POLYVICTIMIZATION IN LATER LIFE Shelly L. Jackson, Ph.D. Financial Fraud and Abuse Visiting Fellow Office for Victims of Crime
THE NEW PUZZLE
Financial Exploitation
Sense of urgency High profile cases State definitions Statutory changes Identified types of FE Survey of APS caseworkers Profiles? Risk factors Internet resources Prosecution Financial institutions MDTs Prevention LTC facilities
Polyvictimization
DEFINITION HAMBY & GRYCH (2013)
Victim
Co-occurring forms of abuse in later life
Revictimization in later life
Life-long revictimization
Cascading (serial forms of abuse)
Offender
Same offender or different offenders
TYPES OF ELDER ABUSE
Distinguish different types of abuse Polyvictimization is different from forms of abuse occurring in isolation Linkages between forms of abuse
CO-OCCURRING…
WHAT ARE THE MOST FREQUENTLY COOCCURRING FORMS OF ELDER ABUSE?
We
don’t know
PREVALENCE
10% to 50% experience two or more forms of abuse
Rates may differ by the type of abuse involved
Gender results are mixed
Decreasing prevalence with increasing number of co-occurring abuse Higher rates in clinical samples of 30% to 40%
NAVARRO ET AL. 2010
46% involve one type of abuse
9% Physical & financial 22.9% Neglect & financial 13.9% self-neglect & financial
TIP OF THE ICEBERG
DIFFERENTIATING VICTIMS Financial Exploitation
No children Live alone No childhood family violence Not aggressive toward abuser Not poor relationship with abuser Younger age No communication deficits No dependence on others No confusion/dementia
Hybrid Financial Exploitation
Widowed Cohabitation with abuser Not good/fair health Unable to drive Fear abuser History of childhood family violence Perceive abuser as caretaker Long history of abuse
DIFFERENTIATING OFFENDERS Financial Exploitation
Non-relative Have children No IPV (p < .07) Know elder short time No overburdened social support
Hybrid Financial Exploitation
Relative Unemployed Unable to drive Financially dependent Known elder a long time Parasitic abuser
INTERPERSONAL DYNAMICS
Dynamics are different for victims of polyvictimization Closer relationship (parent-child) Long-term relationship Long-standing abusive situation
AND NOW…
MORE SERIOUS OUTCOMES
Guardianship
Change of living arrangement
Longer length of abuse
Risk of re-abuse/re-report to APS
ACTUARIAL RISK ASSESSMENT INSTRUMENT (NCCD, 2013)
If multiple types of abuse, 20% increase in revictimization.
:
INCREASED THE ODDS OF SUBMISSION TO THE
DA BY 2X
INCREASED THE ODDS OF CHARGES BEING FILED BY A FACTOR OF TWO; INCREASED THE ODDS OF A PLEA OR CONVICTION BY A FACTOR OF THREE.
FINANCIAL EXPLOITATION CO-OCCURRING WITH PHYSICAL ABUSE
(NAVARRO ET AL. 2012)
Increased the odds of submission to the DA by 2x
Increased the odds of charges being filed by 2x
Increased the odds of a plea or conviction by 3x
THEORY
Accumulating Risk Theory
The higher the number of risk factors, the worse the outcomes
TRAUMA THEORY
IMPACT OF TRAUMA
THE IMPACT OF TRAUMA
Reluctance to accept services may be due to trauma so knowing someone is a polyvictim may open the door for services.
TRAUMA-INFORMED CARE
What’s wrong with you
What has happened to you?
Neither sick nor bad, but injured
LONG-TERM CARE FACILITIES (P
OST ET AL.,
2010)
Polyvictimization occurs in LTC facilities
15% experienced 2+ forms simultaneously
If financially exploited, their risk for physical & emotional abuse, and neglect increase
NEEDS ASSESSMENT
51 VOCA Administrators
Financial fraud (8.3% consumer fraud)
Financial exploitation (5.3% by family)
Elder Abuse (11%)
Polyvictimization (5% - 50%)
NEEDS ASSESSMENT CONCLUSIONS
Polyvictimization – “Never heard of it”
General recognition
Polyvictimization was subsumed under elder abuse Only two states specifically respond to polyvictimization with targeted programming
YOUR PRACTICE
PRESENTING PROBLEMS Human service agencies tend to address the presenting problem without digging deeper to determine whether there is co-occurring abuse (Hamby& Grych, 2013).
SCREEN FOR MULTIPLE FORMS OF ABUSE
A mother and father have been willingly financially supporting their adult children for years by paying for their houses and cars. However, as the couple aged, their needs increased substantially. Rather than deny their children financial assistance, they decide to not fill a prescription or fail to attend a doctor’s appointment and end up in the emergency room. The hospital calls adult protective services reporting self-neglect because the older adults are not taking their medications. Adult protective services learn the couple has an insufficient amount of money because they are supporting their adult children to their own detriment. While the couple was able to financially support their adult children for many years, the elderly person’s financial needs are increasing. Either the adult children are not responding with the help the couple needs or they continue to take their parents’ money even though the parents need the money for their own health care. Either way, the situation is untenable. However, without screening for other forms of abuse, this could have remained a self-neglect case with the possibility of an inappropriate or ineffective intervention.
POLYVICTIMIZATON IS A
PROCESS, NOT AN EVENT ~
RECOVERY WILL BE A PROCESS
REFUSAL OF SERVICES
If client refuses investigation/services, 11.9% increase in subsequent report
16% increase in another self-report
(NCCD, 2013)
IMPLICATIONS FOR PRACTITIONERS
Complexity of Polyvictimization
Requires more time
Requires multiple services/interventions
Uses every skill of an APS caseworker
Repeat cases
Requires additional staff
ENGAGEMENT
It may take more than one visit
Understand reason for refusal
Address their fears
Never denigrate the offender
Offer services for abusers
MULTIPLE NEEDS
Of victims who access victims services, most have multiple needs (Burt, Zweig, Schlichter, & Andrews, 2000) On average, victims need between four and six service domains (Newmark, Bondman, Smith & Liner, 2003)
VICTIM SERVICES
Emotional support/listening
Safety services
Professional therapy
Criminal justice advocacy
Personal advocacy/service planning
Civil legal assistance
VICTIM SERVICES PROVIDERS
Community-Based
Family and caregiver support services Financial services Areas on Aging Legal Services Domestic violence programs Mental health services
System-Based APS LTC ombudsmen Law enforcement/Victim Assistance Medicaid Fraud Control Unites
APS AS SERVICE PROVIDERS
Few victim assistance programs target older victims for outreach (Gregorie, ) so older adults are unaware of available services and few services are available if elder abuse is identified (Macolini, 1995).
INTERVENING IN POLYVICTIMIZATION
Tough Love Financial fiduciary Limit setting Counseling
MULTIDISCIPLINARY
Communication and collaboration between disciplines is important
MULTIDISCIPLINARY TEAMS
Geriatricians Sexual assault nurse examiners Neuropsychologists/clinical psychologists Law enforcement Mental health practitioners Civil attorneys and/or bar members specializing in family and elder law or legal aid Adult Protective Services (APS) Long-term care ombudsman program
Domestic violence advocates Sexual assault advocates
Regulatory agencies Guardianship programs Aging services organizations Faith communities Financial institutions Meals on Wheels (community serving agencies with access to isolated elderly persons) Consumer protection agencies Hospital discharge planner Probation and parole (Community corrections) Emergency Medical Treatment (EMT)
DOES THIS RESONATE WITH YOUR EXPERIENCE? DOES POLYVICTIMIZATION MATTER IN YOUR PRACTICE? HOW DO YOU RESPOND DIFFERENTLY? WHAT ARE POSSIBLE RESPONSES? WHAT OTHER TOOLS DO YOU NEED TO EFFECTIVE RESPOND?
POLYVICTIMIZATION AND PRACTICE
Ask better questions
Bring in other parties to support the victim
Screening
MDT
Identify needed systems changes
Longer time to investigate cases
PRACTICE
Expand reporting and intake forms to identify all forms of elder abuse suffered by a victim
Expand investigations to assess for polyvictimization
Provide polyvictimizaiton training to others
Incorporate victim-centered and trauma informed approaches Evaluate agency policies and practices to assure they address polyvictimization
Assure that agency practices are culturally competent.
WITHOUT KNOWING ABOUT POLYVICTIMIZATION, THE INTERVENTION COULD BE INAPPROPRIATE OR COUNTERPRODUCTIVE
