So you want to do better in responding to

elder abuse: then review your data!

Meghan O’Brien

Social Work Grade 4 Elder Abuse Lead

St Vincent’s Hospital Melbourne (SVHM)

Overview

• The organisation

• The literature – EA and hospitals

• Setting the scene

• Translating evidence into practice

• Data collection – methodology and findings

• Implications for practice and change

• Future directions

The Organisation: St Vincent’s Hospital

Melbourne (SVHM)

• Part of Australia's largest not-for-profit Catholic healthcare

provider, St Vincent’s Health Australia (SVHA)

• Provides acute, sub-acute care, aged care, correctional health,

mental health services and a range of community services

across multiple sites

• Strives to provide high quality health care in accordance to its

Mission which is based on SVHA values of compassion, justice,

integrity and excellence

• EKP offers a number of beginner to advanced courses in Powerpoint 2007 and 2010. Go to: http://intranet/Departments/InformationTechnology/Pages/Training.aspx

• Mentally ill

• Drug and alcohol addiction

• Homeless

• Aboriginal & Torres Strait Islanders

• Prisoners

The literature

• Older adults who are subject to EA, neglect and exploitation face a greater risk of hospitalisation than other seniors (JAMA Internal Medicine 2013)

• For many abuse victims the hospital may offer a “window of opportunity” for help and support (Joubert & Posenelli 2009)

• Health professionals lack specific understanding, education and training in both recognition of symptoms of abuse and strategies for intervention (Levine 2003; Phelan 2003; Naughtin 2007)

• Education of health professionals has been shown to be significant in the prevention of EA (Richardson et al 2002, Sturdy & Heath 2007)

Setting the scene

• SVHM Pilot Study (2005) Surveyed (n = 166) staff

• Australian Research Council Linkage Project (2009)

Baseline data (n = 300)

Development & evaluation of hospital based education package

Pre and post study methodology

• UK Study Tour (2010) Safeguarding approach based on ‘No Secrets’ (2000)

Competency framework – 3 levels

Translating evidence into practice

• Protection of SVHM Vulnerable Older Persons (VOP) Policy

ratified in March 2013

• Introduction of a new Model of Care ( 9 steps)

• EA training for targeted hospital staff

• Establishment of the Vulnerable Older Persons’ Coordination

and Response Group (VOP C&RG) May 2013

Observations

• No new resources to support the work

• Reliance on clinical champions

• Committed staff and managers

• Aligns with SVHM commitment to vulnerable and disadvantaged

• Targeted training focus – inpatients and Emergency

• Data collection must be used to build knowledge and inform improvements

Using data to inform improvements

How are we doing based on what the data is telling us?

What else do we need to consider?

What do we need to do better?

What are the training implications?

Who are our stakeholders?

“Push” and “Pull” of Quality Improvement

Notification of Suspected VOP Form includes:

• Name of patient and hospital record number

• Current location

• Name of next Of kin

• Name of worker making the early notification

• Worker’s role & contact details

• Location of alleged abuse

• Type(s) of alleged abuse

• Alleged person of concern

• Is further action or assessment required?

• Current care plan/action to be undertaken

Performance measurement

Methodology

• Data collection December 2012 – November 2015

• Data mining approach (Epstein 2011)

• Human Research & Ethical Standards Committee approvals

• Data sources included suspected VOP notifications & retrospective auditing of medical records

• Risk framework adapted from Canada (Cavendish 2010) identifies level of risk

Determining level of risk (Cavendish 2010)

Level 1 - imminent risk/intervention required within 24

hours

Level 2 - impending risk/ intervention required in 2 – 10

days

Level 3 - no impending risk/long term impact on quality of

life

Level 4 - no risk/unable to determine

Methodology cont.

Ritchie & Spencer Framework (2001)

Contextual

Evaluative

Diagnostic

Strategic

Auditing to inform practice & improvements

Ritchie & Spencer Framework:

How was the abuse/suspected abuse identified?

How effective was policy compliance?

What was the quality of documentation?

Are there any training/other implications from the

findings?

Is there anything else required to move

forward?

Methodology - sample

Analysis of suspected VOP notifications over 3 years

Year 1 Year 2 Year 3 Total

Number

of cases

32 70 82 184

Average

per

month

2.6 5.8 6.8 5.1

Contextual

Sources of Notifications

Social Work 60%

ED Care Coordinators 18%

Other HARP 12%

Community Programs 10%

Types of Elder Abuse

Financial 53%

Psychological 48%

Physical 40%

Neglect 28%

Sexual 2%

More than one type of abuse suspected:

2 types of abuse suspected = 53 notifications

3 + types of abuse suspected = 32 notifications

Contextual : demographic information • 48% aged 80 years and over

• 71% female

• 24% living alone

• 92% in receipt of the age pension

• 71% from CaLD background (48% needed interpreters)

• 62% living with person of concern and 48% were directly interviewed

• )

Evaluative & Diagnostic Results • In 57% audited cases – disclosure of EA was made

by the older person during routine assessment

• 93% medical records evidenced clinician documentation of suspected EA

• 62% - escalation process (as recommended by policy) was documented

• 65% - documentation of the 2 person assessment model occurred

Risk factors – older person

• 40% dementia/cognitive issues

• 28% history of family violence

• 28% isolation

• 9% mental health issues

• 4% substance abuse issues

Risk factors – person of concern

• 29% mental health issues

• 28% history of family violence

• 18 % substance abuse issues

• 13% carer stress

• 12% carers demonstrated lack of knowledge/education

• 9% gambling, debts

• 3 % foresnic history

Primary person suspected of being responsible for

the EA (person of concern)

Son 35% Spouse 24%

Daughter 17%

Other, friend, carer 11%

Other family member 10%

Son/daughter in law 3%

Data on repeat notifications

• 2 notifications received per patient = 16 patients

• 3 notifications received per patient = 2

• 4 notifications received per patient = 1

• 5 notifications received per patient = 1

Number of notifications Number of patients

184 164

Implications for practice

• 71% suspected VOP notifications - EA was confirmed

• 80% needed an intervention plan/safety net

• 15% needed ongoing monitoring (concerns remained)

• Over time increasing rates of notifications from ED and community – implications for resources and training

• New data trend - patient identified as person of concern/alleged perpetrator (n = 4)

• High levels of assessed risk (74% level 1 and 2)

Strategic - implications for practice

• Value of clear contextual information about types of EA & risk factors

• Clinicians are working with high levels of risk

• Clinician adherence to the Protection of VOP Policy could be strengthened

• Consider standardised & centrally stored documentation

• Longer term outcomes are not monitored

• High rate (28%) of family violence “growing old”

• Ongoing data collection strategy

Strategic - future directions

• Staff training – expansion and resources needed

• Collaboration with the Victorian Department of Health & Human Services

• New Health Justice Partnership with Justice Connect

• SRV EA Roundtable –

• Recommendations from the Victorian Royal Commission into Family Violence – due March 2016

Acknowledgements

Linkage Project funded by the Australian Research

Council. Collaboration between St Vincent's

(SVHM) and the University of Melbourne’s (UOM)

School of Health Sciences

Principal Investigators:

• A Prof. Lynette Joubert, UOM

• A Prof. Marie Gertdz, UOM

• A Prof. Elizabeth Ozanne, UOM

• Prof. David Ames, National Ageing Research

Institute (NARI)

• Ms Fiona McKinnon, SVHM

• Ms Sonia Posenelli, SVHM

Co – Authors: Sonia Posenelli, Melinda Collins &

Carrie Lethborg

Social Work Department SVHM

Executive Director Medical Services, Aged

and Community Care SVHM, SVHM VOP

C&RG Members: Chief Social Worker (Chair),

Director of Geriatric Medicine, Director of

Mission, Social Work Team Leader, Manager

Complex Care Services, Manager Aged

Psychiatry Assessment & Treatment Team

(APATT), Manager Ellerslie Unit, Manager

Aged Care Assessment Service and

Community Transition Care Program,

Manager Treatment Response and

Assessment for Aged Care (TRAAC).