What Law Enforcement Wants To Know About Elder Abuse 19th Annual NAPSA Conference Chicago, IL August

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What Law Enforcement Wants To Know
About Elder Abuse19th Annual NAPSA
Conference Chicago, IL August 26-29,
2008

• Pat King, RN, Forensic Specialist
• Georgia Division of Aging Service
• psking_at_dhr.state.ga.us, [phone]

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Top 10 Barriers

• Lack of professional awareness/education/training
• Emergency Placement
• Lack of resources funding
• Law enforcement unaware of criminal statutes
• Many professionals unaware of reporting
  requirements
• Lack of communication/Collaboration/between
  agencies
• Inadequate sharing of information between
  agencies
• AGEISM
• Reporting (Failure to report/Delay in reporting)
• In this population, what is a suspicious death? A
  suspicious injury?

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Attitude Adjustments

• We dont have nursing homes in this jurisdiction
• We dont ever get those types of calls
• If a 12 year old dies suddenly, thats
  suspicious. If a 65 year old dies suddenly, ..
• They (older victims) have Alzheimers
• They (older victims) make terrible witnesses
• They (older victims) bruise easily
• They (older victims) get broken bones
• They (older victims) get pressure ulcers (bed
  sores)
• They (older victims) fall a lot and,
• He/She was going to die anyway from his/her
  underlying (fill in the blank health condition).

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What Was I Thinking?

• Summer 2007
• Contacted 1st and 2nd largest law enforcement
  agencies in state about conducting elder abuse
  training
• 2nd largest department accepted offer
• 4-hour in-service training began in September,
  and ended in November (750 officers received
  training)
• 3 days/week, 4 hours/session, 20-60/class

Law enforcement, in many instances, will be first
(only) to arrive on-scene for incidents of elder
abuse, neglect exploitation.
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Curriculum

• Developed Based on
• Experience as investigator and forensic nurse
• Informal Survey
• Conversations with law enforcement including
  Peace Officer Standards and Training Council
• Law Enforcement training across US
• Prior county/city law enforcement training

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Curriculum Overview

• 1st Hour Introductions, Statistics, Normal
  Aging, Autonomy
• 2nd Hour Mandated Reporting, Definitions, GA
  Statutes, Markers for Specific Types of Abuse
• 3rd Hour Markers for Specific Types of Abuse
  (continued), Case Scenarios/Discussions, Undue
  Influence
• 4th Hour Investigative Tools, Local Resources
  (Adult Protective Services, Ombudsman,
  Prosecutors), Videos (Roll Call and Sexual
  Assault Case as time allowed)

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Handouts/Resources

• Handouts
• 3 PowerPoint Presentations
• 1) Introduction, Stats, Normal Aging,
• 2) Mandated reporting, OCGA statutes specific
  to abuse, neglect exploitation (ANE), Types
  and markers of ANE, Case scenarios
• 3) Investigative Tools
• Resources
• List of Local Resources
• Elder Abuse Investigation Check List Statutes
• Miscellaneous Alzheimers, Mental Health, etc.
• Videos

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Morphing Curriculum

• Presentation morphed from week to week based on
• ongoing dialogue with, and feedback from,
  officers
• Basic information remained the same
• Subject Matter Expert availability (prosecutors
  often had court)
• Manner and/or emphasis changed
• New materials as news allowed (news provided
  opportunities for discussions of highlighted
  cases)

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Audience

• All sworn officers (line officers to command
  staff, all shifts)
• 3rd in-service for year (added to usual 2/year)
• Morning session - mental health
• After lunch elder abuse
• Fortunately Unarmed

• Responsive
• Engaging
• Receptive
• Challenging
• Practical

Tough audience! Great experience!
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Practical Matters for Officers

• Most pressing Lack of emergency placement for
  victims of elder abuse
• Officers expressed frustration
• Reluctance to answer calls
• What do I do with him/her?
• I cant let him/her ride shotgun for 8 hours.
• I end up baby-sitting.
• I paid for lodging for victim for one night
  until services were available in a.m.
• When I do call to report, I wait 20 minutes to
  get a voice mail.

How to make the system work better for law
enforcement?
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If You Are Interested

• Dr. Brian Payne Chair, Department of Criminal
  Justice _at_ GA State University (new to GA)
• Attended training in October
• Sent email same evening, I had a thought about a
  possible research project (survey) if you are
  interested.
• Survey based on similar APS survey Dr. Payne
  conducted

Brian K. Payne, PhD, Chair and Professor Departmen
t of Criminal Justice, Georgia State University
404-413-1020, bpayne_at_gsu.edu
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Justification for Law Enforcement Training

• Review of the literature revealed four
  overlapping reasons
• Criminalization of elder abuse
• Relatively new focus for criminal justice system
• Lack of training cited as significant barrier
  to effective response
• Evidence of training effectiveness
• Training contributes to higher reporting rates to
  APS
• Those receiving training more likely to support
  formal responses
• Practical
• Dire consequences require effective preparation
  of responders
• Different set of consequences for older persons
  cant respond in ways appropriate for younger
  persons
• Theoretical justification
• Increasing crime justifies increased awareness

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Function of Crime Elder Abuse

• According to Durkheim,
• 1.) Warning light syndrome when law enforcement
  receives elder abuse training, they have been
  warned about problems facing older population
  (If you cant imagine it, you cant address it.)
• 2) Promotes change promotes changes in the way
  officers respond to and interact with older
  citizens
• 3) Community integration promotes collaboration
  with other professionals who otherwise would not
  be part of officers network
• 4) Boundary maintenance promotes learning
  appropriate and inappropriate behavior (mandatory
  reporting, statutes, etc.)

Training programs can be justified for many
reasons, few studies have considered what type of
elder abuse training should be provided to
officers.
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Background on Survey

• Importance of training is often assumed
• But, what do officers really need to know?
• Needs assessmentidentifies gaps between what is
  known and what needs to be known

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The Survey (Three Components)

• 1) Demographics
• 2) Experiences with older persons
• 3) Perceptions about training/Training needs
• Completed by 80 officers (last 3 weeks of
  training)
• The survey was modified from an earlier survey on
  DV training needs of social services workers,
  including APS workers

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Demographics

• Gender, race, years experience
• 85 Male
• 50 Caucasian
• 2.5 30 years in law enforcement

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Experiences with older persons

• 50 Rarely respond to cases with older witnesses
• 40 Rarely respond to cases with older victims
• 1 to 72 Calls/year to assist older persons

Numbers dont match - Dekalb County 700,000
total residents (fastest growing portion of total
population comprised of gt65 and yet only 12 elder
abuse cases in prosecutors office in 07).
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Training Preferences

• 60 Classroom
• 50 Video tapes
• 12 Web-based asynchronous
• 9 Video conferences
• 6 Web-based live
• 6 Self study

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Measuring Awareness about Elder Abuse

• Please tell me about the overall knowledge of
  your police officers regarding elder abuse.
• First, tell me how much you think your fellow
  officers know (on average) about each aspect of
  elder abuse by checking the appropriate box.
• Second, for each item, please tell me how much
  knowledge you think your fellow officers NEED
  about each of the following in order to be
  effective in their job.
• Use a scale from 1-4, where 1 means they need
  almost no knowledge, 2 means they need a little
  knowledge, 3 means they need some knowledge, and
  4 means they need a lot of knowledge.

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The Items

• The basic dynamics of elder abuse
• Theoretical perspectives on elder abuse
• Indicators that may identify elder abuse victims
• Documenting elder abuse in the victims record
• Interviewing victims of elder abuse
• Intervening with perpetrators of violence
  (abusers)
• Communicating warning signs of abuser lethality
  to victims
• Obtaining protection orders for victims
• The availability of community (local) resources
  for victims of elder abuse
• Information about mandatory reporting laws
• Information about abuses occurring in nursing
  homes
• Enforcing failure to report laws
• Georgia laws and legal options available in elder
  abuse situations.
• Accessing adult protective services in elder
  abuse situations

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Items Continued

• Communicating information to the Office of
  Regulatory Services
• The special needs of elder abuse victims
• Coping with frustrations and emotions encountered
  with working with victims of elder abuse.
• Planning for their own safety when working with
  victims
• Developing rapport with older victims/witnesses
• Working with community based services (such as
  shelters) to get needed services
• Working with social services to assist victims
• Obtaining needed medical care for victims
• Obtaining needed mental health care for victims
• Gathering evidence in elder abuse cases
• Intervening in cases with individuals who have
  Alzheimers/dementia
• Gathering evidence in patient abuse cases
  occurring in nursing homes

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How Much they Know v. Need to Know
The larger the gaps between the lines, the more
of a gap in awareness
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Findings

• Officers indicated that fellow officers didnt
  know much about elder abuse.
• Gathering evidence and intervening were the items
  they needed to know the most about.
• Needed to know the least about availability of
  community resources and enforcing failure to
  report laws.

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Findings
For every single item, officers reported that
their fellow officers did not know enough about
elder abuse, neglect exploitation

• No gender differences, but some differences
  related to race and supervisory status
• Supervisors rated needed levels higher than
  non-supervisors

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Implications

• Not surprising, but this data unlike other
  studies on elder abuse training comes directly
  from police officers
• Need for collaborative training at the state
  level as part of multi-disciplinary approach
• Have trainers from one occupation provide
  training to other groups as part of
  multi-disciplinary approach
• Supervisors liked web-based delivery, but
  non-supervisors did not
• Must sell web training to line officers
• Recognize cultural differences related to elder
  abuse awareness
• Some groups will see it as more important than
  others
• Evaluate training (Increased cases? Prosecutions?
  Improved collaborations?)

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Implications for Trainers

• As a trainer
• Be prepared
• Know your material
• Know your audience
• Include Subject Matter Experts
• Be flexible
• If something is not working, change it
• Be respectful
• Avoid telling officers how to do their jobs
• Go for a ride-along
• Be ready
• For tough questions
• If you dont know, say so offer to find out and
  get back to them
• Pay attention
• Youll learn a lot

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Barriers to Developing Training

• Disconnect between policy and practice
• Often, standard operating procedures are
  different from what the stated policy is
• Lack of evidence-based practices
• Because the criminalization of elder abuse
  occurred only recently, there is very little data
  about the best law enforcement strategies

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Ageism

• At the societal and institutional levels, ageism
  serves to keep elder abuse hidden.

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Acceptance of Myths by Law Enforcement and Policy
Makers
A number of myths keep individuals from fully
understanding the best ways to respond to elder
abuse.
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Elder Abuse Fiction and Fact

• Most crimes against seniors are violent street
  crimes.
• The consequences of victimization are the same
  for older and younger victims.
• Elder abuse is similar to child abuse.

• Financial offenses are more common among older
  persons.
• Sometimes consequences are more severe as we grow
  older.
• Its more similar to spouse abuse.

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Fiction and Fact continued

• The best way to deal with elder abuse is to pass
  laws.
• Abusive adult offspring were abused as children.
• Adult offspring are abusive because of their
  parents dependency on them.

• Many laws are ineffective, problematic and
  biased.
• Child abuse victims may become child abusers.
• Abusive adult offspring more likely dependent on
  parent.

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Fiction and Fact Continued

• Many older victims are victims because they were
  in the wrong place at wrong time.
• Crimes against elderly persons are not a big
  problem.
• The CJS should declare a war on elder abuse.

• Most older victims are victimized at or near
  their homes.
• Statistics are misleading and non-existent
• Integrated and interdisciplinary approach is
  needed.

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In Summary

• Return on investment Immeasurable
• Number of arrests by this department has
  increased.
• Number of prosecutions in the county has
  increased.
• County has created a multi-disciplinary team.
• Emergency Placement is now an active priority.
• State-wide law enforcement elder abuse curriculum
  revision underway.
• Article about findings pending publication.
• Survey provided basis for grant submission to
  assess elder abuse training to law enforcement
  statewide.

Multi-disciplinary approach required. Reach out
to law enforcement.
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Resources/References
Durkheim, E.,. Suicide A Study In Sociology,
1897 The Rules of Sociological Method, 1895
Payne, Brian K.  Training Adult Protective
Services Workers about Domestic Violence,
Violence Against Women, in press.