Mississippi Administrative Code › Title 18 - HUMAN SERVICES › Part 2 - Division of Aging and Adult Services › Chapter 1 - State Plan on Aging › Section 18-2-1-IX - Attachments › Attachment 18-2-1-IX-C - Priorities, Goals, Objectives, Outcomes and Performance Measures

Current through June 25, 2024
During the next four years, activities of the DAAS will be
					 guided by the three broad categories of: Home and Community-Based Systems,
					 Elder Abuse Prevention and Advocacy, and Administration and Management that
					 follow with the four (4) goals of the Administration on Aging.
Administration on Aging's Strategic Plan
					 Goals
Goal 1: Empower older people, their families, and other
					 consumers to make informed decisions about, and be able to easily access,
					 existing health and long-term care options.
Goal 2: Enable seniors to remain in their own homes with
					 high quality of life for as long as possible through the provision of home and
					 community-based services, including supports for family caregivers.
Goal 3: Empower older people to stay active and healthy
					 through Older Americans Act services and the new prevention benefits under
					 Medicare.
Goal 4: Ensure the rights of older people and prevent their
					 abuse, neglect and exploitation.
Mississippi Department of Human Services Division of
					 Aging and Adult Services' Goals
Goal 1: Increase the number of older people who will
					 have access to an integrated array of health and social supports.
Strategic Objective 1.1
Strengthen DAAS'
					 capacity to deliver access services to people through an integrated array of
					 health and social services.
Implementing Objectives:
1. Promote the Aging and Disability Resource Center (ADRC)
					 concept and expand partnerships and geographic coverage.
2. Enhance collaboration, cooperation, and commitment to
					 the ADRC notion within the aging network.
3. Develop ADRC access methodologies that include
					 state-of-the-art electronic information resource systems capable of answering
					 inquiries about health and social supports and include components for client
					 intake, care plans, assessment of need, service utilization, and tracking
					 service costs.
4. Develop partnerships with state agencies and other
					 public and private entities to partner in the ADRC and information systems
					 projects.
5. Provide a comprehensive array of information, intake,
					 referral, and counseling services for seniors, disabled adults, and caregivers
					 through the ADRC.
6. Educate the public, including low-income, rural, and
					 limited English speaking older people, about the resources available through
					 the ADRC.
7. Collaborate with ADRC partners to write and submit the
					 ADRC State Plan prior to the start of the 2012 federal fiscal year.
8. Enhance public information, education, and awareness
					 activities by developing and disseminating information regarding issues and
					 concerns of older persons through public media.
9. Ensure provision of service to private pay and
					 non-elderly (disabled adults) clients.
10. Empower consumers to make informed decisions about
					 long-term care programs, existing care options, and planning for long-term care
					 needs through a comprehensive information system.
11. Develop measurable performance objectives through
					 consumer response research that address: program visibility, consumer trust,
					 ease of access, responsiveness to consumer needs, efficiency of operations, and
					 program effectiveness.
12. Participate on the state transportation assessment
					 committee and the United We Ride initiative and apply the toolkit to assess
					 needs of the elderly for transportation.
13. Participate in the state coordination transportation
					 effort to assist seniors locate transportation.
14. Implement a total of 10 fully-functioning ADRCs by
					 Federal Fiscal Year 2014.
Performance Measures (PM):
1. ADRC Standard Operating Procedures.
2. Number of fully-functioning ADRCs.
3. Number of partnerships to support the sustainability of
					 ADRCs.
4. Percentage of follow-ups completed within the required
					 fourteen (14) day window following the initial referral.
5. Compliance with implemented waiting list policy using
					 the customer tracking system.
6. Number of visits to the MississippiGetHelp.org website.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM2: # of Fully Functioning ADRCs
1
2
5
7
10
PM 3: # of partnerships to sustain ADRC
Not tracked
0
1
2
4
PM4: % of follow-ups completed within 14 days
Not tracked
50%
75%
90%
100%
PM6: # of visits to
Not tracked
300,000
600,000
1,200,000
2,400,000
website
Objective 1.2
Support the Aging Network role
					 in developing systems of care that provide an integrated array of health and
					 social supports.
Implementing Objectives:
1. Provide formula grants to AAAs to support information,
					 outreach, access, nutrition, and supportive services; ensuring development of
					 integrated systems of service through the area plans.
2. Provide a statewide client management system to document
					 use of funds.
3. Identify state-of-the-art models and techniques of care
					 to improve access to resource systems and pilot new projects.
4. Maintain and increase the availability of support
					 services for older adults and their caregivers, (i.e., adult day care, case
					 management, congregate meals, emergency response, home-delivered meals,
					 homemaker, information and referral/assistance, legal assistance, ombudsman,
					 outreach, respite, senior center, transportation) with preference in providing
					 services to older individuals with greatest economic or social need, low income
					 minority individuals, and individuals residing in rural areas.
5. Develop strategies for AAAs to strengthen the Home and
					 Community-Based Service System through exploring consumer choice models for
					 service delivery. (i.e., adult day care, congregate meals, emergency response,
					 home-delivered meals, homemaker, respite, senior center, transportation)
6. Discourage age discrimination by increasing public and
					 private sector awareness and involvement in employing older workers who wish to
					 remain in or return to the work force through unsubsidized placement of Title V
					 enrollees.
7. Support future policy and program development through
					 review and analysis of available resource data to identify strategies and
					 approaches for system improvement.
Performance Measures:
1. Number of partnerships with State agencies to enhance
					 and streamline access to services.
2. Number of persons screened for services.
3. Number of new congregate meal sites.
4. Number of high-risk persons identified.
5. Media campaign targeting rural areas to promote
					 awareness on the benefits of hiring older workers.
6. Number of individuals assisted through the Aging and
					 Disability Resource Center information and assistance service.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM2: # of persons
23,489
24,000
24,000
24,000
24,000
screened for services
PM3: # of new congregate sites
Not Tracked
2
3
6
8
PM4: # of high-risk persons served
10,437
10,959
11,507
12,082
12,686
PM6: # of individual assisted through the ADRC
3248
10,000
13,000
16,000
19,000
Objective 1.3
Partner with federal, state, and
					 private sector organizations to promote policies, programs, and activities that
					 increase access for seniors.
Implementing Objectives:
1. Explore opportunities to develop, maintain, and expand
					 the Home and Community-Based Services partnership system including:
a. Departments of Education-Child and Adult Care Food
					 Program and institutions of higher learning, Health, Mental Health-Alzheimer's
					 Division and Development Disabilities Council, Rehabilitation Services,
					 Transportation and Workforce Investment Act programs.
b. State elderly nutrition program.
c. Volunteer, community, fraternal, and religious
					 organizations.
2. Develop joint projects and activities with
					 partners.
3. Participate in government-wide and private sector
					 projects and activities that improve access.
4. Encourage AAA development of partnerships in the public
					 and private sector.
5. Promote the implementation of federal actions such as
					 the Medicare Modernization Act.
6. Coordinate with advocacy organizations to advocate for
					 and promote changes in legislation positively affecting elderly citizens.
Performance Measures:
1. Number of Memoranda of Agreements with State agencies
					 for electronic referrals for services through the client tracking
					 system.
2. Number of partnerships at the Area Agency on Aging level
					 with hospital and nursing home discharge planners.
3. Development of a caregiver training curriculum.
4. Number of caregiver trainings.
5. Promote the introduction of at least one piece of
					 legislation promoting positive changes affecting the Aging population per
					 legislative session.
Outcomes:
Program
2010
2011
2012
2013
2014
Actual
Projected
Projected
Projected
Projected
PMl:#of MOAs with State Agencies for e-refer
0
0
1
2
4
PM2: # of partnerships at AAA with discharge planners
Not Tracked
1
2
5
10
PM4: # of caregiver trainings
Not Tracked
0
1
1
1
PM5:# of bills introduced
2
1
1
1
1
Goal 2: Increase the number of older people who stay
					 active and healthy.
Objective 2.1
Strengthen the DAAS' capacity to
					 provide information to older people to promote an active and healthy lifestyle
					 and educate the public about the importance of lifestyle choices, health
					 promotion, and disease prevention.
Implementing Objectives:
1. Develop activities and resources that educate seniors
					 about starting and maintaining an active and healthy lifestyle and healthy
					 behaviors.
2. Develop health promotion and disease prevention programs
					 for seniors, particularly low-income, rural, and limited English speaking
					 people, and the public.
3. Develop activities to promote life planning strategies
					 for seniors and baby boomers that address the following topics:
a. active aging and social engagement
b. retirement
c. volunteerism
d. money-management
e. wellness and health care counseling
f. long-term care insurance
g. end of life decision making
4. Encourage the development of intergenerational programs,
					 i.e., mentoring children and young adults.
Performance Measures:
1. Number of funding sources utilizing Information and
					 Referral to improve service delivery for promoting a healthy lifestyle.
2. Participation in community health fairs and seminars
					 promoting health.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM2: # of health promotion health fairs
Not Tracked
Not Tracked
20
30
45
Objective 2.2
Develop programs aimed at
					 adopting and maintaining active and healthy lifestyles throughout the Aging
					 Network.
Implementing Objectives:
1. Provide AAAs formula subgrants to support health
					 promotion services and ensure effective use of funds.
2. Provide a statewide client management system to document
					 use of funds.
3. Identify state-of-the-art models and techniques of care
					 that can be used to improve health promotion and disease prevention programs
					 and pilot new projects.
4. Target development and testing programs that help older
					 people stay active and healthy, including the high risk population.
5. Support future policy and program development through
					 review and analysis of available resource data to identify strategies and
					 approaches for improvement.
6. Develop congregate meal program to increase
					 participation and expand wellness programs.
7. Promote older persons as resources for their
					 communities.
Performance Measures:
1. Number of care transition programs available
					 statewide.
2. Number of volunteers utilized at the local level.
3. Number of wellness programs provided at congregate
					 sites.
4. Annual presentation and recognition of the distinguished
					 older Mississippian.
5. Annual recognition of volunteers supporting the Aging
					 network.
6. Number of individuals provided information on the
					 promotion of an active and healthy lifestyle as well as the education of the
					 public about the importance of lifestyle choices, health promotion, and disease
					 prevention.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM1: # of care transition programs
Not
							 Tracked
1
2
5
10
PM3: # of wellness programs at congregate sites
Not Tracked
10
15
20
25
PM6: # of individuals provided info on health
							 promotion
Not Tracked
Not Tracked
Objective 2.3
Partner with government agencies
					 and private sector organizations to promote policies, programs, and activities
					 that encourage people to adopt and maintain active lifestyles and practice
					 healthy behaviors.
Implementing Objectives:
1. Locate joint projects and activities and partner with
					 public and private agencies and organizations to accomplish the
					 objective.
2. In collaboration with the Mississippi Department of
					 Health, assist AAAs to organize health screening fairs.
3. Partner with the Mississippi Department of Health to
					 sponsor influenza/pneumonia vaccination events for seniors.
4. Promote Medicare Prescription Plan enrollment during
					 public health related events.
5. Participate in government and private sector activities
					 and initiatives that have the potential to help older people.
6. Market the Aging Network to the public/private sectors
					 using public awareness activities to develop strategies for communication,
					 coordination, and collaboration and increase awareness and understanding of the
					 benefits of each partnership to promote healthy lifestyles.
7. Co-sponsor SCAM JAMS with Mississippi Secretary of State
					 to help consumers beware of fraud and abuse in the Medicare program. (SMP
					 program)
8. Train SMP volunteer counselors to help detect and report
					 waste, fraud, and abuse.
9. Provide educational events and counseling to help
					 seniors understand Medicare, Medicaid, and other health insurance
					 matters.
10. Maintain and strengthen partnership with Alzheimer's
					 organizations.
Performance Measures:
1. Development of media campaigns to market the Aging
					 network.
2. Participation in local market broadcasting opportunities
					 to promote the Aging network.
Goal 3: Increase the number of families who are
					 supported in the efforts to care for family and friends at home or in the
					 community.
Objective 3.1
Provide information to family
					 and caregivers to support the caregiver role and educate the public on
					 caregiving and the importance of supporting caregivers.
Implementing Objectives:
1. Develop activities and resources that educate seniors,
					 caregivers, and the general public, including policymakers, about family
					 caregiving and the importance of helping families to care for relatives and
					 friends at home.
2. Provide information to families, including low-income,
					 rural, and limited English-speaking families about family caregiving.
3. Promote grandparents caring for grandchildren
					 initiatives.
4. Draft and support state legislation to assist families
					 to care for relatives at home.
Performance Measures:
1. Number of caregiver trainings provided at the area
					 agency on aging level.
2. Expand the number of area agencies on aging offering the
					 Grandparenting program.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM1: # of caregiver trainings
Not Tracked
0
1
1
1
PM2: # of AAAs offering grandparenting programs
1
1
2
4
5
Objective 3.2
Support the Aging Network's role
					 in helping family caregivers.
Implementing Objectives:
1. Provide formula grants to AAAs to support the National
					 Family Caregiver Support Program (Title III E); ensuring the effective use of
					 the funds.
2. Provide a statewide client management system to document
					 use of funds.
3. Identify and disseminate state-of-the-art models and
					 techniques of care to improve services that provide support for and help
					 caregivers.
4. Support future policy and program development through
					 review and analysis of available resources to identify strategies and
					 approaches for improvement.
Objective 3.3
Partner with other Federal
					 agencies and private sector organizations to promote policies, programs, and
					 activities that support family caregivers.
Implementing Objectives:
1. Partner with public and private agencies and
					 organizations on joint projects and activities to accomplish the
					 objective.
2. Participate in government and private sector activities
					 and initiatives that have the potential to benefit the family caregiver program
					 goals.
Performance Measures:
1. Number of referrals to state agencies to streamline
					 access for caregiver services.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM1: # of referrals to state agencies for caregiver
							 services
Not Tracked
0
100
225
500
Goal 4: Increase the number of older people who
					 benefit from programs that protect their rights and prevent elder abuse,
					 neglect, and exploitation.
Objective 4.1
Provide information to older
					 persons on elder rights and consumer protection issues and programs, and
					 educate the public on the importance of such programs.
Implementing Objectives:
1. Develop activities and resources that educate seniors,
					 caregivers, and the general public, including policymakers, on the importance
					 of protecting the rights of older people in preventing elder abuse, neglect,
					 and exploitation.
2. Provide information to seniors, including low-income,
					 rural, and limited English-speaking persons, caregivers, and the general
					 public, about benefits to which they are entitled.
3. Provide the Aging Network with up-to-date information on
					 new amendments or changes to the statutes and/or regulations concerning elder
					 abuse prevention.
4. Support the goals of the Mississippi Leadership Council
					 of Aging to promote the safety and security of older Mississippians.
Performance Measures:
1. Development of a training curriculum to educate the
					 general public on accessing available services.
2. Media campaign to educate the general public on the
					 importance of protecting the rights of older people in preventing elder abuse,
					 neglect and exploitation.
Objective 4.2
Support the Aging Network's role
					 in protecting older consumers in preventing elder abuse, neglect, and
					 exploitation.
Implementing Objectives:
1. Provide formula grants to AAAs to support elder abuse
					 prevention, legal services, legal services hotlines, and long-term care
					 ombudsman programs (Title III B and Title VII); ensuring the effective use of
					 the funds.
2. Provide a statewide client management system and
					 Ombudsman activity tracking program to document use of funds.
3. Identify and disseminate state-of-the-art models and
					 techniques that can be used by states and communities to inform seniors of
					 their rights and prevent elder abuse, neglect, and exploitation.
4. Support the development of new models or techniques that
					 can make it easier for older persons to know their rights.
5. Support future policy and program development through
					 review and analysis of available resources to identify strategies and
					 approaches for improvement in this area.
6. Implement and monitor the Adult Protective Services
					 program in the DAAS.
7. Support the Ombudsman Program to protect residents in
					 nursing and personal care homes from abuse.
8. Promote coordination with law enforcement and the
					 judicial system to educate first responders and increase successful prosecution
					 of persons who are responsible for acts of adult abuse, neglect, and
					 exploitation.
9. Develop training and education opportunities for law
					 enforcement personnel responsible for investigation of adult abuse, neglect,
					 and exploitation.
Performance Measures:
1. Number of resolved nursing home complaints.
2. Number of LTC Ombudsman information and assistance
					 calls.
3. Number of LTC Ombudsman visits to residents.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM1: # of resolved complaints
991
1040
1092
1146
1203
Objective 4.3
Partner with other Federal
					 agencies and public and private sectors to promote policies, programs, and
					 activities to inform seniors of their rights and prevent elder abuse neglect
					 and exploitation.
Implementing Objectives:
1. Partner with public and private agencies and
					 organizations on joint projects and activities to accomplish the
					 objective.
2. Participate in government and private sector activities
					 and initiatives that have the potential to benefit the program goals.
3. Coordinate with the Department of Mental Health
					 Development Disability Council about intervention strategies supporting the
					 concept of aging in place for seniors and persons with developmental
					 disabilities.
4. Promote and support efforts in coordinating services and
					 support systems for seniors with developmental disabilities.
5. Cross-train professionals in the aging and developmental
					 disabilities service networks.
6. Support legislative initiatives to enhance the rights of
					 the elderly, specifically those which will preserve independence and
					 self-determination.
7. Coordinate with advocacy organizations to advocate for
					 and promote changes in legislation positively affecting elderly citizens.
Performance Measures:
1. Number of TRIADs at the local level.
2. Creation of a statewide Elder Abuse Prevention
					 Program.
3. Number of materials distributed.
4. Number of presentation, trainings and events.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM1: # of TRIADs
Not Tracked
5
10
15
20
PM4: # of presentations regarding EAP
Not
							 Tracked
5
10
15
20
Goal 5: Strengthen the effectiveness of DAAS'
					 administration and management practices.
Objective 5.1
Improve strategic management of
					 human capital within DAAS.
Implementing Objectives:
1. Manage the planning, development, and coordination of
					 human resources to sustain an adequate supply of trained permanent personnel to
					 meet the needs of the aging programs at the state and local levels.
2. Maintain workforce plans for DAAS and the AAAs.
3. Provide training and professional staff development for
					 DAAS, AAAs and service providers.
4. Serve as the focal point at the state level for
					 information, data collection/dissemination, training, and technical assistance
					 to agencies, organizations, businesses, and etc. about activities and issues
					 impacting older Mississippians.
5. Provide professional development and continuing
					 education credits during the statewide annual Aging and Long Term Care
					 conference and at selected training events.
6. Promote college/university Gerontological program
					 involvement in the Aging Network.
7. Collaborate with Gerontological organizations to develop
					 resources.
8. Develop the necessary orientation, training
					 manuals/materials, and certification, and training activities needed in new
					 program areas.
Performance Measure:
1. Number of professional development seminars for DAAS,
					 AAAs and service providers.
Objective 5.2
Maintain strong financial
					 management practices.
Implementing Objectives:
1. Provide exemplary financial management for the
					 DAAS.
2. Provide oversight for financial management of
					 AAAs.
3. Guide AAA subgrant activities through the Subgrantee
					 Manual and the Service Provider Policy Manual that outline rules and
					 regulations for administration of subgrants and contracts, and fiscal
					 management of federal, state and local funds.
4. Ensure that AAAs issue a request for proposals for
					 services in the PSA.
Performance Measure:
1. Number of quality assurance checks performed.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM1: # of quality assurance checks performed
Not Tracked
5
10
10
10
Objective 5.3
Leverage technology for optimal
					 program management service delivery.
Implementing Objectives:
1. Create and maintain an efficient Management Information
					 System which produces accurate and timely data collection.
2. Provide training and technical assistance to AAAs to
					 improve reporting.
3. Monitor reporting for NAPIS, NORS, Title V, CACFP and
					 other programs.
4. Submit grants/subgrants electronically.
5. Communicate electronically with AAAs and other human
					 service agencies/organizations.
6. Continue to upgrade the MIS to meet changing data
					 requirements of AAAs and service providers.
7. Integrate service providers into the Aging Network
					 referral and reporting systems.
Performance Measures:
1. Number of trainings and technical assistance visits to
					 AAAs to improve reporting.
2. Number of service providers participating in the state
					 MIS.
3. Number of collaboration meetings to analyze impact of
					 expenditures and service delivery.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM1: # of reporting trainings
Not Tracked
3
2
4
4
PM2: # of provided using MIS
Not Tracked
1
10
20
20
Objective 5.4
Achieve integration of budget
					 and performance.
Implementing Objectives:
1. Evaluate and review of AAA Program Performance Reports
					 (quarterly).
2. Analyze impact of annual subgrants to determine unit
					 cost service delivery/effect on seniors.
3. Monitor NAPIS and NORS requirement outcomes and make
					 modifications as necessary.
4. Review and monitor the AAA reporting systems in NAPIS,
					 NORS, SHIP, SMP, Title V and others.
5. Share performance information with the partners, program
					 stakeholders and advocacy supporters.
Performance Measures:
1. Evaluation of quarterly budget and performance reports
					 to justify expenditures per service and funding source.
Objective 5.5
Provide leadership and oversight
					 in the development, delivery, and provision of Aging programs and services
					 through compliance with established policies, procedures, and Quality Assurance
					 Standards.
Implementing Objectives:
1. Develop State and Area Plan processes.
2. Conduct public hearings.
3. Solicit the views and concerns of older citizens, public
					 officials and the general public on the priority service needs of older
					 Mississippians.
4. Review and monitor Area Plans and take corrective
					 action.
5. Evaluate rural, low income and low-income minority
					 population data in PSAs and formulate fund allocation to meet rural, low income
					 and low-income minority needs through the Intrastate Funding Formula.
6. Monitor and evaluate each AAA's performance and service
					 delivery using the Quality Assurance Review Instruments through desk-top and
					 annual on-site visits.
7. Ensure program coordination.
8. Develop a State Leadership Advisory Council with
					 AAAs.
9. Review and update the Quality Assurance Standards and
					 Review Instruments (with input and recommendations from the AAAs and service
					 providers), Policies and Procedures Manuals, etc. to reflect the
					 reauthorization of the Older Americans Act and Departmental Administrative
					 changes.
10. Ensure that reviews of service providers are conducted
					 to assess effectiveness in serving and meeting the needs of rural, low-income,
					 and low-income minority older persons.
Performance Measures:
1. Number of staff development seminars for DAAS, AAAs and
					 service providers on compliance with established policies and
					 procedures.
2. Attendance at annual public hearings held by each area
					 agency on aging.
3. Number of desktop and annual on-site visits to monitor
					 and evaluate AAA performance and service delivery.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM1: # of policy trainings
Not Tracked
PM3: # of service delivery quality checks
Not Tracked
Objective 5.6
Actively pursue new funding
					 sources for Aging services and programs.
Implementing Objectives:
1. Demonstrate the need for commitment to and support of
					 new partnerships from federal, state, and local government, and the public and
					 private sector.
2. Explore the feasibility of developing sliding fee scales
					 and cost-sharing strategies to increase revenues to support aging services and
					 programs.
Performance Measures:
1. Number of grants opportunities actively pursued.
2. Number of new partnerships to support Aging services and
					 programs.
Outcomes:
Program
2010 Actual
2011 Projected
2012 Projected
2013 Projected
2014 Projected
PM1: # of new grant opportunities pursued
3
2
2
2
2
Administration on Aging Strategic Goals
1. Empower older people, their families, and other
					 consumers to make informed decisions about, and to be able to easily access,
					 existing health and long term care options.
2. Enable seniors to remain in their own homes with high
					 quality of life for as long as possible through the provision of home and
					 community-based services, including supports for family caregivers.
3. Empower older people to stay active and healthy through
					 Older Americans Act services and the new prevention benefits under
					 Medicare.
4. Ensure the rights of older people and prevent their
					 abuse, neglect and exploitation.