The author(s) shown below used Federal funds provided by the U.S. Department of Justice and prepared the following final report: Document Title: Developing End-User Criteria and a Prototype for an Elder Abuse Assessment System Author(s): Kendon J. Conrad, Ph.D., Madelyn Iris, Ph.D., Barth B. Riley, Ph.D., Edward Mensah, Ph.D., Jessica Mazza, M.S.P.H. Document No.: 241390 Date Received: February 2013 Award Number: 2009-IJ-CX-0202 This report has not been published by the U.S. Department of Justice. To provide better customer service, NCJRS has made this Federally- funded grant report available electronically. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. Developing End-User Criteria and a Prototype for an Elder Abuse Assessment System Final Technical Report December 31, 2012 This project was supported by Grant No. 2009-IJ-CX-0202 awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Opinions, findings, and conclusions or recommendations expressed in this publication/program/ exhibition are those of the author(s) and do not necessarily reflect those of the Department of Justice. Principal Investigators: Kendon J. Conrad, PhD, 1,3, Madelyn Iris, PhD, 2 Co-Investigators: Barth B. Riley, PhD, 3 Edward Mensah, PhD, 1 Research Assistant: Jessica Mazza, MSPH,1 1School of Public Health, University of Illinois at Chicago. 2Leonard Schanfield Research Institute, CJE SeniorLife, Chicago Illinois. 3Chestnut Health Systems, Bloomington, Illinois. Abstract 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 as well as state-specific definitions to clarify the 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 report describes the development of the Elder Abuse Decision Support System (EADSS), a web-based, computerized system that uses short screening forms and standardized measures to assess elder mistreatment and exploitation. It then describes system contents and how it works. At intake, short screeners are used to assess suspected abuse; next, web-based measures facilitate interviews with alleged victims, collaterals, and alleged abusers in various e-formats 1 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. with real-time data entry. Then the system generates a written report with recommendations that staff can use for care planning. The system should facilitate improved assessment and reporting as well as assist in treatment planning and evaluation of expected system outcomes such as increased convenience and efficiency and improved quality of assessments. 2 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. Table of Contents ABSTRACT ........................................................................................................................................1 TABLE OF CONTENTS ........................................................................................................................3 EXECUTIVE SUMMARY ......................................................................................................................4 MAIN BODY ....................................................................................................................................18 INTRODUCTION ...............................................................................................................................18 METHODS .......................................................................................................................................28 RESULTS .........................................................................................................................................29 CONCLUSIONS .................................................................................................................................53 REFERENCES ...................................................................................................................................58 DISSEMINATION OF RESEARCH FINDINGS .......................................................................................64 LIST OF FIGURES AND APPENDICES .................................................................................................67 3 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. Executive Summary In 1996, the National Elder Abuse Incidence Study highlighted the significant problem of abuse against older adults: about 450,000 persons above 60 years old were victims of abuse or neglect (National Center on Elder Abuse, 1998). In 2009, using data from 5,777 respondents 60 and older, over 1 in 10 participants reported emotional, physical, or sexual mistreatment or potential neglect during the past year (Acierno et al., 2010). Therefore, despite public and professional education efforts, elder abuse remains an escalating problem (Krienert, Walsh, & Turner, 2009; Park, Johnson, Flasch, & Bogie, 2010; Teaster, Otto, Mendiondo, Abner, & Cecil, 2006; U.S. Government Accountability Office, 2011). Mixson (2010) referred to elder abuse as a potential “perfect storm,” due to state budget freezes, cuts in critical services and a burgeoning aging population (see also, U.S. Government Accountability Office, 2011). In 2009, the National Adult Protective Services Association (2009) conducted a survey of state budgets and found that, on average, over half of respondents reported APS budget cuts of 13.5%, as well as deep cuts to support services; while two-thirds noted that abuse reports to APS had increased by 24%. To ensure that the effects of these budgetary strategies are minimized, improved efficiency and quality of assessment along with user-friendly reporting and treatment planning are urgently needed. In 2010, the National Academies and the National Institute on Aging addressed research issues in elder mistreatment, referring to it as a “societal threat” and “public health burden.” The meeting report (National Academies Committee on National Statistics, 2010) highlighted the needs for improved screening tools that can stratify baseline vulnerability of alleged victims, conceptual development of all types of elder abuse, and outcome measures appropriate for both research and clinical use. 4 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. The significance of these needs is attested to by recent GAO recommendations to the U.S. Senate, all of which pertain to facilitating the development of a nationwide APS data collection system (U.S. GAO, 2011). To highlight the need for standardization, the GAO report noted wide variation in the percentage of reported cases that were investigated: for example, only 20% of cases reported were investigated in Minnesota while 87% were investigated in Illinois. There was also great variation in the percentage of cases reported that were substantiated: West Virginia substantiated only 2.1% of cases reported, Minnesota 3%, Utah 4.7%. In contrast, Texas substantiated 57.1% of cases reported, Illinois, 53% and California, 27.9%. Standardization can address this high variability with high quality input of clients, collaterals and caseworkers. Innovation Experts consider health information technology to be a key to improving efficiency and quality of health care (Chaudhry et al., 2006). Elder abuse assessment and intervention fall within this genre and merit improved decision support technology. Traditional approaches to elder abuse investigation rely on either case management or adult protective services models (U.S.GAO, 2011). In both approaches, care plan decision-making is not systematically supported by evidence-based measures or interventions. In fact, the computer is simply a repository of information that does not process and synthesize data, nor report and interpret findings or provide recommendations (Note: Figures to illustrate this and other points in this executive summary can be found in the full report). A comprehensive, multi-level assessment and decision support system facilitates comprehensive assessment