For the first time in the country, a statewide program has been created to give caseworkers from a state adult protective services agency direct access to geriatric medical experts who can assist in abuse case investigations and determinations.
The Texas Forensic Assessment Center Network (FACN) has been expanded from children’s services to include adults through a formal agreement between the Texas Department of Family and Protective Services (DFPS) and McGovern Medical School.
Funded with $700,000 from DFPS, the adult program is an outgrowth of the Texas Elder Abuse and Mistreatment Institute (TEAM), a collaboration between UTHealth and DFPS. The TEAM Institute includes experts in abuse, neglect, exploitation and self-neglect including geriatric physicians, geriatric nurses, gerontologists and geriatric social workers.
The idea of expanding the state program from Children’s Protective Services (CPS) to Adult Protective Services (APS) has been years in the making.
“Three years ago we began piloting the concept of the FACN to APS caseworkers statewide. Based on this experience, we expanded and adapted the child FACN concept and framework to meet the needs of APS so that the entire program and their clients can access experts,” said Jason Burnett, Ph.D., co-director of the adult FACN and co-director of TEAM. “It is now available to all caseworkers investigating abuse, neglect, exploitation and self-neglect in adults living in the community and all ages of individuals living in facilities.”
FACN-CPS Medical Director Rebecca Giardet, M.D., professor and director of the Division of Child Protection Pediatrics at McGovern Medical School, and Kelly Bolton, R.N., FACN-CPS nurse coordinator, assisted in helping TEAM develop its FACN-APS network.
“Years ago, while serving the city of Houston and Harris County, we dreamed of being able to reach seniors in rural areas,” said Carmel Dyer, M.D., executive director of the UTHealth Consortium on Aging; founder of TEAM; the Roy M. and Phyllis Gough Huffington Chair in Gerontology; and the Nancy P. and Vincent F. Guinee, M.D. Distinguished Chair in Gerontology. “It is a dream come true to launch the first statewide telecommunication multidisciplinary team.”
Services of the FACN-APS will include medical and mental health capacity assessments for adults in suspected abuse cases as well as in confirmed cases of self-neglect. It is the first forensic program in the country to provide medical and capacity assessment via in-home and telehealth mediums, as well as telephone consultations with medical experts and forensic medical records reviews for in-home and facility-based investigations of abuse, neglect, exploitation and self-neglect. The program also provides court-related testimonies from UTHealth clinical staff.
“We can assess an older person’s memory, mood, mobility, medications and history. And we can see if they have the mental capacity to make safe, independent living decisions,” said Burnett, who is also assistant professor of medicine in the Department of Geriatric and Palliative Medicine at McGovern Medical School
Burnett and FACN-APS nurse coordinator Leslie Clark, B.S.N., R.N., have completed 17 trainings with approximately 800 APS caseworkers and staff throughout the state to teach them how to access the new program.
Co-director of the FACN is John Halphen, M.D., J.D., associate professor of geriatric and palliative medicine at McGovern Medical School. He has provided medical and mental capacity assessments, as well as facility assessments, for APS through TEAM for 10 years. Halphen helped develop geriatric and palliative medicine services at Harris Heath System, where he directs those services for UTHealth. Carlos Reyes Ortiz, M.D., Ph.D., assistant professor of geriatric and palliative medicine, and Jessica Lee, M.D., assistant professor of geriatric and palliative medicine, will also serve as FACN geriatric medicine forensic specialists.
Halphen and other geriatric specialists on the team are reviewing cases and records to determine whether a physical injury or condition was the result, or likely to be the result, of abuse or neglect. This includes assessing whether the injury was inflicted or accidental, if it was consistent with a given explanation and whether the condition is developmentally appropriate. In the first three months, the FACN has received more than 110 cases from around the state.
“Evaluation of the vulnerable persons APS serves has been made much more efficient and effective utilizing telecommunication modalities,” Halphen said. “We now have a great secure portal for communication between TEAM and the APS specialist and we are utilizing telecommunication to reach vulnerable APS clients across the state. We at TEAM are very proud to be helping APS in their very important service to some of our state’s most vulnerable residents.”