Missouri Department of Health and Senior ServicesP.O. Box 570, Jefferson City, MO 65102-0570 Phone: 573-751-6400 FAX: 573-751-6010RELAY MISSOURI for Hearing and Speech Impaired and Voice dial: 711

Randall W. Williams, MD, FACOGDirector

Michael L. Parson Governor

PSEM 18-18

November 20, 2018

MEMORANDUM FOR DIVISION OF SENIOR & DISABILITY SERVICES SECTION FOR ADULT PROTECTIVE SERVICES STAFF

From: Kathryn Sharp Sapp, Bureau ChiefDivision of Senior and Disability ServicesAdult Protective Services Policy Unit

Subject: Implementation of Specialized Adult Protective Services in Region 1

The journey toward the specialization of Adult Protective Services (APS) continues with the implementation of Region 1. Effective immediately, Region 1 will begin following the Specialized APS policies: 1701.10 – Philosophy; 1702.00 - Intake and Classification; and 1703.10 - Abuse, Neglect and Exploitation Reports. As with previous region’s implementation, staff in remaining regions (Regions 2 and 3) will continue to operate under existing policy.

All APS policies and memos associated with Regions 1, 4, and 5 Implementation will be accessible through the DSDS Resource page by clicking on the Adult Protective Services Staff Information to access the “Specialized APS” button.

During implementation, CRU will be responsible for generating all intake in Region 1, with the exception of field generated reports under the following circumstances:

1. When it is discovered in the field that there are allegations which are criminal in nature, PS staff shall use the New Intake Screen to create an INV report if there is not a current INV report already assigned to SIU or there is a new alleged perpetrator.

2. When it is determined in the field that a report meets the criteria for an ANE Class I/II/III report, SIU staff shall use the New Intake Screen to create an ANE Class I/II/III report if there is not a current ANE report already assigned to PS staff.

Question concerning the hotline should be sent through your supervisor to the APS Policy Unit email account at APSPolicy@health.mo.gov.

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AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER: Services provided on a nondiscriminatory basis.

Since implementation in April, feedback from field staff (in Regions 1, 4, and 5) have been incorporated into the following policies and practice:

Draft Intake and Classification P olicy (1702.00): o Caregiver “Special Circumstances” guide intake staff in determining whether the

allegation should be classified as self or caregiver neglect, including:

1. If a person or spouse is not mentally or physically capable of caring for the eligible adult, that person will be documented in Case Compass as an involved person (instead of an alleged perpetrator), and the allegation selected will be Self-Neglect Environmental or Self-Neglect Medical/Physical.

2. When an eligible adult is non-responsive or incapacitated and there is indication that another adult (including adult(s) living in the home) has been providing care for the eligible adult, but no caregiver can be identified, the Alleged Perpetrator will be “unknown.”

o Emotional Abuse Allegation:When determining if the allegation rises to the level of a report versus a referral (IDR), the following must be considered:

If no pattern or effect from the emotional abuse is identified, an IDR will be generated.

If the emotional abuse rises to the level of a physical threat, the physical abuse allegation should be selected using the indicator “threat to harm.”

o Response Priority:When determining the urgency of the allegation and classifying Class 1 Sexual or Physical Abuse reports, it is important to identify how recent the assault occurred using the following:

When a minimum of one element of sexual/physical abuse criteria is present AND the perpetrator has access within the next 24 hours, the report shall be coded as a Class 1 (emergency).

When a minimum of one severe abuse element is present AND is the assault happening right now or has occurred within the last 24 hours, the report shall be coded as a Class 1 (emergency).

After-hours Call Outs: Based on experience during initial implementation in Region 5, PS staff will contact/notify SIU staff when necessary to reduce duplicity.

Specialized APS 1703.10: Abuse, Neglect and Exploitation Reports As discussed during the Specialized APS training, Region 1, 4, and 5 staff will be utilizing this new policy that incorporates the use of a safety plan to address the immediate needs of the eligible adult as well as utilizing “valid/invalid” allegation findings.

o Safety Assessment and Planning:Assessing safety is a critical component of APS response. Safety refers to the likelihood of current and/or immediate harm. Staff will work in partnership with the eligible adult to complete their Safety Plan upon initial contact to address concerns relevant to their essential needs, feelings of safety within their home, ability to care for his/herself and a development of a plan to address any concerns. As discussed during Specialized APS training, PS staff will complete the Safety Plan during initial face-to-face contact with the eligible adult to capture the initial concerns, discuss options and resources. Refer to Safety Plan Forms Instructions for further details on completion of tool.

o Risk Assessment:PS Staff in Regions 1, 4, and 5 will only be required to complete a minimum of one Risk Assessment due to the implementation of the Safety Assessment and Planning process. Information gathered during initial face-to-face contact, and throughout the investigation will be included in the Risk Assessment that must be completed prior to concluding the hotline.

o Valid/Invalid Conclusion:PS Staff shall begin utilizing the valid/invalid conclusion code on any open hotline.

Draft APS policy, protocols and changes to Case Compass will remain in draft during the implementation and will continue to be evaluated to build on successes and address any areas that need improving prior to rolling out to other regions.

The Region 1 Implementation Team, comprised of Zachary Goad APCW, Angelia Newman APCW, Nikki Butler APCW, Jennifer Crawford APCW, Stephanie Benton APCW, Sandra Pfitzner APCW, Michelle Gray APCS, Jessica Greninger APCS, Leashie Green APCS, Dianna Race APCS, Karen Ross, APCS, Wanda Staley, APCS, and Eric Johnson RM, have been meeting throughout the process to help shape policies and protocols. The team will continue to meet throughout the rollout of specialization to evaluate the system changes, policies, and practices.

Special thanks to Regions 4 and 5 implementation teams for their continued efforts in shaping ongoing implementation activities.

KSS/av