treading dangerous waters: intervening in elder domestic violence cases 2012 il elder rights...

Treading Dangerous Waters: Intervening In Elder Domestic

Violence Cases

Treading Dangerous Waters: Intervening In Elder Domestic

Violence Cases

2012 IL Elder Rights Conference

Holly Ramsey-Klawsnik, Ph.D.© Ramsey-Klawsnik 2012

All Rights Reserved

Ramsey-Klawsnik Training Materials 2

AgendaAgenda

Common dynamics in Elder DV

Community and facility illustrative cases

Strategies for assisting victims

Pitfalls to avoid


The Many Potential PitfallsThe Many Potential Pitfalls

68 y.o. Mrs. S., psychiatric disability, mentioned marital problems to MD

MD inquired re: details Long-term DV disclosed MD reported & provided expert opinion

to APS, hospitalized Mrs. S.


Mrs. S. con’tMrs. S. con’t

As the case unfolded… There are many junctures at which a

case can be mishandled to the detriment of the victim


Common Dynamics in LL IPVCommon Dynamics in LL IPV

Often long-term abuse May be mutual attachment, dependency Complex victim feelings Abuser feels entitled to bully, control, use Danger often high


Socio-Cultural FactorsSocio-Cultural Factors

Social, cultural, gender, legal realities during formative years of today’s elders

Very much affect older victims of today Must be considered when attempting

investigation or intervention


Child & Grandchild PerpetratorsChild & Grandchild Perpetrators

Assault by offspring often causes powerful ambivalence

Fear of perp arrest & other harm, shame, responsibility for kin’s wrong, attachment

Feelings complicate trauma response and help-seeking


Video ClipVideo Clip

Mother abused by adult son From “A Mother Never Gives Up Hope”

by Terra Nova & NCALL


Elder DV in FacilitiesElder DV in Facilities

May occur in facilities during visits May occur during outings Staff may hear disclosure, witness

assault or evidence Facility response & responsibilities


Case: DV Signs NoticedCase: DV Signs Noticed

Woman with aphasia & paralysis evidences fear of leaving w/ spouse

Facility response APS response Family response


Case: DV Signs ObservedCase: DV Signs Observed

Upon return from outings aides repeatedly observe abuse evidence

Facility response APS response Family response


Helpful ResponseHelpful Response

Build rapport Listen carefully Offer safety options Help victim consider options Encourage use of effective strategies Support victim’s choices Follow legal mandates


Strategies for Victim AssistanceStrategies for Victim Assistance

Active listening Crisis-intervention counseling Problem-solving counseling Referrals to other agencies, including

criminal justice


Active ListeningActive Listening

Client feels heard & understood

Critical in all helping relationships

Foundation of all counseling skills


Active ListeningActive Listening

Listen respectfully, completely to understand message

Watch non-verbal behavior to better understand

Demonstrate sincere interest client

Avoid placing attention elsewhere

Provide minimal encouragements to continue

Repeat key words

Ask questions after client’s presentation


Case: Failure to ListenCase: Failure to Listen

Betty, 76 y.o., stroke, son lives with her Son highly problematic, evidence of FE APS worker offers money manager Betty refuses Worker documents: Betty wants son to

continue handling finances


Crisis InterventionCrisis Intervention

Crisis - crucial situation, causes disequilibrium

Short-term intervention to help settle crisis

Goal - help client return to pre-crisis state

NOT solve long-term problems


Crisis Symptoms Crisis Symptoms

Strong, fluctuating emotions

Inability to function normally: think, eat, sleep

Overwhelming fear, worry, anxiety

Reduced problem-solving ability

Acting on impulse, poor decision-making

Inability to see a solution

Belief that things will never be normal


Steps in Crisis ReductionSteps in Crisis Reduction

Encourage venting Avoid joining crisis mind set Actively listen Focus on client’s reactions, thoughts, feelings Provide emotional support Validate Normalize feelings and reactions Gently correct cognitive distortions Reframe to help see positives


Steps con’tSteps con’t

Provide info re: options, resources Help mobilize resources Use problem-solving counseling


Problem-SolvingProblem-Solving

Analyze problems with client

Help explore options for resolution


DetermineDetermine

Nature & scope of problem

Steps already taken & outcome


Explore Options Explore Options

Encourage client to suggest & consider options

Provide info re: options, resources

Anticipate likely & possible consequences

Empower client to make informed choices

Provide support while client implements


DynamicsDynamics

Victimization » helplessness,hopelessness Avoid joining client in these feelings Model optimistic but realistic attitude With support people explore options,

become hopeful Improved outlook » energy & confidence


Respect Self-DeterminationRespect Self-Determination

• Avoid telling clients what to do

• People more likely to implement own choices


Assisting Mr. R.Assisting Mr. R.

APS report - 82 yo Jose Rodriquez Clinic filed: rectal bleeding, anal tears,

DV disclosure Investigation revealed… Mr. R’s ambivalent feelings Intervention provided


Tearing Down StrengthsTearing Down Strengths

Critical to avoid tearing down victim’s strengths and defenses

Must be able to recognize the + Build on these


Case: Sibling ViolenceCase: Sibling Violence

Elderly, ill sisters reported to APS Mutual physical violence Both treated at hospital repeatedly Police involved & reported Mutual strong attachment


Intervention Missed the Mark Intervention Missed the Mark

Broke down resolve to improve Worker failed to grasp clinical dynamics Did not use problem-solving strategies


Pitfalls to AvoidPitfalls to Avoid

Victim-blaming Colluding with perpetrator Expecting too much change too quickly Telling victim how to solve problems Tearing down strengths and defenses


Our Language MattersOur Language Matters

“We work with people who have family problems”

Better…


Do No HarmDo No Harm

Home visit to inv PA & EA by husband of wife with Parkinson’s Disease

Investigator observes… Investigator remarks… Harm to victim and to case


SummarySummary

Worker behavior, statements, attempted interventions carry much potential to significantly help or harm older DV victims

Importance of professional training, self-reflection and quality supervision

treading dangerous waters: intervening in elder domestic violence cases 2012 il elder rights...

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