Pragmatic Randomized Control Trial of a Coordinated Community Response: Increasing Access to Services for At-Risk Older Adults.

BACKGROUND: Elder abuse, neglect, and financial exploitation (EANF) impacts over five million community-dwelling older adults. Yet, no evidence-based intervention models exist that prevent EANF. OBJECTIVES: In this article, we describe the assessment of process outcomes for a Community Complex Care Response Team (C3RT) model developed, via a practitioner-researcher partnership, to reduce instances of EANF victimization among higher risk community-dwelling older adults by identifying and coordinating their service needs. Specifically, we evaluated whether this C3RT approach produced more service coordination among providers (measured as documented interagency communications), more referrals for services, and more enrollment in services. METHODS: A pragmatic randomized control trial using a 1:1 randomization scheme allocated participants to either the C3RT intervention (N = 74) or standard practice (N = 72) group offered by a local Area Agency on Aging. Outcome data were extracted from the participants' administrative service records. RESULTS: The participants assigned to C3RT had significantly more interagency communications and services provided (p < 0.05) than those in standard practice. CONCLUSIONS: Communications and services increased across a broad range of multidisciplinary services, which attend to the social determinants of health. This study is the first to use objective outcome measures to evaluate the processes of a coordinated community response approach systematically.

Early Stages of COVID-19 Pandemic Had No Discernable Impact on Risk of Elder Abuse and Neglect Among Dementia Family Caregivers: A Daily Diary Study.

There is widespread concern that elder abuse and neglect (EAN) incidents increased during the onset of the COVID-19 pandemic due in part to increases in risk factors. Initial reports relying on administrative systems such as adult protective services records produced mixed results regarding whether or not there was a change in EAN incidents. Using data from an ongoing longitudinal study on EAN in dementia family caregiving that started before the pandemic, we assessed the hypothesis that the pandemic is related to a change in probability of EAN and EAN protective factors. Family caregivers to persons with dementia completed two waves of 21 daily diaries, 6-months apart, assessing their daily use of EAN behaviors. The first group (n = 32) completed their first wave before the pandemic and their second wave during the pandemic. The second group (n = 32) completed both waves during the pandemic. For this cohort, the generalized linear mixed logistic model results showed inconsistent associations between the onset of COVID-19 and the probability of a caregiver engaging in elder abuse or neglect behaviors. In terms of protective factors, the use of formal services was not significantly impacted by COVID-19; however, the likelihood of receiving informal support from family and friends increased significantly during the pandemic period. Dementia family caregivers were not likely impacted negatively by initial pandemic restrictions, such as shelter-in-place orders, as anticipated. These findings contribute to our understanding of how distal, disruptive processes may influence more proximal caregiver stresses and the likelihood of EAN. Supplementary Information: The online version contains supplementary material available at 10.1007/s10896-022-00392-8.

Development and Implementation of a Coordinated Community Response to Address Elder Abuse and Neglect.

BACKGROUND: Elder abuse, neglect, and financial exploitation impacts over five million community-dwelling older adults in the United States. Although services are available to help these victims, they are often fragmented within communities with service providers having limited means to provide preventative services. The coordinated community response (CCR) is a type of coalition intended to overcome siloed services through a single-point-of-entry system and more team-based approaches to prevention. This article describes the development, implementation, and evaluation of the interagency functioning of a local CCR. METHODS: The main goal of the CCR has been to better serve victims of elder abuse, neglect, and financial exploitation. However, through the coalition's evolution, the mission of how to do this shifted from a victim service model to a prevention approach. Unique features of this CCR include a uniform consent form to allow sharing of protected client data among all service providers and a technology-supported infrastructure for service record documentation and referrals. EVALUATION: Using available data from administrative records, the number of unique interagency referrals for services to older adults at risk increased 450% from 2016 to 2018. The strength and type of connections between agencies changed over time. Among all eligible clients offered services, most (77%) agreed to provide uniform consent to allow data sharing among other local partner agencies. DISCUSSION: The evaluation showed that the coalition met most of its planned measurable outputs in the original logic model guiding the CCR programmatic development. The evaluation findings and lessons learned inform updated guidelines for self-assessment of CCRs.

Dynamic structural equation modelling evaluating the progressively lowered stress threshold as an explanation for behavioural symptoms of dementia.

AIM: To evaluate the progressively lowered stress threshold (PLST) conceptual model as an explanation for behavioural symptoms of dementia and test several of its hypothesized propositions. The PLST model suggests that due to impairments in coping, persons living with dementia have a reduced threshold for stress and respond with more behavioural symptoms of dementia as stress accumulates throughout the day. DESIGN: Intensive longitudinal design. METHODS: A sample of N = 165 family caregivers completed brief daily diary surveys for 21 days between the dates of 7/2019 and 8/2020, reporting on a total of 2841 days. Dynamic structural equation modelling was used as the analytic technique to examine the impact of caregiver and care recipient environmental stressors on the diversity of behavioural symptoms of dementia to account for the nested data structure and autoregressive relationships. FINDINGS: Results show direct relationships between environmental stressors and diversity of behavioural symptoms of dementia that same day and the following day. CONCLUSION: Findings provide support for the PLST model propositions. Further, findings suggest an extension to the conceptual model is warranted given evidence of an exposure/recovery trajectory and the lagged effects of stress exposure on behavioural symptoms of dementia presentation. IMPACT: This study tested whether a commonly used nursing model does in fact explain the occurrence of behavioural symptoms of dementia. The main findings support using the model as an intervention framework and suggest the model should be adapted to consider recovery trajectories. Since behavioural symptoms of dementia represent complex and dynamic temporal phenomena, traditional longitudinal assessments and analyses are an insufficient measurement modality for testing models. Findings inform the design of environmental-modification type interventions for behavioural symptoms of dementia management and the methods to evaluate such interventions.

General Offending and Intimate Partner Violence Perpetration in Young Adulthood: A Dutch Longitudinal Study.

This study examines the relationship between general offending and intimate partner violence (IPV) perpetration in young adulthood, using a Dutch longitudinal study. Young adults were followed over four waves, and self-reported data on general offending, IPV perpetration, and a number of individual characteristics were collected. Results of random effects models demonstrated that young adults involved in more diverse offending behavior reported higher levels of different types of IPV perpetration, even when individual factors were taken into account. Moreover, logistic regression analyses showed that general offending was also related to an increased likelihood of continuity in IPV perpetration. Taken together, the findings indicate that it is useful to view IPV perpetration as part of a broader criminal career.

Criminal Protection Orders Among Women Victims of Intimate Partner Violence: Women's Experiences of Court Decisions, Processes, and Their Willingness to Engage With the System in the Future.

Consistent with a therapeutic jurisprudence framework, court decisions and processes can have a therapeutic or antitherapeutic effect on intimate partner violence (IPV) victims. To maximize therapeutic effects, IPV scholars have advocated for survivor-defined practices that emphasize the importance of engaging with victims in a collaborative manner that promotes autonomy, choice, and control. However, limited research exists in the context of criminal protection orders (POs). The current study addressed this gap by assessing whether criminal PO match (whether victims received the level PO they requested [i.e., PO match] or not [i.e., PO mismatch]) and victims' subjective experiences of the court process were associated with their willingness to use the system in the future to address IPV. In a sample of 187 women whose partners were arrested for IPV, experiencing the court processes as positive (ß = .36, p = .001) and court-related fear (ß = .41, p < .001) were positively associated with willingness to use the system in the future. Additionally, PO match moderated the association between subjective court experiences and willingness to use the system in the future. Experiencing the court processes as negative (b = .33, p = .005) and validating (b = -.36, p = .001) was associated with willingness to use the system in the future only for participants who did not receive the PO level they requested. While experiencing the court as positive (b = -.40, p ≤ .001) was associated with willingness to use the system regardless of PO match, it was most strongly associated for participants who did not receive the PO level they requested. Results suggest the importance of ascertaining strategies to improve victims' experiences with the court, especially when victims' requests are not met, to increase future engagement with the system.

The Relationship Between the Development of General Offending and Intimate Partner Violence Perpetration in Young Adulthood.

This study examined how patterns in general offending relate to the occurrence of and likelihood of persistence in intimate partner violence (IPV) perpetration in young adulthood. The study used longitudinal data from the cohort of 18 year olds from the Project on Human Development in Chicago Neighborhoods study. Self-reported offending was measured in all three waves, and data on IPV were collected in Waves 1 and 3. Group-based trajectory modeling identified three distinct general offending trajectory groups: non-offenders, low-rate offenders, and high-rate offenders. The majority of respondents engaged in psychological IPV perpetration, and half of all young adults reported physical IPV, but prevalence rates decreased over the waves. Binary logistic regression analyses showed that those involved in offending, especially those who showed a diverse offending pattern, were at increased risk of perpetrating psychological and (severe) physical IPV, as well as to show persistence in the different forms of IPV perpetration. The findings highlight an important overlap between general crime and IPV perpetration. In recognition that IPV is often part of a broader pattern of antisocial behavior, interventions should focus on interrupting the criminal careers of all young offenders to reduce the prevalence and harms of IPV.

Progress toward national estimates of police use of force.

This research builds on three decades of effort to produce national estimates of the amount and rate of force used by law enforcement officers in the United States. Prior efforts to produce national estimates have suffered from poor and inconsistent measurements of force, small and unrepresentative samples, low survey and/or item response rates, and disparate reporting of rates of force. The present study employs data from a nationally representative survey of state and local law enforcement agencies that has a high survey response rate as well as a relatively high rate of reporting uses of force. Using data on arrests for violent offenses and the number of sworn officers to impute missing data on uses of force, we estimate a total of 337,590 use of physical force incidents among State and local law enforcement agencies during 2012 with a 95 percent confidence interval of +/- 10,470 incidents or +/- 3.1 percent. This article reports the extent to which the number and rate of force incidents vary by the type and size of law enforcement agencies. Our findings demonstrate the willingness of a large proportion of law enforcement agencies to voluntarily report the amount of force used by their officers and the relative strengths and weaknesses of the Law Enforcement Management and Administrative Statistics (LEMAS) program to produce nationally representative information about police behavior.

Lethal intimate partner violence in later life: Understanding measurements, strengths, and limitations of research.

The aim of this article is to conduct a critical analysis of existing family violence literature related to elder abuse homicide, also known as "eldercide." The focus relates to fatal violence perpetrated by current or former intimates. Men are the most likely victims of homicide but are rarely murdered by partners. Older women are most often killed in the home by a spouse or other family, consistent with the notion of "femicide." The Federal Bureau of Investigation Supplemental Homicide Reports and the Bureau of Justice Statistics National Crime Victimization Survey are utilized to illustrate trends by sex over time. Intimate partner homicide-suicide is examined via news surveillance. Strengths and limitations of data and methods are addressed. Homicide trends among the members of the baby boom cohort are predicted based on current and future patterns as they age. To facilitate prevention, researchers are encouraged to move beyond simple prevalence estimates toward greater understanding of complex trends, distinctions, and motivations of these violent deaths.

An examination of whether coordinated community responses affect intimate partner violence.

This study tests the impact of coordinated community response (CCR) on reducing intimate partner violence (IPV) and on modifying knowledge and attitudes. The authors conduct hierarchical linear modeling of data from a stratified random-digit dial telephone survey (n = 12,039) in 10 test and 10 control sites, which include 23 counties from different regions in the United States, to establish the impact of a CCR on community members' attitudes toward IPV, knowledge and use of available IPV services, and prevalence of IPV. Findings indicate that CCRs do not affect knowledge, beliefs, or attitudes of IPV, knowledge and use of available IPV services, nor risk of exposure to IPV after controlling for age, gender, ethnicity, income, and education. Women in communities with 6-year CCRs (as opposed to 3-year CCRs) are less likely to report any aggression against them in the past year. These results are discussed within the context of evaluation challenges of CCRs (e.g., IPV activities in comparison communities, variability across interventions, time lag for expected impact, and appropriateness of outcome indicators) and in light of the evidence of the impact of other community-based collaborations.

Experiencing and witnessing familial aggression and their relationship to physically aggressive behaviors among Filipino adolescents.

The effects of family violence on children's aggressive behaviors have been the focus of much research. However, results have been equivocal in at least the following three areas: (a) the specific effects on aggression of child-directed violence versus child-witnessed violence, (b) the salience of family violence as an explanation of aggression when other theoretically relevant explanations of aggression are controlled (i.e., peers, attachments, or moral beliefs), and (c) the gender-specific effects of family violence. Using a probability sample of adolescents from a medium-sized city in the Philippines, this article assesses the effects of child-directed and child-witnessed violence between parents on aggressive behaviors of adolescents while controlling for theoretically relevant explanations of aggression. Results show that child-witnessed and child-directed violence are positively and significantly related to self-reported aggression, that child-witnessed violence accounts for most of the variance in adolescent aggression, and that neither measures of family violence interacts with gender.