OVC Provider Forum Transcript

Assisting Older Victims of Intimate Partner Sexual Violence
Jenifer Markowitz, Jennifer Gentile Long  -  2012/2/15
Many of the older IPV victims I see are patients with dementia. I genuinely believe their story about their injury but what resources are available to help teach law enforcement about IPV in this pt population *(and that the victim is not always imagining it)? thx
1.  Jenifer Markowi
 I think it's also helpful to make sure you're folding your medical folks into CCR and other multidisciplinary response teams. Having them at the table means having the opportunity for some informal education about issues such as dementia and IPV as they arise in your community.
2.  Jennifer Long
 PART 2: AEquitas Advisors are also available 24/7 to provide case consultation and technical assistance.The National Clearinghouse on Abuse in Later Life (NCALL) has a number of resources available on their website at http://www.ncall.us. It is critical that allied professionals receive discipline specific and multidisciplinary training to improve their response to victims of abuse in later life.
3.  Jennifer Long
 THIS ANSWER IS IN 2 PARTS:It is critical that allied professionals (prosecutors, law enforcement, healthcare professionals and victim advocates) are specially trained so that they can properly evaluate, investigate and dispose of cases, as well as better support victims, through an understanding of the impact of dementia and other age-related, acquired disabilities on a persons credibility, memory and ability to perceive.AEquitas is working closely with the NCALL to develop additional resources and update a training curricula related to the prosecution of abuse in later life.
I am interested in examples of successful advocacy strategies for outreach and services to this group of survivors.
1.  Jenifer Markowi
 Apologies, the VAWNet collection's actual title is Preventing and Responding to Domestic and Sexual Violence in Later Life.
2.  Jennifer Long
 AEquitas is participating in the National Sexual Violence Resource Center's LIfespan project which will look at how trauma complicates life across the age spectrum and how better informed practices can enhance positive outcomes for all persons violated. Information is available at www.nsvrc.org
3.  Jenifer Markowi
 PART II: For the healthcare providers trying to identify ways to identify and intervene with this patient population, there is also a healthcare section immediately following the advocacy section. One thing that isnt included in the collection, however, is IAFNs Nursing Response to Elder Mistreatment Curriciulum. You can find that at http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=459. The Wisconsin Coalition Against Domestic Violence also published an issue of their Coalition Chronicles dedicated to abuse in later life thats worth checking out: http://www.ncall.us/sites/ncall.us/files/resources/CoalitionChronicles_Oct2010[1].pdf. Id love to hear from participants in this web forum, as wellplease let us know what youve found to be particularly successful in your own programs.
4.  Jenifer Markowi
 I think the best place to identify comprehensive advocacy strategies is over at VAWNets special collection on elder abuse (which addresses domestic and sexual violence, as well as stalking): http://vawnet.org/special-collections/DVLaterLife.php. There youll find a section specifically for domestic and sexual violence advocates.
What rights does an elderly woman with very advanced dementia have when her spouse insists on continuing their intimate relationship? How is this affected by the woman being a resident in a long-term care facility?
1.  Jennifer Long
 Sarah -I am going to suggest that you reach out to Beverly Frantz at the Institute on Disabilities bfrantz@temple.edu. Because of her expertise, she can guide you through the evaluation of the situation and the impact, if any, of the offender's cognitive issues on the perpetration of his crime.
2.  Sarah Mills
 How do we get the perpetrator (usually the spouse) to understand that the woman can no longer consentdeny the sexual act? Often, the perpetrator may have his own cognitive issues.
3.  Jennifer Long
 Individuals who reside in long-term care facilities may have more protections but also face more barriers as there have been instances where facilities have not supported reports of sexual assault or have sought to cover up reports or interfere with investigations out of fear of embarrassing the facility and civil liability.
4.  Michele
 Are there educational resources out there that provide info about how to best inform an intimate couple, where one has dementia, about the ways in which they can manage communication/safety/intimacy issues that arise? Are there strategies in other words to teach?
5.  Jennifer Long
 Beverly Frantz is the Criminal JusticeSexuality Coordinator at the Institute on Disabilities at Temple University. She is fantastic resource related to understanding disabilities and their impact on victim credibility. The Pennsylvania Coalition Against Rape (PCAR) provides excellent resources related to providing advocacy and support for victims in later life. Please contact Karla Vierthaler, MPA and visit http://www.pcar.org/elder-abuse for relevant other resources. Another great resource is the National Clearinghouse on Abuse in Later Life (NCALL) a project of WCADV. Please contact Bonnie Brandl at bonnieb@wcadv.org and visit www.NCALL.us and http://www.ncall.us/sites/ncall.us/files/National Domestic Abuse in Later Life Resource Directory 2011_0.pdf for excellent resources.
6.  Jennifer Long
 An individual with advanced dementia retains the same right to autonomy and to live free of sexual violence as all other people and we must be vigilant to ensure that caregivers or intimate partners do not exploit vulnerabilities caused by this condition. It is critical that she is connected with advocates, who understand DV and SV dynamics, working with victims in later life, and age related acquired disabilities, such as dementia or Alzheimers, so that she remains safe from violence and that the people around her understand the limitations caused by her illness and the need to protect her from sexual violence.
What age group in particular are you referring to? because of their age would you say these crimes are not reported? How can we empower these women/men
1.  Jennifer Long
 7. Victim may rely on the abuser for financial support, medication, or personal care. 8. The victim may fear that the violence will increase if she reports the abuse. 9. The victim may believe that reporting the abuse to law enforcement will not do any good. 10. Understanding the barriers to reporting is key to identifying solutions to overcome them and highlights the importance of a multidisciplinary approach to these crimes.
2.  Jennifer Long
 5. Victims may not report because their partner or spouse is intimidating them either overtly or subtly. Again, there may be facts or methods but intimidation is a common tool used by DV perpetrator and is often missed.6. The victim might not want to terminate her relationship with the abuser or see the abuser get arrested. The victim may love the abuser and want to stay in the relationship while hating the abuse and wanting it to end.
3.  Jennifer Long
 3. Another reason victims in later life may not report is out of embarrassment or shame, either because of their victimization or because of discussing sexuality with family members or law enforcement.4. Victims may report to family or friends, but the reactions of those to whom they report, may silence them. This is common among all victims regardless of age. It is important to know that the reaction of the first person to whom the victim discloses impacts a victims decision/willingness to report or participate in the prosecution of their abusers.
4.  Jennifer Long
 Victims in later life face many barriers to reporting IPSV.1. Some victims may not report because they do not know that rape by spouse or intimate partner is a crime. This belief may be due to the victims age. For example, over the last 50 years there have been changes to the laws related to marital rape. It is possible that at some point in their life, spouses were exempt from prosecution.2. Some victims might not recognize that what happened to them is rape because they mistakenly accept the common belief that rapists are strangers.
5.  Jenifer M.
 Regarding your question on the age were talking about, the short answer is, it depends. OVWs Enhanced Training and Services to End Violence and Abuse of Women Later in Life Program defines later in life as 50 and older. The US Administration on Aging appears to define older adults as 60 and older (but in cases of individuals with Alzheimers may be 55 and older). However, individual state statutes may define older adults differently (with many using 65 as the cut off), as may adult protective service agencies. So its important to refer to your own communitys definition when defining the age range.
What are the best practices for preventing DV sexual violence with respect to older adults?
1.  Jennifer Long
 The Pennsylvania Coalition Against Rape (PCAR) provides excellent resources related to providing advocacy and support for victims in later life. Please contact Karla Vierthaler, MPA and visit http://www.pcar.org/elder-abuse for relevant other resources National Clearinghouse on Abuse in Later Life (NCALL) a project of WCADV can also provide excellent resources. Please contact Bonnie Brandl, at bonnieb@wcadv.org and visit www.NCALL.us and http://www.ncall.us/sitesncall.us/files/National Domestic Abuse in Later Life Resource Directory 2011_0.pdffor excellent resources. Finally, the National Center on Elder Abuse lists several Best Practices on its website. See http://www.ncea.aoa.gov/Main_Site/Find_Help/APS/Principles_Guidelines.aspx
What are best practices when intervening and treating older perpetrators of IPSV? Thank you.
What is the incidence and prevalence of IPSV among those over 65 and where may we access the data? Thank you,
1.  Jan M.
 Thank you for the clarification. In light of IPV and IPVSA research, this seems low. This info could help lead us to a better understanding of the health effects of IPVSA, e.g., victims of IPVSA may develop health problems and not live as long as those who are not IPVSA victims. Therefore, those over 65 would have a lower rate of victimization. There are a number of other implications of this information.
2.  Jenifer Markowi
 Jan, see the corrected version of my 1st response. The % was initially left off.
3.  Jenifer Markowi
 I should also mention that Zink and colleagues found a prevalence of about 1.5 percent in a survey of almost 1,000 women 55 and older who were asked if they had experienced IPV since the age of 55. That's from a 2005 paper published in the Journal of General Internal Medicine.
4.  Jan M.
 So, a woman over 65 will have been sexually assaulted 18 times in her life? This seems like a very high number and seems to be different from the The National Intimate Partner and Sexual Violence Survey (NISVS) and other research.
5.  Jenifer Markowi
 PART II: Beyond some of the data on IPV in older adults, what we do seem to have is research on what those patients look like when they present; what some of the clinical forensic markers are, and the like. I would encourage you to review NSVRC's annotated bibliography on sex abuse in later life: http://www.nsvrc.org/sites/default/files/publication_SVlaterlife_bib.pdf. Some great research here.
6.  Jenifer Markowi
 PART I: The challenge here is finding this type of data on IPSV in the older adult population. We have some data about incidence of IPV in older adults (for instance Bonomi and her colleagues found that lifetime incidence of IPV in women over 65 was just over 18%). And several studies discuss the barriers that lead to underreporting by older adults.
Who are the perpetrators? What are their characteristics? Why do they engage in IPSV? How often are they detected and when detected what is the response of those who identify the behavior as IPSV?
1.  Jennifer Long
 Experts who work with sex offenders caution against every trying to put oneself in the shoes of an offender, because it cannot be done. For example, sexual violence may be perpetrated in the course of an intimate partner relationship to try to control the victim or as part of other physical violence, but this is not always the case. Unfortunately, responses to a victim's disclosure of sexual abuse can be negatively impacted by the reasons highlighted in earlier posts, e.g. perceived lack of credibility of victim, perceived niceness of perpetrator, and relationships between the perpetrator and other family members who may be involved. Public awareness and specialized training on these issues for allied professionals addressing these crimes is, therefore, critical.
2.  Jennifer Long
 Although frequently minimized, perpetrators are more experienced, more invested, cross more boundaries, feel safer (because of the victim's vulnerabilities due to advanced age, physical or age-related disability, and perceived lack of credibility), create more betrayal and family conflict and are more psychologicallyemotionally involved in offending. Offenders do not fit into a single mold and each offender and offense must be viewed individually.
3.  Jennifer Long
 It is important to remember that perpetrators frequently hide behind their status as spouses or members of the family or in the community. Further, they often use attributes like kindness to manipulate the community, law enforcement, and the victim into minimizing or disbelieving an allegation of assault.
4.  Jennifer Long
 According to the research, The majority of identified perpetrators in domestic settings are spousespartners and incestuous sons and other relatives (Ramsey-Klawsnik, 1991, 2003). The most frequently identified alleged perpetrators in care facilities are facility employees followed by facility residents (Burgess et al., 2000; Ramsey- Klawsnik et al., 2008). See Sexual Violence in Later Life p. 2 (NSVRC 2010) available at: http://www.nsvrc.org/sites/default/files/publications_SVlaterlife_bulletin.pdf
How does information about IPSV come to light? Do health care providers, adult protective services workers, adult children, the survivor, others report? Who do they report to and what is the response of those individuals / entities?
1.  Jennifer Long
 Abuse against victims in later life comes to light in many different ways. Non-offending caregivers and others who are in frequent contact with victims, e.g. salon employees or store clerks, are in the best position to recognize indicators of abuse and should be educated about local resources and methods of reporting suspected abuse. See www.NCALL.us. Healthcare professionals,APS workers and law enforcement are also in unique positions to recognize abuse and conduct appropriate interviews in which victims feel safe to disclose.
What is important to know about survivors and perpetrators of IPSV. What modifications do current DV (victim and perpetrator treatment) services providers need to implement in order to prevent IPSV and to provide services that really meet the need of this population?
1.  Jennifer Long
 1. The negative collateral consequences of older adults reporting intimate partner sexual violence may be magnified if they are reliant on their partner for care and economic support; 2. Develop pamphlets and educational resources on IPSV geared towards older adults and distribute them at doctors' offices, residential facilities and senior centers; 3. Conduct outreach at senior centers and residential living facililites; 4. Include APS in your jurisdictions' CCR; 5. Develop court accompaniment for older adults who are victims of IPSV; 6. Train civil lawyers to represent older adults in PFA proceedings and to protect them against financial abuse.
If two patients have dementia, how does a professional know if sexual relations are consensual or not?
1.  Jenifer Markowi
 PART II: I would encourage long-term care facilities to increase staff education on this issue and consider creating policies on how sexual behavior is handled within the facility, differentiating healthy sexual behaviors from sexual behaviors requiring client protection. The National Ombudsman Resource Center (http://www.ltcombudsman.org) has some training on this issue. I'd love to know if anyone else has some resources or thoughts on this topic.
2.  Jenifer Markowi
 PART I: This is a great question! Believe it or not, there is some published information on this (see http://www.medscape.com/viewarticle/709814 for a full-text interview with clinicians on this), but not a tremendous amount of research. This is truly one of those situations that needs to be handled on a case-by-case situation. One of the first steps is to make sure the staff in the facility have some education around intimacy, sexuality and sexual behaviors, so that people can reasonably evaluate the situation.
Many of our programs struggle with balancing advocacy foundation of self-autonomy for older survivors and reports to adult protection. Do you have suggestions for resources that discuss this or insight yourselves?
1.  Jennifer Long
 Beverly Frantz, Criminal Justice and Sexuality Coordinator at the Institute on Temple University and bfrantz@temple.edu. 215-685-3100 can provide excellent insight on this issue. She serves as an expert witness as well as faculty for our National Institute on the Prosecution of Sexual Violence.
Often it is difficult to discuss intimate issues with those in later life since many of it see it as private information. How does a professional begin to have a conversation around such a delicate topic?
1.  Jennifer Long
 The National Sexual Violence Resource Center Some strategies include employing advocates in later life,to whom the victim may feel more comfortable disclosing the abuse. Individuals and agencies should also conduct a self-assessment of their own attitudes, practices or policies that could inadvertently be creating barriers to charging. (NSVRC) has a great resource on this issue. See the section entitled Providing Effective Advocacy available at http://www.nsvrc.org/sites/default/files/Elder_Sexual_Assault_Technical-Assistance-Manual.pdf.
Do you know of any examples where faith communities are working to prevent or respond to sexual abuse of older people?
1.  Jenifer Markowi
 I would check with the Faith Trust Institute (http://faithtrustinstitute.org). They are doing fantastic work with faith communities around issues of violence. They have a free webinar on this issue coming up in July; they also have a recorded webinar from this past December. Search elder abuse on their site and you should be able to find it.
As experts in the field, what do you think are 5 key things those in the DV field should know about IPSV of older people?
In a similar vein, as experts in the field, what do you think are 5 key things those in the adult protection field should know about IPSV of older people?
1.  John Laycock
 Older citizens often do not disclose SV because of life long conditioning and a feeling of privacy or secrecy regarding intimate issues. Fear of being alone consumes some older citizens. Trust between the Advocate and the older Citizen is paramount.
2.  Jennifer Long
 1. Screen for abuse. It's underreported and most victims don't disclose.2. Train healthcare providers to screen for abuse and refer patients to advocates and law enforcement.3. Participate in the Coordinated Community Response (CCR) in your jurisdiction. Include advocates for individuals in later life and individuals with and disabilities.4. Work with advocates. They do a great job working with special populations of victims and are adept at issues of cultural competency.5. Work with prosecutors so that they understand the function of APS and the support it can provide to victims. There are more than a top 5, but, this is a good place to start.
Is there an online resource, say a one page document that can be used to showgive to victims of sexual abuse? I'm looking for something that asks questions that are connected to abuse so that they can answer yesno and then provide information on how to seek help...
1.  Jenifer Markowi
 From the healthcare side of the house, the best resource I can recommend on this is the CDC's Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings. The last portion specifically provides screening tools on sexual violence: http://www.cdc.gov/NCIPC/pub-res/images/IPVandSVscreening.pdf. I would also look at VAWNet's special collection on preventing and responding to sexual and domestic violence in later life: http://vawnet.org/special-collections/DVLaterLife.php#301
If a child is abused, most states have a well-developed foster care system. If a senior is abused, there is simply no similar system. Are there any movements to make state-wide protocols for victims of elder abuse??
1.  Jennifer Long
 I would suggest you reach out to Bonnie Brandl of NCALL (bonnieb@wcadv.org) who will know if such a movement exists, and, if it does not, can discuss alternative strategies communities are employing to keep victims in later life safe.
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