ACTIONS TO COUNTER ELDER ABUSE IN FRANCE seventeen years of experience
- MOULIAS R , ALMA (allo mistreatment),
professor emeritus university Paris VI
- BUSBY F, ALMA (allo mistreatment)
www.alma-france.orgTEL. 04 76 84 20 40
To act is more useful than to become indignant
• At the last quart of the XXst century, spreading out of awareness on Elder Abuse.
• Obvious need to go further than describing facts• But how to break the taboo ?• How to know and to « treat » Elder Abuses ?• How to organize an efficient prevention ? • How to create skilled teams able to understand and to
resolve complex abuse situations ?• How to create knowledge in this « new » field ?
www.alma-france.orgTEL. 04 76 84 20 40
Birth of Allo maltraitance (ALMA)a helpline devoted to Elder Abuse
• 1994 : a geriatrician : Pr Hugonot, created the first local helplines in five french districts
• Helpline must be : - in the neibourghood of the victim
- competent in the field
- warranting confidentiality to callers and ethical rules for the victim
-respect autonomy of the victim (choices)• 2008 : national N°39 77 for calls for Elder Abuse,
analyse, counsel and follow up remains made by ALMA
www.alma-france.orgTEL. 04 76 84 20 40
Proximity helplines for listening and counsel : ALMA (allo maltraitance)
• 1 ) Voluntary basis
• 2 ) Competence : Specific education and training of the entire team, pluridisciplinatity, voluntary professionals
• 3 ) Independence of any power, absence of conflict of interests
• 4 ) Neutrality
• 5 ) Proximity (knowledge of local actors and networks)
• 6 ) Confidentiality warranted, and ethical rules of running
• 7 ) Preservation of autonomy of caller and victim.
• 8 ) Evaluation of outcomes
www.alma-france.orgTEL. 04 76 84 20 40
To prevent is better than to treat : education and training
• ALMA (associative): first : sensitizations targetted to nursing homes staffs, home care services,
today: + targetted also towards management, judiciary guardians, social workers, police, professional education (medicine, nurses, psychologists, barristers, etc)
• SF G Gerontology : Tools to avoid E A (Mobiqual)• STATE : - Medico -social Agency ANESM : Good
Practices recommendations
- Instructions to Regional Health Agencies
- Funding helplines: ALMA network and national N°3977
www.alma-france.orgTEL. 04 76 84 20 40
Birth of the concept of « good caring » (bientraitance)
• Perfection in technical help and care is not sufficient i long term care :
• Is the staff aware of needs, wishes, values of the person• Is the team trained to give priority to objectives of the
well-being and the dignity of the person?• to permit to live with well being and dignity in spite of a
« dependent « situation = aim of « well caring »• A very valorizing concept for teams of L T C
www.alma-france.orgTEL. 04 76 84 20 40
1995 2012
France counts 100 ‘départements’ALMA France covers 75% of the territory
ALMA centresDossiers monitored by ALMA
www.alma-france.orgTEL. 04 76 84 20 40
ALMA France goals
• Pledge for ABUSE PREVENTION MEANS
• Further expand network• Support and strengthen
ALMA centres• Develop studies and research• Extend partnerships (national
and international)
• Inform and train about abuse
TRAINING•ALMA volunteers•PROFESSIONALS : medical, social workers, managers, lawiers, psychologists, etc•Aged public and familial caregivers•Politicians, etc.
www.alma-france.orgTEL. 04 76 84 20 40
Management of each ALMA centre
LISTENERS COUNSELLORS
LOCAL ADVISORY COMMITEE (medical, social, judicial local
authorities)- contacted punctually by the
counsellors-Takes measures to «treat» the abuse
situations-informs ALMA about measures taken
-once a year, meet the ALMA team
ADMINISTRATORS-founding centres, searching for
financial support, technical facilitiesRecruiting volunteers, organizing
traning sessions for them-tightening bonds with advisory
committee, other centres and ALMA France
-Warranting ALMA ethical rules
Coordinator(part-time salary)
www.alma-france.orgTEL. 04 76 84 20 40
Profile of the volunteers (retired, active or students)
listeners• Mr. or Mrs EVERYBODY
ready to learn to listen!• Persons who were faced
with abuse• Professionals from various
backgrounds• Students• Always : specific selection,
education, and training: • must be skilled
counsellors• Social workers• Medical and health
professionals (GP, psychiatrists, geriatricians, nurses, managers)
• Justice staff• Psychologists• Social workers• etc.
www.alma-france.orgTEL. 04 76 84 20 40
Learn about abuse and risks
abuse
Repeatedly ?•Financial abuse•Psychological abuse•Physical, sexual abuse•Refreining of citizen rights•Medical abuse•Neglect•Undue influence
Risks ( for whom ?)
• At home and in the city• In institution• Health problems• Dependency on others• Financial difficulties• Lack of time of pro• Reduced, untrained team• Burn out• NH dysfunction, etc.
www.alma-france.orgTEL. 04 76 84 20 40
The HEART of an ALMA centre : listeners
Listeners (2)
-listen with a systemic approach :draw sociogram while listening
-search for information-take notes, fills in dossiers
-transmits to counsellors-take part in analysis
-respect ALMA ethical rulesGood practices for listening
www.alma-france.orgTEL. 04 76 84 20 40
? ? ?
::
G.P.
l
home helper
neighbour
? ‘AUTHOR’
For listeners and counsellors : sociograman unique ALMA tool
??CALLER
A sociogram is a graphic representation which serves to reveal, visualize the relationships between ‘victims and agressor’, within the family and their external environment such as health and social services, work, friends, neighbours, etc.
www.alma-france.orgTEL. 04 76 84 20 40
clarification of situations
CALLERSProfessionals
Family membersfriends, neighbours
‘Victims’ rarely
LISTENERS listen and search for information
Who is involved ? What is the health status of all persons involved ?
Where ? at home, in institution ? Who knows about the situation ?
What are the problems, the complaints ? Are they repeated ?
Since when ? Are there other witnesses ?
Do the victims get social or medical help ?
What are the caller’s questions ? What is expected from ALMA ?
www.alma-france.orgTEL. 04 76 84 20 40
COUNSELLORSALERT
COUNSEL - GUIDETIGHTEN BONDS
with medical, social and judicial servicesENCOURAGE mediation
CALLERSProfessionals
Family membersfriends, neighbours
‘victims’ rarely
www.alma-france.orgTEL. 04 76 84 20 40
The HEART of an ALMA centre : counsellors
Multi-disciplinary counsellors
inform, guide, counsel callersfollow through, monitor dossiers from first call to ‘solution’Encourage the callers and witnesses to take measures
support the professionals in coordinating helping measures
refer to the advisory committee when necessary
-- Only one aim : end of mistreatmentWith respect to strict ethical rules- Good practices for counselling
www.alma-france.orgTEL. 04 76 84 20 40
Is the complaint relevant ?
• 3 calls : this 70 year old man is mistreated, neglected, abandoned ! Do something !!
• ALMA calls the mayor of the town !
• This man is well known and HAPPY ! in HIS way !! ?Not according to the life values of the callers !!
www.alma-france.orgTEL. 04 76 84 20 40
ALMA ETHICAL RULES
18
DOUBLE LISTENING
MULTI-DISCIPLINARY ANALYSIS AND COUNSELLING
CONFIDENTIALITY, DISCRETION
NO JUDGEMENT, IMPARTIALITY
ACT WITH AGREEMENT OF CALLERS/VICTIMS
FOLLOW UP WITHIN THE LEGAL TEXTS (danger to victim ?)
RESPECT THE DIGNITY OF ALL PERSONS INVOLVED
www.alma-france.orgTEL. 04 76 84 20 40
OUTCOMES
• 62 ALMA Centres cover 75 % of the french territory• « Treat » and follow up 5.000 situations of mistreatment
each year (80 % in home and city, 20 % in NH).• Sensitize and train 15.000 to 20.000 professionals/ year• Start studies and publications in the different fields of
Elder Abuse (Neglect, Inappropriate care, Undue influence, Financial abuses, Neglect in terminal care, Reglementary abuses, Cohabitation, Good Practices in listening and counselling, Methodology for helplines for E A, Well -caring, etc)
www.alma-france.orgTEL. 04 76 84 20 40
Conclusion
• Associative helplines working in a national network gives an efficient way to « treat » E A situations and to strongly reduce abuse and neglect in Nursing Homes and Home Care services but also iin family and in the city
• Conditions of competence, proximity, independence and respect of ethical rules can be more warranted by associative organizations
• Voluntary work gives independence, large panels of competence and a low cost for this new type of helplines.
www.alma-france.orgTEL. 04 76 84 20 40
Conclusion (2)• Sensitization and training of all involved teams on
prevention and well-caring is the necessary other activity of such helplines and requires also Good practices and ethics of training.
• The field is not limited to medico social areas of care homes and home care
• Trainers must be trained expert professionals
• ALMA system can be adapted in any other country
Thank you for your attention and your questions