Adult Protective Services Training: A Brief Report on the State of the Nation

ABSTRACT

This brief report summarizes Adult Protective Services training provided to workers across the nation, using survey results from the National Adult Protective Services Association (NAPSA). Although most states delivered training that covered some learning objectives of NAPSA’s 23 core competency training modules, there was a wide variation with some states training workers on all 23 topics, while some states did not provide training on any of the core modules. Having a well-trained APS workforce possessing core competencies to perform the job should be federal and state agencies’ goal, because the quality and level of services for older people and people with disabilities should not differ based on the states they live in.

KEYWORDS:

• Adult protective services
• vulnerable adult abuse and elder abuse
• neglect
• exploitation
• mistreatment
• training
• brief report

Adult Protective Services (APS) workers promote the safety, independence, and quality of life for adults with disabilities and older adults experiencing abuse, neglect, and exploitation. Their job responsibilities begin when APS receives a report. Workers are responsible for investigating allegations, assessing victims’ service needs, and coordinating/providing services to remedy the situation or prevent further harm (Liu & Anetzberger, 2019). The experience of abuse, neglect, and exploitation can result in negative outcomes, including physical injury, social isolation, financial loss, and premature mortality (Yunus et al., 2019). Workers need to be equipped with knowledge from the fields of healthcare, legal, and social services, in addition to possessing competent investigative skills (Otto et al., 2002). APS reports accepted for investigation continue to show a rising trend as documented in the National Adult Maltreatment Reporting System (Aurelien et al., 2019). While the causes resulting in the increases in reports have not been studied, the rise in reports might be due to a growing aging population and a more informed population on what constitutes elder mistreatment. Given the increase in reports, the workforce would benefit from trainings that equip and enhance their skills in order to complete cases in a timely and accurate manner (Administration for Community Living, 2020).

Since APS functions at the state and county level, little national data has been focused on APS educational preparation and training (Connell-Carrick & Scannapieco, 2008). One report showed that at least 35 states reported requiring the possession of a college degree to become a worker (National Adult Protective Services Association & National Association of State Units on Aging, 2012). Supplemental educational preparation could lead to staff’s self-perceived effectiveness on their investigation and substantiation of an allegation of mistreatment. However, four states had no job training; 18 states required less than 1 week of job training; only 10 states had 1 week or more (Administration for Community Living, 2020).

While there is a paucity of empirical literature evaluating APS training outcomes, the few existing studies concluded training improves rates of investigation and substantiation, staff knowledge, worker confidence and self-perceived skills (Connell-Carrick & Scannapieco, 2008; Halarewicz et al., 2019; Jogerst et al., 2004). One study looked at training programs that lasted less than 1 day to those lasting more than 3 weeks, and found that longer training programs for workers were associated with higher substantiation rates, suggesting improved detection of mistreatment (Jogerst et al., 2004). Most recently in New York City, an eight-hour engagement training aimed to improve detection and intervention found increased self-efficacy among workers. The workers commented on the need for ongoing trainings and additional supports (Halarewicz et al., 2019).

Arguably, training might benefit new workers most, since working in the field without sufficient knowledge nor experience could lead to additional harm and suffering to victims (Otto et al., 2002). A three-month classroom and field training in Texas demonstrated new workers’ growing confidence in assessing physical abuse and self-neglect after training, along with the report of positive experiences and knowledge gain (Connell-Carrick & Scannapieco, 2008).

Inadequate APS training has been a major concern of APS since the early 2000s when child welfare already had special training funding for many years (Otto, 2002). Compared to child welfare services which includes child protective services, adult protective services have not received the same level of national guidance and funding (Congressional Research Service, 2019; Otto, 2002). For example, Title IV-E of the Social Security Act required states to develop, expand, and coordinate child and family services programs. To assist the states in achieving these goals, the federal government committed to paying 50% of costs to administer the programs and 75% of costs for training the workforce. In contrast, APS programs and workforce training have not received such commitment in federal funding to protect older adults and adults with disabilities. Insufficient funding has always been one of the problems facing APS (Otto & Bell, 2003). APS workers have lost funding for training at local, state, and national levels due to state budget cutbacks (Otto et al., 2002). Without federal leadership and funding to help states provide the needed training, guidelines that provide direction for APS training (such as reported in Administration for Community Living, 2020) can only be voluntarily adopted and not be enforced.

It is not surprising that training at the state level might be inconsistent and variable due to lack of funding. To enhance the skills and education of the APS workforce, the National Adult Protective Services Association (NAPSA) proposed Minimum Standards for workers’ training to include (1) orientation to the job, (2) supervised fieldwork, (3) core competency training, and (4) advanced or specialized training (Administration for Community Living, 2020). Within the four areas of training, a core competency training curriculum was developed by NAPSA and stakeholders that encompassed 23 training modules since 2005 (National Adult Protective Services Association, n.d.a). These core competencies include a combination of knowledge, abilities, and skills that are required for satisfactory APS job performance. NAPSA suggested that the 23 core competency training modules be completed within the first 2 years on the job, and recommended that these trainings be offered on a regular basis as refresher courses (Administration for Community Living, 2020).

The 23 core competency modules are available for in-person training with a PowerPoint, scripted trainer manual, participant manual, evaluation materials, and transfer of learning activities accessible online (National Adult Protective Services Association, n.d.a). All modules are also available in the online format called eLearning, but eLearning requires a registration fee to support maintenance and update of the training website. Within the 23 core competency modules, NAPSA identified a subset of 12 modules considered essential curriculum for APS new hires’ functioning, or “core of the core” training modules (see Appendix for listing of the modules and description, with an asterisk denoting “core of the core”). Although the 23 core competency training modules are being adopted across the nation, this training is not federally mandated; APS offices can pick and choose the training modules delivered to their workers.

The few empirical studies indicate training has the potential to promote workforce development, but no study has investigated the content of training that has been delivered across the nation. The goal of this study is to examine how states implemented the NAPSA 23 core competency training modules through state APS training, in order to paint a picture of training received by workers nationwide, as well as to identify the most common training topics covered.

Methods

Participants & procedures

The NAPSA Education Committee developed an electronic survey in late 2015 to understand how the NAPSA 23 core competency modules were being used by state and federal district APS offices. To encourage candid answers and avoid unintended biases for responding to the survey, the NAPSA Education Committee guaranteed APS offices that aggregated results would be de-identified, and APS offices could request their ranking against other states. Initially, only 26 APS offices completed the survey from August 2016 to August 2017. To improve the response rate, the NAPSA Education Committee contacted individual APS offices that had not responded to the survey, and increased survey completion to a total of 49 offices, which included the District of Columbia, by January 2018. The data were transferred to University of California, San Francisco (UCSF) when the survey closed. The Institutional Review Board of UCSF (protocol # IRB 20–31407) approved the study and provided annual oversight.

Survey

The NAPSA Education Committee designed the survey to learn more about APS training across the country. The survey had 24 sections, with the first asking participants to choose their state or federal district, and the other 23 sections focused on each of the core competency areas. Within each of the 23 sections, NAPSA’s training description and learning objectives were listed, and questions asked included the following:

1. Does your state have training that covers these learning objectives? Select one: “yes, using the NAPSA module”; “yes, using portions of the NAPSA module with changes”; “yes, using locally developed module to cover all objectives”; “yes, using locally developed module to cover some objectives”; “yes, field based on the job training”; “no.”

2. If you use field based on-the-job training, are you using the NAPSA Field Guide for Supervisors? Select “yes” or “no.” The NAPSA Field Guide for Supervisors was designed for supervisors to work one-on-one with their worker on case review, and it does not substitute for formal training (Delagrammatikas & Kubota, n.d.).

3. Do new APS hires receive this training as part of their initial induction? Select “yes” or “no.”

4. If this training is part of initial induction, how is the training module delivered? Select “in-person,” “eLearning,” “blended,” or “other.”

Respondents had the option to complete the survey over multiple sessions. The majority of respondents (n = 36) completed the survey within 1 day with a median response time of 32 minutes.

Analysis plan

Secondary data analysis was conducted utilizing NAPSA’s survey data using IBM SPSS Statistics software for Mac (IBM Corp., Armonk, N.Y., USA). Descriptive statistics were used for quantitative data analysis. An algorithm was developed to indicate the amount of training and compliance with the NAPSA training modules and training objectives by state (State Training Index). This algorithm was also used to identify the most commonly delivered core training modules across states (Common Training Index). Higher values were assigned if the state used the NAPSA module or a locally developed training that covered all the learning objectives in the module. Lower values were assigned based on compliance with the NAPSA module or objectives of the module.

• Yes, using the NAPSA module = 1

• Yes, using portions of the NAPSA module with changes = 1

• Yes, using locally developed module to cover all objectives = 1

• Yes, field based on the job training & using the NAPSA Field Guide for Supervisors =.75

• Yes, using locally developed module to cover some objectives = .50

• Yes, field based on the job training, but not using the NAPSA Field Guide for Supervisors = .25

• No = 0

Another algorithm was developed to evaluate the extent that the NAPSA-developed training module was used in the training (Common NAPSA Index). Higher values were assigned if the state used the NAPSA module, and lower values were assigned based on the extent the NAPSA module was not used.

• Yes, using the NAPSA module = 1

• Yes, using portions of the NAPSA module with changes = .5

• Yes, field based on the job training & using the NAPSA Field Guide for Supervisors = .25

• Other: This category included locally developed training and field training that did not include the NAPSA Field Guide for Supervisors = 0

Results

To understand the amount of training received by APS workers by state, the State Training Index (range from 0 to 23 modules) was calculated. Two states covered all 23 core competencies, while two states reported covering none (mean = 11.98, median = 11.75, SD = 6.88, see Figure 1 for distribution). On average, 8.51 core competencies were covered by states using a NAPSA module (complete or with modifications) or locally developed training that covered a module’s training objectives.

Figure 1. State training index: number of core competency covered by state

The Common Training Index (range from 0 to 49 states, see Figure 2 for distribution) showed that the most commonly trained core competencies with the more frequent use of NAPSA training were APS overview (Module 1), agency standards (Module 3), abusive relationships (Module 8), and intake (Module 16). All these training topics were delivered in over 40 states and were defined by NAPSA as part of “core of the core.” Additionally, the Common NAPSA Index for all APS workers (range from 0 to 49 states, see Figure 3 for distribution) indicated the most frequently used NAPSA-developed training modules included: APS overview (Module 1), financial exploitation (Module 12), risk assessment (Module 18), abusive relationships (Module 8), professional communication (Module 9), and self-neglect (Module 10). These topics were also part of “core of the core.”

Figure 2. Common training index: frequently delivered training by core competency

Note. Solid bars are “core of the core.”

Figure 3. Common NAPSA index for all APS workers: frequently delivered NAPSA module by core competency

Note. Solid bars are “core of the core.”

For newly hired workers, four states provided training on all 23 core competencies, eight received training on 22 core competencies, two received training on 21 core competencies, and two received training on 20 core competencies. At the other end, one state provided training on just three core competencies, four offered training on one core competency, and three states did not provide training on any of the core competency topics (mean = 13.92, median = 17, SD = 7.78). Looking across all states on the format used to provide core competency training, the majority of new hires received in-person training (n = 544, 78%), eLearning comprised 5% (n = 33), and 17% of the new hires received training using a blended format (n = 121). Most commonly trained core competencies were APS overview (42 states trained on Module 1), agency standards (41 states trained on Module 3), documentation (35 states trained on Module 15), intake (35 states trained on Module 16), and developmental disability (35 states trained on Module 5).

Discussion

APS workers deliver a broad range of services from investigating allegations of mistreatment to providing post-investigation services needed to keep victims safe from mistreatment (Liu & Anetzberger, 2019). It is unlikely that the complexity of their job responsibilities can be covered solely by an academic education. NAPSA’s 23 core competency training modules propose to fill this educational void and to help prepare the APS workers to professionally meet their clients’ needs. Through this survey of state APS offices, we received a glimpse of how workers were being prepared to do their jobs. Overall, variability in training was wide between states. Although, on average, each state covered almost 12 topics of core competencies, two states had training that covered all 23 topics, while two states had no training. Even though improving staff training has been a constant theme discussed in APS since early 2000s (Otto & Bell, 2003), some APS programs seemed to lack the funds or resources to provide necessary training to workers.

The most commonly trained core competencies in over 40 states included APS overview (Module 1), agency standards (Module 3), abusive relationships (Module 8), and intake (Module 16). Data also showed that several states did not have trainings in certain topics, which is concerning, since the 23 topics are regarded as core competencies in conducting APS work. It is especially worrying when “core of the core” training modules are not delivered, since they are essential for new hires to perform their job. Moreover, commonly delivered training developed by NAPSA included APS overview (Module 1), financial exploitation (Module 12), risk assessment (Module 18), abusive relationships (Module 8), professional communication (Module 9), and self-neglect (Module 10). Though financial exploitation and self-neglect were not the most commonly trained core competencies, these NAPSA-developed training materials were popular, indicating the value of these materials to APS workers.

The majority of states provided some training for new hires, while three states provided no training. Several states provided training on most core competency topics to new hires. The most common training approach was in-person, followed by blended (in person and e-Learning), then eLearning. It is unclear if states prefer in-person training over eLearning, or if it is more cost-effective to conduct in-person training since eLearning has a fee associated with accessing materials. The most commonly delivered trainings were APS overview (Module 1) and agency standards (Module 3), followed by documentation (Module 15), intake (Module 16), and developmental disability (Module 5). Compared with training delivered to all workers, new hires were more likely to receive training during their orientation on documentation and working with people who are developmentally disabled.

To professionalize the field and encourage training, NAPSA offers a certificate (National Adult Protective Services Association, n.d.b) for workers who complete the 23 core competency trainings through the Adult Protective Services Workforce Innovations (APSWI) at the Academy for Professional Excellence, School of Social Work, San Diego State University. Since the launch of the Certificate Program in 2017, 498 workers applied to complete the program, and 228 were certified. Participation in and the completion of the APSWI program could be promoted, with state and federal support developed to cover the cost of application and certificate fees of 100 USD.

Limitations

Two states did not provide responses. Since the survey was responded at the state level, it captured what was required statewide. APS programs run at the county-level might have additional training requirements. Moreover, some states might have implemented additional training since the survey. Lastly, in addition to the 23 core competencies, the Administration for Community Living (2020) recently identified the following areas as additional core competencies that APS workers should receive training in the first 24 months of employment: (1) cognitive deficits, including dementia, (2) motivational interview, (3) emotional/psychological abuse, (4) supported decision-making model, and (5) public benefit eligibility, such as Medicare, Medicaid, Social Security. Since the survey did not ask about these additional core competencies, state APS offices could have been providing them, but they were not reflected in the survey data.

Conclusion

Most states provided training that covered learning objectives of some core competencies. A broad variability existed, however, among states ranging from those who trained on all 23 core competencies to those who provided no training for any of the 23 core competencies. The NAPSA modules approximate a national standard, until the federal government begins providing legislative guidance with funding. Considering the intricacies of APS work, workers would benefit from receiving trainings to meet the complex challenges in the field and thereby to better serve APS clients. Increased interest in APS outcomes has come to attention in recent years (Liu et al., 2020). However, without a well-trained workforce, APS outcomes would be directly and negatively impacted. Based on the results of this study, most states should review their training requirements and consider increasing their capacity to offer and deliver essential training.

States could use this study’s finding to educate legislators to fund APS training, especially in light of the fact that child welfare has been receiving state and federal funding for training for decades (Congressional Research Service, 2019). Equal opportunity for training should be offered in all states because older victims or those with disabilities deserve to receive services with workers who are trained to cover minimum standards, just as their counterparts in child welfare. It could be helpful to first ensure “core of the core” training modules are delivered to new workers, then gradually make sure other core competency training modules and advanced topics of training with greatest need are delivered to workers. All states need to incorporate a feedback mechanism regarding the effectiveness of current training that would contribute to improving the state’s training curriculum. Evaluation of training also needs to be encouraged to understand the differences in training format and trainer quality on workers’ knowledge and behavioral changes. Based on previous studies (Cambridge & Parkes, 2004; Strasser et al., 2011), evaluation results should be able to identify training modules workers found to be needed and helpful.

Acknowledgments

We would like to express our gratitude towards the National Adult Protective Services Association (NAPSA) in providing the data for analysis, NAPSA’s Education Committee and Certificate Program for designing and administering the survey, and all the APS administrators who completed the survey. Additionally, we would like to thank Sara Stratton and Andrew Butler for reviewing the manuscript.

Appendix

NAPSA 23 Core Competency Modules

Table

Module		Description
*1	Overview of Adult Protective Services	Provides an understanding of the job which includes knowing who their clients are, under what circumstances they are expected to intervene, and what interventions they are expected to provide.
*2	Ethics, values, and cultural competence in Adult Protective Services	Provides a practical framework for ethical decision-making. It helps APS professionals become more aware of their own value systems, their approach to decision-making, and it will give workers tools to analyze situations from a culturally competent standpoint.
*3	Agency Standards and Procedures: California Regulations for APS	Provides an understanding of APS Regulations by requiring the application of the regulations to abuse reports and case scenarios. Part of the goal is to help understand the overall mandate, where the regulations come from, help define different types of abuse (the basic parameters of abuse) in case situations, and the legal roles and responsibilities to APS client.
4	The Aging Process	Provides a basic understanding of the aging process to enhance the APS worker’s ability to perform investigations and make evaluations.
5	Physical and Developmental Disabilities	Provides information about the unique ways in which APS workers may work a case with an individual with a physical, cognitive or developmental disability.
6	Mental Health in APS	Provides an introduction to mental health disorders and to support on-going and additional study of mental health issues.
7	Substance Abuse and Mature Populations	Provides information on how the problems of ageism, isolation, societal denial, loss, grief and depression occur concurrently with substance use disorders. The module explores the diagnostic criteria of substance use disorders. Participants learn culturally appropriate intervention techniques to use with clients and family members and about codependency. The APS worker’s own personal biases about addiction are also explored.
*8	Dynamics of Abusive Relationships	Teaches how to define elder abuse, identify the various dynamics underlying elder abuse and why some victims refuse services and remain with their abusers, and explore how the dynamics might inform services offered by APS.
*9	Professional Communication	Teaches the timing and pacing of interviews, the order in which interviews are conducted to avoid collusion, the order in which questions are asked, and how to overcome communication barriers and acknowledge cultural diversity. APS workers also learn how to interview clients with sensory and communication disabilities.
*10	Working with Self Neglecting Clients	Teaches the definition of self-neglect, prevalence, risk factors and indicators to watch for when assessing a case. The module teaches how to assess self-neglect across five domains (medical, psychological, environmental, financial and social), and about promising methods to work with a self-neglecting adult, how to develop interventions, how to document a self-neglect case and what agencies they might want to partner with to work these cases.
11	Caregiver or Perpetrator Neglect	Teaches necessary and essential components for effective investigations of caregiver neglect, such as common physical and behavioral indicators of caregiver neglect; factors that contribute to client risk of caregiver neglect; identify the barriers to determining whether caregiver neglect is intentional vs. unintentional; identify the domains of assessing allegations of neglect; demonstrate best practices in interviewing perpetrators; and identify key principles of service planning.
*12	Financial Exploitation	Teaches the necessary and essential components for effective financial exploitation investigations, such as, understanding common victim and perpetrator characteristics; learn the indicators of financial exploitation; understand decision making capacity and undue influence as they are related to financial exploitation cases; describe the primary components of a financial exploitation investigation and the common challenges encountered in these investigations; and demonstrate interviewing and investigative skills through interactive skills practice exercises.
13	Physical Abuse	Provides information on forensic research, geriatric medical information tailored for elder physical abuse investigators, and practical field skills.
14	Elder Sexual Abuse	Teaches increased awareness of elder sexual abuse and provides experience in discussing sexual abuse with others.
*15	APS Case Documentation and Report Writing	Teaches the necessary and essential components of effective documentation and report writing.
*16	The Initial (Intake and) Investigation: Taking the First Steps	Teaches the communications and listening skills for the intake. How to obtain the most relevant information in the most congenial and least interrogating way that will allow the intake worker the basis to decide if the case meets the criteria established by law and policy to open an investigation. If the criteria are met, what will happen? If more information is needed, what is that information? If the criteria are not met, what other services/programs are more appropriate to meet the needs?
*17	Assessing Client Capacity	Provides information to assist APS professionals in identifying the factors that affect their clients’ decisional capacity, and to identify when to seek a professional evaluation.
*18	Investigation: Risk Assessment	Teaches how to assess risk across five domains in terms of severity and urgency. The five domains are: -Physical and functional status. -Mental health status and capacity. -Living environment. -Financial. -Social (risk posed by others, including caretakers and family members).
*19	Voluntary Case Planning	Teaches the basic components of determining the intervention needs and developing a safety plan for elder abuse victims.
20	Involuntary Case Planning	Teaches how to identify situations where the client’s safety takes precedence over the client’s right to self-determination and how to think through making that determination. Ethical issues involved in these tough cases are explored and APS workers learn how to document their decisions appropriately so that their decisions can be defended.
21	Collaboration in APS Work	Teaches the benefits, challenges and barriers to successful collaboration, and the fundamental elements critical to effective team building within a collaborative partnership or relationship. APS workers demonstrate beginning skills in communication and networking with other disciplines routinely involved in adult protective service cases.
22	Working with Law Enforcement	Teaches how to identify crimes and the elements of crimes, how to “build” a case that is more likely to be accepted for prosecution and how to support the victim if the case does go to court. APS workers will learn about their own role as a witness in court.
23	Case Closure	Teaches the factors and conditions which indicate a case should or should not be closed.

*Core of the core.