	

it	is	recommended	that	APS	systems	conduct	

periodic	caseload	studies	to	determine	and	

implement	manageable	ratios.	In	determining	

ratios,	APS	systems	are	encouraged	to	consider	

the	following:

■ Ratio of supervisor to direct

APS service personnel.

There should be a limit on the number of

APS workers assigned to each supervisor

in order to ensure consistency in casework,

quality assurance, and sufficient worker

support. Failure to implement a limit on the

number of APS workers assigned to each

supervisor may result in serious risks to

clients’ safety and worker safety and

well-being, limit supervisors’ ability to provide professional development, and limit

the utilization of best practices.

APS programs should develop a target

and/or cap for the number of APS workers

per supervisor. In developing a worker to

supervisor ratio, consideration should

be given to:

•	 the important role of the supervisor in

Guideline
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 19

reviewing and approving cases during

critical supervisory junctures;

•	 the amount of time needed to supervise complex cases;

•	 the role of the supervisor as trainer,

especially of new APS workers;

•	 the role of the supervisor as mentor

and advisor;

•	 the role of the supervisor in representing the APS system at community

engagement outreach; and

•	 the role of the supervisor on multidisciplinary teams.

Further,	programs	should	consider	the	

challenge	to	supervisors	of	simultaneously	

supervising	workers	from	different	programs	

(e.g.,	APS,	CPS,	in-home	support	services,	

aging	services).	Finally,	it	is	recommended	

that	there	be	a	limit	on	the	number	of	workers	

supervised	by	each	supervisor.

■ Ratio of APS worker to cases

There should be a limit on the number of

cases assigned to each APS worker in order

to ensure delivery of comprehensive APS

services. Failure to implement a limit on

the number of cases assigned to each APS

worker may result in serious risks to the

APS system’s efficiency and efficacy.

Furthermore, research shows that when APS

workers are responsible for handling both

adult and child protective cases, client outcomes suffer. APS programs should develop

a target and/or cap for the number of cases

per APS worker. In developing this ratio,

consideration should be given to

•	 historical trends and experience needed

regarding the types and complexities of

cases in the state;

•	 differences in geographical areas;

•	 differences in time required to manage

cases at various phases in the casework process (e.g., ongoing casework

vs. investigation); and

•	 differences in complexity of allegations (e.g., many financial exploitation

cases, cases that require guardianship,

and self-neglect cases take significant

time and expertise).

1H continued
20 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

1I. Access to Expert Resources

Background

Often it is helpful or necessary to consult with content or clinical experts when handling APS cases. Nearly

every state APS system reported in the APS Survey that they had some access to legal consultation. Over

half of the states surveyed reported that they have access to physicians, while over 60% indicated that

they had access to mental health professionals as well as nurses and physician assistants. The APS Survey

also noted that, while financial exploitation is one of the top areas in APS, access to forensic specialists

and accountants were 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, 2018). Researchers in Texas created a Forensic Assessment Center

Network that uses a Web-based portal and low-cost videophone technology to connect an APS agency

and its clients to a centralized geriatric and elder mistreatment expert medical team for virtual in-home

assessments.

Researchers in child welfare (Brink, Thackeray, Bridge, Letson, & Scribano, 2015) studied the differences

in child welfare case determinations between cases that went to a multidisciplinary team and cases that

went to CPS.15 The authors suggest that the results highlight the importance of the forensic interview in

CPS decisions of child sexual abuse, and the potential role for child advocacy centers in providing trained

professionals to conduct a high-quality interview during the initial assessment. The findings may also

support the use of forensic interviewing in APS cases.

1I

It is recommended that APS systems dedicate

sufficient resources and develop systems and

protocols to allow for expert consultation from

outside professionals in the fields identified as

most needed by APS workers, including, but

not limited to,

■ civil and criminal law;

■ medicine;

■ forensic science, forensic interview specialists;

■ mental health, behavioral health;

■ disability organizations;

■ finance, accounting, real estate;

■ domestic violence, sexual assault;

■ long-term care; and

■ substance use.

It is also recommended that states

incorporate the use of technology to bring

needed resources to clients who might not

otherwise be able to access experts in their

physical locations.

Guideline
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 21

1J

1J. Case Review—Supervisory Process

Background

The APS supervisor provides both clinical and administrative oversight, approves key casework decisions,

and guides the caseworker in overall case planning and management.

The APS Survey revealed that over 70% of states have case review systems and about 75% of those

states review every case (NAPSA & NASUAD, 2012). Cases are mostly reviewed by a supervisor and/or an

administrator. Five states had specialized quality control staff to review cases, and over a quarter reported

that their cases were not reviewed. The NAPSA Minimum Standards suggest that “[a] case review process

[be] standardized and consistently applied.”

It is recommended that APS systems create

policies and protocols for supervisory consultation and case review at critical case junctures

(i.e., decisions that are likely to have a significant impact on the welfare of the client). These

include, at a minimum, but are not limited to,

■ intake and case assignment,

■ investigation planning,

■ determining the investigation findings,

■ service provision planning,

■ if legal action is being considered

(especially involuntary interventions

or actions), and

■ at case closure.

For APS systems where cases may be open for

periods longer than 6 months, a supervisory

consultation and case review should be

conducted at least every 6 months (e.g.,

for redetermination of eligibility or ongoing

service provision).

Guideline
22 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

1K

1K. Worker Safety and Well-being

Background

APS work can involve personal risk to the APS worker. This problem can have a marked impact on the

ability of APS systems to provide services to the adults who need them most.

A 2018 study 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

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. In addition, based on previous studies in child welfare,

the authors suggest that if work stressors identified in this study were addressed effectively, worker

turnover in APS might decrease (Ghesquiere, Plichta, McAfee, & Rogers, 2018).

It is recommended that APS systems create

policies and protocols and provide adequate

resources and training related to APS worker

safety. These provisions should include, at a

minimum, but are not limited to, the following:

■ APS programs should have systems in place

to know where their workers are when conducting investigations in the field.

■ When worker safety concerns are identified, workers should have real-time access

to consultation with supervisors to review

safety assessments and to determine appropriate responses.

■ Workers should have access to resources to

protect them from biological hazards that

may be encountered during home visits

(e.g., gowns, masks).

■ Workers should have access to resources to

protect them from safety hazards, including

access to information related to criminal

and civil legal proceedings, the ability to

request law enforcement accompaniment

for home visits, and worker safety training.

■ Workers should be provided with work/

agency cell phones.

■ Workers should be provided with the means

to keep their personal information confidential, including using a business card that

has only the name of the agency and using

agency vehicles or other means to keep their

personal car license confidential.

■ Workers should never be required to

respond to a situation that would put the

worker at risk without adequate safety

supports available.

■ Workers should have access to available

supportive, professional counseling for jobrelated trauma and stress.

Guideline
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 23

1L

1L. Responding During Community Emergencies

Background

APS plays a role in ensuring the safety and well-being of their clients and other vulnerable adults

during community emergencies.

It is recommended that APS systems create

policies and protocols that clearly outline

the role of APS supervisors and workers in

the event of emergencies in the community,

such as natural disasters (e.g., hurricanes,

flooding, earthquakes, severe storms), violent

attacks, or other states of emergency. It is

recommended that these policies address the

following phases:

■ Planning for emergencies before

they occur,

•	 through multiagency planning and

coordination, by understanding the

role of APS as well as the potential

resources and limitations of partnering

agencies;

•	 by establishing data systems capable

of adequately tracking clients who may

be affected by emergencies;

•	 by establishing a clear chain of command, base of operations, and means

to communicate with workers;

•	 by creating clear lines of communication

and responsibility with first responders,

neighborhood emergency response

teams, Red Cross, etc. before the

emergency has occurred; and

•	 by training workers on emergency

preparedness for when in the office

and when out in the field.

■ Responding during the emergency:

•	 Workers shall not be required to respond

to a situation that would put the worker

or his/her family at risk.

•	 Workers shall understand the changing nature of emergencies and

demonstrate flexibility of attitude and

approach.

•	 Workers should be clear what their role

is and is not during emergencies.

•	 APS personnel shall be provided with

emergency personal protection (e.g.,

filtering masks, gloves) and emergency

equipment (e.g., flashlights, two-way

radios), as needed, to safely carry out

their assigned duties.

Guideline
24 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

1M. Community Outreach and Engagement

Background

Although the public’s awareness of adult

maltreatment is rising, the awareness of how

to respond to suspicions of that maltreatment

and how to reduce repeat visits is still lacking.

Recent research sheds light on the kinds of

maltreatment cases that are not reported to

APS. 90% of financial maltreatment perpetrated

by family and friends and 85% of emotional

maltreatment regardless of relationship to

perpetrator go unreported (Acierno, 2018).

Recent research also indicates that lack

of awareness and miscommunication may

indicate a need for education interventions for

professionals, families, and communities to help reduce repeat visits (Susman et al., 2015). APS programs

should play a role in educating the public about adult maltreatment, the way to report it and to whom, and

the goals and services of the APS program.

Recent efforts have identified effective communications strategies for the community to talk about elder

abuse and related issues to build public understanding and support (FrameWorks Institute, 2019).

1M

Guideline

It is recommended that state APS programs

devote resources for engaging their communities

through public awareness and/or educational

sessions. These sessions should minimally

include

■ defining adult maltreatment,

■ guidance on when and how to report, and

■ APS authority and limitations.
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 25

1N

1N. Participation in Research

Background

Research on adult maltreatment is needed to answer important fundamental questions that exist related

to adult maltreatment risk factors, forensic markers, and the efficacy of APS and other interventions, etc.

APS programs can play an important role in this research. It is in the best interest of those impacted by

adult maltreatment that services, including APS services, are based on sound research and data. It is

important that APS programs develop protocols to allow participation in research and allocate resources

for research. The NAPSA/National Committee for the Prevention of Elder Abuse Research Committee has

provided information on how APS programs may participate in research. See http://www.napsa-now.org/

wp-content/uploads/2018/03/Guiding_Principles_2018.pdf

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 client

outcomes;

■ participate in national APS data collection

efforts; and

■ disseminate findings from research to other

state and county APS programs, policymakers, and other researchers.

Guideline

27 27

2 | Time Frames
28 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

2A. Responding to the Report/Initiating the Investigation

Background

According to the APS Survey, most APS systems prioritize reports into either emergency or nonemergency

situations and have time frames for responding in either a few hours or a few days, as deemed appropriate

(National Adult Protective Services Association [NAPSA] & National Association of States United for Aging

and Disabilities [NASAUD], 2012). In more than 35% of the states, staff must initiate an investigation within

the first 24 hours, but in 45% of the states, it must be initiated in a shorter time period than the first 24

hours. Recent data (2017) from the National Adult Maltreatment Reporting System (NAMRS) shows that,

on average, states took 4.5 days from receipt of a report of alleged maltreatment to the time APS made

contact with the client (Aurelien et al., 2018a).

The federal child welfare system provides guidelines for determining the needed response time

(DePanfilis & Salus, 2003).15

2A

It is recommended that APS systems develop

and implement a consistent protocol for

initiating the APS investigation in response

to the receipt of a report. The purpose of the

investigation is to collect information about

the allegations of maltreatment, assess the

risk of the situation, determine if the client is

eligible for APS services, and make a finding as

to the presence or absence of maltreatment.

Initiating the investigation typically includes

■ contacting the alleged victim, the alleged

victim’s service providers (if any), the reporter, and other individuals with knowledge of

the alleged victim and his/her situation;

■ conducting a social service database search

to identify all department records pertaining

to the adult;

■ reviewing all appropriate department

records including records that are not in

the APS case management database; and

■ searching the APS case management

database for previous reports.

It is recommended that APS see the alleged

victim face-to-face, regardless of the response

time set. There are two levels of response:

■ Immediate response—for cases that

involve risk of death, irreparable harm, or

significant loss of assets and/or property—

should occur in person within the first 24

hours after receiving the report, or sooner.

■ Less immediate response—for less imminent and less severe risk—should occur

1 to 5 business days after the report is

received, or sooner.

Guideline
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 29

2B

2B. Completing the Investigation

Background

The time frame in which APS systems must

complete the investigation varies greatly. The

APS Survey reveals that 31% of programs

must complete the investigation within 30

days, and 42% states allow the investigation

to be completed in more than 30 days. Eight

states have no time frame for completing

the investigation (NAPSA & NASUAD, 2012).

Based on the 2017 NAMRS data, states took on

average of 47.7 days to complete investigations.

Out of 26 states that provided additional data,

17.8% reported investigations were closed

within 15–30 days of receipt of report, 31.5%

reported investigations were closed within 31–60

days of receipt of report, and 13.6% reported

investigations were closed within 61–90 days of

receipt of report (Aurelien et al., 2018a).

Guideline

It is recommended that APS systems create

policy establishing the time frame for

completion of investigations. It is suggested

that this policy

■ provide structure for the worker related to

caseload and time management;

■ encourage consistent practice;

■ keep cases progressing through the

system; and

■ allow for extensions for good cause with

supervisory approval.
30 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

2C. Closing the Case

Background

APS systems are generally designed to provide emergency and short-term response to urgent situations.

The length of time that cases remain open for APS to provide services varies. According to the APS

Survey, as of 2012, 40% of programs reported no specific time frame for closing cases, and eight required

closure within 90 days (NAPSA & NASUAD, 2012). Others allowed cases to remain open longer. In the

states that had timelines, there were provisions for extensions when required. The federal child welfare

system requires a minimum time frame for ongoing case review, as well as a maximum time limit for

determinations of case status (Children’s Bureau, n.d.-c).15

A 2015 study (Mariam, McClure, Robinson, & Yang, 2015) assessed the effectiveness of an elder abuse

intervention and prevention program, for building alliances between elders with suspected abuse. 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 and therefore worth considering.

Cases may be closed for a variety of reasons. Based on 2017 NAMRS reporting from 19 states, half of

cases were closed because the investigation was completed,16 29.3% of cases were closed because the

investigation/protective services were completed,17 or for another closure reason (7.2%).18 States al

reported closing cases even if the investigation had not been completed, due to client refusal (2%),19 client

death (1.5%),20 client decision (1.7%),21 or nonspecific reasons (4.9%22; Aurelien et al., 2018b).

2C
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 31

It is recommended that APS systems establish

case closure criteria and the frequency with

which open cases should be reviewed. Cases

should remain open for the time needed to

resolve the client’s safety issues. A procedure

for closing cases is also recommended. The

criteria for case closure should include, but are

not limited to, situations in which

■ the service plan is completed (e.g., the

client’s situation is stabilized, safety issues

have been resolved or mitigated, client goals

have been achieved to the extent feasible);

■ the client was referred to another APS agency;

■ the client has moved out of the APS

jurisdiction;

■ the client has died (some programs will

continue to investigate if death is considered suspicious);

■ the client having capacity to consent

refuses continued services.

APS should allow for extensions for good cause.

Guideline

33 33

3 | Receiving Reports 

 of Maltreatment
34 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

3A. Intake

Background

The intake process must be easy and fully accessible to those needing to make a report and must include

collection of essential data to facilitate an appropriate, timely, and helpful response to the alleged victim. The

APS Survey revealed that 75% of states had intake lines for reporting alleged adult maltreatment 24 hours a

day, 68% of which were staffed. Other 24-hour intake lines used contracted call centers, a message service,

or online services during nonbusiness hours. In states without a 24-hour intake line, callers were urged to

contact law enforcement to report maltreatment (National Adult Protective Services Association [NAPSA] &

National Association of States United for Aging and Disabilities, 2012). Recent data (2017) from the National

Adult Maltreatment Reporting System shows 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 states

(24.1%) provide a combination of both statewide and local hotlines or call-in numbers, and 20.4% provide

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

The Council on Accreditation recommends that a child abuse report intake system be available 24 hours a

day. The majority of child welfare systems addressed this recommendation in policy and met this guideline

as of 2003 (Office of the Assistance Secretary for Planning and Evaluation, 2003).15

3A

continued on page 35

It	is	recommended	that	APS	systems	have	

a	systematic	method,	means,	and	ability	to	

promptly	receive	reports	of	alleged	maltreatment.	It	is	recommended	that	APS	systems	establish	multiple	methods	for	receiving	reports	

of	alleged	maltreatment	24	hours	a	day,	7	days	

a	week	(e.g.,	toll-free	telephone	hotline,	teletypewriter	[TTY],	fax,	Web-based).	It	is	recommended	that	mechanisms	be	easily	accessible	

and	free	to	the	reporter.	The	hotline	or	other	

service	should	be	fully	accessible	(e.g.,	using	

augmentative	communication	devices)	and	it	is	

recommended	that	programs	utilize	translation	

services,	including	American	Sign	Language,	

for	reporters	who	require	them.

Intake systems should have an APS staff

person on duty to receive and respond to

reports. The system should notify APS of all

reports taken. The system should have the

capacity to respond to emergencies with

trained APS personnel.

The system should ensure the protection

of the reporter’s identity, unless otherwise

ordered by a court. Additionally, the system

should explain to the reporter the role of APS.

When receiving reports, the system should

have a standardized process for eliciting

and documenting the content of the report,

including, but not limited to, information about

■ the alleged victim and his or her

circumstances;

Guideline
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 35

3B

3B. Screening, Prioritizing, and Assignment of Screened-in Reports

Background

Screening is a process of carefully reviewing

the intake information to determine if the

report should be screened in for investigation,

screened out, or referred to a service or program

other than APS. Risk factors are identified

to determine the urgency for commencing

investigation of screened reports. Nearly all

states reported prioritizing reports screened

in for investigation and having required time

frames for APS response associated with

identified risk levels.

The NAPSA Minimum Standards suggest that APS systems have the following four elements,

among others:

■ a prompt process to screen and investigate reports;

■ a review of safety and risk factors, using a consistently-applied screening tool;

Guideline

It is recommended that APS systems develop

standardized screening, triaging, and case

assignment protocols that include, at a

minimum, those elements outlined above in

the background section.

■ the location of the alleged victim;

■ the alleged type(s) of maltreatment;

■ the alleged perpetrator, if any;

■ the level of response needed to be made

by APS due to the alleged victim’s situation

(e.g., immediate); and

■ risks that may be encountered by an

APS worker in responding to this report

(e.g., presence of animals, weapons in

the home).

3A continued

continued on page 36
36 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

■ agency decision-making criteria to review and assign cases, report to other authorities and initiate

court action when required; and

■ a process by which reports are reviewed and assigned for investigation, referred to other providers,

or screened out as soon as possible, but no later than 24 hours after receipt (NAPSA, 2013).

The federal child welfare system provides significant guidance and examples to the states on assessment

tools, screening tools, and protocols for children suspected of being victims of child abuse and neglect

(Children’s Bureau, n.d.-d).15

3B continued
37 37

4 | Conducting the 

 Investigation
38 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

4A

4A. Determining if Maltreatment has Occurred

Background

The response of APS to a report of maltreatment is complicated and involves numerous interrelated tasks that

typically happen concurrently. For the purposes of providing guidance, in this document we have separated

the process of gathering information relevant to determining if the maltreatment occurred (determining a

finding) and the process of gathering information as part of a client assessment. This section focuses on the

process undertaken by APS systems to determine if maltreatment has or has not occurred.

To ascertain whether maltreatment has occurred, information is gathered through interviews with the client,

the alleged perpetrator, and other involved parties, and through review of relevant documents and records.

Evidence gathered during investigation includes, but is not limited to,

■ client statements,

■ direct observations,

■ physical evidence (e.g., injuries, cluttered home, no utility service),

■ corroborating evidence (e.g., witness statements, physician records, other information),

■ circumstantial evidence,

■ unobserved/third-party suspicions, and

■ client history.

Some 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. For

instance, substantiation rates have shown to be higher with the use of the technology-based Elder Abuse

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

(Beach et al., 2017; Conrad, Iris, & Liu, 2017). However, standardized tools should not preclude staff from

approaching clients creatively to explore ways to reduce the risk of harms the client faces and engaging

clients who say they do not want services.

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 variation in elder abuse data. The authors suggest establishing clear

definitions and conducting training to standardize the assignment of findings for elder abuse/neglect cases

(Mosqueda et al., 2016).

As noted elsewhere, the federal child welfare system provides significant guidance and examples to the

states on assessment tools, screening tools, and protocols for children suspected of being victims of child

abuse and neglect (Children’s Bureau, n.d.-d).15 In addition, studies examining differences in child abuse

and neglect determinations have shown that a multidisciplinary team (MDT) approach, including a forensic

interview, is an effective approach for conducting the initial assessment (Brink et al., 2015). Similar findings

have been published in the area of elder abuse, showing that MDT/forensic centers significantly increase

prosecution rates and guardianships for cognitively impaired older adults, and reduce the rate at which cases

reenter the APS system (Wilber, Navarro, & Gassoumis, 2014).
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 39

It is recommended that APS systems establish

standardized practices to collect and analyze

information when determining whether or not

maltreatment has occurred. It is recommended

that the following elements, at a minimum, be

considered:

■ The following issues are explored before

deciding whether or not to notify the

alleged victim of the initial visit:

•	 preservation of individual rights,

•	 preservation of evidence,

•	 maximum engagement potential with

client,

•	 alleged victim safety,

•	 worker safety, and

•	 cognitive status of client (e.g., clients

with dementia may not respond well to

an unannounced visit).

■ APS programs are encouraged to use MDTs

to support decision-making during the

initial assessment.

■ All of the types of maltreatment alleged in

the report are investigated. Any additional

type of maltreatment discovered during the

course of the investigation is noted and

investigated.

■ Other vulnerable adults that are affected by

the alleged maltreatment, or appear to be

alleged victims of possible maltreatment,

are identified and reported to APS.

■ While the investigation may continue, the

client has the right not to participate in the

investigation.

■ Law enforcement has been notified if there

is cause to believe that the alleged victim

has been maltreated by another person in a

manner that constitutes a crime.

■ Immediate attention has been given to

clients in crisis, in imminent risk, or in an

emergency situation.

■ APS programs are encouraged to utilize

standardized and validated screening tools

for assessing decision-making ability and

for determining whether mistreatment has

occurred.

■ APS workers are trained on and have a clear

understanding of the definitions of case

findings (e.g., “confirmed,” “unfounded,”

or “inconclusive”).

■ Acceptance of APS services is voluntary

(except in cases where there has been a

determination of extreme risk and the client

lacks capacity or cannot consent to services; see Section 5b, Involuntary Service

Implementation, below).

■ The worker has been trained and is competent to investigate the particular set of

circumstances described in the report (e.g.,

he/she has received training on working

with nonverbal clients, with clients with intellectual disabilities, with clients who have

mental health issues, with residents of

institutions, or with minority populations).

Guideline
40 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

4B

4B. Conducting an APS Client Assessment

Background

The adult protective services (APS) assessment is key in collecting information about the vulnerable

adult’s overall situation. The purpose of the assessment is to determine the services or actions needed for

the vulnerable adult to be safe and remain as independent as possible. Based on the 2017 National Adult

Maltreatment Reporting System (NAMRS) data, 75% of states use a common instrument or tool throughout

the state to conduct assessments. For other states (25%), assessment instruments are determined by each

county or left to the worker’s discretion (Aurelien et al., 2018a).

Because adult maltreatment may have a traumatizing effect on the alleged victim, it is important that APS

programs utilize principles of trauma-informed care in order to facilitate a respectful and sensitive approach

to working with the alleged victim, starting with the APS client assessment. The Centers for Disease

Control and Prevention (CDC) have identified six key elements of a trauma-informed approach: safety;

trustworthiness and transparency; collaboration and mutuality; peer support; empowerment and choice; and

cultural, historical, and gender issues. (CDC, n.d.). More information can be found at https://www.cdc.gov/

cpr/infographics/6_principles_trauma_info.htm.

Innovative approaches have shown that technology can be effective for conducting virtual in-home

assessments, including mental health assessments, telephone-based protective service planning during

interdisciplinary team meetings, and consultations services (see the Texas Elder Abuse and Mistreatment

Institute Forensic Assessment Center Network [TEAM-FACN] described in Burnett et al., 2018). Virtual

assessment strategies like these may be especially useful for remote areas where services are limited and

lengthy travel may be required.
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 41

It is recommended that APS systems create

and apply systematic assessment methods

to conduct and complete a needs/risk

assessment including the vulnerable adult’s

strengths and weaknesses. The purpose of

the assessment is to determine the services or

actions needed for the vulnerable adult to be

safe and remain as independent as possible.

APS programs are encouraged to integrate

principles of trauma-informed approaches

when conducting the client assessment and

throughout the APS investigation.

APS programs are encouraged to utilize

standardized and validated assessment tools.

The needs and risk assessments should

include criticality or safety of the client in

all the following significant domains (not an

exhaustive list):

■ nature of the maltreatment (e.g., origins,

severity, duration, frequency, etc.);

■ physical health;

■ cognitive functioning (e.g., memory, IQ);

■ decisional ability (including understanding

and appreciation of consequences of decisions, perception of choice, and reasoning);

■ mental health status/behavioral issues;

■ functional ability (e.g., to perform activities

of daily living and instrumental activities of

daily living;

■ personal relationships (including presence

of combative and conflictual relations);

■ support system (formal and informal);

■ environmental conditions (including presence of abused, dangerous, or hoarded

animals in the home); and

■ financial circumstances.

Unless specifically qualified or authorized by

state law, an APS worker does not carry out

clinical health or capacity assessments, but

rather screens for indications of impairment

and, as needed, refers the client on to qualified

professionals (physicians, neuropsychologists,

etc.) to administer thorough evaluations.

It is recommended that state APS systems

create policies for APS workers who are

nurses to do noninvasive screenings to

include: blood sugars, vital signs, pulse

oximetry, etc., and that those policies allow

the results of these screens to be referred to

qualified professionals, including physicians,

psychologists, and psychiatrists.

It is also recommended that an assessment of

the alleged perpetrator and/or caregiver be

conducted to ascertain the risk to the safety

and independence of an alleged victim of adult

maltreatment.

Guideline
42 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

4C. Investigations in Residential Care Facilities

Background

Approximately 50% of APS programs conduct

investigations in congregate care facilities (i.e.,

facilities or institutions). Based on 2017 NAMRS

data, in 38 states, APS investigates allegations of

maltreatment when they occur in at least some

type of “residential facilities”; in 14 states, APS

never investigates allegations of maltreatment in

facilities (Aurelien et al., 2018a).

APS systems that are responsible for

investigating and intervening in cases of

maltreatment in residential care facilities carry

the burden of ensuring that their staff are trained

and are receiving supervision and consultation

on the specific issues that can arise in these

cases. These issues include clinical, forensic, and

legal considerations, such as the possibility that

multiple residents have been harmed when an

abusive employee, resident, or visitor has had

access to vulnerable residents. Special skills

and approaches are often required in residential

care cases, including exercising caution to avoid

escalating danger to those involved (RamseyKlawsnik & Teaster, 2012).

Whether or not the APS system investigates

reports of maltreatment in residential care

facilities, it is critically important that APS

systems coordinate with agencies such as the long-term care ombudsman, state regulatory agencies, law

enforcement, and others that also play a role in safeguarding the health and welfare of congregate care

residents. Memoranda of understanding and other formal documents can help to facilitate local- and statelevel coordination. For example, consultation with law enforcement about the timing of the APS investigation

may ensure that an APS investigation does not compromise a law enforcement investigation.

In 2015, the Code of Federal Regulations (CFR) was amended to include regulations governing states’ longterm care ombudsman programs (45 CFR Part 1324). The regulations include the following requirement:

Through adoption of memoranda of understanding and other means, the [State Long-Term Care]

Ombudsman shall lead state-level coordination, and support appropriate local Ombudsman entity

coordination, between the Ombudsman program and other entities with responsibilities relevant to the

health, safety, well-being or rights of residents of long-term care facilities including, but not limited to:

Adult Protective Services (45 CFR Section 1327.13[h]).

4C

Guideline

It is recommended that APS systems

responsible for responding to alleged and

confirmed maltreatment of vulnerable adults

residing in residential care facilities provide

training, supervision, and consultation to their

staff on the special and complex issues that

can be involved in those maltreatment cases.

It is also recommended that APS systems,

whether or not they investigate allegations

of maltreatment in residential care facilities,

develop formal agreements and protocols with

the entities that play a role in safeguarding

the health and welfare of these residents

in order to facilitate local- and state-level

coordination, in particular, the long-term care

ombudsman program, state licensing, other

regulatory bodies, and law enforcement. It

is recommended that, whenever possible,

APS notify the long-term care ombudsman

when APS is investigating allegations of

maltreatment in residential care facilities.
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 43

4D

4D. Completion of Investigation and Finding

Background

The NAPSA Minimum Standards state that:

APS programs have in place a systematic

method to make a case determination and

record the case findings. A determination

must be made as to whether the abuse,

neglect, self-neglect, and/or financial

exploitation has occurred. The decision

to substantiate the allegation is based

on a careful evaluation of all information

gathered during the Intake, Investigation,

and Needs and Risk Assessment phases

(NAPSA, 2013).

In addition, the NAPSA Minimum Standards recommend protocols that establish a standard of evidence to

be applied when investigation conclusions are reached. Typically, APS systems apply the “preponderance

of evidence” standard requiring that at least slightly more than half of the evidence supports an allegation

to substantiate it. This standard is very different from the “clear and convincing” and “beyond a reasonable

doubt” standards typically applied in criminal situations (Ramsey-Klawsnik, 2015).

Guideline

It is recommended that APS systems create

and implement a systematic method to make

a case determination and record case findings,

including protocols for the standards of

evidence applied as shown in the background

section above.

45 45

5 | Service Planning and 

 Service Implementation
46 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

5A

5A. Voluntary Service Implementation

Background

Adult	protective	services	(APS)	is	a	voluntary	service,	and	its	interactions	with	clients	are	based	on	principles	

of	ethical	practice	including,	but	not	limited	to,	person-centered	planning,	least	restrictive	alternatives,	

and	supported	decision-making.	After	APS	has	completed	the	investigation	and	the	client	assessment,	in	

many	states	a	service	plan	is	created	with	the	client.	The	goal	of	the	service	plan	is	to	improve	client	safety,	

prevent	maltreatment	from	occurring,	and	improve	the	client’s	quality	of	life.	Service	plans	are	monitored,	

and	changes	can	be	made,	with	the	client’s	(or	their	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	essential	services	as	defined	in	statute	or	policy.	(Note:	programs	may	use	various	

terms	to	refer	to	the	plan,	e.g.,	case	plan,	service	plan,	action	plan,	etc.)

The	National	Adult	Protective	Services	Association	(NAPSA)	Minimum	Standards	state	that	the	guiding	

principles	for	APS	person-centered	practice,	summarized	below,	be	followed	when	developing	service	plans.

■ Respect the integrity and authority of clients to make their own life choices.

■ Hold perpetrators, not clients, accountable for the maltreatment and for stopping their behavior. Avoid

blaming questions and statements.

■ Take into consideration clients’ concepts of what safety and quality of life mean.

■ Recognize resilience, and honor the strategies that clients have used in the past to protect themselves.

■ Redefine success: success is defined by the client, not by what professionals think is right or safe

(NAPSA, 2013).

In	addition,	the	NAPSA	Minimum	Standards	for	development	of	the	voluntary	service	plan	include	the	

following	four	recommendations:

■ Identify with the client the factors that influence service plan risks and needs.

■ Engage the client and caregiver as appropriate, in an ethical manner, with useful strategies to develop

mutual goals to decrease risk of maltreatment.

■ Determine with the client and other reliable sources (such as family members, friends, and community

partners) the appropriate services or other interventions that may decrease risk of maltreatment.

■ In some cases, the use of a proper domestic violence safety planning tool is warranted (NAPSA, 2013).

continued on page 47
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 47

Several studies on adult maltreatment have yielded findings that may inform current APS practice. For

example, a study by Jackson & Hafemeister (2014) indicates that interventions tailored to meet the unique

characteristics associated with each type of mistreatment may lead to greater client safety. In addition,

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, Hernandez-Tejada, Anetzberger, Loew, & Muzzy, 2017) as well

as future risk of mistreatment (Burnes, Rizzo, & Courtney, 2014). It has also been shown that APS clients

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). Research on mental

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

an individual’s 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 APS Survey reveals that once a case is initiated through APS, 63% of the programs reporting require

regular communication with the client either by phone or in person (NAPSA & National Association of States

United for Aging and Disabilities [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).

It	is	recommended	that	programs	intervene	

in	adult	maltreatment	cases	as	early	as	

possible	and	develop	targeted	safety	planning	

for	clients	experiencing	different	forms	of	

abuse	and/or	neglect.	For	clients	who	may	

be	reluctant	to	receive	services,	APS	is	

encouraged	to	consider	providing	longerterm	interventions	focused	on	building	a	

working	alliance	with	the	client	and	applying	

motivational	interviewing	techniques.

It is recommended that APS systems develop

the client’s APS voluntary service plan

using person-centered planning principles

and monitor that plan until the APS case is

closed. Services and supports should entail

those that have been shown to be effective in

protecting against negative outcomes, such

as social support and programs that promote

participation in community social outlets

(e.g., senior centers). Programs that facilitate

bidirectional support in the form of education,

volunteerism, or socialization may be most

effective (e.g., AARP Foundation Experience

Corps, congregate meal program; Anetzberger,

2018). In addition, APS systems should

consider working in tandem with mental health

clinicians to offer mental health services, if

needed, at the same time as APS are provided

(see Providing Options to Elderly Clients

Guideline

5A continued

continued on page 48
48 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

Together [PROTECT] intervention described in

Sirey et al., 2015). In areas where it is difficult

to connect clients to social supports in person,

APS can explore referring clients to programs

that use technology to connect individuals to

others (e.g., Senior Center Without Walls).

It is recommended that APS systems establish

clear guidelines related to APS service delivery

which incorporate the elements listed above in

the background section.

5A continued
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 49

5B

5B. Involuntary Service Implementation

Background

APS systems are sometimes called on to

provide services in cases where there has been

a determination of extreme risk and the client

lacks capacity or cannot consent to services. The

NAPSA suggests the following in its Minimum

Standards:

In order to provide an involuntary

intervention, APS obtains legal standing,

either by going to court with legal counsel or

by involving another agency that has legal

jurisdiction. Any and all such court action(s)

is well documented in the case file.

APS programs follow the particular laws

and policies in their jurisdiction regarding

involuntary services to vulnerable adults

who lack the capacity to protect themselves

from maltreatment (NAPSA, 2013).

The NAPSA program standards recognize that

“lack of capacity may also limit the client’s ability to engage in the decisions surrounding the identification

of risk and needs, as well as goals and intervention strategies to be protected from further harm” (NAPSA,

2013). The NAPSA standards go on to emphasize that, although involuntary service planning may involve a

client who lacks capacity in some areas, principles of supportive decision-making should be utilized (NAPSA,

2013). The law has traditionally responded to cognitive disability by authorizing surrogate decision-makers

to make decisions on behalf of individuals with cognitive disabilities. However, supported decision-making,

an alternative paradigm for addressing cognitive disability, is rapidly gaining support. According to its

proponents, supported decision-making empowers individuals with cognitive challenges by ensuring that

they are the ultimate decision-makers but are provided support from one or more others, giving them the

assistance they need to make decisions for themselves (Kohn, Blumenthal, & Campbell, 2013) Working with

the individual requires the recognition that the individual also has strengths and may be able contribute to

the decision-making process.

After an assessment indicates that a client may lack capacity, a service plan is developed that addresses the

risks and needs identified in the assessment, and a formal process should be in place to

■ determine when involuntary intervention may be indicated;

Guideline

It is recommended that state APS systems

create policies and protocols to respond

to situations where there has been a

determination of extreme risk and the client

lacks capacity or cannot consent to services.

The decision to take involuntary action is

not to be taken lightly. It is recommended

that APS systems establish clear guidelines

related to APS involuntary interventions, which

incorporate the elements listed above.

It is recommended that APS systems

adopt promising models which draw on

multidisciplinary experts to help make the

difficult determination as to whether or not APS

should petition the court for a guardianship.

continued on page 50
50 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

■ identify those situations where the client’s immediate safety takes precedence over the client’s right to

self-determination;

■ explore the ethical issues in the decision to use involuntary means;

■ document information needed to justify the use of involuntary interventions, and identify the appropriate resources needed to be able to implement an involuntary case plan;

■ develop and defend an involuntary plan; and

■ have in place a systematic method to continue to provide protective services to those clients who are

being provided involuntary protective services (NAPSA, 2013).

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 to

guardianship (Gassoumis et al., 2015).

5B continued
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 51

5C. Closing the Case

Background

The NAPSA Minimum Standards state: “The goal of intervention in APS is to reduce or eliminate risk of

maltreatment of a vulnerable adult. In most APS programs, once that goal is met, the case is closed.”

However, safety goals should be balanced with the right, preferences, and self-determination of the client,

making case resolution an intrinsically subjective and multilayered outcome. Thus, goals toward case closure

should be specific to each client and should be contingent on clients’ attainment of their specific goals

(Burnes, Connolly, Hamilton, & Lachs, 2018).

The child welfare system provides guidelines on the process for closing cases (DePanfilis & Salus, 2003).15

5C

It is recommended that APS systems establish

case closure criteria and determine the

frequency with which open cases should be

reviewed. Cases should remain open for the

time needed to resolve the client’s safety

issues. A procedure for closing cases is also

recommended. The criteria for case closure

should include, but are not limited to, these

situations:

■ The service plan is completed (e.g., the

client’s situation is stabilized: safety issues

have been resolved or mitigated; client goals

have been achieved to the extent feasible).

■ The client was referred to another

APS agency.

■ The client has moved out of the APS

jurisdiction.

■ The client has died (though some programs

will continue to investigate if death is considered suspicious).

■ The client having capacity to consent

refuses continued services.

The case record should contain documentation

of APS interventions and services delivered,

their outcomes, an assessment of their efficacy,

and the reason for the decision to close the

case. If the resources needed to reduce the risk

are not available, this information should also

be documented in the case file.

Guideline

53 53

6 | Training
54 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

6A

6A. Caseworker and Supervisor Minimum Educational Requirements

Background

Research indicates that higher education requirements for workers lead to higher substantiation of

allegations. In one study, requiring a social work education background led to higher investigation and

substantiation rates (Jogerst et al., 2004). Investigation rates were significantly higher when the state

required that staff have a social work degree; however, substantiation ratios were significantly lower in

these same states (Daly et al., 2005).

The APS Survey shows that at least 35 states report that supervisors and caseworkers must have a college

degree (National Adult Protective Services Association [NAPSA] & National Association of States United for

Aging and Disabilities [NASUAD], 2012).

The federal child welfare system requires states to establish minimum education and qualification

requirements of child protective services (CPS) workers (CAPTA Reauthorization Act, 2010). Child welfare

guidelines promote the recruitment of, including the direction of federal funds toward, individuals with

higher educational attainment and backgrounds in social work education (DePanfilis & Salus, 2003).15

It is recommended that APS direct service

personnel and supervisors be qualified by

training and experience to deliver adult

protective services. It is recommended that

states institute minimum qualifications for APS

workers and supervisors.

■ At a minimum, APS workers should have an

undergraduate college degree.

■ Preference should be given to supervisors

who have an undergraduate college degree

and a minimum of 2 years of experience

in APS.

■ Preference should be given to those with a

master’s degree in social work, gerontology,

public health, or other related fields.

■ It is recommended that APS programs have

in place adequate human resource procedures to screen potential candidates for

suitability for employment.

■ In states that employ nurses in their APS

programs, it is recommended that preference be given to those with a bachelor’s

degree in nursing.

Guideline
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 55

6B

6B. Caseworker Initial and Ongoing Training

Background

It is in the best interest of clients that APS caseworkers receive initial and on-the-job training in the core

competencies of their challenging job. For instance, research has shown that differing interpretations of

definitions of confirmed, inconclusive, and unfounded case findings, along with differences in worker skill,

expertise, and training, may contribute to variability in APS case decisions on allegations and findings

(Mosqueda et al., 2016).

However, research also indicates that more educational preparation and longer training sessions lead to

more staff effectiveness. Studies measured effectiveness of training using several types of indicators—

investigation and substantiation of allegations and staff’s self-perceived effectiveness. The studies indicate

that training improves staff knowledge, confidence, self-perceived skills, and perceived competence in

delivering APS, and it leads to change in practice (DuMont, Kosa, Yange, Solomon, & Macdonald, 2017;

Pickering, Ridenour, Salaysay, Reyes-Gastelum, & Pierce, 2018; Storey & Prashad, 2018), as well as increased

rates of investigation and substantiation of maltreatment reports (Connell-Carrick & Scannapieco, 2008;

Jogerst et al., 2004; Turcotte, Lamonde, & Beaudoin, 2009). Importantly, these improvements have shown to

be significant when comparing outcomes for APS workers who did and did not complete trainings (Storey &

Prashad, 2018).

In the child welfare system, research shows that well-trained staff are able to complete tasks accurately

and in a timely manner.15 In addition, studies suggest that educational programs provide workers with both

competencies and increased commitment to their jobs, which are associated with retention (Zlotnick et al.,

2005). Child welfare agencies deliver a variety of training initiatives to build competencies and align skills

with new practice models. Some states have formed university-agency partnerships that provide training

and, in some cases, funding for child welfare staff to pursue graduate social work degrees (Social Security

Act, Title IV-E). In the federal child welfare system, states are required to provide certain types of training

for CPS workers (Children’s Bureau, n.d.-e). Federal child welfare guidelines promote ongoing training and

certification of caseworkers to maintain competency (DePanfilis & Salus, 2003).

The APS Survey revealed that 18 APS systems provided less than a week of training, 10 one week or more,

and four states provided no training to new caseworkers (NAPSA & NASUAD, 2012). The NAPSA Minimum

Standards identify core activities critical to the mission of APS and recommend that staff receive training on

how to carry out these core activities skillfully.
56 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

Training plays a role in APS worker satisfaction

and worker retention and enables staff to

continue their development. Structured,

comprehensive, standardized training

promotes skillful, culturally competent, and

consistent APS practice. Training curricula

should address the various education levels,

experience, years of service, and training

needs of both new workers and more

experienced workers.

It is recommended that an APS worker training

process have four important components or

phases: orientation to the job, supervised

fieldwork, core competency training, and

advanced or specialized training.

The complex roles performed by APS workers

require both formal content delivery and

guided fieldwork to affect the transfer of

learning from the classroom to practice.

Subject content may be delivered in a variety

of modalities, including, but not limited to,

classroom workshops, reading, workbook

exercises, case conferences, shadowing

experienced workers, online courses, and

virtual-reality- or simulation-based trainings

for experiential learning. APS systems are

encouraged to be creative in content delivery.

Trainers should be qualified and proficient

by academic degree, expertise, and/or work

experience to provide training on the topic

offered. When possible, APS programs are

encouraged to bring in trainers from outside of

the APS program.

■ Orientation to the job

The purpose of the orientation is for workers to acquire knowledge and skills in key

areas and understand when they need to

seek guidance from their supervisor. It is

recommended that APS systems develop

and provide orientation for all new workers.

If possible, key elements of that orientation

need to be completed and workers need

to demonstrate competence in these key

areas before they are assigned cases. It

is recommended that, at a minimum, the

following areas be addressed in the orientation:

•	 concepts articulated in the APS System’s Code of Ethics, including the

principles of autonomy, least restrictive

alternatives, person-centered service,

trauma-informed practice, and supported decision-making;

•	 the role of APS and how the program

fits into the larger long-term services

and support network;

•	 common legal issues with which APS

is involved, including confidentiality,

conflict of interest, and guardianship/

conservatorship (including alternatives

to guardianship and conservatorship);

•	 the types of maltreatment covered by

their state’s statute, including their

definition, signs, and symptoms;

•	 the case documentation process,

including tracking and documenting

attainment of client goals;

•	 the goals and process for conducting

an APS investigation, including both

Guideline

6B continued

continued on page 57
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 57

the determination of maltreatment and

the client assessment;

•	 the process for screening for decisional

capacity;

•	 the process for determining whether

or not maltreatment has occurred, including clear definitions of confirmed,

inconclusive, and unfounded case

finding determinations;

•	 guidance for serving clients with

disabilities;

•	 the importance of culturally competent

service;

•	 the way to incorporate person-centered planning into service planning

and implementation; and

•	 criteria for closing the case and applying a standardized process to determine

level of progress towards client goals.

■ Supervised fieldwork:

It is recommended that the orientation

phase be followed by a period of close

supervision of the new worker by a mentor or supervisor for a period of no less

than 12 months. The ultimate goal of this

supervised fieldwork phase is the “transfer

of learning” (i.e., the direct application of

knowledge and skills to work with clients).

■ Core competency training:

It is recommended that APS systems

provide ongoing training to workers on a

regular basis. It is suggested that training

on the following core competencies for APS

workers be provided within the worker’s

first 24 months:

•	 APS ethical issues and dilemmas

•	 APS philosophy, values and cultural

competence

•	 The aging process

•	 Cognitive deficits, including dementia

•	 Serving clients with physical and intellectual disabilities

•	 Motivational interviewing

•	 Mental health issues

•	 Substance abuse

•	 Dynamics of abusive relationships

•	 Professional communication skills

(written and verbal)

•	 Self-neglect

•	 Caregiver neglect

•	 Financial exploitation

•	 Physical abuse

•	 Sexual abuse

•	 Emotional/psychological abuse

•	 APS case documentation/report writing

•	 Initial investigation and worker safety

•	 Assessing decision-making capacity

•	 Supported decision-making models

•	 Risk assessment

•	 Public benefits eligibility (e.g., Medicare,

Medicaid, Social Security)

•	 Voluntary case planning/intervention

process

•	 Involuntary case planning/intervention

process

•	 Collaboration and resources (including

working in multidisciplinary teams

[MDTs])

•	 Laws related to APS work (e.g., guardianship/conservatorship, mental health

6B continued

continued on page 58
58 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

commitments, domestic violence)

•	 Working with the criminal justice system

•	 Case closure and termination

Nurses working within the APS program should

receive ongoing education related to medical,

physical, emotional and social needs of older

adults and adults with disabilities.

■ Advanced or specialized training:

It is recommended that programs provide

advanced or specialized training for workers. For example, if the APS agency serves

Native American, Hispanic, or other ethnicities, workers should have access to training

specific to those populations. The training

should go beyond a mere “overview” and

provide in-depth content on the specific

needs of those populations to be served.

■ Certification process:

It is recommended that workers be supported in their goal of achieving state or

national certification, if desired.

6B continued
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 59

6C. Supervisor Initial and Ongoing Training

Background

The APS supervisor provides a combination of case oversight, approval of key decisions, case direction,

problem-solving, and support and encouragement to the worker. According to the APS Survey, all but nine

states require training for supervisors (NAPSA & NASUAD, 2012).

Given the potentially hazardous work environment and negative impact on job satisfaction, work stress, and

health outcomes (physical and mental) for APS workers, it is essential that supervisors have the tools to

build positive and supportive work environments. These tools may include management strategies for the

prevention of burnout and secondary traumatic stress (Ghesquiere et al., 2018).

6C

It is recommended that APS supervisors be

qualified by training and experience to deliver

adult protective services. It is recommended

that all APS supervisors receive initial

and ongoing training specific to their job

responsibilities and the complex needs of

APS clients and managing APS workers. It is

recommended that new supervisors be trained

on basic supervisory skills within the first

year of assuming supervisory responsibilities,

including, but not limited to,

■ understanding oneself as supervisor;

■ foundations of effective supervision;

■ teambuilding for APS professionals; and

■ APS supervisor as trainer.

Additional topics for advanced training for

supervisors may include

■ management of personnel issues;

■ data and fiscal operations;

■ worker safety and self-care; and

■ collaboration and resources (Brown, 2019).

Nurses on the APS team should have their

performance monitored and overseen by a

supervisory nurse. The APS nurse should have

access to consultation with a senior nurse and

other members of a medical MDT.

Guideline

61 61

7 | APS Program 

 Performance
62 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

7A. Managing Program Data

Background

Program data serve a key role in telling the story of the important work of APS, and effective data

management is a key for ensuring the story is accurate. Significant variability exists in data collection and

management across the nation. For example, some states keep case data for up to 10 years; other states

purge data at 6 months, or 1 to 2 years.

Adult protection services (APS) programs can only be as effective as their individual practices and

procedures. Thus, evaluation of program performance and well-designed research assessing the impact

of specific practices on APS clients and workers are key to identifying best practices for the field.

APS research has grown significantly over the past few years, with studies focusing on a variety of topics,

such as client satisfaction (Booker, Breaux, Abada, Zia, & Burnett, 2018), factors that predict alleviation of

risk in APS clients (Burnes et al., 2014), and APS workers’ perceptions of repeated referrals and recidivism

to APS (Susman et al., 2015). However, well-designed research is still much needed to demonstrate the

effectiveness of APS programs and practices in improving client outcomes and supporting APS workers and

supervisors do their best work.

The National Adult Protective Services

Association (NAPSA) Minimum Standards

suggest that “APS program data is collected,

analyzed, and reported” and that “[d]ata is

utilized for program improvements such as

budgeting, resource management, program

planning, legislative initiatives and community

awareness, and to improve knowledge about

clients, perpetrators and the services and

interventions provided to them (NAPSA, 2013).”

APS programs are encouraged to keep

program data long enough to ensure their

availability for quality assurance needs (e.g.,

tracking client recidivism rates over time,

identifying trends in maltreatment types, etc.),

and for research purposes (see Susman et al.,

2015, regarding availability of longitudinal

data). It is recommended that the data

collected be congruent with the National Adult

Maltreatment Reporting System.

Guideline

7A
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 63

7B

7B. Evaluating Program Performance

Background

The process of evaluating APS programs’ performance has several goals. First, it provides information on how

the program helps its 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.

The APS Survey reveals that 43 states have developed benchmarks and metrics for program evaluation

(NAPSA & National Association of States United for Aging and Disabilities

[NASUAD], 2012). Generally, however, annual evaluations of program performance are not a standard tool in

each state’s program. Only 17 states reported publishing an annual APS report, with the details of each report

varying greatly.

The federal child welfare system requires the Department of Health and Human Services to establish outcome

measures to monitor and improve state performance (Adoption and Safe Families Act, 1997). In addition,

the child welfare system requires states to implement child welfare improvement policies (Child and Family

Services Improvement and Innovation Act, 2011).15

It is recommended that APS systems compile a

written report on APS programs’ performance

and make that report available to state and

federal bodies and the public on a regular basis.

APS program performance measures should

assess programmatic aspects and service

areas, to determine whether interventions

were executed timely and services met clients’

needs, as well as client-centered outcomes, to

determine whether clients were satisfied with

the services and whether goals specific to the

clients were attained. Innovative measurement

strategies that allow for client variability and

that are capable of tracking change on an

individualized set of outcome indicators, such

as goal attainment scaling (Burnes et al., 2018),

may be effective to assess client-centered APS

intervention outcomes.

Guideline
64 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

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70 March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems

Endnotes

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.

2.	 Universal Declaration of Human Rights; Convention on the Rights of People with Disabilities; United

Nations Principles for Older Persons; Elder Justice Act of 2009; Administration for Community Living

Strategic Plan 2013–2018

3.	 As part of the updates to the Guidelines, element 1G, Protecting Program Integrity, was moved up to

become element 1B. The title for element 4C was changed from “Investigations in Congregate Settings”

to “Investigations in Residential Care Facilities”; and the title for element 4D was changed from

“Completion of Investigation and Substantiation Decision” to “Completion of Investigation and Finding.”

The title for domain 5 was changed from “Services Planning and Intervention” to “Service Planning and

Service Implementation”; element 5A was changed from “Voluntary Intervention” to “Voluntary Service

Implementation”; and element 5B was changed from “Involuntary Intervention” to “Involuntary Service

Implementation.” The title for domain 7 was changed from “Evaluation/Program Performance” to “APS

Program Performance,” and the content was divided into two elements: 7A, Managing Program Data, and

7B, Evaluating Program Performance.

4.	 In federal fiscal year 2017, all 50 states, DC, and four territories provided data related to their APS agency

profile information and investigation data (agency component data).

5.	 The failure of a caregiver or fiduciary to provide the goods or services necessary to maintain the health or

safety of a person. Includes acts of omission and of commission; includes willful deprivation, etc.

6.	 The use of force or violence resulting in bodily injury, physical pain, or impairment. Excludes sexual abuse.

7.	 A person’s inability, due to physical or mental impairment or diminished capacity, to perform essential selfcare tasks, including obtaining essential food, clothing, shelter, and medical care; obtaining goods and

services necessary to maintain physical health, mental health, or general safety; or managing one’s own

financial affairs. Includes hoarding.

8.	 Nonconsensual sexual contact of any kind, including sexual contact with any person incapable of giving

consent.

9.	 The illegal or improper use of an individual’s funds, property, or assets for another person’s profit or

advantage.

10.	The infliction of anguish, pain, or distress through verbal or nonverbal acts. This includes but is not limited

to verbal assaults, insults, threats, intimidation, humiliation, and harassment.

11.	The illegal or improper use of an individual or of an individual’s funds, property, or assets for another’s

profit or advantage.
March 2020 | Updated National Voluntary Consensus Guidelines for State Adult Protective Service Systems 71

12.	The illegal or improper use of an individual for another person’s profit or advantage, including exploitation

of person, servitude, etc.

13.	A type of maltreatment not included in the categorizations provided.

14.	An unexpected fatality or one in which circumstances or cause are medically or legally unexplained.

15. References to the child welfare system or child protective services herein are included to provide the

reader with information about how and what the federal government requires of the professionals working

in that system. These references are not intended to provide guidance to the APS system; they are

intended to show the contrast between what is provided by way of guidance for the child welfare system

versus the guidance provided herein for the APS system.

16. The case was closed after a finding was made on the allegation of maltreatment; the investigation was

closed, and no ongoing protective services case was opened

17. The case was closed after the investigation was completed, additional protective services were provided,

and the protective services case was closed.

18.	The protective services case was terminated prematurely; reason not specified

19.	The client refused to cooperate with the investigation worker, the investigation was terminated without a

finding, and the case was closed.

20.	The client died during the investigation, the investigation was terminated without a finding, and the case

was closed.

21.	The client decided not to continue work with the protective services agency, and the case was closed.

22. A finding could not be made on the allegations of maltreatment for an unspecified reason, and the case

was closed.


Administration	for	Community	Living

Office	of	Elder	Justice	and	Adult	Protective	Services

U.S.	Department	of	Health	and	Human	Services

Washington,	DC	20201