ISO Matrix is a decision support system that provides comprehensive, standardized procedures for Adult Protective Services to Identify (I) the types and severity of abuse, to estimate the types and amounts of Services (S) received, and to measure the Outcomes (O) or effectiveness of the services.

According to Webster, the word “matrix” originates from the Latin, “mater” for mother or womb. It is that from which something originates, takes form, or develops. Modern mathematical usage connotes arrangements of data in rows and columns, e.g., data matrix to be used for matrix algebra. It is a way to use state-of-the-art, best practices to obtain information that can be used to ameliorate abuse and nurture the victim to a better condition.

Brief and simple example. As she loses her eyesight, the client turns over her checkbook to her beloved caregiver. The caregiver starts writing checks to buy herself expensive clothes, bags, and jewelry, all without the approval of the compromised client. Identification: high financial exploitation score. Service: for a low fee, a representative payee or bank fiduciary will take charge of finances. Outcome: financial exploitation score goes to zero.


For the first time in Adult Protective Services history, evidenced-based measures are used to identify severity of each type of elder abuse, to capture outcomes from Adult Protective Services interventions, and to ascertain the effectiveness of Adult Protective Services with quantitative data. The historical lack of outcomes-related data in APS, has affected funding coming to the program. Specifically, policy makers have not been provided with data illustrating and quantifying the impact of Adult Protective Services. Without this accountability, APS may have difficulties justify budget increases. Evidence of effectiveness can also demonstrate best practices, professionalize the field, and increase the status and the demand that lead to wage improvement. Best of all, evidence-based practice will lead to better quality of services and improved client outcomes.

Purdue University, San Francisco Adult Protective Services and Napa Adult Protective Services piloted the Identification, Services, and Outcomes (ISO) Matrix to study outcomes in Adult Protective Services work, through a federal grant from the Administration for Community Living (grant # 90EJIG0010-01-00).


Evidence-based assessment tools are used during Adult Protective Services case investigation to measure the severity of the abuse. The ISO Matrix measures all types of the abusive situation, as well as the characteristics of the alleged victim and abuser. These measures should inform the substantiation decision and design of services.


While measuring the type of services that reduce the harm of abuse, we are also measuring the victim’s willingness to accept services, and the availability of services. No one in the country has studied and quantified interventions provided to Adult Protective Services clients. With this project, we are beginning to identify effective services for specific scenarios.


The same evidence-based assessment tools are used again at case closure to estimate the outcomes of Adult Protective Services interventions, i.e., improvement or decline. With services identified through the creation of a service plan, statistical models can be built to test whether those services were effective in removing or reducing the abuse, and preventing new abuse.

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