Developing, Implementing and Evaluating Training for Attuned Adult Protective Services Work: Challenges and Implications

Background and Purpose

Adults 65 years of age and older will comprise 20% of the US population by 2050.  Accompanying this growth is likely a significant increase in the number of older adults at risk for elder abuse (EA), defined as intentional actions that cause or create a serious risk of harm to vulnerable older adults by persons in a trust relationship to the elder. EA includes physical, sexual, emotional and financial abuse, as well as neglect and abandonment.

While estimates indicate 1 in 10 Americans 60+ are victims of EA every year, EA is significantly under-reported.  One study suggests that for every known EA case, 24 remain unknown. Reasons for under-detection include inadequate professional training and reticence of older adults to report abuse. Adult Protective Services (APS) workers are usually first-responders to EA; thus, it is critical to train APS workers to detect EA and interact with suspected victims in a manner that maximizes opportunities for disclosure. Accurate identification of EA will enable appropriate intervention, and foster programs and policies built on more rigorous, systematic data regarding actual prevalence.    

            The purpose of this project was to create a professional development initiative based on APS worker input and a relational theoretical foundation that would enhance APS workers’ engagement and assessment skills and increase identification of and intervention in possible cases of EA.

Methods

            Focus groups with APS workers informed the development by a team of elder abuse researchers and master teachers of an 8-hour interactive training entitled Opening the Door to Engagement (ODE).   This initiative was pilot tested 3 times with 65 APS workers selected by their parent agency to attend ODE.  Participants completed pre-and post-training instruments assessing for knowledge about EA as well as self-assessed competency in engagement, assessment, and referral skills.  Participants also wrote brief descriptions of an APS encounter prior to and after training to qualitatively assess for potential differences through narrative content analysis.  Finally, participants attended focus groups 6 weeks after training to assess knowledge and skill retention.  

Results

            We found statistically significant improvement in knowledge and self-assessed sense of competence in the first trainee cohort.  Missing data hampered quantitative analysis of the second cohort, but in focus groups and case analyses, participants report and demonstrate enhanced engagement and assessment skills.  Third cohort findings indicating improved sense of competence and enhanced knowledge further support implementation of this curriculum with additional APS cohorts and a systematic evaluation of EA disclosure and intervention rates following before and after training.

Conclusions and Implications

            Learning that focuses on helping APS workers engender trust and connection increases APS workers’ knowledge and sense of competence to identify EA and connect victims to services.  Infusing a relational approach in trainings could improve elder abuse detection rates, although examining these outcomes was beyond the scope of the present study.  Future  work should expand exposure of APS workers to this type of training and assess for increased abuse-disclosure rates in areas where such trainings are implemented.