Montgomery County Adult Protective Services (APS) and Montgomery County Fire and Rescue Services (MCFRS) have launched an innovative partnership to address the most vulnerable among our population. MCFRS is the highest single referrer of cases to APS annually. Patients referred to APS often have a variety of social and medical issues that lead to them calling 911 more frequently than an average resident. Previously, APS case managers would respond to these referrals on their own, but there was limited information flow between EMS and APS regarding case resolution or client needs. To increase the effectiveness of APS referrals, and better address the needs of high utilizers, the Mobile Integrated Health program was started within MCFRS in 2015. MIH partnered with APS and other sections of the Montgomery County Department of Health and Human Services to track EMS high utilizers and identify whether or not they were already receiving county interventions. In many cases, their case managers were unaware of how many 911 calls these clients were generating. Beginning in 2019, the partnership was taken one step further, and a Registered Nurse and Social Worker were added to the MIH team. Both of these positions are also part of the APS program. This cross-training has created a seamless collaboration in which APS and MIH field evaluations can occur simultaneously. The MIH/APS staff can address the needs of appropriate EMS high utilizers by identifying necessary interventions/resources, connecting them to community partners/programs, and diverting 911 calls that would otherwise be generated. These two staff positions also assist in the oversight of the community paramedics who regularly visit EMS high utilizers. Our partnership with APS has also enabled us to share educational information with our providers regarding appropriate APS referrals. In years past, EMS would make referrals but APS was unable to connect with the referring provider due to lack of contact information, misunderstanding of shift rotation, etc. Without a detailed conversation with the provider, APS would not necessarily be able to start an investigation. Once EMS and APS were able to collaborate on these referrals, APS had a consistent connection point which resulted in more APS assessments being performed when needed. MCFRS is proud to say that due to our improved communication and information sharing, 100% of all Fire/Rescue referred cases are deemed to be APS-appropriate and result in an investigation. Lastly, we are working together to explore the introduction of an assessment tool which would be embedded in ImageTrend eMeds report and would allow any clinician to do an immediate and rapid assessment for APS eligibility based on Maryland and Montgomery County criteria. That referral would then be tracked to ensure the clinician followed up directly with APS.
Adult Protective Services (APS) is a program that serves adults, 18 and over, who are in a situation of vulnerability and either at risk of, or experiencing, exploitation and harm. They investigate situations of suspected abuse and provide professional services designed to protect the wellbeing of vulnerable adults. There are a variety of types of abuse and neglect that warrant a report being made to Adult Protective Services, and an APS intake worker will assess each situation and determine if it necessitates intervention by APS.
Date of Implementation
Original program was implemented in 2015. Program enhancements and cross-staffing began in earnest in November 2019
Number and Demographics of Patients
In FY20, APS received 4,955 referrals. Out of those, 971 were converted into investigations, for an investigation rate of 19.5%. In that same timeframe, MCFRS made 51 referrals to APS, and all 51 became investigations, for an investigation rate of 100%. MCFRS referrals accounted for 5% of all APS investigations in FY20.
Outcomes / Utilization
MCFRS MIH and APS now work collaboratively to address the needs of clients. We provide background information for APS caseworkers on their investigations, such as frequency of 911 calls to the client's home, or medical/hospitalization records through CRISP (Chesapeake Regional Information System for our Patients), a state-wide HIE sharing hospitalizations, EMS encounters, private practice visits, and prescription information. Our cross-trained staff can simultaneously assess patients for APS and MIH enrollment, and refer patients to appropriate resources quickly and efficiently. They will also be incorporated in future revisions to our Mobile Crisis Response program, Crisis Now.