Development of a National Adult Protective Services Data System: Namrs Pilot Final Report (volume 1)

VOLUME 1: PILOT OVERVIEW AND FUTURE RECOMMENDATIONS

Y. Yuan, S. Leelaram, S. Dahbour, M. Greene, A. Acker and E. Swartz

WRMA, Inc.

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ABSTRACT:

In September 2013, HHS/ASPE began a 2-year effort to design, develop, and pilot a national reporting system based on data from state adult protective services (APS) agency information systems. The project was funded by Prevention and Public Health funds through an interagency agreement with ACL. The project team conducted extensive outreach to gain an understanding of information needs. More than 40 state administrators, researchers, service providers, and other individuals in the field participated in stakeholder calls. Over 30 state representatives from 25 states participated in three in-person working sessions to discuss the uses of collected data and the key functionalities that should be included in a national system. The national system was named the National Adult Maltreatment Reporting System (NAMRS). Stakeholder meetings resulted in the general design of the data reporting system, conceptualized as three components:

1. Agency Component data, submitted by all agencies, on their policies and practices.
2. Case Component data on client characteristics, services, and perpetrator characteristics, provided by agencies that have report-level tracking systems.
3. Key Indicators Component data consisting of aggregated data on key statistics of investigations and victims, provided by agencies that do not have report-level tracking systems or are unable to provide case-level data.

    

From January through May 2015, nine states--Colorado, Georgia, Illinois, Maine, Massachusetts (Disabled Persons Protection Commission), Missouri, Montana, Pennsylvania, and Texas--participated in a pilot of the data system and submitted the Agency Component and either the Key Indicators Component or the Case Component data. This report (Volume 1) consists of a description of the NAMRS Pilot, findings from the piloting process, and recommendations for the future NAMRS.

DISCLAIMER: The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.

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Acknowledgments

We would like to thank our federal Contracting Officer's Representative, Helen Lamont, and Stephanie Whittier Eliason, Scott Cory, and Clare Barnett for their leadership and guidance throughout the project. The National Adult Protective Services Association and the Center of Excellence on Elder Abuse and Neglect at the University of California, Irvine, were excellent subject matter expert partners. Our deepest appreciation is extended to the many staff from each of the pilot states who gave so freely of their time and experience to help formulate the future NAMRS. We could not have written this report without their willingness to participate in the pilot.

The recommended citation for this report is as follows:

Yuan, Y., Leelaram, S., Dahbour, S., Greene, M., Acker, A., and Swartz, E. (2015). Development of a National Adult Protective Services Data System: Final Report. Submitted to the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.

Acronyms

The following acronyms are mentioned in this report and/or appendices.

3DES	Triple Data Encryption Algorithm
ACL	Access Control List HHS Administration for Community Living
ADL	Activity of Daily Living
App	Application
APS	Adult Protective Services
ASPE	HHS Office of the Assistant Secretary for Planning and Evaluation
AUDIT	Alcohol Use Disorders Identification Test
CAP	Client Advocacy Program
CFR	Code of Federal Regulations
CJIS	Criminal Justice Information Services
DAST	Drug Abuse Screening Test
DBO	Database Object
DSM	Diagnostic and Statistical Manual of Mental Disorders
DSS	Data Security Standard
EJA	Elder Justice Act
EJCC	Elder Justice Coordinating Council
ELMAH	Error Logging Modules and Handlers
EU	European Unit
FDA	HHS Food and Drug Administration
FedRAMP	Federal Risk and Authorization Management Program
FFY	Federal Fiscal Year
FIPS	Federal Information Processing Standard
FSC	Federal Steering Committee
FTE	Full-Time Equivalent
GAD-7	Generalized Anxiety Disorder 7 item scale
GED	General Equivalency Diploma
HHS	U.S. Department of Health and Human Services
HIPAA	Health Insurance Portability and Accountability Act
HITECH	Health Information Technology for Economic and Clinical Health act
HTTP	Hypertext Transfer Protocol
HTTPS	HTTP Secure
I&R	Information and Referral
I&RA	Information and Referral Assistance
IaaS	Infrastructure as a Service
IADL	Instrumental Activity of Daily Living
ID	Identifier
IP	Internet Protocol
IT	Information Technology
LIHEAP	Low-Income Home Energy Assistance Program
LINQ	Language-Integrated Query
MFCU	Medicaid Fraud Control Unit
NAMRS	National Adult Maltreatment Reporting System
NAPSA	National Adult Protective Services Association
OAA	Older American's Act
OADS	Maine Office of Aging and Disability Services
ODBC	Open Database Connectivity
OMB	U.S. Office of Management and Budget
PaaS	Platform as a Service
PCI	Payment Card Industry
PDF	Portable Document Format
PHQ	Patient Health Questionnaire
PII	Personality Identifiable Information
SaaS	Software as a Service
SHA	Secure Hash Algorithm
SNAP	Supplemental Nutrition Assistance Program
SOC	Service Organization Controls
SQL	Structured Query Language
SSA	U.S. Social Security Administration
SSBG	Social Services Block Grant
SSDI	Social Security Disability Insurance
SSI	Supplemental Security Income
SSL	Security Sockets Layer
SSMS	SQL Server Management Studio
STEP	Schizophrenia Test and Early Psychosis indicator
SUA	State Unit on Aging
TA	Technical Assistance
TANF	Temporary Assistance for Needy Families
URL	Uniform Resource Locator
UX	User Experience
VM	Virtual Machine
XML	Extensible Markup Language
XSD	XML Schema Definition

Executive Summary

In September 2013, the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation, began a 2-year effort to design, develop, and pilot a national reporting system based on data from state adult protective services (APS) agency information systems. The pilot effort addressed the Elder Justice Coordinating Council's recommendation to develop a national APS system based on standardized data collection and a core set of service provision standards and best practices. The goal of the future data collection system will be to provide consistent, accurate national data on the exploitation and abuse of older adults and adults with disabilities, as reported to state APS agencies.

The project was funded by Prevention and Public Health funds through an interagency agreement with the HHS Administration for Community Living. WRMA, Inc., a TriMetrix Company (WRMA), in collaboration with the National Adult Protective Services Association, the Center of Excellence on Elder Abuse and Neglect at the University of California, Irvine, and a number of nationally recognized experts, designed and piloted the future system under the oversight of a federal steering committee.

The project team conducted extensive outreach to gain an understanding of information needs. More than 40 state administrators, researchers, service providers, and other individuals in the field participated in stakeholder calls. Over 30 state representatives from 25 states participated in three in-person working sessions to discuss the uses of collected data and the key functionalities that should be included in a national system. The national system was named the National Adult Maltreatment Reporting System (NAMRS). In this report, the version developed and piloted under this project is referred to as the NAMRS Pilot. The future version to be used for nationwide data reporting is referred to as the future NAMRS or just NAMRS.

Stakeholder meetings resulted in the general design of the data reporting system, conceptualized as three components:

1. Agency Component data, submitted by all agencies, on their policies and practices.

2. Case Component data on client characteristics, services, and perpetrator characteristics, provided by agencies that have report-level tracking systems.

3. Key Indicators Component data consisting of aggregated data on key statistics of investigations and victims, provided by agencies that do not have report-level tracking systems or are unable to provide case-level data.

No personally identifiable information is included. Reporting will be voluntary on an annual basis.

From January through May 2015, nine states--Colorado, Georgia, Illinois, Maine, Massachusetts (Disabled Persons Protection Commission), Missouri, Montana, Pennsylvania, and Texas--participated in a pilot of the data system and submitted the Agency Component and either the Key Indicators Component or the Case Component data. During the NAMRS Pilot, the Agency Component and Key Indicators Component data were submitted using electronic data entry forms on the Internet. The Case Component data were submitted using extracts of data in XML format from state information systems. The reporting system was hosted in the Microsoft Azure Cloud environment. The website was an Azure Web App-hosted website. Both the NAMRS Pilot Database and the NAMRS Data Warehouse were SQL Server 2014 databases, operating on separate Azure Virtual Machines. Microsoft Azure, which is compliant with industry certifications, maintained data security.

Based on the pilot, the project team suggested clarifications and revisions to the data elements, data values, and data definitions. In addition, the team made recommendations regarding the activities needed to enhance and modify the pilot system into a fully implemented system to which all states and the territories would report their data on the maltreatment of vulnerable adults.

Next steps include finalizing the content of the system and obtaining approval from the U.S. Office of Management and Budget, establishing the operational practices for developing the full system and overseeing the collection of data, and finalizing the functional requirements for the full system and implementing all modifications to meet these requirements. The formal launch of working with states to report federal fiscal year 2016 data is planned for September-October 2016.

Volume 1 of this report consists of a description of the NAMRS Pilot, findings from the piloting process, recommendations for the future NAMRS, and related appendices. Volume 2 consists of the NAMRS Pilot system documentation, along with its related appendices.

1. Introduction

Over the course of the next 15 years, the population in the United States of persons 65 years or older will climb to approximately 72.1 million.¹ Currently, an estimated 33 million adults in the United States are living with a disability.² Research studies have indicated that many of these persons are at high risk of abuse, neglect, or exploitation.^{3, 4} However, national statistics are not available to provide the information that the Federal Government and the states need to plan and develop prevention and intervention efforts to meet the needs of both of these vulnerable populations.

On March 23, 2010, President Obama signed into law the Elder Justice Act (EJA) as part of the Patient Protection and Affordable Care Act. The Act authorized the prevention, detection, treatment, understanding, intervention in, and, where appropriate, prosecution of elder abuse, neglect, and exploitation.⁵ The EJA also required the establishment of the Elder Justice Coordinating Council (EJCC), which recommended the establishment of a national adult protect services (APS) system.⁶

In September 2013, the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation (ASPE), began a 2-year effort to design, develop, and pilot a national reporting system based on data from state APS agency information systems. The pilot effort addressed the EJCC's recommendation to develop a national APS system based upon standardized data collection and a core set of service provision standards and best practices.

The goal of the future data collection system will be to provide consistent, accurate national data on the exploitation and abuse of older adults and adults with disabilities, as reported to state APS agencies.

The project was funded by Prevention and Public Health funds through an interagency agreement with the HHS Administration for Community Living (ACL). WRMA, Inc., a TriMetrix Company (WRMA), in collaboration with the National Adult Protective Services Association (NAPSA), the Center of Excellence on Elder Abuse and Neglect at the University of California, Irvine, and a number of nationally recognized experts, designed and piloted the future system under the oversight of a federal steering committee (FSC).

Overview of the Project

The project had the following goals:

• Determine information needs of potential stakeholders.

• Define the data elements that address these needs and the scope of the system.

• Design and develop a data reporting system for states to report on APS cases and policies to ACL.

• Conduct a pilot of this approach from the perspectives of availability of data and of the ability to use the reporting system.

• Summarize findings and recommendations on modifications or enhancements for the full implementation of a national system.

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Determine Information Needs

The EJA defines APS as: "such services provided to adults as the Secretary may specify and includes services such as--(A) receiving reports of adult abuse, neglect, or exploitation; (B) investigating the reports described in subparagraph (A); (C) case planning, monitoring, evaluation, and other case work and services; and (D) providing, arranging for, or facilitating the provision of medical, social services, economic, legal, housing, law enforcement, or other protective, emergency, or support services."⁷

APS was operationalized for the pilot system, in consultation with ACL, ASPE, and numerous stakeholders, as the services provided by state and local APS agencies to address allegations of maltreatment of older adults or adults with disabilities. As noted by the National Center on Elder Abuse, APS case workers are "first responders to reports of abuse, neglect, and exploitation of vulnerable adults."⁸ APS defines a vulnerable adult as "a person who is being mistreated or is in danger of mistreatment and who, due to age and/or disability, is unable to protect himself or herself."⁹

State and local agencies provide such services. According to NAPSA, in two-thirds of states, the state administration of APS resides in a department of social services. The remaining one-third are located within State Units on Aging (SUAs) or other state departments.¹⁰ In at least two states, the responsibility for investigating abuse of adults with disabilities is in an agency different from the agency that investigates abuse of older adults.

Following the model of the National Child Abuse and Neglect Data System, ACL decided that the source of data would be state agencies with responsibility for APS. Therefore the National Adult Maltreatment Reporting System (NAMRS) Pilot did not address maltreatment that may be the concern of the long-term care ombudsman program or investigated by other state or local regulatory agencies, such as licensing agencies. The primary focus of the pilot system was to be the persons who were the subject of reports alleging maltreatment.

To determine what the APS field defined as critical information needs, the project team convened key stakeholders to identify the data elements for a national system. The discussions focused on what data from state and local APS agencies are important for the field and the American public.

More than 40 state administrators, researchers, service providers, and other individuals in the field participated in stakeholder calls. More than 30 state representatives from 25 states met during three in-person working group meetings to discuss the uses of data and the key functionalities that should be included in a national system. The national system was named the national adult maltreatment reporting system (NAMRS). In this report, the version developed and piloted under this project is referred to as the NAMRS Pilot. The future version to be used for nationwide data reporting is referred to as the future NAMRS or just NAMRS.

During the stakeholder calls in April 2014, participants considered the following questions:

• What are the highest priority questions or issues that you would like a national APS data system to be able to address? Why?

• In addition to the data that are appropriate for all cases referred to APS agencies, are there data that are specific only to adults with disabilities, or only to older adults, that should be considered?

• What are challenges to collecting and analyzing these data from state agencies? What are your suggestions for overcoming these barriers?

• What other national datasets would be useful to consider as potential linkages to this system?

The team identified multiple crosscutting themes and implications from these calls:

• Defining Abuse--all stakeholder groups were interested in the data system's ability to help the elder justice and persons with disabilities fields create a clear definition of vulnerable adult abuse and neglect. Thus, definitional issues were identified as being critical to the design of the system.

• Learning about Victims and Abusers--all groups were interested in collecting demographic information about the client, along with the client's relationship to the alleged perpetrator. Stakeholders suggested that some of these data needed to address persons with disabilities specifically.

• Describing and Informing APS Practice--stakeholder participants were interested in the data system being able to provide insight into APS practice, case outcomes, and types of interventions.

• Affecting State and National Policy Issues--all groups expressed interest in using the data system to collect information on macro-level issues, which could impact state or national policy.

The participants in the state working group meetings were given the proposed data elements for consideration and comment. The meetings discussed in detail the elements and values to include in the system. Appendix A includes a sample agenda from these meetings. Other advice included:

• Keep in mind the complexity of differences in programs from state-to-state.

• Encourage state-to-state interaction as an invaluable experience in terms of learning what other APS agencies are doing.

• Strive for consistent definitions.

• Consider allowing states to comment with explanatory information throughout.

These meetings proved to be useful to the project team and the state participants. The state representatives praised the completed work and the value of hearing other states' perspectives, and expressed their excitement about the future system.

Define Data Elements

Stakeholder meetings helped to conceptualize the general design of the NAMRS Pilot as three components.

1. Agency Component, data provided by all agencies.

2. Case Component, case-specific data provided by agencies that have report-level tracking systems.

3. Key Indicators Component, aggregated data provided by agencies that do not have report-level tracking systems or are unable to provide case-level data.

FIGURE 1.1. Component Overview

The project team conducted an intensive review of legislation, literature, various research surveys, and other national data collection systems. In addition, the project team conducted several interviews of leading experts on particular concepts or terminology. Chapters 2-4 discuss the data elements used in the NAMRS Pilot and Appendix B consists of the detailed data elements.

Design and Develop a National Reporting System

The NAMRS Pilot data collection components--including the website, database, data loader, and data warehouse--were built and run on the Microsoft Azure Cloud platform.

The system functionality of the NAMRS Pilot was developed and tested in five increments called sprints. Sprint 1 set up the NAMRS Pilot website with user login functionality, giving users access to announcements and resource materials. Sprint 2 added the ability to enter and submit Agency Component data. Sprint 3 added the ability to upload and submit Case Component data. Sprint 4 added the functionality to enter and submit Key Indicators Component data. The fifth and final sprint included reporting and analysis baseline functionality. For a schedule of activities, including major milestones and sprints, refer to Appendix C. Chapter 5 discusses the actual technical infrastructure of the pilot system and provides supporting documentation in Volume 2.

Conduct a Pilot

With the approval of the FSC, the project team invited several states to participate in the NAMRS Pilot. The objective was to invite states with diverse programs, administrative structures, populations, and geography to gain a broad understanding of capacity and variation among state programs. States agreeing to submit the Agency and Case Components included Colorado, Illinois, Maine, Pennsylvania, and Texas. States agreeing to submit the Agency and Key Indicators Components included Georgia, Massachusetts (Disabled Persons Protection Commission), Missouri, and Montana.

Technical assistance (TA) via phone and email was provided to the pilot states. Each pilot state had an assigned liaison, who served as the primary contact between the states and the NAMRS Pilot team. The liaisons were responsible for providing TA and reviewing data submissions. Liaisons had the task of helping states that were submitting the Case Component to cross walk or map data elements from their information system to the NAMRS Pilot data elements. A webinar explaining the data reporting processes for the Case Component was offered on December 22, 2014. Through these efforts, all nine states successfully submitted their respective data components to the NAMRS Pilot with the first submission at the end of January 2015, and the final submission in late May 2015. The Case Component collected data on a total of 109,204 investigations, which included 112,230 clients. The Key Indicators Component collected data on a total of 47,838 clients. Thus, the pilot collected data on 160,068 clients.¹¹ Chapters 2-4 and Appendix D present additional information on the data submitted by each state.

Summarize Findings and Recommendations

During the project, the team identified several key principles for the future NAMRS:

• The content of NAMRS will be based on current data collection reporting capacities among APS agencies throughout the United States.

• The data content will also address aspirational objectives for expanding on the data that states routinely collect on cases, to improve services, program planning and management, and address critical gaps in knowledge at local, state, and national levels.

• State agency administrative information systems will be the source of data.

• Data will be reported based on screened-in reports for which the investigation and other activities were completed within the reporting period of the federal fiscal year (FFY), October 1 to September 30.

• All state agencies will be encouraged to submit data once a year and participate to their maximum ability.

• Submitting data to NAMRS will be voluntary.

• NAMRS will not include information from licensing agencies or state ombudsman offices.

• No personally identifiable information (PII) will be collected.

• Additional safeguards on protecting confidentiality will be implemented during data validation, data management, and data analyses phases.

The remaining sections of the report present additional findings.

Outline of the Report

Chapters 2-8 of this report include the following information:

• Chapter 2, Agency Component Data Elements and Recommendations, discusses the data elements, values and definitions of the NAMRS Pilot Agency Component, along with the findings from the pilot and recommendations for the future NAMRS Agency Component data elements.

• Chapter 3, Case Component Data Elements and Recommendations, discusses the data elements, values, and definitions of the NAMRS Pilot Case Component, along with the findings from the pilot and recommendations for the future NAMRS data elements.

• Chapter 4, Key Indicators Data Elements and Recommendations, discusses the data elements, values, and definitions of the NAMRS Pilot Key Indicators Component, along with findings from the pilot and recommendations for the future NAMRS data elements.

• Chapter 5, Functionality and Architecture of the NAMRS Pilot, presents the system functionality of the NAMRS Pilot Website, database, and data warehouse, and the overall system architecture.

• Chapter 6, Recommendations for Supporting the Future NAMRS, discusses the support provided to the pilot states and their reactions to this support, and presents recommendations for future support of states participating in NAMRS.

• Chapter 7, Recommendations for the Functionality and Architecture of the Future NAMRS, presents recommendations for modifying or enhancing the NAMRS Pilot for full implementation.

• Chapter 8, Next Steps, presents an overview of the next steps in implementing the future NAMRS.

Several appendices are also included:

• Appendix A. Sample NAMRS Pilot State Working Group Agenda
• Appendix B. NAMRS Pilot Data Specifications
• Appendix C. Schedule of NAMRS Pilot Activities
• Appendix D. NAMRS Pilot Data Submitted by States
• Appendix E. Proposed NAMRS Data Specifications
• Appendix F. NAMRS Pilot Validation Criteria
• Appendix G. NAMRS Pilot Case Component Mapping Forms

2. Agency Component Data Elements and Recommendations

This chapter discusses the data elements, values, and definitions of the Agency Component of the NAMRS Pilot. This chapter also discusses findings from the pilot test for the Agency Component and the recommendations for changes to this component in the future NAMRS.

The Agency Component

The NAMRS Pilot Agency Component collected background information on state policies and practices to provide contextual information for the Case Component and Key Indicators Component. The Agency Component also collected information on the agency and contacts who submitted the data. (See Appendix B for detail on each of the data elements.) This chapter discusses the following topics:

• The Agency Component
• Findings from the Agency Component
• Level of Effort to Report

Contextual data included the following nine topics:

1. Data sources (APS agency only or additional agencies).
2. Staffing (budgeted versus filled positions).
3. Acceptance of reports (centralized or local intake).
4. Report counts (not accepted, resolved through Information and Referral (I&R)/Information and Referral Assistance (I&RA), and accepted reports).
5. Standards of evidence for substantiation of investigations.
6. Time to complete an investigation.
7. Types of maltreatment addressed by the state.
8. Use of standardized assessment tools.
9. Service gaps.

Findings from the Agency Component

Piloting of the Agency Component was extremely useful. The states were able to complete nearly all of the data elements; Appendix D includes information on the number of states that were able to report on each data element. The pilot test revealed several findings, which resulted in recommendations of adjustments to the future NAMRS Agency Component specifications. The findings and the recommended actions are listed below. Most of the recommended changes to the Agency Component have been accepted by ACL as of the date of this report. Appendix E, Proposed NAMRS Data Specifications, reflects the accepted recommendations.

Finding 1. The pilot found that staffing information on budgeted positions is not available at the state level.

Action: The future NAMRS Agency Component will simplify the requested data to ask only for the number of filled investigation Full-Time Equivalents (FTEs) (including hotline personnel), and the number of filled supervisory FTEs.

Finding 2. The Pilot Agency Component grouped reports into three categories: (1) screened out and not accepted; (2) resolved through I&R; and (3) accepted for investigation. While all states reported on those accepted for an investigation, states interpreted the other two categories in different and inconsistent ways.

Action: The NAMRS Agency Component will only ask for the number of reports that were not accepted and the number that were resolved through I&R or I&RA. The Key Indicators Component and the Case Component will address the number of accepted reports.

Finding 3. The Pilot Agency Component did not clearly specify whether the statistic requested about the time required to complete an investigation referred to the state standard or a computed average. Many states did not have data on the actual time it took to complete a case.

Action: Since the NAMRS Case Component will be able to compute time to completion for those states that submit the Case Component, and since states were able to provide their state standard, if any, the NAMRS Agency Component will only ask for data on the standard set by policy or practice.

Finding 4. States were inconsistent in discussing the characteristics of the population served by their programs.

Action: The NAMRS Agency Component will add a question that asks specifically about the characteristics of population served. This will include a question about the settings investigated by APS, given that some state agencies do not investigate reports of maltreatment alleged to have taken place in facilities.

Finding 5. States were unclear in discussing whether they collect data on perpetrators.

Action: The NAMRS Agency Component will include a specific question on the extent to which person-specific data on perpetrators is collected.

Finding 6. Many states could not provide data on service gaps.

Action: This finding will not result in a change to the Agency Component. Information on service gaps is of critical interest and concern to the field. The data element will be retained for encouraging states to assess the extent of their services gaps and collecting data in the future.

Finding 7. The recently issued Draft Voluntary Consensus Guidelines for State APS Systems12 recommends focusing on response time.

Action: The NAMRS Agency Component will include a question concerning policies about responding to calls concerning possible adult maltreatment.

Level of Effort to Report

The average level of effort among reporting pilot states was 18 hours. Once a state completes the Agency Component initially, it is unlikely to require such an investment of time in subsequent submissions. Thus if the average is 18 hours the first year, one can suggest that the level of effort would be on average 10 hours in subsequent years to allow state personnel to review their earlier submission and modify it as necessary.

3. Case Component Data Elements and Recommendations

Social services terminology in the United States is in a continually evolving state. Thus, one of the key principles of a voluntary national reporting system is to include concepts that can be found in state and local programs and systems and that can be mapped or cross-walked to terms that are used in the national system. The project team's experience on other national reporting systems is that the detailed examination of concepts, terms, definitions, and logical relationships and dependencies among terms is essential to collecting comparative data. Furthermore, as states become more familiar with how other states define key concepts, there is an opportunity for building consensus definitions. National reporting systems have the potential of encouraging such opportunities among all stakeholders.

In general, in the NAMRS Pilot, definitions of terms and values were based on federal statutes, agency rules and regulations, existing data taxonomies, and guidance from the U.S. Office of Management and Budget (OMB) and the Census Bureau. Definitions were crafted not to serve as detailed guidance of eligibility of clients for specific programs or classification of clients into specific categories. Rather, they were developed to assist states in determining how best to cross walk terms in their own programs and systems to those of the NAMRS Pilot. This chapter discusses the following topics:

• The Case Component
• Findings from the Case Component
• Level of Effort to Report

The Case Component

The Case Component addresses the core requirement of NAMRS--namely to obtain case-specific data to understand the scope of the:

• Maltreatment of older adults and adults with disabilities as investigated by APS agencies.

• Needs of older adults and adults with disabilities who receive an investigation.

• Response of the APS agency to the needs of these persons.

• Outcomes of the activities of the APS agency.

The Case Component was the central component of the NAMRS Pilot. With 58 data elements, it collected data on multiple aspects (i.e., entities) of an APS case (see Appendix B for details):

• The Investigation Entity collected data on each investigation, no matter how many clients were part of the investigation. The investigation entity recognized that APS may provide services subsequent to making a determination of whether the allegations are substantiated or not and allowed a case closure date to also be provided. The investigation entity for the NAMRS Pilot included the following data elements:

  • Investigation ID
  • Report ID
  • Report source
  • State/county Federal Information Processing Standard (FIPS)
  • Investigation start date
  • Investigation disposition date
  • Case closure date

• The Client Entity consisted of characteristics for each client, each of whom has a unique ID encrypted upon submitting it to the NAMRS Pilot. It was possible for some data elements to have multiple values assigned (indicated by an asterisk in the list below). For example, a client could have more than one race. The NAMRS Pilot included the following data elements:

  • Client ID
  • Facility ID
  • State/county FIPS code of client
  • Case closure reason
  • Age
  • Gender identity
  • Sexual orientation
  • Race*
  • Ethnicity
  • English competency
  • Primary language
  • Marital status
  • Schooling level
  • Employment status
  • Income level
  • Benefits*
  • Veteran status
  • Disabilities*
  • Activity of daily living (ADL) score
  • Instrumental activity of daily living (IADL) score
  • Behavioral health screenings*
  • Behavioral health diagnoses*
  • Living setting at start
  • Living setting at close
  • Substitute decision maker at start*
  • Substitute decision maker at close*
  • Services at start*
  • Services provided by APS*
  • Services referred by APS*
  • Services at close*
  • Interagency coordination*
  • Previous report
  • Maltreatment

• The Maltreatment Entity collected data on each allegation of maltreatment and its disposition. The entity included data on each type of maltreatment that was alleged and investigated for each specific client. The NAMRS Pilot included the following data elements:

  • Maltreatment type
  • Maltreatment disposition

• The Perpetrator Entity collected data on each perpetrator associated with a substantiated maltreatment. Data on eight data elements, some of which could have multiple values, were requested. (A data element that could have multiple values is indicated by an asterisk.)

  • Perpetrator ID
  • Age
  • Gender identity
  • Race*
  • Ethnicity
  • Disabilities*
  • Behavioral health screenings*
  • Behavioral health diagnoses*

• The Client-Perpetrator Relationship Entity collected data on each of the characteristics of the relationship between each perpetrator and each client with whom there was a relationship. A perpetrator could be associated with more than one client with at least one substantiated maltreatment, and a client could be associated with more than one perpetrator. Data on eight data elements were requested. (A data element that could have multiple values is indicated by an asterisk.)

  • Cohabitation at start
  • Cohabitation at close
  • Kinship relationship
  • Perpetrator association at start
  • Perpetrator association at close
  • (Type of) perpetrator substitute decision maker at start*
  • (Type of) perpetrator substitute decision maker at close*
  • (Type of) perpetrator legal remedy*

Five states participated by completing the Case Component: Colorado, Illinois, Maine, Pennsylvania, and Texas. These states represent 19 percent of the population of the United States, different administrative structures, and some key differences in policy and practice. Table 3.1 below summarizes these characteristics.

TABLE 3.1. Policy and Practice Differences
State	Population	State Administration	State Policy and Practice	Age of Population Served
Colorado	5,355,866	Colorado Department of Human Services, Aging and Adult Services, Adult Protective Services	State APS administration County DSS APS staff	18+
Illinois	12,880,580	Illinois Department on Aging	State APS administration Contracted APS staff via aging network	18+
Maine	1,330,089	Maine Department of Health and Human Services, Office of Aging and Disability Services (OADS)	State APS administration OADS Aging Services in regional offices	18+
Pennsylvania	12,787,209	Pennsylvania Department of Aging	State APS administration Contracted APS staff via aging network	60+
Texas	26,956,958	Texas Department of Health and Human Services, Department of Family and Protective Services	State APS administration County DFPS APS staff	18+
SOURCE: Population census based on July 2014 estimates U.S. Census Quick Facts.

Appendix D provides information on the responses by the pilot states.

Findings from the Case Component

Two states were able to provide data on the majority of the data elements. In some instances, the other three states reported that some data were recorded in case notes, but were not retrievable for national reporting. Appendix D includes information on the number of states that were able to report on each data element.

In this section we discuss the findings on the data elements in the Case Component and the recommended actions to be taken. In most instances ACL has approved the recommendations. Appendix E, Proposed NAMRS Data Specifications, reflects the changes that have been accepted.

Finding 1. The logic and scope of the Case Component was understandable by the pilot states. States confirmed that the following major logical constructs were relevant to their state APS programs: A case includes an investigation and may include additional services. A case has at least one client. A client is the subject of allegations of maltreatment. Maltreatment types receive dispositions or findings based on the APS investigation. Persons can be associated as perpetrators to clients who have one or more substantiated maltreatments. Perpetrators may have one or more relationships to the client.

Action: No changes in logic or structure are recommended.

Finding 2. Investigation Entity data were supplied by all states. The exception was that two states did not report the state/county FIPS Code, due to the extra work that it would require during the pilot.

Action: No changes to the Investigation Entity are recommended.

Finding 3. No state was able to report on all of the data elements in the Client Entity.

Action: The FSC decided to keep several data elements because of their utility to the field in the future. Additionally:

• The English competency data element was dropped.
• The behavioral health screenings data element and behavioral health diagnoses data element were combined into one data element called behavioral health screenings or diagnoses.

Finding 4. All states were able to report on both data elements in the Maltreatment Entity.

Action: As a point of clarification the future NAMRS will rename the Maltreatment Entity to the Maltreatment Allegation Entity.

Finding 5. All states were able to report on at least some of the data elements in the Perpetrator Entity. Only one state was able to report on all data elements. All states had difficulty in reporting on behavioral health screenings and diagnoses.

Action: The FSC decided to combine the data element for behavioral health screenings and the data element for behavioral health diagnoses into one data element, as was done under the Client Entity.

Finding 6. The pilot revealed a number of issues regarding perpetrators that will need close attention and guidance as to how they should be handled during full implementation: States may not maintain unique IDs of perpetrators. States may not be familiar with linking perpetrators to specific maltreatments. Some states treat the client as the perpetrator in self-neglect maltreatment cases.

Action: These issues will need close attention and guidance as to how they should be handled during full implementation.

Finding 7. Many states were unable to report on data on the Client-Perpetrator Relationship Entity. With the exception of the data element on kinship relationship, most data elements in the Client-Perpetrator Relationship Entity were reported on infrequently. No state was able to report on the perpetrator substitute decision maker at start data element.

Action: The FSC decided to retain all data elements given their significance in terms of outcomes based on the intervention by APS.

Finding 8. In some instances, the TA provided to states indicated that certain data values and definitions should be clarified.

Action: The Case Component in the future NAMRS includes adjustments to several data values and definitions to improve consistency and clarity.

The following table summarizes key changes accepted by the FSC regarding the future Case Component. Consult Appendix B and Appendix E for detailed information.

TABLE 3.2. Code Value and Definition Changes
Data Element	Description of Change to Code Value or Definition
Report Source	Added in-home caregiver and nursing home staff, made multiple response
Facility ID	Removed data element
Case Closure Reason	Refined nested categories
English Competency	Removed data element
Disabilities	Added speech difficulty
Behavioral Health	Combined behavioral health screening and/or diagnoses (client and perpetrator)
Maltreatment Type	Added "other" form of exploitation
Perpetrator Association to Victim	Reframed definition of caregiver values

Level of Effort to Report

The level of effort to complete the Case Component varied a great deal. The five states could be grouped into three categories of level of effort.

• Low Level of Effort--One state expended 91 hours to complete the Case Component, and a second state used 126 hours to complete the Case Component. The software developers in each of these states used 84 and 121 hours, respectively. In both instances these states had technical support with XML knowledge.

• Medium Level of Effort--One state expended 239 hours and another state expended 245.5 hours. In the first state, technical staff used 220 of the 239 hours. They were familiar with XML and the existing state system but used the opportunity to correct and enhance some aspects of their existing system. In the second state the information technology (IT) staff used 138 out of the 245.5 hours. The IT staff were familiar with XML, but not as familiar with the content of the system and the balance of hours was used by programmatic staff.

• High Level of Effort--One state used 674 hours, of which 611 were used by IT staff. This state was not as familiar with XML and the technical support that was provided did not focus early enough on these issues.

4. Key Indicators Data Elements and Recommendations

The plan for full implementation of NAMRS recognizes that not all states will be able to complete the Case Component in the first few years of national implementation. Therefore the Key Indicators Component was designed to collect a select number of statistics, which would help ACL establish national estimates. This chapter discusses the following topics:

• The Key Indicators Component
• Findings from the Key Indicators Component
• Level of Effort to Report

The Key Indicators Component

The NAMRS Pilot Key Indicators Component collected aggregated data on clients, victims, and perpetrators from states that did not provide the Case Component. Victims were defined as those clients for whom there was at least one substantiated allegation of maltreatment. There were a total of 19 data elements, and respondents were able to also comment on each data element. (See Appendix B for more detail on each of the data elements.) The data elements in the Key Indicators Component were:

• Clients who received an investigation.

• Clients who received interagency coordination.

• Clients by case closure reason.

• Victims by age.

• Victims by race.

• Victims by ethnicity.

• Victims by gender identity.

• Victims who received one or more public benefits.

• Victims with one or more disabilities.

• Victims with one or more screened behavioral conditions.

• Victims by maltreatment type.

• Victims with guardian or conservator at start of investigation.

• Victims who received services or were referred for services by APS.

• Perpetrators by age.

• Perpetrators by gender identity.

• Perpetrators who had a kinship relationship to the victim.

Findings from the Key Indicators Component

The NAMRS Pilot Key Indicators Component collected aggregated data on three topics:

• Clients
• Victims (clients who are found to have one or more substantiated maltreatments)
• Perpetrators

The automated data collection form allowed comments to be added for each data element. Four states--Georgia, Massachusetts (Disabled Persons Protection Commission), Missouri, and Montana--were invited to submit the Key Indicators Component, based on past conversation and the perceived level of effort to do so. Appendix D includes the data elements completed by the states.

Finding 1. All states were able to provide data on clients who received an investigation and case closure reason, but only two states were able to submit data on interagency coordination.

Action: No changes were recommended.

Finding 2. All states were able to provide data on the basic demographics of victims, including number, age, race, ethnicity, and gender identity. States did not use the value of transgender under gender identity.

Action: The values for race were changed to be more consistent with the Case Component. The value "multiracial" was deleted and the data element was made multiple response. No other changes were recommended.

Finding 3. All states were able to report on victims by maltreatment type.

Action: The values for maltreatment type were adjusted to be in alignment with the Case Component. The revised values allow for exploitation in general or financial exploitation and other exploitation to be distinguished. The user guide instructions will need updating.

Finding 4. Three states were able to complete victims with one or more disabilities.

Action: No changes were recommended.

Finding 5. Fewer states completed the remainder of the victim data elements: Two states completed victims who received one or more benefits; one state completed victims with one or more screened behavioral conditions; two states completed victims with guardianship or conservator at start of investigation; and two states completed victims who received services or were referred services by APS.

Action: No changes were recommended.

Finding 6. Three of the four states completed two data elements on perpetrators: perpetrators by gender identity and perpetrators with kinship relationship. The remainder of the data elements pertaining to perpetrators were completed by only 1-2 states: perpetrators by age (two states); perpetrators with one or more associations to the victim (two state); and perpetrators with one or more legal remedies (one state).

Action: No changes were recommended.

Finding 7. Although the Key Indicators Component collected data on the number of clients who received an investigation and the number of clients who were found to be victims, it did not collect information on the number of investigations that were completed during the reporting period. All three data points are available through the Case Component.

Action: Number of investigations completed during the reporting period was added to the future NAMRS Key Indicators Component.

Finding 8. Comment field boxes were not extensively used.

Action: No changes were recommended; states will be able to clarify their responses.

Finding 9. Leaving a data cell blank or inserting a zero into a data cell was not consistently done by the pilot states.

Action: During the future implementation of NAMRS, the technical support team will provide additional guidance on these topics.

Level of Effort to Report

The level of effort expended by the states depended upon the extent to which the statistics were already routinely available in the agency. If the state already had extant reports addressing the data in the Key Indicators Component, then completing the 19 data elements, or as many that were readily available in the state system, was not time consuming. However, if the state did not have these data already computed it took significant effort to complete the Key Indicators.

In two of the four states that completed the Key Indicators, the majority of the statistics had already been computed and the level of effort was very low, 6 and 12 hours respectively. In the remaining two states, the data were available in the information system, but needed to be computed for the Key Indicators. In both of these states, significantly greater level of effort was expended, 65 and 103 hours respectively.

The future implementation of NAMRS could assist states in choosing whether the level of effort that might be needed to complete the Key Indicators Component could be more productively used in completing the Case Component, which does not involve any computations. Nevertheless, the Key Indicators Component should be retained because it is unlikely that all states will be able to complete the Case Component in the first few years of the NAMRS implementation.

5. Functionality and Architecture of the Namrs Pilot

The NAMRS Pilot system was designed and developed as an online web-based application that would collect data about adult maltreatment from states and allow access to that data by analysts. It collected data for the Agency Component, the Case Component, and the Key Indicators Component. Data for the Agency Component and Key Indicators Component were entered into the system through electronic forms on the website. The Case Component data were submitted in a standardized XML file, created by each state and uploaded through the website.

The major architectural elements of the system, shown in Figure 5.1, were:

• The NAMRS Pilot Website--Users interacted with this website. This website enabled users to enter or upload their data components, view data about the components, and perform all the other activities required to administer the NAMRS Pilot system.

• The NAMRS Pilot Database--All the data components entered or uploaded through the website were stored in the database. The database also contained other data such as user account data, and value lookups.

• The NAMRS Pilot Data Warehouse--The data components were loaded into the data warehouse from the database so that they were easy to query by analysts. The data warehouse was accessible from the Internet and users could use the analytical tools of their choice.

FIGURE 5.1. NAMRS Pilot Data Flow

This chapter discusses the following topics:

• The NAMRS Pilot Data Model section discusses the main conceptual entities and their relationships.

• The NAMRS Pilot Functionality section discusses each of the three major components from a user perspective.

• The NAMRS Pilot Architecture section provides a general overview of the architecture of the NAMRS Pilot and discusses each component.

• The NAMRS Pilot Security section discusses the maintenance of security of the three major components.

The NAMRS Pilot Data Model

The NAMRS Pilot Data Model consisted¹³ of the entities and relationships illustrated in Figure 5.2 and described below.

FIGURE 5.2. NAMRS Pilot Data Model

There were eight components of the data model:

• The Agency Component captured key features of the state agency that collected and reported APS data. There was one Agency record for each year/state pair.

• The Key Indicators Component collected aggregated data based on computations from each state agency that did not provide Case Component data. There was one Key Indicators record for each year/state pair. States that provided Case Component data did not have a Key Indicators Component record.

• The Case Component collected data on all APS cases that were closed during the reporting period (the FFY). The Case Component consisted of the Case Component Dataset, along with all its descendants (described below). There was one Case Component Dataset record for each year/state pair. Each Case Component Dataset had one or more investigations associated with it. This entity served as a container for all the investigations for one year/state.

• An investigation record represented a single investigation within a Case Component Dataset. An investigation was associated with a single Case Component Dataset and there could be one or more investigations for each Case Component Dataset.

• A client record represented a single client within a particular investigation. A client was associated with a single investigation and there could be one or more clients per investigation. A client could be associated with zero or more relationships (to perpetrator) and had to be associated with one or more maltreatment (at least one substantiated maltreatment).

• A perpetrator record represented a single perpetrator within a particular investigation. A perpetrator would be associated with a single investigation and there could be zero or more perpetrators per investigation. A perpetrator could be associated with zero or more relationships (to client) and must be associated with at least one substantiated maltreatment. Perpetrators could not be associated with unsubstantiated maltreatments.

• A maltreatment record represented a single maltreatment of a client (and might be associated with perpetrator(s)). A maltreatment must be associated with one client and could be associated with zero or more perpetrators. There must be at least one substantiated maltreatment associated with each client if there was a perpetrator.

• A relationship record represented a relationship (e.g., kinship) between a client and perpetrator. A relationship must be associated with a one client and one perpetrator (although a relationship was not required between any particular client/perpetrator pair).

The NAMRS Pilot Functionality

This section discusses the user functionality of each of the three main components.

The NAMRS Pilot Website

The NAMRS Pilot website provided a straightforward user interface that allowed users to access the NAMRS Pilot system. Each of the pages in the NAMRS Pilot Website was designed to be clean and simple. On the pages that were used to enter and upload either Agency Component or Key Indicators data (the most frequently used pages in the website), there were helpful tooltips on most entry fields to provide guidance to users. On long report pages with a large number of items (e.g., frequency counts), the report sections were contracted so that the user could easily view only the items they wanted to view. Reports could also be downloaded as PDF files, so that they could be easily printed. There was a page on the website that displayed announcements to all users to keep them informed about the NAMRS Pilot system. Finally, there was a resource section of the website that provided helpful text and files for users.

Website User Roles

Every NAMRS Website user was assigned a single role on the website. Each role, described below, allowed the user to access different pages or perform different functions on pages.

• State users could enter/upload data and view reports for their own state. They could not access any data for a state other than their own.

• Federal users could view data and reports for all states. They could not change any state data.

• Technical users (including liaisons) could enter/upload data and view reports for all states. Additionally, they could accept/reject data components for any state. Technical users managed resources and announcements displayed on the website to all users.

• Administrator users had the same access as a technical user. Additionally, administrators could manage (create/edit/disable) users in the website.

Website Workflow

As mentioned above, the main function of the NAMRS Pilot Website was to enable states to input data into the system. Figure 5.3 illustrates the general workflow for data input.

FIGURE 5.3. General Workflow for Data Input

Explanations for the workflow steps follow:

• Save Data Component--A state user could access the NAMRS Pilot Website and enter data for the Agency Component and Key Indicators Component. The data were entered into easy-to-use forms on the website. State users did not have to enter all the data in one session. They could enter some of the data for one or more data components, save the data, and return later to continue.

  Case Component data was uploaded to the NAMRS Pilot Website as an XML file that conformed to the NAMRS Pilot XML schema. To upload the XML file, the user would browse to the Case Component page on the website. This page provided the ability to upload the XML file.

• Validate the Data Component--When the user filled out the forms for the Agency Component or Key Indicator Component data, all the data entered into the forms were validated before being saved by the system. Some validation happened in real time as the user was typing (i.e., the user could not enter alphabetic data into fields that only accepted numeric data), and some validation happened after the user clicked the save button (e.g., the user was notified that they had forgotten to enter a required field). The user must have fixed the data before it could be saved into the system.

  There was a different validation process for the Case Component data after an XML file was uploaded. The XML file could be quite large and contain many thousands of investigations in it, or the system might be validating a different state's data, therefore validation might have taken a few minutes to complete. After the users uploaded the Case XML file, they saw a message on the NAMRS Pilot Website informing them that validation might take some time, and that they would receive an email when validation was complete so that they could return to the site and view the results.

• Review Data Component--In the case of the Agency or Key Indicators Components, the users could enter the data on the website over several sessions, and it was validated each time they saved their data. When they were finished entering their Agency or Key Indicators Component data, they were encouraged to review the entries in the forms one last time before actually submitting it for approval. The users could change the data on the forms as desired until submitting it for approval.

  For the Case Component, after the Case Component XML file had been uploaded and validated, the users would return to the website and could review different counts, error/warning messages, and other statistics about their Case Component data so that they could make a decision about whether they wanted to submit their data. If they decided that the data were not acceptable, they could upload a new Case Component XML file and repeat the process. If the data were acceptable, they would continue to the next step.

• Submit Data Component--After state users finished reviewing their data component, they could submit the data for approval. Submitting the data involved simply clicking a submit for approval button.

• Technical Review of Data Submission--A technical user reviewed the data component after a data component submission for approval. For Agency and Key Indicators Components, the technical user would review the same forms that the user filled out and make a decision about whether to accept the data. For Case Component data, the technical user would review the same counts, error/warning messages, and other statistics about the Case Component data to determine whether to accept the data. When the technical user entered a decision about whether to accept the data, the system would send an email to the state users advising them of the decision and giving some further instructions. In addition, the technical user would follow up with the state users to explain why the data were or were not accepted into the system, and provide assistance. Significant TA was provided at this juncture to discuss potential corrections that might be appropriate to the data submission, based either on the automated review or on the review of mapping forms or earlier discussions with the state users.

As the steps above have illustrated, there were two very similar workflows, one for the Agency and Key Indicators Components, and one for the Case Component. Figure 5.4 and Figure 5.5 illustrate these two workflows.

FIGURE 5.4. Agency and Key Indicators Component Workflow

FIGURE 5.5. Case Component Workflow

Data Validation

All NAMRS component data were validated before being saved into the system. The Agency and Key Indicators Components data were entered into the system by the state user through forms in the website, and were validated instantly when the user clicked the save button. The Case Component data were uploaded as an XML file, and could take several minutes to validate.

Agency and Key Indicators Components Validation

• Data Type--All input fields only accepted the proper data type. Numeric fields (such as the FTE counts) only allowed the user to type numbers. Fields that accepted general text accepted any character. As a second level of security, the user repeated the same validation after the form had been submitted.

• Data Length--All comment fields were checked for length and must be less than or equal to 5000 characters in length. As a second level of security, the user repeated the same validation after the form had been submitted.

• Required Fields--Each of the two data components had some required fields, and there was logic to validate that the user had entered data into those fields.

• Data Rules--The Key Indicators Component had several rules that applied logic to determine validity of the data entered. The Agency Component data had no data rules.

Appendix F lists all validation criteria for the Agency Component and the Key Indicators Component.

Case Component Validation

After a user uploaded a Case Component XML file, two types of validation happened. Figure 5.6 illustrates the validations and shows the validation status as well as the error/warning messages.

FIGURE 5.6. Case Component Validation Steps

XML Validation--The XML file was validated against the NAMRS XML schema definition (XSD). Validating the XML against the XSD ensured that the XML file could be read correctly. The XSD ensured that the XML had the proper XML tags, XML tag nesting structure, data types, and unique identifiers (IDs). If there were no XML errors then the file presented as valid and moved on to data rule validation. If there were any errors at all, then the file was invalid, and validation stopped.

Data Rule Validation

If the file passed XML validation, then several rules applied logic to the data in the file to determine the validity of the data. One data validation rule is that each client must have one or more associated maltreatments. Invalid data (as defined by the data rules) were removed from the XML. After validation was completed and invalid data were removed from the XML, a check was done to see if there were any remaining investigations in the XML data. If so, then validation was deemed a success, and all remaining valid data were imported into the database. However, if all investigations had been removed from the file, then validation was deemed to have failed and no data were imported into the database. Appendix F lists the data rules.¹⁴

After validation was complete, an email was sent to the state users informing them whether the XML had passed or failed validation, and instructing them to return to the NAMRS Pilot Website to get more information, including the following:

• Validation Status--The validation status was a message indicating whether the validation succeeded or failed.

• Validation Errors--If there were errors from the XML validation, then the XML errors displayed. These XML errors gave the state users enough information to correct their XML structure. The state users received these same XML errors if they used an XML validation application before uploading.

• Validation Warnings--These were warnings about the data rules. The content of the warning messages are detailed below:

  • Rule Number--The rule number is a number for the rule and can be used to reference the particular violated rule. In the example on the next page, the rule number is N1040.
  • Rule Explanation--The rule explanation was a readable explanation of the rule. In the example on the next page, it states that the report date must be less than or equal to the investigation start date. The report date and the investigation date were part of the Investigation entity.
  • Path Information--The error contained path information that enabled a user to locate the XML element that contained the data rule violation. In the example on the next page, it says that the error resides in the investigation XML tag, which has an investigationId of abc1234def. This information makes it very straightforward for a user or developer to locate the actual error within the XML file using an XML Editor application. (It also makes it easy for the state users to look up their data in their own database.)
  • Action--The action specified what occurred to resolve this data rule violation. The example on the next page states, "This element was removed." It is referring to the XML element in the Path portion of the message, meaning that the entire investigation identified in the path (i.e., investigation with ID of abc1234def) was removed from the XML (including all the clients, maltreatments, and other data element tags, which were part of the indicated investigation).

• Entity Counts--The entity counts were counts of the XML tags for the investigation, client, maltreatment, perpetrator, and relationship tags. Each count showed the number of tags that were found before and after the data rule validation step. This helped the state users determine whether the NAMRS Pilot system actually imported their XML accurately, as well as how much of their data were removed due to data rule violations.

• Identifier Counts--The Identifier Counts were counts of distinct IDs from the XML. The Identifier Counts displayed the number of unique investigation, client, facility, and perpetrator IDs. (Note that each ID must be encrypted and hashed.)

• Case Data Reports--The case data reports were various viewable data reports. These included frequency counts, key indicators, and additional information.

It was expected (and observed in the pilot) that all Case XML files would have some data rule violations that display as warnings. A typical error message display is shown below.

Rule N1040 had errors.

Rule: If the Report Date and Investigation Start Date are both not empty, then the Report Date must be less than or equal to the Investigation Start Date.

Error: Path: investigation/Ids: investigationId=abc1234def Action: This element was removed.

The information above gave the state users enough information to correct their data, if there were actual errors. If there were no errors, but rather just data warnings, then the state users had enough information to determine if they could submit their Case Component for approval. If the state users decided that there were too many warnings they would make changes to their data (or to their software that builds their XML file), re-upload the file, and go through validation again.

NAMRS Pilot Database

The NAMRS Pilot Database was a SQL Server database. The database contained 104 tables split into the functional groups below. State users entered/uploaded the vast majority of the data, which were the NAMRS Components. The NAMRS Pilot System Documentation, Volume 2, includes an Entity Relationship Diagram for the database.

Announcements and Resources

The NAMRS Website displayed announcements on the home page. It also had a resources section which displayed files and text resources to assist state users with using the NAMRS Pilot. All the data required for the announcements and resources was contained within these tables. These tables were part of the core schema.

Case Component XML Validation Rules

The Case Component Loader executed validation rules against the Case XML files. Validation rules were LINQs performed against the XML. All the data required for validation, including the actual LINQs, were contained within these tables. These tables were part of the core schema.

Error Logging

The NAMRS Website used an open-source component for Error Logging Modules and Handlers (ELMAH) for error logging. This component required a single table in the database for saving the log messages. This table was part of the DBO schema.

Lookups

All the tables in the lookup functional group contained rows that were text values for different tables within the system. Each table only had a few rows, generally less than 10-20 rows. These tables were part of the Lookup schema.

NAMRS Components

The tables in this functional group held all the actual NAMRS component data (the data represented by the conceptual model above), as well as some data used for reporting that was calculated from the component data. These tables were part of the NAMRS schema.

Users and Identity

These tables were used for website authentication, authorization, and user information.

The overall database schema was quite straightforward, and changes were able to be made at any time. Over time, the NAMRS data model is expected to change as requirements evolve, and the database structure will need to be modified. Changes to the data components would require changes to: (1) the database; (2) the forms on the website or the software that imports data from the Case Component XML files into the database; (3) the validation functions; and (4) any reports or extracts that use the affected data.

NAMRS Pilot Warehouse

The NAMRS Pilot Data Warehouse provided an easy-to-use database that could be queried using any statistical analysis application, data visualization application, or SQL query application. The data warehouse was tested with SPSS, SAS, Tableau, and SSMS, but there are many different applications that fall into each of these categories. The NAMRS Pilot Data Warehouse was designed to be accessible over the Internet. Any application that can establish an Open Database Connectivity (ODBC) connection could access it, as illustrated in Figure 5.7. ODBC, supported by most applications that are designed to work with data, is a mature protocol for accessing databases.

FIGURE 5.7. Analyst Connects Directly to the Data Warehouse

The structure of the NAMRS Pilot Data Warehouse closely matched the NAMRS data model shown in Figure 5.2. It contained the NAMRS Pilot data from the Case Component tables in the NAMRS data model. Data that were not part of the Case Component, such as the announcements and resources, Case Component XML validation rules, error logging, and user and identity tables were not contained in the data warehouse. The NAMRS Pilot Data Warehouse was not designed to include the Agency or Key Indicators data, which were available in Excel format extracts. The structure of the data warehouse was denormalized to the point where all the Lookup data were stored directly in the main data tables so that it was easy to query using any tools.

NAMRS Pilot Architecture

The NAMRS Pilot system was hosted in the Microsoft Azure Cloud environment. This section discusses the advantages of the cloud environment, which are pertinent to both the NAMRS Pilot and the future NAMRS, the high-level system architecture within the cloud, components used by the NAMRS Pilot, and security features available through the cloud environment.

Cloud Environment

There are several levels of hosting environments, which provide different advantages. Figure 5.8 illustrates these levels.

FIGURE 5.8. Comparison of Hosting Models

• On-Premises Hosting--This is not cloud hosting, but rather consists of purchasing physical hardware and hosting it in a data center.

• Infrastructure as a Service (IaaS)--In this model, the cloud provides a virtual hardware environment that includes virtual network services and virtual server hardware. This eliminates the sunk cost and management of physical hardware.

  • The NAMRS Pilot system was a hybrid of Platform as a Service (PaaS) and IaaS. (In Chapter 7, we recommend moving to a fully PaaS model.) PaaS and IaaS models provide several advantages over an On-Premises model.

• PaaS--In this model, the cloud provides services that can be used by applications. This eliminates all the management of any hardware (physical or virtual), operating systems, and runtime software.

• Software as a Service (SaaS)--In this model, everything is provided and the user simply configures their applications. Examples of these systems are Salesforce, Constant Contact, and NetSuite.

• Scalability and Flexibility--In a cloud environment, it is easy to scale a system up from supporting ten to thousands to even millions by easily adding virtual hardware or services. Scaling can be done manually or automatically. For example, in the case of the NAMRS Pilot, it gives the option to scale the system up during parts of the year that state users will be submitting yearly data, and scaling it back down during less busy parts of the year to minimize unneccessary expenses. The system can be configured to scale up automatically as the system becomes busy and scaled back down as traffic decreases.

• Cost Benefits--In a cloud environment, billing includes only the services being used. There is no need to buy and maintain expensive hardware, and keep that hardware running while it is idle. In the example above, as the system scales down, costs go down; there is no "sunk cost" for underutilized servers.

• Significantly Lower Maintenance Costs--The cloud gives the option of using services rather than hardware (or virtual hardware) in a PaaS model. This means that there is no requirement to apply operating system service packs or monitor hardware for physical errors. This happens in the fabric of the cloud.

• Decreased Downtime--Hardware upgrade and maintenance is mandatory, even the physical hardware that powers the cloud. However, in the cloud, when physical hardware is in maintenance mode, virtual services are relocated, resulting in no downtime.

• Security and Compliance--Cloud services are extremely secure. The Microsoft Azure environment is compliant with most industry compliance standards. (See the section on Security for more information.)

NAMRS Pilot System and Azure Cloud Services

As mentioned above, the NAMRS Pilot system was hosted in the Microsoft Azure Cloud. It was able to take advantage of different services provided by the cloud environment.

Azure Web Apps (PaaS)--This is a managed, secure, scalable, highly-available, load-balanced, and geographically load-balanced web application hosting service. It removes the need to implement a web server or virtual machine (VM). This service was used for hosting the NAMRS Pilot Website.

Azure Redis Cache (PaaS)--This is a managed implementation of the Redis Cache service. This provides secure, scalable, caching inside the Azure Cloud.

Azure Virtual Machine (IaaS)--This is a scalable, highly-available, secure, virtual server located inside the Azure Cloud. The NAMRS Pilot Database and the NAMRS Pilot Data Warehouse used these virtual servers for hosting.

Azure Blob Storage (PaaS)--This is a scalable, highly-available, geographically redundant data storage service for files inside the Azure Cloud. This service was used for storing various files, such as the state's Case Component XML files.

SendGrid Email (PaaS)--This is an email service that is provided through the Azure Marketplace. This service was used for sending emails to various users.

There are many other services available inside the Microsoft Azure Cloud, but the NAMRS Pilot used the ones above.

The following diagram, Figure 5.9, illustrates the different services used and the relationships between them.

FIGURE 5.9. Azure Services used by NAMRS Pilot

As seen in Figure 5.9, the NAMRS Pilot system had several different components. The architecture of each is described in detail below.

NAMRS Website Architecture

The NAMRS Pilot Website was the web interface. This website allowed state users, federal users, technical users, and administrators to log in, view/edit data, upload XML files, and download reports. Previous sections in this document described the functionality of the website.

The website was built as a Microsoft ASP.Net MVC Web Application. It was written in C# and used Entity Framework and LINQ for all database access. It used HTML5, CSS3, and Javascript, as well as many open-source components and frameworks, including jQuery, jQuery UI, Bootstrap, ELMAH, Unity, iTextSharp, and other components. The website was hosted in the Microsoft Azure Cloud as a Web App. A Web App (previously called an Azure Website) is a scalable, highly-available website. The Azure environment managed all the underlying servers, security, server updates, and networking.

As further discussed below, the Web App accesses several other components in the NAMRS environment.

There was some user-based session data used in the NAMRS Pilot Website. An example of these data is that when state users logged in, their assigned state was stored into session data for convenience. Session data are generally used for performance and convenience--the NAMRS Pilot website used very little session data. Session data were stored in the Azure Redis Cache service and was very fast and secure. All data were encrypted as the data moved across the network between the Web App and the Azure Redis Cache service, and all data inside Azure Redis were encrypted.

NAMRS Pilot Database Architecture

All data for the NAMRS Pilot Website were stored in the NAMRS Pilot Database. These included the state's Agency, Key Indicators, and Case Components, announcements and resources that were displayed on the website, and login data. This database used Microsoft SQL Server running on an Azure Virtual Machine.

NAMRS Pilot Data Warehouse

The NAMRS Pilot Data Warehouse provided a way for analysts to query the Case Component data using statistical analysis applications, data visualization applications, query applications, and any other type of application that is capable of querying a database. The data warehouse used Microsoft SQL Server running on an Azure Virtual Machine.

NAMRS Pilot Storage Architecture

The website needed to store and access various files, such as state's Case Component XML files, different PDF files that were pre-generated, and resource files. All these files were stored using an Azure Blob Storage Container.

NAMRS Pilot Email Architecture

The NAMRS Pilot Website sent emails to state users and technical users as the status of state data was updated, and for the forgot password function. For example, when state users submitted their Agency Component, a technical user received an email to inform them that they needed to inspect this data. Then when the technical user approved or rejected the data, the state users received an email to let them know the updated status. Emails were sent through the SendGrid service in the Azure environment. The service allows sending up to 25,000 emails a month in the Azure Cloud at no cost. Additional plans are available for sending more emails for minimal cost.

NAMRS Pilot Case Loader Architecture

The NAMRS Pilot Case Component Loader was an application that ran all the validation on the Case Component XML files, loaded the Case Component data into the database, and did some other processing on the Case Component data. The future Case Component XML files may be a bit large (although not observed in the NAMRS Pilot), so the Case Component Loader will accept the Case XML files as XML files or as zipped XML files.

The uploaded XML files were validated against the NAMRS Case Component XSD file. It was expected that state users validated the file against the XSD before they uploaded it to the NAMRS Pilot Website. Validation was also performed in the NAMRS Pilot Case Component Loader so that if a state user uploaded an invalid XML file, the Loader would identify it as invalid.

The Case Loader performed the functions on all files waiting to be processed:

• Downloaded the file from NAMRS Pilot Storage to the local Temp space.

• Unzipped the file (if the file was zipped).

• Validated the file against the XSD.

• If the file passed the XSD validation, then ran the data validation rules against the file (and performed actions on rule violations) and built a list of warning messages for the user. After validation, a new version of the file without any invalid tags/data was saved.

• Loaded the data from the valid case XML file produced by the previous step into the database.

• Calculated basic counts, computed Key Indicators, and other summary data that was displayed on the website.

• Built the PDF files for the summary counts and frequency counts.

The Case XML Loader was built as a console application (an executable). The application was written in C# and used Entity Framework and LINQ for all database access. The site used several open-source components and frameworks, including DotNetZip, iTextSharp, log4net, and RazorEngine.

This application ran on an Azure Virtual Machine. It was executed as a scheduled task on the VM, running once every minute. The NAMRS Pilot Case Loader accessed many of the same services as the NAMRS Pilot Website.

The Case Loader loaded data from the XML file into the database. It then performed many queries against the database to summarize and calculate counts and other information that were stored back into the database. The Case Loader read Case XML files from the Azure Blob Storage. It also created PDF files and other files that were stored back into the storage containers. The Case Loader sent emails to state users and technical users as the status of state data updates.

NAMRS Pilot Security

Each of the components had different levels of security, which are described briefly below.

Azure Environment

The Azure environment itself has multiple levels of security:

• Physical Security--Azure data centers have excellent physical security.

• Network Security--Data moving across the cloud network is separated for security. Every service and VM has virtual firewall capability available (and VM) to control data moving in and out of the cloud network. Data inside the cloud is all encrypted as it moves across the internal cloud networks.

• Host Security--Physical hardware runs a specialized version of Windows Server and HyperV.

• Application Security--Azure Web applications run in managed VM's (internally) that are all isolated from each other. As a result, there is no possibility of data leaking between different web applications.

• Data Security--Strong storage keys are required for access control. SSL support for data transfers.

• Multifactor Authentication--Multifactor authentication controls logging into the Azure Console to do administration and deployments, among other things.

There is additional information available about Azure Security in the Microsoft Azure Trust Center at http://azure.microsoft.com/en-us/support/trust-center/security/.

Microsoft Azure is also compliant with most American and European industry certifications such as CJIS, EU Model Clauses, FDA 21 CFR Part 11, FedRAMP, HIPAA/HITECH, SOC1/SOC2, and PCI DSS Level 1. More information about Azure Standards Compliance is available in the Microsoft Trust Center at http://azure.microsoft.com/en-us/support/trust-center/compliance/.

NAMRS Pilot Website

The NAMRS Pilot Website employed the following security measures:

• Login--All pages in the site, including the home page, required users to login. (The NAMRS XSD file was available without login, but it was just a public file, not a web page.)

• Encryption--All pages in the site had SSL encryption. (The lock icon was displayed in the user's browser.) If a user attempted to access the site without SSL (HTTP), the site would immediately switch to use SSL encryption (HTTPS) so that no information was ever transported across the web without encryption. (The NAMRS XSD file is available using HTTP because some XML Editors/Validators cannot handle HTTPS or logins. This is an industry standard for XSD files.)

• Hashed Passwords--The site did not store user passwords in the database. Instead, only password hashes were stored. The password hash algorithm used in Microsoft Identity 2 is SHA1. More specifically, it runs 1,000 iterations of a salted SHA1 (where the salt becomes part of the actual hash). This is industry standard, and highly secure.

• Firewall--The Azure Web App service is firewalled from the Internet, and Azure handles all physical and network security. Only ports 80 (HTTP) and 443 (HTTPS) are open to the Internet.

• PII--The NAMRS Pilot system did not store any PII, so there was no way to link any particular piece of data to any individual person.

• Encrypted IDs--States were required to encrypt all IDs in the Case Component using a secure encryption algorithm of their choice. Additionally, the data must have been hashed after encryption. This included the investigation, facility, client, and perpetrator IDs. This could have been done either by the database query that pulled the data from the state's database or by the application that produced the XML file. Most databases (like Microsoft SQL Server, Oracle, and MySQL) have easy-to-use functions for the popular encryption and hashing algorithms. The MD5 hash method was recommended. No recommendation was made for the encryption method, but at least one state used 3DES.

NAMRS Case Loader, Database, and Data Warehouse

The NAMRS Case Loader ran on the same VM as the NAMRS Database. Both the NAMRS Database (with Case Loader) and the NAMRS Data Warehouse employed the following security measures:

• Endpoint Security--A (virtual) firewall protected these VMs. This firewall blocked all ports except the:

  • Powershell (Port 5986)--This allowed Powershell scripting against the VM.
  • Remote Desktop (Port 3389)--This allowed a system administrator to get remote access to the server. Note that this port was mapped to a different public-facing port on each server.
  • SQL Server (Port 1433)--This allowed the SQL to be queried and managed.

• ACL Security--Each of the Endpoints above could be individually limited to an IP address (or range) using an Access Control List (ACL). The ACL on port 1433 was set so that it was only accessible from inside the Azure Cloud so that the NAMRS Website could get to the database. Additionally, all three ports were accessible from the WRMA office. None of these ports (or any other ports) could be accessed from any other IP address on the Internet, so there was no way for anyone on the Internet to attempt to break into the servers.

• Database Login Security--Each user in the data warehouse had unique SQL login credentials.

NAMRS Pilot Database and Data Warehouse Virtual Machines

Since the database and data warehouse ran on VMs, normal maintenance was performed at the operating system level and database server level. In addition to manual service pack updates, there were two scheduled maintenance plans on each SQL Server.

• Nightly--The nightly maintenance plan ran at 1:00 a.m. every morning and backed up all databases on the server (to Azure Storage), checked database integrity, reorganized indexes, and updated statistics.

• Weekly--The weekly maintenance plan ran at 3:00 a.m. every Saturday and rebuilt all indexes on all databases on the server.

6. Recommendations for Supporting the Future Namrs

State participation in the development of the content of the NAMRS Pilot was also a critical factor in the successful enrollment of states. All of the states that participated in the pilot had attended at least one meeting on the overall design of the NAMRS Pilot. The actual submission of data to the NAMRS Pilot required extensive technical support to help states understand the data specifications from the perspective of their own systems and practices, and to be able to work closely with the IT units in their departments to prepare the data submissions. This chapter discusses lessons learned from the pilot process in terms of support that was useful to the states in actually submitting data to the NAMRS Pilot, including the topics:

• Support Provided to the States During the Pilot
• State Perspectives on the Pilot Process
• Recommendations Related to Support of States During Full Implementation of NAMRS

Support Provided to the States during the Pilot

The NAMRS Pilot Website was developed to provide a central site for states to access resources, user guides, and announcements. The states also submitted their data through the NAMRS Pilot Website. The website was very basic, but effective in providing information. The announcements page kept states abreast of new components added to the site, user guides, and notices of modifications of the NAMRS Pilot during the 6-month period.

State team leaders submitted staff names and emails of persons who needed access to the website. Liaisons set up logins for the staff to access the website. A user guide provided basic instructions on accessing resources available on the website. Some state staff had to update their Internet browser, as the NAMRS Pilot Website required Internet Explorer version 9 or above or Google Chrome. During the pilot, staff names and emails were added or deleted upon request. State staff could send inquiries and receive responses by email to the project team. The website was designed to generate emails to state users when specific events occurred such as when a state submitted the Agency Component data.

The website contained many resources for the state staff. User guides provided instructions on accessing the website and loading and submitting data. Data specifications documents provided details on the data elements such as the definition, type, and values. The Code Values and Definition document listed detailed definitions and data values. The Validation Rules documentation provided a summary of the validation rules for submitting the Case Component data. The XSD file were provided to support the development of the case-level data extraction file from the states.

Case Component Mapping Forms

The Agency Component and the Key Indicators Component in the NAMRS Pilot were largely self-explanatory. Understanding the data specifications of the Case Component was more complex, and required more TA.

The process of matching and documenting states' Case Component data to NAMRS Pilot data was called mapping. The project team provided Microsoft Word forms used to complete the mapping documentation (See Appendix G). The mapping forms included the main page that provides data specifications such as the type, size, requirement, and descriptions. If the NAMRS data element was a coded element, a second page was included. The second page allowed the state to map the values used by the state to the NAMRS Pilot values for that element.

Technical Assistance

Each state APS team was assigned a liaison for TA. Eight of the nine states agreed to regularly scheduled calls to provide updates and discuss any issues. One state opted for regular email updates and requested TA by email or phone, as was needed. When questions were of an IT nature, technical staff provided TA. States valued having a project liaison for quick answers to questions or for longer discussions, including guidance on the mapping forms. A total of approximately 80 hours of TA was provided to the nine pilot states, including the review of their data submissions.

• Approximately 10 percent of the 80 hours was spent in helping states with the Agency Component; 20 percent was spent in helping with the Key Indicators Component; 50 percent was spent on helping states with the mapping forms; and 20 percent was spent on reviewing data submissions.

State Perspectives on the Pilot Process

States expressed their appreciation for the TA and made many useful suggestions for the improvement of the system or for improving the process. The biggest challenge for some states was competition within large departments for IT staff time to dedicate to the pilot project. One state paid their third party IT contractor to assist with the pilot work. Another state began the mapping process relying on quality assurance/data analyst staff to do IT developer tasks and realized later in the process that they needed an expert in XML to complete the task. States provided the following insight:

• One state IT staff reported that the lookup lists were helpful in assisting them in rewriting their system. IT staff liked the "submit & resubmit" and "testing & error report" functions of the pilot. The staff in this state acknowledged the challenge of going through the mapping process, but stated that it was necessary work. In one instance (services referred data), the state was able to find an error in their state data system. The mapping form was easy to use, file, and update. One suggestion was to limit/decrease the tester emails sent to everyone especially during the validation phase. Staff was pleased with the responsiveness and coordinating efforts of their liaison. The NAMRS application and their participation in the pilot received positive compliments. The state team provided a wish list for NAMRS.

• Another state reported that their main lesson learned was that they should have brought in IT staff sooner rather than later especially during the mapping process. They spent many hours writing and rewriting code between programmatic and IT staff. They were not proficient in XML. The state suggested:

  • Place all instructions on the website with no password protection.
  • Do not use encryption and unknown tags.
  • Provide validation utilities to states.

• A third state suggested that the case mapping form should match the XML (i.e., have a path to each note). State staff would like the ability to pull reports from the NAMRS data warehouse. Programmatic staff would prefer to map all services provided to a person in their personal residence as "in-home services." The team appreciated the assistance and being included in the pilot.

• A fourth state used an MS Excel spreadsheet to complete their mapping process. They found it easier than completing individual forms in MS Word. They thought that overall, the NAMRS Pilot process was easy to follow.

• A fifth state found the NAMRS Pilot process relatively easy. They had reports developed already that provided the information asked for in the Agency and Key Indicators Components. They only needed to tailor the report period to the FFY and were able to gather the data. They said submission of the data was easy to do with the website. They remarked that they would definitely be able to provide Case Component data in the full implementation version of NAMRS.

• A sixth state thought that working with the NAMRS Pilot data elements was useful as they reviewed their state data. The reports from the NAMRS Pilot provided useful information. The mapping process was tedious but not difficult and very useful in the development extraction program for the XML file. They thought it would be useful to have a cross reference between the XSD file and the mapping forms.

• A seventh state used spreadsheets to calculate the data needed for the Key Indicators Component. They indicated that it might have taken less time to prepare the Key Indicators Component data if they had more reporting capabilities. They said they would refer to the NAMRS Pilot data as they reviewed their system data in the future. They found the reports from the NAMRS Pilot very useful.

• An eighth state indicated that gathering the data for the Agency Component and Key Indicators Component took more time than originally thought. They developed reports to produce the data in the prescribed format. They are looking forward to the future development of NAMRS and the benefits it will provide to the APS field.

Recommendations Related to Support of States During Full Implementation of NAMRS

The overall finding based on providing TA was that the provision of such assistance is crucial to the success of data collection activities. Full implementation will also require an effective communication plan. Communications will be the key to helping all APS programs, regardless of state administrative placement, to stay informed.

Finding 1. For most states, the ability to provide data to the NAMRS Pilot was dependent upon access to TA. While not all states needed the same amount of TA, user documentation, mapping forms, and TA provided by phone were critical to the states. Orientation webinars were also useful.

Action: User documentation, overview webinars, and assignments of particular persons to be the liaison for each state should be included under the full implementation of NAMRS. TA efficiency may be gained if more structured TA tools were used, for example, a tool to log and track detailed questions and issues from the states with resolutions. The tool would assist team members providing TA by allowing them to search for similar issues with resolutions and identify trends in common questions.

Finding 2. There were several new data topics. Specific topical areas often proved more challenging to particular states. For example, many state APS programs do not have a history of collecting data on perpetrators, on clients' legal status, or legal remedies.

Action: Guidance, training, and TA will need to be provided in these key areas. The NAMRS Pilot used subject matter experts to provide TA. The team consisted of one person who was somewhat familiar with aging programs, but very familiar with client tracking systems, and one person who was an expert on aging programs, but with less knowledge of information systems. Both perspectives, content and technical infrastructure, must be available through TA.

Finding 3. Mapping forms were challenging for the states to complete. While recognizing the value of documenting the cross-walk to their own systems, the states found the process burdensome.

Action: Some examples of potential approaches to improving this process are included in the next chapter.

Finding 4. The XML format of the Case Component was challenging for some of the states. The ability to provide the Case Component data in this format was completely dependent upon the skill sets of the IT department or unit.

Action: No change is recommended, as most state IT departments are increasing their skills in using XML.

Finding 5. Submission of data to the NAMRS Pilot required collaboration with other departments. All states recognized that they needed to work closely with their IT departments to submit the Case Component data. States that had strong relationships were able to work smoothly with them. Other states had more difficulty gaining access to the IT departments or even working with them.

Action: TA to support the full implementation of NAMRS could include additional guidance in locating the appropriate technical personnel who will be needed to develop the extracts for the Case Component. Some state IT staff may require specialized TA.

Finding 6. State administrative structures may influence TA needs. Seven of the nine NAMRS Pilot states were located within the SUA. The models for APS program structure include state program administrators and either contracted staff or state employees conducting regional and local APS work. APS programs in SUAs have access or may gain access to client services information if the APS client is also a person receiving other services (e.g., funded by the Older American's Act [OAA], Medicaid, Social Services Block Grant [SSBG], etc.) administered through the SUA. However, the APS programs may not have access to client services data from a sister agency, such as mental health. APS programs in SUAs were more familiar with the OAA definitions of services and taxonomies. All pilot participants were familiar with SSBG definitions of services and taxonomies. The two pilot states not housed in an SUA had some established contacts with the SUA staff.

Action: Some further work may be needed to establish if there are specific TA topics that would be more useful to APS programs located in SUAs and others more useful to those located in state human services agencies. Certainly future TA efforts could create cohorts of states and provide more focused TA based on specific APS administrative structures.

7. Recommendations for the Functionality and Architecture of the Future Namrs

The NAMRS Pilot was designed and developed to test the capacity to collect administrative data from state APS agencies, which in turn can be transformed into information. This information will provide knowledge to the field on the extent and underlying features of abuse, neglect, mistreatment, and exploitation of vulnerable adults. While the NAMRS Pilot design and features met the pilot goals and demonstrated the necessary capabilities, a number of technical refinements and enhancements are warranted prior to the full implementation of NAMRS. These suggested enhancements are informed by what was learned during the pilot and by the anticipated new features and requirements needed to support the full implementation. This chapter identifies several areas for enhancement when implementing the system nationwide.

We discuss the following enhancement topics:

• Enrich Data Quality Through Validation
• Ensure Flexibility of the Database
• Enhance Performance and Scaling
• Improve User Experience (UX)
• Strengthen System Security
• Continue to Use a Proven Development Methodology

The enhancement items under each topic are ranked in terms of our sense of priority in meeting the goals and objectives of full implementation of NAMRS, as follows:

1. Must have for the system to function effectively and meet ACL objectives.

2. Should have to encourage states to participate and reduce their burden.

3. Could have, if resources permit, to further improve the UX.

Enrich Data Quality by Incorporating More Validation Rules

The NAMRS Pilot processed data submissions from states to assure that the data format and values submitted were consistent with the NAMRS Pilot requirements. The NAMRS Pilot achieved this by the process of data validation. Data were validated at the time of data entry for the Agency and Key Indicators Components. For the Case Component XML file, the validation was done in two steps. First, the XML file was validated against a schema file, which checked the structure, data type, and data format. Next, an automated validation process applied a number of rules to validate the data elements.

Even though the NAMRS Pilot validation process was broad and detailed, it was still not comprehensive in checking all the possible scenarios that might affect the data quality. More data validation rules must be applied across the following rule categories:

• Within a Case--The relationships between the data elements within a case must be checked. For example, clients in a case with a maltreatment of self-neglect must not have perpetrators.

• Across Cases--The data elements repeating across cases must be consistent. For example, if a client appears in more than one case, the demographics information must be consistent.

• Distribution of Values--The reporting of data elements must match minimum requirements in terms of counts to enforce comprehensiveness. For example, more than 90 percent of the clients must have the client age reported.

• Unknown and Blank Values--Clearly identify the distinction between unknown and blank values. For example, if a state collects data for a NAMRS data element, the values must be reported. Unknown must be reported when data are not available for some cases. If a state does not collect any data for a NAMRS data element, then blanks must be reported for all cases.

• Missing Data Elements--States must provide dummy data for mandatory NAMRS data elements that they do not collect. For example, some states do not assign IDs to identify perpetrators uniquely. In such cases, the states will be asked to create distinct IDs for each perpetrator.

The NAMRS Pilot produced a number of reports with validation results. While the reports were detailed, they will need to include more information to analyze the completeness and comprehensiveness of the data.

• The validation reports must be reviewed by ACL to identify detailed analyses that must be incorporated. These validation reports will support the acceptance criteria that drive the decision making process of accepting data.

The NAMRS Pilot Case Component consisted of 58 data elements, and hence it requires a number of data validation rules.

• To achieve completeness of validation and to enhance the performance of the application of the validation rules, the XML structure should be enhanced to include metadata information. The metadata can have information about which data elements are reported by a state, what code values are mapped to the NAMRS values, and what elements contain dummy data. States provided this information in the mapping forms during the pilot. Having the metadata embedded in the XML file or accessible to the file will help with quicker validation as extensive validation rules for data elements identified as not reported might be skipped.

• Instead of including metadata as mentioned above, the mapping forms could be integrated into the NAMRS database. The NAMRS Pilot developed mapping forms to help states determine which data elements they had in their systems and which data values could be mapped to NAMRS Pilot data values. The NAMRS Pilot collected mapping form information as paper forms. Reviewing the data against the mapping form was a useful step to identify data quality issues. While some states were enthusiastic about using the mapping forms, some states thought they appeared burdensome and not user friendly. Online screens to collect mapping form information could be added to NAMRS, and the information could be used to validate against the data submitted by the states.

Ensure Flexibility of the Database

The NAMRS Pilot Database stored the submitted data as they were entered and saved via data entry screens or when uploaded as a file. The NAMRS Pilot database also stored the validation rules applied on the Case Component. The NAMRS Loader application read each validation rule from the database and checked the data and the time of loading the data. Adding new validation or modifying the existing rules could be achieved by updating the list of validation rules in the NAMRS Pilot database.

• The full implementation of NAMRS must leverage the flexible validation processing based on the accommodating database to implement more validation rules.

As mentioned previously, the NAMRS Pilot was built to collect data only for the pilot data period of FFY 2015.

• To accommodate data collection for multiple years, the database must be updated to store and process multiyear, multistate data. This change can be implemented in the data model by adding a new entity called the year/state at the top of the entity hierarchy. The year/state entity will be a combination of a specific year and state. For example, 2015-Pennsylvania. As per the data model in Figure 7.1, NAMRS Pilot Data Model with year/state entity, for each combination of the year and state there will be Agency, Key Indicators, and Case Components.

FIGURE 7.1. NAMRS Pilot Data Model with Year/State Entity

The NAMRS Pilot Data Warehouse provided an easy-to-use database that could be queried using any statistical analysis application, data visualization application, or SQL query application. The NAMRS Pilot Database only contained the Case Component data.

• The Agency and Key Indicators Components data must be included in the Data Warehouse of the full implementation of NAMRS. This will enable the analysts to query and analyze data for all the components.

• Loading other external data related to APS into the Data Warehouse of the full implementation of NAMRS should be considered. External data includes population data, Social Security data, and other datasets. This will enable analysts to link various datasets and compute rates, estimates, and stratified sampling.

The NAMRS Pilot Database was based on a flexible data model that encapsulated the complex relationships between entities. An entity is some unit of data that can be classified and have stated relationships to other entities. For example, client is an entity, which consists of information about the client characteristics. A client entity can have relationships with the perpetrator entity.

• New entities and data elements could be added and obsolete ones removed from the data model and subsequently either added to or removed from the physical database without major re-engineering efforts. Changes to the data model would require changes to: (1) the database; (2) the forms on the website or the software that imports data from the case XML files into the database; (3) the validation functions; and (4) any reports or extracts that use the affected data.

Enhance Performance and Scaling by Moving to Platform as a Service

The NAMRS Pilot was designed to collect data from a subset of states, while NAMRS will collect data from 50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas Islands, Virgin Islands, and American Samoa. This implies that the NAMRS Pilot has to scale to accommodate an increased number of users, a higher volume of data, and improved data processing capabilities without forgoing desired levels of system performance.

As explained in an earlier chapter, the NAMRS Pilot Website was built and hosted as an Microsoft Azure Website based on the PaaS model, which provides the hardware architecture and software framework needed to put the application into service, without having to manage and upkeep all the required resources. This means that the existing website is already scalable by assigning more resources (i.e., system memory, storage space, etc.) to the service through the cloud's configuration. Anticipating various modifications during the development cycle of the NAMRS Pilot, the loader and databases are hosted on VMs in Azure based on the IaaS model.

• While they can be scaled by assigning more resources to the VMs through the cloud's configuration, the loader and the databases must be moved to a PaaS model such as Azure SQL for the full implementation of NAMRS to leverage the improved performance and system manageability.

Figure 7.2, NAMRS Pilot Using PaaS, provides a diagram of the NAMRS Pilot with all the components built on the Microsoft Azure PaaS model. A consistent cloud infrastructure will provide a number of improvements in terms of system performance, compatibility among various components, software code writing, manageability, and maintainability. It will greatly improve the speed, agility, and flexibility of the development process, as resources are not spent for upfront configuration and continuous maintenance of the infrastructure environment.

FIGURE 7.2. NAMRS Pilot Using PaaS

Improve User Experience

The NAMRS Pilot Website provided a simple way for users to access the NAMRS Pilot. It was designed to enable the users to access the features to submit data and retrieve output information specific to the pilot. While it served the purpose of the pilot, the website design must be enhanced to improve the ease of use and efficiency of performing tasks.

• For example, in the NAMRS Pilot state users had to navigate to the individual data component screens to see the current data status. The UX must be enhanced by allowing each state to have its own secure private working area that will not be accessed by other states. The home page of the private working areas must list the current status of data collection for the state. This will provide useful information to the user, after the user logs in, and enable quick navigation to the appropriate data collection screens. The private working areas must also include a data repository for the states to store documents pertaining to NAMRS and share with their assigned liaison.

The NAMRS Pilot was built to collect data only for the pilot data period of FFY 2015.

• To accommodate data collection for multiple years, the website must be updated to allow users to select the appropriate data period and then submit data. This enhancement will allow states to submit data for the current or most recent data period as well as resubmit data for the previous years, if necessary.

• In addition, implementing features to disable data collection functionality after the data collection window closes will avoid losing track of data submitted by states outside of the window.

The NAMRS Pilot was built using a software framework that enforces Section 508 accessibility standards compliance. The website was also tested using available open-source test tools for Section 508 compliance. However, framework tools do not guarantee full compliance. Hence, for the full implementation, thorough accessibility testing using manual and automated processes must be carried out. This will impact the development schedule as more time will be necessary for testing.

The full implementation of NAMRS is expected to request the states to submit Agency and Case Component data or Agency and Key Indicators Component data for each data period. Most of the data submitted in the Agency Component may not change much over the years as these data pertain to state APS policies and practices.

• New functionality to clone the Agency Component data for easier data entry and submission across years could be very useful to the state users. Once cloned, state users would have to modify only the appropriate data elements and submit for the new data period.

Strengthen System Security

The NAMRS Pilot enforced security for all components at various levels. It also leveraged the advanced security features provided by the Microsoft Azure Cloud platform. Similar levels of security should be considered for the full implementation.

• ACL must be cognizant of all security requirements and make regular security assessments for continuous verification.

• All IDs in the data submitted by the states must encrypt to ensure data security. Encryption will add another layer of data security so that individuals cannot be tracked back into the source of the data. Consistent data encryption practice by states, prior to submitting data, will allow tracking of individuals across data periods.

• All privileged accounts must be identified and two-factor authentication must be enforced. Privileged accounts are usually the system administrators who are able to add or modify users, make changes to the database and website, initiate backup and restore processes, and install and configure hardware or software.

The common approach for authenticating privilege accounts has been username and password (single factor authentication). The two-factor approach must include another factor for authentication such as a personal identity verification card or another method to obtain something only the privileged user has. The other methods could be a code sent to their phone or email that must be supplied to continue access to administrative functions.

• ACL must have internal privileged accounts to gain complete control of the system environment when necessary. Single sign-on features should also be considered by integrating with ACL's user directory either on-premises or in the cloud.

Continue to Use a Proven Development Methodology

The NAMRS Pilot development process used the Agile Scrum methodology for software development. The Agile methodology breaks up development into several sprints where each sprint generally last anywhere from 1-4 weeks. The NAMRS Pilot development cycle consisted of five sprints with each sprint adding system functionality incrementally. Each sprint consisted of development and testing, and resulted in a production-ready version of the system. After each sprint, the system went through a sprint review process where the functionality was reviewed to obtain feedback on the usability of the system and workflow for submitting, reviewing, and accepting data. Following the sprint review, the new functionality was deployed to the production environment. The Agile sprint methodology used for the development of the NAMRS Pilot was very effective in terms of prioritizing features, improving quality by breaking down development into manageable units, and engaging all stakeholders in the decision making process.

• Adopting the scrum methodology will enable functional and technical enhancements to be quickly coded, tested, and released as issues can be identified earlier and rectified. This approach will be effective as a system development process for the migration from the NAMRS Pilot to NAMRS, as there will be minimum changes in the system components, environment, and requirements.

8. Next Steps

The design, development, and piloting of a national APS data system was a major undertaking that required the commitment and leadership of the Federal Government in partnership with state representatives. More than 30 representatives from 25 states participated in the early stakeholder meetings; approximately 25 staff from the nine pilot states participated in the detailed activities required to test the design by actually submitting data from their own state systems. Furthermore, ACL continued to conduct outreach activities by presenting at several conferences, including information on NAMRS on its website, and briefing agency leadership.

The time and effort spent by the state agencies reflected their deep interest in collecting national data on the mandated scope, programmatic activities, and client outcomes of APS agencies throughout the United States. Moreover, the development of the NAMRS Pilot included the expertise of many federal and non-federal program administrators, researchers, and practitioners to maximize capturing data that would be useful to APS and to related fields, including caregiving, health, housing, employment, nutrition, financial, and legal services.

In developing a strategy for the full implementation of NAMRS, there are several next steps, which would become part of a multiyear plan for collecting, utilizing, and disseminating national data on adult maltreatment. Prior to even developing such a plan, ACL will need to decide if it will go forward in conducting the steps to fully implement NAMRS. If ACL decides to go forward, there are at least seven key components of a strategic plan to do so, including:

1. Reaffirm the Vision
2. Confirm Key Principles
3. Obtain OMB Clearance to Collect Data through NAMRS
4. Establish Operational Practices
5. Detail the System Requirements for the Future NAMRS
6. Enhance the NAMRS Pilot to Meet the Requirements for the Future NAMRS
7. Develop the Communication and Support System for Working with State Agencies

Reaffirm the Vision

Simply stated, the vision underlying the project to design, develop, and pilot a national system was to collect accurate statistics on the maltreatment of older persons and adults with disabilities, based on data collected by all state APS agencies in the United States, including the territories. These data would describe the characteristics of vulnerable adults and the results of APS involvement in responding to their needs.

The vision included collecting detailed case-level data on persons who receive investigation and other services from APS. Case-level data would include demographics, risk factors, maltreatment allegations and findings, services, outcomes of the APS service response, and information on perpetrators. These data would be extracted from data in existing and future state information systems. Such data are often referred to as "administrative data."

Recognizing that not all states would be able to provide case-level data immediately, a short form for collecting key aggregated statistics was developed. A means for collecting policy and programmatic data on each state APS agency was also developed as contextual information.

This vision will need to be reaffirmed. The collection of annual national statistics is an extremely valuable exercise, but does not meet all the potential information needs of policymakers, researchers, advocates, service practitioners, clients, and their families. Administrative data are a foundational set of data, which, due to its periodicity and breadth, can provide many useful insights into social policy and practices.

Confirm Key Principles

The following list includes some of the key principles underlying the pilot:

• Reporting would be from state and territorial agencies.

• Reporting would be on an annual basis.

• Reporting would be voluntary.

• States and other stakeholders would have input into the identification of information needs.

• States would receive technical support to assist them in participating.

ACL will need to revisit these key principles, determine whether they still apply, and identify other key principles. For example, the pilot did not include a detailed examination of the planned future uses of the data. Will there be an annual report? What form will the report take? Will ACL require specific data outputs that might be pre-programmed for easy accessibility? While this is part of the requirements for the system design, the general assumptions about use of the data could be included as a key principle.

Another set of principles could be related to response rate objectives. While it is known that not all states will submit case-level data in the first year of the future NAMRS, it is not clear at what pace states and territories might decide to submit the Case Component. For example, ACL might set targets of: (A) all states and territories submit the Agency Component in the first year; (B) 15 states submit the Case Component in the first year, 25 states and territories in the second year, and 35 states and territories by the third year; and (C) the remaining states and territories would submit the Key Indicators Component each year (40 in the first year, 30 in the second year, and 20 in the third year).

Obtain Clearance from OMB

The Paperwork Reduction Act requires the approval from OMB on any federal data collection exercise. This process includes several steps, including the first and second notices in the Federal Register, development of a supporting statement by the agency, which is submitted by the department to OMB, and completion of various automated forms required by OMB. The supporting statement includes a description of all data elements to be collected, as well as an estimate of level of effort to provide such data.

The NAMRS Pilot served the crucial function of determining if states could submit case-level data, and provided feedback used to refine the data elements, values, and definitions. The revised version will be submitted to OMB for approval. The NAMRS Pilot also provided sufficient information to estimate the level of effort of states to participate in the future NAMRS.

The OMB package needs to be drafted and reviewed by ACL. If the first Federal Register Announcement is published in October, OMB should complete its review by May or June 2016, which is sufficient time for launching the more specific instructions for reporting FFY 2016 data by September 2016 or earlier. ACL is likely to develop a communication plan, which inform states of plans for the future NAMRS in advance of the first Federal Register Announcement. (See Develop Communications and Support System below.)

Establish Operational Practices

The FSC oversaw the work of the NAMRS Pilot project. The FSC consisted of representatives from ASPE, HHS Administration on Aging, HHS Administration on Disability, and the Office of Information Resources Management. The Office of Performance and Evaluation also attended many of the FSC meetings with the contractor responsible for the technical work.

ACL will need to decide where the future NAMRS initiative is "housed," whether a steering committee will be used, and which key ACL units will be members of the FSC. ACL will need to decide what responsibilities will be allocated to contractor staff and what responsibilities will be allocated to federal staff. The role of the regional offices will also need to be considered.

Since ACL is undertaking the revision of other major data collection efforts, there may need to be more intra-agency coordination that otherwise might be required. Quarterly meetings or even bi-monthly meetings may be useful to identify areas of useful coordination, especially with regards to requesting data from state agencies.

The annual data collection schedule will need to be determined, with consideration of its feasibility and impact upon any required reports or data analyses. The NAMRS Pilot worked with states over a period of 6 months from initial contact through final data submission. If the initial formal request for data is sent in September-October 2016, states are likely to be able to complete their data submissions by March-April 2017. Initial data analyses could be released by June 2017.

Detail the System Requirements for the Future NAMRS

This report includes much of the information for developing the requirements for the future NAMRS. Revisions to the data content are fully explicated; recommendations as to technical enhancements are also identified and prioritized.

ACL will need to review this report and determine which requirements will be operationalized in the future NAMRS. Technical staff will develop detailed specifications. Once approved by ACL, systems developers will implement the requirements and conduct testing.

Enhance the NAMRS Pilot to Meet the Requirements of NAMRS

As discussed in this report, ACL could decide to refine the future NAMRS using the Agile Scrum methodology. This would allow for rapid and efficient development of the system, and an iterative approach to developing requirements.

As part of the work plan for the next phase, ACL would approve the proposed development sprints, and participate in the acceptance of each sprint.

Develop the Communications and Support System for Working with the States

Voluntary (and required) reporting systems work best when there is clear communication between the data suppliers (i.e., the state agencies) and the data recipients (i.e., the Federal Government). This communication must be in both directions, with channels for posing and responding to questions. Clear and open communication is also the best means of building consensus in terms of systems content and systems objectives. A return on investment must be evident to the potential data suppliers.

One of the observations of the pilot test was that face-to-face contact with the states was highly beneficial. The current restrictions on holding meetings funded by the Federal Government may hamper the use of this critical method of communication. The main means of communication may be webinars, conference calls, and individual calls.

Another communication challenge discovered through the pilot test was that APS units did not always have ongoing working relationships with the IT units and often had challenges in terms of resource allocation or prioritization of requests to the IT units.

ACL will need to establish the parameters of communication with the states both in advance of the formal request for data in the fall of 2016, and during the data collection period in FFY 2017 and subsequent years.

ACL will also need to build from the experiences of the pilot phase to help states work more closely and efficiently with their IT units. For example, it may be useful to include the senior leadership of state social services umbrella departments in early communications about the future NAMRS to address resource allocation issues at the highest levels, rather than solely at the APS level. SUAs and social services agencies may need help in examining the resource issues related to providing Case Component or Key Indicator Component data.

Conclusion

The NAMRS Pilot confirmed the feasibility of collecting national data on the maltreatment of vulnerable adults. Implementing the full system will require a strategic plan, which addresses key issues such as vision, key principles, Paperwork Reduction Act requirements, enhancing the system functionality, and communication with the state agencies.

Notes

1. See http://www.aoa.acl.gov/Aging_Statistics/index.aspx.

2. See http://www.ncea.aoa.gov/Resources/Publication/docs/NCEA_AwDisabilities_ResearchBrief_2013.pdf.

3. Oktay, J., & Tompkins, C. (2004). Personal assistance providers' mistreatment of disabled adults. Health and Social Work, 29(3), 177-188. Can be accessed from http://pascenter.org/publications/publication_home.php?id=372.

4. Curry, M.A., Renker, P., Hughes, R.B., Robinson-Whelen, S., Oschwald, M., Swank, P.R., et al. (2009). Development of measures of abuse among women with disabilities and the characteristics of their perpetrators. Violence Against Women, 15(9), 1001- 1025. Can be accessed from http://vaw.sagepub.com/content/15/9/1001.abstract.

5. See http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf.

6. See http://www.aoa.acl.gov/AoA_Programs/Elder_Rights/EJCC/docs/Eight_Recommendations_for_Increased_Federal_Involvement.pdf.

7. See http://www.gpo.gov/fdsys/pkg/CRPT-110srpt470/html/CRPT-110srpt470.htm.

8. See http://www.ncea.aoa.gov/Stop_Abuse/Partners/APS/index.aspx.

9. See http://www.ncea.aoa.gov/Stop_Abuse/Partners/APS/index.aspx.

10. See http://www.napsa-now.org/about-napsa/history/history-of-adult-protective-services/.

11. In the pilot, a person was counted as a client each time he or she was the subject of an investigation.

12. See http://www.aoa.acl.gov/AoA_Programs/Elder_Rights/Guidelines/index.aspx.

13. Throughout this chapter the past tense is used when discussing the NAMRS Pilot. The functionality will, however, in general, be similar in the full implementation NAMRS.

14. A quick note about the XML Validation: Any state user that is actually developing the XML file may validate the file before uploading it to the website by using an XML validation application and linking to the URL above. There are many XML validation applications available, including free open-source applications. In the future, TA could be provided to states as to how to validate their files before uploading to the NAMRS website, because there will be several advantages to them, if they use such tools.

Appendix A. Sample Namrs Pilot State Working Group Agenda

Elder Justice Coordinating Council
State Working Group Meeting

Hotel Helix
1430 Rhode Island Avenue, NW
Production Room, 1st Floor
Washington, D.C. 20005
September 9-10, 2014

AGENDA

DAY ONE

9:00 a.m.	Opening and Welcome	ACL ASPE
9:30 a.m.	Background	Ying-Ying Yuan
10:00 a.m.	Case and Client Characteristics	Kathleen Quinn
11:45 a.m.	Lunch on Your Own
1:15 p.m.	Additional Client Characteristics	Maria Greene
3:00 p.m.	Break
3:15 p.m.	Services and Case Closure	Djuna Acker
5:00 p.m.	Day Two Agenda	Stephanie Whittier-Eliason   Helen Lamont
5:15 p.m.	Adjourn
6:30 p.m.	Optional Group Dinner

DAY TWO

8:30 a.m.	Review of Day One	Ying-Ying Yuan Stephanie Whittier-Eliason
8:45 a.m.	Perpetrator Data	Maria Greene
9:45 a.m.	The Agency Component	Kathleen Quinn
10:45 a.m.	Break
11:00 a.m.	Component Overview and Submission Process	Jim Storey Djuna Acker Sunil Leelaram
12:30 p.m.	Closing Remarks	ACL ASPE
1:00 p.m.	Adjourn

Appendix B. Namrs Pilot Data Specifications

B.1. NAMRS Pilot Agency Component Data Specifications

Element#	Element Name	Element Description	Required	Type	Size
Agy1	State	State on behalf of whom data are being submitted.	Yes	Alphanumeric	2
Agency Name
Agy2.1	Agency Name 1	Department or agency name.	Yes	Alphanumeric	100
Agy2.2	Agency Name 2	Branch or unit name.	No	Alphanumeric	100
Agency Physical Address
Agy3.1	Street 1	First line street address of agency physical address.	Yes	Alphanumeric	100
Agy3.2	Street 2	Second line street address of agency physical address.	No	Alphanumeric	100
Agy3.3	City	City of agency physical address.	Yes	Alphanumeric	100
Agy3.4	State	State of agency physical address.	Yes	Alphanumeric	2
Agy3.5	ZIP	ZIP of agency physical address.	Yes	Alphanumeric	10
Agency Mailing Address
Agy4.1	Street 1	First line street address of agency mailing address.	Yes	Alphanumeric	100
Agy4.2	Street 2	Second line street address of agency mailing address.	No	Alphanumeric	100
Agy4.3	City	City of agency mailing address.	Yes	Alphanumeric	100
Agy4.4	State	State of agency mailing address.	Yes	Alphanumeric	2
Agy4.5	ZIP	ZIP of agency mailing address.	Yes	Alphanumeric	10
Agency Contacts (multiple contacts can be entered)
Agy5.1	Name	Contact name.	Yes	Alphanumeric	100
Agy5.2	Title (per contact name)	Contact title.	Yes	Alphanumeric	100
Agy5.3	Email (per contact name)	Contact email.	Yes	Alphanumeric	100
Agy5.4	Phone (per contact name)	Contact telephone.	Yes	Alphanumeric	50
Agy5.5	Contact's role in agency (per contact name)	Contact's role in agency.	No	Single drop down	NA
Code Values		1 = Manager/ director/ supervisor 2 = Data coordinator/manager 3 = Training coordinator/ specialist 4 = IT/data specialist 5 = Policy specialist 6 = Intake manager/ supervisor	7 = Regional supervisor 8 = Field coordinator 9 = Investigator 10 = Social worker 11 = Case manager
Agency Profile Information
Agy6	Data Sources	The sources of information used to submit data this year to NAMRS.	No	Drop down; select 1	NA
Code Values		1 = APS agency only 2 = APS and other agencies
Agy6.1	Comment	Provide names of other agencies if data for this year's submission was also provided.	No	Text	NA
Agy7	Budgeted Investigation FTEs	Number of budgeted APS FTEs for investigation.	No	Numeric	6
Agy7.1	Budgeted Supervisory FTEs	Number of budgeted APS FTEs for supervision.	No	Numeric	6
Agy7.2	Filled Investigation FTEs	Number of filled APS FTEs for investigation.	No	Numeric	6
Agy7.3	Filled Supervisory FTEs	Number of filled APS FTEs for supervision.	No	Numeric	6
Agy7.4	Comment	Provide additional information on staffing if appropriate.	No	Text	NA
Agy8	Accepting Reports	Centralized or localized intake of APS reports.	No	Drop down; select 1	NA
Code Values		1 = Centralized at a statewide hotline or call in number 2 = Local at county or regional hotlines or call in numbers 3 = Combination of both statewide and local hotlines or call in numbers 4 = Other
Agy8.1	Comment	Provide additional information on definition of intake.	No	Text	NA
Agy9	Reports Not Accepted	Number of reports received that were screened out and not accepted by APS for either I&R or investigation.	No	Numeric	6
Agy9.1	Reports Resolved through I&R	Number of reports received that were accepted by APS and resolved through I&R.	No	Numeric	6
Agy9.2	Reports Accepted for Investigation	Number of reports received that were accepted for investigation.	No	Numeric	6
Agy9.3	Comment	Provide additional information on criteria for not accepting reports, resolving through I&R, or accepting for investigation. Provide reference or URL for policy.	No	Text	NA
Agy10	Standard of Evidence	Standard used for substantiating an allegation of maltreatment.	No	Drop down; select 1	NA
Code Values		1 = No state standard 2 = Different standards based on type of perpetrator 3 = Clear and convincing 4 = Preponderance 5 = Credible, reasonable, or probable cause 6 = Other
Agy10.1	Comment	Provide citation or URL of state law, regulations, or program guidance. Include discussion of definitions of perpetrator if relevant.	No	Text	NA
Agy11	Completion of an Investigation	The average amount of days that it takes APS to complete an investigation.	No	Numeric	3
Agy11.1	Comment	Provide additional information on the definition of start of investigation and completion of an investigation. Explain how this average was computed.	No	Text	NA
Agy12	Types of Maltreatment	Indicate which types of maltreatment are investigated by APS.	No	Drop down; select 1 or more	NA
Code Values		1 = Abandonment 2 = Emotional abuse 3 = Financial exploitation 4 = Neglect 5 = Physical abuse 6 = Sexual abuse 7 = Suspicious death 8 = Self-neglect 9 = Other
A12.1	Comment	Provide citation or URL in state law, regulations, or program guidance for maltreatment types investigated by APS.	No	Text	NA
Agy13	Standardized Assessment Instrument or Tool	Indicate whether APS personnel use standard tools throughout the state for assessing risk or safety of clients.	No	Drop down; select 1	NA
Code Values		1 = Yes, use common instrument or tool throughout the state 2 = No, assessment instruments are determined by each county or left to the worker's discretion
Agy13.1	Comment	Provide the name and reference (i.e., URL) for each standardized tool that is used.	No	Text	NA
Agy14	Service Gaps	Indicate which services are not available or accessible in the state.	No	Drop down; select 1 or more	NA
Code Values		1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services	9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 =Substance use services 16 = Transportation 17 = Victim services 18 = Other services

B.2. NAMRS Pilot Case Component Data Specifications

#	Element Name	Element Description	Required	Quantifier	Type	Size	Code Values
Investigation Entity
Inv1	Investigation ID	The unique ID used by the state for each investigation. The ID is assigned to a specific investigation and is only used once. The Investigation ID is encrypted by the state for purposes of data submission.	Yes	Single	A/N	32	Not applicable.
Inv2	Report Date	The month, day, and year the agency was notified of the suspected adult maltreatment.	No	Single	Date	8	Not applicable.
Inv3	Report Source	The role or profession of the person who made the report of the suspected adult maltreatment.	No	Single	N	2	1 = Guardian or conservator 2 = Community-based services 3 = Education 4 = Financial 5 = Law enforcement, judicial, or legal 6 = Medical or health 7 = Mental health 8 = Residential care community 9 = Social service and rehabilitative services 10 = Other professional 11 = Self 12 = Family member 13 = Non-family member 14 = Anonymous
Inv4	State/County FIPS Code of Investigative Agency	The FIPS for state (2 digits) and county code (3 digits) of the APS agency.	No	Single	N	5	Code is the unique identification number assigned to each state and county under the FIPS guidelines. See http://www.census.gov/geo/www/fips/fips.html.
Inv5	Investigation Start Date	The date the investigation is assigned to an investigation worker. If the agency uses another date to indicate the start of an investigation, that date is used.	No	Single	Date	8	Not applicable.
Inv6	Investigation Disposition Date	The date that the agency completed dispositions on the allegations of maltreatment associated with the investigation.	No	Single	Date	8	Not applicable.
Inv7	Case Closure Date	The date that the agency completed all activities related to the investigation of the case.	Yes	Single	Date	8	Not applicable.
Client Entity
Clt1	Client ID	The unique ID used by the state for each client. The ID is assigned to a specific client and is used identify the same client across investigations and reporting periods. The Client ID is encrypted by state for purposes of data submission. Data on multiple clients can be submitted for the investigation.	Yes	Single	A/N	32	Not applicable.
Clt2	Facility ID	The unique ID used by the state for each facility. The ID is assigned to a specific facility where the client lives. The ID is used for the same facility across investigations and reporting periods. The Facility ID is encrypted by the state for purposes of data submission.	No	Single	A/N	32	Not applicable.
Clt3	State/County FIPS Code of Client	The FIPS for state (2 digits) and county code (3 digits) of the client's residence at the start of the investigation.	No	Single	N	5	Code is the unique identification number assigned to each state and county under the FIPS guidelines. See http://www.census.gov/geo/www/fips/fips.html.
Clt4	Case Closure Reason	The primary reason why the case was closed.	No	Single	N	1	1 = Investigation complete 2 = Protective services completed 3 = Client refused services 4 = Unable to complete (closed without finding) 5 = Client died 6 = Other
Clt5	Age	The age of the client in years (at investigation start date).	No	Single	N	2	18,19...74 = Actual age 75 = 75-84 85 = 85 and older
Clt6	Gender Identity	The actual or perceived gender-related characteristics of the client.	No	Single	N	1	1 = Male 2 = Female 3 = Transgender
Clt7	Sexual Orientation	The client's enduring pattern of or disposition to experience sexual or romantic desires for, and relationships with, people of one's same sex, the other sex, or both sexes.	No	Single	N	1	1 = Straight 2 = Gay/lesbian 3 = Bisexual 4 = Questioning 5 = Other
Clt8	Race	The population(s) or group(s) that the client identifies as being a member. Multiple races can be submitted for the client.	No	Multiple	N	2	10 = American Indian or Alaska Native 20 = Asian (non-specific)    21 = Asian Indian    22 = Chinese    23 = Filipino    24 = Japanese    25 = Korean    26 = Vietnamese    27 = Other Asian 30 = Black or African American 40 = Native Hawaiian or Other Pacific Islander (non-specific)    41 = Native Hawaiian    42 = Guamanian or Chamorro    43 = Samoan    44 = Other Pacific Islander 50 = White
Clt9	Ethnicity	The affiliation of the client as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicities can be submitted for the client.	No	Multiple	N	2	10 = Yes, Hispanic or Latino/a, or Spanish Origin (non-specific)    11 = Mexican, Mexican American, Chicano/a    12 = Puerto Rican    13 = Cuban    14 = Other Hispanic, Latino/a, or Spanish Origin 20 = No, not Hispanic or Latino/a, or Spanish Origin
Clt10	English Competency	The client's ability to communicate using the English language.	No	Single	N	1	1 = Very well 2 = Well 3 = Not well 4 = Not at all
Clt11	Primary Language	The primary language or method that the client uses for written and verbal communication.	No	Single	N	2	1 = Arabic 2 = Chinese 3 = English 4 = French 5 = German 6 = Korean 7 = Russian 8 = Spanish or Spanish Creole 9 = Tagalog 10 = Vietnamese 11 = Sign language 12 = Assistive technology 13 = Other
Clt12	Marital Status	The client's status based on state residency laws.	No	Single	N	1	1 = Never married 2 = Married 3 = Domestic partner, including civil union 4 = Divorced 5 = Separated 6 = Widowed 7 = Other
Clt13	Schooling Level	The highest educational degree attained by the client.	No	Single	N	1	1 = Less than high school 2 = High school diploma or equivalent 3 = Associate's degree or Bachelor's degree 4 = Advanced degree
Clt14	Employment Status	The involvement of the client in the labor force.	No	Single	N	1	1 = Employed 2 = Unemployed 3 = Not in labor force 4 = Other
Clt15	Income Level	The level of annual income of the client including all sources of income.	No	Single	N	1	1 = Less than $25,000 2 = $25,000-$49,999 3 = $50,000-$74,999 4 = $75,000-$99,999 5 = $100,000 or more
Clt16	Benefits	The federal and state benefits received by the client during the investigation. Multiple benefits can be submitted for the client.	No	Multiple	N	2	1 = Medicaid 2 = Medicare 3 = publicly-subsidized housing 4 = SSDI 5 = Social Security retirement benefits 6 = SSI 7 = TANF 8 = Veterans' disabled benefits 9 = Other 10 = None
Clt17	Veteran Status	The client's status related to the U.S. Armed Forces.	No	Single	N	1	1 = Veteran 2 = Non-Veteran
Clt18	Disabilities	The client's physical, emotional, and mental health issues that result in limitation in activities and restrictions to fully participate at school, work, or in the community. Multiple disabilities can be submitted for the client.	No	Multiple	N	1	1 = Ambulatory difficulty 2 = Cognitive difficulty 3 = Hearing difficulty 4 = Independent living difficulty 5 = Self-care difficulty 6 = Vision difficulty 7 = Other 8 = None
Clt19	ADL Score	The client's score on the Katz Index of Independence in ADLs.	No	Single	N	1	Permissible values are 0-6
Clt20	IADL Score	The client's score on the Lawton IADLs.	No	Single	N	1	Permissible values are 0-8
Clt21	Behavioral Health Screenings	The results of screening assessments on the client, conducted by the APS agency. Multiple results can be submitted for the client.	No	Multiple	N	2	1 = Alcohol use disorder 2 = Anxiety 3 = Bipolar disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and other psychotic disorders 7 = Substance use disorder 8 = Traumatic brain injury 9 = Other 10 = None
Clt22	Behavioral Health Diagnoses	The results of assessments on the client, conducted by medical or clinical professionals. Multiple results can be submitted for the client.	No	Multiple	N	2	1 = Alcohol use disorder 2 = Anxiety 3 = Bipolar disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and other psychotic disorders 7 = Substance use disorder 8 = Traumatic brain injury 9 = Other 10 = None
Clt23	Living Setting at Start	The primary residential environment of the client at the start of investigation.	No	Single	N	2	10 = Own residence or residence of relative or caregiver 20 = Residential care community setting (non-specific)    21 = Licensed residential care community setting    22 = Non-licensed residential care community setting 30 = Nursing home (non-specific)    31 = Licensed nursing home    32 = Non-licensed nursing home 40 = Other
Clt24	Living Setting at Close	The primary residential environment of the person at the time of case closure.	No	Single	N	2	10 = Own residence or residence of relative or caregiver 20 = Residential care community setting (non-specific)    21 = Licensed residential care community setting    22 = Non-licensed residential care community setting 30 = Nursing home (non-specific)31 = Licensed nursing home    32 = Non-licensed nursing home 40 = Other
Clt25	Substitute Decision Makers at Start	The authorizations that are in effect related to health, personal, or financial decision making for the client at the start of the investigation. Multiple substitute decision makers can be submitted for the client.	No	Multiple	N	2	10 = Health care proxy in effect 20 = Financial proxy in effect 30 = Guardianship or conservatorship (non-specific)    31 = Guardianship or conservatorship of person    32 = Guardianship or conservatorship of property 40 = Representative payee 50 = None
Clt26	Substitute Decision Makers at Close	The authorizations that are in effect related to health, personal, or financial decision making for the client at time of case closure. Multiple substitute decision makers can be submitted for the client.	No	Multiple	N	2	10 = Health care proxy in effect 20 = Financial proxy in effect 30 = Guardianship or conservatorship (non-specific)    31 = Guardianship or conservatorship of person    32 = Guardianship or conservatorship of property 40 = Representative payee 50 = None
Clt27	Services at Start	The services known to the agency that the client was already receiving at the start of the investigation.	No	Multiple	N	2	1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services 9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 = Substance use services 16 = Transportation 17 = Victim services 18 = Other services 19 = None
Clt28	Services APS	The services which the agency provided on behalf of the client during the investigation or while the agency kept an open case.	No	Multiple	N	2	1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services 9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 = Substance use services 16 = Transportation 17 = Victim services 18 = Other services 19 = None
Clt29	Services Referred	The services for which the agency referred the client.	No	Multiple	N	2	1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services 9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 = Substance use services 16 = Transportation 17 = Victim services 18 = Other services 19 = None
Clt30	Services at Close	The services known to the agency that the client was receiving at the time of case closure.	No	Multiple	N	2	1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services 9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 = Substance use services 16 = Transportation 17 = Victim services 18 = Other services 19 = None
Clt31	Interagency Coordination	The agencies to which the client was referred.	No	Multiple	N	1	1 = Law enforcement or prosecutorial offices 2 = Protection and advocacy or CAP 3 = State licensing agency 4 = State MFCU 5 = Long-term care ombudsman program 6 = Other 7 = None
Clt32	Previous Report	The indication that the agency has information that the client was the subject of a previous report.	No	Single	N	1	1 = Yes 2 = No
Clt33	Maltreatment Setting	The location where alleged maltreatment occurred.	No	Single	N	2	10 = Own residence or private residence of relative or caregiver 20 = Residential care community setting (non-specific)    21 = Licensed residential care community setting    22 = Unlicensed residential care community setting 30 = Nursing home (non-specific)    31 = Licensed nursing home    32 = Unlicensed nursing home 40 = Adult day services center (non-specific)    41 = Licensed adult day services center    42 = Unlicensed adult day services center 50 = Place of business or other services 60 = Other
Maltreatment Entity
Mal1	Maltreatment Type	The alleged maltreatments that are investigated.	Yes	Single (per entity)	N	1	1 = Abandonment 2 = Emotional abuse 3 = Financial exploitation 4 = Neglect 5 = Physical abuse 6 = Sexual abuse 7 = Suspicious death 8 = Self-neglect 9 = Other
Mal2	Maltreatment Disposition	The disposition of each alleged maltreatment.	Yes	Single	N	1	1 = Substantiated 2 = Inconclusive 3 = Unsubstantiated 4 = Other
Perpetrator Entity
Per1	Perpetrator ID	The unique ID used by the state for the person who is found to be responsible for substantiated maltreatment(s). The ID is assigned to a specific perpetrator and is used to identify the same perpetrator across investigations and reporting periods. The Perpetrator ID is encrypted by state for purposes of data submission.	Yes	Single	N	32	Not applicable.
Per2	Age	The age of the perpetrator in years (at investigation start date).	No	Single	N	2	18,19...74 = Actual Age 75 = 75-84 85 = 85 and Older
Per3	Gender Identity	The actual or perceived gender-related characteristics of the perpetrator.	No	Single	N	1	1 = Male 2 = Female 3 = Transgender
Per4	Race	The population(s) or group(s) that the perpetrator identifies as being a member. Multiple races can be submitted for the perpetrator.	No	Multiple	N	2	10 = American Indian or Alaska Native 20 = Asian (non-specific)    21 = Asian Indian    22 = Chinese    23 = Filipino    24 = Japanese    25 = Korean    26 = Vietnamese    27 = Other Asian 30 = Black or African American 40 = Native Hawaiian or Other Pacific Islander (non-specific)    41 = Native Hawaiian    42 = Guamanian or Chamorro    43 = Samoan    44 = Other Pacific Islander 50 = White
Per5	Ethnicity	The affiliation of the perpetrator as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicities can be submitted for the perpetrator.	No	Multiple	N	2	10 = Yes, Hispanic or Latino/a, or Spanish Origin (non-specific)    11 = Mexican, Mexican American, Chicano/a    12 = Puerto Rican    13 = Cuban    14 = Other Hispanic, Latino/a, or Spanish Origin 20 = No, not Hispanic or Latino/a, or Spanish Origin
Per6	Disabilities	The perpetrator's physical, emotional, and mental health issues that result in limitation in activities and restrictions to fully participate at school, work, or in the community. Multiple disabilities can be submitted for the perpetrator.	No	Multiple	N	1	1 = Ambulatory difficulty 2 = Cognitive difficulty 3 = Hearing difficulty 4 = Independent living difficulty 5 = Self-care difficulty 6 = Vision difficulty 7 = Other 8 = None
Per7	Behavioral Health Screenings	The results of screening assessments on the perpetrator, conducted by the APS agency. Multiple results can be submitted for the perpetrator.	No	Multiple	N	2	1 = Alcohol use disorder 2 = Anxiety 3 = Bipolar disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and other psychotic disorders 7 = Substance use disorder 8 = Traumatic brain injury 9 = Other 10 = None
Per8	Behavioral Health Diagnoses	The results of assessments on the perpetrator, conducted by medical or clinical professionals. Multiple results can be submitted for the perpetrator.	No	Multiple	N	2	1 = Alcohol use disorder 2 = Anxiety 3 = Bipolar disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and other psychotic disorders 7 = Substance use disorder 8 = Traumatic brain injury 9 = Other 10 = None
Client-Perpetrator Relationship Entity
CPR1	Cohabitation at Start	The indication if the perpetrator and victim are cohabitating at the start of the investigation.	No	Single	N	1	1 = Yes 2 = No
CPR2	Cohabitation at Close	The indication if the perpetrator and client are cohabitating at the time of case closure.	No	Single	N	1	1 = Yes 2 = No
CPR3	Kinship Relationship	The indication if the perpetrator is related to the client by affinity (blood, adoption, marriage, etc.)	No	Single	N	2	10 = Yes (not specific) 11 = Spouse 12 = Domestic partner, including civil union 13 = Parent 14 = Child 15 = Sibling 16 = Grandparent 17 = Grandchild 18 = Other relative 20 = None
CPR4	Perpetrator Association at Start	The indication if the perpetrator has a caregiving relationship to the client at the start of the investigation.	No	Single	N	1	1 = Nursing home staff 2 = Residential care community staff 3 = Paid formal caregiver 4 = Paid informal or family caregiver 5 = Unpaid informal or family caregiver 6 = Other relationship 7 = None
CPR5	Perpetrator Association at Close	The indication whether the perpetrator has a caregiving relationship to the client at time of case closure.	No	Single	N	1	1 = Nursing home staff 2 = Residential care community staff 3 = Paid formal caregiver 4 = Paid informal or family caregiver 5 = Unpaid informal or family caregiver 6 = Other relationship 7 = None
CPR6	Perpetrator Substitute Decision Maker at Start	Authorizations that the perpetrator has in relation to the victim, and that are in effect, related to health, personal or financial decision making at the start of the investigation.	No	Multiple	N	2	10 = Health care proxy in effect 20 = Financial proxy in effect 30 = Guardianship or conservatorship (non-specific)    31 = Guardianship or conservatorship of person    32 = Guardianship or conservatorship of property 40 = Representative payee 50 = None
CPR7	Perpetrator Substitute Decision Maker at Close	Authorizations that the perpetrator has in relation to the victim, and that are in effect, related to health, personal or financial decision making at the time of case closure.	No	Multiple	N	2	10 = Health care proxy in effect 20 = Financial proxy in effect 30 = Guardianship or conservatorship (non-specific)    31 = Guardianship or conservatorship of person    32 = Guardianship or conservatorship of property 40 = Representative payee 50 = None
CPR8	Perpetrator Legal Remedy	The legal remedies that were sought by the APS agency regarding the status of the perpetrator.	No	Multiple	N	1	1 = Removal of guardianship rights 2 = Restraining order on perpetrator regarding the victim 3 = Eviction of perpetrator 4 = Restitution by perpetrator 5 = Other legal remedy 6 = None

B.3. NAMRS Pilot Key Indicators Component Data Specifications

Element #	Element Name	Element Description	Other Instructions
K1	Clients who Received an Investigation	Number of clients involved in an investigation that was completed during the reporting period.	Count each client in each investigation. If a client was the subject of 2 investigations, count twice.
K1.1	Comment	Provide additional information on how number of clients was determined.
K2	Clients who Received Interagency Coordination	Number of clients in which an interagency coordination was part of the investigation.	See Appendix D for description of Interagency Coordination. Count each client once for each investigation in which he/she received 1 or more interagency coordination activities.
K2.1	Comment	Provide additional information on how number of clients who received interagency coordination was determined.
Clients by Case Closure Reason		Number of clients whose case was closed for specific reason:
K3.1	Investigation Completed		See Appendix D for definitions of values. A client is counted for each case closure. There can only be 1 primary case closure reason per client per case.
K3.2	Protective Services Completed
K3.3	Refused Services
K3.4	Unable to Complete (closed without finding)
K3.5	Client Died
K3.6	Other
K3.7	Unknown
K3.8	Comment	Provide additional information on how number of clients by case closure reason was determined.
K4	Victims of 1 or More Maltreatments	Number of victims in which at least 1 maltreatment disposition was substantiated per investigation.	A victim is counted once for each investigation in which a maltreatment was substantiated, no matter how many maltreatments were substantiated.
K4.1	Comment	Provide additional information on how number of victims was determined.
Victims by Age		Number of victims by age at time of report.
K5.1	18-29 years		The victim age is computed by subtracting the client's date of birth from the Investigation Start Date. An estimated age can be used. The victim's age is counted once per each investigation in which the client was found to be a victim. Age could differ between investigations.
K5.2	30-39 years
K5.3	40-49 years
K5.4	50-59 years
K5.5	60-69 years
K5.6	70-74 years
K5.7	75-84 years
K5.8	85 and older
K5.9	Unknown
K5.10	Comment	Provide additional information on how age was computed.
Victims by Race		Number of victims by race. If a victim is of multiple races, count as multiracial.	Count each victim once per investigation.
K6.1	American Indian or Alaska Native
K6.2	Asian
K6.3	Black or African American
K6.4	Native Hawaiian or Other Pacific Islander
K6.5	White
K6.6	Multiracial
K6.7	Unknown
K6.8	Comment	Provide additional information on how number of victims by race was determined.
Victims by Ethnicity		Number of victims by ethnicity.	Count each victim once per investigation.
K7.1	Hispanic, Latino/a, or Spanish
K7.2	Not Hispanic, Latino/a, or Spanish
K7.3	Unknown
K7.4	Comment	Provide additional information on how number of victims by ethnicity was determined.
Victims by Gender Identity		Number of victims by gender.	Count each victim once per investigation.
K8.1	Male
K8.2	Female
K8.3	Transgender
K8.4	Unknown
K8.5	Comment	Provide additional information on how number of victims by gender was determined.
K9	Victims Who Received 1 or More Public Benefits	Number of victims who received 1 or more public benefits.	See Appendix D for definition of values. A victim is counted once per investigation in which he/she received 1 or more public benefits.
K9.1	Comment	Provide additional information on how number of victims by receipt of benefits was determined.
K10	Victims with 1 or More Disabilities	Number of victims with 1 or more disabilities.	See Appendix D for definition of values. A victim is counted once per investigation in which he/she was identified as having 1 or more disabilities.
K10.1	Comment	Provide additional information on how number of victims with 1 or more disabilities was determined.
K11	Victims with 1 or More Screened Behavioral Conditions	Number of victims with 1 or more screened behavioral conditions.	See Appendix D for definition of values. A victim is counted once per investigation in which he/she was screened as having 1 or more behavioral conditions.
K11.1	Comment	Provide additional information on how number of victims with a behavioral condition was determined.
Victims by Maltreatment Type		Number of victims by substantiated maltreatment type.	See Appendix D for definition of values. A victim is counted each time he/she was substantiated as a victim of a specific maltreatment type. If a person was found to be a victim of neglect in 2 investigations, the count for neglect would be 2 for that victim.
K12.1	Abandonment
K12.2	Emotional Abuse
K12.3	Financial Exploitation
K12.4	Neglect
K12.5	Physical Abuse
K12.6	Sexual Abuse
K12.7	Suspicious Death
K12.8	Self-neglect
K12.9	Other
K12.10	Unknown
K12.11	Comment	Provide additional information on how number of victims by maltreatment type was determined.
K13	Victims with Guardian or Conservator at Start of Investigation	Number of victims with guardian or conservator at start of investigation.	See Appendix D for explanation of guardian or conservator. A victim is counted once per investigation in which he/she was screened as having 1 or more guardians or conservators.
K13.1	Comment	Provide additional information on how number of victims by 1 or more guardians or conservators was determined.
K14	Victims Who Received Services or Were Referred for Services by APS	Number of victims who received services or were referred for services by APS.	See Appendix D for explanation of services. A victim is counted once per investigation in which he/she received or was referred for 1 or more services. If a client received multiple services and also was referred for multiple services in 1 investigation, he/she is counted only once.
K14.1	Comment	Provide additional information on how number of victims by services was determined.
Perpetrators by Age		Number of perpetrators by age.	Count each perpetrator once per client per investigation. If a person was the perpetrator of 2 clients in 1 investigation, the person is counted twice.
K15.1	18-29 years		The perpetrator age is computed by subtracting the person's date of birth from the Investigation Start Date. An estimated age can be used.
K15.2	30-39 years
K15.3	40-49 years
K15.4	50-59 years
K15.5	60-69 years
K15.6	70-74 years
K15.7	75-84 years
K15.8	85 and older
K15.9	Unknown
K15.10	Comment	Provide additional information on how number of perpetrators by age was determined.
Perpetrators by Gender Identity		Number of perpetrators by gender.	Count each perpetrator once per client per investigation. If a person was the perpetrator of 2 clients in 1 investigation, the person is counted twice.
K16.1	Male
K16.2	Female
K16.3	Transgender
K16.4	Unknown
K16.5	Comment	Provide additional information on how number of perpetrators by gender was determined.
K17	Perpetrators who had a Kinship Relationship to the Victim	Number of perpetrators related to the victim by affinity (blood, adoption, marriage, etc.).	Count each perpetrator once per client per investigation. If a person was the perpetrator of 2 clients in 1 investigation and is related to 1 victim and not the second, the perpetrator is counted only once.
K17.1	Comment	Provide additional information on how number of perpetrators by kinship relationship was determined.
K18	Perpetrators who had 1 or More Associations to Victim	Number of perpetrators with 1 or more caregiving relationships to the victim.	Count each perpetrator once per client per investigation. If a person was the perpetrator of 2 clients in 1 investigation and has 1 or more caregiving relationships to 1 victim and not the second, the perpetrator is counted only once.
K18.1	Comment	Provide additional information on how number of perpetrators by association to the victim was determined.
K19	Perpetrators for whom 1 or More Legal Remedies on Behalf of the Victim were Sought	Number of perpetrators for whom at least 1 legal remedy was sought.	Count each perpetrator once per client per investigation. If a person was the perpetrator of 2 clients in 1 investigation and had 1 or more legal remedies sought related to 1 victim and none with the second, the perpetrator is counted only once.
K19.1	Comment	Provide additional information on how number of perpetrators by legal remedy was determined.

B.4. NAMRS Pilot Code Values and Definitions

Element	Code	Value	Value Definition
Report Source	1	Guardian or Conservator	An individual or entity, also sometimes known as a surrogate decision maker, appointed through state law to make personal and/or property decisions for another person who lacks the capacity to make such decisions, as determined by a court.
	2	Community Based Services	Professional or service provider supporting older adults and adults with disabilities to maintain independence.
	3	Education	Employees of a public or private educational institution or program; includes teachers, teacher assistants, administrators, and others directly associated with the delivery of educational services.
	4	Financial	Professionals managing finances or planning for future financial needs. Includes bank officials, financial planners, etc.
	5	Law Enforcement, Judicial, or Legal	People employed by a local, state, tribal, or federal justice agency. This includes police, courts, district attorney's office, probation or other community corrections agency, and correctional facilities.
	6	Medical or Health	People employed by a medical facility or practice. This includes physicians, physician assistants, nurses, emergency medical technicians, dentists, chiropractors, coroners, and dental assistants and technicians.
	7	Mental Health	Persons who offer services for the purpose of improving an individual's mental health or to treat mental illness. Includes psychiatric nurses, clinical psychologists, etc.
	8	Residential Care Community	Employee of a residential care community including those providing room and board of at least 2 meals per day and help with personal care and may exclusively serve persons with disabilities.
	9	Social Service and Rehabilitative Services	Employees of a public or private social services or social welfare agency, or other social worker or counselor who provides similar services including rehabilitative services.
	10	Other Professional	Persons who encountered the victim as part of their occupation. Includes landlords, housing authorities, clergy, etc.
	11	Self	Person allegedly being maltreated.
	12	Family Member	Persons related by blood, marriage, or adoption. Includes spouse, domestic partner, parent, foster parent, child, in-laws, etc.
	13	Non-Family Member	Other individual who is not a professional or family member. Includes friends, neighbors, household member, etc.
	14	Anonymous	An individual who notifies an APS agency of suspected maltreatment without identifying himself or herself.
Maltreatment Setting	10	Own residence or private residence of relative or caregiver	Client's home or the client's relative or caregiver's home. Includes foster homes.
	20	Residential care community setting (non-specific)	Including those providing room and board of at least 2 meals per day and help with personal care and may exclusively serve persons with disabilities.
	21	Licensed residential care community setting	Official authority by the state to function and operate
	22	Unlicensed residential care community setting	No official authority by the state to function and operate
	30	Nursing home (non-specific)	Includes skilled nursing homes
	31	Licensed nursing home	Official authority by the state to function and operate
	32	Unlicensed nursing home	No official authority by the state to function and operate
	40	Adult day services center (non-specific)	Includes adult day care, adult day health services centers
	41	Licensed adult day services center	Official authority by the state to function and operate
	42	Unlicensed adult day services center	No official authority by the state to function and operate
	50	Place of business or other services	Includes place of employment, sheltered workshops, hospitals, schools, banks, other offices, etc.
	60	Other	Includes shelters, public spaces
Maltreatment Type	1	Abandonment	The desertion of a person by an individual who has assumed responsibility for providing care for that person, or by an individual with physical custody of another person.
	2	Emotional Abuse	The infliction of anguish, pain, or distress through verbal or non-verbal acts. This includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment.
	3	Financial Exploitation	The illegal or improper use of an individual's funds, property, or assets.
	4	Neglect	The failure of a caregiver or fiduciary to provide the goods or services necessary to maintain the health or safety of a person. Includes acts of omission and of commission; includes willful deprivation, etc.
	5	Physical Abuse	The use of force or violence resulting in bodily injury, physical pain, or impairment. Excludes sexual abuse.
	6	Sexual Abuse	Non-consensual sexual contact of any kind, including sexual contact with any person incapable of giving consent.
	7	Suspicious Death	An unexpected fatality or 1 in which circumstances or cause are medically or legally unexplained.
	8	Self-neglect	A person's inability, due to physical or mental impairment or diminished capacity, to perform essential self-care tasks including obtaining essential food, clothing, shelter, and medical care; obtaining goods and services necessary to maintain physical health, mental health, or general safety; or managing one's own financial affairs. Includes hoarding.
	9	Other	A type of maltreatment not included in the categorizations provided.
Maltreatment Disposition	1	Substantiated	The finding that the allegation of maltreatment is supported under state law and policy.
	2	Inconclusive	The finding that there is insufficient information to either support or not support the allegation of maltreatment, but there is a reason to suspect maltreatment.
	3	Unsubstantiated	The finding that the allegation of maltreatment is not supported under state law and policy.
	4	Other	Disposition not included in categorizations provided. Includes inappropriate allegations that were investigated.
Gender Identity	1	Male	Male gender assigned at birth matches one's gender identity of male.
	2	Female	Female gender assigned at birth matches one's gender identity of female.
	3	Transgender	Gender identity, gender expression, and biological sex do not all align (e.g., man, masculine, and male).
Sexual Orientation	1	Straight	Sexual or romantic attractions and behaviors focus exclusively or mainly on members of the other sex.
	2	Gay/Lesbian	Sexual or romantic attractions and behaviors focus exclusively or mainly on members of the same sex.
	3	Bisexual	Sexual or romantic attractions and behaviors are directed at members of both sexes to a significant degree.
	4	Questioning	Exploring one's own sexual orientation, investigating influences that may come from family, religious upbringing, and internal motivations.
	5	Other	A sexual orientation not included in the categorizations provided.
Race	10	American Indian or Alaska Native	Having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
	20	Asian (non-specific)	Having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
	21	Asian Indian	Having origins of Asian Indian.
	22	Chinese	Having origins of Chinese.
	23	Filipino	Having origins of Filipino.
	24	Japanese	Having origins of Japanese.
	25	Korean	Having origins of Korean.
	26	Vietnamese	Having origins of Vietnamese.
	27	Other Asian	Having Asian origins other than those listed.
	30	Black or African American	Having origins in any of the Black racial groups of Africa.
	40	Native Hawaiian or Other Pacific Islander (non-specific)	Having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
	41	Native Hawaiian	Having origins of Native Hawaiian.
	42	Guamanian or Chamorro	Having origins of Guamanian or Chamorro.
	43	Samoan	Having origins of Samoan.
	44	Other Pacific Islander	Having Pacific Islander origins other than those listed.
	50	White	Having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Ethnicity	10	Yes, Hispanic or Latino/a, or Spanish Origin (non-specific)	Of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
	11	Mexican, Mexican American, Chicano/a	Having origins of Mexican, Mexican American, Chicano/a, regardless of race.
	12	Puerto Rican	Having origins of Puerto Rican, regardless of race.
	13	Cuban	Having origins of Cuban, regardless of race.
	14	Other Hispanic, Latino/a, or Spanish Origin	Having Hispanic, Latino/a, or Spanish origins other than those listed, regardless of race.
	20	No, not Hispanic or Latino/a, or Spanish Origin	Not of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
English Competency	1	Very well	Having high level of competency of the English language.
	2	Well	Having good level of competency of the English language.
	3	Not well	Having poor level of competency of the English language.
	4	Not at all	Having no competency of the English language.
Primary Language	1	Arabic	Primary language is Arabic.
	2	Chinese	Primary language is Chinese.
	3	English	Primary language is English.
	4	French	Primary language is French.
	5	German	Primary language is German.
	6	Korean	Primary language is Korean.
	7	Russian	Primary language is Russian.
	8	Spanish or Spanish Creole	Primary language is Spanish or Spanish Creole.
	9	Tagalog	Primary language is Tagalog.
	10	Vietnamese	Primary language is Vietnamese.
	11	Sign Language	Primary language is Sign Language.
	12	Assistive technology	Assistive, adaptive, and rehabilitative devices for people with disabilities.
	13	Other	A language not included in the categorizations provided.
Marital Status	1	Never married	Refers to persons who report themselves as never married.
	2	Married	Refers to persons who are currently legally married.
	3	Domestic partner, including civil union	In a committed relationship with another adult, including both same sex and opposite-sex relationships
	4	Divorced	Refers to those whose marriages were legally dissolved.
	5	Separated	A termination of cohabitation of spouses either by mutual agreement or, in the case of judicial separation, under the decree of a court.
	6	Widowed	Refers to those whose marriages were terminated through death of their spouse and have not remarried.
Level of Schooling	1	Less than high school	Did not receive a high school diploma or equivalent, such as GED.
	2	High school diploma or equivalent	Received high school diploma or equivalent, such as GED.
	3	Associate's degree or Bachelor's degree	Associate's degree: granted after a 2-year course of study, especially by a community or junior college. Bachelor's degree: earned for an undergraduate course of study that nominally requires 3-5 years of study, depending on institution and field of study.
	4	Advanced degree	A post-graduate degree, such as a Master's degree or a Doctorate.
Employment Status	1	Employed	Persons who are working or temporarily not working due to illness or other reasons.
	2	Unemployed	Persons who are not employed, and actively looking for work and available to start a job.
	3	Not in labor force	Students, homemakers, retired workers, seasonal workers not looking for work, persons residing in institutions, persons doing only incidental unpaid family work.
	4	Other	Includes sheltered workshop participants.
Benefits	1	Medicaid	Free or low-cost health care coverage under the U.S. Medicaid program, serving families and individuals with low-income and limited resources.
	2	Medicare	Free or low-cost health care coverage under the U.S. Medicare program, serving people age 65 and older, and younger persons with disabilities and those who have permanent kidney failure.
	3	Publicly-Subsidized Housing	Government sponsored economic assistance aimed toward alleviating housing costs and expenses for people in need with low to moderate incomes. Includes direct housing subsidies, non-profit housing, rent supplements, and some forms of co-operative and private sector housing.
	4	Social Security Disability Insurance	Benefits under SSDI, a federal program providing income supplements to people who are physically restricted in their ability to be employed because of a notable disability. It does not depend on the income of the disabled individual receiving it.
	5	Social Security Retirement Benefits	Benefits received by retired workers who have paid into the Social Security system during their working years. Paid out on a monthly basis to retired workers and their surviving spouses.
	6	Supplemental Security Income	Stipends through SSI program, provided to low-income people who are either 65 years or older, blind, or disabled.
	7	Temporary Assistance for Needy Families	Temporary financial assistance through TANF program, which helps pregnant women and families with 1 or more dependent children pay for food, shelter, utilities, and expenses other than medical.
	8	Veterans' Disabled Benefits	Benefits provided to Veterans with disabilities including Disability Compensation, Dependency and Indemnity Compensation, Special Monthly Compensation, Adapted Housing grants, Service-Disabled Veterans' Insurance, and Veterans' Mortgage Life Insurance.
	9	Other	Public benefit other than those specified in the categorizations provided.
Veteran Status	1	Veteran	Person who has served in the U.S. Armed Forces.
	2	Non-Veteran	Person who has not served in the U.S. Armed Forces.
Disabilities	1	Ambulatory Difficulty	Having serious difficulty walking or climbing stairs.
	2	Cognitive Difficulty	Because of a physical, mental, or emotional problem, having difficulty remembering, concentrating, or making decisions.
	3	Hearing Difficulty	Deaf or having serious difficulty hearing.
	4	Independent Living Difficulty	Because of a physical, mental, or emotional problem, having difficulty doing errands alone such as visiting a doctor's office or shopping.
	5	Self-care Difficulty	Having difficulty bathing or dressing.
	6	Vision Difficulty	Blind or having serious difficulty seeing, even when wearing glasses.
	7	Other	Disabilities other than those specified in the categorizations provided.
	8	None	Assessed, but no disability determined.
ADL	N	Total score	Indicates the client's total score on the Katz Index of Independence in ADLs. Permissible values are 0-6.
IADL	N	Total score	Indicates the client's total score on the Lawton IADLs. Permissible values are 0-8.
Behavioral Health	1	Alcohol Use Disorder	The consumption of alcohol that impacts the ability to conduct daily activities including quantity and frequency of alcohol consumption as well as feelings of not being able to stop drinking, of remorse about drinking, not being able to remember due to drinking, needing a drink early in the day, etc. Screening tools, such as AUDIT or others, may be used. Diagnosis depends upon clinical training.
	2	Anxiety	An affective disorder that makes it difficult to conduct daily activities including feelings of nervousness, not being able to stop or control worrying, worrying too much about different things, being restless so it is hard to sit still, becoming easily annoyed or irritable and feeling afraid. Screening tools, such as the GAD-7 or others, may be used. Diagnosis depends upon clinical training.
	3	Bipolar Disorder	A mood disorder characterized by alternating moods of mania and depression which can last for long periods of time and which may impact the ability to plan, schedule, and complete daily activities. Screening tools, such as the Mood Disorder Questionnaire or others, may be used. Diagnosis depends upon clinical training.
	4	Dementia	The progressive decline of cognitive ability which impacts daily activities. Alzheimer's is 1 type of dementia. Dementia may be associated with memory loss, difficulty performing familiar tasks, problems with language, disorientation to time and place, poor or decreased judgment, problems with abstract thinking, loss of initiative and changes in personality, mood, or behavior. Screening tools, such as the Alzheimer's Association Ten Warning Signs or others, may be used. Diagnosis depends upon clinical training.
	5	Depression	A loss of interest in daily activities including feelings of hopelessness, little energy, poor appetite or overeating, feeling bad about oneself, trouble concentrating and thoughts of suicide. Screening tools, such as the PHQ-9 or others, may be used. Diagnosis depends upon clinical training.
	6	Schizophrenia and Other Psychotic Disorders	An affective disorder characterized by having delusions and hallucinations that may impact daily activities by causing difficulties in interacting with others. Screening tools, such as STEP1 or others, may be used. Diagnosis depends upon clinical training.
	7	Substance Use Disorder	The use of drugs, including over the counter drugs, prescriptions drugs, cannabis (marijuana, hashish), solvents, tranquilizers, barbiturates, cocaine, stimulants, hallucinogens or narcotics that impact the ability to conduct daily activities including the quantity and frequency of use of such drugs, and feelings of being unable to stop when wanting to, of guilt or being neglectful, of withdrawal symptoms or having blackouts or flashbacks due to drug usage. Screening tools, such as DAST 10 or others, may be used. Diagnosis depends upon clinical training.
	8	Traumatic Brain Injury	The result of a violent blow or injury to the head. Physical damage to the brain may result in long-term complications that impact daily activities due to difficulties in sleeping, dizziness, vision, memory concentration, and mood changes. Screening tool is usually the result of self-reporting of the injury or symptoms. Diagnosis depends upon clinical training.
	9	Other	Behavioral conditions not included in the value list of behavioral health that are due to brain damage, disease or unknown causes which impact the ability to conduct daily activities. Examples include amnesia, delirium, behavioral syndromes such as eating disorders, sleep disorders, and other personality disorders. Screening may use a range of tools. Diagnosis depends upon clinical training.
	10	None	No behavioral health conditions have been determined.
Living Setting	10	Own residence or residence of relative or caregiver	Client's home or the client's relative or caregiver's home. Includes foster homes.
	20	Residential care community setting (non-specific)	Including those providing room and board of at least 2 meals per day and help with personal care and may exclusively serve persons with special needs.
	21	Licensed residential care community setting	Official authority by the state to function and operate.
	22	Non-licensed residential care community setting	No official authority by the state to function and operate.
	30	Nursing home (non-specific)	Includes skilled nursing homes.
	31	Licensed nursing home	Official authority by the state to function and operate.
	32	Non-licensed nursing home	No official authority by the state to function and operate.
	40	Other	Includes shelters, no fixed residence.
Substitute Decision Makers	10	Health Care Proxy in Effect	The appointment of a person to communicate the clients' wishes as to medical treatment in terminal illness or injury situations and to communicate for them in the event they cannot communicate for themselves. A document also known as a durable power of attorney for health care, medical power of attorney, or appointment of a health care agent, allows an individual to appoint another person (a proxy or agent) to express the individual's wishes and make health care decisions for the individual if he or she cannot speak for him or herself. Depending on the state, these documents are known as living wills, medical directives, health care proxies, or advance health care directives.
	20	Financial Proxy in Effect	Authorization, by a written document, that 1 individual may act in another's place as agent or attorney-in-fact with respect to some or all legal and financial matters. The scope of authority granted is specified in the document and may be limited by state statute. A power of attorney terminates on the death of the person granting the power (unless "coupled with an interest") and may terminate on the subsequent disability of the person granting the power (unless the power is "durable" under the instrument or state law).
	30	Guardianship or Conservatorship (non-specific)	A relationship created by state law in which a court determines that an adult individual lacks capacity to make decisions about self-care or property, and appoints another individual or entity as a conservator, or by a similar term, as a surrogate decision maker. It becomes the duty and power of that individual to make personal and/or property decisions for another.
	31	Guardianship or Conservatorship of Person	If the individual has a critical need for someone to act on their behalf due to mental or physical disability.
	32	Guardianship or Conservatorship of Property	(Or Estate): if the person is incapable of managing his or her own financial affairs.
	40	Representative Payee	An individual or organization appointed by SSA to receive Social Security and/or SSI benefits for someone who cannot manage or direct someone else to manage his or her money. The main responsibilities of a payee are to use the benefits to pay for the current and foreseeable needs of the beneficiary and properly save any benefits not needed to meet current needs. A payee must also keep records of expenses. When SSA requests a report, a payee must provide an accounting to SSA of how benefits were used or saved.
	50	None	No person in substitute decision making role as defined in the categorizations provided.
Services	1	Care/Case Management Services	Development and implementation of a service plan to mobilize the formal and informal resources and services identified in the assessment to meet the needs of the client. Includes the development and oversight of a plan to ensure the safety and well-being of the client; developing a safety plan with a person's support network; referring and arranging support services, etc.
	2	Caregiver Support Services	Assistance to family and other informal caregivers to improve or sustain capacity for caring for the older adult or adult with disabilities. Includes counseling, support groups, training, respite, etc.
	3	Community Day Services	Services or activities provided to adults who require care and supervision in a protective setting for a portion of a 24-hour day. Includes out of home supervision, health care, recreation, and/or independent living skills training offered in centers most commonly known as Adult Day, Adult Day Health, Senior Centers, and Disability Day Programs.
	4	Education, Employment, and Training Services	Services and activities to assist people in achieving or maintaining economic self-support. Includes training programs, job coaches, supported employment, senior employment programs, and public school individualized education plans.
	5	Emergency Assistance and Material Aid Services	Providing, arranging for, or facilitating the provision of medical, social service, economic, emergency, or support services. Includes financial assistance or referral for food, clothing, energy/utility assistance, and home repairs/modifications; environmental clean-up of client's home including but not limited to removal of trash, extermination services and cleaning; relocation assistance; urgent medical expenses not typically covered by insurance (eye glasses, dentures); emergency housing/shelter; etc.
	6	Financial Planning Services	Services or activities to assist in managing finances or planning for future financial needs. Includes meeting with bank officials, financial planning, estate planning, money management, and retirement income planning.
	7	Housing and Relocation Services	Services or activities designed to assist in the obtaining of suitable or safe housing and living arrangements. Includes tenant counseling; helping to identify and correct substandard housing conditions; making moving arrangements and minor renovations to personal residence; and relocating to institutional care or facility care.
	8	In-home Assistance Services	Services or activities provided to clients to achieve or maintain self-sufficiency. Includes homemakers and home health aides; visiting and telephone reassurance; chore maintenance; personal care services, etc.
	9	Legal Services	Legal counsel and representation provided by an attorney to address civil matters such as housing issues and advance care planning, and criminal matters.
	10	Medical and Dental Services	Services and activities designed to assist individuals and families to attain and maintain a favorable condition of health; includes evaluations.
	11	Medical Rehabilitation Services	Services and activities for persons with developmental or physical disabilities, or persons with visual or auditory impairments, are services or activities to maximize the potential of persons with disabilities, help alleviate the effects of physical, mental or emotional disabilities, and to enable these persons to live in the least restrictive environment possible. Includes training in mobility, communication skills, the use of special aids and appliances, self-sufficiency skills for people with disabilities, occupational therapy, physical therapy, speech and language pathology, early intervention and other therapies that help people learn the skills they need to live, learn, work and play in their communities.
	12	Mental Health Services	Services and activities, including commitment, assessment, and evaluations, for people with behavioral health conditions characterized by dysregulation of mood, thought, and/or behavior, as recognized by the DSM-5. Includes services and activities that apply therapeutic processes to personal, family, situational, or occupational problems in order to bring about a positive resolution of the problem or improved individual or family functioning or circumstances.
	13	Nutrition	Services and activities, including appeals and applications, to provide food to a client lacking recommended daily nutritional requirements and/or ADLs limitations. Includes home delivered meals, nutritional counseling, congregate meals, senior farmers' market program, etc.
	14	Public Assistance Benefits	Services and assistance to provide a safety net for disadvantaged individuals who lack the resources to provide basic necessities for themselves and their families. Includes such programs as financial aid (TANF), nutrition (SNAP), energy assistance (LIHEAP), health care (Medicaid), etc.
	15	Substance Use Services	Services and activities primarily designed to deter, reduce, or eliminate substance abuse or chemical dependence. Includes a comprehensive range of personal and family counseling methods, methadone treatment for opiate abusers, or detoxification treatment for alcohol abusers. Services and activities may be provided in alternative living arrangements such as institutional settings and community-based halfway houses.
	16	Transportation	Services or activities that provide or arrange for the travel, including travel costs, of individuals in order to access services, or obtain medical care or employment.
	17	Victim Services	Services and activities provided to, or on behalf of, victims at any stage of the criminal justice process, including post sentencing services and support. Includes programs supporting victims of domestic violence, sexual assault, abuse of older women, violence against women, and general crimes which are being handled by the police or prosecutors' offices.
	18	Other Services	Services and activities not included in the categorizations provided.
Interagency Coordination	1	Law Enforcement or Prosecutorial Offices	Government units staffed by police, sheriffs, district attorneys, etc.
	2	Protection and Advocacy or Client Advocacy Program	Agencies that have the authority to provide legal representation and other advocacy services, under all federal and state laws, to all people with disabilities, along with those agencies that provide information and assistance to individuals seeking or receiving vocational rehabilitation services under the Rehabilitation Act.
	3	State Licensing Agency	Government units responsible for the licensing of facilities and agencies serving older adults and adults with disabilities.
	4	State Medicaid Fraud Control Unit	State agencies that investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities.
	5	Long-Term Care Ombudsman Program	State program that addresses complaints and advocates for people in the long-term care system.
	6	Other	Type of agency not included in the categorizations provided.
Case Closure Reason	1	Investigation complete	All activities related to the case were completed.
	2	Protective services completed	Protective services were conducted.
	3	Client refused services	Client refused any investigative services.
	4	Unable to complete (closed without finding)	A disposition that does not conclude with a specific finding because the APS response could not be completed.
	5	Client died	Case closed because client died before investigation was complete.
	6	Other	Case closed for a reason other than the reasons in the categorizations provided.
Kinship Relationship	10	Yes (not specific)	Kinship relationship exists
	11	Spouse	Partner in a marriage
	12	Domestic partner, including civil union	Adults in a committed relationship with another adult, including both same sex and opposite-sex relationships
	13	Parent	The birth mother or father, adoptive mother or father, or step-mother or step-father or the victim.
	14	Child	Biological son or daughter, adoptive son or daughter, or step-son or step-daughter
	15	Sibling	Children or offspring have 1 or both parents in common; a brother or sister (by blood, adoption, marriage)
	16	Grandparent	Parent of one's father or mother; a grandmother or grandfather (by blood, adoption, marriage)
	17	Grandchild	A child of one's son or daughter (by blood, adoption, marriage)
	18	Other relative	Another family member, including in-laws and kinship foster parents
	20	None	No kinship relationship, includes non-kinship foster parents
Perpetrator Association to Victim	1	Nursing Home Staff	An employee of a nursing home, including a skilled nursing home. Nursing homes primarily provide skilled nursing, rehabilitation, and long-term care.
	2	Residential Care Community Staff	An employee of a residential care community. Other terms used to refer to these places are assisted living, personal care, and adult care homes, facilities, and communities; adult family and board and care homes; adult foster care; homes for the aged; and housing with services establishments.
	3	Paid Formal Caregiver	An employee of an agency or organization, or a trained professional, who provides care for a fee. Includes adult day staff, caregivers in the home, or private duty in a residential care setting.
	4	Paid Informal or Family Caregiver	A family member or other individual who receives private or public funds for providing care. The caregiver usually has personal ties to the care recipient. Examples include family, friends, and neighbors.
	5	Unpaid Informal or Family Caregiver	A family member or other individual who provides care without pay and who usually has personal ties to the care recipient. Examples include family, friends and neighbors. The caregiver can be a "primary" or "secondary" caregiver, can provide full-time or part-time help, and may live with the care recipient or separately.
	6	Other Relationship	Another trusted person providing care, not included in the categorizations provided.
	7	None	No association to victim as defined in the categorizations provided.
Legal Remedies	1	Removal of Guardianship Rights	The termination of a relationship, created by state law and determined by a court, in which an individual or entity acts as a conservator, or by a similar term, as a surrogate decision maker for another person who lacks capacity to make decisions about self-care or property. The individual no longer has duty and power to make personal and/or property decisions for the other.
	2	Restraining Order on Perpetrator Regarding the Victim	A court order issued to prohibit an individual from carrying out a particular action, especially approaching or contacting a specified person.
	3	Eviction of Perpetrator	The act of expelling someone, usually a tenant, from a property.
	4	Restitution by Perpetrator	Compensation paid to victim by perpetrator for the losses or injuries incurred as a result of a criminal offense.
	5	Other Legal Remedy	Legal remedies not included in the categorizations provided.
	6	None	No legal remedies were sought on behalf of the client.

Appendix C. Schedule of Namrs Pilot Activities

C.1. Major Milestones

C.2. Sprint Schedule and Overview

Appendix D. Namrs Pilot Data Submitted by States

D.1. Number of Clients Reported On

Case Component States	Number of Clients
State A	83,787
State B	16,033
State C	5,572
State D	2,432
State E	1,381
Key Indicators Component States	Number of Clients
State F	25,996
State G	14,138
State H	5,276
State I	2,428

D.2. Agency Component Completion of Elements

Agency Component Completion of Elements (9 states total)

D.3. Case Component Completion of Elements, by Entity

Case Component Completion of Elements: Investigation Entity (5 states total)

Case Component Completion of Elements: Maltreatment Entity (5 states total)

Case Component Completion of Elements: Client Entity (5 states total)

Case Component Completion of Elements: Perpetrator Entity (5 states total)

Case Component Completion of Elements: Client-Perpetrator Relationship Entity (5 states total)

D.4. Key Indicators Component Completion of Elements

Key Indicators Component Completion of Elements (4 states total)

Appendix E. Proposed Agency Component Data Specifications

E.1. Proposed Agency Component Data Specifications

The Agency Component includes agency information such as agency name, addresses, and contact information. The Agency Component collects information on the policies and practices of each state APS agency as context for understanding the Case Component or the Key Indicators Component submission. While all data elements pertain to the reporting period for the annual data collection, the information in some elements will not change each year. Data topics include the following:

• Data Sources--sources of information used to submit data.

• Population Served--characteristics of the population served.

• Staffing--number of filled investigator and supervisor FTEs.

• Intake Processes--centralized, local or regional, combination.

• Referrals--number of reports received; not accepted, or resolved through I&R/I&RA; accepted.

• Standard of Evidence--legal criteria for substantiating maltreatment.

• Completion of Investigation--amount of time for APS to complete investigations based on standard.

• Types of Maltreatment--state definitions or statutory references for definitions.

• Assessment Tools--uses statewide standardized tools for investigation.

• Service Gaps--client services that are not available.

• Perpetrators--whether or not the agency collects person-specific data on perpetrators.

Some data elements have a tiered structure of code values. In such cases the specifications show the tiered structure by indenting the optional, more specific code values.

States can submit additional explanatory information on each item.

TABLE E.1. Agency Component Data Specifications: General Information
Element#	Element Name	Element Description	Required	Type	Size
Agency1.1	Agency name 1	Department or agency name	Yes	Alphanumeric	100
Agency1.2	Agency name 2	Branch or unit name	No	Alphanumeric	100
Agency2.1	Street 1	First line street address of agency physical address	Yes	Alphanumeric	100
Agency2.2	Street 2	Second line street address of agency physical address	No	Alphanumeric	100
Agency2.3	City	City of agency physical address	Yes	Alphanumeric	100
Agency2.4	State	State of agency physical address	Yes	Alphanumeric	2
Agency2.5	ZIP	ZIP of agency physical address	Yes	Alphanumeric	10
Agency3.1	Street 1	First line street address of agency mailing address	Yes	Alphanumeric	100
Agency3.2	Street 2	Second line street address of agency physical address	No	Alphanumeric	100
Agency3.3	City	City of agency physical address	Yes	Alphanumeric	100
Agency3.4	State	State of agency physical address	Yes	Alphanumeric	2
Agency3.5	ZIP	ZIP of agency physical address	Yes	Alphanumeric	10
Agency4.1	Name	Contact name	Yes	Alphanumeric	100
Agency4.2	Title (per contact name)	Contact title	Yes	Alphanumeric	100
Agency4.3	Email (per contact name)	Contact email	Yes	Alphanumeric	100
Agency4.4	Phone (per contact name)	Contact telephone	Yes	Alphanumeric	50
Agency4.5	Contact's role in agency (per contact name)	Contact's role in agency Code Values: 1 = Manager/director/supervisor 2 = Data coordinator/manager 3 = Training coordinator/specialist 4 = IT/data specialist 5 = Policy specialist 6 = Intake manager/supervisor 7 = Regional supervisor 8 = Field coordinator9 = Investigator 10 = Social worker 11 = Case manager	No	Drop down; select 1	NA

TABLE E.2. Agency Component Data Specifications: Agency Profile
Element#	Element Name	Element Description	Required	Type	Size
Agency5	Data sources	The sources of information used to submit data this year to NAMRS. Code Values: 1 = APS agency only 2 = APS and other agencies	No	Drop down; select 1	NA
Agency5.1	Comment	Provide names of other agencies that provided data.	No	Text (characters)	5,000
Agency6	Population served	Provide a brief description of the characteristics of the population, including age, living arrangement, vulnerability, etc. whom APS is mandated to serve. Provide the citation in state statute or regulation, or agency policy.	No	Text (characters)	5,000
Agency6.1	Population served: setting	If your agency investigates allegations in residential care communities and/or nursing homes, please indicate whether or not your agency would conduct an investigation if the allegation does not pertain to a specific resident, but rather to the residents in general.	No	Text (characters)	5,000
Agency7	Investigator FTEs filled	Number of filled APS FTEs responsible for the hotline and/or conducting investigations.	No	Numeric	6
Agency7.1	Supervisor FTEs filled	Number of filled APS FTEs responsible for supervision.	No	Numeric	6
Agency7.2	Comment	Provide additional information as to whether the numbers in 7 and 7.1 were the annual total or total for a given day.	No	Text (characters)	5,000
Agency8	Intake	Centralized or localized intake of APS reports. Code Values: 1 = Centralized at a statewide hotline or call in number 2 = Local at county or regional hotlines or call in numbers 3 = Combination of both statewide and local hotlines or call in numbers 4 = Other	No	Drop down; select 1	NA
Agency8.1	Comment	Provide additional information on the definition of intake.	No	Text (characters)	5,000
Agency9	Reports accepted for investigation	Number of reports accepted for investigation during the reporting period.	No	Numeric	6
Agency9.1	Reports not accepted, or resolved through I&R/I&RA	Number of reports that were either not accepted by APS for investigation, or were resolved through I&R/I&RA.	No	Numeric	6
Agency9.2	Comment	Please confirm that the sum of 9 and 9.1 is the total number of investigations received during the reporting period. Please provide additional information regarding policy for accepting reports and not accepting reports, or resolving through I&R/I&RA.	No	Text (characters)	5,000
Agency 10	Response time	The length of time from receipt of call or notice of alleged maltreatment to face-to-face contact with the client by the APS worker, based on the standard set by policy or practice.	No	Numeric	3
Agency 10.1	Comment	Provide additional information on the definition of response time to allegations of maltreatment. If different types of allegations are given different priorities in terms of response time, please provide additional information.	No	Text (characters)	5,000
Agency11	Investigation completion time	The length of time from investigation start to investigation completion, based on the standard set by policy or practice.	No	Numeric	3
Agency11.1	Comment	Provide additional information on the definition of start of investigation and completion of an investigation.	No	Text (characters)	5,000
Agency12	Types of maltreatment	Indicate which types of maltreatment are investigated by APS. Code Values: 10 = Abandonment 20 = Emotional abuse 30 = Exploitation    31 = Financial exploitation    32 = Other exploitation 40 = Neglect 50 = Physical abuse 60 = Sexual abuse 70 = Suspicious death 80 = Self-neglect 90 = Other	No	Drop down; select 1 or more	NA
Agency12.1	Comment	Provide citation or URL in state law, regulations, or program guidance for maltreatment types investigated by APS.	No	Text (characters)	5,000
Agency13	Standard of evidence	Standard used for substantiating an allegation of maltreatment. Code Values: 1 = No state standard 2 = Different standards based on type of perpetrator 3 = Clear and convincing 4 = Preponderance 5 = Credible, reasonable, or probableCause 6 = Other	No	Drop down; select 1	NA
Agency13.1	Comment	Provide citation or URL of state law, regulations, or program guidance. Include discussion of definitions of perpetrator if relevant.	No	Text (characters)	5,000
Agency14	Assessment tools	Indicate whether APS personnel use standard tools throughout the state for assessing risk or safety of clients. Code Values: 1 = Yes, use common instrument or tool throughout the state 2 = No, assessment instruments are determined by each county or left to the worker's discretion	No	Drop down; select 1	NA
Agency14.1	Comment	Provide the name and reference (i.e., URL) for each standardized tool that is used.	No	Text (characters)	5,000
Agency15	Service gaps	Indicate which services are not available or accessible in the state. Code Values: 1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services 9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 =Substance use services 16 = Transportation 17 = Victim services 18 = Other services	No	Drop down; select 1 or more	NA
Agency15.1	Comment	Provide additional information on how gaps in services were identified, if possible.	No	Text (characters)	5,000
Agency16	Perpetrators	Does APS collect person-specific data on persons found to be perpetrators of substantiated maltreatment? Does your information system collect unique IDs and demographic characteristics of such persons? If there is specific state statute or regulation, or agency policy on such data, please provide the citation.	No	Text (characters)	5,000

E.2. Proposed Case Component Data Specifications

The Case Component includes information pertaining to each report that is screened-in and investigated by the APS agency. The information is specific to the investigation, including the clients, maltreatments, and perpetrators associated with the specific investigation. A case is comprised of an investigation and any ancillary tasks that APS undertakes on behalf of the client. The Case Component collects data on APS cases that were closed during the reporting period.

The Case Component is comprised of five entities. Each entity is comprised of attributes. The key entities for the data submission are:

• Investigation--each investigation undertaken by APS with a case closure date during the report period.

• Client--each person subject of an investigation.

• Maltreatment Allegation--each maltreatment associated with each client, requires the attributes of maltreatment type and maltreatment disposition.

• Perpetrator--each person determined to be responsible for one or more maltreatments with a disposition of substantiated.

• Client-Perpetrator Relationship--the relationship between the client, who is the victim of a substantiated maltreatment, and the perpetrator, as explained by one or more of the eight possible attributes.

On the following tables, the column “quantifier” indicates if a data element can have multiple values. For example, a client may have received multiple types of benefits, while there can only be one primary reason for case closure.

Some data elements have a tiered structure of code values. For example, the data element race allows the client to be identified as Asian OR as a specific Asian race. In such cases the specifications show the tiered structure by indenting the optional, more specific code values.

Definitions of specific data element values can be found in the NAMRS Definitions of Code Values.

Each reporting period submission may have multiple investigations.

TABLE E.3. Investigation Entity
#	Element Name	Element Description	Required	Quantifier	Type	Size	Code Values
Inv1	Investigation ID	The unique ID used by the state for each investigation. The ID is assigned to a specific investigation and is only used once. The Investigation ID is encrypted by the state for purposes of data submission.	Yes	Single	A/N	32	Not applicable
Inv2	Report date	The month, day, and year the agency was notified of the suspected adult maltreatment.	No	Single	Date	10	Not applicable
Inv3	Report source	The role or profession of the person who made the report of the suspected adult maltreatment. Multiple report source code values can be submitted for the client.	No	Multiple	N	2	1 = Substitute decision maker 2 = In-home caregiver 3 = Nursing home staff 4 = Residential care community staff 5 = Education professional 6 = Financial professional 7 = Law enforcement, judicial, or legal professional 8 = Medical or health professional 9 = Mental and behavioral health professional 10 = Social services professional 11 = Other professional 12 = Relative 13 = Neighbor, friend, other non-relative, other non-professional 14 = Self 15 = No role identified
Inv4	State/county FIPS code of investigative agency	The FIPS for state (2 digits) and county code (3 digits) of the APS agency. (Primary agency responsible for the determination of the investigation.)	No	Single	N	5	Code is the unique identification number assigned to each state and county under the FIPS guidelines. See http://www.census.gov/geo/www/fips/fips.html.
Inv5	Investigation start date	The date the investigation is assigned to an investigation worker. If the agency uses another date to indicate the start of an investigation, that date is used.	No	Single	Date	10	Not applicable
Inv6	Investigation disposition date	The date that the agency completed dispositions on the allegations of maltreatment associated with the investigation.	No	Single	Date	10	Not applicable
Inv7	Case closure date	The date that the agency completed all activities related to the investigation of the case.	Yes	Single	Date	10	Not applicable

Each investigation may have multiple clients. Each client can be associated with more than one investigation but a separate client entity is required for each investigation.

TABLE E.4. Client Entity
#	Element Name	Element Description	Required	Quantifier	Type	Size	Code Values
Clt1	Client ID	The unique ID used by the state for each client. The ID is assigned to a specific client and is used identify the same client across investigations and reporting periods. The client ID is encrypted by state for purposes of data submission. Data on multiple clients can be submitted for the investigation.	Yes	Single	A/N	32	Not applicable
Clt2	Maltreatment setting	The location where the alleged maltreatment occurred.	No	Single	N	2	10 = Own residence or private residence of relative or caregiver 20 = Residential care community (non-specific)    21 = Licensed residential care community    22 = Unlicensed residential care community 30 = Nursing home (non-specific)    31 = Licensed nursing home    32 = Unlicensed nursing home 40 = Adult day services center (non-specific)    41 = Licensed adult day services center    42 = Unlicensed adult day services center 50 = Place of business or other services 60 = Other
Clt3	State/county FIPS code of client	The FIPS for state (2 digits) and county code (3 digits) of the client's residence at the start of the investigation.	No	Single	N	5	Code is the unique identification number assigned to each state and county under the FIPS guidelines. See http://www.census.gov/geo/www/fips/fips.html.
Clt4	Case closure reason	The primary reason why the case was closed.	No	Single	N	2	10 = Investigation completed 20 = Investigation completed and protective services case completed 30 = Investigation unable to be completed (non-specific)    31 = Investigation unable to be completed due to death of client during investigation    32 =Investigation unable to be completed due to refusal of client 40 = Protective services case opened but not completed (non-specific)    41 = Protective services case closed due to death of client    42 = Protective services case closed due to client decision to not continue 50 = Other
Clt5	Age	The age of the client in years (at investigation start date).	No	Single	N	2	18,19...74 = Actual age 75 = 75-84 85 = 85 and older
Clt6	Gender identity	The actual or perceived gender-related characteristics of the client.	No	Single	N	1	1 = Male 2 = Female 3 = Transgender
Clt7	Sexual orientation	The client's enduring pattern of or disposition to experience sexual or romantic desires for, and relationships with, people of one's same sex, the other sex, or both sexes.	No	Single	N	1	1 = Straight 2 = Gay/lesbian 3 = Bisexual 4 = Questioning 5 = Other
Clt8	Race	The population(s) or group(s) that the client identifies as being a member. Multiple race code values can be submitted for the client.	No	Multiple	N	2	10 = American Indian or Alaska Native 20 = Asian (non-specific)    21 = Asian Indian    22 = Chinese    23 = Filipino    24 = Japanese    25 = Korean    26 = Vietnamese    27 = Other Asian 30 = Black or African American 40 = Native Hawaiian or Other Pacific Islander (non-specific)    41 = Native Hawaiian    42 = Guamanian or Chamorro    43 = Samoan    44 = Other Pacific Islander 50 = White
Clt9	Ethnicity	The affiliation of the client as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicity code values can be submitted for the client.	No	Multiple	N	2	10 = Yes, Hispanic or Latino/a, or Spanish Origin (non-specific)    11 = Mexican, Mexican American, Chicano/a    12 = Puerto Rican    13 = Cuban    14 = Other Hispanic, Latino/a, or Spanish Origin 20 = No, not Hispanic or Latino/a, or Spanish Origin
Clt10	Primary language	The primary language or method that the client uses for written and verbal communication.	No	Single	N	2	1 = Arabic 2 = Chinese 3 = English 4 = French 5 = German 6 = Korean 7 = Russian 8 = Spanish or Spanish Creole 9 = Tagalog 10 = Vietnamese 11 = Sign language 12 = Assistive technology 13 = Other
Clt11	Marital status	The client's status based on state residency laws.	No	Single	N	1	1 = Never married 2 = Married 3 = Domestic partner, including civil union 4 = Divorced 5 = Separated 6 = Widowed 7 = Other
Clt12	Schooling level	The highest educational degree attained by the client.	No	Single	N	1	1 = Less than high school 2 = High school diploma or equivalent 3 = Associate's degree or Bachelor's degree 4 = Advanced degree
Clt13	Employment status	The involvement of the client in the labor force.	No	Single	N	1	1 = Employed 2 = Unemployed 3 = Not in labor force 4 = Other
Clt14	Income level	The level of annual income of the client including all sources of income.	No	Single	N	1	1 = Less than $25,000 2 = $25,000-$49,999 3 = $50,000-$74,999 4 = $75,000-$99,999 5 = $100,000 or more
Clt15	Benefits	The federal and state benefits received by the client during the investigation. Multiple benefit code values can be submitted for the client.	No	Multiple	N	1	1 = Medicaid 2 = Medicare 3 = Publicly-subsidized housing 4 = SSDI 5 = Social Security retirement benefits 6 = SSI 7 = TANF 8 = Veterans' disabled benefits 9 = Other
Clt16	Veteran status	The client's status related to the U.S. Armed Forces.	No	Single	N	1	1 = Veteran 2 = Non-Veteran
Clt17	Disabilities	The client's physical, emotional, and mental health issues that result in limitation in activities and restrictions to fully participate at school, work, or in the community. Multiple disability code values can be submitted for the client.	No	Multiple	N	1	1 = Ambulatory difficulty 2 = Cognitive difficulty 3 = Communication difficulty 4 = Hearing difficulty 5 = Independent living difficulty 6 = Self-care difficulty 7 = Vision difficulty 8 = Other 9 = None
Clt18	ADL score	The client's score on the Katz Index of Independence in ADLs.	No	Single	N	1	Permissible values are 0-6
Clt19	IADL score	The client's score on the Lawton IADLs.	No	Single	N	1	Permissible values are 0-8
Clt20	Behavioral health screenings or diagnoses	The results of assessments on the client, conducted by the APS agency. Multiple behavioral health code values can be submitted for the client.	No	Multiple	N	2	1 = Alcohol use disorder 2 = Anxiety 3 = Bipolar disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and other psychotic disorders 7 = Substance use disorder 8 = Traumatic brain injury 9 = Other 10 = None
Clt21	Living setting at start	The primary residential environment of the client at the start of investigation.	No	Single	N	2	10 = Own residence or residence of relative or caregiver 20 = Residential care community (non-specific)    21 = Licensed residential care community    22 = Non-licensed residential care community 30 = Nursing home (non-specific)    31 = Licensed nursing home    32 = Non-licensed nursing Home 40 = Other
Clt22	Living setting at close	The primary residential environment of the client at the time of case closure.	No	Single	N	2	10 = Own residence or residence of relative or caregiver 20 = Residential care community (non-specific)    21 = Licensed residential care community    22 = Non-licensed residential care community 30 = Nursing home (non-specific)    31 = Licensed nursing home    32 = Non-licensed nursing home 40 = Other
Clt23	Substitute decision makers at start	The authorizations that are in effect related to health, personal, or financial decision making for the client at the start of the investigation. Multiple substitute decision maker code values can be submitted for the client.	No	Multiple	N	2	10 = Health care proxy in effect 20 = Financial proxy in effect 30 = Guardianship or conservatorship (non-specific)    31 = Guardianship or conservatorship of person    32 = Guardianship or conservatorship of property 40 = Representative payee 50 = None
Clt24	Substitute decision makers at close	The authorizations that are in effect related to health, personal, or financial decision making for the client at time of case closure. Multiple substitute decision maker code values can be submitted for the client.	No	Multiple	N	2	10 = Health care proxy in effect 20 = Financial proxy in effect 30 = Guardianship or conservatorship (non-specific)    31 = Guardianship or conservatorship of person    32 = Guardianship or conservatorship of property 40 = Representative payee 50 = None
Clt25	Services at start	The services known to the agency that the client was already receiving at the start of the investigation. Multiple service code values can be submitted for the client.	No	Multiple	N	2	1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services 9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 = Substance use services 16 = Transportation 17 = Victim services 18 = Other services 19 = None
Clt26	Services APS	The services that the agency provided on behalf of the client during the investigation or while the agency kept an open case. Multiple service code values can be submitted for the client.	No	Multiple	N	2	1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services 9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 = Substance use services 16 = Transportation 17 = Victim services 18 = Other services 19 = None
Clt27	Services referred	The services for which the agency referred the client. Multiple services code values can be submitted for the client.	No	Multiple	N	2	1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services 9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 = Substance use services 16 = Transportation 17 = Victim services 18 = Other services 19 = None
Clt28	Services at close	The services known to the agency that the client was receiving at the time of case closure. Multiple services code values can be submitted for the client.	No	Multiple	N	2	1 = Care/case management services 2 = Caregiver support services 3 = Community day services 4 = Education, employment, and training services 5 = Emergency assistance and material aid services 6 = Financial planning services 7 = Housing and relocation services 8 = In-home assistance services 9 = Legal services 10 = Medical and dental services 11 = Medical rehabilitation services 12 = Mental health services 13 = Nutrition 14 = Public assistance benefits 15 = Substance use services 16 = Transportation 17 = Victim services 18 = Other services 19 = None
Clt29	Interagency coordination	The agencies to which the client was referred. Multiple interagency coordination code values can be submitted for the client.	No	Multiple	N	1	1 = Law enforcement or prosecutorial offices 2 = Protection and advocacy or CAP 3 = State licensing agency 4 = State MFCU 5 = Long-term care ombudsman program 6 = Other 7 = None
Clt30	Previous report	The indication that the agency has information that the client was the subject of a previous report.	No	Single	N	1	1 = Yes 2 = No

Each client may have multiple maltreatment allegation entities within a specific investigation but only one of a particular maltreatment type. Each maltreatment allegation entity is associated with only one client. Each maltreatment allegation entity must be composed of a maltreatment type and maltreatment disposition.

TABLE E.5. Maltreatment Allegation Entity
#	Element Name	Element Description	Required	Quantifier	Type	Size	Code Values
Mal1	Maltreatment type	The alleged maltreatments that are investigated.	Yes	Single (per entity)	N	2	10 = Abandonment 20 = Emotional abuse 30 = Exploitation (non-specific)    31= Financial exploitation    32= Other exploitation 40 = Neglect 50 = Physical abuse 60 = Sexual abuse 70 = Suspicious death 80 = Self-neglect 90 = Other
Mal2	Maltreatment disposition	The disposition of each alleged maltreatment.	Yes	Single (per entity)	N	1	1 = Substantiated 2 = Inconclusive 3 = Unsubstantiated 4 = Other

Each investigation may have zero, one, or more than one perpetrator. A perpetrator must be associated with at least one substantiated maltreatment investigation that is associated with a specific client within the investigation. A perpetrator may be associated with more than one investigation but a separate perpetrator entity is required for each of the associated investigations.

TABLE E.6. Perpetrator Entity
#	Element Name	Element Description	Required	Quantifier	Type	Size	Code Values
Per1	Perpetrator ID	The unique ID used by the state for the person who is found to be responsible for substantiated maltreatment(s). The ID is assigned to a specific perpetrator and is used to identify the same perpetrator across investigations and reporting periods. The Perpetrator ID is encrypted by the state for purposes of data submission.	Yes	Single	A/N	32	Not applicable
Per2	Age	The age of the perpetrator in years (at investigation start date).	No	Single	N	2	18,19...74 = Actual age 75 = 75-84 85 = 85 and older
Per3	Gender identity	The actual or perceived gender-related characteristics of the perpetrator.	No	Single	N	1	1 = Male 2 = Female 3 = Transgender
Per4	Race	The population(s) or group(s) that the perpetrator identifies as being a member. Multiple race code values can be submitted for the perpetrator.	No	Multiple	N	2	10 = American Indian or Alaska Native 20 = Asian (non-specific)    21 = Asian Indian    22 = Chinese    23 = Filipino    24 = Japanese    25 = Korean    26 = Vietnamese 27 = Other Asian 30 = Black or African American 40 = Native Hawaiian or Other Pacific Islander (non-specific)    41 = Native Hawaiian    42 = Guamanian or Chamorro    43 = Samoan    44 = Other Pacific Islander 50 = White
Per5	Ethnicity	The affiliation of the perpetrator as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicity code values can be submitted for the perpetrator.	No	Multiple	N	2	10 = Yes, Hispanic or Latino/a, or Spanish Origin (non-specific)    11 = Mexican, Mexican American, Chicano/a    12 = Puerto Rican    13 = Cuban    14 = Other Hispanic, Latino/a, or Spanish Origin 20 = No, not Hispanic or Latino/a, or Spanish Origin
Per6	Disabilities	The perpetrator's physical, emotional, and mental health issues that result in limitation in activities and restrictions to fully participate at school, work, or in the community. Multiple disability code values can be submitted for the perpetrator.	No	Multiple	N	1	1 = Ambulatory difficulty 2 = Cognitive difficulty 3 = Communication difficulty 4 = Hearing difficulty 5 = Independent living difficulty 6 = Self-care difficulty 7 = Vision difficulty 8 = Other 9 = None
Per7	Behavioral health screenings or diagnoses	The results of assessments on the perpetrator, conducted by the APS agency. Multiple behavioral health code values can be submitted for the perpetrator.	No	Multiple	N	2	1 = Alcohol use disorder 2 = Anxiety 3 = Bipolar disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and other psychotic disorders 7 = Substance use disorder 8 = Traumatic brain injury 9 = Other 10 = None

Each client and perpetrator can have a designated relationship if data on one or more of the entity attributes is provided. A client and perpetrator have only one relationship entity within an investigation.

TABLE E.7. Client Perpetrator Relationship Entity
#	Element Name	Element Description	Required	Quantifier	Type	Size	Code Values
CPR1	Cohabitation at start	The indication if the perpetrator and client are cohabitating at the start of the investigation.	No	Single	N	1	1 = Yes 2 = No
CPR2	Cohabitation at close	The indication if the perpetrator and client are cohabitating at the time of case closure.	No	Single	N	1	1 = Yes 2 = No
CPR3	Kinship relationship	The indication if the perpetrator is related to the client by affinity (blood, adoption, marriage, etc.).	No	Single	N	2	10 = Yes (non-specific)    11 = Spouse    12 = Domestic partner, including civil union    13 = Parent    14 = Child    15 = Sibling    16 = Grandparent    17 = Grandchild    18 = Other relative 20 = None
CPR4	Perpetrator association at start	The indication if the perpetrator has a caregiving relationship to the client at the start of the investigation.	No	Single	N	2	10 = Nursing home staff 20 = Residential care community staff 30 = Relative caregiver (non-specific)    31 = Paid relative caregiver    32 = Unpaid relative caregiver 40 = Non-relative caregiver (non-specific)    41 = Paid non-relative caregiver    42 = Unpaid non-relative caregiver 50 = Other relationship 60 = None
CPR5	Perpetrator association at close	The indication whether the perpetrator has a caregiving relationship to the client at time of case closure.	No	Single	N	1	10 = Nursing Home Staff 20 = Residential care community staff 30 = Relative caregiver (non-specific)    31 = Paid relative caregiver    32 = Unpaid relative caregiver 40 = Non-relative caregiver (non-specific)    41 = Paid non-relative caregiver    42 = Unpaid non-relative caregiver 50 = Other relationship 60 = None
CPR6	Perpetrator substitute decision maker at start	Authorizations that the perpetrator has in relation to the client, and that are in effect, related to health, personal or financial decision making at the start of the investigation. Multiple substitute decision maker code values can be submitted for the client-perpetrator relationship.	No	Multiple	N	2	10 = Health care proxy in effect 20 = Financial proxy in effect 30 = Guardianship or conservatorship (non-specific)    31 = Guardianship or conservatorship of person    32 = Guardianship or conservatorship of property 40 = Representative payee 50 = None
CPR7	Perpetrator substitute decision maker at close	Authorizations that the perpetrator has in relation to the client, and that are in effect, related to health, personal or financial decision making at the time of case closure. Multiple substitute decision maker code values can be submitted for the client-perpetrator relationship.	No	Multiple	N	2	10 = Health care proxy in effect 20 = Financial proxy in effect 30 = Guardianship or conservatorship (non-specific)    31 = Guardianship or conservatorship of person    32 = Guardianship or conservatorship of property 40 = Representative payee 50 = None
CPR8	Perpetrator legal remedy	The legal remedies that were recommended or sought by the APS agency regarding the status of the perpetrator. Multiple legal remedy code values can be submitted for the client-perpetrator relationship.	No	Multiple	N	1	1 = Recommendation of removal of guardianship rights 2 = Recommendation of restraining order on perpetrator regarding the client 3 = Recommendation of eviction of perpetrator 4 = Recommendation of restitution by perpetrator 5 = Recommendation of other legal remedy 6 = None

E.3. Proposed Key Indicators Component Data Specifications

The Key Indicators Component includes aggregated counts of key statistics related to an investigation, clients, and perpetrators. This component is designed to collect data that are most commonly computed by states on an annual basis. States may need to re-compute these statistics for the pilot test reporting period, which may be different from the standard reporting period used by the state. The Key Indicators Component is submitted only by those states that cannot submit the Case Component.

The Key Indicators Component collects duplicated counts of clients or perpetrators. If a client is involved in multiple investigations, the client is counted multiple times.

The data domains in the Key Indicators Component include the following:

• Investigations--number completed.

• Clients--number that received an investigation, that received interagency coordination, and by case closure reason.

• Victims--clients found to be victims by one or more maltreatments, by demographics, disabilities, behavioral conditions, maltreatment type, and outcomes.

• Perpetrators--by demographics, kinship relationship, association to victim, and legal remedies.

Some data elements have a tiered structure of code values. In such cases the specifications show the tiered structure by indenting the optional, more specific code values.

States can submit additional explanatory information on each item.

TABLE E.8. Investigations
Element Category/No.	Element Name	Element Description/Values	Required	Instructions
Investigations Completed
K1	Investigations completed	Number of investigations completed during the reporting period.	Yes	Investigation could have been received in previous reporting period, but must have been closed during current reporting period.
K1.1	Comment	Provide additional information on the number of investigations completed during the reporting period.	No

TABLE E.9. Clients
Element Category/No.	Element Name	Element Description/Values	Required	Instructions
Clients Who Received Investigations				Count each client in each investigation. If a client was the subject of 2 investigations, count twice.
K2	Clients who received an investigation	Number of clients involved in an investigation that was completed during the reporting period.	Yes
K2.1	Comment	Provide additional information on how number of clients was determined.	No
Clients Who Received Interagency Coordination				Count each client once for each investigation in which he/she received 1 or more interagency coordination activities.
K3	Clients who received interagency coordination	Number of clients in which an interagency coordination was part of the investigation.	No
K3.1	Comment	Provide additional information on how number of clients who received interagency coordination was determined.	No
Clients by Case Closure Reason				This includes the number of clients by case closure reason whose case was closed for a specific reason.A client is counted for each case closure. There can only be 1 primary case closure reason per client per case.
K4.1		Investigation completed.	No
K4.2		Investigation completed and protective services case completed.	No
K4.3		Investigation unable to be completed (non-specific).	No
K4.3.1		Investigation unable to be completed due to death of client during investigation.	No
K4.3.2		Investigation unable to be completed due to refusal of client.	No
K4.4		Protective services case opened but not completed (non-specific).	No
K4.4.1		Protective services case closed due to death of client.	No
K4.4.2		Protective services case closed due to client decision to not continue.	No
K4.5		Other	No
K4.6		Unknown	No
K4.7	Comment	Provide additional information on how number of clients by case closure reason was determined.	No

TABLE E.10. Victims
Element Category/No.	Element Name	Element Description/Values	Required	Instructions
Clients Found to be Victims				A victim is counted once for each investigation in which a maltreatment was substantiated, no matter how many maltreatments were substantiated.
K5	Clients found to be victims	Number of victims in which at least 1 maltreatment disposition was substantiated per investigation.	Yes
K5.1	Comment	Provide additional information on how number of victims was determined.	No
Victims by Age				The victim age is computed by subtracting the client's date of birth from the investigation start date. An estimated age can be used.The victim's age is counted once per each investigation in which the client was found to be a victim.Age could differ between investigations.
K6.1		18-29 years	No
K6.2		30-39 years	No
K6.3		40-49 years	No
K6.4		50-59 years	No
K6.5		60-69 years	No
K6.6		70-74 years	No
K6.7		75-84 years	No
K6.8		85 and older	No
K6.9		Unknown	No
K6.10	Comment	Provide additional information on how age was computed.	No
Victims by Race				This includes the number of victims by race with victims of multiple races counting as multiracial.
K7.1		American Indian or Alaska Native	No
K7.2		Asian	No
K7.3		Black or African American	No
K7.4		Native Hawaiian or Other Pacific Islander	No
K7.5		White	No
K7.6		Unknown	No
K7.7	Comment	Provide additional information on how number of victims by race was determined.	No
Victims by Ethnicity				Count each victim once per investigation.
K8.1		Hispanic, Latino/a, or Spanish	No
K8.2		Not Hispanic, Latino/a, or Spanish	No
K8.3		Unknown	No
K8.4	Comment	Provide additional information on how number of victims by ethnicity was determined.	No
Victims by Gender Identity				Count each victim once per investigation.
K9.1		Male	No
K9.2		Female	No
K9.3		Transgender	No
K9.4		Unknown	No
K9.5	Comment	Provide additional information on how number of victims by gender was determined.	No
Victims Receiving Benefits				A victim is counted once per investigation in which he/she received 1 or more benefits.
K10	Victims who received 1 or more benefits	Number of victims who received 1 or more benefits.	No
K10.1	Comment	Provide additional information on how number of victims by receipt of benefits was determined.	No
Victims with Disabilities				A victim is counted once per investigation in which he/she was identified as having 1 or more disabilities.
K11	Victims with 1 or more disabilities	Number of victims with 1 or more disabilities.	No
K11.1	Comment	Provide additional information on how number of victims with 1 or more disabilities was determined.	No
Victims with Behavioral Conditions				A victim is counted once per investigation in which he/she was screened as having 1 or more behavioral conditions.
K12	Victims with 1 or more screened or diagnosed behavioral conditions	Number of victims with 1 or more screened or diagnosed behavioral conditions.	No
K12.1	Comment	Provide additional information on how number of victims with a behavioral condition was determined.	No
Victims by Maltreatment Type				A victim is counted each time he/she was substantiated as a victim of a specific maltreatment type.If a person was found to be a victim of neglect in 2 investigations, the count for neglect would be 2 for that victim.
K13.1		Abandonment	No
K13.2		Emotional abuse	No
K13.3		Exploitation (non-specific)	No
K13.3.1		Financial exploitation	No
K13.3.2		Other exploitation	No
K13.4		Neglect	No
K13.5		Physical abuse	No
K13.6		Sexual abuse	No
K13.7		Suspicious death	No
K13.8		Self-neglect	No
K13.9		Other	No
K13.10		Unknown	No
K13.11	Comment	Provide additional information on how number of victims by maltreatment type was determined.	No
Victims with Guardian or Conservator				A victim is counted once per investigation in which he/she was screened as having 1 or more guardians or conservators.
K14	Victims with guardian or conservator at start of investigation	Number of victims with guardian or conservator at start of investigation.	No
K14.1	Comment	Provide additional information on how number of victims by 1 or more guardians or conservators was determined.	No
Victims Who Received or were Referred for Services				A victim is counted once per investigation in which he/she received or was referred for 1 or more services. If a client received multiple services and also was referred for multiple services in 1 investigation, he/she is counted only once.
K15	Victims who received services or were referred for services by APS	Number of victims who received services or were referred for services by APS.	No
K15.1	Comment	Provide additional information on how number of victims by services was determined.	No

TABLE E.11. Perpetrators
Element Category/No.	Element Name	Element Description/Values	Required	Instructions
Perpetrators by Age				The perpetrator age is computed by subtracting the person's date of birth from the investigation start date. An estimated age can be used.Count each perpetrator once per client per investigation.If a person was the perpetrator of 2 clients in 1 investigation, the person is counted twice.
K16.1		18-29 years	No
K16.2		30-39 years	No
K16.3		40-49 years	No
K16.4		50-59 years	No
K16.5		60-69 years	No
K16.6		70-74 years	No
K16.7		75-84 years	No
K16.8		85 and older	No
K16.9		Unknown	No
K16.10	Comment	Provide additional information on how number of perpetrators by age was determined.	No
Perpetrators by Gender Identity
K17.1		Male	No
K17.2		Female	No
K17.3		Transgender	No
K17.4		Unknown	No
K17.5	Comment	Provide additional information on how number of perpetrators by gender was determined.	No
Perpetrators with Kinship Relationship				Count each perpetrator once per client per investigation.If a person was the perpetrator of 2 clients in 1 investigation and is related to 1 victim and not the second, the perpetrator is counted only once.
K18	Perpetrators who had a kinship relationship to the victim	Number of perpetrators related to the victim by affinity (blood, adoption, marriage, etc.).	No
K18.1	Comment	Provide additional information on how number of perpetrators by kinship relationship was determined.	No
Perpetrators with Association to Victim				Count each perpetrator once per client per investigation.If a person was the perpetrator of 2 clients in 1 investigation and has 1 or more caregiving relationships to 1 victim and not the second, the perpetrator is counted only once.
K19	Perpetrators who had 1 or more associations to victim	Number of perpetrators with 1 or more caregiving relationships to the victim.	No
K19.1	Comment	Provide additional information on how number of perpetrators by association to the victim was determined.	No
Perpetrators with Legal Remedies				Count each perpetrator once per client per investigation.If a person was the perpetrator of 2 clients in 1 investigation and had 1 or more legal remedies sought related to 1 victim and none with the second, the perpetrator is counted only once.
K20	Perpetrators for whom 1 or more legal remedies on behalf of the victim were recommended or sought	Number of perpetrators for whom at least 1 legal remedy was recommended or sought.	No
K20.1	Comment	Provide additional information on how number of perpetrators by legal remedy was determined.	No

E.4. Proposed Code Values and Definitions

The NAMRS Code Values and Definitions serve as a reference to the Agency Component Data Specifications, Case Component Data Specifications, and Key Indicators Data Specifications. It provides definitions of code values found in each data component.

TABLE E.12. Definitions of Code Values
Element	Code	Value	Value Definition
Report Source
	1	Substitute decision maker	Includes health care proxy, financial proxy, guardian or conservator of person or property, representative payee.
	2	In-home caregiver	Individuals who have the responsibility for the care of the client, providing in-home monitoring, management, supervision, etc.
	3	Nursing home staff	Employees of a nursing home or skilled nursing home, which provide services for residents who require medical or nursing care, or rehabilitative services.
	4	Residential care community staff	Employees of a residential care community including those providing room and board of at least 2 meals per day and help with personal care. These places include residential communities identified as assisted living residences, board and care homes, congregate care, enriched housing programs, personal care homes, homes serving primarily persons with disabilities, and homes serving primarily older adults.
	5	Education professional	Employees of a public or private educational institution or program; includes teachers, teacher assistants, administrators, and others directly associated with the delivery of educational services.
	6	Financial professional	Professionals managing finances or planning for future financial needs. Includes bank officials, financial planners, etc.
	7	Law enforcement, judicial, or legal professional	People employed by a local, state, tribal, or federal justice agency. This includes police, courts, district attorney's office, probation or other community corrections agency, and correctional facilities.
	8	Medical or health professional	People employed by a medical facility or practice. This includes physicians, physician assistants, nurses, emergency medical technicians, dentists, chiropractors, coroners, and dental assistants and technicians.
	9	Mental and behavioral health professional	Persons who offer services for the purpose of improving an individual's mental health or to treat mental illness. Includes psychiatric nurses, clinical psychologists, etc.
	10	Social services professional	Employees of public or private social services or social welfare agency, or other social worker or counselor who provides similar services including rehabilitative services.
	11	Other professional	Persons who encountered the client as part of their occupation. Includes landlords, housing authorities, clergy, etc.
	12	Relative	Persons related by blood, marriage, or adoption. Includes spouse, domestic partner, parent, foster parent, child, in-laws, etc.
	13	Neighbor, friend, other non-relative, other non-professional	Other individual who is not a professional or person related to client by blood, marriage, or adoption. Includes friends, neighbors, etc.
	14	Self	Person allegedly being maltreated.
	15	No role identified	An individual who notifies an APS agency of suspected maltreatment without identifying his or her role.
Maltreatment Setting
	10	Own residence or private residence of relative or caregiver	Client's home or the client's relative or caregiver's home. Includes a house, apartment, mobile home or trailer, group of rooms, etc.
	20	Residential care community (non-specific)	Provides room and board of at least 2 meals per day and help with personal care. Includes residential communities identified as assisted living facilities, board and care homes, congregate care, enriched housing programs, personal care homes, homes serving primarily persons with disabilities, and homes serving primarily older adults.
	21	Licensed residential care community	Licensed, registered, listed, certified, or otherwise regulated by the state.
	22	Unlicensed residential care community	Not licensed, registered, listed, certified, or otherwise regulated by the state.
	30	Nursing home (non-specific)	Nursing home or skilled nursing home that provides services for residents who require medical or nursing care, or rehabilitative services.
	31	Licensed nursing home	Licensed, registered, listed, certified, or otherwise regulated by the state.
	32	Unlicensed nursing home	Not licensed, registered, listed, certified, or otherwise regulated by the state.
	40	Adult day services center (non-specific)	Includes adult day care, adult day health services centers. Day care services for adults are those services or activities provided to adults who require care and supervision in a protective setting for a portion of a 24-hour day.
	41	Licensed adult day services center	Licensed, registered, listed, certified, or otherwise regulated by the state.
	42	Unlicensed adult day services center	Not licensed, registered, listed, certified, or otherwise regulated by the state.
	50	Place of business or other services	Includes place of employment, sheltered workshops, hospitals, schools, banks, other offices, shelters, places of worship, etc.
	60	Other	A setting not included in categorizations provided, including recreational areas and other public spaces.
Case Closure Reason
	10	Investigation completed	The case was closed after a finding was made on the allegation of maltreatment, the investigation was closed, and no ongoing protective services case was opened.
	20	Investigation completed and protective services case completed	The case was closed after the investigation was completed, additional protective services were provided, and the protective services case was closed.
	30	Investigation unable to be completed (non-specific)	A finding was not able to be made on the allegations of maltreatment for an unspecified reason and the case was closed.
	31	Investigation unable to be completed due to death of client during investigation	The client died during the investigation, the investigation was terminated without a finding, and the case was closed.
	32	Investigation unable to be completed due to refusal of client	The client refused to co-operate with the investigation worker, the investigation was terminated without a finding, and the case was closed.
	40	Protective services case opened but not completed (non-specific)	The protective services case was terminated prematurely; reason not specified.
	41	Protective services case closed due to death of client	The client died during the case and the case was closed.
	42	Protective services case closed due to client decision to not continue	The client decided not to continue work with the protective services agency, and the case was closed.
	50	Other	Case was closed for a reason not included in the categorizations provided.
Gender Identity
	1	Male	Male gender assigned at birth matches one's gender identity of male.
	2	Female	Female gender assigned at birth matches one's gender identity of female.
	3	Transgender	Gender identity, gender expression, and biological sex do not all align (e.g., man, masculine, and male).
Sexual Orientation
	1	Straight	Sexual or romantic attractions and behaviors focus exclusively or mainly on members of the other sex.
	2	Gay/lesbian	Sexual or romantic attractions and behaviors focus exclusively or mainly on members of the same sex.
	3	Bisexual	Sexual or romantic attractions and behaviors are directed at members of both sexes to a significant degree.
	4	Questioning	Exploring one's own sexual orientation, investigating influences that may come from family, religious upbringing, and internal motivations.
	5	Other	A sexual orientation not included in the categorizations provided.
Race
	10	American Indian or Alaska Native	Having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
	20	Asian (non-specific)	Having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
	21	Asian Indian	Having origins of Asian Indian.
	22	Chinese	Having origins of Chinese.
	23	Filipino	Having origins of Filipino.
	24	Japanese	Having origins of Japanese.
	25	Korean	Having origins of Korean.
	26	Vietnamese	Having origins of Vietnamese.
	27	Other Asian	Having Asian origins other than those listed.
	30	Black or African American	Having origins in any of the Black racial groups of Africa.
	40	Native Hawaiian or Other Pacific Islander (non-specific)	Having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
	41	Native Hawaiian	Having origins of Native Hawaiian.
	42	Guamanian or Chamorro	Having origins of Guamanian or Chamorro.
	43	Samoan	Having origins of Samoan.
	44	Other Pacific Islander	Having Pacific Islander origins other than those listed.
	50	White	Having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Ethnicity
	10	Yes, Hispanic or Latino/a, or Spanish origin (non-specific)	Of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
	11	Mexican, Mexican American, Chicano/a	Having origins of Mexican, Mexican American, Chicano/a, regardless of race.
	12	Puerto Rican	Having origins of Puerto Rican, regardless of race.
	13	Cuban	Having origins of Cuban, regardless of race.
	14	Other Hispanic, Latino/a, or Spanish origin	Having Hispanic, Latino/a, or Spanish origins other than those listed, regardless of race.
	20	No, not Hispanic or Latino/a, or Spanish origin	Not of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Primary language
	1	Arabic	Primary language is Arabic.
	2	Chinese	Primary language is Chinese.
	3	English	Primary language is English.
	4	French	Primary language is French.
	5	German	Primary language is German.
	6	Korean	Primary language is Korean.
	7	Russian	Primary language is Russian.
	8	Spanish or Spanish Creole	Primary language is Spanish or Spanish Creole.
	9	Tagalog	Primary language is Tagalog.
	10	Vietnamese	Primary language is Vietnamese.
	11	Sign language	Primary language is sign language.
	12	Assistive technology	Assistive, adaptive, and rehabilitative devices for people with disabilities.
	13	Other	A language not included in the categorizations provided.
Marital status
	1	Never married	Refers to persons who report themselves as never married.
	2	Married	Refers to persons who are currently legally married.
	3	Domestic partner, including civil union	In a committed relationship with another adult, including both same sex and opposite-sex relationships.
	4	Divorced	Refers to those whose marriages were legally dissolved.
	5	Separated	A termination of cohabitation of spouses either by mutual agreement or, in the case of judicial separation, under the decree of a court.
	6	Widowed	Refers to those whose marriages were terminated through death of their spouse and have not remarried.
	7	Other	A marital status not included in the categorizations provided.
Schooling Level
	1	Less than high school	Did not receive a high school diploma or equivalent, such as GED.
	2	High school diploma or equivalent	Received high school diploma or equivalent, such as GED.
	3	Associate's degree or Bachelor's degree	Associate's degree: granted after a 2-year course of study, especially by a community or junior college. Bachelor's degree: earned for an undergraduate course of study that nominally requires 3-5 years of study, depending on institution and field of study.
	4	Advanced degree	A post-graduate degree, such as a Master's degree or a Doctorate.
Employment Status
	1	Employed	Persons who are working or temporarily not working due to illness or other reasons.
	2	Unemployed	Persons who are not employed and actively looking for work and available to start a job.
	3	Not in labor force	Students, homemakers, retired workers, seasonal workers not looking for work, persons residing in institutions, persons doing only incidental unpaid family work.
	4	Other	Employment status not included in the categorizations provided. Includes sheltered workshop participants.
Benefits
	1	Medicaid	The U.S. Medicaid program provides health coverage to persons including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
	2	Medicare	The U.S. Medicare program is a health insurance program for people age 65 and older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
	3	Publicly-subsidized housing	Government sponsored economic assistance aimed toward alleviating housing costs and expenses for people in need with low to moderate incomes. Includes direct housing subsidies, non-profit housing, rent supplements, and some forms of co-operative and private sector housing.
	4	SSDI	SSDI provides benefits to disabled or blind persons who are "insured" by workers' contributions to the Social Security trust fund.
	5	Social Security retirement benefits	Benefits received by retired workers who have paid into the Social Security system during their working years. Paid out on a monthly basis to retired workers and their surviving spouses.
	6	SSI	SSI makes cash assistance payments to aged, blind, and disabled persons (including children) who have limited income and resources.
	7	TANF	Temporary financial assistance through TANF program, which helps pregnant women and families with 1 or more dependent children pay for food, shelter, utilities, and expenses other than medical.
	8	Veterans' disabled benefits	Disability compensation paid to Veterans because of injuries or diseases that were incurred in or aggravated during active duty, active duty training, or inactive duty training.
	9	Other	Public benefit other than those specified in the categorizations provided.
Veteran Status
	1	Veteran	Person who has served in the U.S. Armed Forces or is otherwise classified as a Veteran by the U.S. Department of Veteran Affairs.
	2	Non-Veteran	Person who has not served in the U.S. Armed Forces or is otherwise not classified as a Veteran by the U.S. Department of Veteran Affairs.
Disabilities
	1	Ambulatory difficulty	Having serious difficulty walking or climbing stairs.
	2	Cognitive difficulty	Because of a physical, mental, or emotional problem, having difficulty remembering, concentrating, or making decisions.
	3	Communication difficulty	Because of a physical, mental, or emotional problem, having difficulty with speech or language.
	4	Hearing difficulty	Deaf or having serious difficulty hearing.
	5	Independent living difficulty	Because of a physical, mental, or emotional problem, having difficulty doing errands alone such as visiting a doctor's office or shopping.
	6	Self-care difficulty	Having difficulty bathing or dressing.
	7	Vision difficulty	Blind or having serious difficulty seeing, even when wearing glasses.
	8	Other	Disabilities other than those specified in the categorizations provided.
	9	None	Assessed, but no disability determined.
ADL score
	N	Total score	Indicates the client's total score on the Katz Index of Independence in ADLs. Permissible values are 0-6.
IADL score
	N	Total score	Indicates the client's total score on the Lawton IADLs. Permissible values are 0-8.
Behavioral Health Screenings or Diagnoses
	1	Alcohol use disorder	The consumption of alcohol that impacts the ability to conduct daily activities including quantity and frequency of alcohol consumption as well as feelings of not being able to stop drinking, of remorse about drinking, not being able to remember due to drinking, needing a drink early in the day, etc. Screening tools, such as AUDIT or others, may be used. Diagnosis depends upon clinical training.
	2	Anxiety	An affective disorder that makes it difficult to conduct daily activities including feelings of nervousness, not being able to stop or control worrying, worrying too much about different things, being restless so it is hard to sit still, becoming easily annoyed or irritable and feeling afraid. Screening tools, such as the GAD-7 or others, may be used. Diagnosis depends upon clinical training.
	3	Bipolar disorder	A mood disorder characterized by alternating moods of mania and depression which can last for long periods of time and which may impact the ability to plan, schedule, and complete daily activities. Screening tools, such as the Mood Disorder Questionnaire or others, may be used. Diagnosis depends upon clinical training.
	4	Dementia	The progressive decline of cognitive ability which impacts daily activities. Alzheimer's is 1 type of dementia. Dementia may be associated with memory loss, difficulty performing familiar tasks, problems with language, disorientation to time and place, poor or decreased judgment, problems with abstract thinking, loss of initiative and changes in personality, mood, or behavior. Screening tools, such as the Alzheimer's Association Ten Warning Signs or others, may be used. Diagnosis depends upon clinical training.
	5	Depression	A loss of interest in daily activities including feelings of hopelessness, little energy, poor appetite or overeating, feeling bad about oneself, trouble concentrating and thoughts of suicide. Screening tools, such as the PHQ-9 or others, may be used. Diagnosis depends upon clinical training.
	6	Schizophrenia and other psychotic disorders	An affective disorder characterized by having delusions and hallucinations that may impact daily activities by causing difficulties in interacting with others. Screening tools, such as STEP1 or others, may be used. Diagnosis depends upon clinical training.
	7	Substance use disorder	The use of drugs, including over the counter drugs, prescriptions drugs, cannabis (marijuana, hashish), solvents, tranquilizers, barbiturates, cocaine, stimulants, hallucinogens or narcotics that impact the ability to conduct daily activities including the quantity and frequency of use of such drugs, and feelings of being unable to stop when wanting to, of guilt or being neglectful, of withdrawal symptoms or having blackouts or flashbacks due to drug usage. Screening tools, such as DAST 10 or others, may be used. Diagnosis depends upon clinical training.
	8	Traumatic brain injury	The result of a violent blow or injury to the head. Physical damage to the brain may result in long-term complications that impact daily activities due to difficulties in sleeping, dizziness, vision, memory concentration, and mood changes. Screening tool is usually the result of self-reporting of the injury or symptoms. Diagnosis depends upon clinical training.
	9	Other	Behavioral conditions not included in the value list of behavioral health that are due to brain damage, disease or unknown causes which impact the ability to conduct daily activities. Examples include amnesia, delirium, behavioral syndromes such as eating disorders, sleep disorders, and other personality disorders. Screening may use a range of tools. Diagnosis depends upon clinical training.
	10	None	No behavioral health conditions have been determined.
Living Setting
	10	Own residence or residence of relative or caregiver	Client's home or the client's relative or caregiver's home. Includes a house, apartment, mobile home or trailer, group of rooms, etc.
	20	Residential care community (non-specific)	Provides room and board of at least 2 meals per day and help with personal care. Includes residential communities identified as assisted living residences, board and care homes, congregate care, enriched housing programs, personal care homes, homes serving primarily persons with disabilities, and homes serving primarily older adults.
	21	Licensed residential care community	Licensed, registered, listed, certified, or otherwise regulated by the state.
	22	Non-licensed residential care community	Not licensed, registered, listed, certified, or otherwise regulated by the state.
	30	Nursing home (non-specific)	Nursing home or skilled nursing home that provides services for residents who require medical or nursing care, or rehabilitative services.
	31	Licensed nursing home	Licensed, registered, listed, certified, or otherwise regulated by the state.
	32	Non-licensed nursing home	Not licensed, registered, listed, certified, or otherwise regulated by the state.
	40	Other	A setting not included in categorizations provided, including shelters, correctional facilities, or no fixed residence.
Substitute Decision Makers
	10	Health care proxy in effect	The appointment of a person to communicate the clients' wishes as to medical treatment in terminal illness or injury situations and to communicate for them in the event they cannot communicate for themselves. A document also known as a durable power of attorney for health care, medical power of attorney, or appointment of a health care agent, allows an individual to appoint another person (a proxy or agent) to express the individual's wishes and make health care decisions for the individual if he or she cannot speak for him or herself. Depending on the state, these documents are known as living wills, medical directives, health care proxies, or advance health care directives.
	20	Financial proxy in effect	Authorization, by a written document, that 1 individual may act in another's place as agent or attorney-in-fact with respect to some or all legal and financial matters. The scope of authority granted is specified in the document and may be limited by state statute. A power of attorney terminates on the death of the person granting the power (unless "coupled with an interest") and may terminate on the subsequent disability of the person granting the power (unless the power is "durable" under the instrument or state law).
	30	Guardianship or conservatorship (non-specific)	A relationship created by state law in which a court determines that an adult individual lacks capacity to make decisions about self-care or property, and appoints another individual or entity as a conservator, or by a similar term, as a surrogate decision maker. It becomes the duty and power of that individual to make personal and/or property decisions for another.
	31	Guardianship or conservatorship of person	If the individual has a critical need for someone to act on their behalf due to mental or physical disability.
	32	Guardianship or conservatorship of property	(Or Estate): if the person is incapable of managing his or her own financial affairs.
	40	Representative payee	An individual or organization appointed by SSA to receive Social Security and/or SSI benefits for someone who cannot manage or direct someone else to manage his or her money. The main responsibilities of a payee are to use the benefits to pay for the current and foreseeable needs of the beneficiary and properly save any benefits not needed to meet current needs. A payee must also keep records of expenses. When SSA requests a report, a payee must provide an accounting to SSA of how benefits were used or saved.
	50	None	Perpetrator has no authorizations in relation to the client.
Services
	1	Care/case management services	Development and implementation of a service plan to mobilize the formal and informal resources and services identified in the assessment to meet the needs of the client. Includes the development and oversight of a plan to ensure the safety and well-being of the client; developing a safety plan with a person's support network; referring and arranging support services, etc.
	2	Caregiver support services	Assistance to family and other informal caregivers to improve or sustain capacity for caring for the older adult or adult with disabilities. Includes counseling, support groups, training, respite, etc.
	3	Community day services	Services or activities provided to adults who require care and supervision in a protective setting for a portion of a 24-hour day. Includes out of home supervision, health care, recreation, and/or independent living skills training offered in centers most commonly known as Adult Day, Adult Day Health, Senior Centers, and Disability Day Programs.
	4	Education, employment, and training services	Services and activities to assist people in achieving or maintaining economic self-support. Includes training programs, job coaches, supported employment, senior employment programs, and public school individualized education plans.
	5	Emergency assistance and material aid services	Providing, arranging for, or facilitating the provision of medical, social service, economic, emergency, or support services. Includes financial assistance or referral for food, clothing, energy/utility assistance, and home repairs/modifications; environmental clean-up of client's home including but not limited to removal of trash, extermination services and cleaning; relocation assistance; urgent medical expenses not typically covered by insurance (eye glasses, dentures); emergency housing/shelter; etc.
	6	Financial planning services	Services or activities to assist in managing finances or planning for future financial needs. Includes meeting with bank officials, financial planning, estate planning, money management, and retirement income planning.
	7	Housing and relocation services	Services or activities designed to assist in the obtaining of suitable or safe housing and living arrangements. Includes tenant counseling; helping to identify and correct substandard housing conditions; making moving arrangements and minor renovations to personal residence; and relocating to institutional care or facility care.
	8	In-home assistance services	Services or activities provided to clients to achieve or maintain self-sufficiency. Includes homemakers and home health aides; visiting and telephone reassurance; chore maintenance; personal care services, etc.
	9	Legal services	Legal counsel and representation provided by an attorney to address civil matters such as housing issues and advance care planning, and criminal matters.
	10	Medical and dental services	Services and activities designed to assist individuals and families to attain and maintain a favorable condition of health; includes evaluations.
	11	Medical rehabilitation services	Services and activities for persons with developmental or physical disabilities, or persons with visual or auditory impairments, are services or activities to maximize the potential of persons with disabilities, help alleviate the effects of physical, mental or emotional disabilities, and to enable these persons to live in the least restrictive environment possible. Includes training in mobility, communication skills, the use of special aids and appliances, self-sufficiency skills for people with disabilities, occupational therapy, physical therapy, speech and language pathology, early intervention and other therapies that help people learn the skills they need to live, learn, work and play in their communities.
	12	Mental health services	Services and activities, including commitment, assessment, and evaluations, for people with behavioral health conditions characterized by dysregulation of mood, thought, and/or behavior, as recognized by the DSM-5. Includes services and activities that apply therapeutic processes to personal, family, situational, or occupational problems in order to bring about a positive resolution of the problem or improved individual or family functioning or circumstances.
	13	Nutrition	Services and activities, including appeals and applications, to provide food to a client lacking recommended daily nutritional requirements and/or ADLs limitations. Includes home delivered meals, nutritional counseling, congregate meals, senior farmers' market program, etc.
	14	Public assistance benefits	Services and assistance to provide a safety net for disadvantaged individuals who lack the resources to provide basic necessities for themselves and their families. Includes such programs as financial aid (TANF), nutrition (SNAP), energy assistance (LIHEAP), health care (Medicaid), etc.
	15	Substance use services	Services and activities primarily designed to deter, reduce, or eliminate substance abuse or chemical dependence. Includes a comprehensive range of personal and family counseling methods, methadone treatment for opiate abusers, or detoxification treatment for alcohol abusers. Services and activities may be provided in alternative living arrangements such as institutional settings and community-based halfway houses.
	16	Transportation	Services or activities that provide or arrange for the travel, including travel costs, of individuals in order to access services, or obtain medical care or employment.
	17	Victim services	Services and activities provided to, or on behalf of, victims at any stage of the criminal justice process, including post sentencing services and support. Includes programs supporting victims of domestic violence, sexual assault, abuse of older women, violence against women, and general crimes which are being handled by the police or prosecutors' offices.
	18	Other services	Client receives services and activities not included in the categorizations provided.
	19	None	Client receives or was referred to no services.
Interagency Coordination
	1	Law enforcement or prosecutorial offices	Agencies responsible for enforcing laws and maintaining public order and safety, including government units staffed by police, sheriffs, district attorneys, etc.
	2	Protection and Advocacy or CAP	Agencies under the Protection and Advocacy for Persons with Mental Illness Act that have the authority to provide legal representation and other advocacy services, under all federal and state laws, to all people with disabilities, along with those agencies that provide information and assistance to individuals seeking or receiving vocational rehabilitation services under the Rehabilitation Act.
	3	State licensing agency	Government units responsible for the licensing of facilities and agencies serving older adults and adults with disabilities.
	4	State MFCU	State agencies that investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities.
	5	Long-Term Care Ombudsman Program	State program that addresses complaints and advocates for people in the long-term care system.
	6	Other	Client was referred to a type of agency not included in the categorizations provided.
	7	None	The client was not referred to any other agencies.
Maltreatment Type
	10	Abandonment	The desertion of a person by an individual who has assumed responsibility for providing care for that person, or by an individual with physical custody of another person.
	20	Emotional abuse	The infliction of anguish, pain, or distress through verbal or non-verbal acts. This includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment.
	30	Exploitation (non-specific)	The illegal or improper use of an individual or of an individual's funds, property, or assets for another's profit or advantage.
	31	Financial exploitation	The illegal or improper use of an individual's funds, property, or assets for another person's profit or advantage.
	32	Other exploitation	The illegal or improper use of an individual for another person's profit or advantage, including exploitation of person, servitude, etc.
	40	Neglect	The failure of a caregiver or fiduciary to provide the goods or services necessary to maintain the health or safety of a person. Includes acts of omission and of commission; includes willful deprivation, etc.
	50	Physical abuse	The use of force or violence resulting in bodily injury, physical pain, or impairment. Excludes sexual abuse.
	60	Sexual abuse	Non-consensual sexual contact of any kind, including sexual contact with any person incapable of giving consent.
	70	Suspicious death	An unexpected fatality or 1 in which circumstances or cause are medically or legally unexplained.
	80	Self-neglect	A person's inability, due to physical or mental impairment or diminished capacity, to perform essential self-care tasks including obtaining essential food, clothing, shelter, and medical care; obtaining goods and services necessary to maintain physical health, mental health, or general safety; or managing one's own financial affairs. Includes hoarding.
	90	Other	A type of maltreatment not included in the categorizations provided.
Maltreatment Disposition
	1	Substantiated	The finding that the allegation of maltreatment is supported under state law and policy.
	2	Inconclusive	The finding that there is insufficient information to either support or not support the allegation of maltreatment, but there is a reason to suspect maltreatment.
	3	Unsubstantiated	The finding that the allegation of maltreatment is not supported under state law and policy.
	4	Other	Disposition not included in categorizations provided. Includes inappropriate allegations that were investigated.
Kinship Relationship
	10	Yes (non-specific)	Kinship relationship exists.
	11	Spouse	Partner in a marriage.
	12	Domestic partner, including civil union	Adults in a committed relationship with another adult, including both same sex and opposite-sex relationships.
	13	Parent	The birth mother or father, adoptive mother or father, or step-mother or step-father of the client.
	14	Child	Biological son or daughter, adoptive son or daughter, or step-son or step-daughter.
	15	Sibling	Children or offspring have 1 or both parents in common; a brother or sister (by blood, adoption, marriage).
	16	Grandparent	Parent of one's father or mother; a grandmother or grandfather (by blood, adoption, marriage).
	17	Grandchild	A child of one's son or daughter (by blood, adoption, marriage).
	18	Other relative	Another family member, including in-laws and kinship foster parents.
	20	None	No kinship relationship, includes non-kinship foster parents.
Perpetrator Association
	10	Nursing home staff	An employee of a nursing home, including a skilled nursing home. Nursing homes primarily provide skilled nursing, rehabilitation, and long-term care.
	20	Residential care community staff	An employee of a residential care community including those providing room and board of at least 2 meals per day and help with personal care. These places include residential communities identified as assisted living residences, board and care homes, congregate care, enriched housing programs, personal care homes, homes serving primarily persons with disabilities, and homes serving primarily older adults.
	30	Relative caregiver (non-specific)	An individual related to the client by blood, adoption, marriage, etc. who has the responsibility for the care of the client, providing in-home monitoring, management, supervision, etc.
	31	Paid relative caregiver	An individual related to the client by blood, adoption, marriage, etc. who has the responsibility for the care of the client, and receives payment for providing in-home monitoring, management, supervision, etc.
	32	Unpaid relative caregiver	An individual related to the client by blood, adoption, marriage, etc. who has the responsibility for the care of the client, and does not receive payment for providing in-home monitoring, management, supervision, etc.
	40	Non-relative caregiver (non-specific)	An individual not related to the client by blood, adoption, marriage, etc. who has the responsibility for the care of the client, providing in-home monitoring, management, supervision, etc.
	41	Paid non-relative caregiver	An individual not related to the client by blood, adoption, marriage, etc. who has the responsibility for the care of the client, and receives payment for providing in-home monitoring, management, supervision, etc.
	42	Unpaid non-relative caregiver	An individual not related to the client by blood, adoption, marriage, etc. who has the responsibility for the care of the client, and does not receive payment for providing in-home monitoring, management, supervision, etc.
	50	Other relationship	Another trusted person providing care, not included in the categorizations provided.
	60	None	The perpetrator has no caregiving association to the client.
Substitute Decision Makers
	10	Health care proxy in effect	The appointment of a person to communicate the clients' wishes as to medical treatment in terminal illness or injury situations and to communicate for them in the event they cannot communicate for themselves. A document also known as a durable power of attorney for health care, medical power of attorney, or appointment of a health care agent, allows an individual to appoint another person (a proxy or agent) to express the individual's wishes and make health care decisions for the individual if he or she cannot speak for him or herself. Depending on the state, these documents are known as living wills, medical directives, health care proxies, or advance health care directives.
	20	Financial proxy in effect	Authorization, by a written document, that 1 individual may act in another's place as agent or attorney-in-fact with respect to some or all legal and financial matters. The scope of authority granted is specified in the document and may be limited by state statute. A power of attorney terminates on the death of the person granting the power (unless "coupled with an interest") and may terminate on the subsequent disability of the person granting the power (unless the power is "durable" under the instrument or state law).
	30	Guardianship or conservatorship (non-specific)	A relationship created by state law in which a court determines that an adult individual lacks capacity to make decisions about self-care or property, and appoints another individual or entity as a conservator, or by a similar term, as a surrogate decision maker. It becomes the duty and power of that individual to make personal and/or property decisions for another.
	31	Guardianship or conservatorship of person	If the individual has a critical need for someone to act on their behalf due to mental or physical disability.
	32	Guardianship or conservatorship of property	(Or Estate): if the person is incapable of managing his or her own financial affairs.
	40	Representative payee	An individual or organization appointed by SSA to receive Social Security and/or SSI benefits for someone who cannot manage or direct someone else to manage his or her money. The main responsibilities of a payee are to use the benefits to pay for the current and foreseeable needs of the beneficiary and properly save any benefits not needed to meet current needs. A payee must also keep records of expenses. When SSA requests a report, a payee must provide an accounting to SSA of how benefits were used or saved.
	50	None	The perpetrator has no authorization in relation to the client.
Legal Remedies
	1	Recommendation of removal of guardianship rights	The termination of a relationship, created by state law and determined by a court, in which an individual or entity acts as a conservator, or by a similar term, as a surrogate decision maker for another person who lacks capacity to make decisions about self-care or property. The individual no longer has duty and power to make personal and/or property decisions for the other.
	2	Recommendation of restraining order on perpetrator regarding the client	A court order issued to prohibit an individual from carrying out a particular action, especially approaching or contacting a specified person.
	3	Recommendation of eviction of perpetrator	The act of expelling someone, usually a tenant, from a property.
	4	Recommendation of restitution by perpetrator	Compensation paid to client by perpetrator for the losses or injuries incurred as a result of a criminal offense.
	5	Recommendation of other legal remedy	Legal remedies not included in the categorizations provided.
	6	None	No legal remedies were sought on behalf of the client.

Appendix F. Namrs Pilot Validation Criteria

F.1. Agency Component Validation

Data Type Validation

The following fields (or groups of fields) must be numeric:

• FTE counts
• Report counts
• Completion of an investigation

Data Length Validation

All the Comments fields are validated to have a length of 5,000 characters or less.

Required Fields Validation

The following fields are required:

• Agency name 1
• Physical address--street 1, city, state, ZIP
• Mailing address--street 1, city, state, ZIP
• Contact--name, title, email address, phone

F.2. Case Component Data Rule Validation

N1010--A client must have at least one maltreatment.
Path:	caseComponent/investigation/clients/client
Locators:	investigationId, clientId
Action:	This <client> element was removed. If there was a linked <relationship> element (relationship with perpetrator), it was removed as well.

N1020--If a maltreatment refers to a perpetrator, the maltreatment must be substantiated.
Path:	caseComponent/investigation/maltreatments/maltreatment/perpetratorRefs
Locators:	investigationId, clientId, maltxTypeVal
Action:	This <perpetratorRefs> element was removed from the <maltreatment> element.

N1040--If the report date and investigation start date are both not empty, then the report date must be less than or equal to the investigation start date.
Path:	caseComponent/investigation
Locators:	investigationId
Action:	This <reportDate> element was removed.

N1050--If the report date and investigation disposition date are both not empty, then the report date must be less than or equal to the investigation disposition date.
Path:	caseComponent/investigation
Locators:	investigationId
Action:	This <reportDate> element was removed.

N1060--If the report date is not empty, then the report date must be less than or equal to the case closure date.
Path:	caseComponent/investigation
Locators:	investigationId
Action:	This <reportDate> element was removed.

N1070--If the investigation start date and investigation disposition date are not empty, then the investigation start date must be less than or equal to the investigation disposition date.
Path:	caseComponent/investigation
Locators:	investigationId
Action:	This <investStartDate> element was removed.

N1080--If the investigation start date is not empty, then the investigation start date must be less than or equal to the case closure date.
Path:	caseComponent/investigation
Locators:	investigationId
Action:	This <investStartDate> element was removed.

N1090--If the investigation disposition date is not empty, then the investigation disposition date must be less than or equal to the case closure date.
Path:	caseComponent/investigation
Locators:	investigationId
Action:	This <dispDate> element was removed.

N1110--The race code value of 20 must not be used in conjunction with code values 21-27. The code value of 40 must not be used in conjunction with code values 41-44.
Path:	caseComponent/investigation/clients/client/race
Locators:	investigationId, clientId
Action:	The <race> element was removed from this <client>.

N1120--The ethnicity code value of 10 must not be used in conjunction with code values 11-14. The code value of 20 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/ethnicity
Locators:	investigationId, clientId
Action:	The <ethnicity> element was removed from this <client>.

N1130--The disability code value of 8 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/disabilities
Locators:	investigationId, clientId
Action:	The <disabilities> element was removed from this <client>.

N1140--The behavior health screening code value of 10 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/behaviorHealthScrns
Locators:	investigationId, clientId
Action:	The <behaviorHealthScrns> element was removed from this <client>.

N1150--The behavior health diagnosis code value of 10 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/behaviorHealthDiags
Locators:	investigationId, clientId
Action:	The <behaviorHealthDiags> element was removed from this <client>.

N1160--The substitute decision maker code value of 30 must not be used in conjunction with code values 31 and 32. The code value of 50 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/subDecMkrsStart
Locators:	investigationId, clientId
Action:	The <subDecMkrsStart> element was removed from this <client>.

N1170--The substitute decision maker code value of 30 must not be used in conjunction with code values 31 and 32. The code value of 50 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/subDecMkrsClose
Locators:	investigationId, clientId
Action:	The <subDecMkrsClose> element was removed from this <client>.

N1180--The service code value of 19 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/servicesStart
Locators:	investigationId, clientId
Action:	The <servicesStart> element was removed from this <client>.

N1190--The service code value of 19 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/servicesAps
Locators:	investigationId, clientId
Action:	The <servicesAps> element was removed from this <client>.

N1200--The service code value of 19 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/servicesReferred
Locators:	investigationId, clientId
Action:	The <servicesReferred> element was removed from this <client>.

N1210--The service code value of 19 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/servicesClose
Locators:	investigationId, clientId
Action:	The <servicesClose> element was removed from this <client>.

N1220--The interagency code value of 7 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/clients/client/interagency
Locators:	investigationId, clientId
Action:	The <interAgency> element was removed from this <client>.

N1230--The race code value of 20 must not be used in conjunction with code values 21-27. The code value of 40 must not be used in conjunction with code values 41-44.
Path:	caseComponent/investigation/perpetrators/perpetrator/race
Locators:	investigationId, perpetratorId
Action:	The <race> element was removed from this <perpetrator>.

N1240--The ethnicity code value of 10 must not be used in conjunction with code values 11-14. The code value of 20 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/perpetrators/perpetrator/ethnicity
Locators:	investigationId, perpetratorId
Action:	The <ethnicity> element was removed from this <perpetrator>.

N1250--The disability code value of 8 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/perpetrators/perpetrator/disabilities
Locators:	investigationId, perpetratorId
Action:	The <disabilities> element was removed from this <perpetrator>.

N1260--The behavior health screening code value of 10 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/perpetrators/perpetrator/behaviorHealthScrns
Locators:	investigationId, perpetratorId
Action:	The <behaviorHealthScrns> element was removed from this <perpetrator>.

N1270--The behavior health diagnosis code value of 10 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/perpetrators/perpetrator/behaviorHealthDiags
Locators:	investigationId, perpetratorId
Action:	The <behaviorHealthDiags> element was removed from this <perpetrator>.

N1310--The substitute decision maker code value of 30 must not be used in conjunction with code values 31 and 32. The code value of 50 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/relationships/relationship/perpSubDecMkrsStart
Locators:	investigationId, clientId, perpetratorId
Action:	The <perpSubDecMkrsStart> element was removed from this <relationship>.

N1320--The substitute decision maker code value of 30 must not be used in conjunction with code values 31 and 32. The code value of 50 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/relationships/relationship/perpSubDecMkrsClose
Locators:	investigationId, clientId, perpetratorId
Action:	The <perpSubDecMkrsClose> element was removed from this <relationship>.

N1330--The legal remedy code value of 6 must not be used in conjunction with other code values.
Path:	caseComponent/investigation/relationships/relationship/perpLegalRem
Locators:	investigationId, clientId, perpetratorId
Action:	The <perpLegalRem> element was removed from this <relationship>.

N2010--A perpetrator must be related to at least one substantiated maltreatment.
Path:	caseComponent/investigation/perpetrators/perpetrator
Locators:	investigationId, perpetratorId
Action:	The <perpetrator> element was removed. If there was a linked <relationship> element (relationship with client), it was removed as well.

N2020--Each relationship must have at least one non-unknown attribute specified.
Path:	caseComponent/investigation/relationships/relationship
Locators:	investigationId, clientId, perpetratorId
Action:	The <relationship> element was removed.

N2030--An investigation must be related to at least one client.
Path:	caseComponent/investigation
Locators:	investigationId
Action:	The <investigation> element was removed.

N2040--The case closure date must be within the reporting period.
Path:	caseComponent/investigation
Locators:	investigationId
Action:	The <investigation> element was removed.

F.3. Key Indicators Component Validation

Data Type Validation

The following fields (or groups of fields) must be numeric:

• Clients who received an investigation
• Clients who received interagency coordination
• Clients by case closure reason
• Clients found to be victims
• Victims by age
• Victims by race
• Victims by ethnicity
• Victims by gender identity
• Victims who received one or more benefits
• Victims with one or more disabilities
• Victims with one or more screened behavioral conditions
• Victims by maltreatment type
• Victims with guardian or conservator at start of investigation
• Victims who received services or were referred for services by aps
• Perpetrators by age
• Perpetrators by gender identity
• Perpetrators who had a kinship relationship to the victim
• Perpetrators who had one or more associations to victim
• Perpetrators for whom one or more legal remedies on behalf of the victim were sought

Data Length Validation

All comment fields are validated to have a length of 5,000 characters or less.

Required Fields Validation

The following fields are required:

• Clients who received an investigation
• Clients found to be victims

Data Rules Validation

The following fields have data rules

• Clients who received interagency coordination <= clients who received an investigation
• Clients by case closure reason total <= clients who received an investigation
• Clients found to be victims <= clients who received an investigation
• Victims by age total <= clients found to be victims
• Victims by race total <= clients found to be victims
• Victims by ethnicity total <= clients found to be victims
• Victims by gender identity total <= clients found to be victims
• Victims who received one or more benefits total <= clients found to be victims
• Victims with one or more disabilities total <= clients found to be victims
• Victims with one or more screened behavioral conditions total <= clients found to be victims
• Victims by maltreatment type abandonment <= clients found to be victims
• Victims by maltreatment type emotional abuse <= clients found to be victims
• Victims by maltreatment type financial exploitation <= clients found to be victims
• Victims by maltreatment type neglect <= clients found to be victims
• Victims by maltreatment type physical abuse <= clients found to be victims
• Victims by maltreatment type sexual abuse <= clients found to be victims
• Victims by maltreatment type suspicious death <= clients found to be victims
• Victims by maltreatment type self-neglect <= clients found to be victims
• Victims by maltreatment type other <= clients found to be victims
• Victims by maltreatment type unknown <= clients found to be victims
• Victims by maltreatment type total >= clients found to be victims
• Victims with guardian or conservator at start of investigation <= clients found to be victims
• Victims who received services or were referred for services by APS <= clients found to be victims

Appendix G. Namrs Pilot Case Component Mapping Form

G.1. Investigation

Entity:	Investigation
Element Name:		Investigation ID					Element #:		Inv1
Type:	Alphanumeric	Size:	32	Required:	Yes	Quantifier:	Single	Last Revised:	12/17/2014
Element Description:
The unique identifier used by the state for each investigation. The identifier is assigned to a specific investigation and is only used once. The Investigation identifier is encrypted or encoded by the state for purposes of data submission.
Code Values:
Not applicable.
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Investigation
Element Name:		Report Date					Element #:		Inv2
Type:	Date	Size:	8	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The month, day, and year the agency was notified of the suspected adult maltreatment.
Code Values:
Not applicable.
Other Instructions:
This is the date that a report of suspected maltreatment was made. If an agency combines several reports into one investigation, the Report Date is the date of the earliest report. The determination of combining reports into one investigation is per each agency's policy and procedures.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Investigation
Element Name:		Report Source					Element #:		Inv3
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/11/2014
Element Description:
The role or profession of the person who made the report of the suspected adult maltreatment.
Code Values:
1 = Guardian or Conservator 2 = Community-Based Services 3 = Education 4 = Financial 5 = Law Enforcement, Judicial, or Legal 6 = Medical or Health 7 = Mental Health 8 = Residential Care Community 9 = Social Service and Rehabilitative Services 10 = Other Professional 11 = Self 12 = Family Member 13 = Non-Family Member 14 = Anonymous
Other Instructions:
If an agency combines several reports into one investigation, submit the Report Source of the earliest report.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Investigation
Element Name:		Report Source					Element #:		Inv3
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/11/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Investigation
Element Name:		State/County FIPS Code of Investigative Agency					Element #:		Inv4
Type:	Numeric	Size:	5	Required:	No	Quantifier:	Single	Last Revised:	12/17/2014
Element Description:
The FIPS for state (2 digits) and county code (3 digits) of the APS agency.
Code Values:
Code is the unique identification number assigned to each state and county under the FIPS guidelines. See http://www.census.gov/geo/www/fips/fips.html.
Other Instructions:
All investigations will have the same state identification number. The Investigative Agency number may be a regional office or a local office depending upon the state APS administrative structure.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Investigation
Element Name:		Investigation Start Date					Element #:		Inv5
Type:	Date	Size:	8	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The date the investigation is assigned to an investigation worker. If the agency uses another date to indicate the start of an investigation, that date is used.
Code Values:
Not applicable.
Other Instructions:
Each agency's policies and procedures define the date of an investigation. If an agency has both the date the investigation is assigned to an investigation worker and another date that is considered to be the start of the investigation, submit the date assigned to the worker.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Investigation
Element Name:		Investigation Disposition Date					Element #:		Inv6
Type:	Date	Size:	8	Required:	No	Quantifier:	Single	Last Revised:	12/17/2014
Element Description:
The date that the agency completed dispositions on the allegations of maltreatment associated with the investigation.
Code Values:
Not applicable.
Other Instructions:
Each agency's policies and procedures define this date. If maltreatment dispositions are associated with different dates, the Investigation Disposition Date should be the latest of these dates.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Investigation
Element Name:		Case Closure Date					Element #:		Inv7
Type:	Date	Size:	8	Required:	Yes	Quantifier:	Single	Last Revised:	12/17/2014
Element Description:
The date that the agency completed all activities related to the investigation of the case.
Code Values:
Not applicable.
Other Instructions:
Each agency's policies and procedures define the date of case closure. If the state data does not include the case closure date, the investigation disposition date may be used in this element.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

G.2. Client

Entity:	Client
Element Name:		Client ID					Element #:		Clt1
Type:	Alphanumeric	Size:	32	Required:	Yes	Quantifier:	Single	Last Revised:	12/17/2014
Element Description:
The unique identifier used by the state for each client. The identifier is assigned to a specific client and is used identify the same client across investigations and reporting periods. The Client identifier is encrypted or encoded by state for purposes of data submission.
Code Values:
Not applicable.
Other Instructions:
Multiple unique Client IDs can be associated with an investigation. The determination as to whether an investigation includes multiple clients is left to each agency's policies and procedures.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Facility ID					Element #:		Clt2
Type:	Alphanumeric	Size:	32	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The unique identifier used by the state for each facility. The identifier is assigned to a specific facility where the client lives. The identifier is used for the same facility across investigations and reporting periods. The Facility Identifier is encrypted or encoded by the state for purposes of data submission.
Code Values:
Not applicable.
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		State/County FIPS Code of Client					Element #:		Clt3
Type:	Numeric	Size:	5	Required:	No	Quantifier:	Single	Last Revised:	12/17/2014
Element Description:
The FIPS for state (2 digits) and county code (3 digits) of the client's residence at the start of the investigation.
Code Values:
Code is the unique identification number assigned to each state and county under the FIPS guidelines. See http://www.census.gov/geo/www/fips/fips.html.
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Case Closure Reason					Element #:		Clt4
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The primary reason why the case was closed.
Code Values:
1 = Investigation Complete 2 = Protective Services Completed 3 = Client Refused Services 4 = Unable to Complete (closed without finding) 5 = Client Died 6 = Other
Other Instructions:
Code 3 is used if the investigation was completed, services were offered, and the client refused services. Code 4 is used if agency was unable to complete the investigation because the client refused the investigation. Code 5 is used if agency was unable to complete the investigation because the client died.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Case Closure Reason					Element #:		Clt4
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Age					Element #:		Clt5
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The age of the client in years (at investigation start date).
Code Values:
18,19...74 = Actual Age 75 = 75-84 85 = 85 and Older
Other Instructions:
The Client Age is computed by subtracting the client's Date of Birth from the Investigation Start Date. If the age ranges between 18 and 74, the actual age is used. Ages of 75-84 inclusive are grouped and coded as 75. Ages of 85 or older are grouped and coded as 85.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Gender Identity					Element #:		Clt6
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The actual or perceived gender-related characteristics of the client.
Code Values:
1 = Male 2 = Female 3 = Transgender
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Gender Identity					Element #:		Clt6
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Sexual Orientation					Element #:		Clt7
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The client's enduring pattern of or disposition to experience sexual or romantic desires for, and relationships with, people of one's same sex, the other sex, or both sexes.
Code Values:
1 = Straight 2 = Gay/Lesbian 3 = Bisexual 4 = Questioning 5 = Other
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Sexual Orientation					Element #:		Clt7
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Race					Element #:		Clt8
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The population(s) or group(s) that the client identifies as being a member. Multiple races can be submitted for the client.
Code Values:
10 = American Indian or Alaska Native 20 = Asian (non-specific)    21 = Asian Indian    22 = Chinese    23 = Filipino    24 = Japanese    25 = Korean    26 = Vietnamese    27 = Other Asian 30 = Black or African American 40 = Native Hawaiian or Other Pacific Islander (non-specific)    41 = Native Hawaiian    42 = Guamanian or Chamorro    43 = Samoan    44 = Other Pacific Islander 50 = White
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example if the client is Asian of Filipino and Japanese descent, only submit Code 23 and Code 24. Do not submit Code 20.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Race					Element #:		Clt8
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Ethnicity					Element #:		Clt9
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The affiliation of the client as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicities can be submitted for the client.
Code Values:
10 = Yes, Hispanic or Latino/a, or Spanish Origin (non-specific)    11 = Mexican, Mexican American, Chicano/a    12 = Puerto Rican    13 = Cuban    14 = Other Hispanic, Latino/a, or Spanish Origin 20 = No, Not Hispanic or Latino/a, or Spanish Origin
Other Instructions:
The code values allow for more or less specificity to be submitted. If the person is of Hispanic or Latino/a or Spanish origin but the specific ethnicity is not known, submit code value 10.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Ethnicity					Element #:		Clt9
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		English Competency					Element #:		Clt10
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The client's ability to communicate using the English language.
Code Values:
1 = Very Well 2 = Well 3 = Not Well 4 = Not at all
Other Instructions:
This assessment is based upon the social worker's judgment or other assessment instruments used by the agency staff.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		English Competency					Element #:		Clt10
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Primary Language					Element #:		Clt11
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The primary language or method that the client uses for written and verbal communication.
Code Values:
1 = Arabic 2 = Chinese 3 = English 4 = French 5 = German 6 = Korean 7 = Russian 8 = Spanish or Spanish Creole 9 = Tagalog 10 = Vietnamese 11 = Sign Language 12 = Assistive Technology 13 = Other
Other Instructions:
If a person is fluent in more than one language or method of communication, choose the primary language the person uses with agency staff.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Primary Language					Element #:		Clt11
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Marital Status					Element #:		Clt12
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The client's status based on state residency laws.
Code Values:
1 = Never Married 2 = Married 3 = Domestic Partner, Including Civil Union 4 = Divorced 5 = Separated 6 = Widowed 7 = Other
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Marital Status					Element #:		Clt12
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Schooling Level					Element #:		Clt13
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The highest educational degree attained by the client.
Code Values:
1 = Less than High School 2 = High School Diploma or Equivalent 3 = Associate's Degree or Bachelor's Degree 4 = Advanced Degree
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Schooling Level					Element #:		Clt13
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Employment Status					Element #:		Clt14
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The involvement of the client in the labor force.
Code Values:
1 = Employed 2 = Unemployed 3 = Not in Labor Force 4 = Other
Other Instructions:
If client is retired but also employed, use Code 1. If client is participating in sheltered workshops or work centers for sub-minimum wages, use code value 4.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Employment Status					Element #:		Clt14
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Income Level					Element #:		Clt15
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The level of annual income of the client including all sources of income.
Code Values:
1 = Less than $25,000 2 = $25,000-$49,999 3 = $50,000-$74,999 4 = $75,000-$99,999 5 = $100,000 or More
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Income Level					Element #:		Clt15
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Benefits					Element #:		Clt16
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The federal and state benefits received by the client during the investigation. Multiple values can be submitted.
Code Values:
1 = Medicaid 2 = Medicare 3 = Publicly-Subsidized Housing 4 = SSDI 5 = Social Security Retirement Benefits 6 = SSI 7 = TANF 8 = Veterans' Disabled Benefits 9 = Other 10 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Benefits					Element #:		Clt16
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Veteran Status					Element #:		Clt17
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The client's status related to the U.S. Armed Forces.
Code Values:
1 = Veteran 2 = Non-Veteran
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Coments:

Entity:	Client
Element Name:		Veteran Status					Element #:		Clt17
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Disabilities					Element #:		Clt18
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The client's physical, emotional, and mental health issues that result in limitation in activities and restrictions to fully participate at school, work, or in the community. Multiple disabilities can be submitted for the client.
Code Values:
1 = Ambulatory Difficulty 2 = Cognitive Difficulty 3 = Hearing Difficulty 4 = Independent Living Difficulty 5 = Self-care Difficulty 6 = Vision Difficulty 7 = Other 8 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Disabilities					Element #:		Clt18
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		ADL Score					Element #:		Clt19
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The client's score on the Katz Index of Independence in ADLs.
Code Values:
Permissible values are 0-6.
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		IADL Score					Element #:		Clt20
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The client's score on the Lawton IADLs.
Code Values:
Permissible values are 0-8.
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Behavioral Health Screenings					Element #:		Clt21
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The results of screening assessments on the client, conducted by the APS agency. Multiple results can be submitted for the client.
Code Values:
1 = Alcohol Use Disorder 2 = Anxiety 3 = Bipolar Disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and Other Psychotic Disorders 7 = Substance Use Disorder 8 = Traumatic Brain Injury 9 = Other 10 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Behavioral Health Screenings					Element #:		Clt21
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Behavioral Health Diagnoses					Element #:		Clt22
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The results of assessments on the client, conducted by medical or clinical professionals. Multiple results can be submitted for the client.
Code Values:
1 = Alcohol Use Disorder 2 = Anxiety 3 = Bipolar Disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and Other Psychotic Disorders 7 = Substance Use Disorder 8 = Traumatic Brain Injury 9 = Other 10 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Behavioral Health Diagnoses					Element #:		Clt22
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Living Setting at Start					Element #:		Clt23
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The primary residential environment of the client at the start of investigation.
Code Values:
10 = Own Residence or Residence of Relative or Caregiver 20 = Residential Care Community Setting (non-specific)    21 = Licensed Residential Care Community Setting    22 = Non-licensed Residential Care Community Setting 30 = Nursing Home (non-specific)    31 = Licensed Nursing Home    32 = Non-licensed Nursing Home 40 = Other
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the nursing home is licensed, submit Code 31. If the license status is not known, submit Code 30.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Living Setting at Start					Element #:		Clt23
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Living Setting at Close					Element #:		Clt24
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The primary residential environment of the person at the time of case closure.
Code Values:
10 = Own Residence or Residence of Relative or Caregiver 20 = Residential Care Community Setting (non-specific)    21 = Licensed Residential Care Community Setting    22 = Non-licensed Residential Care Community Setting 30 = Nursing Home (non-specific)    31 = Licensed Nursing Home    32 = Non-licensed Nursing Home 40 = Other
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the nursing home is licensed, submit Code 31. If the license status is not known, submit Code 30.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Living Setting at Close					Element #:		Clt24
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Substitute Decision Makers at Start					Element #:		Clt25
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The authorizations that are in effect related to health, personal, or financial decision making for the client at the start of the investigation. Multiple Substitute Decision Makers can be submitted for the client.
Code Values:
10 = Health Care Proxy in Effect 20 = Financial Proxy in Effect 30 = Guardianship or Conservatorship (non-specific)    31 = Guardianship or Conservatorship of Person    32 = Guardianship or Conservatorship of Property 40 = Representative Payee 50 = None
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the guardianship is specifically for the person submit Code 31. If the specificity is not known, submit Code 30.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Substitute Decision Makers at Start					Element #:		Clt25
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Substitute Decision Makers at Close					Element #:		Clt26
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The authorizations that are in effect related to health, personal, or financial decision making for the client at time of case closure. Multiple Substitute Decision Makers can be submitted for the client.
Code Values:
10 = Health Care Proxy in Effect 20 = Financial Proxy in Effect 30 = Guardianship or Conservatorship (non-specific)    31 = Guardianship or Conservatorship of Person    32 = Guardianship or Conservatorship of Property 40 = Representative Payee 50 = None
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the guardianship is specifically for the person submit Code 31. If the specificity is not known, submit Code 30.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Substitute Decision Makers at Close					Element #:		Clt26
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Services at Start					Element #:		Clt27
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
Element Description:
The services known to the agency that the client was already receiving at the start of the investigation.
Code Values:
1 = Care/Case Management Services 2 = Caregiver Support Services 3 = Community Day Services 4 = Education, Employment, and Training Services 5 = Emergency Assistance and Material Aid Services 6 = Financial Planning Services 7 = Housing and Relocation Services 8 = In-home Assistance Services 9 = Legal Services 10 = Medical and Dental Services 11 = Medical Rehabilitation Services 12 = Mental Health Services 13 = Nutrition 14 = Public Assistance Benefits 15 = Substance Use Services 16 = Transportation 17 = Victim Services 18 = Other Services 19 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Services at Start					Element #:		Clt27
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Services APS					Element #:		Clt27
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
Element Description:
The services which the agency provided on behalf of the client during the investigation or while the agency kept an open case.
Code Values:
1 = Care/Case Management Services 2 = Caregiver Support Services 3 = Community Day Services 4 = Education, Employment, and Training Services 5 = Emergency Assistance and Material Aid Services 6 = Financial Planning Services 7 = Housing and Relocation Services 8 = In-home Assistance Services 9 = Legal Services 10 = Medical and Dental Services 11 = Medical Rehabilitation Services 12 = Mental Health Services 13 = Nutrition 14 = Public Assistance Benefits 15 = Substance Use Services 16 = Transportation 17 = Victim Services 18 = Other Services 19 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Services APS					Element #:		Clt27
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Services Referred					Element #:		Clt29
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
Element Description:
The services for which the agency referred the client.
Code Values:
1 = Care/Case Management Services 2 = Caregiver Support Services 3 = Community Day Services 4 = Education, Employment, and Training Services 5 = Emergency Assistance and Material Aid Services 6 = Financial Planning Services 7 = Housing and Relocation Services 8 = In-home Assistance Services 9 = Legal Services 10 = Medical and Dental Services 11 = Medical Rehabilitation Services 12 = Mental Health Services 13 = Nutrition 14 = Public Assistance Benefits 15 = Substance Use Services 16 = Transportation 17 = Victim Services 18 = Other Services 19 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Services Referred					Element #:		Clt29
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Services at Close					Element #:		Clt30
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
Element Description:
The services known to the agency that the client was receiving at the time of case closure.
Code Values:
1 = Care/Case Management Services 2 = Caregiver Support Services 3 = Community Day Services 4 = Education, Employment, and Training Services 5 = Emergency Assistance and Material Aid Services 6 = Financial Planning Services 7 = Housing and Relocation Services 8 = In-home Assistance Services 9 = Legal Services 10 = Medical and Dental Services 11 = Medical Rehabilitation Services 12 = Mental Health Services 13 = Nutrition 14 = Public Assistance Benefits 15 = Substance Use Services 16 = Transportation 17 = Victim Services 18 = Other Services 19 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Services at Close					Element #:		Clt30
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Interagency Coordination					Element #:		Clt31
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
Element Description:
The agencies to which the client was referred.
Code Values:
1 = Law Enforcement or Prosecutorial Offices 2 = Protection and Advocacy or CAP 3 = State Licensing Agency 4 = State MFCU 5 = Long-Term Care Ombudsman Program 6 = Other 7 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Interagency Coordination					Element #:		Clt31
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Multiple	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Previous Report					Element #:		Clt32
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The indication that the agency has information that the client was the subject of a previous report.
Code Values:
1 = Yes 2 = No
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Previous Report					Element #:		Clt32
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client
Element Name:		Maltreatment Setting					Element #:		Clt33
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The location where alleged maltreatment occurred.
Code Values:
10 = Own Residence or Private Residence of Relative or Caregiver 20 = Residential Care Community Setting (non-specific)    21 = Licensed Residential Care Community Setting    22 = Unlicensed Residential Care Community Setting 30 = Nursing Home (non-specific)    31 = Licensed Nursing Home    32 = Unlicensed Nursing Home 40 = Adult Day Services Center (non-specific)    41 = Licensed Adult Day Services Center    42 = Unlicensed Adult Day Services Center 50 = Place of Business or Other Services 60 = Other
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example if the nursing home is licensed submit Code 31. If the license status is not known, submit Code 30.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client
Element Name:		Maltreatment Setting					Element #:		Clt33
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

G.3. Maltreatment

Entity:	Maltreatment
Element Name:		Maltreatment Type					Element #:		Mal1
Type:	Numeric	Size:	1	Required:	Yes	Quantifier:	Single	Last Revised:	12/17/2014
Element Description:
The alleged maltreatments that are investigated.
Code Values:
1 = Abandonment 2 = Emotional Abuse 3 = Financial Exploitation 4 = Neglect 5 = Physical Abuse 6 = Sexual Abuse 7 = Suspicious Death 8 = Self-neglect 9 = Other
Other Instructions:
Each maltreatment entity has only a single maltreatment type.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Maltreatment
Element Name:		Maltreatment Type					Element #:		Mal1
Type:	Numeric	Size:	1	Required:	Yes	Quantifier:	Single	Last Revised:	12/17/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Maltreatment
Element Name:		Maltreatment Disposition					Element #:		Mal2
Type:	Numeric	Size:	1	Required:	Yes	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The disposition of each alleged maltreatment.
Code Values:
1 = Substantiated 2 = Inconclusive 3 = Unsubstantiated 4 = Other
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Maltreatment
Element Name:		Maltreatment Disposition					Element #:		Mal2
Type:	Numeric	Size:	1	Required:	Yes	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

G.4. Perpetrator

Entity:	Perpetrator
Element Name:		Perpetrator ID					Element #:		Per1
Type:	Numeric	Size:	32	Required:	Yes	Quantifier:	Single	Last Revised:	12/17/2014
Element Description:
The unique ID used by the state for the person who is found to be responsible for substantiated maltreatment(s). The ID is assigned to a specific perpetrator and is used to identify the same perpetrator across investigations and reporting. The Perpetrator Identifier is encrypted or encoded by the state for purposes of data submission.
Code Values:
Not applicable.
Other Instructions:
Data on multiple substantiated perpetrators for each client can be submitted for the investigation.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Perpetrator
Element Name:		Age					Element #:		Per2
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The age of the perpetrator in years (at investigation start date).
Code Values:
18,19...74 = Actual Age 75 = 75-84 85 = 85 and older
Other Instructions:
The Perpetrator Age is computed by subtracting the perpetrator date of birth from the Investigation Start Date. If the age ranges between 18 and 74, the actual age is used. Age of 75-84 inclusive are grouped and coded as 75. Ages of 85 or older are grouped and coded as 85.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Perpetrator
Element Name:		Gender Identity					Element #:		Per3
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The actual or perceived gender-related characteristics of the perpetrator.
Code Values:
1 = Male 2 = Female 3 = Transgender
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Perpetrator
Element Name:		Gender Identity					Element #:		Per3
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Perpetrator
Element Name:		Race					Element #:		Per4
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The population(s) or group(s) that the perpetrator identifies as being a member. Multiple races can be submitted for the perpetrator.
Code Values:
10 = American Indian or Alaska Native 20 = Asian (non-specific)    21 = Asian Indian    22 = Chinese    23 = Filipino    24 = Japanese    25 = Korean    26 = Vietnamese    27 = Other Asian 30 = Black or African American 40 = Native Hawaiian or Other Pacific Islander (non-specific)    41 = Native Hawaiian    42 = Guamanian or Chamorro    43 = Samoan    44 = Other Pacific Islander 50 = White
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example if the perpetrator is Asian of Filipino and Japanese descent, only submit Code 23 and Code 24. Do not submit Code 20.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Perpetrator
Element Name:		Race					Element #:		Per4
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Perpetrator
Element Name:		Ethnicity					Element #:		Per5
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The affiliation of the perpetrator as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicities can be submitted for the perpetrator.
Code Values:
10 = Yes, Hispanic or Latino/a, or Spanish Origin (non-specific)    11 = Mexican, Mexican American, Chicano/a    12 = Puerto Rican    13 = Cuban    14 = Other Hispanic, Latino/a, or Spanish Origin 20 = No, Not Hispanic or Latino/a, or Spanish Origin
Other Instructions:
The code values allow for more or less specificity to be submitted. If the person is of Hispanic or Latino/a or Spanish origin but the specific ethnicity is not known, submit code value 10.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Perpetrator
Element Name:		Ethnicity					Element #:		Per5
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Perpetrator
Element Name:		Disabilities					Element #:		Per6
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The perpetrator's physical, emotional, and mental health issues that result in limitation in activities and restrictions to fully participate at school, work, or in the community. Multiple disabilities can be submitted for the perpetrator.
Code Values:
1 = Ambulatory Difficulty 2 = Cognitive Difficulty 3 = Hearing Difficulty 4 = Independent Living Difficulty 5 = Self-care Difficulty 6 = Vision Difficulty 7 = Other 8 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Perpetrator
Element Name:		Disabilities					Element #:		Per6
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Perpetrator
Element Name:		Behavioral Health Screenings					Element #:		Per7
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The results of screening assessments on the perpetrator, conducted by the APS agency. Multiple results can be submitted for the perpetrator.
Code Values:
1 = Alcohol Use Disorder 2 = Anxiety 3 = Bipolar Disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and Other Psychotic Disorders 7 = Substance Use Disorder 8 = Traumatic Brain Injury 9 = Other 10 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Perpetrator
Element Name:		Behavioral Health Screenings					Element #:		Per7
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Perpetrator
Element Name:		Behavioral Health Diagnoses					Element #:		Per8
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The results of assessments on the perpetrator, conducted by medical or clinical professionals. Multiple results can be submitted for the perpetrator.
Code Values:
1 = Alcohol Use Disorder 2 = Anxiety 3 = Bipolar Disorder 4 = Dementia 5 = Depression 6 = Schizophrenia and Other Psychotic Disorders 7 = Substance Use Disorder 8 = Traumatic Brain Injury 9 = Other 10 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Perpetrator
Element Name:		Behavioral Health Diagnoses					Element #:		Per8
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

G.5. Client Perpetrator Relationship

Entity:	Client-Perpetrator Relationship
Element Name:		Cohabitation at Start					Element #:		CPR1
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The indication if the perpetrator and victim are cohabitating at the start of the investigation.
Code Values:
1 = Yes 2 = No
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client-Perpetrator Relationship
Element Name:		Cohabitation at Start					Element #:		CPR1
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client-Perpetrator Relationship
Element Name:		Cohabitation at Close					Element #:		CPR2
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The indication if the perpetrator and client are cohabitating at the time of case closure.
Code Values:
1 = Yes 2 = No
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client-Perpetrator Relationship
Element Name:		Cohabitation at Close					Element #:		CPR2
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client-Perpetrator Relationship
Element Name:		Kinship Relationship					Element #:		CPR3
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
Element Description:
The indication if the perpetrator is related to the client by affinity (blood, adoption, marriage, etc.)
Code Values:
10 = Yes (not specific)    11 = Spouse    12 = Domestic Partner, including Civil Union    13 = Parent    14 = Child    15 = Sibling    16 = Grandparent    17 = Grandchild    18 = Other Relative 20 = None
Other Instructions:
The code values allow for specific kinship to be submitted if known. If the perpetrator is kin to the client but the specific kinship is not known, use code value 10.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client-Perpetrator Relationship
Element Name:		Kinship Relationship					Element #:		CPR3
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Single	Last Revised:	11/20/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Association at Start					Element #:		CPR4
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The indication if the perpetrator has a caregiving relationship to the client at the start of the investigation.
Code Values:
1 = Nursing Home Staff 2 = Residential Care Community Staff 3 = Paid Formal Caregiver 4 = Paid Informal or Family Caregiver 5 = Unpaid Informal or Family Caregiver 6 = Other Relationship 7 = None
Other Instructions:
If the perpetrator has multiple associations to the client, choose primary association.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Association at Start					Element #:		CPR4
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Association at Close					Element #:		CPR5
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
Element Description:
The indication whether the perpetrator has a caregiving relationship to the client at time of case closure.
Code Values:
1 = Nursing Home Staff 2 = Residential Care Community Staff 3 = Paid Formal Caregiver 4 = Paid Informal or Family Caregiver 5 = Unpaid Informal or Family Caregiver 6 = Other Relationship 7 = None
Other Instructions:
If the perpetrator has multiple associations to the client, choose primary association.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Association at Close					Element #:		CPR5
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Single	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Substitute Decision Maker at Start					Element #:		CPR6
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
Authorizations that the perpetrator has in relation to the victim, and that are in effect, related to health, personal or financial decision making at the start of the investigation.
Code Values:
10 = Health Care Proxy in Effect 20 = Financial Proxy in Effect 30 = Guardianship or Conservatorship (non-specific)    31 = Guardianship or Conservatorship of Person    32 = Guardianship or Conservatorship of Property 40 = Representative Payee 50 = None
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the guardianship is specifically for the person submit Code 31. If the specificity is not known, submit Code 30.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Substitute Decision Maker at Start					Element #:		CPR6
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Substitute Decision Maker at Close					Element #:		CPR7
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
Authorizations that the perpetrator has in relation to the victim, and that are in effect, related to health, personal or financial decision making at the time of case closure.
Code Values:
10 = Health Care Proxy in Effect 20 = Financial Proxy in Effect 30 = Guardianship or Conservatorship (non-specific)    31 = Guardianship or Conservatorship of Person    32 = Guardianship or Conservatorship of Property 40 = Representative Payee 50 = None
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the guardianship is specifically for the person submit Code 31. If the specificity is not known, submit Code 30.
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Substitute Decision Maker at Close					Element #:		CPR7
Type:	Numeric	Size:	2	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Legal Remedy					Element #:		CPR8
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
Element Description:
The legal remedies that were sought by the APS agency regarding the status of the perpetrator.
Code Values:
1 = Removal of Guardianship Rights 2 = Restraining Order on Perpetrator Regarding the Victim 3 = Eviction of Perpetrator 4 = Restitution by Perpetrator 5 = Other Legal Remedy 6 = None
Other Instructions:
State Data Information:
Can the state provide data for this element?				___ Yes		___ No
State File/Table Name:					State Field/Element Name:
Comments:

Entity:	Client-Perpetrator Relationship
Element Name:		Perpetrator Legal Remedy					Element #:		CPR8
Type:	Numeric	Size:	1	Required:	No	Quantifier:	Multiple	Last Revised:	12/5/2014
State File/ Table Name		State Field/ Element Name		State Code Value		State Code Description/Name		NAMRS Code
Enter NAMRS Code Values NOT Included:

Project and Report Information

This report was prepared under contract #HHSP23320095656WC between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and Walter R. McDonald and Associates. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/office-disability-aging-and-long-term-care-policy-daltcp or contact the ASPE Project Officer, Helen Lamont, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. Her e-mail address is: Helen.Lamont@hhs.gov.

Files Available

VOLUME 1: PILOT OVERVIEW AND FUTURE RECOMMENDATIONS

• HTML  https://aspe.hhs.gov/report/development-national-adult-protective-services-data-system-namrs-pilot-final-report-volume-1
• PDF  https://aspe.hhs.gov/pdf-report/development-national-adult-protective-services-data-system-namrs-pilot-final-report-volume-1

VOLUME 2: SYSTEM DOCUMENTATION

• HTML  https://aspe.hhs.gov/report/development-national-adult-protective-services-data-system-namrs-pilot-final-report-volume-2
• PDF  https://aspe.hhs.gov/pdf-report/development-national-adult-protective-services-data-system-namrs-pilot-final-report-volume-2