[Federal Register Volume 84, Number 233 (Wednesday, December 4, 2019)]
[Notices]
[Pages 66426-66428]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-26182]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living

[OMB#0985-XXXX]


Agency Information Collection Activities; Submission for OMB 
Review; Public Comment Request; Adult Protective Services Client 
Outcome Study

AGENCY: Administration for Community Living, HHS.

ACTION: Notice.

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SUMMARY: The Administration for Community Living is announcing that the 
proposed collection of information listed above has been submitted to 
the Office of Management and Budget (OMB) for review and clearance as 
required under the Paperwork Reduction Act of 1995. This 30-Day notice 
collects comments on the information collection requirements related to 
the ``Adult Protective Services Client Outcome Study'' (New Data 
Collection [ICR New]).

DATES: Comments on the collection of information must be submitted 
electronically by 11:59 p.m. (EST) or postmarked by January 3, 2020.

ADDRESSES: Submit written comments on the collection of information by:
    (a) email to: [email protected], Attn: OMB Desk Officer 
for ACL;
    (b) fax to 202.395.5806, Attn: OMB Desk Officer for ACL; or
    (c) by mail to the Office of Information and Regulatory Affairs, 
OMB, New Executive Office Bldg., 725 17th St. NW, Rm. 10235, 
Washington, DC 20503, Attn: OMB Desk Officer for ACL.

FOR FURTHER INFORMATION CONTACT: Stephanie Whittier Eliason, 
Administration for Community Living, Washington, DC 20201, (202) 795-
7467, [email protected].

SUPPLEMENTARY INFORMATION: In compliance with 44 U.S.C. 3507, ACL has 
submitted the following proposed collection of information to OMB for 
review and clearance.
    APS programs are provided by state and local governments nationwide 
and serve older adults and adults with disabilities in need of 
assistance due to maltreatment, which can include: Physical, emotional, 
and sexual abuse; financial exploitation; neglect; and self-neglect. 
APS is an important avenue through which maltreatment is reported to 
law enforcement or other agencies.
    Additionally, APS programs are often the gateway for adults who 
experience

[[Page 66427]]

maltreatment to access additional community, social, health, behavioral 
health, and legal services to maintain independence in the settings in 
which they prefer to live. APS programs work closely with clients and a 
wide variety of allied professionals to maximize safety and 
independence, while respecting each client's right to self-
determination. At this time, there is no single funding stream for APS 
nor a single set of rules and regulations that APS programs must 
follow. Building the evidence-base for APS programs and practices, 
promoting the use of evidence-based and promising practices, and 
developing guiding standards are key needs for the APS field.
    The proposed new data collection will examine if and how APS 
programs make a difference in the lives of APS clients. Specifically, 
the data collection will help examine (1) what changes clients report 
as a result of receiving APS services; (2) how satisfied clients are 
with the APS services they receive; (3) to what extent clients report 
APS helps them achieve their goals; (4) to what extent clients report 
APS supports their right to self-determination; (5) to what extent APS 
programs affect client safety (risk of maltreatment); (6) how APS 
program intervene to reduce client risk of maltreatment; (7) what 
factors help or hinder APS efforts to reduce risk of maltreatment; (8) 
to what extent APS programs affect client well-being (e.g., quality of 
life, financial, physical health, etc.); (9) how APS programs intervene 
to improve client-well-being; and (10) what factors help or hinder APS 
efforts to improve client well-being. The data collection will be 
conducted with three target populations: (1) APS clients, (2) APS 
caseworkers, and (3) APS leaders. APS leaders will consist of APS state 
and APS county leaders.
    Data collection with these three target populations will include: A 
brief, anonymous APS client questionnaire, including a de-identified 
client data form; a semi-structured in-person interview with APS 
clients; a semi-structured in-person focus group with APS caseworkers; 
and a semi-structured interview with APS leaders.
    The APS client questionnaire is designed to be as brief as 
possible, while examining key client outcome areas, identified in 
collaboration with a national expert panel consisting of federal 
experts, researchers, practitioners, and program leaders in APS. The 
outcomes areas focus on: Satisfaction with APS, safety, and well-being, 
and will be assessed with nine questions. The question statements 
examining these areas are designed to be short and easy to understand. 
The first item on the questionnaire provides a simple ``yes/no'' 
response option. For the remaining questions, APS clients or a proxy 
(respondents) are asked to rate the extent which they agree with each 
statement using a Likert-type rating scale ranging from `strongly 
disagree' to `strongly agree'. Respondents also have the option of 
sharing anything else about their experience with APS through an open-
ended question at the end of the form. The questionnaire will be hand-
delivered to the client or proxy respondent by the APS caseworker at 
case closure. The respondent will complete the questionnaire and mail 
it back to the research team by using a prepaid return envelope.
    The client data form will be linked to the client questionnaire 
using a pre-populated eight-digit form number. The client data form is 
designed to capture de-identified, basic demographic information and 
additional details about APS clients and their cases.
    These data points are expected to be among the information about 
clients, and their cases, that caseworkers already collect during 
normal APS processes. The form does not collect any personally 
identifiable information. The form will be completed online by APS 
caseworkers. If an APS program prefers another method of completing the 
form, hard copies can be provided and mailed back to the research team 
using a prepaid return envelope.
    Individual interviews with APS clients are designed to gain more 
in-depth knowledge about the experiences and needs of APS clients along 
the key outcome areas assessed in the questionnaire. A standardized, 
semi-structured interview guide will be used to guide the interviews 
with clients who provide informed consent.
    Focus groups with APS caseworkers will be conducted in person, 
using a standardized, semi-structured focus group guide. Individual 
interviews with APS leaders will be conducted either in-person or by 
phone with county and state leaders using a standardized, semi-
structured, interview guide. Similar to client interviews, focus groups 
with APS caseworkers and interviews with APS leaders will focus on the 
identified outcome areas. Additional questions will be asked to gain 
insight into access and availability of services, collaboration and 
partnerships with other entities in the community, and barriers and 
facilitating factors that affect APS services and client outcomes. The 
interview guide for APS leaders also contains questions related to APS 
policies and procedures.

Comments in Response to the 60-Day Federal Register Notice

    A notice was published in the Federal Register on August 20, 2019 
(Vol. 84, Number 161; pp. 43137-43139). ACL received a total of three 
comments in response to the notice. None of the comments raised 
significant concerns about the proposed collection of information. The 
following table lists each comment, by data collection tool, and 
provides ACL's response.

------------------------------------------------------------------------
   Data collection tool(s)           Comment            ACL response
------------------------------------------------------------------------
Client Data Form............  The status at         The level of client
                               closing should        engagement item is
                               include an            designed to capture
                               additional option:    this information.
                               Services knowingly    However, the item
                               refused by            wording should
                               competent adult.      specify engagement
                                                     with APS, including
                                                     the investigation
                                                     and services
                                                     (specified
                                                     separately).
                                                     Competency can be
                                                     determined using
                                                     the respondent type
                                                     item. The following
                                                     changes are
                                                     proposed: (1)
                                                     Revise the item to
                                                     read: ``Level of
                                                     Client Engagement
                                                     with APS:``; (2)
                                                     Create table
                                                     (similar to the
                                                     item for type of
                                                     maltreatment) or
                                                     other revised
                                                     formatting to
                                                     capture level of
                                                     client engagement
                                                     with two separate
                                                     aspects of APS: (a)
                                                     the investigation,
                                                     (b) services. No
                                                     revisions are
                                                     proposed to the
                                                     response options
                                                     for this item.

[[Page 66428]]

 
Client Data Form............  The above initiative  ACL recognizes that
                               will be of great      APS programs vary
                               benefit to the        in terms of the
                               field of APS. Thank   criteria used to
                               you for undertaking   determine
                               much needed work.     eligibility to
                               Your approach is      receive APS. ACL
                               sound and we look     further believes
                               forward to the        that this
                               results of this       information is
                               work. My comment      meaningful to the
                               regarding APS is of   study. The
                               a broad general       following change is
                               nature. What is an    proposed: (1) Add
                               APS client in the     new item to the
                               USA? There is no      client data form:
                               unified definition    ``How did the
                               on what is a person   client qualify to
                               that needs APS        receive APS
                               services. Most        services (check all
                               states use a          that apply)?'' with
                               definition that       check boxes for two
                               includes a            response options:
                               vulnerability. The    ``1) On the basis
                               person is 18+ and     of old age''; ``2)
                               due to a permanent    On the basis of
                               physical or mental    disability/
                               disability is         vulnerability/
                               unable to provide     etc''.
                               for his or her own
                               care and
                               protection.
                               However, many
                               states (10 to 12 I
                               believe) have an
                               age demarcation on
                               what is an APS
                               client. Anyone 60+
                               or 65+ is an
                               automatic client.
                               This is misleading.
                               As you know, \2/3\
                               of the members of
                               congress are over
                               60 or 65, not to
                               mention our
                               president and many
                               of the democrats
                               running for the
                               presidency. Are
                               those states
                               telling us that
                               just because you
                               are 60 you cannot
                               protect or provide
                               for yourself and
                               you need APS
                               services? These
                               states have laws
                               that go back
                               decades and they
                               have not been
                               updated. This
                               creates an
                               inconsistency in
                               national data on
                               abuse, neglect,
                               exploitation a true
                               vulnerable APS
                               client. APS needs
                               to focus on folks
                               who are vulnerable.
                               Not folks who
                               happen to be 60+
                               and are caught in
                               the pool. The US
                               needs a consistent
                               definition of what
                               is an APS client so
                               that the data can
                               be more meaningful.
Interview Guide APS Leaders;  Below are comments:   The APS leader
 Focus Group Guide APS         Applaud ACL   interview guide and
 Caseworkers.                  for doing this        APS caseworker
                               study via a random    focus group guide
                               sampling of           include an item
                               clients, APS          that very closely
                               caseworkers and       matches the
                               administrators at     recommendation in
                               both the state and    the comment. For
                               local level.          example, the
                               Questions     ``Conclusion''
                               seek to validate if   section, item ``A''
                               client autonomy and   of the APS leader
                               engagement is         interview guide
                               honored (i.e.,        reads: ``If money
                               client self-          and resources were
                               determination         unlimited, what
                               recognized by the     would you change
                               APS investigator      about [name of APS
                               and the need for      program] in order
                               APS to balance        to do a better job
                               Autonomy with         of improving
                               Beneficence and       clients' lives?''
                               Nonmaleficence.).     This item extends
                               These         the focus of the
                               surveys of clients,   question beyond
                               APS caseworkers and   service delivery to
                               administrators ask    client outcomes,
                               open-ended, semi-     which is of primary
                               structured            interest for this
                               questions around      study.
                               domains of client
                               satisfaction,
                               improved safety,
                               and resource
                               access, which is a
                               nice approach.
                               Recommend
                               one additional
                               question for
                               caseworkers and
                               administrators,
                               ``If you had an
                               unlimited budget,
                               what would you give
                               to APS to improve
                               their services
                               delivery?`` Good
                               luck with this
                               important work.
------------------------------------------------------------------------

    The proposed data collection tools may be found on the ACL website 
for review at https://www.acl.gov/about-acl/public-input.

Estimated Program Burden

    ACL estimates the burden associated with this collection of 
information as follows:

----------------------------------------------------------------------------------------------------------------
                                                 Number of      Responses per      Hours per      Annual burden
     Respondent/data collection activity        respondents       respondent        response          hours
----------------------------------------------------------------------------------------------------------------
Client Questionnaire........................            6,000                1            0.167            1,002
Client Data Form............................            6,000                1            0.167            1,002
Client Interview............................               24                1             0.75               18
APS Caseworker Focus Group..................               84                1              1.5              126
APS Leaders Interview.......................               16                1                1               16
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    Total...................................           12,124  ...............             3.58            2,164
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    Dated: November 27, 2019.
Lance Robertson,
Administrator and Assistant Secretary for Aging.
[FR Doc. 2019-26182 Filed 12-3-19; 8:45 am]
BILLING CODE 4154-01-P