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APS
Adult protective Services mh&mr iNVESTIGATIONS oVERVIEW

The Adult Protective Services MH&MR Investigations Program investigates reports of abuse, neglect, and exploitation of persons with disabilities (children and adults) receiving services in state operated and/or contracted settings that serve adults and children with mental illness
mental retardation, or other types of developmental disabilities. Investigation results are sent to the facility or program administrator for appropriate action.

Paid Expenditures and Total Average Filled
Full Time Equivalent (FTE) Staff

Total Staff 120.5
Direct Delivery Total 114.7
Direct Delivery Workers 87.6
Direct Delivery Supervisors 16.0
Direct Delivery Other 11.1
Staff Costs $6,490,069.77

Worker demographic

Turnover Rate   18%
Tenure Less than 1 Year 26.4%
1-3 Years 25.3%
Greater than 3 Years 48.4%
Entry Salary   $30,481.44
Average Age   42.2
Race/Ethnicity African-American 12.1%
Anglo 61.5%
Hispanic 26.4%
Other 0.0%

Supervisor Demographics

Turnover Rate   0.0%
Tenure Less than 1 Year 0.0%
1-3 Years 12.5%
Greater than 3 Years 87.5%
Entry Salary   $39,117.96
Average Age   46.1
Race/Ethnicity African-American 12.5%
Anglo 56.3%
Hispanic 25.0%
Other 6.3%

Description of the Report Investigation Process

Step 1: Notifications

The following persons are notified
within one hour of the receipt of
the intake:

  • Facility administrator
  • Law enforcement if
    allegations involves serious
    physical injury, sexual abuse,
    or death of an adult.
  • Law enforcement of any
    allegation involving a child.
Step 2: Investigation Activities
  • Face to face contact with
    alleged victims
  • Interview of witnesses and
    alleged perpetrator
  • Collection of written
    statements and documentary
    evidence.
  • Photographing of injuries
  • Photographing/diagramming
    scene of incident
  • Gathering other relevant
    evidence
Step 3: Investigation Findings
  • Analyze evidence
  • Determine finding(s)
  • Generate investigative report
  • Provide report to facility
    administrator
  • Provide report to law
    enforcement if investigation
    confirms abuse, neglect, or
    exploitation that may
    constitute a criminal offense

Note: This chart is for reference only and does not
necessarily represent the flow of a case.

Statistics FY 2009

  • Completed MH&MR Investigations: 9,730
  • Confirmed MH&MR Investigations: 1,049

Most Common...

  • Person reporting abuse/neglect/exploitation: Facility Staff (29.2%)
  • Allegation confirmed: Neglect (55.9%)
  • MH&MR setting investigated: State Supported Living Centers (42.4%)
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Legal Responsibility for Statewide Intake

Statutory References

Federal: Title XX, Social Security Act
State: Human Resources Code, Chapters 40 and 48
Texas Family Code, Title V
Health and Safety Code, Chapter 532 and Chapters 591-595

Major Provisions

  • Mandatory reporting of abuse, neglect, and exploitation
    of adults who are elderly (defined as age 65 and older) or
    adults with disabilities.
  • Receipt and investigation of all reports (unless patently
    false); initiation of investigations within 24 hours of
    receipt of report.
  • Responsibility for investigations of abuse, neglect, and
    exploitation of persons receiving services in state operated
    mental health and mental retardation facilities (State
    Hospitals, State Schools, and State Centers) and/or state
    contracted settings (Community MH and MR Centers,
    Home and Community-based Services programs, and
    Texas Home Living Waiver Program) that serve adults and
    children with mental illness or mental retardation.
  • Responsibility for referring reports to other state agencies
    when DFPS is not the appropriate investigating agency.
  • Provision or arrangement of services needed to prevent or
    alleviate abuse, neglect and/or exploitation.
  • Enhancing and developing community resources in
    an effort to increase awareness of abuse, neglect and
    exploitation and to address increasing needs of APS
    consumers
  • Responsibility for referring adult victims of abuse, neglect
    and/or exploitation to the Department of Aging and
    Disability Services (DADS) for guardianship services when
    these persons appear to lack the capacity to consent to
    services. Guardianship is the least restrictive alternative
    that will ensure the person’s safety and well-being when no
    other guardian is available.
  • Assessment of factors that may indicate an adult’s possible
    lack of capacity to consent to services and pursuit of a
    medical evaluation if indicated.
  • Using the least restrictive alternative in the provision of
    protective services.
  • Authority to seek court orders when necessary to gain
    access to the individual, to prevent interference with the
    provision of voluntary protective services, to provide
    emergency protective services, to access records or
    documents, and to initiate emergency protective services
    (e.g., a removal) after hours and on holidays without a
    court order.
  • Requirement to notify law enforcement if APS suspects
    that an elderly person or adult with a disability has been
    abused, neglected, or exploited in a manner that constitutes
    a criminal offense.
  • Confidentiality of case records.

Other Programmatic Information:

Factors Contributing to Abuse, Neglect, and
Exploitation:
  • Aging population
  • Growing number of younger persons with disabilities
  • Alcohol and drug dependency
  • Poverty
  • Lack of affordable housing and high costs of utility bills
  • De-institutionalization of persons who are mentally ill
    and/or mentally retarded when community support is not
    adequate
  • Inadequate access to health care and costly medications
  • Pathological family relationships/violence as a coping
    mechanism in society
  • Physical and mental stress of caregiving in traditionally
    non-violent, caring households
  • Denial of benefits, such as SSI and Medicaid, to some
    elderly and disabled immigrants
Challenges:
  • Affordable and safe housing for elders and adults with
    disabilities
  • Waiting lists and other limitations in the availability of inhome
    care and home health care
  • Shortage of resources to serve persons denied long-term
    care and other benefits under welfare reform
  • Gaps in surrogate decision-making processes for
    incapacitated persons in hospitals, nursing homes and
    community-based settings
  • Inadequate community services for persons discharged
    from state hospitals and schools
  • Lack of statewide access to preventative or early
    intervention services such as long-term case management
    for elderly persons and adults with disabilities who
    are at risk, but not yet experiencing abuse, neglect, or
    exploitation
  • Hiring and maintaining a skilled workforce while the
    availability of caseworkers and specialized geriatric social
    work training is not keeping pace with the ever-increasing
    number of older Americans

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Completed Investigations in MH&MR Settings By Source of Report, Fiscal Year 2009

Sources Number Percent
Facility Staff 2,881 29.2%
Self 2,360 24.0%
Other 787 8.0%
Anonymous 661 6.7%
Social Services 607 6.2%
Mental Health 421 4.3%
Family Member 397 4.0%
Nurse 340 3.5%
Healthcare 300 3.0%
Paid Caregiver 282 2.9%
Unknown 267 2.7%
Public Employee 232 2.4%
Friend/Neighbor 68 0.7%
DFPS Staff 64 0.6%
Law Enforcement 96 1.0%
Psychologist 73 0.7%
Physician 15 0.2%

Note: A report of abuse/neglect may come from multiple sources.

Average Length of Completed MH&MR Investigations by Region,
Fiscal Year 2009

Region Investigations Average Days
1 Lubbock 391 12.1
2 Abilene 1,269 17.5
3 Arlington 1,227 7.2
4 Tyler 636 10.5
5 Beaumont 296 9.6
6 Houston 604 18.8
7 Austin 2,138 14.1
8 San Antonio 789 18.9
9 Midland 1,058 10.6
10 El Paso 214 7.7
11 Edinburg 1,088 11.2
Unknown* 20 21.9
Grand Total 9,730 13.1

*Unknown not included in calculation of state average.

Number of MH&MR Investigations Referred to Law Enforcement by Setting, Fiscal Year 2009

Setting Law Enforcement Provided Notification of Investigation* Law Enforcement Provided Investigation Report**
State Schools 979 263
State Hospitals 491 108
HCS 360 52
Community MHMR Centers 117 18
State Centers 16 0
Other 9 0
Total 1,972 441

* Notification sent on investigations which involve a child or serious physical injury, sexual abuse, or death of an adult person served.
** This data includes all cases in which a final investigation report was sent regardless of investigation disposition.

Types of Confirmed Allegations in MH&MR Settings, Fiscal Year 2009

Types of Confirmed Allegations Number Percent
Neglect  1,003 55.9%
Physical Abuse 383 21.4%
Emotional Abuse 250 13.9%
Exploitation 136 7.6%
Sexual Abuse 21 1.2%

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Characteristics of Victims in Confirmed Investigations in MH&MR Facilities, Fiscal Year 2009

Characteristic: Race/Ethnicity

Characteristic:
Race/Ethnicity		 Female Percent of Total Male Percent of Total Unknown Percent of Total Subtotal Percent of Total
Anglo 240 18.1% 479 36.0% 4 0.3% 723 54.4%
African American 72 5.4% 137 10.3% 0 0.0% 209 15.7%
Hispanic 111 8.4% 202 15.2% 3 0.2% 316 23.8%
Native American 1 0.1% 0 0.0% 0 0.0% 1 0.1%
Asian 5 0.4% 2 0.2% 0 0.0% 7 0.5%
Other 28 2.1% 39 2.9% 6 0.5% 73 5.5%
Total Victims 457 34.4% 859 64.6% 13 1.0% 1,329 100.0%

Characteristics of Perpetrators in Confirmed Investigations in MH&MR Facilities, Fiscal Year 2009

Perpetrator Characteristic: Race/Ethnicity

Race/Ethnicity Female Percent of Total Male Percent of Total Unknown Percent of Total Subtotal Percent of Total
Anglo 174 14.0% 92 7.4% 7 0.6% 273 22.0%
African American 236 19.0% 162 13.1% 6 0.5% 404 32.6%
Hispanic 126 10.2% 87 7.0% 2 0.2% 215 17.3%
Native American 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Asian 2 0.2% 0 0.0% 0 0.0% 2 0.2%
Other 85 6.9% 44 3.5% 217 17.5% 346 27.9%

Note: A completed investigation may have more than one victim.

Perpetrator Characteristic: Age

Age Female Percent of Total Male Percent of Total Unknown Percent of Total Subtotal Percent of Total
Under 18 0 0.0% 1 0.1% 20 1.6% 21 1.7%
18-25 170 13.7% 126 10.2% 8 0.6% 304 24.5%
26-35 171 13.8% 114 9.2% 56 4.5% 341 27.5%
36-45 113 9.1% 80 6.5% 43 3.5% 236 19.0%
Over 45 168 13.5% 63 5.1% 44 3.5% 275 22.2%
Unknown 1 0.1% 1 0.1% 61 4.9% 63 5.1%
Total 623 50.2% 385 31.0% 232 18.7% 1,240 100.0%

Note: Each victim may have more than one perpetrator. Each perpetrator may have more than one victim.

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Completed Investigations by MH&MR Settings by Fiscal Year

Fiscal Year Completed Investigations
2005 8,169
2006 7,930
2007 8,088
2008 8,870
2009 9,730

Completed Investigations by MH&MR Settings,
Fiscal Year 2009

Fiscal Year Completed Investigations
State Schools 4,121
State Hospitals 2,500
HCS 2,163
Community MHMR Centers 653
State Centers 293
Total 9,730

Disposition of Completed MH&MR Investigations,
Fiscal Year 2009

Setting of MH&MR Investigations

Setting Confirmed (%)Confirmed Unconfirmed (%)Unconfirmed Inconclusive (%)Inconclusive
Community 87 0.9% 248 2.5% 81 0.8%
HCS 385 4.0% 868 8.9% 273 2.8%
State Centers 31 0.3% 166 1.7% 19 0.2%
State Hospitals 163 1.7% 1,261 13.0% 133 1.4%
State Schools 383 3.9% 2,036 20.9% 267 2.7%
State Total 1,049 10.8% 4,579 47.1% 773 7.9%

Setting of MH&MR Investigations

Setting Unfounded (%)Unfounded Other (%)Other Blank (%)Blank Subtotal (%)Subtotal
Community 9 0.1% 47 0.5% 181 1.9% 653 6.7%
HCS 25 0.3% 143 1.5% 469 4.8% 2,163 22.2%
State Centers 2 0.0% 25 0.3% 50 0.5% 293 3.0%
State Hospitals 139 1.4% 230 2.4% 574 5.9% 2,500 25.7%
State Schools 455 4.7% 320 3.3% 660 6.8% 4,121 42.4%
State Total 630 6.5% 765 7.9% 1,934 19.9% 9,730 100.0%

Setting of MH&MR Investigations

Region Confirmed (%)Confirmed Unconfirmed (%)Unconfirmed Inconclusive (%)Inconclusive
1 Lubbock 94 1.0% 162 1.7% 50 0.5%
2 Abilene 176 1.8% 740 7.6% 63 0.6%
3 Arlington 125 1.3% 421 4.3% 97 1.0%
4 Tyler 53 0.5% 300 3.1% 33 0.3%
5 Beaumont 51 0.5% 112 1.2% 60 0.6%
6 Houston 36 0.4% 313 3.2% 103 1.1%
7 Austin 211 2.2% 869 8.9% 109 1.1%
8 San Antonio 85 0.9% 460 4.7% 72 0.7%
9 Midland 82 0.8% 497 5.1% 86 0.9%
10 El Paso 46 0.5% 90 0.9% 15 0.2%
11 Edinburg 90 0.9% 614 6.3% 85 0.9%
Other 0 0.0% 1 0.0% 0 0.0%
State Total 1,049 10.8% 4,579 47.1% 773 7.9%

Setting of MH&MR Investigations

Region Unfounded (%)Unfounded Other (%)Other Blank (%)Blank Subtotal (%)Subtotal
1 Lubbock 14 0.1% 81 0.8% 15 0.2% 416 4.3%
2 Abilene 34 0.3% 60 0.6% 206 2.1% 1,279 13.1%
3 Arlington 86 0.9% 52 0.5% 439 4.5% 1,220 12.5%
4 Tyler 18 0.2% 5 0.1% 237 2.4% 646 6.6%
5 Beaumont 11 0.1% 42 0.4% 16 0.2% 292 3.0%
6 Houston 2 0.0% 2 0.0% 140 1.4% 596 6.1%
7 Austin 229 2.4% 340 3.5% 340 3.5% 2,098 21.6%
8 San Antonio 25 0.3% 2 0.0% 134 1.4% 778 8.0%
9 Midland 147 1.5% 101 1.0% 155 1.6% 1,068 11.0%
10 El Paso 1 0.0% 69 0.7% 0 0.0% 221 2.3%
11 Edinburg 63 0.6% 11 0.1% 247 2.5% 1,110 11.4%
Other 0 0.0% 0 0.0% 5 0.1% 6 0.1%
State Total 630 6.5% 765 7.9% 1,934 19.9% 9,730 100.0%

Note: "Other" and "Blank" include cases referred back to the facility or closed at intake because they do not meet the definitions of abuse and neglect and therefore are not investigated.

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