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2400 SHIELD Assessment Tools

APS IH September 2014

APS utilizes the SHIELD (Strategies that Help Intervention and Evaluation Leading to Decisions) 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 investigations to assess alleged victims’ overall risk of continued abuse, neglect, and exploitation in order to:

  •   reach a full understanding of alleged victims’ situations 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

  •   inform decision-making about legal action.

Types of SHIELD Assessments

There are three types of SHIELD assessment tools:

  •   Safety Assessment (SA)

  •   Risk of Recidivism Assessment (RORA)

  •   Strengths and Needs Assessment (SNA)

Assessment

Assessment Goals

When to Complete the Assessment

Safety 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

See:

2410 Safety Assessment

2811 Risk-based Contact Standards

3300 Maintenance Cases

3220 Strengths and Needs Assessment

Appendix XVII: SHIELD Policy and Procedures Overview

2410 Safety Assessment

APS IH September 2014

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.

APS starts the Safety Assessment at case initiation and completes it with the alleged victim during the initial face-to-face contact. A Safety Reassessment (Sections 2-5) may 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 Reassessments 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 a 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 a Safety Assessment has already been completed, a Safety Reassessment may 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, APS specialist completes the assessment during the initial face-to-face contact based on the alleged victim’s current circumstances, which include factors that resulted in hospitalization, the alleged perpetrator’s ability to access the alleged victim, and so on. If the alleged victim returns home, a Safety Reassessment must be completed.

See:

2241 Procedure for Initial Face-to-Face Contact with the Alleged Victim

2261 Procedure When Alleged Victim Refuses to Cooperate With APS Investigation

2420 Assessing Indicators of a Lack of Capacity to Consent to or Refuse Protective Services During an Investigation

4000 Legal Actions

2411 Procedure for Completing the Safety Assessment

APS IH September 2014

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 for certain closure cases, as outlined in policy.

See:

2233.1 Procedure for Determining Self-Neglect Resolved Before Making the Initial Face-to-Face Contact

2642.1 Documentation of Death Due to Natural Causes or Accident

2642.2 Documentation of Death Due to Self-Neglect

2643.1 Documentation of Death When Alleged Perpetrator's Actions Did Not Contribute to Alleged Victim's Death

2645.1 Documentation of Death When Alleged Perpetrator's Actions May Have Contributed to Alleged Victim's Death

2921.1 Rapid Closure Codes and Disposition of Other

Section 1: Case Initiation

The APS specialist completes Section 1 of the Safety Assessment during the case initiation 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 prior to that contact. Sections 2 through 5 may be reassessed any time during the investigation or Intensive Case Services when the alleged victim’s situation or environment significantly changes.

In Section 2, the APS specialist indicates whether any factors are present which influence the alleged victim’s vulnerability. The presence of vulnerabilities does not always indicate an alleged victim is unsafe, but provides a context for the remaining sections of the Safety Assessment.

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 those that are present. If no danger factors are present, the APS specialist marks None of the Above. 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

When current danger factors are identified, an immediate intervention agreement is required. 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:

  •   a description of any problem or problems identified during the assessment;

  •   all immediate interventions or actions recommended to remedy the current danger factors;

  •   actions each person (APS specialist, alleged victim, and caretaker) is responsible for;

  •   all immediate interventions or actions agreed to or refused by the alleged victim or by his or her caretaker;

  •   the results of the accepted interventions; and

  •   the final outcome of the problem.

The APS specialist also documents in Section 4 any interventions or actions offered to a caretaker as well as the caretaker’s acceptance or refusal of any interventions being offered directly to the caretaker or to the alleged victim.

Section 5: Safety Decision

The APS specialist determines the safety decision based on if:

  •   current danger factors were identified;

  •   the alleged victim accepts recommended interventions; and

  •   the alleged victim agrees to participate in an Immediate Intervention Agreement to alleviate current danger.

The APS specialist answers each question on the decision tree until reaching a safety decision. The alleged victim is considered to be:

  •   Safe when there are no danger factors present and based on the currently available information, the alleged victim is not likely to be at risk of serious harm;

  •   Conditionally Safe when there are one or more danger factors present, but the alleged victim has accepted services necessary to alleviate the danger factors; or

  •   Unsafe when there are one or more danger factors present and the alleged victim refuses services or lacks capacity to refuse services that would alleviate the danger factors.

If no significant safety issues are identified during the initial face-to-face contact, the APS specialist begins gathering information necessary to reach an allegation disposition.

The contact standard, or frequency of contact with the alleged victim and collaterals, during the remainder of the investigation is based on the safety decision. See 2511 Procedure for Safety Contacts.

See:

2230 Situations Involving Current Danger Factors (Immediate Interventions)

2400 SHIELD Assessment Tools

2921.18 Self-Neglect Resolved Before Face-to-Face

3214.1 Service Plan Actions, Action Results, and Outcomes

Appendix XVII: SHIELD Policy and Procedures Overview

2412 Documentation for the Safety Assessment

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.

See:

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 to or Refuse Protective Services During an Investigation

APS IH September 2014

An alleged victim in an APS investigation lacks the capacity to consent to or refuse protective services if physical or mental impairments prevent the alleged victim from understanding the:

  •   nature of protective services offered; and

  •   consequences of agreeing to receive or reject protective services.

APS uses the Safety Assessment to inform decision-making in identifying indicators of alleged victims’ possible lack of capacity to consent to or refuse 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 alleged victims’ decision-making capacity is never the sole basis of not providing protective services to alleged victims who are determined to be unsafe. APS seeks evaluations from medical or mental health professionals to determine whether alleged victims are physically or mentally capable of making informed decisions about the need for protective services.

APS acts quickly when alleged victims are found to be at risk of harm. In emergency situations, APS may provide emergency protective services before obtaining medical reports. APS seeks legal actions when alleged victims are at high risk of harm and are determined to lack the ability to make informed decisions.

See also:

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 to or Refuse Protective Services

APS IH September 2014

When an alleged victim is reluctant to accept APS involvement, it is especially important for the APS specialist to evaluate the alleged victim’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 alleged victim. The APS specialist conducts subsequent visits as necessary to determine whether there are signs that an alleged victim lacks capacity to consent to protective services.

See also:

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

2421.1 Procedure When the Alleged Victim Refuses Protective Services

APS IH September 2014

When an alleged victim who has been determined to be unsafe, conditionally safe, or is high risk due to a mandatory override and refuses protective services, the APS specialist consults the supervisor or subject matter expert (SME):

  •   for additional case action to attempt to gain cooperation from the alleged victim; and

  •   to determine whether a medical or mental health assessment is indicated.

When an alleged victim who has been determined to be safe refuses protective services, the APS specialist may attempt to gain cooperation from the alleged victim before closing the case.

In either situation, the APS specialist completes the RORA to the best of his or her ability before closing the case.

See also:

2261 Procedure When Alleged Victim Refuses to Cooperate With APS Investigation

2422 Procedure for Seeking Medical or Mental Health Evaluations

2810 Procedure for Completing the Risk of Recidivism Assessment

2421.2 Documentation for Alleged Victim Refuses Protective Services

APS IH September 2014

To document cases in which an alleged victim with capacity refuses services, 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 services, the APS specialist documents:

  •   the services offered and the alleged victim’s refusal in the Service Plan; and

  •   consultation with the supervisor or subject matter expert regarding additional case actions to be taken.

See:

2520 Supervisor Consultations

2531 Procedure for SME Consults

2800 Risk of Recidivism Assessment

2921 Investigation Closure Reason Codes

2422 Procedure for Seeking Medical or Mental Health Evaluations

APS IH September 2014

During the course of the investigation, the APS specialist may determine the alleged victim is in a state of ongoing abuse, neglect, or financial exploitation and that the alleged victim is refusing protective services. The actions taken by the APS specialist in conjunction with the supervisor or subject matter expert (SME) are dependent upon the alleged victim’s level of safety. If an alleged victim is determined to be safe, seeking a medical or mental health evaluation is not necessary, but may be appropriate in some situations as described below.

Procedures for Unsafe

If the alleged victim is determined to be unsafe, the APS specialist consults the supervisor or SME to determine whether a medical or mental health evaluation is necessary, and if so:

  •   arranges to have the alleged victim 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 alleged victim’s capacity to consent to protective services and his or her physical and mental condition if the alleged victim is at serious risk of harm, to determine whether an emergency order for protective services is necessary.

Procedures for Safe or Conditionally Safe

In some cases when the alleged victim is determined to be safe or conditionally safe, the APS specialist may still have concerns regarding:

  •   the alleged victim’s capacity; and

  •   the possibility that the actions or services the alleged victim agreed to may fail or not take place at all.

In this situation, the APS specialist consults the supervisor or SME to determine whether a medical or mental health evaluation is necessary or a referral to the DADS Guardianship Services Program is appropriate, and if so:

  •   arranges to have the alleged victim evaluated by a physician, if directed by the supervisor or SME;

  •   obtains a verbal or written statement of the alleged victim’s capacity to consent, if evaluated by a physician;

  •   refers to DADS guardianship program as appropriate. APS does not seek a Certified Medical Exam (CME) when a case is being referred to DADS for guardianship.

See:

2411 Procedure for Completing the Safety Assessment

2520 Supervisor Consultations

2531 Procedure for SME Consults

2921 Investigation Closure Reason Codes

Human Resources Code §48.208

Appendix III: Decision-Making Tree

4500 Emergency Order for Protective Services (EOPS)

4780 Referrals to DADS Guardianship Services

2423 Documentation for Seeking Medical or Mental Health Evaluations

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.

See:

2333 Documentation of Investigation Contacts

4130 Documentation of Legal Actions

5222 External Documentation Page

 

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