created an impetus for change, an initiative for change is also emerging from various professions to recognize the signs of domestic violence and to conduct proper inquiries and referrals when such cases come to their attention. Despite their pivotal role, however, the training and education of health care professionals about family violence remain inadequate for proper intervention (Institute of Medicine, 2001).

Mental health professions have adopted standards, procedures, and practices for dealing with many forms of domestic violence, which have been implemented sporadically at community, state, and national levels. Social service professionals have supported and often been responsible for the development of new treatment orientations and options for both victims and perpetrators of domestic violence. At a preventative level, many communities have recognized their responsibility in dealing with woman and child abuse issues through training programs, education, and the allocation of resources to relevant individuals and families. Finally, the general public’s level of consciousness has been raised by the widespread use of hot lines, abuse registries, and public education campaigns.1 This chapter considers how these developments in related areas of domestic violence can inform the field of elder abuse intervention.

ASSESSMENT AND INTERVENTION ISSUES

Screening and Detection

There have been numerous attempts in the last decade to develop screening instruments to identify persons at risk for elder abuse or neglect, following the lead of child welfare authorities. However, detection of abuse and neglect of the elderly is complicated by a number of factors, such as the recognition that older adults are often unwilling to report abuse due to feelings of shame, fear of retaliation, or fear of being placed in an institution (Mulligan, 1990). By and large, elder abuse investigators have developed screening instruments much like those aimed at detecting child or woman abuse, which are designed and put into place by persons in hospitals and other front-line community-based settings.

The goals of risk assessments are to guide and structure decision-making, to predict future harm and classify cases, to aid in resource manage-

1  

Although these changes have had a dramatic impact on the problem of domestic violence, especially considering the relatively short period of time in which a social change of this magnitude has been accomplished, they have been far from universal and consistent across North America



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