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October 25,
2013
ELDER JUSTICE
COORDINATING COUNCIL
AND ROADMAP PROJECT
UPDATES
ELDER JUSTICE
COORDINATING COUNCIL
Established by Elder Justice Act
Responsible for making recommendations relating to elder abuse, neglect and exploitation
Representation from HHS, DOJ, SSA, CFPB, US Postal Service, HUD, Treasury, FTC, VA, Labor, SEC, and Corporation for National and Community Service
ELDER JUSTICE COORDINATING COUNCIL
Raising Public Awareness
Enhancing Response
Advancing Research
Financial Exploitation
OCTOBER 2012 INAUGURAL
MEETING
Support the investigation and prosecution of elder abuse, neglect, and financial exploitation cases through the launch of the Elder Justice Website, development of a “successful practices” guide to creating additional Elder Abuse Forensic Centers, and creation of a National Resource Center for the Investigation and Prosecution of Elder Abuse .
Support and protect elder victims by improving identification of elder abuse and enhancing response and outreach to victims.
Develop a national Adult Protective Services (APS) system based upon standardized data collection and a core set of service provision standards and best practices.
MAY 13, 2013 EJCC MEETING
Establish a coordinated federal research agenda to identify
best practices for prevention of and intervention in elder
abuse and elder financial exploitation .
Develop a strategic, multifaceted public awareness campaign
including media relations, public service announcements, and
online tools and information with clear and consistent
messaging to raise awareness and understanding of elder
abuse, neglect, and exploitation .
Develop training to educate stakeholders across multiple
sectors and disciplines on preventing, detecting, intervening,
and responding to elder abuse, neglect, and exploitation.
MAY 13, 2013 EJCC MEETING
Bolster ability of financial services providers to
address financial exploitation.
Reduce financial exploitation by fiduciaries through
enhanced oversight and collaboration among federal
and state entities.
Improve ability of APS and first responders to screen
for diminished capacity, vulnerability to financial
abuse, and whether individuals have been victimized.
MAY 13, 2013 EJCC MEETING
EJWG presented proposed steps to begin implementing the 9
elder justice recommendations and highlighted some early
accomplishments
Improving Responses to Elder Abuse, Neglect and Exploitation
Problem: (1) Need more multidisciplinary networks; and (2) Need
more readily accessible training and resources for investigators and
prosecutors
Proposals for implementation
Establish Elder Justice Website
Develop replication manuals for establishing more elder abuse forensic
centers, financial abuse specialists teams, and other MDTs
Establish National Resource Center for investigating and prosecuting elder
abuse
SEPTEMBER 24, 2013
Combatting Financial exploitation
Problem: Perception by financial services providers
that there were legal barriers to reporting suspected
financial exploitation of the elderly
On September 23, the CFPB and six other federal
financial regulators released guidance on privacy law
and reporting financial abuse of older adults in order
to clarify that the privacy provisions of the Gramm-
Leach-Bliley Act generally permit financial
institutions to report suspected elder financial abuse
to appropriate authorities
SEPTEMBER 24, 2013 EJCC MEETING
ELDER JUSTICE
ROADMAP PROJECT
Task: To generate concept map and identify general domains
Step 1: Soliciting views from 750 stakeholders on the most critical priorities
for the field (via concept mapping)
Step 2: Sorting those priorities into thematic clusters and rating ideas
by importance and feasibi l i ty
Step 3: Conducting six facilitated discussions with groups of experts on
designated topics: 1. caregiving, 2. diminished capacity/mental health, 3.
diversity, 4. prevention, 5. screening, and 6. victim services.
Step 4: Conducting Leadership Interviews – with high-level federal officials
(White House and agency) and heads of influential non -profits, foundations,
research projects, federal advisory committees, and strategic
communications entities – regarding how best to gain traction, set an
agenda, and act in time to address a difficult and growing problem that has
profound implications for millions of people.
ROADMAP PROJECT: PHASE I
Identifying Participants
© 2012 Concept Systems, Inc.
•750 individuals were invited to participate in the online brainstorming and rating activities, representing systems including:
Aging network Faith-based Financial system Health care Legal system Mental health Protective service Social service Victim service
•250 of these individuals were also invited to participate in the online sorting activity.
“To understand, prevent,
identify or respond to elder
abuse, neglect, or
exploitation we need…”
ELDER JUSTICE ROADMAP PROMPT
© 2012 Concept Systems, Inc.
Eliciting Knowledge and Opinion
•Online brainstorming session: May 1, 2012 – May 25, 2012
121 final
statements
686 statements generated
to provide caregivers with adequate support and services to develop competency and reduce stress. (11)
to research the impact and value of mandatory reporting. (28)
to establish a national elder abuse hotline. (60)
to increase resources for and capacity of long term care ombudsmen to address elder abuse. (85)
to develop housing, social, and other initiatives designed to reduce the isolation of older adults. (121)
© 2012 Concept Systems, Inc.
Organizing Knowledge and Opinion
Each statement was rated twice
(Importance and Feasibility)
121 statements were sorted into
groups
Work quickly
and effectively under
pressure 49
Organize the work when
directions are not specific.
39
Decide how to manage multiple
tasks. 20
Manage resources effectively.
4
This point map shows all of the ideas in relation to one another…
© 2012 Concept Systems, Inc.
“To understand, prevent, identify or respond to elder abuse, neglect, or exploitation we need…”
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© 2012 Concept Systems, Inc.
Each point represents one of the brainstormed ideas.
law enforcement officers and units dedicated to addressing and investigating elder abuse. (70) 1
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courts to improve how they handle elder abuse cases and accommodate the needs of older people. (18) improved identification and tracking of elder abuse cases by law enforcement and prosecutors. (51) law enforcement officers and units dedicated to addressing and investigating elder abuse. (70)
© 2012 Concept Systems, Inc.
Conceptually similar ideas appear closer together.
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© 2012 Concept Systems, Inc.
The ideas are organized into groups…
…so that similar ideas can be considered in a shared conceptual structure.
1 5
6 20 22 28 29 32 39
43 49 50
57
62
65 74
112
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Research
© 2012 Concept Systems, Inc.
1. national incidence and prevalence research to measure all types of elder abuse.
5. to translate the questions and dilemmas faced by practitioners into research that can assist them.
6. research into the long term (longitudinal) nature of elder abuse for victims and perpetrators, and
contextual factors (such as poverty or isolation) that can affect elder abuse.
20. research on the nexus between mental health and elder abuse, both for victims and perpetrators.
22. research the rates of and connections between abuse, neglect and exploitation at home and in
facilities, and develop policy accordingly.
28. to research the impact and value of mandatory reporting.
29. research into the consequences of elder financial exploitation, such as potential declines in health
and increased risk for other types of elder abuse.
32. research to identify forensic markers to assist in the detection of elder abuse.
39. research and policy regarding the role of diminished, variable or questionable capacity in
increasing the risk of elder abuse.
43. research to identify perpetrator characteristics, including why they abuse and
how to develop preventive interventions.
Prevention and Response
© 2012 Concept Systems, Inc.
54. to increase access to and monitoring of home care to promote quality care at home and prevent elder abuse. 64. to clarify the roles and responsibilities of entities responding to elder abuse (such as adult protective services, ombudsman, guardians, law enforcement, legal services, victim advocates and others) to identify conflicts of interest, gaps and overlaps in services. 73. to foster person-centered approaches in all aspect of services and prevention targeting elder abuse (such as client-centered, victim-centered, and patient-centered approaches). 99. effective responses and prevention efforts tailored to marginalized and underserved populations. 117. high-quality, accessible civil legal services to detect, prevent and address elder abuse (including those services funded through the Older Americans Act and Legal Services Corporation). 119. to increase the availability of community care coordination and case management services to reduce the risk and incidence of elder abuse. 121.to develop housing, social, and other initiatives designed to reduce the isolation of older adults.
22
Leadership and Engagement
© 2012 Concept Systems, Inc.
85. to increase resources for and capacity of long term care ombudsmen to address elder abuse. 86. an annual national elder justice conference. 94. more elder abuse forensic centers and other similar multidisciplinary entities that bring a coordinated approach to elder abuse cases. 101. an equivalent or expansion of the long term care ombudsman program to advocate for people who receive care in settings other than nursing homes. 103. a strong movement to advance elder justice, informed by key teachings from other social movements. 109. to identify compelling spokespersons for the issue who will attract public attention. 114. AARP to assign higher priority and devote more resources to addressing elder abuse.
Leadership and Engagement
© 2012 Concept Systems, Inc.
85. to increase resources for and capacity of long term care ombudsmen to address elder abuse. 86. an annual national elder justice conference. 94. more elder abuse forensic centers and other similar multidisciplinary entities that bring a coordinated approach to elder abuse cases. 101. an equivalent or expansion of the long term care ombudsman program to advocate for people who receive care in settings other than nursing homes. 103. a strong movement to advance elder justice, informed by key teachings from other social movements. 109. to identify compelling spokespersons for the issue who will attract public attention. 114. AARP to assign higher priority and devote more resources to addressing elder abuse.
© 2012 Concept Systems, Inc.
The Emergent Structure
…contains all of the details and provides a conceptual framework.
1. Research
2. Research Translation
3. Evaluation and Methods
4. Under-Recognized Populations and Issues 5. Safety and Accountability
6. Awareness and Capacity Building
7. Prevention and Response
8. Leadership and Engagement
9. Policy and System Infrastructure
© 2012 Concept Systems, Inc.
The Emergent Structure
1. Research
2. Research Translation
3. Evaluation and Methods
4. Under-Recognized Populations and Issues 5. Safety and Accountability
6. Awareness and Capacity Building
7. Prevention and Response
8. Leadership and Engagement
9. Policy and System Infrastructure
Direct or Front Line Services (Practice)
Research
Education/Training Policy
© 2012 Concept Systems, Inc.
Importance Rating
On a scale of 1 to 5, please rate how relatively important you think each idea is to addressing elder abuse at a national level in the next five years, where: 1= relatively unimportant 2= somewhat important 3= moderately important 4= very important 5= extremely important.
© 2012 Concept Systems, Inc.
Feasibility Rating
On a scale of 1 to 5, please rate how feasible you think it is to implement each idea within the next five years, where: 1= Not feasible 2= Somewhat feasible 3=Feasible 4=Very feasible 5= Extremely feasible.
© 2012 Concept Systems, Inc.
Of those who responded…
Which of the following best describes the system in which you work in relation to elder abuse?
21%
1%
1%
8%
16%
2% 13%
6%
12%
20%
Aging network (42)
Faith-based (2)
Financial system (1)
Health care (17)
Legal system (33)
Mental health (4)
Protective service (26)
Social service (12)
Victim service (25)
Other (40)
© 2012 Concept Systems, Inc.
Importance by Feasibility – All Participants, Relative
Importance N=199
Feasibility N=149
Policy and System Infrastructure
Policy and System Infrastructure
Safety and Accountability
Safety and Accountability Prevention and Response
Prevention and Response
Awareness and Capacity Building
Awareness and Capacity Building
Evaluation and Methods
Evaluation and Methods
Under-Recognized Populations and Issues Under-Recognized Populations and Issues
Research Translation
Research Translation
Leadership and Engagement
Leadership and Engagement
Research
Research
3.51 3.10
3.85 3.50
r = -0.32
© 2012 Concept Systems, Inc.
Feas
ibil
ity
Low
High
Importance Low High
49
Low Importance Low Feasibility
High Importance Low Feasibility
High Feasibility Low Importance
High Importance High Feasibility
Importance mean for this cluster
Feasibility mean for this cluster
Comparing Statements in a Cluster on Ratings: Go Zones
© 2012 Concept Systems, Inc.
Research
1 29 32
62 74 5 112
6 57
65 20
22 28
39
43 49
50
4.11
3.4
2.29
Feasibility
2.86 3.51 4.54
Importance
r = 0.55
5. to translate the questions and dilemmas faced by practitioners into research that can assist them. 112. research regarding the relationship between self-neglect and elder abuse, neglect, and exploitation.
1. national incidence and prevalence research to measure all types of elder abuse.
29. research into the consequences of elder
financial exploitation, such as potential declines in health and increased risk for other types of elder abuse.
32. research to identify forensic markers to
assist in the detection of elder abuse. 62. research, including program evaluation,
to determine the effectiveness of interventions that are used to address elder abuse, such as which adult protective services and ombudsman models are most effective.
74. to measure the economic cost of elder
abuse (e.g. facility placements, hospitalizations, trips to the emergency room, lost assets and wages, etc.) in order to identify areas of costs savings gained by addressing the problem.
© 2012 Concept Systems, Inc.
Policy and System Infrastructure
16 47
55 76
97
108
26
30
116
31 79
100
37
66 67 88 95
105 4.11
3.23
2.29
Feasibility
2.86 3.85 4.54 Importance
r = -0.30
26. the Centers for Disease Control and Prevention to recognize and address elder abuse as a serious public health issue, like child abuse and intimate partner violence, warranting comparable surveillance, prevention, and treatment programs. 30. to identify and resolve impediments to multidisciplinary coordination in elder abuse matters due to confidentiality, privacy, and other laws, regulations and protocols. 116. to develop national Adult Protective Services (APS) definitions and standards, including for feasible caseloads, collaborations, training requirements and data collection.
16. a well-funded national center on elder abuse with resources similar to those allocated for child abuse centers, and specialized resource centers for entities like Adult Protective Services, older victim services, the ombudsman program, legal services, guardianship, etc. 47. a federal Office of Elder Justice, comparable to federal offices dedicated to addressing child abuse and violence against women. 55. to create an adequately funded national infrastructure for APS that includes a national resource center, data collection, program evaluation, training, technical assistance, and resources for adequate staffing. 76. to fully fund and implement elder justice provisions in existing laws, such as the Elder Justice Act, the Older Americans Act and the Violence Against Women Act. 97. Medicare, Medicaid, and other insurance reimbursement for elder abuse screening, detection and intervention. 108. more funds for elder abuse victims' services.
© 2012 Concept Systems, Inc.
Policy and System Infrastructure
16 47
55 76
97
108
26
30
116
31 79
100
37
66 67 88 95
105 4.11
3.23
2.29
Feasibility
2.86 3.85 4.54 Importance
r = -0.30 37. the Coordinating Council created by the Elder Justice Act to identify priorities, allocate resources, and coordinate efforts by the federal government in addressing elder abuse. 66. private foundations, religious and corporate philanthropies, and private donors to support research, policy and programs related to elder abuse. 67. local, state, and national entities to create and implement strategic plans to address elder abuse. 88. to address issues that arise when elder abuse cases extend beyond state boundaries, for example through interstate compacts, abuse registries and full faith and credit provisions. 95. a national think tank or comparable entity to analyze and disseminate information about complex elder justice issues and provide leadership on communication and policy issues. 105. to convene the Elder Justice Act's Advisory Board.
31. to improve law, policies, training, oversight and data collection related to abuse of powers of attorney. 79. to improve laws, policies, training, monitoring, oversight and data collection related to guardianship and conservatorship. 100. to draft, enact, and fund new elder justice legislation to address current gaps in the law.
Collect data and conduct research to expand what we know about elder
abuse and inform ef for ts to respond to, prevent and raise awareness about
i t .
Pay specific attention to understanding and addressing topics with a
significant nexus to elder abuse, such as: caregiving, diminished capacity,
diversity, mental health, prevention, screening and victim services.
Engage leaders in related fields to bui ld coalit ions and col laborative
responses, and to incorporate elder abuse in research and training.
Cultivate ef fective and committed al l ies and champions.
Raise public awareness through identification of target audience(s) .
Develop a focused plan with clear, achievable shor t, medium and long term
goals and how to achieve them.
Allocate resources to address the dire and chronic shor tages in al l aspects
of elder abuse response .
ROADMAP PROJECT: PHASE I
OVERARCHING THEMES
Phase II is intended to synthesize the
information gathered in Phase I into short,
medium and long-term priorities in various
categories, and develop recommendations for
implementation.
Conversations about the specifics and
scheduling of Phase II are underway.
Meeting with Project Guidance Group in
February
ELDER JUSTICE ROADMAP
PHASE II
