APS IH November 2017
APS uses three assessment tools to:
• promote client safety;
• identify strengths and needs; and
• reduce current and future abuse, neglect, and financial exploitation.
APS evaluates observations made and evidence collected during the investigation to assess an alleged victim's overall risk of continued abuse, neglect, and exploitation. This allows APS to:
• reach a full understanding of the alleged victim's situation regardless of the listed allegations;
• document the nature, extent, and root causes of all identified problems;
• provide a foundation for service delivery that will, to the extent possible, bring an end to the abuse, neglect, or financial exploitation and remove any threats to safety;
• identify any signs that indicate the alleged victim may lack capacity to consent; and
• make an informed decision about legal action.
Types of Assessments
There are three assessment tools:
• Safety Assessment (SA)
• Risk of Recidivism Assessment (RORA)
• Strengths and Needs Assessment (SNA)
The assessments have different purposes and points in time when they are completed, as shown in the table below:
When to Complete the Assessment
• Promote the alleged victim's safety
• Identify the alleged victim's needs
• Reduce or alleviate current abuse, neglect, or financial exploitation
• At the beginning of the investigation during case initiation and initial face-to-face contacts
• May complete at any other time during the course of the case (investigation or Intensive Case Services) when the alleged victim's situation significantly improves or deteriorates
Risk of Recidivism Assessment
• Determine the likelihood of future abuse, neglect, or financial exploitation
• Indicate if there is a need for Intensive Case Services
At the end of an investigation with at least one validated finding of abuse, neglect, or financial exploitation
Strengths and Needs Assessment
• Identify the alleged victim's and caretaker's strengths and needs
• Identify root causes of abuse, neglect, and financial exploitation
• Reduce or alleviate future abuse, neglect, or financial exploitation
• As soon as possible after a case is progressed to Intensive Case Services, but no later than 14 calendar days after progression
• Any other time during Intensive Case Services when a new intake is received, or when a new significant need is identified
2410 Safety Assessment
2811 Risk-Based Contact Standards
3300 Maintenance Cases
3220 Strengths and Needs Assessment
Appendix XVII: Assessments Policy and Procedures Overview
APS IH / April 2015
The purpose of a Safety Assessment is to determine if the alleged victim will be safe for the short term, generally about a week. APS assesses alleged victims’ overall risk of harm and level of safety to determine if immediate interventions, including legal actions, are necessary. APS takes immediate and appropriate action when alleged victims are in a situation that poses a serious threat to life or safety.
Human Service Technicians (HSTs), contractors, and student interns may not complete Safety Assessments or Re-assessments. Only trained APS staff in the position of APS specialist I or higher may complete Safety Assessments or Re-assessments.
APS starts the Safety Assessment at case initiation and completes it with the alleged victim during the initial face-to-face contact. If the Safety Assessment is completed at a location other than where the alleged victim resides, a Safety Re-assessment must be completed when the alleged victim returns home.
A Safety Re-assessment (Sections 2-5) may also be completed at any other time during the life of the case when the alleged victim’s situation significantly improves or deteriorates. All Safety Assessments and Safety Re-assessments must be completed face-to-face with the alleged victim, except as outlined in policy (see 2261 Procedure When Alleged Victim Refuses to Cooperate With APS Investigation).
The Safety Assessment provides structured information concerning the current threat of harm or death to an alleged victim. The assessment guides decision-making in determining whether the alleged victim is:
• Safe in his or her current environment;
• Conditionally safe with an immediate intervention agreement in place that addresses identified current dangers; or
• Unsafe because the alleged victim does not accept recommended interventions.
Alleged Victim Has Moved
When an alleged victim permanently moves to a new setting such as an assisted living facility or new residence before an initial Safety Assessment can be completed, the APS specialist completes the assessment as soon as it is possible to see the alleged victim in his or her new environment. If the alleged victim moves after an initial Safety Assessment has already been completed, the APS specialist uses his or her judgment to determine whether the situation appears to have significantly changed and a Safety Re-assessment should be completed.
Alleged Victim is in a Temporary Setting
If the alleged victim is hospitalized or is temporarily in an alternative setting at the time of the initial face-to-face contact, the APS specialist completes the Safety Assessment during the initial face-to-face contact based on the alleged victim’s current circumstances. Those circumstances include the factors that resulted in the hospitalization, the alleged perpetrator’s ability to access the alleged victim, and so on.
If a Safety Assessment was performed at the alleged victim’s home, and the alleged victim is hospitalized during the course of the case, a Safety Re-assessment is not required at the hospital.
In either situation, a Safety Re-assessment must be completed when the alleged victim returns to his or her place of residence.
APS April 2019
The Safety Assessment is a tool for the APS specialist to assess and document the alleged victim’s current safety. There are five sections in the Safety Assessment. The APS specialist completes the full Safety Assessment for all cases, except when using certain closure codes, as outlined in policy.
A person is included on the Safety Assessment as a caretaker if all of the following apply:
• The person is an adult.
• The person has acted in a way that would make a reasonable person believe he or she has accepted responsibility for providing protection, food, shelter, or care for an alleged victim. The person may have done this by act, word, or course of conduct.
• The person is not a paid caretaker, as defined in the Texas Administrative Code §705.1001(20).
Section 1: Case Initiation
The APS specialist completes Section 1 of the Safety Assessment during the case initiation contact for all open investigations.
The APS specialist is not required to complete the remaining sections of the assessment if the investigation is being closed using rapid closure procedures.
Section 2: Factors Affecting Vulnerability
The APS specialist completes Sections 2 through 5 during the initial face-to-face contact and includes any information gathered from other sources before that contact.
The APS specialist may reassess Sections 2 through 5 any time during the Investigation, Maintenance, or Intensive Case Services stage when the alleged victim’s situation or environment significantly changes.
In Section 2, the APS specialist indicates whether any factors are present that affect how vulnerable the alleged victim is. The presence of vulnerabilities does not always indicate that an alleged victim is unsafe, but it provides a context for the remaining sections of the Safety Assessment.
The APS specialist identifies Vulnerability Factors in a way that is consistent with the documentation in the case Narrative. For example, if the intake states that a client uses a walker to move around, the APS specialist marks Diminished Physical Functioning, unless other case documentation indicates the client does not need assistance to move around. If a certain Vulnerability Factor is not mentioned in the intake or documentation, no additional documentation is required to explain why the APS specialist did not mark it.
Section 3: Current Danger Factors
The factors listed in this section describe conditions that, if present, place the alleged victim in danger of injury or death. The APS specialist makes reasonable efforts to gather information necessary to assess each factor and mark the ones that are present. If no danger factors are present, the APS specialist marks None of the Above Apply. If there are factors posing an immediate threat to the alleged victim’s safety, the APS specialist marks Other and describes the situation in the Narrative.
Section 4: Immediate Interventions
An immediate intervention agreement is required when the APS specialist identifies current danger factors. The APS specialist works collaboratively with the alleged victim to determine what immediate interventions are available to remedy the situation. The APS specialist uses Section 4 to document the following:
• A description of any problems identified during the assessment.
• All immediate interventions or actions that the APS specialist or others recommend to remedy the current danger factors.
• Actions that each person (APS specialist, alleged victim, and unpaid caretaker) is responsible for.
• All immediate interventions or actions that the alleged victim or his or her unpaid caretaker accepts or refuses.
• The unpaid caretaker’s acceptance or refusal of any interventions that APS offers directly to the caretaker or to the alleged victim.
• The results of the interventions that the alleged victim or unpaid caretaker agreed to.
• The final outcome of the problem.
Section 5: Safety Decision
The APS specialist determines the Safety Decision based on the following:
• Whether the APS specialist identified any current danger factors.
• Whether the alleged victim accepts recommended interventions.
• Whether the alleged victim agrees to participate in an Immediate Intervention Agreement to alleviate identified danger.
The APS specialist answers each question in the assessment until reaching a Safety Decision. There are three possible Safety Decisions, as follows:
• Safe: No danger factors are present, and, based on the currently available information, the alleged victim is not likely to be at risk of serious harm.
• Conditionally Safe: One or more danger factors are present, but the alleged victim has accepted services that are necessary to alleviate the danger.
• Unsafe: One or more danger factors are present, and the alleged victim refuses services to alleviate the danger or lacks capacity to accept or refuse services.
The APS specialist continues gathering information to reach an allegation disposition, even if he or she does not identify any significant safety issues during the initial face-to-face contact.
The contact standard is based on the Safety Decision. The contact standard is how often contact is required with the alleged victim and collaterals during the rest of the investigation. See 2511 Procedure for Safety Contacts.
APS IH September 2014
The APS specialist:
• completes Section 1 of the Safety Assessment in all cases;
• completes Sections 2-5 of the Safety Assessment in any case that was not closed using rapid closure procedures or as self-neglect resolved before initial face-to-face;
• documents in the Safety Assessment a narrative summary of the case initiation and initial face-to-face contacts and any other contacts made during the initial face-to-face visit that are used to complete the Safety Assessment, including an explanation of any identified current danger factors;
• completes a contact detail page and narrative for all contacts made for other purposes during the initial face-to-face visit, including investigation and service provision as outlined in 2333 Documentation of Investigation Contacts; and
• closes the case without completing Sections 2 through 5 of the Safety Assessment when the investigation is appropriately closed using a rapid closure reason.
2213 Documentation of Case Initiation
2232 Documentation of Situations Involving Current Danger Factors
2242 Documentation for Initial Face-to-Face Contact With the Alleged Victim
2921 Investigation Closure Reason Codes
3214.1 Service Plan Actions, Action Results, and Outcomes
2420 Assessing Indicators of a Lack of Capacity to Consent When a Client Refuses or Withdraws From Protective Services During the Investigation
APS IH April 2018
When a client refuses or withdraws from protective services during the investigation stage, the specialist uses the Safety Assessment to assist with identifying indicators the client lacks the capacity to consent. A client may lack the capacity to consent if physical or mental impairments prevent the client from understanding the:
• nature of protective services offered; and
• consequences of agreeing to receive or reject protective services.
APS considers danger factors identified on the Safety Assessment and any other indicators of a possible lack of capacity, such as difficulty recognizing problems and developing or carrying out plans to address problems.
The APS specialist’s opinion about a client’s decision-making capacity is never the sole basis for not providing protective services to a client who is determined to be unsafe. APS seeks evaluations from medical or mental health professionals to determine whether clients are physically or mentally capable of making informed decisions about the need for protective services.
APS acts quickly when clients are at risk of harm. In emergency situations, APS may provide emergency protective services before obtaining a medical or mental health assessment. APS seeks legal actions when clients are at high risk of harm and are determined to lack the ability to make informed decisions.
3110 Determining Eligibility for Services
4500 Emergency Order for Protective Services (EOPS)
Appendix III: Decision-Making Tree
2421 Procedure for Assessing Indicators of a Lack of Capacity to Consent When the Client Refuses or Withdraws From Protective Services
APS IH April 2018
When a client is reluctant to accept APS involvement, it is especially important for the APS specialist to evaluate the client’s ability to make informed decisions about his or her need for protective services.
In these cases, the APS specialist reviews the Safety Assessment to determine if any of the identified danger factors indicate a possible lack of capacity.
Certain conditions, such as dementia, severe depression, suicidal ideation, undue influence, and delirium may not be evident during the initial interview with the clients. The APS specialist conducts subsequent visits as necessary to determine whether there are signs that a client lacks capacity to consent to protective services.
2260 Alleged Victim Refuses to Cooperate with APS Investigation
2261 Procedure When Alleged Victim Refuses to Cooperate with APS Investigation
2262 Documentation for an Alleged Victim Refuses to Cooperate With APS Investigation
APS IH October 2018
When a client who refuses protective services has been determined to be unsafe, conditionally safe, or high risk due to a mandatory override, the APS specialist consults the supervisor or subject matter expert:
• for additional case action to attempt to gain cooperation from the client; and
• to determine whether a medical or mental health assessment is necessary.
When a client who has been determined to be safe refuses protective services, the APS specialist may attempt to gain cooperation from the client before closing the case.
In either situation, the specialist must complete the Risk of Recidivism Assessment.
APS IH April 2018
If a client accepts services during the investigation and then withdraws after an allegation is found to be valid, the APS specialist:
• attempts additional home visits to gain the client’s cooperation, which includes, at a minimum, one successful face-to-face (FTF) visit and a second successful or attempted follow-up FTF visit;
• may consult with the subject matter expert; and
• consults with the supervisor to determine whether a professional evaluation of the client’s capacity to consent is warranted.
The supervisor may waive the requirement for additional home visits, especially if the client has indicated that he or she does not want APS services and the supervisor believes, based on the APS specialist’s observations, that the client may feel harassed by continued APS visits.
APS IH April 2018
When an alleged victim with capacity refuses or withdraws from services offered during the investigation, the APS specialist:
• documents the services offered in Section 4 of the Service Plan;
• completes the APS Service Plan, selecting No – Client has refused all actions/withdrawn as the outcome; and
• selects Client Refused Services as the closure reason on the Investigation Conclusion page.
When an alleged victim with questionable capacity refuses or withdraws from services, the APS specialist documents:
• the services offered and the alleged victim’s refusal or withdrawal in the Service Plan; and
• consultation with the supervisor or subject matter expert regarding additional case actions, if any will be taken.
APS IH April 2018
During the course of the investigation, the APS specialist may determine the client is in a state of ongoing abuse, neglect, or financial exploitation and that the client is refusing or withdrawing from protective services. The actions taken by the APS specialist in conjunction with the supervisor or subject matter expert (SME) depend on the client’s level of safety. Seeking a medical or mental health evaluation is not always necessary but may be appropriate in some situations as described below.
Procedures When the Client Is Unsafe
If the client is determined to be unsafe, the APS specialist consults the supervisor or SME to determine whether a medical or mental health evaluation is necessary. If an evaluation is necessary, the specialist:
• arranges to have the client evaluated by a physician, registered nurse, physician assistant, advanced practice nurse, licensed psychologist, licensed professional counselor, or master social worker; and
• obtains a written statement of the client’s capacity to consent to protective services and his or her physical and mental condition if the client is at serious risk of harm. The specialist uses the written statement to determine whether an emergency order for protective services is necessary.
Procedures When the Client Is Safe or Conditionally Safe
In some cases when the client is determined to be safe or conditionally safe, the APS specialist may have concerns regarding the:
• client’s capacity;
• actions or services the client agreed to may fail if they refuse, or
• actions or services the client agreed to may not take place at all if they withdraw.
The APS specialist consults the supervisor or SME to determine whether a medical or mental health evaluation is necessary or a referral to the HHSC Office of Guardianship Services is appropriate. If an evaluation is necessary, the specialist:
• arranges to have the client evaluated by a physician, if directed by the supervisor or SME;
• obtains a verbal or written statement of the client’s capacity to consent; and
• refers to the HHSC Office of Guardianship Services, as appropriate.
APS IH September 2014
The APS specialist:
• documents the supervisory or subject matter expert (SME) consultation about determining the need for a medical or mental health evaluation. The APS specialist completes a Contact Detail page with the appropriate Contact/Summary Type and records the consultation in the Narrative section of the page;
• files any written statements in the paper case file;
• enters any written statements or medical records or assessments obtained in the External Documentation page; and
• documents related legal actions on the Legal Action/Outcome page.
2333 Documentation of Investigation Contacts
4130 Documentation of Legal Actions
5222 External Documentation Page