Elder abuse is an escalating problem that has been referred to as a potential “perfect storm” due to an aging population of “baby boomers” along with state budget freezes and cuts in critical services. Experts consider health information technology to be a key to improving efficiency and quality of health care. Elder abuse assessment and intervention fall within this genre and merit improved decision support technology.
An Elder Abuse Decision Support System (EADSS) was developed to address this problem by translating research into practice with computerized, web-based, standardized screening, assessment, reporting, and care planning.
What is the EADSS?
The EADSS is a web-based multi-component intake, assessment and reporting system, that can be used on a desktop computer, a tablet PC or any other device that supports internet access. The EADSS offers immediate, real-time access to: intake assessments, the Older Adult Mistreatment Assessment (OAMA), assessment reports, a detailed client information form, an alleged abuser information form and alleged abuser interview, as well as care plan recommendations for both victims and abusers. Statistical reports can be generated on an “as needed” basis, by individual, agency, region, and state-wide.
How Does the EADSS Work?
The EADSS provides all the advantages of an electronic record—searchable, accessible to all with permission through an internet connection; it provides standardized questionnaires using best practice models and generates valid quantitative scores; then it produces customized reports with client and caseworker input and provides care plan recommendations. Adoption of the EADSS includes training on its use which includes all steps in the APS intake, assessment, reporting, care planning, and follow-up procedures. The existence of an electronic record on a central server creates a living history of each case that is accessible by anyone who is authorized to access the system.
Intake. The intake form provides standardized wording that covers all potential areas of abuse. The information about alleged abusers (AA) and alleged victims (AV) is entered online and is available for electronic transfer to promote responsiveness. The EADSS database is searchable, so that case history is easily available and duplication is avoided.
Assessment. The Older Adult Mistreatment Assessment (OAMA) includes published measures of financial exploitation, emotional abuse and neglect as well as measures of physical abuse and sexual abuse that have been in use for over a decade in Illinois. These have been field-tested to reduce time by using screeners that enable skipping out of questions that are not applicable to the case at hand.
Abuser Forms. Since the cause of the abuse always involves an abuser, an abuser information form helps to obtain this information, and an abuser interview form is available for use in discussing the case with the alleged abuser(s).
Client Information Form. This form is started at the first face-to-face visit and is a summary demographic sheet. This is an open form that is edited throughout the investigation. It includes questions about mental status, endangering behaviors, substance abuse, and ADLs. It obtains information about other agencies working with the client, client living arrangements, individuals in the household, medical history, medications, health insurance, and financial information. The form is also used to verify and complete information collected at intake.
Reporting. Reports are generated automatically by the system. They include all items indicating abuse, those items not indicated, all caseworker notes, and summaries. Quantitative scores are helpful for indicating severity of abuse and for follow-up to measure improvement or decline. Summary reports can be generated to examine state-wide trends and to explore various issues of interest to improve program processes and outcomes.
Care Plan Recommendations. The report also generates recommended interventions, i.e., services, programs, actions, based on the specifics of the abuse recorded in the OAMA and abuser forms. Staff can update the form as interventions are put in place. This information is useful in developing the care plan which can be edited by the worker in consultation with the supervisor.
Follow up. Follow up procedures are standardized to provide evidence of intervention effectiveness.
How Was the EADSS Developed?
Assessment measures for the EADSS were developed using concept mapping (a method of converting brainstorming from many experts into pictorial maps) , focus groups and in-depth interviews involving input from 84 stakeholders, some at multiple time-points, including national experts, state administrators, agency providers, and consumers. These measures were then field-tested at seven provider agencies in Illinois with 227 substantiated clients under the auspices of the Illinois Department on Aging. The field-test findings validated measures with the Rasch measurement model (a method that orders items according to the severity of each specific indicator on a ruler measuring elder abuse). Then, with further review by state and national experts, a web-based decision support system was developed. This EADSS is housed under the auspices of the Global Appraisal of Individual Needs (GAIN) Assessment Builder System (ABS) located at Chestnut Health Systems in Normal, Illinois. The GAIN was developed under the leadership of Michael L. Dennis, PhD, Director of the GAIN Coordinating Center.
The significance of this work is attested to by recent U.S. Government Accountability Office recommendations to the U.S. Senate, all of which pertain to developing a nationwide adult protective services data collection system. Better assessment will help to improve care planning and programming designed to reduce and prevent elder abuse. With use of the EADSS by many states and countries, prevalence studies and research reports will be possible with more representative samples.
Conrad, K.J., Iris, M., Riley, B. B. Mensah, E., Mazza, J. (2013). Developing End-User Criteria and a Prototype for an Elder Abuse Assessment System, Document No.: 241390, Award Number: 2009-IJ-CX-0202.
Conrad, K.J & Iris, M. (2013). Conceptualizing and Measuring Financial Exploitation and Psychological Abuse of Elderly Individuals [Paperback].
Conrad, K.J., Ridings, J.W., Iris, M., Fairman, K.P., Rosen, A., Wilber, K.H. (2011). Conceptual Model and Map of Financial Exploitation of Older Adults. Conceptual Model and Map of Financial Exploitation of Older Adults. Journal of Elder Abuse & Neglect, 23(4):304-325. DOI: 10.1080/08946566.2011.584045
Conrad, K.J., Iris, M., Ridings, J.W., Rosen, A., Fairman, K., Anetzberger, G. (2011). Conceptual Model and Map of Psychological Abuse of Older Adults. Journal of Elder Abuse & Neglect, 23(02), pp. 147 – 168. DOI: 10.1080/08946566.2011.558784
Conrad, K.J., Iris, M., Ridings, J.W., Langley, K., Anetzberger, G. (2010). Self-report Measure of Psychological Abuse of Older Adults. The Gerontologist, 51 (3): 354-366. doi:10.1093/geront/gnq103
Conrad, K.J., Iris, M., Ridings, J.W., Langley, K., Wilber, K.H. (2010). Self-Report Measure of Financial Exploitation of Older Adults. The Gerontologist, 50(6) 758-773. doi: 10.1093/geront/gnq054
Iris, M., Ridings, J., Conrad, K.J. (2010). The Development of a Conceptual Framework for Understanding Elder Self-Neglect. The Gerontologist, 50(3), 303-315. Doi: 10.1093/geront/gnp125
Iris, M., Conrad, K.J., & Ridings, J.W. (In press.) Observational measure of elder self-neglect. Journal of Elder Abuse and Neglect.
This work was supported by Award Nos. 2006-MU-MU-0004, 2009-IJ-CX-0202, & 2011-IJ-CX-0014 awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice (DOJ). The opinions, findings, and conclusions or recommendations expressed in this exhibition are by the author(s) and do not necessarily reflect those of the DOJ. Funding was also received from the Retirement Research Foundation. In-kind support has been provided by the Illinois Department on Aging Elder Rights Division and several of its contracted agencies.