Responding to Older Crime Victims with Disabilities
Nancy Alterio, Mary Counihan  -  2013/9/27
http://ovc.ncjrs.gov/ovcproviderforum
 
 
What is the process for reassigning a elderly disable person,(beginning of dementia) from an independent living affordable home to an assisted living arrangement affordable home?
 
1.  Nancy Alterio
 Home care services are available to provide support for elders to remain in the community as long as possible. They may be supplemented by other services, such as Adult Day Health. If family is involved, Protective Services would work with the family to provide informal supports, or if appropriate, to work with their family member to voluntarily choose another living situation that would provide more support, such as Assisted Living. In very high risk cases, where the elder lacks the capacity and is very unsafe in their current environment, and there is no family appropriate or available, Protective Services can petition the court to appoint a guardian and the guardian can then determine the most appropriate living situation.
 
2.  Nancy Alterio
 In Massachusetts Protective Services wouldn’t be involved in actively reassigning an elder with dementia to another living situation unless the risk of staying in their own home is very high. An elder who retains capacity and is accepting in home services could remain in their home as long as they are safe to do so. Often elders with beginning dementia can continue to make their own decisions. If Protective Services gets a report that an elder with early dementia is at risk, the Executive Office of Elder Affairs (EOEA) is obligated by statute to implement the least restrictive intervention that reduces the risk and prevents further harm.
 
3.  Constance
 Inform the current facility of your intentions/concerns and hopefully they have a protocol for monitoring and documenting behaviors and issues.
 
4.  Mary Counihan
 Even though a move like this must be voluntary, it is a very scary proposition for most people. Providing the person with support and information is essential and involving him/her in the selection process to the extent possible is equally important. If the person has family and friends actively involved in his/her life garner their support for the move. In selecting the facility, you want to make sure that the level of care the person needs can be provided by the facility. Gather information directly from the facilities, but also from other sources such as the local Ombudsman, and check for licensing violations with state. The Consumer Voice website http://www.ltcombudsman.org/ has great information about this process.
 
 
very difficult to make judges understand how traumatic bullying of the elderly disabled is - even after I obtained 5 Orders of Protection, they were all dismissed by a local judge, who, in my opinion, violated the law as clearly stated in Oregon, on the forms provided by the court, and by other cases - what to do?
 
1.  Mary Counihan
 Training on elder abuse for judges has been developed and presented throughout the country, but it seems unlikely that this judge attended the training. Information on judicial training is available at http://www.centeronelderabuse.org/education_overview.asp if you are interested in trying to arrange something for your state.
 
2.  Nancy Alterio
 Response continued...To prevent this type of response in the future, training should be provided to judges. In Massachusetts training is conducted with judges through the bench/bar committee where local attorneys and judges meet and discuss issues. While discussions/trainings are usually not case specific, the sensitive issue of bullying elders and persons with disabilities could be discussed. Judges in Massachusetts receive mandatory training and have had disability training.
 
3.  Nancy Alterio
 In Massachusetts we have a Judicial Complaint Division and a complaint would/could be filed against the judge. We also have an appeal process that could be utilized. Don’t know if these are options for you in Oregon. In addition, in Massachusetts this could possibly constitute criminal harassment or stalking on the part of the bullies/perpetrators, so I recommend taking the case to the local District/State Attorney’s Office to see if criminal charges could be filed against the perpetrators.
 
 
What are some suggestions on how to most effectively respond to older individuals with disabilities in regards to them as a victim of a crime?
 
1.  Nancy Alterio
 Response continued...No one person or agency possesses all of the skills, knowledge and resources necessary to respond to the complex problem of abuse/crimes of persons/elders with disabilities. Each person or agency brings different perspectives, experience and information to the table. Utilizing existing resources available, collaboration can be accomplished. In working together, abuses/crimes committed against persons with disabilities can be recognized, reported, investigated and prosecuted in an efficient and timely manner.
 
2.  Nancy Alterio
 Whatever your role is in responding to older individuals with disabilities, you should respond as you would in serving any other individual. Whether you’re an investigator, prosecutor or victim advocate provide the same services to this individual that you would to others. Don’t let the disability or age interfere with your expertise. A key difference is that these cases often require extra time and collaboration. These cases can often be highly complex and challenging, so I recommend reaching out to others in the field with an expertise in the subject matter for assistance if you need help with communicating with the individual or providing services to the individual.
 
3.  Mary Counihan
 Do a thorough evaluation, build on the client's strengths, involve the client to the extent possible in deciding the plan of action, and mobilize the client's support system. Most problems are multifaceted, so the response must similarly be multifaceted. Change is scary, so respect that the client may need time to make changes. Be patient and supportive. Small steps are good and harm reduction is often the goal. Resources for this are: http://www.ncea.aoa.gov and http://www.napsa-now.org
 
 
What are some suggestions on how to begin developing partnerships, and creative and effective approaches to service delivery. In other words, what has worked for you?
 
1.  Nancy Alterio
 Response continued: Multidisciplinary Response to Crime Victims with Disabilities: State-Level Replication Guide This guide describes the Building Partnerships for the Protection of Persons with Disabilities Initiative (BPI), which uses a prosecution-based multidisciplinary team approach to address abuse committed against persons with disabilities. Abstract | HTML (State Replication Guide) | HTML (Replication Guide Set) http://www.ovc.gov/pubs/victimswithdisabilities/stateguide/overview.html http://www.ovc.gov/pubs/victimswithdisabilities/communityguide/index.html
 
2.  Mary Counihan
 Reach out to the prospective partner and initiate a conversation to establish a common goal/what you both want to happen when you work together. Explore the points of conflict (if any) to determine the cause (different expectations, lack of knowledge about the limitations of the other agency, etc.) You may need to realign your expectations based on this new information. Be open to doing things a little differently if in so doing it will assist your partner agency in reaching your shared goal. Keep the lines of communication open and schedule periodic, on-going meetings to assess how things are working from each of your perspectives.
 
3.  Nancy Alterio
 Response continued: A more comprehensive and detailed list of the components necessary to develop a successful partnership is described in the following two guides developed through funding by OVC that describe how to develop successful partnerships at a state and community level:
 
4.  Nancy Alterio
 Developing a successful partnership, although the concept may be simple, the work can be difficult and requires perseverance. There are several components necessary to developing, implementing and sustaining a successful partnership. First you need to identify the individuals, agencies with an interest and those that have jurisdiction. Open communication needs to take place to establish a sufficient understanding of similarities, differences, role and interest. The partnership should be formalized by identifying leaders, written agreements, goals, work plan, regular meetings, agendas, meeting minutes and ongoing evaluation.
 
 
What are some of the typical barriers in responding to disabled elder victimization?
 
1.  Nancy Alterio
 Response continued: In domestic violence cases, one barrier is finding appropriate shelter for abused victims, particularly if they have care needs that cannot be met in one of the existing DV shelters. And DV and Sexual Assault advocates do not do home visits which is also a barrier to getting appropriate counseling services, although EOEA are working with both to try and meet the needs of our elder victims.
 
2.  Nancy Alterio
 Response continued: According to Deb Fogarty, Executive Office of Elder Affairs (EOEA) Director of Protective Services, they are seeing more medically complex elders in the community who are sometimes involved with multiple systems and have multiple needs and risks. They are also seeing the younger cohort of elders with substance abuse issues, and many elders who have untreated mental health issues and finding services is a barrier for both substance abusing and mentally ill elders.
 
3.  Nancy Alterio
 Response continued: Communication and physical challenges can make it more difficult for the victim to report or escape the abuse. Social isolation, poverty, discrimination and stigmas and stereotypes are often additional barriers. In responding to individuals with communication barriers or cognitive changes, workers need to assess that the individual has the capacity to make decisions. Can the elder understand the choices and weigh the consequences of those decisions? In financial exploitation cases, many elders may be embarrassed to discuss the incident and therefore resistant to interventions.
 
4.  Mary Counihan
 Resources for this are: http://www.ncea.aoa.gov and http://www.napsa-now.org
 
5.  Nancy Alterio
 There are many barriers in responding to elder persons with disabilities. Persons with disabilities are some of our most vulnerable citizens. The vulnerability of a person with a disability is heightened when he or she is dependent upon a caregiver. Often times the caregivers/abusers are known to the victims and may be family members. Victims often don’t want to disclose the abuse because of their reluctance to get the caregiver in trouble or are resistant to interventions due to fear of going to a nursing home because they don’t understand there are other options available for home care services.
 
6.  Mary Counihan
 Victims often feel shame and embarrassment so they don't seek help or tell others about what has happened and become more withdrawn and isolated. They are fearful about a loss of independence and worry that if anyone finds out about what has happening (or is happening) they will be placed in a care facility. Frequently their physical and mental health suffers. Depression is common. In elder abuse most often the abuser is a family member so the victim has an emotional connection to the abuser and is often protective of the abuser--not just because of fear retribution, but because of parental affection, loyalty, guilt, etc. When the abuser is the victim's care giver, he/she has unfettered access to the victim and the elder may be totally dependent on the abuser.
 
 
Asked on behalf of the Victimology & Victim Services course @ Becker College... What are the difficulties in explaining the criminal justice process and victims rights to an elderly person/victim with disabilities?
 
1.  Janine Hunt-Jac
 I can see how someone with a cognitive disability, whether from a traumatic brain injury, or another type, might be too trusting of family or agency, therefore leaving themselves open to continuing abuse. On the other hand, simply having a disability doesn't guarantee s/he is going to be unable to understand their rights. I think officers, lawyers, and others involved in court proceedings need to be careful of making that kind of assumption
 
2.  Constance
 What I have found is that an elderly person/victim with disabilities is generally trusting of family and those in authority and easily dismisses negative intentions. Secondly, the over-use of jargon by others (atty, social workers) can cause confusion.
 
3.  Janine Hunt-Jac
 Unless the elder with the disability happens to have an intellectual disability or a form of dementia, you would explain things to them in the same way you would anyone else. In a situation where a victim does have an intellectual disability, you may be faced with someone who is unable to understand completely what his or her rights are. In that case, attempt to work closely with a family member, if possible, or someone from an agency that is familiar with the specific disability.
 
4.  Mary Counihan
 This depends on the what the disability is. Assuming that you are primarily concerned about victims with cognitive impairments it is helpful to know the extent of the impairment and how it manifests itself. Some people have times of the day when they are cognitively clearer than at other times. If this is true of the senior you are working with time your explanation accordingly. Speak to the elder in a quiet, calm place. Be as clear and concrete in your description as possible. Take your queues from the elder and provide as much information as he/she appears able to handle. People with significant dementia may not understand your words but they are very sensitive to the emotion behind your words so remain as warm, supportive, and patient as possible.
 
5.  Nancy Alterio
 Response continued: When needed, seek assistance from someone with knowledge of the individual and/or disability within protective services or a service providing agency. The worker should always assess that the individual understands the information being provided. Workers may have to repeat themselves and use different words to explain the information. Every person with an intellectual disability is unique and there may be broad differences in ability to think and communicate.
 
6.  Nancy Alterio
 The worker should establish a trusting rapport. Any written information should be explained and offer to help fill out any paperwork. Speak directly, slowly and keep sentences short and words simple. As long as it is clear the other individual is not associated with the abuse/crime, ask the victim if there is someone they want to be with them.
 
7.  Nancy Alterio
 When communicating with persons with disabilities with intellectual or cognitive challenges, including explaining the criminal justice process, workers need to be patient and provide extra time and sometimes this extra time is significant. Workers need to show the same respect to an elder/person with a disability that they show to all victims. Workers should not assume the person is incapable of understanding or communicating and should assess communication abilities and determine level of understanding. The information exchange should be done in a safe environment with limited distractions.
 
 
Asked on behalf of the Victimology & Victim Services course @ Becker College: Older victims w/disabilties may be more vulnerable to re-victimization (the second insult) in the crimoinal justice system. How are they prepared to go through a lengthy trial?
 
1.  Mary Counihan
 In California there are many efforts happening to make the court room experience more tolerable for the elder victims. Specialized Elder Courts have been created that are sensitive to the needs of seniors. Support animals are used to comfort and calm older victims during the courtroom proceedings. VOCA Victim Compensation Program is specifically designed to respond to the emotional and physical needs of crime victims and help victims understand and participate in the criminal justice system. It can pay for mental health counseling and transportation to and from court. Some Victim Witness Programs provide not only transportation to and from court but someone to be with the victim in the courtroom throughout the trial.
 
2.  Mary Counihan
 It can be very frustrating for us when our clients make decisions that put themselves at risk. Generally, it is not that the elder wants the abuse to continue rather they don't want their son or daughter to be jailed. Something to try is working with the victims to get treatment for their abusive child through the diversion process. They might be more willing to cooperate if treatment is the result rather than imprisonment.
 
3.  Janine Hunt-Jac
 It must be very frustrating for law enforcement to encounter abuse and be unable to intervene because the victim is unwilling to go to court. I'm guessing that this is true no matter how old the victim. Elderly or disabled victims may be more afraid of institutionalization than of remaining with their abuser, particularly if the abuse is financial. Trading victimization and a known abuser, especially if he or she is a family member for an unknown situation may be more than the victim is willing to risk.
 
4.  Nancy Alterio
 Yes it is very frustrating. We work to build a trusting relationship with the victim and also continue to assess capacity to determine if the victim is competent to make the decision to stay in this situation. We also look to see what types of supports we can bring into the home or other family members we can involve. Often times, over time and building trust, we can make a difference.
 
5.  Sgt. Debbie Sta
 We investigate numerous cases involving elderly parents living with their son or daughter that is abusing them, but the victim will refuse to cooperate and want to stay in the home with the abuser, it's just so frustrating
 
6.  Nancy Alterio
 Response continue: Victims are introduced to the court room setting off hours and prior to trial, so they can feel more comfortable when going to court. It is essential to establish a trusting rapport with the victim. The prosecutors will conduct additional retrial interviews and for the convenience of the person, usually conduct these interviews in the home or a safe setting. When necessary and approved by the victim, guidance is sought from their health care providers. Whatever accommodations are necessary to address the victim’s accommodations and comfort, are sought and approved by the court prior to trial.
 
7.  Nancy Alterio
 In the majority, if not all of the District Attorney’s Offices in Massachusetts, there are special units to work with elders and persons with disabilities. Within these units, there are specially trained prosecutors who have received training to assist these vulnerable victims. The prosecutors also receive training on the resources available through Protective Services and the service providing agencies to them and the victims. Just like every other case, the District Attorney assigns a victim witness advocate to work and support the victim throughout the prosecution.
 
 
What are some of the emerging issues - impacts of new policy like the EJA, victimization trends, new technology to better provide service, etc. that professionals serving older victims with disabilities should be aware of this year?
 
1.  Mary Counihan
 Many state APS programs are using technology to enhance their ability to respond and investigate reports of abuse. Texas is an excellent example. They have created mobile offices so that workers can work from any location by providing caseworkers with a computer tablet, an air card, a portable scanner, a printer, and a cell phone. Video conferencing is being used to access consultations from the field.
 
2.  Mary Counihan
 In addition to the funding that Nancy talked about, the EJA also created a National Resource Center for APS http://www.napsa-now.org/resource-center/main/ and the Elder Justice Coordinating Council http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/EJCC/index.aspx. The Council has created a list of Proposals for Increased Federal Involvement. Among these proposals is the creation of a national APS data collection system. A contract has just been issued to develop such a system.
 
3.  Nancy Alterio
 The President requested and the Senate Appropriation Committee approved $8,000,000 in FFY14 funding for EJA. APS will only get this funding if Congress passes FFY14 appropriation bills and not continuing resolution bills. Continuing resolution bills won’t provide for any new funding. This funding would be used for demonstration projects, training and research but not staff. There are many technologic advances with treating, communicating and serving persons with disabilities including the robotic/prosthetic limps controlled by the persons own thought process. United Cerebral Palsy (UCP) is a good resource on technology to serve individuals with physical and communication challenges. http://ucp.org/resources/assistive-technology/
 
 
Have you found that Multidisciplinary Teams are helpful in these situations dealing with disability issues?
 
1.  Mary Counihan
 Elders with disabilities almost all have myriad issues that need to be addressed. Bringing the folks with the requisite expertise together allows the providers to more fully understand the complexity of the situation and create a more personalized, nuanced response to the client's needs. It facilitates smoother collaboration and minimizes people working at cross-purposes.
 
2.  Nancy Alterio
 In Massachusetts we find using a multidisciplinary approach a must. These cases are complicated and require expertise in many areas including investigators, prosecutors, service providers, clinician, victim advocates, etc… Many of the partners in Massachusetts wrote a guide on building partnerships to effectively respond to abuses/crimes committed against persons with disabilities funded by OVC. Multidisciplinary Response to Crime Victims with Disabilities: State-Level Replication Guide http://www.ovc.gov/pubs/victimswithdisabilities/stateguide/overview.html
 
 
We tend to experience resistance from our local law enforcement in believing the crimes were committed when the victim is an elderly individual with disabilities. Is there sensitivity trainings available or other resources specifically for law enforcement?
 
1.  Mary Counihan
 People with dementia are even more likely to be discredited as reliable reporters of fact. However, in a study done by Aileen Wiglesworth and Laura Mosqueda they found that people with dementia aged 55 and older could provide reliable evidence regarding emotional events they suffered. If you are interested in the full report entitled "People with Dementia as Witnesses to Emotional Events" it can be found at http://www.centeronelderabuse.org/research.asp
 
2.  Nancy Alterio
 Unfortunately persons with disabilities are frequently not believed and not just by law enforcement. OVC has funded the development for training for law enforcement. One publication is titled, “First Response to Victims of Crime” which addresses law enforcement’s response to crimes committed against persons with disabilities. They have also funded the development of trainings specific to elders. You can likely obtain these materials through www.ovc.gov/ovcres. Also here in Massachusetts we train all new recruits through the academy through a-one-day training. If you would like a copy of the curriculum you can email me at nancy.alterio@state.ma.us
 
 
how are older refugees and other migrant inform and offer resources on dv for prevention and awareness
 
1.  Mary Counihan
 This is an example of how important a coordinated effort to address elder abuse is. APS, DV, health service providers, and community service providers all need to work together to make sure immigrants and refugees who are new to the US know about what services are available to help them. Most likely an immigrant's first contact with the social services system will be a community service agency. These agencies need to know about the protective services available to victims so they can help connect their clients the services they need. APS needs to reach out to these agencies to make sure they know about what help they can provide.
 
2.  Nancy Alterio
 We would work with the Department of Public Health and our local DV program that specializes in working with refugees and other immigrant populations for services including DV and prevention and awareness, in addition to the local district/state attorney’s office.
 
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