New Hampshire Adopts Data-Driven
Response to Help Older Adults
With 12 district offices throughout the state, social workers with New Hampshire’s Adult Protective Services often took the approach they thought was right in handling reports of abuse or neglect.
But leaders in the department knew the way cases were handled could be more consistent. So they moved to a Structured Decision Making process in 2008, setting forth a series of tools for social workers in the now 11 district offices to use.
“It helped us focus our attention where our attention needs to be focused,” said Rachel Lakin, administrator of the Adult Protective Services program. “It does it in an objective way so that we are not just reacting to community pressure or those kinds of things.
“We have a set of tools that really help us to make those decisions along with our clinical judgment.”
The Structured Decision Making process is one of eight national winners of The Council of State Governments’ Innovations Awards that will be recognized next week in Bellevue, Wash., during CSG’s National Conference and North American Summit.
The process begins with an intake assessment of the situation, including a level or response priority. “That really gave the workers a timeframe to respond to reports,” Lakin said. The most critical situations make it to the top of the list.
That’s followed by a safety assessment, which directs attention to other issues that could affect safety of the individual, not only with the individual but also that individual’s primary support person, to ensure the person is safe. Staff members also look at resources available in the various parts of the state.
“We ask that the social workers identify and list the service or appropriate intervention whether it was available or not,” Lakin said. That will help the state track gaps in services in various parts of the state.
Then, social workers conduct a risk assessment that has shifted the way in which the department does business, according to Lakin. Based on a series of questions, a client is listed as a low, moderate or high risk. In those cases in which a client is at moderate or high risk, the state opens a case for six months and follows it through to prevent another report of maltreatment.
Social workers also conduct a strengths and needs assessment of the individual, completed when a case is opened, every six months after or at the closing of a case.
“The purpose is to really guide where our efforts should go,” Lakin said.
Sally Varney, Quality Management program manager with the Division of Community Based Care Services, said the key is not just consistency in use of the assessment tools. “It’s about paying attention to critical decision points, as well as having a consistent process,” she said.
Diane Langley, director of Bureau of Elderly and Adult Services, said the process has given the state much better data collection.
“In these times of really limited resources, we are able to provide much more specific documentation that’s objective, that isn’t anecdotal, so that legislators have something concrete to respond to,” she said.
It also helps the department look much more objectively at staffing needs and allocation of resources in a more efficient and effective way.
Lakin said the process could benefit other states, but stresses each state is different.
“I think it’s important that they make it their own because each state has its own laws around adult protection and it varies from state to state,” she said.