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APS
Adult protective Services mh&mr iNVESTIGATIONS oVERVIEW

The Adult Protective Services MH&MR Investigations Program investigates reports of abuse, neglect, and exploitation of persons with disabilities (children and adults) receiving services in state operated and/or contracted settings that serve adults and children with mental illness mental retardation, or other types of developmental disabilities. Investigation results are sent to the facility or program administrator for appropriate action.

Paid Expenditures and Total Average Filled
Full Time Equivalent (FTE) Staff

Total Staff 151.5
Direct Delivery Total 147.0
Direct Delivery Workers 106.0
Direct Delivery Supervisors 20.6
Direct Delivery Other 20.4
Staff Costs $8,322,953.75

Worker demographic

Turnover Rate   18.1%
Tenure Less than 1 Year 25.0%
1-3 Years 39.5%
Greater than 3 Years 35.5%
Entry Salary   $30,481.44
Average Age   40.6
Race/Ethnicity African-American 16.90%
Anglo 58.9%
Hispanic 24.2%
Other 0.0%

Supervisor Demographics

Turnover Rate   8.9%
Tenure Less than 1 Year 0.0%
1-3 Years 0.0%
Greater than 3 Years 100.0%
Entry Salary   $39,117.96
Average Age   46.4
Race/Ethnicity African-American 8.7%
Anglo 69.6%
Hispanic 17.4%
Other 4.3%

Description of the Report Investigation Process

Step 1: Notifications

The following persons are notified within one hour of the receipt of the intake:

  • Facility administrator
  • Law enforcement if allegations involves serious physical injury, sexual abuse, or death of an adult.
  • Law enforcement of any allegation involving a child.
Step 2: Investigation Activities
  • Face to face contact with alleged victims
  • Interview of witnesses and alleged perpetrator
  • Collection of written statements and documentary evidence.
  • Photographing of injuries
  • Photographing/diagramming scene of incident
  • Gathering other relevant evidence
Step 3: Investigation Findings
  • Analyze evidence
  • Determine finding(s)
  • Generate investigative report
  • Provide report to facility administrator
  • Provide report to law enforcement if investigation confirms abuse, neglect, or exploitation that may constitute a criminal offense

Note: This chart is for reference only and does not necessarily represent the flow of a case.

Statistics FY 2010

  • Completed MH&MR Investigations: 9,922
  • Confirmed MH&MR Investigations: 1,198

Most Common...

  • Person reporting abuse/neglect/exploitation: Facility Staff (28.7%)
  • Allegation confirmed: Neglect (55.7%)
  • MH&MR setting investigated: State Supported Living Centers (39.6%)
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Legal Responsibility for Statewide Intake

Statutory References

Federal: Title XX, Social Security Act
State: Human Resources Code, Chapters 40 and 48
Texas Family Code, Title V
Health and Safety Code, Chapter 532 and Chapters 591-595

Major Provisions

  • Mandatory reporting of abuse, neglect, and exploitation
    of adults who are elderly (defined as age 65 and older) or
    adults with disabilities.
  • Receipt and investigation of all reports (unless patently
    false); initiation of investigations within 24 hours of
    receipt of report.
  • Responsibility for investigations of abuse, neglect, and
    exploitation of persons receiving services in state operated
    mental health and mental retardation facilities (State
    Hospitals, State Schools, and State Centers) and/or state
    contracted settings (Community MH and MR Centers,
    Home and Community-based Services programs, and
    Texas Home Living Waiver Program) that serve adults and
    children with mental illness or mental retardation.
  • Responsibility for referring reports to other state agencies
    when DFPS is not the appropriate investigating agency.
  • Provision or arrangement of services needed to prevent or
    alleviate abuse, neglect and/or exploitation.
  • Enhancing and developing community resources in
    an effort to increase awareness of abuse, neglect and
    exploitation and to address increasing needs of APS
    consumers
  • Responsibility for referring adult victims of abuse, neglect
    and/or exploitation to the Department of Aging and
    Disability Services (DADS) for guardianship services when
    these persons appear to lack the capacity to consent to
    services. Guardianship is the least restrictive alternative
    that will ensure the person’s safety and well-being when no
    other guardian is available.
  • Assessment of factors that may indicate an adult’s possible
    lack of capacity to consent to services and pursuit of a
    medical evaluation if indicated.
  • Using the least restrictive alternative in the provision of
    protective services.
  • Authority to seek court orders when necessary to gain
    access to the individual, to prevent interference with the
    provision of voluntary protective services, to provide
    emergency protective services, to access records or
    documents, and to initiate emergency protective services
    (e.g., a removal) after hours and on holidays without a
    court order.
  • Requirement to notify law enforcement if APS suspects
    that an elderly person or adult with a disability has been
    abused, neglected, or exploited in a manner that constitutes
    a criminal offense.
  • Confidentiality of case records.

Other Programmatic Information:

Factors Contributing to Abuse, Neglect, and
Exploitation:
  • Aging population
  • Growing number of younger persons with disabilities
  • Alcohol and drug dependency
  • Poverty
  • Lack of affordable housing and high costs of utility bills
  • De-institutionalization of persons who are mentally ill
    and/or mentally retarded when community support is not
    adequate
  • Inadequate access to health care and costly medications
  • Pathological family relationships/violence as a coping
    mechanism in society
  • Physical and mental stress of caregiving in traditionally
    non-violent, caring households
  • Denial of benefits, such as SSI and Medicaid, to some
    elderly and disabled immigrants
Challenges:
  • Affordable and safe housing for elders and adults with
    disabilities
  • Waiting lists and other limitations in the availability of inhome
    care and home health care
  • Shortage of resources to serve persons denied long-term
    care and other benefits under welfare reform
  • Gaps in surrogate decision-making processes for
    incapacitated persons in hospitals, nursing homes and
    community-based settings
  • Inadequate community services for persons discharged
    from state hospitals and schools
  • Lack of statewide access to preventative or early
    intervention services such as long-term case management
    for elderly persons and adults with disabilities who
    are at risk, but not yet experiencing abuse, neglect, or
    exploitation
  • Hiring and maintaining a skilled workforce while the
    availability of caseworkers and specialized geriatric social
    work training is not keeping pace with the ever-increasing
    number of older Americans

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Completed Investigations in MH&MR Settings By Source of Report
Fiscal Year 2010

Sources Number Percent
Facility Staff 2,875 28.7%
Self 2,305 23.0%
Other 828 8.3%
Social Services 678 6.8%
Anonymous 601 6.0%
Nurse 448 4.5%
Family Member 388 3.9%
Mental Health 375 3.7%
Healthcare 372 3.7%
Unknown 366 3.6%
Paid Caregiver 289 2.9%
Public Employee 233 2.3%
Law Enforcement 102 1.0%
Friend/Neighbor 91 0.9%
Psychologist 62 0.6%
Physician 18 0.2%
DFPS Staff 1 0.0%

Note: A report of abuse/neglect may come from multiple sources.

Average Length of Completed MH&MR Investigations by Region
Fiscal Year 2010

Region Investigations Average Days
1 Lubbock 515 11.4
2 Abilene 1,290 10.3
3 Arlington 1,266 8.0
4 Tyler 490 9.7
5 Beaumont 302 12.6
6 Houston 734 21.0
7 Austin 2,101 11.9
8 San Antonio 764 22.2
9 Midland 1,268 9.6
10 El Paso 252 7.4
11 Edinburg 923 11.3
Unknown* 17 12.9
Grand Total 9,922 12.1

*Unknown not included in calculation of state average.

Number of MH&MR Investigations Referred to Law Enforcement by Setting
Fiscal Year 2010

Setting Law Enforcement Provided Notification of Investigation* Law Enforcement Provided Investigation Report**
State Supported Living Center 1,241 576
State Hospital 675 120
HCS 597 171
Community MH&MR Center 117 27
Private ICF/MR 88 36
State Center 40 1
Other 15 0
Total 2,773 931

* Notification sent on investigations which involve a child or serious physical injury, sexual abuse, or death of an adult person served.
** This data includes all cases in which a final investigation report was sent regardless of investigation disposition.

Types of Confirmed Allegations in MH&MR Settings
Fiscal Year 2010

Types of Confirmed Allegations Number Percent
Neglect  1,086 55.7%
Physical Abuse 411 21.1%
Emotional Abuse 314 16.1%
Exploitation 99 5.1%
Sexual Abuse 39 2.0%

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Characteristics of Victims in Confirmed Investigations in MH&MR Facilities
Fiscal Year 2010

Characteristic: Race/Ethnicity

Characteristic:
Race/Ethnicity		 Female Percent of Total Male Percent of Total Unknown Percent of Total Subtotal Percent of Total
Anglo 334 21.3% 540 34.4% 2 0.1% 876 55.9%
African American 72 4.6% 180 11.5% 0 0.0% 252 16.1%
Hispanic 132 8.4% 223 14.2% 0 0.0% 355 22.6%
Native American 0 0.0% 1 0.1% 0 0.0% 1 0.1%
Asian 2 0.1% 4 0.3% 0 0.0% 6 0.4%
Other 24 1.5% 48 3.1% 6 0.4% 78 5.0%
Total Victims 564 36.0% 996 63.5% 8 0.5% 1,568 100%

Characteristics of Perpetrators in Confirmed Investigations in MH&MR Facilities
Fiscal Year 2010

Perpetrator Characteristic: Race/Ethnicity

Race/Ethnicity Female Percent of Total Male Percent of Total Unknown Percent of Total Subtotal Percent of Total
Anglo 206 15.0% 123 9.0% 12 0.9% 341 24.9%
African American 265 19.3% 177 12.9% 3 0.2% 445 32.5%
Hispanic 146 10.7% 109 8.0% 1 0.1% 256 18.7%
Native American 1 0.1% 0 0.0% 0 0.0% 1 0.1%
Asian 1 0.1% 4 0.3% 1 0.1% 6 0.4%
Other 86 6.3% 52 3.8% 183 13.4% 321 23.4%

Note: A completed investigation may have more than one victim.

Perpetrator Characteristic: Age

Age Female Percent of Total Male Percent of Total Unknown Percent of Total Subtotal Percent of Total
Under 18 0 0.0% 1 0.1% 9 0.7% 10 0.7%
18-25 177 12.9% 170 12.4% 7 0.5% 354 25.8%
26-35 183 13.4% 129 9.4% 54 3.9% 366 26.7%
36-45 152 11.1% 80 5.8% 35 2.6% 267 19.5%
Over 45 191 13.9% 80 5.8% 31 2.3% 302 22.0%
Unknown 2 0.1% 5 0.4% 64 4.7% 71 5.2%
Total 705 51.5% 465 33.9% 200 14.6% 1,370 100%

Note: Each victim may have more than one perpetrator. Each perpetrator may have more than one victim.

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Completed Investigations by MH&MR Settings by Fiscal Year

Fiscal Year Completed Investigations
2006 7,930
2007 8,088
2008 8,870
2009 9,730
2010 9,922

Completed Investigations by MH&MR Settings
Fiscal Year 2010

Fiscal Year Completed Investigations
State Schools 3,931
State Hospitals 2,641
HCS 2,172
Community MHMR Centers 643
ICF-MR Facilities 274
State Centers 261
Total 9,922

Disposition of Completed MH&MR Investigations
Fiscal Year 2010

Setting of MH&MR Investigations

Setting Confirmed (%)Confirmed Unconfirmed (%)Unconfirmed Inconclusive (%)Inconclusive
Community MH&MR Center 115 1.2% 227 2.3% 96 1.0%
HCS 440 4.4% 1,119 11.3% 306 3.1%
Private ICF/MR 46 0.5% 85 0.9% 33 0.3%
State Center 27 0.3% 145 1.5% 30 0.3%
State Hospital 141 1.4% 981 9.9% 125 1.3%
SSLC 429 4.3% 1,789 18.0% 247 2.5%
State Total 1,198 12.1% 4,346 43.8% 837 8.4%

Setting of MH&MR Investigations

Setting Unfounded (%)Unfounded Other (%)Other Blank (%)Blank Subtotal (%)Subtotal
Community MH&MR Center 6 0.1% 80 0.8% 119 1.2% 643 6.5%
HCS 44 0.4% 275 2.8% 457 4.6% 2,641 26.6%
Private ICF/MR 3 0.0% 59 0.6% 48 0.5% 274 2.8%
State Center 5 0.1% 6 0.1% 48 0.5% 261 2.6%
State Hospital 122 1.2% 329 3.3% 474 4.8% 2,172 21.9%
SSLC 442 4.5% 510 5.1% 514 5.2% 3,931 39.6%
State Total 622 6.3% 1,259 12.7% 1,660 16.7% 9,922 100%

Region of MH&MR Investigations

Region Confirmed (%)Confirmed Unconfirmed (%)Unconfirmed Inconclusive (%)Inconclusive
1 Lubbock 121 1.2% 219 2.2% 53 0.5%
2 Abilene 207 2.1% 614 6.2% 82 0.8%
3 Arlington 138 1.4% 446 4.5% 110 1.1%
4 Tyler 50 0.5% 234 2.4% 42 0.4%
5 Beaumont 40 0.4% 131 1.3% 51 0.5%
6 Houston 76 0.8% 379 3.8% 116 1.2%
7 Austin 172 1.7% 687 6.9% 90 0.9%
8 San Antonio 140 1.4% 411 4.1% 79 0.8%
9 Midland 95 1.0% 620 6.2% 98 1.0%
10 El Paso 37 0.4% 99 1.0% 21 0.2%
11 Edinburg 122 1.2% 505 5.1% 95 1.0%
Other 0 0.0% 1 0.0% 0 0.0%
State Total 1,198 12.1% 4,346 43.8% 837 8.4%

Region of MH&MR Investigations

Region Unfounded (%)Unfounded Other (%)Other Blank (%)Blank Subtotal (%)Subtotal
1 Lubbock 44 0.4% 75 0.8% 36 0.4% 548 5.5%
2 Abilene 47 0.5% 101 1.0% 248 2.5% 1,299 13.1%
3 Arlington 70 0.7% 66 0.7% 413 4.2% 1,243 12.5%
4 Tyler 3 0.0% 1 0.0% 162 1.6% 492 5.0%
5 Beaumont 12 0.1% 20 0.2% 37 0.4% 291 2.9%
6 Houston 7 0.1% 25 0.3% 128 1.3% 731 7.4%
7 Austin 293 3.0% 446 4.5% 300 3.0% 1,988 20.0%
8 San Antonio 26 0.3% 119 1.2% 43 0.4% 818 8.2%
9 Midland 72 0.7% 298 3.0% 123 1.2% 1,306 13.2%
10 El Paso 2 0.0% 95 1.0% 3 0.0% 257 2.6%
11 Edinburg 46 0.5% 13 0.1% 153 1.5% 934 9.4%
Other 0 0.0% 0 0.0% 14 0.1% 15 0.2%
State Total 622 6.3% 1259 12.7% 1,660 16.7% 9,922 100%

Note: "Other" and "Blank" include cases referred back to the facility or closed at intake because they do not meet the definitions of abuse and neglect and therefore are not investigated.

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