Examining Adult Protective Services Outcomes: Services Associated With the Decrease of Mistreatment Differed by Elder Mistreatment Type.

BACKGROUND AND OBJECTIVES: Adult Protective Services (APS) are the frontline agencies investigating elder mistreatment and providing/coordinating postinvestigation services. Yet, their effectiveness in reducing different types of mistreatment in relation to services is unknown. This study aimed to address the knowledge gap by identifying services provided by mistreatment type, and examining the associations of services with mistreatment reduction. RESEARCH DESIGN AND METHODS: A pretest-post-test design was implemented using the Identification, Services, and Outcomes (ISO) Matrix to assess mistreatment levels during case investigation and at case closure after services were provided. San Francisco and Napa APS participated in a 6-month data collection. RESULTS: The 4 most prevalent types of mistreatment were examined: emotional, physical, financial abuse, and neglect by others. On average, level of mistreatment decreased across mistreatment types after APS intervention. Care/case management, mental health, and other services were most common, while specific services differed depending on type of mistreatment. Care/case management services were associated with physical and emotional abuse reduction, legal services further correlated with emotional abuse reduction; financial planning services were associated with financial abuse reduction; care/case management and other services were associated with neglect reduction. DISCUSSION AND IMPLICATIONS: This is the first study to address APS services by mistreatment type and the outcomes of services. Adoption of the ISO Matrix by APS programs opens the possibility of research and practice collaboration in APS outcomes research using a standardized approach.

Convivir (to Coexist) and Other Insights: Results From the Positive Aging for Latinos Study.

Many Latinos in the United States do not have access to culturally sensitive services to help them age well. We combined community-based participatory research with concept mapping methods to understand how a sample of community-dwelling Latino older adults view positive aging. Nine focus groups (N = 101) generated 85 non-repeating statements, which were used to produce a final map with 11 clusters, organized into four overarching regions: Convivir (To Coexist), Self-Sufficiency, Perspectives on Life, and Healthy Behaviors. Further analyses revealed three themes: (1) the importance of varied social connections, as conveyed by the region labeled Convivir; (2) a multifaceted understanding of "stability" that includes finances, relationships, and spirituality; and (3) the need for a mature mindset reflected in the thematic cluster Tomalo Suave (Take It Easy). Findings can inform the development of interventions for Latino older adults and the cultural adaptation of programs initially designed for non-Latinos.

Balancing practicality and validity of elder abuse identification measures: using data from adult protective services investigations.

Background and Objectives. In testing a comprehensive decision support system for Adult Protective Services (APS), this study addressed two problems common in APS research and practice: the psychometric quality of the measures and measurement burden. Research Design and Methods. Data were generated on 1,472 APS cases over six months in two California counties using the Identification, Services and Outcomes (ISO) Matrix, a comprehensive decision support system for APS. The ISO Matrix uses Short-Forms developed from the Elder Abuse Decision Support System (EADSS). Mini-Forms were developed from the Short-Forms and tested in order to reduce measurement burden. Mini-Forms were developed on each measure using sensitivity and specificity of the items in predicting the criterion of substantiation (yes/no). Psychometric quality was addressed by estimating predictive validity and Cronbach's alpha of Short-Forms. Predictive validity and reliability were also estimated on the Mini-Forms as was their correlation with the Short-Forms. Results. On Short-Forms, good predictive validity was found for all measures except those that were very rare. Results for even shorter Mini-Forms were mixed, and some will require further research on their reliability and validity. Discussion and Implications. Short-Forms had good psychometric properties and some Mini-Forms did as well. Ongoing adoption by several California counties and Montana demonstrates the viability and sustainability of using the ISO Matrix for research and practice.

Stakeholders' Ideas About Positive Aging for Latinos: A Conceptual Map.

Few studies explore the differences between diverse stakeholders' understandings of what constitutes "positive aging" for Latino older adults. To address this gap, we worked with a 20-member steering committee (SC) of community stakeholders to collect concept mapping data from 38 scholars and community workers. We generated 90 statements related to positive aging from the literature and produced concept maps based on four different stakeholder groups' ratings of them. All stakeholders prioritized "Financial Security," but scholars marked "Spirituality" as least important whereas community workers rated it second highest. The design of programs for Latino older adults should reflect such differences.

Can standardized measures provide helpful feedback about adult protective services substantiation? Pilot data from a short self-neglect assessment.

Can standardized assessment contribute to improving Adult Protective Services (APS) practice? In this exploratory study, San Francisco and Napa APS utilized a newly developed short self-neglect assessment to test how standardized measures provide information for substantiation decision making. Findings demonstrated satisfactory reliability and validity for the short self-neglect assessment, and analyses revealed important issues that could improve practice. Review of outliers revealed: (1) problems using the assessment tool, (2) misunderstandings of APS procedures, and (3) struggles navigating the case management system. These revelations could all be easily addressed in training. Caseworker's clinical judgment and experience also continue to have a place in complementing the use of the standardized assessment.

The Importance of Investigating Abuser Characteristics in Elder Emotional/Psychological Abuse: Results from Adult Protective Services Data.

OBJECTIVES: Elder emotional/psychological abuse is the infliction of mental anguish on older adults through verbal or non-verbal acts. Using indicators based on existing literature, theoretically important abuser characteristics and victim vulnerabilities were collected using the Elder Abuse Decision Support System (EADSS) to test a theory of emotional/psychological abuse. METHOD: Eight-hundred-and-ten alleged emotional/psychological abuse cases were investigated by caseworkers in six Illinois adult protective services (APS) agencies; 466 individuals endorsed at least one item on the Older Adult Psychological Abuse Measure (OAPAM). RESULTS: Bivariate ordinary linear regression results established that all abuser characteristics were predictive of emotional/psychological abuse scores. In the hierarchical regression model where abuser characteristics were entered after victim vulnerabilities, abuser characteristics predicted emotional/psychological abuse above and beyond victim vulnerabilities (ΔR2 = 0.349, p < .001). Abuser risk and abuser's negative attitudes towards victims remained as significant predictors in the final model. Post hoc analysis identified significant items of abuser risk and negative attitudes, including: an emotionally draining relationship between abuser and victim, abuser's poor temper control, and abuser's angry feelings towards victims. DISCUSSION: Abuser weaknesses and strengths as highlighted in the theoretical framework should be further investigated for future prevention and intervention in cases of emotional/psychological abuse.

Validation of the MedUseQ: A Self-Administered Screener for Older Adults to Assess Medication Use Problems.

BACKGROUND: Older adults taking multiple prescription and nonprescription drugs are at risk for medication use problems, yet there are few brief, self-administered screening tools designed specifically for them. OBJECTIVE: The study objective was to develop and validate a patient-centered screener for community-dwelling older adults. METHODS: In phase 1, a convenience sample of 57 stakeholders (older adults, pharmacists, nurses, and physicians) participated in concept mapping, using Concept System® Global MAXTM, to identify items for a questionnaire. In phase 2, a 40-item questionnaire was tested with a convenience sample of 377 adults and a 24-item version was tested with 306 older adults, aged 55 and older, using Rasch methodology. In phase 3, stakeholder focus groups provided feedback on the format of questionnaire materials and recommended strategies for addressing problems. RESULTS: The concept map contained 72 statements organized into 6 conceptual clusters or domains. The 24-item screener was unidimensional. Cronbach's alpha was .87, person reliability was acceptable (.74), and item reliability was high (.96). CONCLUSION: The MedUseQ is a validated, patient-centered tool targeting older adults that can be used to assess a wide range of medication use problems in clinical and community settings and to identify areas for education, intervention, or further assessment.

Abuser Risk Measure: Reports by Alleged Victims to Adult Protective Services.

BACKGROUND AND OBJECTIVES: Within the elder abuse field, research on the characteristics of the abusers is scant, and no validated measure of abuser risk exists. The purpose of this study was to develop and test the Abuser Risk Measure (ARM). RESEARCH DESIGN AND METHODS: The Rasch measurement model and traditional psychometrics were used on a sample of 425 elder abuse cases that completed an elder abuse investigation and had a substantiation decision (yes/no). All had usable ARM responses that were obtained primarily from the alleged victim. ARM construct/criterion validity was tested against four types of elder abuse using substantiation decision as the criterion. Item analyses guided the development of a full 21-item ARM measure and, subsequently, a short, 9-item screener. RESULTS: The 21-item ARM met the Rasch criteria. Although the screener was borderline on Rasch criteria, the combination of a good Cronbach's alpha with strong criterion validation provided a rationale for endorsing its validity. Both versions of the ARM were significantly and most strongly predictive of physical and emotional abuse, and significant for financial exploitation. While not significantly predictive of neglect alone, they were strongly and significantly predictive of total types of abuse. DISCUSSION AND IMPLICATIONS: This study was innovative in developing abuser risk items, analyzing client data, and generally supporting ARM validity for elder abuse. Theoretically, and now empirically, it is becoming clear that measures of abuser risk have an important role to play in both case assessment and in research.

Examining the Role of Substance Abuse in Elder Mistreatment: Results From Mistreatment Investigations.

Substance abuse has long been identified as a risk factor for elder mistreatment, yet research on the topic remains sparse. This study tested hypotheses whether perpetrator and victim substance use problems were associated with financial exploitation, physical abuse, emotional abuse, and neglect versus no abuse. Cross-sectional data were collected on 948 cases with yes/no substantiation decisions where 357 cases had no abuse in elder mistreatment investigations. Hypotheses were tested using odds ratios, bivariate, and multiple linear regression analyses including a control for victim vulnerability. Of 948 alleged victims, 42 (4.4%) exhibited signs of substance use problems. Among the 323 alleged perpetrators, 87 (26.9%) were reported to have substance use problems. Substance use problems by alleged perpetrators were associated ( p < .01) with financial exploitation, physical abuse, and emotional abuse but not neglect. Substance use problems by alleged victims were associated with neglect, but not the other types. Alleged perpetrators with substance use problems tended to commit multiple forms of abuse, were male and not caregivers. Except for the findings on neglect, the associations with elder mistreatment were stronger for alleged perpetrators with substance use problems, than for alleged victims. Clarification of the role of perpetrator risk factors such as substance abuse should improve risk identification and subsequent intervention.

Development of short-form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions.

Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short-form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS data set contains 948 elder abuse cases (age 60+) with yes/no abuse substantiation decisions for each abuse type following a 30-day investigation. Item sensitivity/specificity analyses were conducted on long-form items with the substantiation decision for each abuse type as the criterion. Validity was further tested using receiver-operator characteristic (ROC) curve analysis, correlation with long forms and internal consistency. The four resulting short-form measures, containing 36 of the 82 original items, have validity similar to the original long forms. These short forms can be used to standardize and increase efficiency of APS investigations, and may also offer researchers new options for brief elder abuse assessments.

Elder Abuse Decision Support System: Field test outcomes, abuse measure validation, and lessons learned.

The Elder Abuse Decision Support System was designed to meet the critical need for improved methods for assessment and substantiation of elder mistreatment, using a web-based system with standardized measures. Six Illinois agencies participated in the field test. One-year pre/post analyses assessed substantiation results, using Illinois' standard investigation procedure as a comparison. Pre/post acceptability was assessed with caseworkers in focus groups with adult protective service staff. Validity of measures was assessed using Cronbach's alpha and receiver operator characteristic curve analyses with final substantiation decision as a criterion. Increased substantiation of abuse was found. Regarding acceptability, the two systems were found to have differing strengths and weaknesses. Outcome measures had high validity estimates, while focus groups indicated directions for improvement. This study was a successful proof of concept that data collected in the field would be useful for clinical purposes as well as for research.

Validation of the Full and Short-Form Self-Help Involvement Scale Against the Rasch Measurement Model.

BACKGROUND: Substance use disorders (SUDs) are one of the nation's most costly problems in terms of dollars, disability, and death. Self-help programs are among the varied recovery support options available to address SUD, and evaluation of these programs depends on good measurement. There exists an unmet need for a psychometrically sound, brief, efficient measure of self-help involvement for individuals with SUD that is valid across different substances and age-groups. METHODS: Using data from 2,101 persons presenting for SUD treatment, the full 21-item Global Appraisal of Individual Needs Self-Help Involvement Scale (SHIS) and a newly developed 11-item short-form version were validated against the Rasch measurement model and each other. Differential item functioning (DIF) was assessed by primary substance and age. RESULTS: Both versions met Rasch psychometric criteria. The full scale had minor misfit with no DIF for alcohol, marijuana, or opioids but a few instances of DIF for amphetamine and cocaine users as well as for age, in that youth tended to endorse several easier items more frequently than did adults. The 11-item short form had neither misfit nor DIF by substance and only minor DIF by age was highly correlated with the full version and was relatively more efficient. Criterion-related validity was supported for both. CONCLUSIONS: Both the long and short versions of SHIS are psychometrically sound measures of a more comprehensive conceptualization of self-help involvement for SUDs that can be used as part of an in-depth assessment or as a short measure that lessens respondent burden.

Observational measure of elder self-neglect.

The purpose of this study was to improve measurement of elder self-neglect by testing the psychometric properties of the Elder Self-Neglect Assessment (ESNA). Social workers, case managers, and adult protective services providers from 13 Illinois agencies completed a 77-item assessment for 215 clients suffering from self neglect. Analyses used Rasch item response theory and traditional validation approaches to test for dimensionality, model fit, and additional construct validation, resulting in a 62-item assessment. The ESNA met Rasch fit criteria with good internal consistency, item reliability, and construct validity. A 25-item short form also met Rasch criteria. A hierarchy of items associated with severity of abuse was produced by frequency of occurrence. ESNA indicators of self-neglect align into two broad categories: behavioral characteristics and environmental factors, which must be accounted for in a comprehensive evaluation. Theoretical refinements developed using the empirically generated item hierarchy may help to improve assessment and intervention.

Using the Rasch measurement model in psychometric analysis of the Family Effectiveness Measure.

BACKGROUND: Valid assessment of family functioning can play a vital role in optimizing client outcomes. Because family functioning is influenced by family structure, socioeconomic context, and culture, existing measures of family functioning-primarily developed with nuclear, middle-class European American families-may not be valid assessments of families in diverse populations. The Family Effectiveness Measure was developed to address this limitation. OBJECTIVES: The aim of this study was to test the Family Effectiveness Measure with data from a primarily low-income African American convenience sample using the Rasch measurement model. METHODS: A sample of 607 adult women completed the measure. Rasch analysis was used to assess unidimensionality, response category functioning, item fit, person reliability, differential item functioning by race and parental status, and item hierarchy. Criterion-related validity was tested using correlations with five other variables related to family functioning. RESULTS: The Family Effectiveness Measure measures two separate constructs: The Effective Family Functioning construct was a psychometrically sound measure of the target construct that was more efficient because of the deletion of 22 items. The Ineffective Family Functioning construct consisted of 16 of those deleted items but was not as strong psychometrically. Items in both constructs evidenced no differential item functioning by race. Criterion-related validity was supported for both. DISCUSSION: In contrast to the prevailing conceptualization that family functioning is a single construct, assessed by positively and negatively worded items, use of the Rasch analysis suggested the existence of two constructs. Whereas the Effective Family Functioning scale is a strong and efficient measure of family functioning, the Ineffective Family Functioning scale will require additional item development and psychometric testing.

A review of the foot function index and the foot function index - revised.

BACKGROUND: The Foot Function Index (FFI) is a self-report, foot-specific instrument measuring pain and disability and has been widely used to measure foot health for over twenty years. A revised FFI (FFI-R) was developed in response to criticism of the FFI. The purpose of this review was to assess the uses of FFI and FFI-R as were reported in medical and surgical literature and address the suggestions found in the literature to improve the metrics of FFI-R. METHODS: A systematic literature search of PubMed/Medline and Embase databases from October 1991 through December 2010 comprised the main sources of literature. To enrich the bibliography, the search was extended to BioMedLib and Scopus search engines and manual search methods. Search terms included FFI, FFI scores, FFI-R. Requirements included abstracts/full length articles, English-language publications, and articles containing the term "foot complaints/problems." Articles selected were scrutinized; EBM abstracted data from literature and collected into tables designed for this review. EBM analyzed tables, KJC, JM, RMS reviewed and confirmed table contents. KJC and JM reanalyzed the original database of FFI-R to improve metrics. RESULTS: Seventy-eight articles qualified for this review, abstracts were compiled into 12 tables. FFI and FFI-R were used in studies of foot and ankle disorders in 4700 people worldwide. FFI Full scale or the Subscales and FFI-R were used as outcome measures in various studies; new instruments were developed based on FFI subscales. FFI Full scale was adapted/translated into other cultures. FFI and FFI-R psychometric properties are reported in this review. Reanalysis of FFI-R subscales' confirmed unidimensionality, and the FFI-R questionnaires' response categories were edited into four responses for ease of use. CONCLUSION: This review was limited to articles published in English in the past twenty years. FFI is used extensively worldwide; this instrument pioneered a quantifiable measure of foot health, and thus has shifted the paradigm of outcome measure to subjective, patient-centered, valid, reliable and responsive hard data endpoints. Edited FFI-R into four response categories will enhance its user friendliness for measuring foot health.

Dimensionality, hierarchical structure, age generalizability, and criterion validity of the GAIN's Behavioral Complexity Scale.

This study used Rasch measurement model criteria and traditional psychometric strategies to examine key psychometric properties of the Behavioral Complexity Scale (BCS), a widely used measure of externalizing disorders that focuses on attention deficit, hyperactivity, and conduct disorders. With a sample of 7,435 persons being screened for substance use disorders, the BCS was found to (a) be unidimensional, (b) have a hierarchical severity structure, (c) be generalizable to both youths and adults, and (d) meet hypothesized correlations with criterion variables. The BCS performed well as a unidimensional measure. The Rasch severity hierarchy of attention deficit to hyperactivity to conduct disorders provided a perspective that suggested that a dimensional measure could be used as an alternative and, in some ways, as an improvement to categorical diagnosis and common dimensional approaches. The finding of 3 low-severity conduct disorder items also supported a revision of categorical criteria, especially in substance use disorders.

Conceptual model and map of financial exploitation of older adults.

This article describes the processes and outcomes of three-dimensional concept mapping to conceptualize financial exploitation of older adults. Statements were generated from a literature review and by local and national panels consisting of 16 experts in the field of financial exploitation. These statements were sorted and rated using Concept Systems software, which grouped the statements into clusters and depicted them as a map. Statements were grouped into six clusters, and ranked by the experts as follows in descending severity: (a) theft and scams, (b) financial victimization, (c) financial entitlement, (d) coercion, (e) signs of possible financial exploitation, and (f) money management difficulties. The hierarchical model can be used to identify elder financial exploitation and differentiate it from related but distinct areas of victimization. The severity hierarchy may be used to develop measures that will enable more precise screening for triage of clients into appropriate interventions.

Conceptual model and map of psychological abuse of older adults.

Psychological abuse of older adults is a hidden and pervasive problem that is not well conceptualized nor well measured. Goals. The goals were to (a) conceptualize psychological abuse using three-dimensional concept maps, and (b) develop theoretical models. Methods. Statements describing the construct were generated by local and national panels. These were sorted and rated using Concept Systems software whereby the concepts were depicted as a map. Results. The concept maps guided development of theoretical hierarchies. Significance. Theoretical models may help to develop measures to estimate prevalence better and may enable more precise screening for triage into appropriate interventions.

Self-report measure of psychological abuse of older adults.

PURPOSE: This study tested key psychometric properties of the Older Adult Psychological Abuse Measure (OAPAM), one self-report scale of the Older Adult Mistreatment Assessment (OAMA). DESIGN AND METHODS: Items and theory were developed in a prior concept mapping study. Subsequently, the measures were administered to 226 substantiated clients by 22 elder abuse staff from 7 agencies in a full-scale field test. The resulting database was used to estimate the psychometric properties of the OAPAM using the Rasch item response theory model and traditional validation techniques. Analyses included tests for dimensionality, model fit, and theoretical construct validation. Results from the OAPAM client report were validated against the adult protective services substantiation decision of abuse and the elder abuse staff assessment of psychological abuse (PA). RESULTS: The client self-report measures met stringent Rasch analysis fit and unidimensionality criteria and had high person (internal consistency) and item reliability. The validity results supported the usefulness of the client measures and led to reconsideration of aspects of the hypothesized theoretical hierarchy. A short form was developed. Cut-points were proposed to distinguish levels of PA. IMPLICATIONS: The measure is now available to aid in the assessment of PA of older adults by both clinicians and researchers. Theoretical refinements developed using the Rasch item hierarchy may help to improve assessment and intervention.

Self-report measure of financial exploitation of older adults.

PURPOSE: this study was designed to improve the measurement of financial exploitation (FE) by testing psychometric properties of the older adult financial exploitation measure (OAFEM), a client self-report instrument. DESIGN AND METHODS: rasch item response theory and traditional validation approaches were used. Questionnaires were administered by 22 adult protective services investigators from 7 agencies in Illinois to 227 substantiated abuse clients. Analyses included tests for dimensionality, model fit, and additional construct validation. Results from the OAFEM were also compared with the substantiation decision of abuse and with investigators' assessments of FE using a staff report version. Hypotheses were generated to test hypothesized relationships. RESULTS: the OAFEM, including the original 79-, 54-, and 30-item measures, met stringent Rasch analysis fit and unidimensionality criteria and had high internal consistency and item reliability. The validation results were supportive, while leading to reconsideration of aspects of the hypothesized theoretical hierarchy. Thresholds were suggested to demonstrate levels of severity. IMPLICATIONS: the measure is now available to aid in the assessment of FE of older adults by both clinicians and researchers. Theoretical refinements developed using the empirically generated item hierarchy may help to improve assessment and intervention.