. "15. Elder Abuse Intervention: Lessons from Child Abuse and Domestic Violence Initiatives." Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press, 2003.
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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
ment by identifying service needs for children and families, and to facilitate communication within the agency and other community stakeholders (Hollinshead and Fluke, 2000). Evidence suggests that risk and safety assessments have benefited children and families in the child welfare system. Implementation of an immediate safety assessment protocol for children in Illinois, for example, resulted in a 23 percent decrease of recurrence in a six-month period; three years after the implementation of this tool the recurrence rates were down by over 28 percent (Fluke et al., 1999).
The problem of woman abuse has also been approached through improved screening and detection, especially in relation to suspicious injury. Like elder abuse, the problem is complicated by the fact that most battered women are reluctant to volunteer the circumstances related to their injuries. However, when they are directly asked if this is the case, most women disclose the relevant information (Hotch, 1994). The conventional wisdom that women in abusive relationships are reluctant to disclose such information or that they resist efforts to change the nature of their relationship is not supported—more often than not, battered women will share their experiences with medical personnel when provided with a nonconfrontational and nonjudgmental atmosphere. Consequently, many hospitals now have protocols for screening woman abuse and other forms of domestic violence, which typically include a list of warning signs and symptoms that should prompt specific questions during the history-taking procedure. Such protocols may also serve as training instruments to ensure ongoing awareness and sensitivity to potential domestic violence victims. The Vancouver General Hospital, for example, reported that their rate of correctly detecting domestic violence cases increased 2.5 times as the result of introducing such a protocol (Jaffe et al., 1996).
The assessment of elderly persons who may be at risk for maltreatment by a family member is currently less formalized than is true of the other types of domestic violence. Whereas the medical system plays a prominent role in elder abuse, there are important insights that the mental health and social service systems can add to the overall assessment of persons at risk for family abuse, especially concerning victim and family characteristics.
Several elder abuse-screening instruments are currently available, which direct attention toward characteristics of the person, the caregiver, or the family system (e.g., Kozma and Stones, 1995; McDonald, 1996; Reis and Nahmiash, 1995, 1998). These measures are used as brief screening tools to identify persons who may be at risk for further follow-up and assessment, based on known indicators of elder abuse. The 29-item Indicators of Abuse (IOA) screening measure, for example, is based on an abuse-indicator model comprised of three main types of abuse signals: (a) caregiver personal problems/issues; (b) caregiver interpersonal problems/issues; (c) care receiver social support shortages and past abuse. Although practical,