in Chapter 2. That chapter also discusses use of the LEAD standard methodology to validate case identification methods. In addition, the clinical process of case investigation in the community practice setting has substantial implications for the social service (adult protective services) and justice systems. The Adult Protective Services experience is of particular interest. In a survey (National Association of Adult Protective Services Administrators) for 1999–2000 in which all 50 states responded, of the complaints received by adult protective services, only two-thirds were investigated. Of those investigated, half were substantiated for abuse or neglect. While the complaints and investigative processes are tracked by every state, the methods of case validation preceding the finding varies widely from state to state.

The starting point for adult protective services response to a complaint of alleged elder mistreatment is the state statute and administrative rules. A total of 26 states respond to complaints for people age 60 years and older, and 18 states respond to complaints for people age 65 and older. Two states include any adult who is vulnerable or has disabilities. As discussed earlier, state statutes also differ significantly in their definitions. For example, some statutes do not cover neglect.

If the complaint received by adult protective services meets the local statutory definitions, a caseworker is assigned to assess or investigate the situation, determine if the abuse is substantiated, and develop a plan to protect the person from further harm. The assessment-investigation process is often identified by adult protective services workers as one of the most difficult aspects of their work. There is a paucity of training for them prior to receiving a caseload, with only a handful of states requiring significant training. In addition, states differ in their emphasis on case identification versus provision of social services. Some states are more weighted toward investigation, that is, the process of making a finding about the allegation and abuse registries, while others spend more time on the provision of services and less on investigating.

Once a case of elder mistreatment has been assigned for investigation, most state statutes require a face-to-face visit with the alleged victim within a prescribed time period, more quickly depending on the seriousness of the report, but typically within 48 hours. Once at the home or residence, in the majority of instances, the adult protective services worker must first receive consent of the client for the assessment-investigation. If the client refuses, the worker cannot proceed. When conducting an assessment-investigation, the worker’s task is not only to find out what happened and determine if it was abuse or neglect, but it may also include an evaluation of the person’s functional capacity, and his/her ability to live independently (physical tasks) and to make judgments (mental tasks). This knowledge helps to determine what support should be offered so that the person can live as independently as possible, and it is also useful in determining their ability to protect



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement