Comprehensive Older Adult and Caregiver Help (COACH): A person-centered caregiver intervention prevents elder mistreatment.

BACKGROUND: Elder mistreatment (EM) harms individuals, families, communities, and society as a whole. Yet research on interventions is lagging, and no rigorous studies demonstrating effective prevention have been published. This pilot study examines whether a first-of-its-kind coaching intervention reduced the experience of EM among older adults with chronic health conditions, including dementia. METHODS: We used a double-blind, randomized controlled trial to test a strengths-based person-centered caregiver support intervention, developed from evidence-based approaches used in other types of family violence. Participants (n = 80), family caregivers of older adults who were members of Kaiser Permanente, completed surveys at baseline, post-test, and 3-month follow-up. The primary outcome was caregiver-reported EM; additional proximal outcomes were caregiver burden, quality-of-life, anxiety, and depression. Nonparametric tests (Mann-Whitney U, Fisher's Exact, Wilcoxon Signed Rank, and McNemar's) were used to make comparisons between treatment and control groups and across time points. RESULTS: The treatment group had no EM after intervention completion (assessed at 3-month follow-up), a significantly lower rate than the control group (treatment = 0%, control = 23.1%, p = 0.010). CONCLUSIONS: In this pilot study, we found that the COACH caregiver support intervention successfully reduced EM of persons living with chronic illness, including dementia. Next steps will include: (1) testing the intervention's mechanism in a fully powered RCT and (2) scaling the intervention for testing in a variety of care delivery systems.

Effect of an elder abuse and self-neglect intervention on repeat investigations by adult protective services: RISE project.

BACKGROUND: Adult Protective Services (APS) is the primary agency responsible for investigating elder abuse and self-neglect (EASN) allegations in the United States. The harms of EASN are well established; however, APS lacks a conceptually derived evidenced-based intervention phase. RISE is a community-based intervention designed to complement APS that provides enhanced services and a longer intervention phase. The objective of this study was to test whether exposure to the RISE/APS collaboration was associated with reducing the case outcome of recurrence (repeat investigations) compared to usual care APS only services. METHODS: A retrospective observational study (n = 1947) of two counties in Maine where RISE was available to provide enhanced services to persons referred from APS. An extended regression endogenous treatment Probit model using APS administrative data was used to predict case recurrence. RESULTS: Between July 2019 and October 2021, 154 cases participated in RISE and 1793 received usual APS only services. 49% of cases in RISE had 2 or more prior substantiated allegations versus 6% for those receiving usual APS care, and 46% of cases in RISE had a recurrence during the observation period versus 6% for usual care group. However, after accounting for the non-random treatment assignment, RISE was associated with a significantly lowered likelihood of recurrence compared to persons receiving usual care provided by APS (probability of recurrence reduced by 0.55 for the Average Treatment Effect on the Treated and 0.26 for the Average Treatment Effect). CONCLUSIONS: A reduction in recurrence carries important implications for APS clients, costs, resources, and workflow. It may also serve as a proxy indicating a reduction in revictimization and harm for EASN victims.

Use of Motivational Interviewing by Advocates in the Context of an Elder Abuse Response Intervention: The RISE Project.

Purpose: Despite the increasing number of elder abuse and self-neglect (EASN) cases, many older adults are reluctant to engage with formal support services, such as Adult Protective Services (APS). This study examined the use of motivational interviewing (MI) by advocates, as a component of a larger EASN intervention, RISE (Repair Harm, Inspire Change, Support Connection, Empower Choice), implemented in partnership with APS. Advocates applied MI as part of RISE to help clients explore and resolve ambivalence around pursuing change and ultimately enhance service engagement. Methods: This study conducted qualitative interviews and a focus group with all RISE advocates (n = 4) to understand how MI is applied in the context of an EASN intervention with older adult clients. A descriptive phenomenological approach involving two independent assessors was used to code verbatim transcripts into themes. Results: Three domains were identified: (1) therapeutic relationship, which describes the importance of foundational relationship building in MI to support older adults who have experienced EASN; (2) techniques, which refers to MI strategies advocates apply and adapt in the context of EASN intervention; and (3) implementation challenges, which reflects the difficulties advocates encounter when using MI in cases of EASN. Conclusions: The experiences of advocates suggest MI is a beneficial and amenable approach to help older adults who have experienced EASN navigate issues of ambivalence and explore their motivation for change. This study represents the first in-depth exploration of MI in the context of EASN intervention.

RISE: A Conceptual Model of Integrated and Restorative Elder Abuse Intervention.

Despite a growing number of elder abuse (EA) cases nationwide, response programs such as adult protective services (APS) lack a defined, prolonged intervention phase to address these complex situations. This article presents RISE, a model of EA intervention that works alongside APS or other systems that interact with at-risk older adults. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields (including motivational interviewing, teaming, restorative justice, and goal attainment scaling), the RISE model intervenes at levels of the individual older adult victim, individual harmer, their relationship, and community to address EA risk and strengthen systems of support surrounding the victim-harmer dyad. The RISE model addresses an intervention gap in existing systems to better meet the needs of EA victims and others in their lives, leading to more sustainable outcomes.

A qualitative evaluation of the "RISE" elder abuse intervention from the perspective of adult protective services caseworkers: addressing a service system gap.

Our understanding of effective elder abuse (EA) response interventions is limited. Adult Protective Services (APS), the primary agency responsible for responding to EA, lacks a coherent, conceptually driven, prolonged intervention phase. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields, the RISE EA intervention addresses this APS systems gap. Based on a three-year pilot project involving a partnership between RISE and Maine APS, the current study conducted a qualitative evaluation of RISE, from the perspective of APS caseworkers (n = 14) who worked with RISE, to understand RISE strengths and areas for improvement. Findings suggest APS workers perceive that RISE complements the scope and nature of APS, enhances APS caseworker well-being, and reduces repeat APS cases, while further APS/RISE collaboration and clarification on RISE role responsibilities and referral eligibilities are areas of growth. This study provides preliminary evidence for RISE as a community-based EA intervention in partnership with APS.

The distribution of COVID-19-related risks.

We document two COVID-19-related risks, viral risk and employment risk, and their distributions across the Canadian population. The measurement of viral risk is based on the VSE COVID-19 Risk/Reward Assessment Tool, created to assist policy-makers in determining the impacts of pandemic-related economic shutdowns and re-openings. Women are more concentrated in high-viral-transmission-risk occupations, which is the source of their greater employment loss over the first part of the pandemic. They were also less likely to maintain contact with their former employers, reducing employment recovery rates. Low-educated workers face the same viral risk rates as high-educated workers but much higher employment losses. This is largely due to their lower likelihood of switching to working from home. For both women and the low-educated, existing inequities in their occupational distributions and living situations have resulted in them bearing a disproportionate amount of the risk emerging from the pandemic. Assortative matching in couples has tended to exacerbate risk inequities.

Dans cet article, nous documentons deux risques associés à la COVID­19, soit le risque de contracter le virus étant donné l'emploi occupé et le risque de perdre son emploi dans le contexte de la pandémie. La répartition de ces risques dans la population canadienne est aussi documentée. La mesure du risque viral est basée sur l'outil de visualisation des risques par profession et industrie liés à la COVID­19 de la VSE, créée pour aider les décideurs à déterminer les impacts des fermetures et réouvertures des différents secteurs de l'économie durant la pandémie. On note que les femmes sont plus présentes dans les professions à haut risque viral, ce qui explique en partie leur plus grande perte d'emploi durant la première partie de la pandémie. Durant la pandémie, elles étaient également moins susceptibles de demeurer en contact avec leurs anciens employeurs, ce qui a affecté négativement leur taux de retour au travail. Le risque viral était similaire pour les travailleurs peu éduqués et les travailleurs hautement qualifiés, mais les pertes d'emplois ont été beaucoup plus importantes pour les travailleurs peu éduqués. Cette différence peut être attribuable à leur plus faible capacité à effectuer leur travail à domicile étant donné la nature de leur emploi. Tant pour les femmes que pour les personnes peu éduquées, les inégalités existantes dans leurs conditions de vie et leur répartition professionnelle les ont conduites à subir une part plus élevée du risque lié à la pandémie. Enfin, l'appariement assortatif des couples selon les professions a eu tendance à exacerber les inégalités face aux risques.

Primary school reopenings and parental work.

In this paper, we exploit the geographical pattern of primary school reopenings during the COVID-19 pandemic in Canada to estimate the impact of school reopenings on parental employment and work hours. We use a triple-difference approach, in which we first compare parents of primary-school children in regions where schools reopened to similar parents in regions where schools remained closed and add parents of older, secondary-school children as an additional control group. We estimate the impact of school reopenings separately for mothers and fathers, and for single parents and parents living in dual-parent households. We find a positive impact of school reopenings on employment and on actual hours worked. The effects tend to be stronger for single mothers, but are also present for mothers and fathers in dual-parent households in the spring of 2020. Overall, single mothers experienced an 18 percentage point increase in their employment at work rate following school reopenings. We also split our sample according to whether the job can be done from home, and find stronger impacts for those whose jobs cannot easily be done from home.

La réouverture des écoles primaires et le travail des parents. Dans cet article, nous exploitons la dispersion géographique des réouvertures d'écoles primaires durant la pandémie de COVID­19 au Canada afin d'estimer l'impact des réouvertures d'écoles sur l'emploi des parents et leurs heures de travail. Nous utilisons une approche de triple différence, dans laquelle nous comparons tout d'abord les parents d'enfants à l'école primaire dans les régions où les écoles ont réouvert aux parents similaires dans les régions où les écoles sont restées fermées, puis nous ajoutons les parents d'enfants plus âgés, à l'école secondaire, comme groupe de contrôle additionnel. Nous estimons l'impact des réouvertures d'écoles séparément pour les mères et les pères, et pour les parents monoparentaux et ceux dans les ménages à deux parents. Nous trouvons un impact positif des réouvertures d'écoles sur l'emploi et les heures effectivement travaillées. Les effets tendent à être plus marqués pour les mères monoparentales, mais sont aussi présents pour les mères et les pères dans les ménages à deux parents au printemps 2020. En tout, les mères monoparentales ont connu une hausse de 18 points de pourcentage de leur taux d'emploi (au travail) suite aux réouvertures d'écoles. Nous séparons aussi notre échantillon selon que l'emploi puisse être fait de la maison et trouvons des impacts plus forts pour ceux dont l'emploi ne peut facilement être fait de la maison.

Developing a rigorous, systematic methodology to identify and categorize elder mistreatment in criminal justice data.

Elder mistreatment is complex, with cases typically requiring integrated responses from social services, medicine, civil law, and criminal justice. Only limited research exists describing elder mistreatment prosecution and its impact. Researchers have not yet examined administrative prosecutorial data to explore mistreatment response, and no standardized analytic approach exists. We developed a rigorous, systematic methodologic approach to identify elder mistreatment cases in prosecutorial data from cases of crimes against victims aged ≥60. To do so, we operationalized elements of the accepted definition of elder mistreatment, including expectation of trust and vulnerability. We also designed an approach to categorize elder mistreatment cases, using the types of charges filed, into: financial exploitation, physical abuse, sexual abuse, verbal/emotional/psychological abuse, and neglect. This standardized methodological approach to identify and categorize elder mistreatment cases in prosecution data is an important preliminary step in analyzing this potentially untapped source of useful information about mistreatment response.

Designing and implementing an electronic nursing record to support compassionate and person-centred nursing practice in an acute hospital using practice development processes.

BACKGROUND: The complexity of nursing practice can pose challenges to the development of an e-record that meets all the requirements and standards whilst capturing the essence of the relationship between the nurse and his/her patients. AIMS: 1. Describe the process of designing the content of an electronic nursing record (e-record) specific to nursing in an Irish/UK context, using Practice Development (PD) methodology.2. To share the learning of involving the end-user in the development of a person-centred e-nursing record. METHODS: Evidence-based PD methodologies, principles and evaluation tools were employed to involve end users in the development of a person-centred and evidence-based e-record. RESULTS: The results are limited to evaluation of the design process and reported using the SQUIRE guidelines for reporting quality improvement. Investing in time to involve end users in the design and implementation phase resulted in satisfaction and adoption of the e-record by nurses. CONCLUSIONS: For nurses to be satisfied with the content and process flow of an e-nursing record it needs to include the relational and non-clinical aspect of nursing practice in addition to the clinical pre-set content. Involving the end user in a meaningful way supports a positive outcome.

The feasibility of goal attainment scaling to measure case resolution in elder abuse and neglect adult protective services intervention.

OBJECTIVES: This pilot study describes implementation procedures of goal attainment scaling (GAS) and examines the feasibility of using GAS to measure the multifarious intervention outcome of case resolution in elder mistreatment (EM) adult protective services (APS). METHODS: Substantiated EM victims (n = 27) were recruited prospectively from the State of Maine APS. An adapted GAS approach was implemented involving development of a pre-populated goal scale menu and web-based GAS application. RESULTS: The GAS menu comprised 18 goals and corresponding scales spanning several domains of case resolution: social support, service access, health/functioning, enhancing independence, and protective measures. The overall GAS process had mean length 33.8 min per case. The mean GAS summary t-score (54.3) aligned with theoretical expectations. DISCUSSION: Without a measure of case resolution, research cannot compare the effectiveness of different EM intervention models. Findings suggest that GAS is a feasible, client-centered strategy to measure the multifarious EM intervention case resolution outcome.

Elder mistreatment: priorities for consideration by the white house conference on aging.

Elder mistreatment is recognized internationally as a prevalent and growing problem, meriting the attention of policymakers, practitioners, and the general public. Studies have demonstrated that elder mistreatment is sufficiently widespread to be a major public health concern and that it leads to a range of negative physical, psychological, and financial outcomes. This article provides an overview of key issues related to the prevention and treatment of elder mistreatment, focusing on initiatives that can be addressed by the White House Conference on Aging. We review research on the extent of mistreatment and its consequences. We then propose 3 challenges in preventing and treating elder mistreatment that relate to improving research knowledge, creating a comprehensive service system, and developing effective policy. Under each challenge, examples are provided of promising initiatives that can be taken to eliminate mistreatment. To inform the recommendations, we employed recent data from the Elder Justice Roadmap Project, in which 750 stakeholders in the field of elder mistreatment were surveyed regarding research and policy priorities.

Approaches to evaluation in Australian child and family welfare organizations.

Child and family welfare organizations around the world aspire to achieve missions that will improve outcomes for vulnerable children and families and ultimately reduce the prevalence and impact of child maltreatment. In Australia, this work is currently being influenced by an increasingly turbulent political and economic climate; one that is requiring organizations to engage with evaluation in new and advanced ways so that they are not left behind in the increasingly complex and competitive environment that they now operate in. Despite the apparent awareness and understanding of the essential place of evaluation in quality and effective service delivery, it is also understood that evaluation of the human services work that child and family welfare organizations undertake is extremely challenging due to its intricate, ever-changing and often innovative nature. Embedding evaluation within such organizations therefore requires a tailored and planned decision-making and implementation process. This paper will briefly describe the recent socio-political history and environment that Australian child and family welfare organizations operate in and how this has impacted on engagement with evaluation. With consideration to this, it will describe the evaluation approaches available to organizations and the factors that may influence selection of a specific approach. It will then explore the benefits and challenges of these evaluation approaches, and consider the implications for child and family welfare agencies more broadly.

Reforming child welfare: an integrated approach.

Throughout the 1990s, child welfare systems were exposed to intense pressure. As a result, most systems have undertaken processes of reform and change. This article discusses the strategic development of New Zealand's service system in child welfare. A partnership between managerial discipline and professional leadership has been critical in the service system reform. With respect to management, a strong vision, a culture of high performance, and greater organizational stability and confidence provided the platform on which professional reforms could be established-including the knowledge framework, the service model, the practice package, and staff support. The managerial efforts that have provided the platform for the professional reforms are discussed, followed by an exploration of the professional reform package.

Where elder abuse and the justice system collide: police power, parens patriae, and 12 recommendations.

This article discusses the intersection of the justice system and elder abuse, arguing for a multidisciplinary framework for approaching the problem. It concludes with 12 recommendations for enhancing the justice system's response to elder abuse.

Elder self-neglect and the justice system: an essay from an interdisciplinary perspective.

Elder self-neglect is a complex issue for the legal system-one not always easily distinguished from other types of elder abuse, neglect, and exploitation. The issue inherently implicates several disciplines, and although self-neglect is not prosecuted per se, prosecutions of other types of elder abuse, neglect, and exploitation may affect self-neglect as well. In addition, other types of legal intervention, such as guardianship actions, may serve to protect vulnerable older people, but it is critical to ensure that such interventions do not inappropriately infringe on the older person's civil liberties or result in exploitation or worse. There are daunting challenges to doing work in this field-death; ageism; medical, legal, and ethical complexities; and a chronic paucity of funding. It is nevertheless imperative that researchers expand their efforts to elucidate the nature and scope of elder self-neglect; its interplay with other forms of abuse, neglect, and exploitation; and the most effective mechanisms for intervention and prevention. Such efforts, and in particular interdisciplinary approaches to these common problems, are critical to improving care for the nation's older people and assisting millions of families and practitioners.

Multiplex immunoassay for serological diagnosis of Mycobacterium bovis infection in cattle.

Efforts to develop a better diagnostic assay for bovine tuberculosis have shown that the sensitivity and specificity of an assay can be improved by the use of two or more antigens. As reported here, we developed a multiplex chemiluminescent immunoassay that can simultaneously detect antibody activity to 25 antigens in a single well in a 96-well plate array format. The chemiluminescent signal is captured with a digital imaging system and analyzed with a macro program that tracks each serum for its pattern of antibody activity for Mycobacterium bovis antigens. The comparison of sera from 522 infected and 1,489 uninfected animals showed that a sensitivity of 93.1% and a specificity of 98.4% can be achieved with a combination of antigens. The assay system is rapid and can be automated for use in a centralized laboratory.

Up front and personal: confronting dynamics in the Family Group Conference.

The Family Group Conference is a participatory model of decision making with families in child protection. It is a legal process that brings together the family, including the extended family, and the professionals in a family-led decision-making forum. Bringing together extended family and professionals to discuss child protection concerns can create a highly charged dynamic. Workers are challenged by family, family are challenged by workers, and family members challenge each other. Practice is also exposed to wider scrutiny as professionals also challenge the work. This article briefly describes the development and practice of family group conferencing as a family-centred legal process in Aotearoa, New Zealand. It then examines the findings of a study exploring the dynamics emerging from family group conference practice from the perspective of the coordinators who convene them. Family group conferencing as a family strengthening practice is discussed.

Reflexivity, reflection, and the change process in offender work.

This study explores the therapeutic engagement experiences of men who have sexually offended against children and who are involved in a prototypical prison-based group treatment programme. The study examined factors relating to the therapeutic engagement of the offender in treatment, and in particular, the impact of the "out-of-group" time between sessions. The findings, although tentative, suggest that between formal therapy sessions, clients of the programme make significant movement either toward or away from engagement in the therapy. The implications of these processes with respect to clinical practice and the development of offender services are discussed.