Journal of Elder Abuse & Neglect
Vol. 13, No. 2
2001

Reviewed by Loree Cook-Daniels

A 2001 project in the state of Ohio developed an assessment tool and referral protocol for addressing instance of elder abuse, including those involving domestic violence. Articles on this project and its resulting tools comprise most of the Vol. 13, No. 2 (2001) edition of the Journal of Elder Abuse & Neglect (JEAN).

The guest editor of this JEAN was Georgia Anetzberger, Ph.D., of the Benjamin Rose Institute, who also served as the project’s principal investigator. The project itself, funded by a Family Violence Prevention and Services Act Grant, grew out of an Ohio Family Violence/Elder Abuse/Domestic Violence Roundtable recommendation that such tools were necessary to increase elder abuse identification and referrals. Roundtable members felt existing tools would not meet their needs because such tools: (1) fail to distinguish between types, signs, and risk factors of elder abuse; (2) fail to include domestic violence in late life as a specific aspect of elder abuse; and (3) do not reflect the Ohio state laws and actual community service systems.

There are four JEAN articles on the tool. The first reviews the whole concept of assessment tools and referral protocols and explains how the project came about. The third describes how the tools were developed, evaluated, and revised. The fourth describes case situations and how the tools were or could be used in those situations.

It is the second article, “Screening Tools and Referral Protocol for Stopping Abuse Against Older Ohioans: A Guide for Service Providers” (pp. 23-38), that may be of most interest to those who work directly with elders. It first describes the referral protocol, which is a one-page chart (with an additional page of notes) that walks someone with limited knowledge of elder abuse through a process by which he or she can determine whether the elder in front of him or her needs assistance related to abuse or domestic violence and, if so, to which agency the referral should be made. The protocol includes when to use three primary assessment tools the project also designed:

• Actual Abuse Tool;

• Suspected Abuse Tool; and

• Risk of Abuse Tool.

The Actual Abuse Tool is a 2-page document that is designed to help users realize the elder they are working with has been involved in a case of elder abuse or domestic violence. It gives concrete examples within each of four categories of abuse: physical abuse (hit, pushed, scratched, sexually assaulted, etc.); psychological abuse (yelled at, locked in a room, stalked, etc.); neglect by others or self (denied adequate care and supervision, lacking adequate shelter, etc.); and exploitation (money, property, or other assets used or sold without consent, etc.). Once the person filling out the form acknowledges there’s been a report of (or they’ve witnessed) one of these types of abuse, the second page asks for information that will be needed by the agency to which the case should be referred. This data includes: the source of information about the abuse; an assessment of the victim’s immediate danger, an assessment of both the victim’s and the perpetrator’s willingness to accept help, and how fast the reporter thinks intervention is needed. The form then refers the user back to the protocol for whom to call.

The Suspected Abuse Tool is to be used in situations where there’s no abuse reported or observed, but the professional suspects there may be abuse. This page lists signs or symptoms of the four types of abuse described above, this time focusing on things that could indicate abuse but that could also result from other causes, such as bruises, being anxious, having inadequate utilities, and having unexplained changes in legal documents such as wills. Like the Actual Abuse Tool, the Suspected Abuse Tool contains a second page collecting information that will be needed by the agency to which the case is referred, and tells the user to go back to the protocol for more information on whom to call.

The final primary tool, Risk of Abuse Tool, is a checklist like the others. This one looks at risk factors – things that do not indicate abuse has happened, but that research has associated with the potential for abuse. Both the possible victim and the possible perpetrator are assessed for characteristics such as a history of past abuse, substance abuse, and being a “blamer.” The protocol then helps the user refer the case to the appropriate type of social services (such as an Area Agency on Aging) that can provide assistance and assess and/or monitor the situation more.

The whole packet of tools (including some secondary assessment tools not discussed here) is 29 pages long and was disseminated throughout Ohio. To receive a sample copy (as long as limited supplies last), contact Farida Ejaz at the Benjamin Rose Institute, 850 Euclid Avenue, Cleveland 44114.