Upon completion of the investigation the worker must reach a determination regarding each allegation. Each allegation must be determined as:
Substantiated – the evidence collected indicates abuse, neglect or exploitation of an incapacitated adult is confirmed
Unsubstantiated – the evidence collected indicates abuse, neglect or exploitation of an incapacitated adult is not confirmed
Decision Making Process
The APS worker is dependent on the process of collecting and analyzing evidence in order to:
decide whether an incapacitated person has been abused neglected, or exploited
assess risk potential for future
decide what services are needed
Effective decisions help overcome subsequent challenges to worker’s findings.
Making decisions in extreme circumstances can be easy.
Making decisions in other circumstances can be very difficult.
Systemic Decision Making
The systemic decision-making process includes the following components:
Articulating critical investigative questions;
Determining what information is necessary to ensure adequate answers for the questions;
Cross-checking and evidence reliability;
comparing the evidence on specific factors impacting on the incapacitated adult;
Checking for cultural biases and influences
As workers gain experience in making decisions, most of these components will become routine aspects of every investigation. Armed with the knowledge of which decisions will be required, workers will structure activities to ensure that the information necessary to reach these decisions is gathered in an effective and timely manner.
The first three steps of systemic decision making will become routine on every investigation.
The amount of cross-checking required in step four will vary based upon the:
Nature of the referral (emergency or non-emergency).
Amount of conflicting information obtained.
Reliability of the information provided by those interviewed.
The fifth step is the most important, since it organizes how the evidence is weighed and assures that all pertinent factors will be considered in the decision.
The sixth step, consultation with a range of possible experts, is always an option to help make difficult decisions.
The seventh step verifies that bias has been controlled. It reflects:
Worker’s skill; and
highly polished sensitivity. REMEMBER, a decision making process will not make decisions for you. The worker still will have to apply their own skills, experience, and professional judgment to the unique circumstances of the investigation.
RELIABILITY OF INFORMATION
The reliability or trustworthiness of the information source is an important clue to the weight or credibility that should be assigned to the evidence.
Even though evidence may be reliable, sound, and accurate, it may not be relevant to the investigation. For example, the fact that a client’s home provides adequate shelter does not help determine if sexual abuse has occurred.
Weigh facts base on:
Importance to the question at hand.
Evidence should support one alternative or another. The following types of evidence are generally unreliable and of questionable significance:
Unsupported information from an involved party.
Information from a biased source (e.g., neighbor engaged in a boundary-line dispute, ex-spouse, etc).
Other information which cannot be verified by a second source.
Apply the “reasonable and prudent person standard,” This standard asks the following questions:
What would a reasonable (ordinary, average) and prudent person do in a similar situation?
Is this behavior which is being considered outside the “norm?”
By applying this standard within the context of a full range of factors, it will be easier to determine whether abuse, neglect, or exploitation occurred.
Do not use this standard in a medical setting, as medical professionals are needed to make this determination.
Requirements for documentation in the case record are the same regardless of whether the report is determined to be substantiated or unsubstantiated.
The record is subject to review by supervisors, field representatives, and other staff as appropriate.
The case record can be subpoenaed in subsequent private guardianship proceedings if the allegations investigated are pertinent to the proposed guardianship.
ASSESSING THE RELIABILITY OF AN INFORMATION SOURCE
Education, training, and experience may qualify persons (including the investigator) as experts in their field. For example, certain report allegations (e.g., subdural hemotoma, malnutrition, etc.) require a medical diagnosis in order to classify the report. The physician’s diagnosis is inherently more reliable than an explanation by a person with no medical training.
Uninvolved third party
The more removed a person is from the individuals involved in an incident, the more likely the source is to be objective. A stranger passing by a house who sees a man physically abuse an aged person is not personally involved in the incident. Therefore, he is likely to be more objective than an involved party (e.g., a family member, the caretaker).
In some situations, an eyewitness observation account by an uninvolved third party can be more reliable than a professional’s analysis. The professional is generally involved in the situation after the abuse, neglect, or exploitation occurred, and must reconstruct what could have happened based on the consequences presented to him. The eyewitness, if observant, can explain exactly how the incident occurred and thereby eliminate any “guesswork” by the professional.
GUIDELINES FOR MAKING A SUBSTANTIATION DECISION
The following are principles to consider in making a decision about whether ANE occurred:
The fact that a report is made does not, by itself, constitute abuse, neglect or exploitation; it must be thoroughly investigated before that determination can be made.
The fact that the incident which was reported did occur does not mean the report is confirmed; what occurred must constitute abuse, neglect or exploitation as defined by statute.
The lack of severity of the abuse, neglect or exploitation does NOT mean the report is unsubstantiated.
The denial by the alleged abuser is not acceptable as the only rationale for determining the report as unsubstantiated.
The fact that the alleged victim denies the ane is not reason, by itself, to determine a report as unsubstantiated.
The fact that the victim or other person states that the ane occurred does not in itself justify a decision to determine the report as substantiated.
The inability of the alleged victim to talk, due to any reason, is not justification for determining a report as unsubstantiated.
The inability of the alleged victim to provide information and the denial of the alleged perpetrator requires that the worker seek corroborative information through collateral contacts in order to resolve the conflict between the allegations of the report and the denial of the alleged abuser.
The lack of bruises, marks or other physical injury is not by itself justification for determining a report as unsubstantiated.
The existence of an injury or a mark does not automatically constitute a substantiated report. The worker must determine if the injury or mark occurred as a result of abuse or neglect.
Hostility or cooperation on the part of the alleged abuser is not a deciding factor in determining reports.
The worker is reminded that a person can abuse, neglect, or exploit an incapacitated adult without “intending” to do harm.
SUBSTANTIATION WHEN ITS A CLOSE CALL
Review the guidelines for making a substantiation decision
Use the Substantiation Ledger Sheet:worker and supervisor make individual analysis and then compare notes
Review indicators to see if any were missed
Present the case at a staff meeting:let other workers ask questions and have input
Review definitions of ANE
Review Risk Assessment to see if there are too many “unknowns”
Imagine that you have to write a detailed report to the perpetrator explaining why abuse was substantiated:What would you say?
Imagine that you have to write a detailed report to the victim and reporter explaining why abuse was unsubstantiated:What would you say?