Elder Mistreatment Abuse, Neglect, and Exploitation in an Aging America (2003) / Chapter Skim
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15. Elder Abuse Intervention: Lessons from Child Abuse and Domestic Violence Initiatives
15. Elder Abuse Intervention: Lessons from Child Abuse and Domestic Violence Initiatives
Pages 501-526
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From page 501... ...
This is not surprising, however, when one considers how intervention in related areas of domestic violence developed slowly at first, hampered by a lack of research findings on causes and limited funding directives. Almost in stages, the related fields of child abuse and domestic violence grew from the voices of concerned practitioners as well as survivors, gaining the attention of the public and the recognition of researchers and professionals.
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From page 502... ...
Increased interest and understanding by researchers and clinicians in the field of domestic violence make it possible to establish a scientific foundation for implementing prevention and treatment initiatives and public policy to end elder abuse and related forms of violence. Society's responses to woman abuse and child abuse, in particular, took more than two decades to turn from preliminary recognition and acknowIedgment to more uniform opposition and action.
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From page 503... ...
This chapter considers how these developments in related areas of domestic violence can inform the field of elder abuse intervention. ~ , ~ ASSESSMENT AND INTERVENTION ISSUES Screening and Detection There have been numerous attempts in the last decade to develop screening instruments to identify persons at risk for elder abuse or neglect, following the lead of child welfare authorities.
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From page 504... ...
Consequently, many hospitals now have protocols for screening woman abuse and other forms of domestic violence, which typically include a list of warning signs and symptoms that should prompt specific questions during the history-taking procedure. Such protocols may also serve as training instruments to ensure ongoing awareness and sensitivity to potential domestic violence victims.
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From page 505... ...
Moreover, most existing measures are biased toward factors related to physical abuse and neglect, with less attention paid to factors of psychological and financial abuse or violation of the person's rights. Intervention Goals Following efforts by advocates to recognize the basic humanitarian need for assistance, most intervention and prevention efforts in elder abuse, child abuse, and domestic violence began with broadly based services offered within existing social networks.
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From page 506... ...
The end result was that, in one manner or another, new statutes concerning domestic violence in all its forms are now in place throughout North America. However, there are still fewer legal options available to older victims than for other victims of domestic violence (Taffe et al., 1996~.
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From page 507... ...
of domestic violence laws. Advocates of aclult protection legislation argue that oicler aclults are safeguarcleci by such means, and attempts can be macle to improve their level of functioning while protecting them from harm.
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Domestic Violence Laws Men who are physically abusive toward their partners and/or children typically come to the attention of domestic violence specialists through either arrest or treatment referral. Unfortunately, studies on the efficacy of both arrest and treatment outcomes with this population are discouraging: Neither arrest nor treatment has been shown to have large effects on men's violent behavior toward their partners.
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From page 509... ...
Since enactment of the Violence Against Women Act, communities have increased coordination and cooperation among police, prosecutors, victim advocates, the judiciary, and other community institutions related to domestic violence (Sullivan and Allen, 2001~. Although controversy over the relative benefits of arrest in domestic violence cases continues, many state and provincial legislatures and local police departments have adopted pro-arrest, warrantless arrest, or mandatory arrest policies in such cases.
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From page 510... ...
Community Services Community services for child abuse and domestic violence have been widely used, and similar approaches to elder abuse and neglect have gained proponents in recent years. Community responses are usually integrated to reduce costs and oversights and involve crisis intervention services (such as hot lines, police involvement in laying charges, protection orders, and emergency and secondary shelters)
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From page 511... ...
Changes in medical practice related to improved assessment in domestic violence cases include refined standard medical procedures as needed for domestic violence assessment and improved history taking and assessment as needed to complement the medical examination (McDonald and Collins, 2000~. These efforts have resulted in physicians, nurses, and ancillary personnel being more skilled in recognizing and reporting relevant cases of woman or child abuse, and providing medical testimony when needed.
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This approach is modeled after interagency domestic violence task force teams, which serve as the means by which various relevant players (e.g., legal services, child protection, shelters, service providers, and educators) can communicate and solve problems.
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Intervention techniques for the kinds of deficits exhibited by physically abusive families were modified for this population on the basis of well-developed behavioral training methods, such as child management skills training, stress and anger management training, and cognitive restructuring approaches (Wolfe, 1999~. Based on an awareness that child abuse may arise from poor parental preparation and assistance, especially in the early years, intervention strategies for physical abuse have emphasized education, training, and resources for at-risk families and community service providers, as well as direct assistance to caregivers to reduce stress, anger, and similar issues.
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Counseling centers for abusive men are now regarded as an important addition to community services for domestic violence. Offender treatment programs originated in the early 1970s as voluntary programs for men whose partners were seeking the aid of shelter services.
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Coordinated Community Response. The domestic violence movement sparked innovative programs, such as support and advocacy services, which elder abuse efforts have begun to emulate.
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concluded that caregiver intervention studies show promise of achieving clinically significant outcomes in improving depressive symptoms and reducing anxiety, anger, and hostility, symptoms that have been causally linked to various forms of domestic violence. As in the child abuse literature, intervention
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Caregivers may also benefit from training in general problem-solving skills and specific anger-management skills related to their role (Schulz et al., 2001~. EDUCATION AND PREVENTION Similar to child abuse and woman abuse, prevention of elder abuse focuses on educational initiatives, which are believed to be critical elements in any comprehensive approach to domestic violence.
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From page 518... ...
Although formal evaluation is lacking, these efforts base their support on the success of similar initiatives in the fields of child abuse and domestic violence, described below. Child Abuse and Domestic Violence Initiatives Child abuse prevention has been approached through both universal efforts (e.g., educating the general public about its various signs; learning healthy childrearing skills)
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From page 519... ...
Although elder abuse clearly involves a different focus and timing of intervention, any of its components fit with existing knowledge of this issue, such as establishing community linkages, supporting families during stressful periods, teaching basic caregiver skills, and building on strengths of the target adult as well as caregivers and others. Public awareness campaigns, such as public service announcements and advertisements, have been widely used throughout North America to combat child abuse and domestic violence.
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, these approaches seem well-suited for elder abuse prevention as well. Public Health Models Emerging changes in public policy, legislation, and service delivery illustrate a commitment to finding ways to reduce the prevalence and harmful effects of all forms of domestic violence.
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SUMMARY In sum, the absence of theory-based treatments and outcome research in the area of elder abuse remains striking. Similar to related family violence interventions such as child abuse and women abuse programs, existing elder abuse programs have been largely aimed at individual needs based on victim accounts of abuse and violence, rather than a theory of change based on population based epidemiology (Chalk and King, 1998~.
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Family Violence Prevention Fund 1998 Domestic violence advertising campaign tracking survey. San Francisco: Author.
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1994 Identification, Assessment, Care, Referral, and Follow-up of Women Experiencing Domestic Violence VDI70 Come to tI7e Emergency Department for Treatment. Ottawa, ON: Health Canada, Family Violence Prevention Division.
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Chez 1997 Ending Domestic Violence. Thousand Oaks, CA: Sage Publications.
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From page 525... ...
Allen 2001 Evaluating coordinated community responses for abused women and their children. In Domestic Violence in tI7e Lives of Children: TI7e Future of Research, Intervention, and Social Policy, S.A.
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