Adult Protective Services Training: Insights from California Caseworkers

ABSTRACT

Adult Protective Services (APS) training is critical to the mission of APS in supporting the workforce, but not much is known from caseworkers’ perspectives. To learn more, 63 caseworkers in five California counties, from urban, suburban, and rural areas, participated in focus groups. Discussion was organized around three open-ended questions regarding implementation of the National Adult Protective Services Association (NAPSA) training content in practice: (1) What trainings have changed your practice and how? (2) How could training be changed to make it easier to implement? (3) What characteristics of your work environment interfere with implementation of learning? Through iterative reading and review of focus group transcripts, four themes emerged: (1) motivations, (2) barriers, (3) facilitators, and (4) impact. Caseworkers also made recommendations to improve training for better implementation of concepts and skills. Caseworkers involved in this study were quick to assert the need for increased access to training, more sophisticated content, and experiential learning. Moreover, expanding and enhancing safety training was recommended, as was aligning training with local needs and policies. Since the NAPSA approved APS core competencies and advanced topics are also offered and used in other counties and states, considering how to improve training could benefit caseworkers nationwide.

KEYWORDS:

• Adult protective services
• elder mistreatment
• abuse
• neglect
• self-neglect
• exploitation
• training
• workforce development

About one in 10 Americans aged over 60 have experienced some type of mistreatment each year, including physical, psychological, sexual abuse, financial exploitation, and neglect (Acierno et al., 2010; Lachs & Pillemer, 2015). As our population continues to age, the number of reports to Adult Protective Services (APS), the agency that investigates elder mistreatment and provides post-investigation services, will rise quickly. Available data from the National Adult Maltreatment Reporting System (NAMRS) showed that from 2016 to 2018 nationwide, cases with reports that were accepted for investigation increased 15.2% (Aurelien et al., 2019). A serious concern in the APS field is the shortage of comprehensively trained APS caseworkers (also known as investigators in some states). To provide practical suggestions for workforce development, this paper presents a review of the state of APS training and findings from a study of California caseworkers’ perspectives on training.

APS caseworkers are state and local public servants who receive and investigate cases involving mistreatment, commonly including physical, emotional, financial, sexual abuse, neglect, and self-neglect. Through investigation, APS caseworkers assess and evaluate how to keep clients living safely and independently in community settings. In addition to protective and emergency services, caseworkers also provide or arrange social, healthcare, legal, and other services such as housing (Liu & Anetzberger, 2019). It is recommended that APS caseworkers have an undergraduate degree, and preference should be given to those with a master’s degree in social work, gerontology, public health, or related fields (Administration for Community Living, 2020). Since APS is administered at the state and county level, very little national data have been focused on APS educational preparation and training. A report showed that at least 35 states require a college degree for caseworkers or supervisors, though more educational preparation can improve staff’s self-perceived effectiveness and substantiation of allegations during investigation (Administration for Community Living, 2020).

Training requirements for APS caseworkers are also determined at the local level and vary widely across states. In an APS administrative survey conducted in 2012, 18 states required less than one week of training, 10 states had one week or more, and four states had no training (Administration for Community Living, 2016). In response to the variability in APS training nationally, the National Adult Protective Services Association (NAPSA) proposed Minimum Standards advising a caseworker’s training to include: (1) orientation to the job, (2) supervised fieldwork, (3) core competency training, and (4) advanced or specialized training (National Adult Protective Services Association, 2013). NAPSA and stakeholders developed a training curriculum including 23 core competency training modules to encompass the minimum standards (National Adult Protective Services Association, n.d.-a). Modules are available for online and in-person training. Topics of advanced or specialized training modules were also developed. In-person modules include a PowerPoint, scripted trainer manual, participant manual, evaluation materials, and transfer of learning activities. Many modules were also offered in the online format called eLearning. The Administration for Community Living (2020) recommended completing all core competency training modules within the first two years on the job and revisiting these modules on a regular basis as refresher courses.

The 23 core competency training modules are being adopted by individual agencies across the nation. In-person training materials are available for free, but eLearning has a registration fee to support maintenance and update of the training website. Recently, a report indicated these training modules are likely underutilized because of the fee structure (Bates & Chapman, 2020). Fortunately, APS programs in California have free access to all 23 core competency training modules because of dedicated funding from the California Department of Social Services (CDSS). Supported by CDSS, California’s three regional training academies (RTAs) coordinate and deliver in-person and synchronous online core competency training modules across the state, with the goal to offer high-quality training, reduce duplication of training, and promote workforce development.

Despite initiatives to equip APS caseworkers with training, little empirical evidence has been gathered to assess the impact of APS training on performance-related outcomes. Small studies, however, show positive effects from training. Previous research indicated that longer training programs for caseworkers were associated with higher substantiation rates, implying increased detection of mistreatment (Jogerst et al., 2004). A 3-month classroom and field training implemented in Texas improved staff’s confidence in assessing physical abuse and self-neglect, along with the report of positive experiences and knowledge gain (Connell-Carrick & Scannapieco, 2008). An eight-hour engagement training in New York City with the goal of improving detection and intervention found increased self-efficacy among caseworkers, though caseworkers commented on the need for ongoing training and additional supports (Halarewicz et al., 2019).

Although these small studies are encouraging, gaps in our understanding of APS training remain. To understand the impact of the 23 core competency training modules, we conducted focus groups with California APS caseworkers across multiple counties, since caseworkers in the state have access to both in-person and online training. Our study explored their perceptions of the training, its effect on their daily work, and ways to better implement the training. We expected to identify if and how caseworkers found training modules to be needed, helpful, and useful, and to collect their ideas for improvement of these training modules.

Materials and methods

Research design

We conducted a qualitative study using focus groups to allow collective and synergistic discussion among participants about their experience with training. To facilitate candid discussion, all focus group discussions were confidential, and supervisors were not allowed to attend. The Institutional Review Board of University of California, San Francisco approved the study and provides annual oversight.

Recruitment process

Participation in focus groups was voluntary and confidential. Researchers worked with CDSS to identify APS agencies in counties with urban, suburban, and/or rural areas. APS supervisors in the counties of Fresno, Los Angeles, Merced, Sacramento, and San Francisco were asked to schedule one or more groups with dates and times that would maximize the opportunity for caseworker attendance, such as adjacent to another meeting where they were already present. Caseworkers were invited to sign up in advance or drop-in to meetings, and group size was targeted at 10 to 12 participants to maximize the range of responses (Morgan, 1996).

Criteria for participation in a focus group was employment as an APS caseworker in one of the identified counties and exposure to APS core competency (NAPSA, n.d.-a), and possibly, advanced training between 2014 and 2017. Some participants might have taken an e-Learning module, attended one of RTAs’ modules, or both. All participants spoke English fluently and the groups were conducted in English. Supervisors of caseworkers were excluded. No caseworkers at a focus group were excluded from participation.

Data collection

Researchers used a descriptive approach to inquiry. This pragmatic method best collects a description of facts and practical information about phenomena in language that is meaningful to participants (Sandelowski, 2000). It is most commonly used for quality improvement, clarification of concepts, and hypothesis development (Neergaard et al., 2009). This descriptive approach best suited our study to provide straightforward information about the “who, what, where and why” of the training experience and its implementation, as well as areas where improvement may be most beneficial.

Prior to conducting the focus groups, a discussion guide was prepared. We organized the guide around three open-ended questions regarding adoption of the training content in practice. The questions were written to elicit participants’ thoughts on the training that reflected core elements of andragogy (experience, readiness, and motivation to learn) and barriers outside of the educational materials and modules (Mukhalalati & Taylor, 2019): (1) What trainings have changed your practice and how? (2) How could training be changed to make it easier to implement? (3) What characteristics of your work environment interfere with implementation of learning? Participants were asked to reflect on trainings offered between 2014 and 2017 (see Appendix A).

A total of 63 caseworkers in five California counties participated in seven semi-structured one-hour focus groups hosted between March 15 to May 8, 2018. Attendance across all groups ranged from 5 to 13 participants (Mean = 9). Fresno county’s focus group included 13 participants; Sacramento’s included 11; Merced’s included 5; San Francisco’s included 8; and Los Angeles’ three groups included 9, 6, and 11, respectively, on the same date. Across all groups eight (13%) participants were male, and 55 (87%) participants were female. Participants signed a consent form before the focus group discussion started, and were told they may withdraw at any time during the hour-long discussion. One researcher (A.N.) facilitated focus groups by using the discussion guide, and another (K.R.) took notes by writing down ideas expressed within each group. Participants introduced themselves and were identified by only first name during the focus group. All sessions were audio-taped and video-taped for transcription and analysis purposes. Focus groups ranged in duration from 50 to 90 minutes, with an average duration of 65 minutes.

Data analysis strategies

Transcripts of the focus groups were independently coded by two researchers (A.N. and K.R.) using ATLAS.ti (8.2.4). Constructs were developed by consensus after independent coding of each transcript with input from all researchers. Because focus groups were guided with questions about the adoption of training content into practice, emergent constructs concerned the factors affecting participation in training sessions and application of training material. A codebook was created and shared in Microsoft Word (16.16.21), and constructs were further divided into sub-themes as appropriate (see Appendix B).

Results

Through iterative reading and review of seven focus group transcripts, four themes emerged regarding APS training participation and application: (1) motivations, (2) barriers, (3) facilitators, and (4) impact. Additionally, participants provided specific recommendations for improving training, largely in response to an explicit request for ideas. Each of the following sections presents a description of the themes with quotes that emerged in the focus groups, and subthemes that emerged within each theme.

Theme 1: motivations to training participation and application

APS caseworkers across all focus groups expressed a desire to meet the challenges faced in their work and to increase their knowledge and skills to improve case outcomes. In all groups, there was an underlying understanding that attending and applying training can provide benefits to both clients and APS:

“I love learning and love learning new things and anything that’s going to make my job easier or better for my clients especially.”

In addition to general professional development and client benefit, acquisition of specific knowledge emerged as an important sub-theme among caseworkers’ motivations to participate in training. Here a caseworker mentions the desire to learn about legal issues:

“ … the wills, trust, all of that, but that area is so blurred for me because I just don’t understand … I just didn’t understand I didn’t go to school for it … You can always go to the legal experts but you want to make sure you know why you’re going.”

Another expressed a desire to learn healthcare knowledge to benefit clients:

“What about the healthcare part? You know there is a Medi-Cal component that you want to know … make sure if your client has it or a specific insurance if they have and how they work to get them more services or see if they qualify for the free services.”

Theme 2: barriers to training participation and application

APS caseworkers identified a number of factors that hinder participation in training and the use of new knowledge and skills. These sub-themes to barriers were: poor access to training due to caseload volumes and logistics; inability to apply learning due to overly simplified content; and lack of support from supervisors and colleagues in using the training.

Heavy caseloads and packed schedules posed a major problem to training access for participants in all focus groups.

“Because it’s not a day of training, it’s a day of backed up phone calls.”

“Sometimes you get some really cool techniques and they sound really fun and you’d like to review them and go through, but you don’t have time. You’re back. As soon as you hit the door, you’re running. Not only have we increased caseloads, our caseloads have gotten more complex.”

“Since January, I’ve probably received over 60 referrals and I can’t keep up. So, that is the biggest barrier to getting stuff done that needs to get done, because we are so short staffed and just are so short on time and resources. So, trainings are great, and sometimes it’s like, a whole day in [training location 1] or [training location 2], is a whole day of me not getting work done. So, that’s hard for me.”

Additional barriers to training access for at least two groups of APS caseworkers came from logistical challenges for both in-person and remote training:

“Within a matter of three weeks one time, I had two trainings, and it’s not a close drive for me. It took me an hour and twenty minutes just to get here for one hour. And then going back, it’s gonna be even worse.”

For some, however, eLearning, was only available on protected computers in the office and access was impeded by distractions and remote schedules:

“You want to get us, you want it to absorb into our cranium we need to be present. When we are in the office, we are on the phone, typing, talking.”

Additionally, APS caseworkers reported that some training characteristics posed barriers to the application of training, such as content perceived as too basic or not well-matched to the practice at their local level.

“I could see how if you’ve been doing it [casework] for more than a year though, you might already feel like, ‘Oh my god, this[training] is killing me! It’s just like, so basic!’”

“I just wish that if another county was training us, that they’ve conversed, speak with [name of county]. Because they would tell us that if they’re not able to locate a client two times, I think, they send a letter to your house that we’re trying to reach you. So, I think she was from [another] County, as she asking if we do that, and we’re like, no, we don’t do that. So, we’re not on the same page. So, we’re being trained by a different county that is not the same as us, so I would think that someone from [name of county]would train us next time.”

Participants in all focus groups reported that the supervisors might not allow for implementation of new knowledge, and this can make caseworkers less motivated to learn.

“So, I’ll just go back and do a general ‘Hey, this is what it [training] was about or whatever.’ But honestly, I stopped just because I don’t want to hear like, ‘No, that’s not how we do it.’ So, I’ll just do it how I was officially trained to do it.”

Theme 3: facilitators to training participation and application

Focus group participants also identified a number of factors that facilitated interest, learning, and the use of new knowledge and skills. These included useful content, multiple modalities, experienced trainers, and resources for use during and after training.

Useful content with depth and breadth seemed helpful to broaden caseworkers’ skill set from those just beginning to those more experienced in APS casework:

“Great for someone who is just starting, because you come across something different every single day. You see something different. You don’t always know what you’re walking into. You have an idea and sometimes it’s completely different when you get there and start getting into the investigation. So, having a wide range of topics that you have studied is great.”

“The stuff I have appreciated that has been the additional modules that are more in depth, because I feel like I came in with a financial abuse deficit and had to learn a lot; so those that like, annuities before I was at APS, I didn’t even know that that was a thing. Those have been really helpful.”

Online modules and in-person sessions with opportunities to ask questions facilitated participation in training.

“I’m a hands-on, so the ones that I’ve gotten the most out of have always been the ones where we go to the class, ’cause you’re able to ask for clarification, ask more in-depth questions.”

“Maybe because eLearning, if you’re on duty that day, you can squeeze it in because you’re gonna be in the office instead of like, I could [make] four or five visits, so I gotta do all these visits, and you’re spending there a whole day when it could be squeezed into half a day.”

Experienced trainers and those with content expertise led to a better perception of the usefulness of trainings.

“Yeah, I liked that one [trainer for documentation] too, because she was very specific about this hitting every point that you begin kind of going from a funnel or a cone from very broad, to very specific. So, you can make sure that you’re secure in when you pull the case. And she was giving us an example … Generalizing and getting specifics of it, all your i’s are dotted, and all your t’s are crossed. She was really good.”

“It used to be that the trainings that we used to get before were from people who were actually practitioners, they were doing the work in the community and they had a contract with them to come and give us these trainings. So that was a lot more helpful for us and they were good presenters because they knew how to present the topic. You could see the difference in the quality of the training, we were excited. Even if it was all day, was like we got something out of that training.”

Finally, tools and resources were also reported to be particularly helpful by trainees. Handouts or other resources ensure that workers use the knowledge gained in training in their regular practice.

“ … I appreciated the training on, to finding all the different types of abuse, physical abuse, neglect, and then having the handouts that go with that, just I’m referring to that frequently. Is it the matrix? … Yeah, so for me in particular that’s something I frequently refer to.”

“You know we need actual physical tools in our toolbox. There was a class a long time ago on how to take good digital images. They gave us a little tool bag with actually special forensic rulers with different colors.”

Theme 4: impact of training participation and application

Impact emerged as an important theme in caseworkers’ engagement with APS training. Caseworkers were quick to state that although barriers to practice change are real, training is important and should occur more regularly to maximize the opportunities to implement the most recent knowledge and skills. The reported impacts of training include improved communication with clients and colleagues, stronger documentation, professional development, and safety.

Focus group participants in all groups reported changes in their communication and ability to work with clients as a result of trainings on a variety of topics:

“Absolutely. Yeah, it [training] gives me a lot more patience with them [clients] and also helps me maybe keep the case open a little bit longer. Give them a little more time. Give them different options, you know, instead of just one.”

“ … the training we had on substance abuse, I thought that was really good, and to always ask each client if they have any issues with illicit drug use, or … ‘Cause that’s a big thing right now, too, and it’s easy to just think, ‘Oh, this individual may have dementia’, but where did that stem from? Is it related to substance abuse, or is it more medical and stuff? I thought that was a very helpful training, a very good training, actually.”

Communication with other service agencies was also positively affected by trainings.

“ … legal issues and law enforcement [training topic] … helped me in being able to speak to law enforcement and knowing what they wanted. We’re never going to be able to speak their language totally … and they’ll probably never, ever speak ours totally, but it did help when I had to cross report to law enforcement, somewhat on what they’re expecting, what they’re looking at … ”

Documentation of cases by participants in all groups also changed after specific trainings on case planning, legal issues, APS case documentation, and report writing:

“It helped with like what verbiage to leave out of the documents. So, like stuff that’s really not relevant, like if you go in someone’s house, maybe what they had on their counter hasn’t, you know, might not be relevant to the case. So, you leave all that stuff out.”

“And along that line as well, after taking a training I remember going back and creating my own little template, per se, so that I can be sure to add all the notes that I need to add or discussing the allegations, the visual of the home, the description of the client. Things like that were things that were important for me to make sure I keep in every case.”

Across all focus groups, training was discussed as a valuable opportunity for participants to enhance their professional development among experienced and new caseworkers.

“It’s just time, and confidence. But, you know there’s some things that help you grow as a practitioner, and something like that, that’s new, that’s current, how to look … perspectives of how to look at clients, maybe new resources of how we can help some clients would be helpful, that we don’t know about.”

“That’s another thing. To improve training by refreshing older workers. Not older, but you know, seasoned workers. It’s true! My coworker has been here for fifteen years, she hasn’t been to any of the training that I have. I’m training her. How is it that you’ve worked here longer and I know more than you do? Because I came in at a prime time, apparently, when there was a lot of good training.”

Especially important to participants was their appreciation for feeling valued by their department, especially with regard to safety. Many participants in most of the focus groups reported feeling safer as a result of training and greatly appreciated opportunities to learn and apply techniques that reduce their risk of harm in the field.

“I really like the worker safety training because it was really helpful in just pinpointing what I should be looking for before I go to their house, and if I don’t feel safe, what to do, and just learning all those things that are really important in the field. So, these things that I didn’t even think about prior to this.”

Recommendations

These descriptions of APS caseworkers’ engagement with training were reinforced with specific recommendations on how to bolster training participation, application, and impact. During the groups, APS caseworkers suggested developing in-depth content for specific topics; promoting caseworker safety; introducing peer support; and improving application of the materials learned.

Participants in all focus groups expressed a desire for enhanced content. Among experienced caseworkers who started working in APS before the core competency training was available, there was a recommendation for more complexity in the topics presented.

“You know, because it [training] gives you a framework of what you’re going to be doing; but when you’ve been here for a while we need … more advance training that so we can get excited about it, and learn new tools, and just learn cases, maybe that are difficult and maybe also be part of the training.”

Specific recommendations for content enhancement included providing more information about legal and financial issues (especially scams), self-neglect, and how to apply training in specific situations.

“Something specifically on how to deal with scams. We get referrals where it’s a family member that gained access or whatever, we can deal with that. But, when they’re being scammed by someone in another country, they’re losing thousands of dollars. We have no resources, and we don’t know how to go about it. I print stuff out from the FBI and Federal Trade Commission websites to give to clients, because we have no other resources, just to try to show them these are scams. I was this morning with someone and she’s not believing me, and I don’t know what else to do.”

“Everybody gets cases and situations that self-neglect is huge on many different levels; and so, like they’re talking about the training we are getting around financial abuse, but also getting more specific training around … learning how to integrate it more into the specific work, that would be very helpful.”

Additional support for caseworkers was recommended by enhancing training on safety, a topic of interest for all participants in the focus groups. One participant stated that no caseworker should make any visits before receiving basic training on self-protection, and others expressed interest in learning about risks and prevention of infectious disease.

“How would you address someone who is angry? How would you address someone who is guarded? You know, when you walk in the house, you know as soon as you walk in the house you need to look for every exit point.”

“I think we did a training about how to approach dogs. I love dogs. I know better if the dog is doing a certain thing not to approach it but in terms of I think exposure to different things in the hospital, to people who have shingles and TB and I go most of the time with my co-workers.”

There was also enthusiasm for peer support throughout training:

“That’s what CPS does … they have peer trainers. So that you’re with that one person and you’re shadowing them. So, I think that would be a better or a more effective way for new social workers to learn. You’re having to go through boot camp and then in conjunction with that, there’s somebody that you’re going out [with]. So, you can see this stuff in action, or if you’re learning, now you can ask questions, right?”

Finally, participants expressed that increased attention in the training materials to what the caseworkers do on the ground would increase the usefulness of trainings, especially given the time constraints in the field. Additionally, many focus group participants noted that it is important for supervisors and other service organizations to get the same information and to work with other organizations to create content for trainings.

“But even for our administration and supervisors to receive these trainings too, because we may hear something or be taught one thing here, and then it’s like, no, you’re not supposed to do that. So, I think it’s important, I think as a department-wide, that everybody should receive these trainings.”

“For example, I’m gonna say as they said, even the officers or the social workers at the hospital, or 211, they need to educate them and let them know what are restrictions, what our limitations are.”

Discussion

The goal of this study was to understand California APS caseworkers’ perspective on the implementation and usefulness of NAPSA’s core competency training modules. Our qualitative analysis of focus group data among caseworkers from rural, suburban, to urban California counties revealed that they were motivated to learn; they value training and perceive it as critical to their knowledge base, safety, professional development, and case outcomes; and there were local and workload-related barriers to using the knowledge in their daily work.

Focus group participants reported demonstrated benefits in their knowledge and associated skills from training on their work, ability to help clients, and feelings of safety in the field. Ghesquiere et al. (2018) reported APS caseworkers were exposed to substantial occupational hazards and stressors that were often undocumented, and our findings supported the importance to train caseworkers on responding to them. Another important finding was that heavy caseloads, access to training, and local protocols and relationships with other service agencies were key obstacles to practice change. Halarewicz et al. (2019) highlighted the importance for supervisors to support the training learned by caseworkers. Caseworkers in our study expressed the same sentiments that supervisors should be trained on the same modules. Since California APS is county-run, each county may have slightly different policies, so it is especially important for trainers to understand not just APS practice, but also county policies. In fact, it was recommended that APS supervisors refresh their skills with ongoing training (Administration for Community Living, 2020). If supervisors receive the same training as caseworkers, they could facilitate the understanding of county policies’ impact on the application of training in field work. Participants had practical and innovative suggestions for improvements in training. For example, they thought more training and easier access to both in-person and synchronous online modalities for themselves and the agencies with whom they must interact, such as hospitals and law enforcement, would be helpful so that other service agencies understand APS work. Jackson (2017) had noted that professionals working in APS and victim services lack training and cross training, so fostering relationships with these agencies and creating collaborative trainings may facilitate training goals.

As a result of the qualitative analysis of focus group data on trainings in APS core competency and advanced training modules, we developed a list of individual specific recommendations for consideration by CDSS. Though the data were collected in California, many of the following recommendations should also apply to APS nationwide in strategic planning for training, since the core competency has been recognized as NAPSA’s Minimum Standards and recommended by the National Voluntary Consensus Guidelines for State APS Systems (Administration for Community Living, 2020). Additionally, a recent publication (Liu & Ross, 2020) reported that most states adopt at least some topics of the core competency in their APS training. The only difference is that California APS has the advantage of accessing both in-person and online training materials without additional fees, so access to online training could be a potential problem for other APS programs without training funding.

1. Consider caseworker caseload, since it is a barrier to ability to participate in and benefit from training. Where possible, temporarily reduced caseload should be a component of planning a training. At the national level, conduct a caseload study to investigate how overworked caseworkers are, and how it impedes caseworkers’ professional development and provision of best services to clients. The other possibility is to provide incentives to encourage participation in training. For example, NAPSA offers a certificate (NAPSA, n.d.-b) for caseworkers who complete the 23 core competency trainings. The certificate could potentially professionalize the field and encourage training (Liu & Ross, 2020), especially if caseworkers were to testify in court or seek promotion opportunities. Otherwise, more training sessions do not translate to more training, let alone effective training, for caseworkers.

2. Increase access to training in both synchronous online and in-person modalities. Although the synchronous online sessions might not be the best learning environment for everyone, it can increase access for caseworkers in rural areas and heavy-traffic urban areas to engage in professional development opportunities.

3. Provide safety training for all workers that includes information about caseworker health risks and protection, including physical safety and infectious disease risks.

4. Design trainings to meet the needs of caseworkers at different levels of experience (e.g., separating new caseworkers’ training from refresher training), and increase offerings on topics such as self-neglect, legal issues, financial exploitation, scams and fraud.

5. Provide opportunities for professional development during and after trainings, such as peer-to-peer support, that allows for continued learning and to share professional knowledge encountered during case investigations.

6. Find experienced trainers with locally relevant knowledge. Ensure that trainers are aware of county differences and design training courses that address the policy and procedure differences in each county. Use trainers who are practitioners or others with practical experience on the training topic.

7. Engage supervisors in trainings to update and refresh their knowledge, as well as to standardize the knowledge and approach across supervisors and caseworkers. Transfer of learning depends on supervisory and managerial encouragement for adopting new techniques, skills, and information learned; otherwise, the uplift from the training fades.

Limitations and future research

Our sample was limited to seven focus groups in five California counties, so additional studies should be conducted to capture national representation. Nonetheless, since the recruitment process deliberately included urban, suburban, and rural areas in Southern, Central, and Northern California, it should be representative of California caseworkers’ experiences and insight. Future research on training should follow caseworkers closely before and after training to examine how knowledge or skills learned in training is applied to field work and affects client outcomes. In addition, based on caseworkers’ feedback, training opportunities for supervisors or administrators would enhance the APS workforce from the bottom to the top.

Conclusion

NAPSA’s 23 core competency training modules lay a national foundation for building a strong APS workforce with the knowledge and skill needed for field work. Without appropriate training, the mission of APS to protect vulnerable adults is compromised. We found that caseworkers were motivated to learn, valued skills and knowledge learned from training, and desired specific changes to training content. Training content and planning can be made more meaningful by accounting for these findings and increasing the complexity of the content and covered cases, aligning training content with local practices, and utilizing peer support during and after training. Empowering those who serve older adults, particularly older adults who are being victimized, will improve the health, wellbeing, and safety of both caseworkers and clients.

Declaration of interest

No potential competing interest was reported by the authors.

Acknowledgments

We would like to express our gratitude towards Fresno, Sacramento, Merced, San Francisco, and Los Angeles Adult Protective Services in participating in this study. We would also like to thank Lori Delagrammatikas and Sara Stratton for reviewing our manuscript, as well as John Hartmire and Kim Rutledge for pulling SOC 242 data in response to reviewer comments.

Data availability statement

The data that support the findings of this study are available from the corresponding author, P. L., upon reasonable request. Restrictions may apply to the availability of these data based on data usage agreement between University of California, San Francisco and California Department of Social Services.

Additional information

Funding

This work was supported by California Department of Social Services under [Grant 17-3207].

Appendix A.

Focus Group Guide for the Evaluation of APS Training 2014-2017

Q #1.

• Key Question: How have the trainings changed your practice?

• You might want to provide an example (“The documentation course helped me to determine what information was most important to include in the case report and so has cut down how much time I spend on paperwork”) and ask for specific examples.

• Follow up: What training topics did you find were easiest to implement practice changes and why?

• Follow up: What training topics did you find were hardest to implement practice changes and why?

• Probing Question (if necessary): Did anyone else have a similar experience?

• Follow up: What do you think it was about the training of these topics that made it easier or harder to implement what you had learned about them?

• Probing Question (if necessary): Does anyone else feel the same way?

Q #2.

• Key Question: How do you think that training could be changed to make it easier for you to implement what you have learned in core competencies or special topics?

• Probing Question (if necessary): Did anyone else have a similar experience?

Q #3.

• Key Question: What characteristics of your work environment have affected your ability to use your training?

• You might want to provide examples here such as support of your supervisors and managers, issues with the case management system, lack of community understanding of elder abuse and APS’ role, etc.

• Follow up: How well did the training reflect the environment in which you work?

Ending Question: What advice would you give to the people providing the training or your supervisors to help you better utilize your training?

Appendix B.

Focus Group Code Book

Table

Constructs	Sub-themes	Description/Example
Motivations: why do social workers want to participate in training?	Benefit to Client	Care about clients – want to help, training is valuable and important
	Benefit to Office	Efficiency, new ideas and opportunities
	Professional Development (Benefit to trainee)	Growth, sharing knowledge with others
	Benefit to Community	Improved communication with police, hospital, legal, banking
	Safety	Wanting more information about reading situations and assuming protective stances (e.g., positioning around a door)
	Satisfaction	Feeling valued, having standards
Barriers: what interfered with application of training?	Attendance	Time, frequency, location/access (e.g., distance/e-learning), caseload, supervisor invitation/approval
	Content	Remedial or inapplicable content, complexity of financial scams
	County Environment	Internal, external (legal), supervisors new and not trained, heavy caseload, decentralized offices/remote work, other agencies (police, hospitals)
	Dissatisfaction	Feeling time wasted
Facilitators: what helped application of training?	Content	Sophistication, case examples, engagement, Q&A, relevant topics
	Modality	E-learning easier, In-person better for sharing – learn so much from each other
	Trainer	Experienced, knowledge of audience and local policy and resources, field work
	Tools	Handouts, resources
	Follow Up	Trainer provided contact information and resources
Impact: what effects have resulted from receiving training?	Practice Change	Documentation, interview methods, communication with external agencies
	Worker Safety	Increased confidence and knowing when to walk away or call police
	Efficiency	Interviews, documentation, communication
	Client Service	Conserved, more compassionate approach