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In 2014, The New York Community Trust generously provided Phase One funding to the NYC Elder Abuse Center (NYCEAC) to develop and deliver a pilot curriculum to teach NYC Adult Protective Services (APS) staff to gather information about APS client decision-making abilities. A semi-structured interview tool, IDA (Interview of Decisional Abilities), was created for use by NYC APS caseworkers, and a pilot training was conducted in its use. The Phase One training imparted conceptual knowledge about decision-making capacity, provided experiential training necessary to support APS caseworkers in gathering information about clients’ decision-making abilities, encouraged triaging capacity referrals to psychiatry for further assessment and supported supervisors in their oversight of caseworkers’ provision of these services.
Phase One project goals were accomplished by:
Convening a Project Planning Committee (PPC) to provide expertise in the development of the curriculum and training and achieve the goals of the grant project. The PPC met in full capacity and in workgroups to discuss critical issues related to capacity assessments and crystalize the key concepts to include in the semi-structured interview tool and trainings. The PPC also provided guidance to a core PPC training group who fine-tuned the curriculum and the semi-structured interview tool, developed case studies, created a Train-the-Trainer curriculum and developed the project’s evaluation materials. Over the course of the project year, PPC members made many decisions to guide the project towards successful completion. Click here to view highlights of the PPC’s key decisions.
Developing a Semi-Structured Interview Tool – “Interview of Decisional Abilities (IDA)”: The purpose of IDA is to gather information about an APS client’s decision-making abilities and to guide referral to psychiatry, if needed, for assessment of decision-making capacity. Developing IDA required the Core Training Workgroup to carefully review the ACED (as components of IDA borrow from both the concepts and the structure of The Assessment of Capacity for Everyday Decision-making (the ACED), developed by Drs. Lai and Karlawish); assess each question and potential response; and determine the most effective way to ask that question and document the response. It was imperative to develop a semi-structured interview tool that accurately captured a client’s understanding and appreciation of his/her risk and service options and that would be understood by APS caseworkers. This process took 10 months with feedback from the APS mini-pilot participants, the full PPC, and an outside capacity research expert.
IDA has 6 steps, or anchor points, which include asking the client his/her understanding and appreciation of the problem and service option. The first step of the IDA is to complete a cover sheet, which helps the APS caseworker identify the issue or problem to use with IDA, i.e., the issue with the most imminent, acute risk. Each step provides simple instructions for utilization and clear information on what APS caseworkers should do with the information gathered. After the 6 steps are completed, the APS caseworker chooses one of the four case disposition options listed on the IDA. APS caseworkers utilize IDA during the APS assessment process. But IDA is only one part of the overall APS assessment process. IDA is uniquely designed to allow caseworkers to easily synchronize their assessment results with appropriate interventions.
Conducting a training for NYC APS caseworkers and supervisors: NYC APS leadership identified APS caseworkers and supervisors with all levels of experience and skill to participate in the training. This 2-day pilot training was designed for 50 APS caseworkers and supervisors and was conducted in April and May 2015. The training was completed twice with a 3-week field-testing period utilizing IDA with their clients in between Day 1 and Day 2. Click here to view training agendas for Day 1 and Day 2. After the formal training, a few caseworkers and supervisors were selected by APS leadership to continue field-testing IDA during July 2015. The training included an overview of cognition, cognitive impairment and decision-making abilities; instruction on the use of IDA; role-play exercises using case studies developed for utilizing IDA, including case studies and applying a case using; ongoing supervision; and the opportunity for practice and feedback over time.
The training design utilized didactic and experiential methods to convey information and develop skills. During the training, APS caseworkers had the opportunity to: a) practice IDA questions; b) apply the tool to case studies; c) document conclusions including observations, quotes, etc.; d) make a recommendation on client’s decision-making ability; and e) discuss results with supervisors. APS supervisors were taught the above as well as how to supervise APS caseworkers utilizing IDA with clients.
Obtaining feedback from training participants and trainers: This project charted new territory. Thus, a message of “learning together” and encouraging conversation was conveyed to the trainees throughout the training. In support of this message, the PPC designed an evaluation process promoting honest feedback, both positive and negative. Both trainers and participants evaluated the training. The participants completed a pre/post-test and feedback forms and provided feedback on notecards during a training exercise and then again during a post-training phone meeting. The PPC trainers discussed the training pilot’s overall successes and challenges. The project results provide insight into the benefits, complexities and challenges of standardizing how APS caseworkers assess decision-making capacity. Critical feedback gathered from the training was fully integrated into the project’s planning for Phase Two, which is now underway. Phase Two includes refining IDA and the training curriculum, and improving teaching methods.
For more information:
If you would like more information about this pilot project, please contact Pam Ansell, Project Coordinator, at email@example.com or NYCEAC. Please note that IDA and the training curriculum are in the pilot stage of development and thus are not available for distribution at this time.