District of Columbia APS Advances Practice Through SDM® Implementation
The District of Columbia Department of Human Services has been committed to protecting older and vulnerable adults since establishing its Adult Protective Services (APS) in 1985. However, in 2017, the agency stepped up its commitment by moving to the Structured Decision Making® (SDM) system of research-based assessment tools.
A few years ago, DC APS identified challenges common to APS programs throughout the country: an increase in maltreatment reports without increased resources. DC APS began asking what they could do to increase consistency in making decisions about these cases and connect assessments to daily practice for real-time assessment documentation and data collection. This would allow them to provide information to managers and supervisors for help with program planning, evaluation, and resource allocation.
Through an Administration for Community Living (ACL) grant designated for using data to improve decision making and service delivery for the vulnerable adults they serve, DC APS partnered with NCCD to develop and implement four SDM® APS assessments.
These assessments address screening and response time, safety, risk of future APS involvement, and decisions regarding case planning and service referrals for clients identified as high risk. Three of the four assessment tools were implemented in September 2017, and the fourth is expected in the summer of this year.
Developing and implementing these tools has been no small feat. The combined team of DC APS workers, supervisors, IT staff, and managers worked with NCCD program staff, researchers, and IT development staff to customize, test, tweak, test some more, program, certify, train, and implement three of the assessment tools while simultaneously collecting and analyzing data to do much of the same thing with the fourth tool in early 2018.
We started with policy reviews and an onsite kickoff meeting. Then, after drafting the assessment tools, NCCD staff returned for workgroup meetings. A select group of workers from each DC APS team, as well as supervisors and managers, made up the workgroup. Together, we went through each word of the drafted assessments with a fine-tooth comb, adjusting for local policy, practice, and language.
Next, we tested the assessments for reliability, tweaking the assessments where definitions were confusing or did not test well. After slight modification and review by NCCD’s fidelity implementation team, development continued with field testing. At this stage, social workers practice using assessments in the field to test their utility and offer feedback. The three assessments changed slightly based on field test results, then were finalized for integration into the local DC APS case management system.
DC APS’s IT developer worked with NCCD’s IT team to program the tools, and NCCD performed user acceptance testing on each tool to ensure it met SDM certification standards. Once integrated into the IT system and certified, the SDM tools were ready for training and implementation.
All DC APS staff were trained to use the SDM tools during a four-day onsite training in September. APS workers, supervisors, and managers practiced completing the SDM assessments and entering data directly into the programmed assessments on their new Surface Pros (also provided by the ACL grant), gaining experience in real-time completion in a mobile work environment.
This year we continue to develop, test, train, and implement the much-anticipated risk assessment. After that, NCCD will complete a process evaluation of all the tools, including the collection of quantitative and qualitative data, to evaluate the outcomes of the new system.
NCCD sees DC APS as a model for implementing the SDM system. To implement the whole system of tools after completing multiple tests for reliability, accuracy, and utility is ideal. The process evaluation to follow will help us understand the outcomes, the successes and challenges of implementation, and inform continued use of the SDM assessments in DC APS as well as other jurisdictions. We commend DC APS for its commitment to the vulnerable adults it serves.
Karen Meulendyke is a program associate on the NCCD Social Services Practice team.