A recent 70-page report provided an overview of the Department of Economic Security’s Adult Protective Systems (DES APS), which identified a lack of an overall strategic direction. The Arizona House’s Ad Hoc Committee on Abuse and Neglect of Vulnerable Adults met last month to discuss the findings.
Michael Lahti, PhD, senior evaluation associate with LeCroy & Milligan Associates, broke down the report as a contractor for the Arizona Auditor General. Further identified issues are that no state agency is responsible for managing vulnerable adult cases following a DES APS investigation, and that there are currently no processes for assessing whether services were provided during or after an investigation of mistreatment.
“Arizona’s Adult Protective System cannot determine whether vulnerable adults are protected from abuse, neglect, and exploitation, and if services received after an investigation effectively reduce mistreatment and revictimization,” Lahti said.
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Authority for APS involvement starts with a report of maltreatment that’s sent to APS. Authority is limited to investigations that include adults over the age of 18 who are unable to defend themselves against abuse, neglect, and exploitation by others due to physical and cognitive impairments. The investigations are an administrative process rather than criminal.
Lahti added how there’s currently no way to track service outcomes for adults who are served by various agencies, including DES APS, the Arizona Health Care Cost Containment System, and the Arizona Department of Health Services. Looking at examples from other states, Lahti said Arizona could create protocols for providing services following an investigation, and processes of measuring and reporting the outcomes of those vulnerable adults. Lahti said effective services can prevent additional threats of safety and can lessen healthcare costs associated with older and vulnerable adults.
The report analyzed accountability mechanisms across the system and found key outcome data for assessing system effectiveness is lacking.
“The Arizona Adult Protective Services system lacks independent oversight and quality assurance processes. Although some program data is collected and publicly available, outcome measures and data for services provided to vulnerable adults during and after an investigation is lacking.”— Lahti
The current APS system lacks the capacity to produce accurate data on performance and key outcomes for vulnerable adults. If outcomes are measured, it would better describe how the system assists vulnerable adults, and would allow workers and supervisors to conduct their best work.
Lahti said for the Arizona APS system to have the capacity to produce accurate performance data, DES should collaborate with a working group to identify accountability mechanisms, system-wide performance reporting processes, and to determine whether a specific state agency should be assigned the responsibility of case management services.
Areas for future review include the timeliness and quality of DES APS investigations, the role of public fiduciaries, barriers to services and lack of services in rural areas, and the effectiveness of Tribal Memorandums of Understanding.
Molly McCarthy, assistant director of DES APS, said they recently held an open comment period around attempts to create consistency around proposed rulemaking. She brought up the use of federal funding for the system.
“Part of the federal dollars that are supposed to be rolling out are supposed to support some of that work to create infrastructure and get states on the same page,” McCarthy said.
McCarthy explained how APS acts as a blend of an investigator and social worker. APS employees initiate case planning, monitoring, evaluation, and connecting clients with medical, social, economic, legal, and housing services. Coordination with law enforcement and courts takes place as needed.
Alleged perpetrators of abuse and maltreatment can be placed on the APS Registry to prevent future instances of harm. The registry is for employers and the public to utilize as a repository of substantiated allegations.
“Arizona law requires placement on the registry for 25 years. That’s probably the most severe nationally, so understanding that impact on due process and potential impact on that hearing process with an ALJ [administrative law judge],” McCarthy said.
DES APS also received a federal grant several years back, McCarthy said, which allowed the department to switch up their training approaches. Training and onboarding for new APS investigators increased from two to eight weeks.
This conversation will be used as a roadmap going forward. The Ad Hoc Committee plans to work alongside the governor and legislature to create a working group that will assist with proposed reforms.