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June 10, 2020
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WEST LAFAYETTE, Ind. — Adults at risk for self-neglect are often placed on Adult Protective Services’ (APS) radar by neighbors who notice environmental issues, such as increasing amounts of insects or trash.
If not addressed properly or in a timely manner, the at-risk adults could face eviction and a longer and more difficult road to recovery.
But a new assessment tool developed by a team led by a Purdue University social scientist can help caseworkers address issues of self-neglect and get resources to clients in a quicker manner.
The Identification, Services, and Outcomes (ISO) Matrix – a short abuse, neglect and exploitation assessment, including self-neglect – was developed to test how standardized measures can provide confirmation on mistreatment. The ISO Matrix shows flexibility in the development of structured decision making and addresses inconsistencies.
The self-neglect portion of the matrix and research are featured in the Journal of Elder Abuse and Neglect. Pi-Ju (Marian) Liu, an assistant professor of nursing in Purdue’s College of Health and Human Sciences who specializes in studying exploitation of older and vulnerable adults, served as the lead researcher. Co-authors are Sara K. Stratton of San Francisco Adult Protective Services, Zachary Hass of Purdue’s schools of Nursing and Industrial Engineering and Regenstrief Center for Healthcare Engineering, and Kendon Conrad of the University of Illinois at Chicago.
“This study looks at the combined roles of caseworker judgment and standardized assessment in APS,” Liu said. “This is a new way to assist in intervention and care, as well as gather data and look at more detail on APS outcomes at a variety of levels.”
Liu said the that no one before has captured APS outcomes using standardized assessment tools even though APS is often the first agency responding to reports. The research group specifically looked at self-neglect, which is an adult’s refusal or failure to perform essential self-care tasks and they have no designated person responsible for that care. It is one of nine types of mistreatment investigated in California, and the most commonly reported type of mistreatment to APS.
“While most APS workers are social workers, others come from backgrounds that include nursing, education and law enforcement, so training is important to direct APS workers to look for evidence,” Liu said. “This is one of the reasons we introduced the ISO Matrix to the APS workforce so that everyone uses the same indicators to look for evidence that would be associated with elder mistreatment.”
APS officials from California’s San Francisco and Napa counties volunteered to serve as pilot counties for the study.
Forty-three APS caseworkers and nine supervisors from San Francisco APS and seven caseworkers and one supervisor from Napa County participated in a six-month pilot demonstration from August 2018 to January 2019. There were 2,063 face-to-face cases that used the ISO Matrix (1,819 from San Francisco and 244 from Napa). Out of the 2,063 cases, 1,192 – or 58% – had reports of self-neglect. California has three categories of substantiation: unfounded, inconclusive and confirmed. Five subtypes of self-neglect were collected: physical care, medical care, health and safety hazards, malnutrition/dehydration and financial.
“Self-neglect is the most prevalent type of mistreatment reported to APS,” said Akiles A. Ceron, director of San Francisco APS. “Assessing a client’s ability to self-care and to self-protect is challenging, as APS works to balance an endangered client’s safety and their right to self-determination. Standardized assessment tools allow all APS workers to ‘speak the same language’ in looking for evidence that is often presented in self-neglect cases.”
Caseworkers provided feedback on the matrix through focus groups and general communication to refine the tools, as well as the wording, training and case management system interface.
Both San Francisco and Napa County APS continue to use the ISO Matrix. Seventeen other counties in California are interested in adopting the ISO Matrix, as well. The state of Montana APS began using it in March.
Funding for this research came from the Administration for Community Living, U.S. Department of Health and Human Services (DHHS) under Grant 90EJIG0010-01-01.
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Writer: Matthew Oates, 765-586-7496 (cell), oatesw@purdue.edu, @mo_oates
Source: Pi-Ju (Marian) Liu, 765-496-0615, marianliu@purdue.edu.
Akiles A. Ceron, Director, San Francisco APS, akiles.ceron@sfgov.org
Kristi Guerrero, Supervisor, Napa APS, kristi.guerrero@countyofnapa.org
Note to Journalists: A photo of Marian Liu and a stock image are available onGoogle Drive.She is available for phone and web-based conference interviews.
ABSTRACT
Can standardized measures provide helpful feedback about adult protective services substantiation? Pilot data from a short self-neglect assessment
Pi-Ju Liu, Sara K. Stratton, Zachary Hass & Kendon J. Conrad
Journal of Elder Abuse and Neglect
Full article: https://www.tandfonline.com/doi/full/10.1080/08946566.2020.1742837
Can standardized assessment contribute to improving Adult Protective Services (APS) practice? In this exploratory study, San Francisco and Napa APS utilized a newly developed short self-neglect assessment to test how standardized measures provide information for substantiation decision making. Findings demonstrated satisfactory reliability and validity for the short self-neglect assessment, and analyses revealed important issues that could improve practice. Review of outliers revealed: (1) problems using the assessment tool, (2) misunderstandings of APS procedures, and (3) struggles navigating the case management system. These revelations could all be easily addressed in training. Caseworker’s clinical judgment and experience also continue to have a place in complementing the use of the standardized assessment.
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Research News
View RSS feedMore Research NewsJuly 26, 2017 |
A Purdue University precision innovation developed for brain tumor surgery is being expanded to provide medical professionals with a rapid, robust supplemental assessment tool to more efficiently preserve, analyze and remove identified cancerous tissue and increase patient survival rates.
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The technology was developed out of the Aston Lab in Purdue’s College of Science, headed by Graham Cooks, the Henry B. Hass distinguished professor of analytical chemistry. Valentina Pirro, a research scientist in Purdue’s Department of Chemistry, was also instrumental in the technology’s development.
The team’s morphologically friendly mass spectrometry imaging technique could determine if microscopic cancerous tissue is still present in a sample and thus provide more information to influence a surgeon’s decisions regarding further tissue removal.
Pirro says other mass spectrometry techniques have limitations.
“Mass spectrometry can identify and measure molecules within a tissue by measuring a signal that relates to the mass and structure of the molecule. It can be used in cancer diagnostics because it’s able to monitor the differential distribution of lipids or malformed metabolites that distinguish normal and cancerous tissue,” she says. “With some form of mass spectrometry imaging, the chemicals or solvents used in the process can often destroy the tissue sample. Essentially, you have one shot at getting the data and then the sample is gone.”
Cooks and his research team have developed a morphologically friendly method for tissue imaging that can be used to perform Desorption Electrospray Ionization Mass Spectrometry (DESI-MS).
“Our method allows researchers to choose solvent combinations that don’t affect the morphology, or form, of the tissue. This means the tissue’s native structure is preserved and after the experiment you’re able to take your tissue and stain it or use it for other experiments to retrieve complementary chemical information,” Pirro said. “The analysis is extremely simple and straightforward, because we can analyze tissue sections or smears with no sample preparation and then validate our results with standard histopathology. Essentially this solvent is used as a spray that is directed onto a small area of a sample and extracts molecules contained within. We can run an image by simply moving the spray right on top of a tissue section or smear.”
This assessment can be completed quickly while in the operating room, without interfering with the surgery, Pirro added.
“We were able to modify a commercial DESI-MS instrument so that it sits on top of a cart as a standalone system and can be easily wheeled in the operating room when needed. Once a surgeon resects a small biopsy, we can smear it on a glass slide and analyze it as is. After a few minutes we can tell the surgeon if the tumor is still present in the tissue sample and estimate the percentage of infiltration,” she says. “By adding these objective measures, we are hoping that the surgeon will be guided in the resection and make fast decisions on whether or not to remove more tissue.”
Pirro says that preoperative MRI images are typically used to help guide surgeons; however, they are limited.
“Preoperative MRI images don’t always precisely translate to the area of surgery,” she says. “Additionally, there may be high infiltration of the tumor beyond what the MRI image is able to see. These limitations can cause difficulty in safely removing as much of the tumor as possible.”
The technical challenges for brain tumor surgery and treatment applications helped led the research team to this expanded use of the technology.
“Brain tumors are specifically complicated because they infiltrate into the brain and don’t make clear borders,” Pirro says. “In order to make sure the patient has the highest chance of survival, it’s imperative that as much cancer tissue as possible is removed while trying to minimize neurological damages.”
The technology is currently being used in preclinical settings.
“We have completed studies on a lot of tissue samples to confirm that we are able to get valuable diagnostic information. We are currently using the technique in the operating room in preclinical assessments where we perform our experiment without influencing the surgical practice itself,” Pirro says. “We have completed 18 different surgeries to show that the assessment is feasible, rapid and robust. Additionally, we have been able to identify tissue highly-infiltrated with tumor even when the MRI images may say otherwise.”
Pirro says the next step for the technology is a clinical trial.
“Through a clinical trial the technology could influence the decision strategy. Ideally you would compare surgeries done with and without this technology and see if there is an improvement in the survival rate,” she says. “We imagine a company licensing this technology to take these next steps before eventually bringing it to market and provide this supplemental tool to surgeons everywhere.”
The Purdue Research Foundation’s Office of Technology Commercialization has patented the technology and it is available for license. For information, call 765-588-3470 or email innovation@prf.org.
Original: http://bit.ly/2hnBQBI