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
- Gender identity
- Sexual orientation
- English competency
- Primary language
- Marital status
- Schooling level
- Employment status
- Income level
- Veteran status
- 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
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
- Gender identity
- 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||
|Illinois||12,880,580||Illinois Department on Aging||
|Maine||1,330,089||Maine Department of Health and Human Services, Office of Aging and Disability Services (OADS)||
|Pennsylvania||12,787,209||Pennsylvania Department of Aging||
|Texas||26,956,958||Texas Department of Health and Human Services, Department of Family and Protective Services||
|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:
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:
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.