APSI INITIAL INQUIRY PACKET

INTAKE CRITERIA FOR APSI SERVICES

APSI intake criteria is necessary to ensure that those individuals with the most immediate needs receive appropriate protective services. The need for such services will be determined by APSI based upon available resources and the following criteria. The criteria are subject to revision if contract resources change at any point during the year.

APSI is committed to serving eligible individuals:

with significant and complex disabilities;

who lack the capacity to make decisions;

have no suitable family or alternatives to guardianship,

whose needs cannot be met through the remedies available to County Boards of DD, if applicable, per O.R.C. Sections 5126.30-5126.34;

the individual’s situation can only be rectified by the implementation of corporate protective services; and/or

who are ordered by the probate court to be served by APSI.

In addition, the individual must meet the following basic criteria:

1. Individual is a resident of Ohio.

2. Individual is eligible for County Board DD services.

3. Individual is at least 18 years of age.

APSI believes that an individual will be provided with appropriate supports by available family members and other advocates in lieu of corporate protective services when those supports are sufficient to meet the needs of the individual. APSI will carefully review each individual’s needs and will work with the referring entity to exhaust all viable alternatives to guardianship prior to involvement by APSI, which may include emergency remedies through Probate Court, court-ordered protective services, restraining orders, an/or involuntary commitment. Thus, APSI will serve as guardian of last resort.

As part of exhausting all viable alternatives, APSI may also:

initiate procedures requiring proof of contact with family or verification of death of family before proceeding with a referral.

refer eligible individuals to an agency alternative guardianship program, if available.

Initial Screen Checklist

Please review “Intake Criteria for APSI Services”, enclosed, regarding APSI’s intake criteria. Using that guide, please answer the following questions and return to the Regional Program Director. Upon receipt, review, and approval of sufficient supporting documentation that these alternatives have been exhausted, the individual will be placed on the waiting list in the order in which this referral was received. If sufficient documentation is NOT included to support the above criteria, OR IF ANY QUESTIONS ARE LEFT UNANSWERED, the referral will be denied.

Date: County:

Individual Name

Address:

Referral Source	Phone:

Address

E-mail address:

County Board Service Support Administrator Phone

Address:

E-mail address:

Basic Criteria:

Resident of Ohio: Yes No

Eligible for DD services: Yes No

18 years of age or older: Yes No Date of Birth:

What is happening with this person?

What service is being requested of APSI?

Does the individual have a current guardian? If so, who? Please list county and case number.

Does the individual have significant and complex disabilities? (mental health, criminal justice, severe behavioral or medical issues). ________ Describe:

Does the individual lack the ability to provide informed consent? (lack the ability as opposed to refusing to accept consequences). ________Describe:

Does the individual have no suitable family to serve as guardian? (Please provide documentation in response to each question.)

Have all family members been contacted? ________ (Attach documentation)

Are all family members deceased? ________ (Attach documentation)

Are there verified and documented reasons why any family cannot serve as guardian? ________ (Attach documentation such as expert opinion, failed reunification plan, criminal involvement) Describe :

What alternatives to APSI guardianship have been attempted?

Have the following remedies been tried as appropriate?

Court Order Protective Services (ORC 5126.30-5126.34)

Involuntary Commitment

Civil Protection Order

Emergency Guardianship

Injunctions, such as a temporary restraining order

Describe:

Can the situation only be rectified by the implementation of protective services (Guardianship is the only way to resolve the situation, the decision of the guardian will have a direct impact on the outcome, and the decision is able to be enforced against the individual’s wishes, if necessary): Describe:

Submitted by: __________________________________________________ Date: ________________

Alternatives to APSI Guardianship:

Family as guardian:

Indigent guardianship fund, some courts waive fees, some courts do not require attorney, APSI can provide TA, SSA can assist in process, parents can nominate out-of-state individual to serve as guardian (ORC Sections 1337.09 (D).

Restoration to Competency:

Individual can request hearing at any time, “Statement of Expert Evaluation” to show competency.

Alternate Guardian:

Contact Probate Court for a list of attorneys who will serve as guardian pro bono.

Contact the Ohio Guardianship Association to find a list of professional guardians.

Power of Attorney:

Assumes individual is competent to assign a POA.

Civil Commitment:

An order for a civil commitment (“probate action”) for either mental health or mental retardation can be filed by any interested party who has knowledge of the individual.

The mental health commitment process (ORC 5122) alleges the individual is a danger to himself or others. Crisis centers can initiate “pink slip.”

The mental retardation process (ORC 5123.71-5123.79) requires the person to be a risk of physical impairment or injury to self OR that the person is subject to significant habilitation in an institution.

Referral to Mental Health (ADAMHS boards):

Case management, counseling, psychiatric services, residential placement as needed.

Residential Supports:

Request temporary admission to a DC for stabilization, use civil commitment as necessary.

Civil Protection Order:

Available to victims of domestic violence. County Board can assist the individual in filing a protective order.

Court Ordered Protective Services:

ORC 5126.30 – 5126.34 (Procedures to investigate abuse/neglect and implement emergency protective services through Probate Court);

Obtain a temporary restraining order to gain access to individuals to develop a

protective services plan;

Initiate a complaint to get court approval to implement a protective services plan;

Get an emergency order for short-term temporary protective measures prior to filing a complaint; and/or

Get short term emergency relief after filing a complaint, but before final hearing.