General Procedure

Identification, Services and Outcomes (ISO) Matrix for Adult Protective Services (APS)

Introduction

This document describes how the ISO Matrix improves APS’ ability to reduce vulnerable adults’ risks of abuse and neglect, and maintain their independence to live in the community.

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

Evidence-based measures are used in the ISO Matrix to capture outcomes from APS interventions, and to ascertain the effectiveness of APS with quantitative data. With evidence-based measures in place, there is the opportunity for better quality of services and improved client outcomes.

Use of the Elder Abuse Decision Support System (EADSS) Short-Form*

The ISO Matrix uses the EADSS Short-Form to identify elder abuse and neglect. The EADSS Short-Form is used to conduct a comprehensive elder abuse investigation and to obtain a baseline assessment of abuse that can later be compared to caseworkers’ substantiation decision. These screening measures help the APS caseworker identify abuse/neglect in their interviews with alleged victims, collaterals, and alleged abusers.

The ISO Matrix extends the use of the EADSS Short-Form by adding a post-test to see if there are positive outcomes following provision of APS services. The ISO Matrix assists the caseworker to ask the client evidence-based questions about the types of abuse that are investigated under APS jurisdiction in that locality. The questions also elicit information about client and abuser risk factors. Caseworkers can also use their observations and interview collaterals to obtain information to answer the questions, especially when a client is not able to or refuses to answer question

Completing the ISO Matrix Pre-test Assessment

The ISO Matrix Pre-test Assessment is completed for APS cases where there is an initial face-to-face contact with the client.

  1. During the interview with the client, the APS caseworker identifies any abuse or neglect by asking the client the ISO matrix questions adopted from the EADSS Short-Form regarding the types of abuse and neglect that APS investigates, as well as client and abuser risk indicators**.
    1. There is a tear-out section in the ISO Matrix Project Manual that can be used to facilitate asking the client the questions for the ISO Matrix Pre-test Assessment.
    2. The tear-out section begins with self-neglect or neglect by others because the caseworker, in many instances, can use their observation to determine the answers to the questions.
    3. The order of the types of abuse questions can be changed by the caseworker in asking the questions of the client in order to facilitate the interview.
  2. Determines the harm level as “in-crisis, vulnerable, or no immediate harm”.
  3. For the allegations made in the APS report of abuse, it is recommended that the caseworkers ask all of the questions pertaining to that type of abuse or neglect being alleged, to complete a full investigation.
  4. The best method of obtaining answers to the ISO matrix questions is to include the questions in the conversation with the client.
  5. If the client is not able to participate in the assessment process, then an appropriate collateral (e.g., typically not an alleged abuser) may serve as a proxy in accordance with program confidentiality regulations.
  6. If there are no collaterals and the client cannot participate, as stated above, the caseworker can complete the assessment based on their observations and knowledge of the case.
  7. It is important for the caseworker to be aware that the final answer to every question rests with their best professional judgment.
  8. Following each type of abuse, the client’s level of risk is assessed.
  9. After completing the ISO Matrix pre-test, the answers can be documented in the program’s case data management system.

Service Plan Development

When abuse has been identified through the administering of the ISO Matrix Pre-test Assessment, the APS caseworker develops a service plan to remedy the abuse with input from the client. The service plan contains specific items identified to address the abuse/neglect found in the APS investigation. Service plans most often include the information listed below:

  1. Desired outcomes of the proposed interventions.
  2. Resources and strategies to be used in attaining desired outcomes.
  3. Description of each planned service.
  4. The start date as well as expected end date, if known.
  5. Provider name, if available.
  6. Amount of service implemented.
  7. Whether or not the client is able to consent to services.
  8. If the case is to be presented to a multidisciplinary team (MDT).

Completing the ISO Matrix Post-test Assessment

When services have been provided and near case closure, the APS caseworker administers the ISO Matrix Post-test Assessment.

  1. The APS caseworker follows these steps:
    1. Re-administers the same ISO Matrix questions to examine the reoccurrence and the new occurrence of abuse, if any.
    2. Determines the outcome level as “in-crisis, vulnerable, stable, safe or thriving”.
    3. Completes the client level of engagement as judged by the caseworker as “declines all interventions; partially engaged with services, agrees with remedies and service being proposed; or actively engaged in seeking advice and pursuing remedies”.
    4. Completes the availability of services screen as “remedy was/was not available”.
  2. The ISO Matrix Post-test questions can be asked of the client at a face-to-face visit; by a telephone call; through a contact with a collateral; or answered by the caseworker, if known.
  3. There are two numerical scores from the Pre-test and Post-test Assessments that can be compared to evaluate, in part, the results of interventions provided to remedy abuse.

Case Closure

The decision to close an APS case is to be made by the APS caseworker and the client jointly, whenever possible. Case closure is a systematic method to evaluate the services provided and whether the risks of abuse or neglect have been reduced or eliminated. If possible, a person who provides services to, or sees a client frequently, may agree to be identified as a “gatekeeper” to notify APS if the client’s situation worsens.

In some situations, the risk of abuse may be so significant that APS determines that the case cannot be closed. At this point, there may be an evaluation of the need for provision of involuntary services to protect the client from imminent harm.

References

*Beach, S., Liu, P., DeLiema, M., Iris, M., Howe, M. & Conrad, K. J. (2017). Development of short form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions. Journal of Elder Abuse and Neglect, 29(4), 229-253. doi:10.1080/08946566.2017.1338171

*Conrad, K. J., Iris, M., & Liu, P. (2017). Elder Abuse Computerized Decision Support System: Field test outcomes, abuse measure validation, and lessons learned. Journal of Elder Abuse and Neglect, 29(2-3), 134-156. doi: 10.1080/08946566.2017.1314843

**Conrad, K.J. & Conrad, K.M. (2019). Abuser Risk Measure for older adults: Reports by alleged victims to adult protective services. Gerontologist, 59(5), e403–e414. doi:10.1093/geront/gny091

**ISO Matrix Project Manual

[Last updated on 2/24/2020]