1. Estimating Incidence of Elder
Abuse from Social Services Data
Phase I Report:
Recommendations for Improving
Adult Protective Services Data in California
UCI Geriatrics Funded by the Archstone Foundation
Protective Services Operations CommitteeProtective Services Operations Committee
March 12, 2008March 12, 2008

2. Goals of this Project
• Ultimate – Best possible data on
incidence of elder and dependent
adult abuse in California
• “Phase 1” – Recommendations for
improving SOC 242 incidence data

3. Why Focus on the SOC 242?
Best information available on elder and
dependent adult abuse:
Detailed
Accessible
Dedicated to adult abuse
Broad jurisdiction

4. Does the SOC 242 need
improvement?
A major achievement in establishing
concepts (report, allegation, finding, etc)
and organizing them. However, The
SOC 242 could be improved by
•Guidelines and standard methods to
promote consistency among counties
•Simplification and clarification

5. “Natural” Variation
• Variation in incidence of reported
abuse is affected by geography,
economics, culture and successful
programs.

6. Data Collection Issues
Causes of variation in statistics that
obscure true incidence
•Different definitions for a single term.
•Where on the form does something get
counted?
•Do some counties count things that
others do not?

7. Efforts to Improve the SOC 242
• CDSS & PSOC: SOC 242 Workgroup
(2007)
* UCI Geriatrics: Archstone Grant
(2006-2007)

8. Research Methods
• Analysis of one year of SOC 242 data
(9/04 through 8/05)
• Telephone interviews with APS
program managers and staff (54
counties)
• Vignette Survey (47 counties)
• In-person interviews (18 counties)

9. Final Report Structure
• Executive Summary
• Introduction – our research process
• Chapters – discuss the regulations and
practices we found
• Recommendations – specific suggestions
• Conclusions – general observations about data
collection on the SOC 242
• Appendices – data, supporting material and
previous presentations

10. Final Report Structure
Chapters – follow progress of a report
or case through APS and the SOC 242
I. Intake (and Information and Referral)
II. Reports of Abuse
III.No in-person response (and NIFFI)
IV.Opening and closing cases
V. Confirmed, Inconclusive, Unfounded
VI.Types of abuse and neglect

11. Final Report Structure
• Appendices
– Each chapter has its own appendix of
related regulations, interview excerpts
and vignette survey data
– Previous presentations to PSOC
– Copies of the Vignette Survey and the
SOC 242

12. Ch. I – Intake
• Duties
– Receive calls and SOC 341 forms
– Record allegations, victim’s identity and other
pertinent information
• Intake workers range from
– Entry level clerical, to
– The most experienced field social workers
• Who performs Intake? Ranges from
– Workers solely within APS, to
– Other department that has minimal
communication with APS

13. Ch. I – Information & Referral
Item 19 - Some definitions:
• No protection issues: “give them
information and send them on their way.”
• Information related to care of elders and
dependent adults
On the other hand:
• Domestic violence call for a non-dependent
adult recorded as an I&R.
• “Give the caller the information about the
ombudsman and also make the referral”

14. Ch. I - Recommendations
• Make it a “best practice” to have the
most experienced APS case workers
staffing Intake
• Decide: can a Report of Abuse be
counted as an I&R and if so which
ones?
• Decide: why count I&R and what is
included?

15. Ch. II – Reports of Abuse
• Item 7, reports of abuse, and Item 7b,
reports within APS jurisdiction
• The SOC 242 defines a report of abuse as
“A verbal or written account of an incident
of suspected elder or dependent adult
abuse…”
• APS jurisdiction (as defined by the APS
Manual) covers all elders and dependent
adults residing in the county who do not
live in a long-term care facility or a state
institution

16. Ch. II – Jurisdiction
Questions
• Can be difficult to determine over the
phone whether or not a person is a
dependent adult
• Ombudsmen have different limits on
what they will take as a case
• Gray area when a client lives in one
county but the abuse occurs in
another

17. Ch. III – Reports that receive
no in-person response
• Items 8, 27 and 28
• Includes reports that fall under
– NIFFI
– MPP 33-510.21-.24
– Reports that will not be opened as cases
until the next month
– Others

18. Ch. III – Reports that receive
no in-person response
• Some examples of what different
people told us could go on Item 8:
– NIFFI cases do not go on line 8
– Cases do not go on line 8
– Everything on line 8 is a case
– Everything on line 8 is a case and a NIFFI

19. Ch. III - Recommendations
We have a number of recommendations,
but three major themes are:
• Make the relationships among Items
7, 7b, 8, 27 and 28 explicit
• Add lines so that all the major
categories on Item 8 can be broken
out
• Clarify which reports on Item 8 are
cases

20. Ch. IV – Cases
The SOC 242 says that “a case is equal to a
person,” but can that person only be:
1) An alleged abused/neglected elder or
dependent adult in APS jurisdiction? Or,
2) Any person reported for suspected
abuse/neglect whom an APS social worker
has gone out to investigate?

21. Ch. IV – Cases
The number of Cases (Item 2):
• measures the number of APS clients
and/or
• is a measure of APS workload

22. Ch. IV – Recommendations
Find a way for “case” to cover both
situations
• expand the definition to include
attempted investigations, or
• have two types of case:
– appropriate APS clients
– investigations started but closed because
the client is not appropriate

23. Ch. V – Investigations
and Findings
• Confirmed investigations are a
measure of incidence
• Factors that undermine the
usefulness of this number:
– Lack of standards/guidelines for
confirmed, inconclusive and unfounded
– “External” pressures on findings
– The “autonomy” question

24. Ch. V – Confirmed,
Inconclusive, Unfounded
These terms are defined in reference to
investigations and credible evidence;
beyond that, they only say that APS has
decided on one or the other. There is no
real guidance for how to decide
findings. The SOC 242 Work Group has
begun to look into another state’s
ratings of different types of evidence.

25. Standard of Proof
• Preponderance of evidence (51%)
• Beyond a shadow of doubt (99%)

26. Ch. V – Findings
External Pressures on findings, unrelated to
evidence:
• How will the finding affect the alleged
perpetrator?
• How police and prosecutors perceive or use
findings (e.g., will confirming help a
prosecution?)
• Would unfounded or inconclusive findings reduce
others’ motivation to help the victim?
• Social workers’ training and experience
• Do the original allegations need findings or can
they be dismissed if they are without merit?

27. Ch. V – Autonomy
Can a mentally competent APS client
choose to live in conditions that a
social worker considers self neglect?
What should the social worker do?
• Respect their autonomy – find the
allegations inconclusive or unfounded
• “Confirm what you see,” but follow up
with respect for the client’s wishes

28. Ch V. - Recommendations
• Define credible evidence or publish
ratings of different types of evidence
• Based on the above decision, establish
a standard of proof for confirmed,
inconclusive, unfounded
• Develop a policy to guide social
workers between “confirming what
they see” and respecting a client’s
ability to make their own choices

29. Ch. VI – Types of Abuse and
Neglect
• Most complex part of the SOC 242 is
Part D (Items 12 through 15h, related
to Items 9a and 9b)
• Main issues:
– Confusion and difficulty regarding the
structure that relates investigations,
cases, reports and allegations
– Practices that skew the proportions of
types of self-neglect

30. Ch. VI – Structure Issues
• Can there be more than one type of
abuse on a single case?
• Can a case have allegations of abuse
by others and self-neglect?
• Can one enter inconclusive reports
(Items 12 and 14) without any
inconclusive investigations?

31. Ch. VI – Types of Self Neglect
Issues that affect what types of self-neglect
get reported:
• “Catch-all” allegation for cases that are
uncertain
• Routinely adding a particular allegation as
a consequence of others but without
evidence
• How much experience and training do case
workers have?
• Are there case workers with specialized
training (e.g., a nurse who can spot subtle
signs of medical self-neglect but who might
miss signs of financial self-neglect)?

32. Ch. VI – Recommendations
• Clarify that an investigation can have
multiple reports of both self neglect and
abuse by others, and that a report can have
multiple allegations
• Minor change to the SOC 242: inconclusive
reports can be entered even without an
inconclusive investigation
• Define types of self neglect more thoroughly
and follow up with training and/or
guidelines for case workers

33. Where do we go from here?
• Archstone Foundation has granted
year-to-year funding for up to 3 years
for Phase 2.
• Goal: Work with PSOC and CDSS to
improve the quality of elder abuse
incidence data in California.
• First step: evaluate and prioritize
Phase 1 Recommendations

34. Three types of
Recommendations:
– Proposals: changes on the form or
in the collection process
– Choices: outline options that we
feel CDSS needs to consider
– Clarifications: SOC 242 rules that
are appropriate but need better
explanation on the form

35. Thanks for your
cooperation and support!
UCI Geriatrics Project Team
714-456-5530
awiglesw@uci.edu rkeslerw@uci.edu
mtwomey@uci.edu
• Richard KeslerWest, BS
• Laura Mosqueda, MD
• Mary Twomey, MSW
• Aileen Wiglesworth, PhD
www.centeronelderabuse.org