Federally approved Training Awareness ACL Application (1).pdf

Project Relevance & Current Need

The Illinois Department on Aging (IDoA) Adult Protective Service (APS) Program was implemented in 1991 and through the Illinois APS Act (Chapter 320 ILCS 20/l et seq.) has the authority to investigate abuse, neglect, and exploitation of older adults. In 2013, the APS Act was amended to further expand our jurisdiction investigation of adults aged 18-59 with disabilities. IDoA oversees the state-wide APS Program which currently contracts with 41 designated APS provider agencies located throughout the state. Recent challenges encountered by the Program involve the need to enhance APS training for a variety of audiences and deliver an updated public and professional education campaign.

The grant proposal includes four individual projects, all with the goal of enhancing training or awareness of APS reporting, assessment and service, each with its own focused audience and message. The four projects include:

Expected outcomes of the overall project include: 1) an increase in APS caseworker retention as a result of an enhanced skill set, 2) a more educated and informed public on issues of abuse, neglect and exploitation, 3) an increased number of reports to the APS Program, 4) an increase in self-reports by older adults and adults with disabilities, 5) increased reporting by key mandated reporters, and 6) an increase in prosecution of APS related cases.

1. Caseworker Simulation Training

2. Caseworker Trauma-informed Training

3. Public and Professional Awareness Campaign

4. Legal Professional Training

Such outcomes are relevant to the intent of the Administration for Community Living (ACL) funding announcement by improving the infrastructure for providing APS service through enhanced training and awareness involving all aspects of a case. The training component of the project will enhance investigations of adult maltreatment, improve skills and abilities needed by

APS caseworkers and supervisors, and develop and strengthen collaboration with and knowledge of legal professionals throughout the state. The public and professional awareness component will increase knowledge relating to the role and responsibilities of the APS Program.

The Illinois APS Program has experienced several changes and increased responsibilities in the past six years including: 1) Program expansion to include the investigation of self-neglect in

2018, 2) Implementation of an APS Abuser Registry in 2018, which lists caregivers recommended for inclusion on the Registry as a result of a verified and substantiated finding of abuse, and 3) Program jurisdiction expansion during 2019 to include those individuals who reside in facilities, and are the subjects of maltreatment reports that are not facility-based.

Facilities includes, but is not limited to, licensed facilities defined in the Nursing Home Care

Act, those licensed under the Intellectual Disability/Developmental Disability Community Care

Act, Community-Integrated Living Arrangements, assisted living arrangements, etc. Each of these expansions has resulted in new standards and procedures to be followed and added responsibilities for APS staff. The complexity of managing APS cases and interacting with varied professionals has grown immensely. The most recent APS public awareness campaign was completed during 2014 and did not include any of the expansions highlighted above.

Awareness and education to both the public and targeted professionals is long overdue.

In addition, initial training of APS caseworkers needs to be strengthened to enhance the learning process related to skills required for investigation of the diverse and complex population served by the program. A survey of Illinois’ APS providers found a 38% turnover rate in APS staff during state fiscal year 2018.

A focused effort to enhance initial caseworker training is a program objective that will result in an increased retention early in a caseworker’s career. Research supports initiating Project 1:

Simulation Training for APS caseworkers as a learning method that improves caseworker skills such as: active listening, problem-solving, observation and communication, can lead to improved service to clients. Simulation training can increase the caseworker’s confidence in entering stressful environments commonly found in APS investigations. Simulation training provides a mock setting where caseworkers engage with others role playing as clients and participate in standardized scenarios based on actual APS client situations. Research shows that deliberate practice of a skill is positively correlated with greater proficiency (Ericsson, Krampe, & Tesch-

Romer, 1993). Nadia Woodstock, APS Program Development Manager for California’s Sonoma

County, notes the following principles of adult learning should be followed while training social workers: 1) Adults take what they are learning now and connect those to past experiences, knowledge and opinions, 2) Adults need to be given tasks that directly relate to learning objectives and reinforce learning, 3) Adult learners thrive in collaborative settings with their trainers and peers. Simulation training goes beyond conveying instruction and information and allows trainers to identify through observation whether concepts are understood by trainees. This project will be part of a growing national movement to provide simulation training to support learning how to investigate adult maltreatment.

Per the Adult Protective Services County of Orange Facilitator Handbook (2018), “The use of simulation training has been widely recognized as an effective training tool in numerous fields, including military, medicine, law enforcement and social work. Child welfare agencies are routinely using simulation exercises for new social worker training and likewise, APS programs are following suit” (p. 3). Project 1 aligns with ACL National Voluntary Consensus Guidelines for State Adult Protective Services (6B) by providing training in core competencies for APS workers. The Voluntary Consensus Guidelines also note in Section 6B, that “studies suggest that educational programs provide workers with both competencies and increased commitment to their job, which are associated with retention.” IDoA believes the addition of simulation training will play a key role in worker retention of new hires by placing them in safe yet realistic scenarios they can practice in and receive immediate feedback before entering the field.

Support for Project 2: Trauma-Informed Training for APS caseworkers and supervisors is evident through the nationally representative survey which determined 89.7% of adults reported having been exposed to at least one traumatic event with an average exposure to 3.30 different types of events (Kilpatrick et al., 2013). APS caseworkers frequently encounter clients who have been chronically maltreated and traumatized. The impact of trauma is complex and mediated by class, gender, race, ethnicity and culture. The Substance Abuse and Mental Health Services

Administration (SAMHSA) (2014) defines trauma as “Experiences that cause intense physical and psychological stress reactions. It can refer to a single event, multiple events, or a set of circumstances that is experienced by an individual as physically and emotionally harmful or threatening and that has lasting adverse effects on the individual’s physical, social, emotional, or spiritual well-being” (p. 7). Trauma-informed work incorporates delivering services in a manner that avoids inadvertently repeating unhealthy interpersonal dynamics in the caseworker-client relationship. According to SAMHSA, 50-70% of women in psychiatric hospitals, 40-60% of women receiving outpatient mental health services, and 55-90% of women with substance abuse disorders report being physically or sexually abused, or both, in their lives (SAMHSA, 2007).

Levenson (2017) notes “Trauma-informed social workers rely on their knowledge about trauma to respond to clients in ways that convey respect and compassion, honor self-determination, and enable the rebuilding of healthy interpersonal skills and coping strategies” (p. 1). IDoA recognizes the need to incorporate consistent trauma-informed practice as an ethical obligation into standard APS training for our caseworkers to better serve clients. As the diversity of APS clients grows, caseworkers need to recognize the characteristics that result in disproportionate trauma exposure, avoid blame or stereotypes and emphasize strengths to reduce trauma-induced consequences. Additionally, the experience of secondary trauma by caseworkers, is a reality with possible severe impacts.

The impact of exposure to trauma through clients and its resulting secondary traumatic stress is now being viewed as an occupational hazard for settings that work with children and adults with complicated adaptations to trauma (Abrams & Shapiro, 2014). Lack of trauma-informed training can be detrimental not only for clients but also for caseworkers unprepared to handle such cases.

Providing caseworkers with knowledge on secondary and vicarious trauma can help them respond to work-related stress and burn out, which promotes improved program functioning and more effective practice with clients. Project 2 aligns with the ACL National Voluntary

Consensus Guideline (1A) by implementing training to APS staff on the trauma-informed approach to client service including recognizing the signs of trauma and working to empower clients. Trauma-informed practice is believed to lead to improved client relations and will increase caseworker consideration of client demographic elements submitted to NAMRS.

The need for Project 3: Public and Professional Awareness is based not only on the many changes to Illinois’s APS Program discussed above but also due to the anticipated growth in the baby boomer population, which alone increases the possibility of maltreatment in coming years and the need for continued awareness. IDoA’s FY 2017 Annual Report notes since 2000, Illinois older adults aged 60 and older have grown from 1.9 million to 2.5 million. This age range now represents 19.6% of the population of Illinois. By 2030, it is estimated that the 60 years and older population will increase to 3.6 million and will represent 24% of Illinois population. Public education to this growing population plays a critical role in abuse prevention. Tsumba’s 2012

‘White Paper for Elder Justice Coordinating Council’ conducted a market research study to determine the feasibility of a public education campaign addressing elder abuse. The findings found a “pressing need for a clear and consistent public education campaign to raise awareness and understanding of elder abuse, as well as to educate people about identifying and avoiding situations in which older Americans are at risk of abuse.” (Tsumba, 2012). While various factors contribute to a rise in APS reporting, IDoA did observe a ten-percent increase in APS reports following the previous 2014 awareness campaign. The 2009 National Elder Mistreatment Study reports that approximately one in 10 Americans over age 60 experience abuse (Acierno et al., 2009). In Cook County Illinois alone, there is a population of 457,110 persons 60 years and older, and another 556,077 older adults residing in Suburban Cook County. In FY 2017, Office of APS received approximately 8,000 reports from these areas. It is critical to educate the baby boomer population about the signs of Aging and how to report maltreatment prior to advanced aging when cognitive decline can increase. Awareness campaigns including messages of how to remove oneself from an abusive or neglectful situation will empower individuals to speak up for themselves.

Project 3 aligns with the ACL National Voluntary Consensus Guidelines (1M), which recommends APS programs devote resources for engaging communities through public awareness and/or educational sessions.

Implementation of Project 4: Legal Professional Training is supported again through the rising aging population resulting in an increase in the number of court cases related to abuse, neglect and exploitation. The two main intervention systems for adult victims of maltreatment are APS and the justice system. Adult maltreatment is a system-wide issue with victims affected by the actions or inactions of the professionals involved. In 2019, consistent feedback from Illinois’s

APS providers related to the need for professional legal training includes such topics as: state laws related to abuse/neglect/exploitation, guardianship and guardian duties, judicial protocols on guardianship petitions or Orders of Protection, awareness of what APS is, how APS assists clients in court, and APS confidentiality. In 1993, the State Justice Institute funded the American

Bar Association (ABA), Commission on Law and Aging to conduct a study related to the state courts’ ability to handle elder abuse cases. Among the problems identified was the lack of knowledge about and sensitivity to elder abuse by judges which leads to an inhibition to bring such cases to court (Stiegel, 2016). It was identified that judges and court staff need training and practical tools such as bench cards on issues related to elder abuse including but not limited to

State laws, services, decision-making capacity, undue influence, and effective orders (Stiegel, 2012). Providing such training to legal professionals will serve to increase professional coordination and improve service to APS clients found to be victims of crimes.

Senate Bill SJR0013, which passed both houses of the Illinois General Assembly in May 2019, created an Elder Abuse Task Force to investigate the effectiveness of current elder protective services and laws, examine barriers to prosecution and strategies to increase public awareness of elder abuse and reporting, study training resources and best practices in other states, and identify a long-range plan to combat elder abuse. IDoA finds all four projects included in this proposal align with the goals of the Task Force and subsequently will have further consideration and support from the Task Force moving forward during the three-year grant period and beyond.

IDoA was successfully awarded a 2015 ACL grant that allowed for the development of a web-based case management system, which significantly increased the number of data elements now reported to the National Adult Maltreatment Reporting System (NAMRS). Due to staffing and technical issues the system was not implemented until August, 2018. The proposed enhanced training to APS caseworkers and supervisors is expected to improve the quality of data collection and analysis during assessment. Experienced active listening along with increased caseworker awareness, competence and confidence all lead to more effective communications with clients.

These practiced skills allow a caseworker to fully engage with a client taking the time to ask the questions needed to understand the client and the situation in a holistic manner, while increasing the accuracy and quantity of data reported to IDoA and NAMRS. IDoA has successfully reported data to NAMRS over three federal fiscal years 2016-2018. IDoA will analyze both the case management system and the NAMRS data to target populations for focused awareness efforts and evaluate the projected outcomes as discussed in this proposal.

Approach

The grant proposal includes four distinct projects, all with the goal of enhancing training or awareness of APS reporting, assessment and service. IDoA’s Office of APS will have overall responsibility for the leadership of the project. Jody Kershaw, IDoA Office of APS Liaison, will serve as the Project Director coordinating the overall project, serving as ACL contact and responsible for grant reporting. The Project Director served as the lead on the 2015 ACL grant award, including management of the project and reporting to ACL. Claudia Kemple, IDoA

Office of APS Trainer, will serve as the project lead related to the caseworker simulation training, coordinating with other Office of APS trainers. Maureen Squires, IDoA Office of APS

Public Service Administrator, will serve as project lead for the trauma-informed training and the public and professional awareness campaign. Karen Kloppe, IDoA Office of APS’ Legal

Assistance Developer, will serve as project lead for the professional legal training piece.

The approach to Project 1: Simulation Training will involve partnering with the Child Protection

Training Academy (CPTA) at the University of Illinois at Springfield (UIS), which established the Simulations Laboratories program in 2016 to provide a safe learning environment with realistic challenges that bolster investigators skills and confidence. To date, the Laboratories have only been used for the Illinois Department of Children and Family Service (DCFS) child protection investigators. IDoA recognizes the benefits this established training will provide APS investigators. APS caseworkers must be appropriately trained to perform a home visit before being sent into the field. In order for the caseworker to move forward with an investigation, the caseworker must quickly and effectively establish trust and rapport with the client. The

Simulations Laboratories program consists of a house on the UIS campus, which is designed to simulate a client’s home. In addition, a meeting room on the main campus is outfitted as a

Courtroom to simulate the court experience. Paid actors from Southern Illinois University (SIU)

School of Medicine’s Standardized Patient Program portray client and family members. UIS currently contracts with SIU for the actors’ services. Therefore, the cost for the actors related to this project will be handled between UIS and SIU. These actors will be trained to play alleged victims, alleged abusers and collateral informants.

UIS also has established relationships with retired and active professionals who play roles matching their professional expertise in the mock courtroom. Many APS caseworkers find that the courtroom can be a very intimidating environment. The mock courtroom is a safe location where mistakes are expected to be made, but allowing the caseworker to strengthen skills without harm to self or the client. Utilizing courtroom simulation will facilitate open communication while better preparing caseworkers to testify and attend court. While the

Simulations Laboratories are currently in one central Illinois location, CPTA is currently negotiating a second location in the Chicagoland area, which should be finalized during the first year of the grant period.

The IDoA Office of APS is responsible for providing training to all APS caseworker and supervisory staff. Currently, APS caseworker training consists of a four-day initial certification followed by a two-day Phase II certification within six months. The initial certification objectives include increasing knowledge of abuse theories, learning skills and techniques for investigation/assessment/intervention/closure, learning Illinois APS policies and procedures, exploring ethical issues, and learning effective documentation skills. The three-day Simulation

Training will be added at the end of the initial four-day classroom certification training. IDoA will incorporate the courtroom experience for the trainees using the simulation courtroom on

Day 3 of Simulation Training. New APS hires will be the target audience of the simulation trainings.

APS initial certification training is offered a total of six times per calendar year in two different locations in the State with up to 30 attendees per training. Only 10-15 trainees will attend the simulation training at one time, with a maximum of 420 caseworkers completing simulation training during the three-year grant period. The Simulation Trainings will be offered two consecutive weeks following the four-day classroom training to accommodate all caseworkers.

During grant year 1, four trainings will be offered, twelve in year 2 and twelve in year 3. The first simulation training will be offered in March of 2020.

IDoA will enter into a contract with UIS, for the services of Dr. Betsy Goulet, Department of

Public Administration and Susan Evans, training specialist, both with the CPTA. IDoA staff trainers will work with the CPTA staff to develop simulation training specific to APS. Both

Goulet and Evans have several years experience in child protection, which will be coupled with

IDoA’s trainers who have a combined 43 years of APS experience, which includes field experience as both an APS caseworker and caseworker supervisor.

The interest in the Simulation Laboratories originated from Dr. Goulet’s experience in 2010 with simulation training at the National Child Protection Training Center in Minnesota. In developing the Simulation Laboratories, Dr. Goulet and Ms. Evans completed simulation research during

2015, including contact with the Residential Simulation Lab of California State University to understand how simulations work in social work trainings. As of June of 2018, 474 child protection investigators have been successfully trained at the Simulation Laboratories. With the increase in the staff time needed to provide the initial certification training and the need to ensure back-up for IDoA’s trainers, two additional staff trainers will be identified in State Fiscal Year

2020. These positions will be supported and sustained outside the grant award. As part of the simulation training, trainees will be able to participate in a live call with a reporter of maltreatment as well as interview the alleged victim, alleged abuser, and any collaterals.

Simulations will consist of 7 to 8 minutes of actual role-playing with actors for each trainee, followed by 5 minutes of debriefing the trainee. One simulation will be completed per day.

Debriefing will include immediate feedback from the actors, trainers and other trainees. Video recording will be available and will be used as a review tool during the debriefing. Trainees will be asked to complete evaluations prior to completing the training, at the completion of training, and then again 6-months later to better determine whether lessons learned were utilized and beneficial. These evaluations will include trainee suggestions for simulation training improvements. Results of these evaluations will be tabulated and assessed by a contracted UIS graduate student and the IDoA trainers. A report on the findings will be prepared by UIS.

The first six months of year one of the grant will comprise the research and development phase of the standard APS simulation curriculum, involving IDoA trainers and the CPTA staff. This period will also include creating or gathering agendas, vignettes, props, supplies, handouts, trainee evaluations, and securing training dates.

One barrier to Project 1 will be the travel costs associated with mileage and hotel for the APS trainees during the three-day simulation training. Trainees will be participating from throughout the State and APS provider agencies already bear the cost of sending staff to the initial caseworker training. IDoA will include grant stipends specific to APS Providers for trainee travel to complete the simulation training. The stipends will be supported and sustained outside the grant award, beginning in State Fiscal Year 2020 and include approximately $43,200 during the three-year grant period.

The approach to Project 2: Trauma-Informed Training will involve contracting with a national expert in trauma-informed practice to complete a one-day specialized trauma-informed training during the Fall 2020 Illinois hosted Adult Protection and Advocacy Conference (APAC).

Training will include how trauma affects people and cover secondary trauma and creation of a self-care plan for caseworkers. The training will incorporate realistic case studies along with a step-by-step approach for caseworkers to consider. This training will be recorded by the Illinois

Department of Central Management Services and used as an additional tool to be utilized by new

APS caseworkers in the future. Trainees will complete pre and post tests and training evaluations, followed by the completion of a survey 6-months post-training to assess usefulness of the information learned. Trauma-informed training will allow such concepts to be consistently interwoven and applied throughout the duration of a case and across all APS Providers. The

Public Service Administrator for the Office of APS will oversee development and arrangements for the APAC training, along with development of the associated tests, evaluations, and surveys.

IDoA foresees no expected barriers to successful completion of this project. IDoA plans to measure the impact of the enhanced training on staff retention through a newly established

Training Tracking Database used by the majority of IDoA contracted providers.

The approach to Project 3: Public and Professional Awareness Campaign will involve a targeted approach to inform the public state-wide and targeted professionals about APS and adult maltreatment. With all the additional populations covered by the Office of APS, a restructured message is needed. The public awareness campaign will consist of developing printed, electronic, and media materials. The message will educate the public about self-neglect, adults with disabilities aged 18-59, and financial exploitation of older adults. Messages will include providing accurate information about what adult maltreatment is, where it happens, and how to recognize it. The campaign will educate people that adult maltreatment and justice is relevant to them while also reducing the stigma of victimization and fighting ageism. IDoA will utilize staff from IDoA’s Office of Marketing and Publications to help develop the various themes to be used for targeted audiences. Cost of this staff will be provided as Non-Federal In-Kind contributions.

IDoA will contract with CBS Television Community Partnerships-Chicago (CBS) to help create and disseminate the awareness campaign to the targeted audiences. The updated, multi-platform education and outreach campaign includes a 26 percent in-kind contribution by CBS in each of the three grant years. This amounts to $136,500 over the three-year grant period in donated broadcast television, marketing and social media distribution intended to have a direct, measurable and positive impact. CBS agrees to contribute in the form of creative services, production, research, distribution and execution of the campaign and materials. The campaign would be featured in appropriate television programming and digital environments in key markets to maximize impact. The number of older adults who regularly use social media is growing. According to Tsumba (2012), “between April 2009 and May 2010, the number of

Internet users ages 50 and older engaged on social media increased from 22 to 42 percent” (p.6).

IDoA intends to use a multi-pronged approach and include social media outlets to reach additional target populations and enhance our outreach efforts.

Further, the campaign theme and other graphics will be utilized by IDoA to create tool kits that can be used and adapted by each of the thirteen Planning and Service Areas (PSAs), including the APS Providers within each PSA, to further opportunities for outreach locally. Providers will be encouraged to target known areas with higher rates of hospitalizations and ER visits as a result of abuse and neglect of adults. Awareness tool kits for sister agencies such as the Illinois

Criminal Justice Information Authority’s Illinois Family Violence Coordinating Councils will also be made available for dissemination throughout the state. These kits will include brochures, palm cards, fact sheets and posters.

Year one of this project will consist of contracting with CBS for the development and beginning dissemination of the theme and campaign materials. During year one, IDoA staff will share and obtain feedback on the draft campaign components with IDoA’s APS Advisory Committee, whose purpose is to provide advice on policy issues and to assist IDoA’s Office of APS in being responsive to concerns regarding the program. This Committee is comprised of representatives, appointed by IDoA, from the Area Agencies on Aging and APS Provider Agencies. Engaging the committee will promote buy in to the campaign and convey support to the rest of the APS network. IDoA will collaborate with sister agencies such as the Illinois Department of Human

Services Division of Rehabilitation Services and Division of Developmental Disabilities to gather further feedback on reaching the adults with disabilities population. In year one IDoA will order from a competitive supplier freestanding banners using the campaign theme. Such banners would be housed in each of the thirteen PSAs throughout the state and used by APS Providers on a rotating basis for various events throughout Illinois. We envision the banners to be used at conferences, senior events, World Elder Abuse Awareness Day events, seminars, trainings and the Illinois State Fair, which hosts senior related events at the Senior Building for the duration of ten days.

Year two will include further implementation of the campaign, including marketing and distribution of the tool kits and outreach to the public and targeted areas. IDoA will contract with the Illinois Broadcasters Association (IBA) to air public service announcements during a 13-week campaign using its 224-member radio stations throughout the state. The radio campaign will utilize the already developed theme. IDoA will further enhance visual elements of the campaign by ordering and placement of 200 billboards throughout Illinois from the Illinois

Association of Outdoor Advertiser (IAOA). IDoA’s last campaign utilizing such exposure proved highly effective. The cost of the billboards is for installation only as the IAOA is waiving the rental charge as an in-kind contribution.

As the tool-kits are utilized, APS Providers will be required to report their awareness activities and targeted audiences reached. Therefore, year two will include the beginning of an evaluation by IDoA of the APS Provider feedback and analysis of reporting statistics. IDoA’s Public

Service Administrator, will serve as lead on the project, coordinating with other IDoA staff and the contractors. A potential barrier to the proposed project is the time needed by Providers to become familiar with the campaign kits and to complete outreach efforts. Such time is taken into consideration in the Work Plan. It is believed an awareness campaign can serve to also garner additional community support and trust for the local APS Provider. Therefore, it benefits the

APS Providers to make time to use the kits to the fullest.

Year three will consist of the final dissemination of the campaign by CBS. Office of APS will continue to distribute awareness tool kits to mandated reporter professionals and the public.

IDoA will gather data and analyze end results of the campaign including input from CBS considering geography, media platforms and reception to messaging. Office of APS will develop a plan to sustain messaging and maximize visibility post campaign, particularly in identified areas still underrepresented in reporting. IDoA will consider and incorporate any needed changes into program practice based on learned outcomes.

The approach to Project 4: Training for Legal Professionals will build upon past efforts to improve handling of investigations by law enforcement, increase prosecution, and provide effective legal interventions in cases involving abuse, neglect, and financial exploitation of older adults and adults with disabilities. IDoA will work with national legal experts on a consulting basis to develop a training roadmap to produce a video series relating to how different types of professionals interact with an alleged victim during a case. The videos will address a range of issues, including: 1) ageism and implicit bias; 2) trauma-informed interviewing and investigations; 3) capacity, undue influence, and other evidentiary issues relating to individual cognitive deficits; 4) measures to counteract excuse and justification defenses offered by alleged abusers; 5) best practices for case management and court docketing; 6) access and accommodation issues needed by older adults and individuals who have disabilities; and 7) innovative legal interventions to protect the alleged victim in both criminal prosecutions and related civil proceedings. The project product will include an Education Resource Kit that can be used to foster increased collaboration between the various entities and organizations providing training to law enforcement and prosecutors on maltreatment of older adults and adults with disabilities.

The focus for year one will be procurement of appropriate consultants with national expertise relating to elder abuse, law enforcement, and elder law and abuse prosecution to develop the training roadmap. In year two, IDoA staff will work with these consultants to script and film videos at the UIS simulation house, office, and model courtroom settings with the film production team at the UIS Child Protection Training Academy. IDoA plans to work with the

Illinois Office of Communications and Information Video Services for film product, editing, and closed captioning. The only charge is limited to closed captioning. However, other partners may be able to provide support for this work as well. Part of this work will include preparation of a

Trainer Manual, course material for different types of professionals, and the Education Resource

Toolkit. IDoA will showcase the videos at the Illinois APAC in 2021. Invitations will be extended to contacts at other training organizations to open opportunities for collaboration and use of the Education Resource Toolkit. Using the training roadmap, IDoA will endeavor to expand on the training videos moving into the future based on participant feedback.

The target audiences for Project 4 include: law enforcement, prosecutors, judges, Title III-B

Legal Assistance Developers and other Elder Law Attorneys. Outreach will be packaged through videos, trainer manual, course material, training event and resource kits. Possible trainings may be offered through various existing avenues, including: 1) the Elder Justice Coordinators in the

United States Attorney’s Offices for the Northern, Central, and Southern Districts of Illinois; 2) the Judicial Education Division in the Administrative Office of Illinois Courts; 3) the Office of

Attorney General’s Elderly Service Officer’s training curriculum; 4) the Illinois State’s

Attorneys Appellate Prosecutor; 5) the Office of State Guardian at the Illinois Guardianship and

Advocacy Commission; 6) the Illinois State TRIAD (law enforcement, community advocates, and social services); 7) the Illinois Criminal Justice Information Authority’s Family Violence

Coordinating Councils throughout the State; and 8) the Elder Law Section Council of the Illinois

State Bar Association. The lead person for this project is IDoA Legal Assistance Developer , who has 28 years’ experience in State government and 15 years with the IDoA. The Legal

Assistance Developer’s role within the Office of APS is to provide leadership and assistance to promote legal advocacy and assistance programs under the Older Americans Act as part of the

Aging Network.

While IDoA has already reached out to these other legal entities and organizations to discuss this training component under the grant, a barrier to securing commitments is the current lack of a product to present to appropriate leadership for consideration. Also, a pre-approval process is needed to obtain continuing education credits for the different types of professionals who could benefit from participation in this elder abuse training, so some collaboration may have extended cycles. IDoA will build and maintain a calendar for promoting upcoming training opportunities as a public resource to legal professionals to help navigate timing associated with this pre-approval process and scheduling of other training events by all training organizations.

Project Impact

Project 1 Simulation Training outcomes consist of:

➢ Trainees will demonstrate active listening during training – measured by trainers following each training

➢ Trainees will identify areas of improvement after debriefing – measured by trainee evaluations following debriefing

➢ Trainees will demonstrate improvement in interviewing skills and reflective practice abilities – measured by trainee evaluations taken 3 - 6 months following training

➢ Trainees will increase their knowledge of APS standards and procedures – measured by comparison of a trainee pre-exam compared to post-exam following simulation training

➢ Trainees will increase their competence and confidence and decrease their anxiety levels

– measured by trainee evaluations at the end of simulation training

➢ Trainers will identify knowledge/skill deficits for establishing training objectives – measured yearly through trainer review of trainee evaluations

➢ Increase in APS caseworker retention – measured by a comparison of the turnover rates preceding and following implementation of simulation training

Simulation Trainings will become a standard of initial caseworker certification with IDoA dedicated training staff to manage and facilitate future trainings following completion of the grant period. Adoption of simulation as a standard of APS training will be viewed as more accountable and ethical by the population served. Data from the Simulation Laboratories used by

Illinois DCFS is beginning to indicate investigator turnover is decreasing for those who received training through simulation. Cross and Chiu (2018) found in an investigator survey once they controlled for age, experience and other variables, non-simulation trained investigators were more likely to think about leaving their job. The quality of APS training is believed to be important in staff retention and will be studied further through this grant opportunity by evaluating the pre and post trainee evaluations and turnover rate. Adding Simulation Training to the APS standard training is an evidence-based approach to significantly improving caseworker practice and service to clients.

Project 2 Caseworker Trauma-informed Training outcomes consist of:

➢ Trainees will have improved attitudes and readiness for adopting trauma-informed practice – measured through trainee surveys

➢ Trainees will realize the widespread impact of trauma and understand potential paths for recovery – measured through trainee exams

➢ Trainees will recognize the signs and symptoms of trauma in clients, families, staff, and others involved with the system – measured through trainee exams

➢ IDoA will integrate knowledge about trauma into training practices – measured by completion of this task

➢ Trainees will use self-reflection and self-care practice to prevent and address secondary traumatic stress/vicarious trauma in self and organization – measured through follow-up trainee survey

➢ Increase in APS caseworker retention – measured by the rate of caseworker turn over from year before training offered to year after training

A core guiding principle of the Illinois APS Program is the client’s right to self-determination.

Effective trauma-informed care engages clients as partners and empowers them to guide their intervention. IDoA will utilize these outcomes to justify including trauma-informed care into standard APS training in the future.

Project 3 Public and Professional Awareness outcomes consist of:

➢ Sustained increase in annual reporting to Illinois APS by targeted populations – measured by numbers of Intakes received and data elements for each

➢ Increase in self-reports to APS Program by older adults and adults with disabilities – measured by number of Intakes received and alleged victim age

➢ Increase in reporting by key mandated reporters – measured by the number of Intakes received by reporter type

➢ Heightened awareness of the public and mandated reporters on issues of abuse, neglect, and exploitation – measured by tracking the reach and effectiveness of the campaign messages including APS Provider reporting pinpointing geographic location

➢ Heightened visibility of Illinois APS program – measured by tracking the reach of the campaign messages including APS Provider reporting

Per the Illinois APS Act (Chapter 320 ILCS 20/l et seq.) Section 3.5(a), IDoA is responsible for promotion of public and professional education to increase awareness of abuse, neglect, financial exploitation, and self-neglect and to increase reports. IDoA will continue to meet this mandated responsibility as further data from our case management system is collected, analyzed, and distributed allowing for further targeted public and professional outreach. Such work is contingent on the availability of funds through the Illinois Commitment to Human Services

Fund. This Public Awareness Campaign is expected to lead to further advocacy for funding and support of the APS Program into the future.

Project 4 Legal Professional Training outcomes consist of:

➢ Improved communication between state judges and APS Providers responsible for investigating adult maltreatment – measured by the number of training sessions and events completed

➢ Increased awareness of adult maltreatment and the APS Program amongst Illinois judges and prosecutors – measured by the number of training sessions, training events, kits distributed and training attendees

➢ Increased prosecution of adult maltreatment crimes – Such an outcome is difficult to measure at this time as no method of tracking specific older adult or adults with disabilities as crime victims is known to be available at this time. IDoA will explore how this may be developed while coordinating with other legal organizations.

➢ Cross-disciplinary training to improve the capacity of all professionals’ work with older adults and adults with disabilities to identify and report adult maltreatment – measured by the number of training sessions, training events, attendees and toolkits distributed

Per the Illinois APS Act (Chapter 320 ILCS 20/l et seq.) Section 3.5, IDoA is responsible for improving response by various legal, financial, social, and health systems in addition to coordination of efforts with other agencies, councils and like entities, to include but not limited to the Administrative Office of the Illinois Courts and the Office of Attorney General.

IDoA intends to use outcome data from each project to justify the need and support for continuation of each project into the future through the Illinois Commitment to Human Services

Fund.

Evaluation

IDoA will utilize the information gathered from the measured outcomes to evaluate whether the objectives of the project were met related to the overarching goal of enhancing training and awareness of APS reporting, assessment and service. Please see the ‘Project Impact’ section above for each specific measure to be used for each objective. IDoA will need to fully evaluate each project outcome measure available to determine program impact and future direction. This data will include qualitative and quantitative data from the various surveys, evaluations and exams related to each project along with 1) new data elements collected in response to NAMRS reporting requirements, and 2) program data related to caregivers reported to the APS Abuser

Registry. IDoA’s case management system will provide more precise data elements related to individuals served and the case plans developed to meet the needs of those individuals.

With the expansion of APS services in Illinois, it becomes imperative to identify the actual impact the program is having on outcomes for the individual. Our expanded data system will positively inform data analysis, which will ultimately allow the program to further target its resources to those most critical service components. In years two and three of the grant period, the APS Program plans to explore an Intergovernmental Agreement with an Illinois Department of Public Health epidemiologist to review project measured outcomes and analyze overall APS

Program impacts. There would be no additional cost to the grant from this work.

IDoA will track lessons learned for each project for reporting to ACL and for the benefit of any future similar projects attempted by our office. IDoA outcomes will provide information for other states to consider when enhancing their own APS training or developing awareness campaigns.

Each of our four individual projects will affect the entire State of Illinois and can be duplicated across the country with the appropriate resources. Successful completion of the enhanced training and awareness outreach will result in increased reports to Illinois APS statewide and by targeted populations.

Capacity

IDoA was created by the State Legislature in 1973 to improve the quality of life for Illinois older adults by coordinating programs and service enabling older adults to preserve their independence if possible. IDoA is the single State agency in Illinois authorized to receive and dispense Federal

Older Americans Act funds, as well as specific State funds, through Area Agencies on Aging and community-based service providers.

IDoA’s administrative structure reflects the major areas of activity required to fulfill the agency’s legislative mandate and overall mission. In addition to the Executive Office, the other organization units are the Division of Community Relations and Outreach, the Division of

Finance and Administration, the Division of Planning, Research & Development, the Division of

Home and Community Services, the Division of Aging Client Rights and the Division of

Benefits, Eligibility Assistance and Monitoring. IDoA’s Senior HelpLine, which is part of the

Division of Community Relations and Outreach, houses the Adult Protective Service Program’s

24-hour toll-free line.

IDoA is responsible for administering its statewide APS Program, under the authority of the

Adult Protective Services Act (320ILCS 20/1 et seq.). The APS Program is housed in the

Division of Aging Client Rights and receives its funding through the Commitment to Human

Services Fund which is included in IDoA’s appropriation and allocated specifically for the APS

Program.

The APS Program is locally coordinated through 41 provider agencies which are designated by the Area Agencies on Aging and IDoA. The Adult Protective Services Act requires that provider agencies assist older adults age 60 and over and adults with disabilities age 18-59 by receiving reports of suspected abuse, neglect, financial exploitation, or self-neglect, conducting face-to-face assessments, determining if allegations of abuse are founded, referring for necessary support services and providing case work and follow-up services on substantiated cases. The APS

Program responded to 17, 085 reports of abuse, neglect and exploitation in State Fiscal Year

2018. It is through the State legislature’s on-going support for the APS Program and the APS providers’ long-standing provision of services outlined above that IDoA is well positioned to continue the activities initiated through this project after the grand period ends.

IDoA regularly works with other state agencies and associations such as the Illinois Department of Healthcare and Family Services, Illinois Department of Public Health, Illinois Department of

Human Services, Illinois State Police, Illinois Office of Attorney General, the Illinois Criminal

Justice Information Authority’s Illinois Family Violence Coordinating Councils, Illinois

Coalition Against Domestic Violence, Illinois Coalition Against Sexual Assault, Illinois Network of Centers for Independent Living and more to coordinate on issues of the rights of older adults and adults with disabilities.

The IDOA APS Program currently consists of a total of ten staff including three focused on

Program training and outreach. Key IDoA personnel for this project are dedicated to directing this project to meet project objectives on-time and successfully. IDoA personnel were chosen based on their experience and skills related to each project component.

Works Cited

Abrams, J., Shapiro, M. (2014). Teaching trauma theory and practice in MSW programs: A clinically focused, case-based method. Clinical Social Work Journal, 42 (4), 408-418.

Acierno, Ron, Hernandez-Tejada, M., Mussy, W., Kenneth, S. (2009, March). National Elder

Mistreatment Study.

Cross, Theodore P., Chiu, Yu-Ling. (2018). FY2018 Program Evaluation of the Child Protection

Training Academy for New DCFS Investigators. Retrieved from Illinois Department of

Children and Family Services https://cfrc.illinois.edu/pubs/rp_20181016_FY2018ProgramEvaluationoftheChildProtecti onTrainingAcademyforNewDCFSInvestigators.pdf

Ericsson, K.A., Krampe, R.T., & Tesch-Romer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363-406.

‘Facilitator Handbook, Simulation Training – Beyond the Classroom’. County of Orange, Training and Career Development, 2018. doi:

http://www.napsa-now.org/wp-content/uploads/2018/08/505-APS-Simulation-Training-

Beyond-the-Classroom-1.pdf

Illinois Department on Aging. (2018, December). Fiscal Year 2017 Annual Report. Retrieved from Illinois Department on Aging:

https://www2.illinois.gov/aging/Resources/NewsAndPublications/Publications/Document s/FY17_IDoA_AnnualReport.pdf https://cfrc.illinois.edu/pubs/rp_20181016_FY2018ProgramEvaluationoftheChildProtectionTrainingAcademyforNewDCFSInvestigators.pdf https://cfrc.illinois.edu/pubs/rp_20181016_FY2018ProgramEvaluationoftheChildProtectionTrainingAcademyforNewDCFSInvestigators.pdf http://www.napsa-now.org/wp-content/uploads/2018/08/505-APS-Simulation-Training-Beyond-the-Classroom-1.pdf http://www.napsa-now.org/wp-content/uploads/2018/08/505-APS-Simulation-Training-Beyond-the-Classroom-1.pdf…