1. Special Assistance Required by Victims of Most Prevalent Types of Adult Abuse – Adequacy of Structural Mechanisms to Provide It Mary C. Sengstock, PhD., C.C.S. Wayne State University SOC 5870 – Family Violence m.sengstock@wayne.edu

2. Recommendations from Study of Adult Abuse in Michigan Review Effectiveness of Mandatory Reporting of Adult Abuse in Michigan (Detroit Area) Funded by Blue Cross & Blue Shield of Michigan Foundation July 2006 – Oct. 2008 Focus Groups with Service Providers: – Mandated Reporters – Adult Protective Services (APS) Investigators

3. Most Common Approach to Managing Adult Abuse Mandatory Reporting To a Specified State Social Welfare Agency: – Usually Called “Adult Protective Services” By Specified Health & Social Service Workers Primarily Physicians, Nurses, Social Workers

4. Major Problem Observed Discrepancy Between Most Frequent Types of Abuse Reported … & Specialties of Most Mandated Reporters Focus of Current Presentation: Possible Measures to Rectify This Discrepancy

5. Most Common Abuse Types Observed in Michigan Neglect: Failure of an Assigned Caregiver to Provide Effectively For Dependent Adult Self-Neglect: Failure of an Independent Adult to Care Adequately for Him/Herself Financial Maltreatment: Misuse of Dependent Adult’s Money or Property by Others

6. Focus of This Presentation State Agencies & the Information They Need Major Types of Abuse/Neglect Observed: Neglect – Self-Neglect – Financial Maltreatment Views of Agencies Most Likely to Observe Cases of the Most Frequent Types Evaluation of Likelihood of Providing the Needed Services

7. Current Mandatory Reporters: Primarily Health Care Workers: – Physicians, Nurses, Medical Social Workers – Home Health Care Workers Abuse Types They Recognize: – Direct Physical Abuse, Caregiver Neglect Unrecognized Abuse: – Financial Abuse, Self-Neglect – Often Seen Late – With Little Hope or Remedy

8. Concern of Governor’s Task Force on Adult Abuse (2006) Need for “…more cohesive, coordinated, and proactive response…” to the problem Inadequate Attention to Most Frequently Observed Types: Neglect – Self-Neglect – Financial Maltreatment Need for a “Focal Point” (Coordinating Agent)

9. Most Frequent Types Observed or Suspected (* % Not Computed for Small Numbers) Type of AbuseReportedSubstantiated% Substantiated Self-Neglect58 (27.6%)51 (30.4%)87.9% Neglect56 (25.7%)42 (25.0%)75.0% Multiple Types52 (24.8%)43 (25.6%)82.7% Physical Abuse26 (12.4%)20 (22.9%)76.9% Financial11 (5.2%)9 (5.4%)81.8% Other7 *3 ** Totals21026880.0%

10. Focus Group Respondents Agency Type Wave 1 Groups Wave 1 Individual Interviews Wave 2 Groups Wave 2 Individual Interviews Total Groups Total Individual Interviews State Agency 2739516 Health Care 3153 630 Senior Center 132437 Totals6258281453

11. Most Frequent APS Reporters Physicians – Nurses – Social Workers Hospitals – Home Health – Oversight Agencies Use “Social Work Model” Time-Consuming Investigations – Client Involvement What They Observe: Physical Abuse – Physical Neglect What They Fail to See: Financial Abuse – Much Self Neglect – Intimidation (Rarely Observed in Medical Settings)

12. Major Problem Area: Financial Maltreatment Physicians, Nurses, Social Welfare Workers Unlikely to Observe Who Can Observe & Provide Assistance? Bankers – Attorneys – Prosecutors – Judges Likelihood of Their Involvement?

13. Analysis of the Focus Groups Interviews With APS Workers 5 Focus Groups Total of 15 Workers Interviewed (Some 2x) 2 Senior Centers Total of 7 Individuals Interviewed : – 2 Center Directors (1 interviewed 2x) – 1 Police Officer (interviewed 2x) – 1 Fire Fighter (interviewed 2x)

14. Concerns – APS Workers Lack of Attention to Neglect, Self-Neglect, Financial Maltreatment Such Cases Are Rarely Seen By Health Care Workers Unless It is Quite Extreme Information Received Is Inadequate to Conduct an Investigation (Name, Address, Symptoms Observed, Contact Information)

15. Concerns – APS Workers (ctd.) Lack of Cooperation By Agencies Which Prevent Workers from Reporting Preference for Employees to Report to Management Lack of Cooperation by Court Officials Non-Cooperative Bank/Financial Officers Inattentiveness By Guardians Patients, Families, Workers Failing to Report Due to Fear of Retaliation

16. Concerns – Senior Center Workers Great Commitment to The Seniors They Serve Guardians Misusing Client Funds Unresponsive Guardians Use of Agency Attorneys to Handle Issues APS Unresponsive: – “I called APS so many times you can’t even remember…” – “The only thing I got them to do was … serve [meals] on holidays…”

17. Findings – Senior Center Workers (ctd) “… I’ve talked to other senior directors … aging professionals … the frustration levels … the red tape…” “… mountains of paperwork … we make a phone call and worry about the paperwork later…” “APS … CPS … biggest 2 wastes of time in my world… They do nothing in my opinion… waste of government money…”

18. Senior Center Proposed Solutions Non-Reporting: How many cases you do NOT report to APS? “Tons.” “…one call is not going to do it… if there’s 3 of us calling, … they’re going to start listening…” “… just me on the phone every 15 minutes…” “There’s no best practices … for elder abuse … no mandates, … no guidelines.”

19. Senior Centers As Examples of a Type Agencies Not Part of the Health Care/Social Work Network Most Likely to Observe Non-Medical Abuse: Self-Neglect – Moderate Neglect in the Home – Financial Maltreatment More Likely to Be Observed by: Senior Centers – Banks -- Public Safety – Courts

20. How to Obtain Cooperation from Non-Medical Agencies Police, Courts, Community Workers (EX: Senior Centers) Not Familiar/Comfortable with Social Work Models More Comfortable with the “Crime Investigation” Approach Is APS Capable of Developing New Models of Reporting for These Cases? Can Other Agencies Play this Role?

21. Past Experience of Their Involvement Re Dependent Adults Bankers: Some Recognize Need – Do Not View Involvement as Their Role Prosecutors: Care About Children – Not Adults – “If These Were Kids, I’d Be Concerned.” Judge: Main Concern: Proper Court Procedure – May Handle Cases But Not Aware of Problems – EX: Attorney Guardians/Conservators: Not Attentive to Proper Dependent Adult Care

22. Bankers: Why Are They Unlikely to Report? Uncertain of Their Right to Intervene View the Actions of Legal Agents as “Not Their Business” Unclear on the Legal Right of the Banker Reflects Focus Back on the Legal Profession

23. Legal Professionals: Why Are They Unlikely to Report? Lack of Respect for Social Work Resist Approaches Outside the Legal Context Anti- Elder Attitudes of Legal Professionals – “If It Were Kids, I’d Be Concerned.” Lack of Respect for Mental Health, Social Work – “Social Workers Are Lazy” – “Social Workers Don’t DO Anything – Just Talk”

24. Efforts of Legal Professionals in Other Regions 2008: California: Prosecutors Deliberately Target Elder Cases – San Diego County Model 2010: Elder Abuse Downplayed by new California Attorney General [Christine Jewett, “Prosecutions of elder abuse cases decline under Jerry Brown.” California Watch, Aug. 21, 2010. http://californiawatch.org/prosecutions-elder-abuse-cases- decline-under-jerry-brown-013] http://californiawatch.org/prosecutions-elder-abuse-cases- decline-under-jerry-brown-013 Projects Fail Without High Level Involvement

25. Michigan Efforts 2010: California Guest Presentation in Michigan (Paul Greenberg) Wayne County (Detroit) Prosecutor Participant Major Attendees: Social Welfare Workers, Other Traditional Mandatory Reporters Most Legal Professionals Not Present Current: State Office on Aging Project: Involve Legislature, Prosecutors, Attorneys, Physicians Funding May Be Problematic

26. Remedy for Problem: Recruit Legal Professionals Financial Abuse Cannot Be Tackled By Social & Health Care Workers Alone They Find it Difficult to Identify It They Certainly Cannot Handle It! Financial Issues Are Not Within Their Expertise

27. Is It Possible to Recruit Legal Professionals? Need a Determined Campaign Recruit Prosecutors, Judges, Attorneys Co-opt Them into “the System”! Ideal Long-Term Task for a Clinical or Applied Sociologist to Organize Project?

28. How to Get Lawyers Involved? Spouse Abuse Example Clinical/Applied Sociology Venture – Provide Social Structural Information & Consequences for New Situations, Problems – Involve Critical Individuals/Groups in the Process – Help Critical Individuals/Groups Use This to Develop THEIR Program Plans [M.C. Sengstock, 1985. “Sociological Strategies for Developing Community Resources: Services for Abused Wives as an Example.” Clinical Sociology Review, 1985: 132-144.]

29. Example of Successes with Spouse Abuse Reluctant Family Service Director: – Became Committee Member – Chose to Have Staff Ask Clients About Abuse – Astonished at the Increase in Cases Uncovered Non-Cooperative Social Agency Director: – Invited to Hearing on Financial Problems of Abused Wives – Entered Room & Announced Appointment of New Special Director for Such Problems

30. Technique #1: Provide Social Structural Data & Consequences Increasing Number of Elders Elderly Health & Financial Difficulties Increased Life & Activity of Elders (Not a Few Months of Suffering) Need For Increased Concern for Older Adults… Equal to Current Preferred Focus on Children Remind Them of the Political Clout of Seniors!

31. Technique #2: Involve Critical Individuals & Groups in the Process Need to Include: Judges – Prosecutors – Attorneys – Bankers Co-opt Them into the Process!

32. Means of Co-optation Recruit for Planning Committees if Possible Invite Non-Members for Hearings on Critical Issues – EX: – Prosecutor Only Concerned with Children – Judges with Many Guardianship Cases Bring in Victims to Describe Problems

33. Possible Solution Include Legal & Banking Professions in Process Coopt Them to Develop THEIR OWN Programs Would Target Financial Abuse – Also Help With Physical Abuse & Neglect Need to Make It THEIR Plan – Not Imposed from Outside Not a Plan That Can Be Conducted by Adult Protective Services or Human Services Alone New Michigan Plan Bears Watching

34. Brain-Storming: How Can We Implement the Major Proposals for Michigan from the Governor’s Task Force & Blue Cross Study? 2 Dimensions: Improving APS Model Supplementing APS Model

35. Improving APS Model Enhance Services and Funding for Needs of Vulnerable Adults (vs. Children). More Training Opportunities for Mandated Reporters. More APS Worker Training (Mentally Impaired) Increase APS Staffing Levels. Registry of Repeat Offenders. Increase Communication/Coordination Among Mandated Reporters Via Task Force/Network. Policy makers (Legislature, Executive Branch): Include Service Worker Input in Development of Policy and Procedures. 35

36. Supplement APS Model Models Adapted to Legal and Criminal Justice Professions (Victim Advocacy; Restorative Justice) Models Appropriate for Senior Centers and Family Service Agencies (Family Caregiver Support; Community Service Models) Models Effective with Banking Industry (for Use With Financial Abuse) Involve Workers in these Professions in Development of Models for that Profession. Legislative & Executive Branches: Ensure Adequate Funding for Dependent Victims of Adult Abuse 36