Professional Norms about Reporting to Adult Protective Services: Confronting Perceived Workplace Pressures

Background & Purpose: Elder abuse is under-reported by aging services professionals. A prevalence study from New York State (NY) found health care providers and community agencies accounted for 9.1% and 8.1% of the cases reported to Adult Protective Services (APS). Victims and families reported almost twice that many cases. This difference may be influenced by the absence of mandatory reporting laws for elder abuse in NY.

Using the Theory of Planned Behavior (TPB), this study examined the subjective professional norms social workers identify about reporting suspected elder abuse. TPB theorizes that norms create perceived positive or negative pressure towards performing behaviors. State laws, professional codes of ethics, agency policies, and how co-workers behave shape professional norms. Workplace norms create an understanding of “the way things are done here” that can be openly acknowledged or unconsciously followed. This study demonstrates how professional norms and ethics create a complex array of both positive and negative pressures towards reporting elder abuse.

 Methods:  Data was collected for this mixed methods study from 21 Master’s level social workers (MSW) practicing in aging (12 MSW) or in health and human services (9 MSW) across one Pennsylvania county. Five survey questions gathered respondents’ perceptions of the workplace norms regarding reporting elder abuse. In-person interviews allowed survey answers to be discussed in more depth. Theoretically directed content analysis was used to organize the qualitative data into TPB constructs. Initial coding identified transcript sections related to professional norms. Themes then surfaced for the perceived complex pressures towards reporting elder abuse in social work settings.

Findings:  Formal policies, procedures, and regular training set the stage for professional norms towards reporting elder abuse. Survey results showed 5 MSWs believed their workplace had no written procedures regarding reporting elder abuse, 9 marked their workplace rarely or never reported elder abuse, and 15 indicated they had not had training about how to report elder abuse within the last year. Respondents shared their impression that the professional community, including various types of colleagues, was supportive of reporting. Yet, they acknowledged the potential for conflict about if and when a report to APS is warranted. Often this conflict seemed driven by the ethical tension between clients’ right to self-determination and professionals’ desire to protect clients, especially if perceived as impaired or vulnerable. The data also generated a related theme about the strength of the social work ethic of client-directed services. MSWs were highly concerned about clients’ opinions about being reported. Clients’ views produced mixed pressures for respondents towards reporting elder abuse.

Conclusion and Implications:  Social workers may consider making reports of elder abuse in workplace contexts that have the potential to include: 1) A lack of clear procedures and training, but a perception that the workplace climate is supportive of reporting, 2) Ethical codes about both self-determination and protection that are in tension with each other, and 3) The complexity of client directed services when the client and social worker’s opinions differ. These types of conflicting perceived professional norms require pro-active training that supports employees.