NCCD is pleased to host and moderate the "APS Research to Practice" webinar series sponsored by the National Adult Protective Services Association (NAPSA) and National Committee for the Prevention of Elder Abuse (NCPEA) Research Committee. NCCD and the NAPSA-NCPEA research committee share the goals of promoting research in the areas of adult and elder mistreatment, and supporting APS agencies' use of research to inform and strengthen practice. These webinars are held quarterly.
Note: Presenters and webinar organizers generously donate their time and expertise. Points of view or opinions are those of the presenter(s) and do not necessarily represent the official position or views of the sponsoring or supporting organizations/entities. None of the sponsoring or supporting organizations/entities, its agents, funders, or employees bear any responsibility for the analyses or interpretations of the presented research.
Depression is common among older adults who no longer can care for themselves; and both self-neglect and depression are associated with poor health outcomes, including increased mortality. This webinar will explore some of the potential health and behavioral correlates of depression in older adults who neglect themselves. In addition, the webinar will cover implications for further research and the development of programs to address depression in this population. Part of a series on APS research to practice, this webinar is sponsored by the joint research committee of the National Adult Protective Services Association and the National Committee for the Prevention of Elder Abuse, with support from NCCD. (Materials: slide presentation)
Dr. Smith, from Fordham University School of Social Service, will present findings from her new research, which examined older women's perceptions of their 'difficult' adult children and of themselves. The webinar is an opportunity to discuss Dr. Smith's findings, which were collected by doing in-depth open-ended interviews with low-income older mothers (>62), half of whom had sought services within agencies that service the needs of elder abuse victims. This is one of the few studies that focused on the experience of victims of abuse.
In many cases of financial exploitation, the exploited person’s capacity to make decisions is the core issue that must be assessed. Therefore, it is essential for investigators to have effective instruments for measuring a person’s capacity to make independent financial decisions, but one challenge is the lack of tools to detect deficits in financial capability. This session introduces a new screening scale for financial decision-making capacity. The Lichtenberg Financial Decision Screening Scale (LFDSS) is a brief, 10-item screening scale designed to assess a vulnerable adult’s decisional ability at the point in time when the adult is making a significant financial decision. In this webinar, we will review instructions for administering the LFDSS, review screening questions and scoring, and discuss case studies using the scale. (Materials: slide presentation)
In this webinar we will discuss the implementation of mental health screening and Problem-Solving Therapy (PST) in routine elder abuse services. Providing Options To Elderly Clients Together (PROTECT) is a mental health program in which anxiety and depression screening and PST with anxiety management are integrated into elder abuse services to improve outcomes for victims with depression and/or anxiety. The webinar will describe the methods used and the effects of the program on staff and clients. (Materials: slide presentation)
This webinar is conducted by Pamela B. Teaster, Ph.D., Virginia Tech Center for Gerontology. It presents a study that uses a public health model to examine allegations of elder abuse made to Kentucky Adult Protective Services (APS) and the investigations that followed in order to understand how APS addressed the needs of abused elders. Elder abuse allegations made to APS during the study week were collected using three study tools. Allegations and resulting investigations were analyzed using descriptive statistics. Results describe characteristics of the abuse calls, investigations, victims, perpetrators, and investigation times. The substantiation ratio, recidivism, and whether investigation increased or decreased the risk of abuse were also assessed. Examining APS casework through the lens of nested systems (ecological systems theory) has the potential to improve the outcomes of those served by APS and can be used as a model for APS programs across the country.
Elder self-neglect (ESN) represents half or more of all cases reported to adult protective services. ESN directly affects older adults and also their families, neighbors, and the larger communities around them. ESN has public health implications and is associated with higher than expected mortality rates, hospitalizations, long-term care placements, and localized environmental and safety hazards. This webinar begins by describing results from a study using concept mapping to create a conceptual model of ESN and the items needed to measure it. On this webinar, presenters will discuss findings from a study that resulted in the development of the Elder Self-Neglect Assessment (ESNA). The tool was field-tested by social workers, case managers, and adult protective services providers from 13 Illinois agencies. ESNA indicators of self-neglect align into two broad categories: behavioral characteristics and environmental factors, which must be accounted for in a comprehensive evaluation. Discussion will focus on the clustering of items into the two categories and on the hierarchy of items which should represent severity of self-neglect. (NOTE: the webinar recording begins on slide 3 of the slide handout. Introductory remarks are excluded due to recording technical difficulties). (Materials: slide presentation)
It is often difficult to figure out if an injury or wound is due to elder abuse. In part, this is because many of the normal and common age-related changes mask and mimic signs of elder abuse. "Older adults bruise easily" and "old people who aren't mobile develop pressure sores" are common refrains that may be hard to refute. In this webinar we will review the research and clinical findings that help distinguish forensic markers of elder mistreatment. (Materials: slide presentation) Presenter - Laura Mosqueda, MD, FAAFP, AGSF, Chair, Department of Family Medicine, Professor of Family Medicine and Geriatrics (Clinical Scholar) and Associate Dean of Primary Care, Keck School of Medicine of University of Southern California
This webinar consists of a two-part panel presentation. First, Dr. Christina Policastro, Assistant Professor, Department of Criminal Justice & Criminology, Georgia Southern University, will provide an overview and summary of findings from a research study that assessed levels of elder abuse awareness among social work, nursing, health professions, and criminal justice students. Next, Risa Breckman and Dr. Karl Pillemer will present an overview of The Risk and Resiliency Internship Project (RRIP), created by NYC Elder Abuse Center (NYCEAC) and The Legacy Project, designed to expose undergraduates to the wisdom and robust experience of older generations as well as to the issue of elder abuse. Risa Breckman is an Assistant Professor of Gerontological Social Work in Medicine and the Director of the NYC Elder Abuse Center at Weill Cornell Medical College's Division of Geriatrics and Palliative Medicine. Dr. Karl Pillemer is a Professor of Human Development at Cornell University and Professor of Gerontology in Medicine at the Weill Cornell Medical College. (Materials: slide presentation)
Jason E. Schillerstrom, MD, presented a discussion on the relationship between different cognitive domains (memory, visuospatial function, and executive function) and self-care abilities. The webinar specifically highlights the relationship between executive function and money management ability. Many state legal definitions of capacity are in part dependent on a person's ability to provide care for themselves. Persons unable to provide care for themselves because of a physical or mental condition often meet the definition for incapacity. However, when working with elders, there is often an assumption that cognitive deficits, such as memory impairment, are responsible for the disability. (Materials: slide presentation)
Jason Karlawish, MD, provides an overview of the development and use of the Assessment of Capacity for Everyday Decision-Making (ACED). The ACED is the first tool available with data supporting its reliability and validity to effectively address a common clinical issue: is a patient who refuses an intervention to help manage an instrumental activity of daily living (IADL) disability capable of making this decision? The ACED is useful for assessing the capacity to solve functional problems of older persons with mild to moderate cognitive impairment from disorders such as Alzheimer's disease. Common clinical scenarios are the person who has problems performing an IADL, such as cooking, but refuses help to manage that IADL. Is the person capable of refusing this help? The ACED provides patient specific assessments of decisional abilities needed to make that informed refusal. The ACED works well for persons with short term memory impairments since the provided summary sheet can be referred to throughout the interview. The ACED can also help in real-world assessment of a person's cognitive abilities. It can also inform the assessment of complex cases of the "self-neglect syndrome." The ACED interview takes 15-20 minutes to administer. At the close of an ACED interview, the interviewer has a set of data that describe the person's performance on the decision making abilities. (Materials: slide presentation)
In this presentation, Dr. Adria Navarro and Dr. Kathleen Wilber discuss findings from their study that examines effectiveness when APS uses a novel multidisciplinary team (MDT)—an elder abuse forensic center—to increase prosecution of elder financial abuse crimes. Findings from this study of APS recipients between 2007-2009 found a ten times greater likelihood of cases being submitted to the District Attorney's office. The researchers shared the process used by the forensic center team to determine whether prosecution should become a case goal. (Materials: slide presentation)
In this presentation, Mark Yaffe, M.D., discusses his research on the development and validation of a brief tool for physician use to support identification and assessment of the presence or absence of suspected elder abuse. Use of the tool has the potential to sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals. While the tool was validated for use by family physicians, this presentation will also discuss what potential may exist for use by other health and social service providers, as well as for self-administration by seniors. (Materials: slide presentation)
In this presentation, Holly K. Caldwell, PhD(c), MSN, RN, shared the results of an integrative review of elder abuse (EA) screening instruments for use in primary care. Using criteria similar to the US Preventive Services Task Force review by Nelson et al in 2004, the authors found 10 studies conducted between 2004 and 2011 that met their inclusion criteria. Ms Caldwell will discuss her findings about five novel instruments, advances in EA screening instrument development, including the enhanced ability of such instruments to identify current harm or risk of harm, and strides being made in elder abuse screening instruments designed for use in healthcare and with patients with dementia and their caregivers. Please note that a recording of this webinar is not available due to technical problems, but a copy of the presentation slides is available here.
Increasing demands for demonstrating positive results and outcomes of community services, including Adult Protective Services, have put significant pressure on program administrators and service providers to engage in ongoing evaluation research. In this webinar Dr. Madelyn Iris, Dr. Rebecca Berman, and Lisa Peters Beumer will describe the principles underlying effective organizational capacity-building for evaluation, review critical steps necessary for achieving evaluation goals, and highlight the benefits of engaging in on-going evaluation practice. Examples will be drawn from an innovative program called ASSERT (Assistance, Services and Support for Evaluation Research Training, a practical educational program that provides community services providers with the strategies, approaches and skills they need to conduct meaningful program evaluation and utilization-focused research. (Materials: slide presentation)
In this webinar, Shelly Jackson, Ph.D., shared findings from her research comparing pure financial exploitation (PFE) of an elderly person—financial exploitation that occurs independently of another form of elder abuse—with hybrid financial exploitation (HFE)—financial exploitation that co-occurs with physical abuse and/or neglect. Implications for how professionals intervene and work with victims of pure financial exploitation vs. hybrid financial exploitation are discussed. (Materials: slide presentation)
Presenters Lori Delagrammatikas, Mary Twomey, Krista Brown, Kris K. Brown, and Mary Counihan discuss how researchers and APS practitioners worked together to develop a protocol to improve the consistency of APS investigation findings in California. After researchers identified great variability in APS decision-making across California, APS practitioners developed a protocol which clearly delineated the essential defining elements of each type of abuse/neglect, provided direction and focus for gathering information, and supplied workers with a structure for evaluating the relative strength and integrity of that information. The protocol has been implemented throughout the state and researchers are in the process of studying its efficacy by evaluating the current level of consistency in findings. The webinar describes the research, protocol and training development, evaluation efforts, and the collaborations needed to affect change statewide. (Materials: slide presentation, supplemental materials)
In this follow-up to the Spring 2012 webinar, Kendon Conrad, Ph.D., Madelyn Iris, Ph.D., and Jessica Mazza, MSPH provided participants with an online demonstration of the Elder Abuse Decision Support System (EADSS) that uses standardized measures and short screening forms to assess elder mistreatment and exploitation, as well as expected system outcomes such as increased convenience and efficiency and improved quality of assessments. (Materials: slide presentation)
Kendon Conrad, Ph.D., Madelyn Iris, Ph.D., and Jessica Mazza, MSPH presented on the development of the Elder Abuse Decision Support System (EADSS). Nationally, elder mistreatment and financial exploitation continue to be under-reported, resulting in inaccurate prevalence and incidence statistics, and increased suffering of older adults. Important systemic factors contributing to this problem include lack of valid, standardized assessment procedures, and state-specific definitions and scope of various types of abuse, neglect, and exploitation. Advances in assessment methodology and computer technology offer promising solutions to improve the identification and tracking of elder mistreatment and exploitation, as well as the reduction of some barriers related to the responsive assessment and delivery of services to victims. This presentation describes the development of EADSS, an Elder Abuse Decision Support System, that uses standardized measures and short screening forms to assess elder mistreatment and exploitation, as well as expected system outcomes such as increased convenience and efficiency and improved quality of assessments. The presentation focuses on the Older Adult Financial Exploitation Measure to illustrate the methods used to develop items. (Materials: slide presentation)
Arlene Groh, RN, BA, Rick Linden, Ph.D., Elizabeth Nieson, RN, and Detective Constable David Haughey will provide information about the origins of the project; will consider the evaluation findings, the current status of Waterloo's response and possible reapplication of Waterloo's model. In 2000, The Community Care Access Centre (CCAC) of Waterloo Region, in partnership with social service agencies, secured funding to design, implement and evaluate a restorative justice approach to financial, physical and emotional abuse and the neglect of older adults by someone in a position of trust. Dr. Rick Linden with funding from The Law Commission of Canada and Justice Canada completed an evaluation. In April 2011 his findings were published in The Journal of Elder Abuse and Neglect. www.tandf.co.uk/journals/WEAN. The original program had some success but referrals to the restorative justice program were low. The program evolved to the Elder Abuse Response Team (EART), a partnership between the Waterloo Region Police Services and the CCAC (2004) whose practice is embedded in restorative justice values and principles and which follows best practice in conflict management. The new program has been very successful in increasing referrals and in ensuring that community partners work well together. (Materials: slide presentation)
Jackie Berman, Ph.D. and Art Mason presented findings from the New York State Elder Abuse Prevalence Study. From the executive summary of the full report: This study is one of the most ambitious and comprehensive studies to quantify the extent of elder abuse in a discrete jurisdiction ever attempted, and certainly the largest in any single American state. With funding from the New York State William B. Hoyt Memorial Children and Family Trust Fund, a program administered under NYS Office of Children and Family Services, three community, governmental, and academic partners (Lifespan of Greater Rochester, the New York City Department for the Aging and the Weill Cornell Medical College) formed a collaborative partnership to conduct the study. (Materials: slide presentation)
Dr. Holly Ramsey-Klawsnik and Dr. Pamela B. Teaster discuss selected findings from "The Study of Sexual Abuse of Vulnerable Adults in Care Facilities." This study was funded by the National Institute on Aging and analyzed detailed data regarding 429 reported sexual abuse cases that were investigated by Adult Protective Services and/or licensing authorities in five states across the nation. The presentation discusses findings regarding the victims, perpetrators, abuses, APS investigations, case findings, and case outcomes. Discussion will focus on using these research findings to improve APS response to allegations of sexual abuse in care facilities. (Materials: slide presentation)
Jane N. Nathanson, Social Work and Rehabilitation Consultant, and Specialist in Human-Animal Health & Welfare, discusses her work in the area of animal hoarding. This presentation is based on her recent publication in the Journal of Elder Abuse & Neglect, 2009 Oct;21(4):307-24. Article abstract: Substantial research and literature indicate how people and companion animals form relationships that are, for the most part, mutually beneficial. Yet there are highly dysfunctional human-animal relationships that do occur, meriting attention and remediation. One of the most perplexing and problematic human-animal relationships is encountered in cases of animal hoarding--a deviant behavior associated with extremely deleterious conditions of comorbid animal and self-neglect. Adult Protective Services workers often encounter theoretical and methodological dilemmas with these complex cases. To intervene most effectively, it becomes critical to elucidate some of the developmental factors of animal hoarding behavior and its correlation with self-neglecting behaviors in general. This article presents an in-depth diagnostic perspective as derived from the author's research and clinical experience. An analysis of the complex dynamics of the relationship between animal hoarders and their pets is presented in conjunction with accepted theories of self-neglect. With enhanced knowledge and understanding of animal hoarding, human service professionals will be better prepared to respond to these clients, evoke greater rapport and cooperation, and engage in the interdisciplinary efforts that are essential for optimal resolution. (Materials: slide presentation, presentation outline)
Deborah O'Connor, Ph.D., RSW, a professor in the School of Social Work at the University of British Columbia, and the (founding) Director of the Centre for Research on Personhood in Dementia, talks with us about her work upon which the theories presented in the recent article entitled "Assessing Capacity Within a Context of Abuse or Neglect" were based. This article is available in the Journal of Elder Abuse and Neglect, volume 21, issue 2. This article examines the unique aspects associated with assessing and determining capacity for older adults who are living in a situation of abuse or neglect. Specifically, examining how living in a situation of abuse or neglect may influence the determination of capacity and exploring the implications of conducting an assessment within a potentially abusive context. (Materials: slide presentation)
Jason Schillerstrom, M.D., of the University of Texas Health Science Center at San Antonio describes recent research findings detailing the prevalence of general cognitive, executive function, and visuospatial impairments, as well as depression in APS clients referred to psychiatry for a decision making capacity evaluation. The significance of disproportionate executive impairments will be discussed and webinar participants will specifically learn how clock drawing tasks can be used to screen for cognitive impairments relevant to decision making capacity. (Materials: CLOX I, slide presentation, webinar Q&A)