Development of short-form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions

Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short-form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS data set contains 948 elder abuse cases (age 60+) with yes/no abuse substantiation decisions for each abuse type following a 30-day investigation. Item sensitivity/specificity analyses were conducted on long-form items with the substantiation decision for each abuse type as the criterion. Validity was further tested using receiver–operator characteristic (ROC) curve analysis, correlation with long forms and internal consistency. The four resulting short-form measures, containing 36 of the 82 original items, have validity similar to the original long forms. These short forms can be used to standardize and increase efficiency of APS investigations, and may also offer researchers new options for brief elder abuse assessments.     

Pilot testing the detection of elder abuse through emergency care technicians (DETECT) screening tool: results from the DETECT pilot project

Objective: To pilot test the feasibility of implementing an elder abuse (EA) screening tool (DETECT) designed for medics.

Methods: Testing occurred between September 17th, 2015 and October 26th, 2015. MedStar Mobile Healthcare medics completed the DETECT tool when responding to calls for community-dwelling patients 65 years of age or older.

Results: The DETECT tool was used 1,248 times by 97% of medics responding to an eligible 911 call. Medics responded affirmatively to at least one screening item on 209 of the completed screenings (16.8%). Immediately following the introduction of the DETECT tool, there was an increase of 5.4 (226% above baseline) reports per month (p = 0.0056).

Conclusions: The DETECT tool was easily incorporated into medic’s field-based practice and resulted in an increase in medic generated reports of EA to APS. Future research designed to evaluate the tool’s validity and reliability are warranted.     

Trauma-informed care and elder abuse: a synergistic alliance

ABSTRACT

Elder abuse is a global systemic problem in which one or more traumatic or stressful life experiences directly affect older adults, their families, and communities. Despite its devastating impact, the understanding of—and response to—elder abuse has rarely been explored through a trauma-informed lens. Despite the prevalence of traumatic and stressful life experiences, research and practice are just beginning to target the intersection of elder abuse and life course trauma. This article demonstrates how knowledge about the causes, consequences, and responses to elder abuse can be integrated with the principles of trauma-informed care to improve agency and community responses to preventing or intervening with elder abuse and neglect. In order to address the ongoing problems with detection and treatment of elder abuse, we assert that instilling trauma and elder abuse informed care in organizational services and policies forms a synergistic alliance and would address many of these concerns.     

Climate Change Adaptation: Community Action,Disadvantaged Groups and Practice Implications for Social Work

This paper explores community-level action in relation to socially based climate change adaptations for vulnerable citizens—older people in particular. While awareness of risk and adaptation has increased in various institutions across Australia, the translation of awareness into action is limited, particularly in the area of socially based adaptive measures for the most vulnerable. Through content analysis of local government documents in two major Australian cities, this paper assesses the extent of action and identifies trends and strategies in relation to social adaptation. Findings indicate varying levels of action and some examples of “best practice,” but overall, evidence indicates more effort is needed at the community level. The role of the social work profession in challenging and broadening discourse is also explored especially in terms of highlighting the social impacts of climate change in future policy development, community action, and initiatives.     

“The Abuse of Older Australians (Elder Abuse)”: Reform Activity and Imperatives

ABSTRACT

Significant national reform activity is occurring that concerns the abuse of older people by trusted others. This includes an Australian Law Reform Commission report entitled Elder Abuse – A National Legal Response (2017), and the adoption in 2019 of the first ever “National plan to respond to the abuse of older Australians (elder abuse)”. While service responses in this field largely exist at, and will continue to be provided at, state and territory level, this article considers current and needed reform initiatives in a field of increasing national government attention.

IMPLICATIONS

• The adoption of the first ever national plan concerning the abuse of older people in Australia adds significant impetus and direction for reform in this key social policy area.

• Most service and regulatory reforms aimed at improving responses to the abuse of older people will occur at state and territory level.

• The breadth of likely and necessary reforms is significant, ranging from policing practices through to guardianship law reform.

     

The Management and Practice of Joint Adult Protection Investigations between Health and Social Services: Issues Arising from a Training Intervention

The implementation of government policy for the protection of vulnerable adults [Department of Health (2000 Department of Health. 2000. No Secrets: Guidance on Developing and Implementing Multi‐agency Policies and Procedures to Protect Vulnerable Adults from Abuse, London: HMSO.  [Google Scholar]) No Secrets] has set expectations for the development of multi‐agency policies and procedures in adult protection in England. Multi‐agency working in adult protection mainly concerns complex cases involving more than one service user or where a number of managers or practitioners are involved. However, these also tend to be the most serious abuse cases where the necessity for effective inter‐agency co‐ordination collaboration between social services authorities (local authorities) and health trusts (NHS) is most acute, especially with the development of partnership working such as in learning disability [Department of Health (2001 Department of Health. 2001. Valuing People: A New Strategy for Learning Disability for the 21st Century, London: Department of Health.  [Google Scholar]) Valuing People]. Moreover, effective collaboration with the police in the conduct of adult protection casework and process is required for cases where criminal offences may have been committed. These demands put high expectations on the professionals involved. Based on a series of joint training interventions between social services and health personnel in Kent, this paper identifies key issues for the effective performance of joint adult protection investigations and maps both the challenges and management and practice competencies required. Potential solutions to the complexities of managing multi‐agency investigations in adult protection were identified with potential relevance to improving adult protection case management and co‐ordination more widely.     

Working with Older People with Alcohol Problems: Insight from Specialist Substance Misuse Professionals and their Service Users

Significant numbers of older people worldwide have a drinking level or pattern which places them at risk of harm. In England, older people are more likely to be admitted to hospital for an alcohol-related condition than younger people and levels of alcohol-related harm are increasing fastest in this population. Whilst alcohol problems in older people are highly treatable, they frequently go undetected or ignored. The aim of this study was to develop guidelines for health and social care workers on what intervention strategies are likely to work best with older drinkers. Insight from alcohol practitioners who specialise in working with older people and the perspectives of older people receiving alcohol treatment were gained through focus groups and individual interviews. This paper reports some of the key findings including a perception that health and social care workers often did not intervene when alcohol misuse was suspected because of ageist attitudes and false beliefs about older people's drinking. Participants however acknowledged that social workers faced difficult choices in relation to the ‘right’ of older people with alcohol problems to continue to drink and the ‘risk’ associated with them doing so. The implications for social work education and training are discussed.     

Co-operation in a child welfare case: a comparative cross-national vignette study

The purpose of this article is to explore how social workers co-operate around a case where a four-year-old child is exposed to hardship or abuse in the family. The empirical data were collected using a vignette technique in Denmark, Germany, Sweden, the state of Texas (USA) and Britain. The data show that it is common to discuss, as well as work jointly, with others in an obviously serious child welfare case, and that different professional expertise is involved. Discussions of a case are generally held within the agency rather than with external specialists. Moreover, there is a positive relationship between the severity of the case and the degree of collaborative working. The data show that there are differences in the answers between the countries under study. One cause contributing to differences might be variation in organisation of the social services in the countries. Another explanation could be the extent to which legislation affects co-operation at the single case level. To be able to establish regular co-operation between different agencies, it seems to be important that co-operation is integrated in the process of the practice in social work.     

The prevalence of elder abuse and neglect in Iran: a systematic review and meta-analysis

ABSTRACT

Objective: The aim of this study was to estimate the prevalence of elder abuse and neglect in Iran.

Methods: We searched PubMed, Embase, Scopus, and PsycINFO by the end of 2017. The prevalence was calculated based on the percentage or the amount reported in the studies. Heterogeneity was assessed by the I² statistic, and the data were combined using random effects model. The results were reported as the pooled estimates and the 95% confidence intervals (CIs). The review protocol was registered in PROSPERO (CRD42017070744).

Results: A total of 16 studies involving 6,461 participants aged 60 years and over were included. The pooled prevalence for overall elder abuse was 45.7% (95% CI: 27.3–64.1, p < .001).

Discussion: The prevalence of elder abuse and neglect is substantial in the Iranian population aged 60 years and over. More research is needed to investigate the actual prevalence of elder abuse at the national level.     

When social work students meet workers with mental-health lived-experience: a case study

Current social work education in India reflects globalization priorities and tendencies of neo-colonialism that emulate curriculum priorities and duplicate content developed in countries like the USA. Social work education as implemented by countries like the USA, has limited success in transnational training of social workers and their ability to address emerging social problems and deep rooted structural imbalances within non-USA social contexts. Yet, the concept of the world being an emerging global village is used to justify and reaffirm the colonial goals of universal education and pedagogies within social work and its application to starkly different contexts, such as India. This paper argues against the imperialist nature of social work education through examples from social work syllabi from Indian schools of social work. Secondly, this paper examines the role of academic collaborations and international organizations in addressing the challenges in curriculum development. Finally, through an example from a Curriculum Development Project undertaken in a sub-Saharan African country by one of the authors, the paper demonstrates ways of generating more local content for curricula that would create culturally sensitive social services.     

Social Media and Social Work: The Challenges of a New Ethical Space

ABSTRACT

Social media and other online technologies have transformed communication between social workers and service users, with many practitioners engaging and working with clients through social networking sites. While there are numerous ethical issues associated with online practice related to con?dentiality, dual relationships, and boundary crossing, there is lack of clarity about how to deal with such issues. This article uses a case example to develop a nuanced understanding of ethical issues and ethical behaviour in online spaces. We argue that social workers need to link their knowledge of the complex interplay between discourses that underpin daily practice like those related to power, permanency, authorship, audience, embodiment, and professionalism to social media created spaces. In doing this, social workers must retain their commitment to ethical values and critical reflective practice. We conclude with recommendations for education, research, and practice.     

The intersection of employment and care: evidence from a UK case study

Working carers are a key focus of UK policies on health and social care and employment. Complementing national and European evidence, this paper presents a local case study of working carers. It draws on data from a county-wide survey containing a module on caring. Data were primarily categorical and were analysed using SPSS. Three quarters of all carers who responded to the survey were of working age: two thirds were employed and one third had been employed previously. The majority of working carers were mid-life extra-resident women. Over half of cared for relatives were elderly parents/in law; ‘physical illness’ was the primary cause of dependency. A tenth provided intensive care and half reported that caring adversely affected their health. Both were triggers for leaving employment. Two thirds of households received input from services and/or friends/family; being a co-resident carer appeared to mitigate against service allocation. Four issues were identified as pivotal to facilitating employment: access to advice and information, the availability of a matrix of affordable good-quality social-care services, ‘joined up’ needs assessment of the carer and cared for person, and employers identifying carers in their workforce. Europe's ageing profile underscores the study's timeliness.     

Enhancing Critical Reflection amongst Social Work Students: The Contribution of an Experiential Learning Group in Care Homes for Older People

As part of a Practice Learning Centre, representing a partnership between an English University social work department and a non-governmental organisation, 12 students were placed in care homes for older people for their first period of assessed practice. The aims of this initiative were to facilitate: development of critical reflection; deployment of social work skills in a care home setting; and opportunities for social work students to work with care home residents. The learning was captured via four Experiential Groups facilitated by the Practice Educator with responsibility for assessing the students' practice. On-site supervisors also participated. Key learning included understanding of: the importance of critical reflection as a key social work skill; the influence of organisational norms and care home culture on the quality of care practice; the complexity and emotion-rich nature of person-centred care; and the pivotal role of relationships in work with people with dementia. Links made in the Groups—between the experiential and theoretical, the emotional and cognitive, and the structural and personal—demonstrate their value as learning platforms. Placements in care homes have considerable potential to enrich practice education; this is especially important in the context of an ageing population.     

Religion and spirituality in social work practice and education in a cross-cultural context: findings from a Norwegian and UK study

As service populations have changed, social workers in Norway and the UK have responded to the needs of diverse cultures, which often include issues of religion and spirituality. Members of the Norwegian Union of Social Educators and Social Workers (FO) and the British Association of Social Workers (BASW) were sampled to explore attitudes regarding the placement of religion and spirituality in practice and education. UK workers were generally more accepting of religion and spirituality than their Norwegian colleagues. Factors such as secularism, differences in the educational systems, and different historical trajectories in the profession's development may contribute to differences between the UK and Norway. The authors recommend additional research in each country regarding the role of religion and spirituality in social work education and practice, the general culture, the bureaucratic delivery of social services, client and social worker interactions, and in the stratification of social class.     

The Norwegian police and victims of elder abuse in close and familial relationships

Over recent decades, domestic violence or family violence, violence against women and child abuse has received much attention in the media, in political discourse and in social research. However, abuse of older adults arouses limited interest. In government action against domestic violence and in police guidance manuals, the elderly receive little attention. The aim of this article is primarily to demonstrate how the police attempt to prevent elder abuse in close relationships, especially in parent-child relationships. This article highlights some contradictions between the need of the police to produce criminal cases (often contrary to the interests of the victims) on the one hand, and the police's duty to prevent further abuse on the other. Research has documented that help and prevention measures in question make the situation even worse for the victims they are meant to help.     

台湾儿童保护服务的实践与启示

台湾儿童保护服务的发展近30年,已实现儿童保护服务的专业化与职业化。台湾儿童保护服务的法制架构与行动信念包含初级预防、次级预防和三级预防等不同层次,其中,家庭维系和家庭重整是当下台湾儿童保护服务的重要转向。     

Building Social Inclusion for Rural Older People Using Information and Communication Technologies: Perspectives of Rural Practitioners

Abstract

The literature identifies rural, older people as at risk of social exclusion, as a result of rural disadvantage. In this context, improved access to information and communication technologies (ICTs) has potential to build social inclusion, yet current evidence shows that rural, older people are the lowest current users of technology. This paper draws on the practice and local knowledge of rural practitioners from one Victorian region in order to explore: (a) the practice issues associated with ICT use among rural, older people; and (b) the characteristics of effective practice models in the rural, social work context. An analysis of findings highlights the need to respond to the diverse skills, needs, and learning styles of older people, to demonstrate the benefits of ICTs, involve users, and build confidence. Major barriers include poor ICT usage by many rural agencies and low practitioner capacity, as well as access and resources.     

Defining and Estimating Risk and Protection: An Illustration from the School Success Profile

This article links a risk and protection conceptual framework with definitions of risk and protection from epidemiology. It describes methods for estimating and modeling risk and protection that yield readily interpretable results using contingency tables and logistic regression. Data from a national sample of adolescents illustrate key concepts, providing implications for research and practice.     

Disclosure among victims of elder abuse in healthcare settings: a missing piece in the overall effort toward detection

Elder abuse remains a largely hidden problem in our society and only a small minority of victims are connected to formal support/protective services. Healthcare settings have been identified as a critical milieu to uncover cases of elder abuse; however, under-detection in these settings is a major issue. Victimization disclosure is an important component within the overall detection effort, yet it has received little attention in the elder abuse literature. Drawing on relevant literature from other domains of family/interpersonal violence, this article highlights the disclosure process, as well as disclosure barriers, facilitators, and competencies to consider when working with older adults.     

A new role for imaging in the diagnosis of physical elder abuse: results of a qualitative study with radiologists and frontline providers

Pediatric radiologists play a key role in the detection of child abuse through the identification of characteristic injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, they currently play little to no part in this effort. We examine the reasons behind this limited role, and potential strategies to expand it, by interviewing attending faculty from Emergency Radiology, Geriatrics, Emergency Medicine, Pediatric Radiology, and Pediatrics. Our interviews revealed that radiologists’ contribution to elder abuse detection is currently limited by gaps in training, gaps in knowledge about imaging correlates, and gaps in inter-team clinical communication. Specifically, radiographic interpretation of elder trauma is severely restricted by lack of communication between frontline providers and radiologists about patients’ injury mechanism and functional status. Improving this communication and re-conceptualizing ED workflow is critical to expanding and optimizing radiologists’ role in elder abuse detection.