In FY2016, ACL established the Elder Justice Innovation Grants program to support work to create credible benchmarks for adult maltreatment prevention, and for program development and evaluation. The Elder Justice Innovation Grants program supports the development and advancement of knowledge and approaches about new and emerging issues related to elder justice. Since the inception of the Elder Justice Innovations Grants program in FY2016, ACL has made 38 awards to address various topics of relevance that have contributed to the improvement of the field of adult maltreatment prevention and intervention at large and contributed to the evidence-base of knowledge. In FY2022, ACL has funded a new set of grants that seek to enhance Adult Protective Services approaches to cases involving opioids and substance use disorders, improve results for APS clients, and improve guardianship. Summaries of all Elder Justice Innovation grant projects are below.
- Grants Awarded in FY2022
Enhancing Adult Protective Services Approaches to Cases Involving Opioids and Substance Use Disorders
- The Elder Abuse Institute of Maine in collaboration with Adult Protective Services of Maine and New Hampshire, The Dartmouth Center for Health and Aging and other key stakeholders will, in the course of this project, implement and test RISESUP, a substance use intervention that builds upon and expands RISE. The goal of RISESUP is to enhance services provided and outcomes in cases of adult maltreatment complicated by substance use. The objectives will be to improve the care of victims of adult maltreatment by: (1) providing evidence-based treatments and service connections for persons with substance use issues cooccurring in adult maltreatment; (2) providing evidence-based treatments and service connections for alleged harmers with substance use issues when appropriate; and (3) improving statewide reporting to The National Adult Maltreatment Reporting System(NAMRS) to provide actionable data for future policymaking and service provision. Anticipated outcomes include: (1) improvements in well-being, reduced risk of adverse effects of substance misuse and reduced risks of re-victimization in victims of adult maltreatment; (2) increased capacity for connecting alleged harmers with evidence-based treatment options for substance misuse; (3) improved quality of life and work experience for APS workers; and (4) improved state-wide reporting to NAMRS in cases involving substance use issues.
Improving Results for APS Clients
University of Texas Health Science Center at Houston’s goal is to demonstrate the feasibility and effectiveness of a community based stepped-care program, increase long term meaningful social engagement and decrease elder mistreatment and/or self-neglect (EM/SN) recurrence, loneliness, and depression in isolated APS clients by: (1) expanding the UTHealth student-initiated social phone calls program for APS EM/SN clients to four universities (eight graduate level health professional programs) in Houston, (2) incorporate a stepped-care approach including mental health screening, educating, and linking APS clients to trauma-informed mental health services (when indicated by step based screening), (3) training health professional and social science students in empathy focused communication and mental health awareness within the context of EM/SN, (4) conducting weekly student volunteer-initiated social engagement calls with APS clients statewide, and (5) developing a sustainability and diffusion of innovation plan. Anticipated psychosocial outcomes include: (1) improved depression, and (2) improved loneliness, anxiety, and other psychosocial outcomes at 12-week post-treatment.
Virginia Commonwealth University’s Virginia Center on Aging (VCOA), in partnership with the Virginia Department for Aging and Rehabilitative Services (DARS), proposes to improve outcomes for APS clients by fulfilling two goals. VCU’s first goal aims to mitigate challenges and barriers to reporting elder abuse by achieving two objectives, which are to: (1) develop a solution-focused intervention for practitioners, older adults, caregivers, and “first-line” community members; and (2) educate about recognizing and identifying abuse, the role of ageism, barriers to reporting abuse and seeking services, and best practices for linking systems of care. VCU’s second goal is to develop and disseminate an interactive, web-based “Safety Connector” for use by practitioners, older adults, and caregivers who seek to link themselves or others to systems of care by achieving three additional objectives, which are to: (1) develop the Safety Connector, including a screening tool component; (2) integrate the Safety Connector into No Wrong Door; and (3) disseminate and educate about the Safety Connector across the state of Virginia. Anticipated outcomes from this work are: (1) practitioners, older adults, and caregivers of older adults will have increased knowledge of resources available for APS clients; (2) an increase in referral to and utilization of services that improve safety and wellbeing; (3) increased trust in APS and increased trust between APS and other community organizations and partners; (4) increased interdisciplinary efficiency and streamline service delivery; (5) increased institutional and structural capacity; (6) decreased ageist attitudes; and (7) identification of enduring and emerging challenges facing APS clients and recommendations of solutions.
Regents of the University of Minnesota’s goal is to understand the effects of a new adult protection law in Minnesota–Chapter 45A–that authorizes temporary accounts holds and third-party disclosures to address financial exploitation. The objectives of this two-year study are to: (1) compare financial exploitation cases referred for Chapter 45A statutory protections to cases referred to APS to identify differences in the characteristics of vulnerable adults, alleged perpetrators, and the type of exploitation alleged; (2) conduct APS and law enforcement training on Chapter 45A to ensure that socially and economically disadvantaged vulnerable adults receive equal access to the statute’s protections; and (3) track and evaluate the potential outcomes of temporary holds, including loss prevention, involvement of trusted fiduciaries, referrals to civil or criminal courts, loss of financial autonomy, and disrupted banking relationships. This project represents the first systematic effort to evaluate temporary holds on adult protection. Outreach and education will improve access to financial protections for disadvantaged vulnerable adults who are disproportionately affected by elder mistreatment. The study will also inform other states’ implementation practices.
Salisbury University’s goals are to expand the prevention, response, investigation, and protection of Worcester County, Maryland’s elder population from fraud, financial and high-tech exploitation, while increasing the pipeline of qualified financial and high-tech crime investigators for the future by leveraging use of the Salisbury University Fraud Program, Salisbury University students, and the expertise of Salisbury University faculty. The objectives are to: (1) expand criminal investigative resources to respond to elder financial and high-tech exploitation referrals; (2) expand social case worker resources with the expertise to respond to elder financial and high-tech exploitation referrals; (3) increase the availability of future fraud examiners, investigators and case workers specialized in elder financial and high-tech exploitation investigations through training and education; and (4) train existing law enforcement, social workers and APS/Health Department case workers to improve response to financial and high-tech elder exploitation. Anticipated outcomes include: (1) prompt investigation of all financial and high-tech elder exploitation referrals; (2) numerical increase in the identification, investigation and/or prosecution of financial and high-tech elder exploitation suspects; (3) numerical increase in social outreach to elder financial or high-tech exploitation victims; and (4) numerical reduction in repeat victimization of elder financial or high-tech exploitation victims, each as measured by referral reports that are required under Maryland law.
University of Southern California’s goal is to develop and implement an algorithm that can identify cases that are appropriate for presentation to an adult maltreatment multidisciplinary team (MDT) and that leads to improved outcomes for clients whose cases are presented to the MDT. USC’s objectives are to: (1) regularly engage with APS & MDT stakeholders; (2) develop an algorithm; (3) prepare for launch; (4) implement the algorithm; (5) assess the algorithm impact; (6) disseminate to practitioners and researchers; and 7) complete all required administrative tasks. Anticipated outcomes are the: (1) development of a new model of referring cases to MDTs; (2) increased ability of the MDT to be responsive to cases that could benefit from its intervention; (3) reduced client risk/harm at case closure; and (4) reduced risk/harm of maltreatment following case closure.
Allegheny County Department of Human Services, Area Agency on Aging (DHS/AAA) will implement “Pathways to Safety” (Pathways), a scalable and collaborative Protective Services (PS) intervention. Pathways aims to prevent persons who are age 60 and older who have experienced abuse from reexperiencing abuse. This intervention strives to achieve this goal by leveraging data- and practice-based evidence of effective services. Pathways’ objectives are: (1) to implement a stronger support system that will preserve older adults’ independence and mitigate risk of recurrent abuse by improving older adults’ access to services in areas of need, including food insecurity, physical health, activities of daily living and social isolation, and (2) to measure and evaluate the Pathways system. The second objective, through measurement and evaluation will (a) leverage research partnerships, (b) document effective programming, and (c) use data for making determinations of best practices and lessons learned. Additionally, cost savings outcomes will be evaluated.
- The Administrative Office of Pennsylvania Courts’ goals are to (1) assure due process for the alleged incapacitated person (AIP); (2) improve guardianship monitoring capabilities to prevent abuse and exploitation; and (3) promote alternatives to guardianship. Their objectives are to: (1) assess guardianship in Pennsylvania; (2) improve due process, effective monitoring of guardians, and consideration of alternatives; and (3) measure and educate about improvements. Their proposed interventions will include promoting appointment of counsel for the AIP; promoting alternatives to guardianship; and improving the data collected through Pennsylvania’s Guardianship Tracking System (GTS) to monitor guardians more effectively. Expected outcomes include (1) improved guardianship monitoring and data; (2) increased knowledge of individuals, families, guardians, attorneys and courts; (3) reduction in plenary guardianships granted; (4) increased appointment of counsel for the AIP; and (5) improved due process by piloting legal advocacy through representation of alleged incapacitated persons and incapacitated persons, and through assuring interpretation and translation, including through assistive listening technology, advanced communication technology and interpreters (including American Sign Language (ASL) interpreters).
- The District of Columbia (DC) Courts goals are to assess the fairness, safety, and integrity of the adult guardianship process from petition to court proceeding, to appointment, monitoring, and termination. The project seeks to enhance the Court’s ability to monitor guardianships by focusing on the evaluation tools used to report the updated status of capacity and the need for continued guardianship. Their objectives are to: (1) conduct a comprehensive review and assessment of DC’s adult guardianship assessment and monitoring process; (2) revise capacity assessment forms; (3) provide training and capacity building, and (4) recruit additional examiners and social workers for the Probate Fiduciary Panel. Anticipated outcomes include: (1) a revised and updated capacity evaluation form to assess guardianship needs; (2) approved forms that are easy to use and readily available for all stakeholders; (3) the ability of examiners and social workers to adequately use the revised assessment tools and forms; (4) the ability for guardians, guardianship advocates, and other stakeholders to demonstrate understanding of the new assessment tool and monitoring process; and 5) additional members on Probate Fiduciary Panel.
- The Supreme Court of Virginia goals are to to improve guardianship monitoring, policy, practice, and reporting to advance the protection of vulnerable individuals subject to guardianship. Their objectives are to: (1) improve data collection and implement data standards; (2) enhance monitoring practices; (3) improve access to justice; (4) support alternatives to guardianship; (5) strengthen case management processes; (6) facilitate data and information sharing; and (7) implement updates to the process and systems statewide. Anticipated outcomes include: (1) increased access to justice through the ability to electronically file with the court; (2) improved case data and case-flow management through data collection; (3) support for less restrictive options by capturing information which will ultimately result in individuals losing fewer rights and the ability to exercise greater self-determination; (4) clear definitions and data standards that would bring consistency throughout the state; (5) enhanced monitoring; (6) electronic data/information exchange; and (7) statewide implementation and standardization that will provide a common platform of statewide data for 119 of Virginia’s 120 circuit courts.
- Grants Awarded in FY2021
- The Alaska State Courts are working with key stakeholders to increase competence and consistency in all state courts handling guardianship, improve the proficiency of the court and all participants in the guardianship process, improve monitoring of financial issues and identify less restrictive options, and provide equitable customer assistance statewide.
- The Massachusetts Administrative Office of Trial Court is creating an Office of Adult Guardianship and Conservatorship Oversight within the Administrative Office of the Probate and Family Court to increase court oversight of guardians/conservators and guardian/conservator arrangements to protect older adults (aged 60+) and adults with disabilities from abuse, financial exploitation, and neglect.
- The Maryland Court of Appeals is conducting a comprehensive statewide assessment of the existing guardianship process and system to identify current strengths, weaknesses, concerns, and needs. The court will develop a response to that assessment with interventions to address identified weaknesses, concerns, and needs; produce an evaluation aimed at measuring the quality of the assessment and the effectiveness and replicability of the interventions; and disseminate findings.
- The Judiciary Courts of the State of Minnesota is designing and implementing a guardian/conservator grievance/investigation process to alert the court of potential maltreatment and fraud. The process will be designed to detect fraud and abuse of individuals subject to guardianship/conservatorship. It will document and track information received by better utilizing, and enhancing where necessary, electronic record systems. Minnesota is contracting with Volunteers of America to provide training in supported decision-making to inform judges, guardians, conservators, interested parties, and court visitors on topics that support and protect the interests of individuals under a guardianship/conservatorship.
- The Judiciary Courts of the State of Nevada is assessing the statewide guardianship program, expanding access to guardian and judicial education, and measuring changes to the system and ways to improve data collection of the district courts.
- The New York Unified Court System is implementing a uniform, modern data tracking system. The system would give court officials, particularly judges and court examiners, a continuous and complete overview of the services being provided to the alleged incapacitated person needing court assistance. The system will provide court administrators, legislatures, stakeholders, and the public with access to information about court system processes and efficiencies so that resources can be redistributed and/or enhanced as needed. The system will be designed to track more family and friends to serve as guardians.
- The Oregon Office of the State Court Administrator is establishing processes that will enable courts to better detect financial mismanagement of protected persons’ assets and conduct a comprehensive study of the Oregon court’s guardianship and conservatorship monitoring practices.
Adult Protective Services-Community Transitions
- The Benjamin Rose Institute on Aging (BRIA) is collaborating with Utah Adult Protective Service (APS) and the Utah Association of Area Agencies on Aging to develop, implement, and evaluate an innovative practice addressing caretaker neglect and to provide services and resources to alleged victims and perpetrators. The goal of this project is to develop a practice to coordinate care beyond APS case closure as well as to demonstrate improvements in physical health, emotional health, function, and social supports for alleged victims and perpetrators. BRIA will guide practice, policy, and future research on caretaker neglect and polyvictimization (multiple forms of victimization) by providing evidence on maltreatment, needs/challenges, services, and outcomes for victims and perpetrators.
- Purdue University's project examines “pathways to safety” for at-risk adults served by Adult Protective Services (APS) and community-based service providers. Purdue is exploring how community-based service providers work with APS to support at-risk adults living safely and independently in the community, identify community-based services that mitigate abuse, improve at-risk adults’ mental and physical health, and sustain their functional status, and facilitate community-based services that prevent recurrent abuse.
- Lifespan of Greater Rochester Inc. and project partners are piloting a model of co-locating an aging service care manager with APS staff for on-site consultation and joint assessment of clients to facilitate access to the full array of OAA-funded and other community services, and to offer intensive care management by project care managers at Lifespan once the crisis that prompted a referral to APS is stabilized.
- The Hebrew Home for the Aged at Riverdale is enhancing services to APS-involved older adults experiencing abuse nationwide through proliferation, accessibility, and increased capacity for shelter intervention programs with the goal of demonstrating how elder shelter programs serve as a conduit between APS services and community service programs for people who are experiencing abuse.
- The Center of Excellence on Elder Abuse and Neglect (EAFC) at the University of California, Irvine is partnering with Orange County Adult Protective Services (APS) and the Health Care Agency’s Office of the Public Guardian (PG) to develop a person-centered program to disrupt the cycle of elder and dependent adult abuse (EDDA) for Public Guardian clients. This program, Ending and Disrupting Elder Abuse Recidivism (ENDEAR) for Person-Centered APS - Community Transitions, focuses on APS clients who have been referred to the PG for determinations of guardianship and provide coordinated case management for victims/survivors.
- The Iowa Department on Aging is assessing and exploring the various community services that produce better outcomes for persons transitioning from APS interventions and programs that remediate and prevent recurrence of abuse over the longer term. Iowa is implementing measurable improvements in health, social, and functional status and mitigating the risk of recurrent abuse. The project will include the creation of a coordinated referral process to assist in prevention efforts.
- The Community Service Agency (Stanislaus County, California) seeks to improve systems and responses to older adults and adults with disabilities with substantiated cases of self-neglect, neglect, and financial and physical abuse in Stanislaus County, California. This includes coordinating among community-based partner agencies and Older Americans Act programs. Enhancements will be made to evidence-informed and practice-informed services, strategies, advocacy, and interventions for APS clients to ensure they achieve long-term measurable improvements in health, social, and functional status; preserve their autonomy and independence; and mitigate the risk of recurrent abuse. Data will be used to inform research, practice, and policy, and assess efficacy of community-based services for APS clients transitioning from APS interventions.
- Grants Awarded in FY2018
- Orutsararmiut Native Council (ONC) sought to develop an Elder Justice program in the Bethel, Alaska targeted to the Elders of Bethel who are almost 100% Alaska Native Yup’ik Eskimo. ONC’s goal was to provide an individual-level holistic, comprehensive, culturally-appropriate and trauma-informed response to their elders, reducing harm and maltreatment, building resiliency, supporting caregivers and meeting the needs of elders with disabilities. The objectives were to use a multi-faceted approach, including a model based on the Family Care Conference (FCC), which is an elder-focused, family-centered, community-based intervention for the prevention and mitigation of elder abuse developed by the Maori people of New Zealand.
- Grants Awarded in FY2017
APS Administration Promising Practices Innovation Grants:
- The University of Southern California (USC): One of the most important issues that Adult Protective Services workers grapple with is determining what kind of decision-making ability their client, the abused person, has. USC trained APS workers and community-based professionals on the use of a tool to test this (called the Interview for Decisional Abilities), working with statewide APS professionals to develop consistent policies for integrating the tool into their practice, and creating an implementation toolkit for national dissemination.
- The Regents of the University of California, Irvine (UCI) developed a curriculum and training for APS and community agencies on how to integrate elements of trauma-informed care (TIC) into their practice to reduce the harm caused by elder abuse. Relatively new to the field of elder abuse, trauma-informed care is a framework for service delivery that is grounded in an understanding of the impact of trauma. It recognizes the importance of physical, psychological, and emotional safety for both providers and survivors, and it works to help victims rebuild a sense of control and empowerment. UCI also tested integration of a case-management component into their elder abuse forensic center and enhanced counseling and legal assistance available to elders experiencing elder abuse. They evaluated outcomes of both interventions.
Responses to Reduce Harm Innovation Grants
Center for Elder Law & Justice, Inc. implemented an Elder Justice Navigator program designed to provide court navigation assistance and coordination of community-based services to older adults who have experienced maltreatment.
Rush University tested the feasibility, acceptability and efficacy of using simulated video equipment to reduce the frequency and severity of abuse in high-risk populations. This grant was later transferred to Rutgers University.
Adult Maltreatment Outcomes Analysis Innovation Grants
The Regents of the University of California, San Francisco (UCSF) tested a “proof of concept” by piloting the Identification, Services, and Outcomes (ISO) Matrix, a tool that defines actions and interventions that may reduce risk of abuse in order to increase consistency of APS practice in California. A mobile application version of the ISO Matrix was used by APS in San Francisco and Napa counties, and UCSF measured and evaluated how its use affects client outcomes and APS practice. This grant was later transferred to Purdue University.
- Grants Awarded in FY2016
Forensic Center Innovation Grant:
- The University of Southern California produced new information on the Elder Abuse Forensic Center (EAFC) model to guide future decision-making about implementation of the model. This grantee facilitated replication as well as increased understanding of the model’s components, functions and outcomes. The grant's goal was to collect relevant information on the EAFC model that can be used by all.
Innovation Grant to Address Abuse in Indian Country:
- The University of North Dakota provided mini-grants to American Indian Tribes, Alaskan Villages, and Hawaiian Homesteads to support increased awareness, elder abuse policy development, and infrastructure building for reporting, investigation, and intervention to support indigenous elders. UND collected data on prevalence of elder abuse in the Tribal community using a tribally-based participatory model.
Innovation Grants to Understand Self-Neglect:
- The Benjamin Rose Institute partnered with Texas’ APS system and the WellMed Charitable Foundation to screen individuals in the community and identify individuals potentially at-risk of self-neglect. These individuals were assigned a social worker to coordinate wrap-around supportive services with the goal of preventing self-neglect. The initiative built on the successes and lessons learned from WellMed’s 2012-2015 Elder Abuse Prevention grant project.
- Rush University Medical Center, in conjunction with the Rush Institute for Healthy Aging and other key stakeholders and social service agencies, leveraged and expanded on existing research to improve the prediction of elder self–neglect. They created a predictive index of self-neglect onset in diverse communities and examining the racial/ethnic differences among several cohorts.
- The National Adult Protective Service Association collaborated with various agencies to conduct a five-pronged approach to examine self-neglect. The project sought to improve the understanding of people who self-neglect by identifying characteristics of self-neglecting individuals, factors related to etiology and primary and secondary prevention, triggers, factors correlated with willingness or lack thereof to use services to reduce self-neglect, biological and psychosocial components of self-neglect, and impact of self-neglect on affected individuals. They also identified promising approaches to prevent and ameliorate self-neglect and its recurrence. This project included a literature review and a state-by-state review of APS policies, practices, and tools.
Innovation Grants to Address Abuse in Guardianship:
- Stark County Probate Court partnered with Adult Protective Services to develop the Stark County Eldercaring Coordination Program. The program provided conflict mediation assistance to elders and families, expanded its Court’s Guardianship Visitor Program through partnerships with other court systems, and evaluated support systems to eliminate the need for guardianship.
- The American Bar Association Commission on Law and Aging collaborated with the National Center for State Courts (NCSC) to expand and enhance state Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS). The collaborative effort sought to improve the ability of state and local guardianship systems to develop protections less restrictive than guardianship and advance guardianship reforms.
- Volunteers of America Minnesota developed and established a replicable statewide model based on supported decision-making to provide alternatives to guardianship and conservatorship in Minnesota. Minnesota established a Center for Excellence in Supported Decision Making to provide training and services including guardianship mediation and other diversion programs utilizing the model.