Increasing Safety for At-Risk Adults: Screening In-Home Care Providers

Abstract

Years ago, the director of a program for adults with developmental disabilities asked me to teach a workshop for staff after a male aide molested a wheelchair-bound client in a bathroom. A head nurse at a hospital for frail elders asked for a workshop after a stroke patient was diagnosed with a sexually transmitted disease. Why me? I asked the people extending these generous invitations. Good question--my field is child welfare. Everybody else refused, they answered. Bad answer. From my perspective as a child welfare social worker, I see unnecessary gaps in screening and hiring practices for in-home helpers who work with dependent adults and frail elders. I have heard the justifications for the status quo from consumers, client advocates, and agency directors and find them unpersuasive and unnecessarily dangerous. PREREQUISITES FOR WORK WITH MINORS People wishing to work with children in health and mental health programs, schools, child care, foster care, group homes, and residential programs must submit fingerprints to their prospective employer who, in turn, sends them to the state's Department of Justice for clearance. The clearance includes juvenile court and child protective services cases as well as criminal convictions (Goldman & Salus, 2003; Howell, 1993; Lockyer, 2000). The former may be more relevant than a Department of Motor Vehicles (DMV) or criminal background check because the triggers (for example, crying, enuresis, defiance, and temper tantrums) that lead a parent to abuse a child are apt to abound in work with children. Once hired, employees must be informed of their responsibilities under the child abuse reporting laws and agree to report reasonable suspicions of abuse or neglect promptly to the appropriate protective agency. They must sign a statement saying they know they are mandated by law to report suspected child abuse and neglect, understand what constitutes abuse and neglect, and know how and when to report their reasonable suspicions. The employer must keep the fingerprint clearance and this signed statement in the employee's personnel file. Most states require more extensive training for those applying for social work, marriage and family therapy, and clinical psychology licenses (Goldman & Salus, 2003; Howell, 1993). Whenever there is a question about omissive or comissive behavior by an employee or an agency, an investigator's first move is to check the personnel files for fingerprint clearances and reporting law agreements. That is not to say that people seeking to victimize children do not scale these hurdles--far too many do--but, as hurdles go, they are good deterrents. Prospective employees must be fingerprinted and pay the nominal fee the police, sheriff, and DMV charge, usually about $15. Each state's Department of Justice charges the employer approximately $75 to $85 per candidate to run the scans. Agencies, even child care agencies operating on shoestring budgets, are expected to include this expense in their budgets as a reasonable and necessary cost of doing business. Child welfare is committed to preserving family ties for at-risk children (National Council of Juvenile and Family Court Judges, Child Welfare League of America, Youth Law Center, & National Center for Youth Law, n.d.) and waives many requirements for relatives providing child and foster care that would be mandatory for nonrelatives doing the same work. This double standard aims to keep families together with minimal assurances of safety and raises the bar considerably for nonrelatives wishing to become foster parents or to work with children in day care centers, schools, and therapeutic programs. WORKING WITH AT-RISK ADULTS In adult services, the landscape is very different. Some people contact an agency for helpers and generally rely on the agency to screen staff. Many agencies have improved their screening in the past several years, but consumers cannot assume that agencies do more than contact references and perhaps the DMV. …