individuals who have experienced self neglect. during our executive committee meeting last month, we talked about our experience with homeless clients spending time at the library, many of them with mental illness demand need of help. we wanted to provide information about mental health and community resources that are available. we will hear from adult protective services, the san francisco library, a mobile shower pilot project, and the community ambassadors program. so, please stay with us for an informative meeting. we will also continue discussions during our june meeting in recognition of national mental health month. the next agenda item is no. 6 and this is a presentation by jill needless ielsen of the adult protective

center. >> thank you. i have some handouts. i do have some that i think is probably enough. i can leave them up here. good afternoon. my name is jill nielsen. i am the program director of adult protective services. we have a program that is housed within the department of aging and adult services. we are a part of the human services agency. thank you very much councilmembers for the invitation. my understanding is that adult protective services has not addressed the council in some time, although other dos programs have been here. so i was planning on doing a brief overview of adult protective services just to make sure we

had a foundation of what the program our framework of basic services are before i delve into the self neglect piece. i know you have questions, please interrupt me and ask questions. i want to be able to provide you with real targeted information. before i start i want to make sure that the council and the public was aware that the homeless population in san francisco is not the target population for adult protective services per say. that is not to say that we do not provide services to homeless individuals, but it is by far the rare exception. i will get into that. what i'm prepared to speak about is the concept of self neglect. a ps is a state mandated county program. there is a program in

every county in california, but because the program was realigned during the 2011 realignment. each program in california looks a little different. had are in san francisco, our program, we have 30 aps social workers and 3 aps nurses also. and we receive approximately 450 reports of abuse every single month. we have a 24-hour reporting capacity. we work very closely with the centralized intake department through the department aging adult services. that's a primary entry point for a ray of services that dos provides and that we support in the community and most of the reporter's who will call in to report an abuse is what we call mandated reporter's and typically that is someone who

is through their professional capacity as working with an elder over the age of 65 or an individual over the age 18 who is considered to be a dependent adult. those are the two classifications of individuals that we serve. the terms dependent adult is not one that i really like to use. it is a state term and i think when it was conceptualized it was to distinguish between adults with disabilities who are not in need of protection. that is to say, adult protective services provide services to adults that are over the age of 18 that have a physical mental health cognitive disability, but beyond that, an individual with a disability that is unable to protect him or herself from exploitation from abuse, from neglect. all

adults with disabilities are not in need of services. that can be a very gray area, sometimes. typically when we receive a report, we just ---er, on the side of caution. half of our cases involve self neglect. although the self neglect maybe cooccurring. it maybe happening at the same time that an individual is being abused, neglected or exploited by someone else. in fact, very often what we see is that the self neglect makes an individual more vulnerable to exploitation and abuse and neglect by others. truly, the self neglect cases that we see range from mild to very very severe. mandated reporter's include nurses and

doctors and anyone who comes into contact with an elder dependent adult through the course of their work and i say that because in many cases we have to follow-up with someone because they are not following their medication routine and neglecting their own health. when we think about the concept of neglect, we can all relate. some of us have been guilty of some neglect at one time or another. the seriousness that we might see are cases of hoarding and clutter and really poor hygiene, wounds, diabetes that is not managed and individuals that have not seen a doctor in decades even though they may have access to a doctor.

how does aps intervene? one of the primary tools that aps social workers utilize and distinguishes us from other social services programs is that we don't make appointments. we have the luxury that our social workers go out unannounced and knock on the door. this is helpful because this is how you catch people in their natural settings and especially for our abuse cases. this is very vital for the investigation that we need to carry out. we don't need to notify an abuser that we are about to show up and make that attempt to investigating a case. more often than not our clients don't have the capacity to pull it together anyway for us. we show up unannounced and as you can imagine sometimes people aren't real representative -- receptive to our uninvited unscheduled

announcements. however, i have really skilled social workers and it's a rare exception that we are not able to actually carry out a psycho social assessment with a client oncer able to find them and locate them. sometimes that can be an obstacle and getting the correct information about where that individual is located. that actually is what makes it very challenging for us to serve homeless individuals unless they are in a stable shelter situation where we can actually follow-up with them. so, in the best case scenario an aps social worker working with a client we will carry out an assessment and collaborate with the client to try to establish what that individual's goals are, how can we try to assist this

client to maintain independence and to improve their general sense of well being. that does not always happen. of course we have many clients that lack insight into their own well being into the self negative behaviors that they might be exhibiting and very often it can be a mental health diagnoses, cognitive i mpairment, substance abuse that can prevent someone from being fully aware of the impact of their self negative behaviors. that is with a client that refuse can be tricky for any aps social worker. that is where some of this gray area comes in. i know sometimes there is the perception from the public that this individual is living in a hoarded apartment. why

can't you do anything about it? and we look to what i will consider involuntary services only as a last resort. when i speak of involuntary services i'm speaking only about conservatorship. there are two types. i don't want to go too into depth on the conservator ship. i think this council has addressed at some point. it's a topic. let's say we have mental health conservatorship and the probate code for people that have dementia and need the support of a conservatorship throughout the duration of the rest of their life. we look towards those involuntary services as a

last resort. what we are going to be working with prior to that time is try to connect to a client with a ray of services. some of those services are connecting clients to managed programs like clf and paragraphs -- programs that you are well aware of. we have the support from a department which is very limited, but we have an emergency fund and we use that to pay for emergency medications for our clients, emergency food. we've spent a lot of money for food for our clients and will pay for emergency short-term stays at a motel or even payback rent for clients if it will really keep them safe and that's what the situation is calling for. we also do a lot of work to really try to pull in collateral parties. of course we are working to pull in

family members any support of individuals that might be able to help the client that we are working with regain a sense, a general level of well being and maintaining independence. it's each client's trajectory will be different and we'll have an individualized taylor service plan. those that are not as receptive to services, it is not our stance to offer services and back out. we will generally carry out at least two visits with the client and we are carrying out phone calls to try to really develop and strengthen rapport with the client and sometimes we have to start out incrementally with the

client. we also try to take a warm approach with what we are doing. in terms of the approach i referred to previously, the over arching framework for us is in terms of the way we would carry out a service plan is maintaining the individual in the least restrictive environment, always trying to keep the greatest level of independence that we possibly can. always trying to create a service plan that is in correspondence -- accordance with the individual that we are working with and the rights to self determination. the packet i handed out to you, the packet will speak to this of right to self determination which is really what distinguishes adult protective services from child protective services. there is this misconception

that the adult protective services might have the same authority than children's protective services. the truth is they are adults and they have the right to make bad decisions. when would you lose that right and when would an involuntary service happen. it's not a clear cut line, but we would consider a conservatorship for an individual in the event that the individual clearly lacks capacity. and additionally when i say lacks capacity what i'm saying is they lack capacity to make medical decision or financial decisions for themselves and that's because of dementia or a severe mental health diagnosis. we might look at

involuntary services if the capacity issue is there and if there are significant safety risk to the client. with the clients that are being abused sometimes the safety issue is more apparent. where they have already shown that they are not able to deal with the risk and it would be very appropriate to safe guard finances. in terms of -- neglect, it's someone who clearly can manage their medical care, clearly cannot manage their own really basic necessities. can they provide for food, clothing and shelter. along those lines, i know there was an interest in speaking to the 51/50 criteria. adult protective services workers we do not

have 51/50 authority. it's really essentially the way that the welfare institutions coda allow for the first step of an lps mental health conservatorship and this is when they are placed in involuntary hold and taken to psychiatric services and even our elderly clients that are on a 5150 are on a through generation at diversion because they are at capacity. when we are at an event that an aps workers tries to initiate a 5150 we call on a crisis worker and they are limited due to staff resources at the time and we are also working with the police. what the criteria is grave disability typically. there are times that the client might be a danger to self or

danger to others. but more often with the self negative -- neglecting clients there is a grave disability that we are trying to establish. a grave disability is when we are trying to say that this client does not have the ability to provide for his own food, clothing and shelter. the real challenge with the 5150 criteria is that those that have pretty significant mental health issues and trying to apply that 5150 code with that person who has an impairment, an organic brain syndrome like dementia so it's not a good fit. if they go into psych emergency they are very often discharged right away. it is a challenge when you have a self neglect

individual that needs a board and care to maintain that individual's health and safety needs. it's a crosscutting issue here in this city that we do not have sufficient board and care placement that meet the lower income threshold for our ssi medi-cal population. i'm sure this is not new to the council. aps, we are trying to expand our emergency placement resources, but we have to work within the resources that are available here in this city and even though i currently have support for my department to be funding potential contracts for emergency place a. placements. it's challenging to find someone

to work with you because when we have a challenging rate, there is not much of an incentive for vendors to be working with us. really it's a challenge. we are trying to be creative. we work in collaboration with the hot team most generally when there is a case that involves abuse by others. so, should i stop at this point and see if there are questions. i know i have been talking for a long time. >> sure, do councilmembers have questions or comments from ms. nielsen? go ahead. >> thank you ms. nielsen for your very interesting topic. you mentioned that aps will knock on doors, so these are doors of families, i assume. i guess my question is, does

aps also knock on doors of day programs or programs out there for those with special needs? >> do we visit clients at their day programs? we will if we need to connect with a client and certainly we do work closely with the golden gate regional center and so very often especially our clients that when there is abuse by others, some type of situation, it could be very advantages to visit a client at their program because it's a more neutral environment, a safer place to talk about what might be happening at home. but there are the omnibus man office is the licensed board and cares and licensed nursing homes. we work closely with

the omnibus man office. they will be the lead agencies and we'll provide support as needed. does that answer your question? >> yes. thank you. >> any other questions from councilmembers? i have one. this is a painful subject to think about. you talked about the complications of long-term abuse and how that affects self neglect, so i'm assuming what you mean is that the higher the abuse, the more likely to person is to self neglect as well and that can reinforce? >> what i was actually saying that an individual that is self neglecting is more open to exploitation by others because typically someone

exhibiting mental health behavior, such as they may not be able to manage their own finances. and let me come in and i can help you manage your finances. a trusted individual and someone who is not minding their checkbook to start with and all of their money from the social security check is gone just an example. there is very little research that has been done in the area of self neglect and actually in the realm of aps casework. it's a growing area of interest, elder abuse, when we say elder abuse we are also referring to abuse with adults with disability. the federal initiative on community

living, the administration just recently added to its budget $25 million which is supposed to be targeted to establish a national aps data set and also to begin a basic body of research around the area of elder abuse because people are very surprised to learn that there is just, there are very very limited research on the topic. usually the way we are handling this cases is anecdotal wisdom. i'm a licensed social worker and i have many staff that are trained, seasoned and it's not to say that we need research to be able to know to guide us on a daily basis. it's important for the field to have that research to be supporting us and to be establishing evidence based casework practice. it's an interesting question, but what i spoke about earlier is more

anecdotal wisdom than anything else. >> how long has adult protective services been in existence? >> in its current form it has been around since 1999. it's a baby program. we are still in our maturation stage. prior to 1999, one of my supervisors was here and there were 5 workers and they were answering the phone and working with the police. they were primarily working with physical abuse cases. 1999 actually i feel like i need to acknowledge it was the program director mary counihan that was in my position for about 14 years who was responsible for the state legislation. it was senate bill 2199 and it was so significant for the program. she really expanded through this legislation expanded the mandated reporting laws and aps today

is really the only legislation that we've had that's been significant which was the 2199 bill which established the 24 hour reporting, for example, a mandate to have tangible services on the books. prior to that there was very little the county had to guide the program. that being said, since 1999 there hasn't been a lot of enhancements to the programs and under the realignment what you find is that county programs really vary. that's really a concertain statewide because elders and individuals with disabilities should be provided equal protection under the law regardless of whether or not they live in san francisco or contra costa county. there is a budget proposal going forward right now sacramento and it would do

two things: one to expand the budget statewide. currently there is $150,000 to train aps workers for the whole state. we are lucky in san francisco that we have the additional support and we can actually train our workers and certainly statewide that is not the case and what is having greater impact on san francisco is that the budget proposal is requesting a state coordinator for aps. right now there is only.75 full time employees within the california department of social services to actually monitor the aps program which is absolutely in support. there are questions that come up, policies questions and procedures. if there is an interest in what's happening in sacramento, we actually are still asking for support and

letters for this budget proposal. i had be happy to get information if it's something you want to think about in terms of sending the letter. are there other questions? >> i have one more, i'm sorry. you mentioned you receive 450 calls a month? >> reports of abuse. >> my question is, is that a high for the size of our population? >> yes. that's correct. san mateo county by comparison, san mateo county has almost the same population. slightly under the total population. they have the same over 65 population. i can't speak to the adults with disabilities breakdown. they receive about 100 reports a month. by comparison, we have a lot of reports we receive here in san francisco. i an attribute that to a number of factors. one is that we have a very responsive

aps program. the more that an aps program can do, the greater the need and the more calls that you are going to be getting. we also have a very services rich community and we have a lot of mandated reporter's here and they are very thoughtful and conscientious about calling in and we have a program with a centralized intake unit and not many have that and you really can lose reports that way. we have a thriving aps program. i would like to think we could be starting to work on prevention and working ourselves so to speak but given the graphics and the issues like here in san francisco. >> thank you so much for coming today. >> thank you so much and i'm happy to come back if there is a need.

>> we'll now have some public comment on this issue. i have eugenia parrot? >> first of all enormous gratitude for adult protective services. for my housing when they were contacted on my behalf about six or seven months ago. >> speak into mic. >> my residence was 284 mission, france hotel which really closed down. completely infested with violence and drug dealers and other forms of crime. half of the residents of the hotel swore to kill me having observe my calling the police one day. infested with roaches, bed

bugs, blah blah, it doesn't stop. to make my story short. the manager of the hotel yelled at me and one other disability lady one day. get the hell out of my hotel. you should be disabled to be here. buftly put. now, with adult protective services when they were contacted on my behalf. they promises to get me housing thankfully i was on the housing authority list. i now live in a gorgeous apartment 2698 california with my low income. i and my cat are so happy and so safe. thank you very much. i'm also a survivor of 13 years of tenderloin. under the