OVC Provider Forum Transcript

Serving Elder Abuse Victims in Indian Country
Melissa Riley  -  2009/11/4
Could you please address any innovative services specifically for elder victims of sexual abuse or assault? Thanks.
1.  Melissa
 Innovative services specific to elders in Indian Country are going to involve knowledge of culture and integrating that with key resources necessary to respond to elder sexual assault. Demographics of a community are critical to knowing what to do to implement an innovative yet practical resource for sexual assault response. I would like to suggest the following: Follow-up with local law enforcement and medical facilities to find out how many cases within a 1-year period have been addressed by their officersmedical staff. If there are none to few, ask why or what they perceive to be the problem to be.Talk to the prosecutors office and see if there are any cases that have been through the court system for elder sexual assault.Meet with SANE/SART folks and see what their response has been to elders.See if there are elder abuse codes and criminal codes that address elder sexual abuse. (If not, advocate for it)Find out what resources respond to elder populations (CHR, senior programs, elder centers, nursing homes, clinics, PHN's, social services, behavior health, cultural programs) and talk with them.Once are the resources and data is collected - meet with tribal folks and introduce your statistics.Once all of the data is presented. Develop a resource list and add components to it such as translators, spiritual healing, other community leaders that are willing to help be a part of a response. Develop a referral system and protocol that includes the resources and provide training on elder needs and issues. One important thing is to include elders in your assessment and development of resources.
With Tribal Programs working with Elder Abuse is there now Statistics pertaining to Elder Abuse in Indian Country? How about statistics for the state of Minnesota on Elder Abuse?
1.  rose barber
 I think you can get this information from your lead elder abuse agencies which are in every county and some tribes. I remember having to gather these for our tribe.
2.  Jacob Davis
 I work as a Project Coordinator for the National Resource Center on Native American Aging and we send out a Needs Assesment to particpating tribes to gather useful data. Maybe in one of our future cycles we could have questions about elder abuse included.
3.  Melissa
 The statistics for Elder Abuse in Indian Country is still very limited. One of the stated causes for this can be contributed to lack of tribal codes specific to elders, lack of reporting, no resources, lack of information or training by service providers to fully identify abuse, to name a few. There is one publication titled, Older Americans 2008: Key indicators of well-being. The publication is by the Federal Interagency Forum on Aging Related Statistics. Most of the information in this publication refer to 2004 data collected on a nation-wide survey and it includes physical, mental, and social needs.
What type of elder abuse prevention programs have you helped develop? Is there a lot of elder abuse among American Indians? More so than the rest of society? What type of research is conducted through your organization? What type of positive results have you seen from your work? What can I do to stop elder abuse in my community?
1.  Tracy De LaCruz
 You said that in Indian Country elder abuse is a silent problem because of reasons such as shame etc. I am wondering if the at-risk elders were receptive to the outreach services that were offered to them?
2.  Melissa
 Prevention programs I developed were based on a strong collaboration with local and state providers that collectively identified the gap in services for elders in our area. (That was the first step) Basically, I assumed a senior companion group and enhanced the outreach services and integrated a victim service component to it that allowed for local elders to go out and establish relationships with other elders who were at-risk. At-risk elders were identified as those who had disabilities, severe health problems, lived alone, were raising grandchildren, who had other adults living with them that were under probation services, or were referred to our program by service providers or other community members. Once the elder companions were established a bi-weekly or weekly visit by elders to elders was established. A care plan and a visit by me was conducted on a periodic basis to see what services were being rendered by my senior companions (elders) and how the recipient of companionship services were doing. In between visits, the senior companions and I attended as much free training as we could get to help increase their awareness of trends and issues that impacted the elders in Indian Country. This included updates in MedicareMedicaid, communication, etc. The overall goal was to help intervene or prevent abuse by having 'spotters' in the community. I believe the program worked well and we enhanced our relationship with the local agencies and other tribal networks throughout the state.There is a lot more abuse going on in Indian Country with our elders but the problem is that there is a high tolerance for it. It is a silent problem. There are also issues to lack of response or reporting due to shame, culture, family issues, and all of the internal networks in our communities. Our organization (Unified) is assessing elder abuse on a community level with our grantees who are tasked with victim services. We have had a health response to the topic but the task of creating prevention campaigns, training, and developing codes is a community effort that we like to empower our grantees with.I would strongly suggest a needs assessment that includes definitions of what your community perceives to be as elder abuse, look at current resources available, and collaborate with localstate agencies. That will help you develop resources in response to the problem. Very important to include elders in this task.
we have an inter-tribal elder coalition that wants to address this issue. they have had problems finding an appropriate vehicle to gather support from their individual tribal governments. Any suggestions?
1.  CJ Doxtater
 Well, I'm honored that you thought I was Clifford. He is my elder, I work for the state coalition as the aging & disability coordinator. However, I am tribal and have attended GLNAEA (the grassroots coalition wan elder abuse task force and are attempting to get a tribal resolution from each of the 11 tribes. After several years, they have 5 but have been approaching the tribes individually. Your idea, to approach the tribes as a group may be just the key to get the momentum for passing some tribal elder abuse codes. Thank you very much for your aid
2.  Dave Baldridge
 Hi, Clifford,We developed a concept for the NM Title VI programs but haven't tried it. Maybe you could create a resolution signed by all your coalition members, so your voice is collective. Then try to get it on the agenda of every tribal council (several of your members attending the meeting to support it) and go to the ITC as well. With every tribal council that signs on, your voice gains strength--a domino effect.
The majority of cases we receive involve theft from the elder's home by their own children. It is extremely difficult to convince them to prosecute these cases. Is there a better approach that can be used to assist a client to understand that this is abuse and that charges need to be filed in order to create security for them?
How can those of us in the Fire Service/Emergency Medical Services assist the Native American communities in our county with elder abuse and domestic violence? I would like to create a format to do this, and would like your opinion. Thank you for your time.
1.  Melissa
 That is a great idea! I would suggest seeking out what agencies in each community that respond to domestic violence and elder abuse. Some great ideas are to participate in any community sponsored events for either one of these issues. I know EMS and Fire Department staff are limited in time but maybe delegate a key staff person to be a liaison between agencies serving victims and your department. Attend meetings, share outreach materials, sponsor or co-sponsor walks/runs/candlelight ceremonies, or anything that shows your support. Agencies are often swamped with outreach and they want to do what they can, but they can be limited in staff, resources, etc. EMS staff can offer to distribute brochures/pamphlets to victims. Victim programs often times need help spreading the word about their services. These are a few ideas but I appreciate your effort and hope that works out!
2.  Jacob Davis
 I feel that this is a good issue that needs to be called to attention. I think that it would be beneficial if there was cultural competency training made available when you work with a native american population.
What are the barriers to providing services to this specific population?
1.  Tracy De LaCruz
 Melissa it seems as if working with tribes is a greater challenge than working with the rest of society. I had not considered all of the barriers that you have had to overcome such as language and cultural barriers.
2.  Melissa
 Barriers that I encountered was that I was a Native but not from those specific communities. Language and understanding of cultural practices were a part of the barriers I had to overcome. The next barrier was the remoteness and lack of telephone services, transportation, and manpower. Elders tend to keep close to their home or with relatives and reservation homes are spread out so responding or following up on referrals was a challenge for me. One thing I started to do was team up with service providers I knew were visiting the same person and then go out together so that we did not overwhelm and create challenges in developing a relationship with elders and their families. Sometimes territorial issues came up and protectiveness of the elder or families, but those can be overcome. It just takes time. One benefit I had was that I was eager to learn greetings and important pieces of the culture so that I was more culturally responsive. Just because I was Native did not mean I could address another tribe's needs.
An increasing number of tribes are starting their own adult protection programs. What innovative practices do you know of whereby tribal and state APS programs work together to effectively serve Native American elders?
1.  Helen Camel, SW
 The Conf. SalishKootenai are providing APS ser to tribal members living on res.4-5 tribes are interested in providing owns ser. Begining discuss has begun for direct funding for ser from State406-675-2700, Ex 1230.
2.  Melissa
 I don't know of a best practice model for collaboration between APS and tribes. My first question to you might be what state you are writing from and then I might be able to direct you to that potential resource.
The Pueblo of Zuni's community intervention program to prevent teen suicide has apparently been exptremely successful. Are you aware of any similar Indian Country programs for domestic violence or sexual assault issues?
1.  Melissa
 I also work with the Turtle Mountain Band of Chippewa in North Dakota and they have a wonderful shelter, staff, and system of care set up to respond to victims. I conduct training there on an annual basis and suggest them as a resource for best practices.
2.  Jacob Davis
 I have done some domestic violence and child abuse workshops on the Turtle Mountain Band of Chippewa in North Dakota. It has been well attended and the feedback is very positive. The last one that I did focused on healthy relationships and emphasized the signs of domestic abuse.
3.  Melissa
 Most definitely. There are numerous successful programs in New Mexico. TEWA and Laguna Pueblo to name a few. You can e-mail me and I can provide more information to you on additional programs.
what are the challenges to collaboration between APS jurisdictions & tribal jurisdictions?
1.  Melissa
 The major challenge for me was to review the state codes and systems in order to determine where jurisdiction would fall especially in cases where nursing homes were off the reservation or elders were seen in facilities off the reservation where the incidents were reported. Once those referral systems, codes, and resources were identified the state would often refer the cases to the tribe to follow-up on and recognized jurisdiction except in cases were the incident occurred off the reservation.
Is the financial exploitation of Elders a significant occurance? Are there any statistics of incidence?
1.  Tracy De LaCruz
 Great question, I also wonder if financial exploitation of elders in Indian Country is more or less prevalent than in the rest of society.
2.  Melissa
 Oh my, yes! Exploitation is a huge issue. I do not know of any statistics of incidence. My resource was the local police departments, tribal courts, and social services. I worked at a social services program so we had access to the referral counts and were responsible for BIA reporting so that was easily accessible however for cases that we did not know about or were following, we asked those agencies for their numbers. This is keeping in mind that not all tribes/villages have elder abuse codes or codes that reflect exploitation. Exploitation involving finances were often difficult cases to work with due to elders dementia, medication effects, fear, shame, etc.
Is there a national model for tribes to use in developing an Elder Abuse code? If so, how may I obtain a copy? If not, are there any other resources that you would recommend?
1.  Beatriz
 If you have a Tribal domestic violence code that should cover any victims of DVSA. If not, maybe that Tribal code needs to be revised to add the elders and so on.
2.  Melissa
 I would suggest contacting the National Indian Council on Aging or you contact me by e-mail at: melissa@unified-solutions.org
3.  Jacob Davis
 I beleive that Oneida has developed an elder code and I was led to believe, while I was at a conference there last week, that they were willing to share it to other tribes.
Is corporate guardianship used in cases of elder abuse when the individual is incapacitated? If so, are their special considerations for providing corporate guardianship to an American Indian? Are their guardianship resources specific to work in Indian country?
1.  Melissa
 This all depends on if the tribe has a guardianship clause in their code. Most of the times the tribal court will do a 'test' to see if guardianship is necessary. If the state court and code has jurisdiction, then the guardianship clause most likely include corporate guardianship and this often done in cases where the elder is being placed in a nursing home and is assigned a guardian and has an advocate and social worker. The guardianship resources I have found are through NICOA and the BIA. I would also contact the state Medicaid program or AARP for more information specific to your state.
What are the key cultural adaptations you have had to make to develop programs to alleviate elder abuse in Native communities?
1.  Melissa
 Key cultural adaptations have been understanding the roles of the families, traditional practices, roles of traditional leaders, learning some of the language, communication patterns, using traditional leaders for translation of messages, learning about the whole tribe in general, and learning appropriate responses (verbal,physical) to elders.
Have you recieved a lot of community support and assistance in your work?
1.  Melissa
 In the beginning elder abuse was not a very popular topic with many in the community. It was difficult to get people to open and share ideas about elder abuse and a lot of community members felt that it was an issue that needed to be left up to family but my problem was that family were often times the perpetrators (exploitation, physical abuse, emotional abuse, medical neglect, etc.)After a while I just kept it going with elders I was currently working with and I took my message to state conferences and quarterly NICOA meetings. Interest and collaboration took about a year. It is a long process but I kept pushing and trying to constantly educate myself on various issues and share them with other agencies and the elders until I had my own advocacy corner.
Have you helped tribes develop elder codes? Does the culture of the tribe play a part in the development of the code?
1.  Melissa
 I was managing the local elder program and we were fortunate to have a grant to modify the elder abuse code put in place several years earlier and I was able to work with the prosecutor and local agencies to revise the original code. The culture of the tribe ALWAYS plays a part in the code and it should. Understanding the cultural needs of the elders, family systems, matriarchal/patriarchal systems in tribes, response to death, communication methods/patterns are all often very important to consider when developing codes. This calls for exploration and collaboration with tribal elders and agencies to make sure that the code protects elders while not infringing on their culture and tradition.
Dealing with elder abuse is a sensitive subject for many people. Is it difficult to seperate your personal feelings from your work?
1.  Melissa
 It can be difficult to separate your feelings from work, but it is critical that you keep yourself in 'check' at all times. Personal feelings often will get you in trouble professionally, so it is important to develop self-help and methods for self-care to decrease or avoid personal feelings. These are things I learned the hard way as a provider and would be my professional recommendation to anyone who is sensitive to other people's pain.
Elder abuse is a serious issue that deserves attention. Any advice on can I rasie awareness in my local community for these particular victims?
1.  Melissa
 I would first explore what the serious issues are in relation to elder abuse. Lack of reporting, understanding what it is, who it applies to, who are mandatory reporters, lack of codes, law enforcement training, etc. Something I use to do is go out where elders congregate during the day or evening and ask to speak to them and get to know them. Then develop some team work with local agencies. I would suggest teaming up with agencies that respond to elders such as CHR's, clinics, social service programs, elderly centers, meals on wheels, etc. Then create some flyers, have the tribe sign a proclamation for the Month of November or May and have awareness activities. These are just a few things I did in the communities.
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