Theory Driven Adaptation of an Elder Abuse Consultation Service

TL;DR

This paper describes the development and adaptation of a specialized elder abuse consultation service to better support victims and healthcare providers.

Contribution

The paper introduces a theory-driven approach to adapting an elder abuse consultation service in response to real-world challenges.

Findings

The team saw over 200 cases a year after starting with 42 cases in the first year.

Adaptations included limiting response to stranger financial abuse and focusing on inpatient consultations.

A stepped model of care was developed to manage increasing demand while maintaining core goals.

Abstract

Elder abuse consultation services are a new model of care for victims of elder mistreatment who are seen in the emergency room or hospital setting. Our team, the Vulnerable Elder Services, Protection, and Advocacy Team (VESPA) at the University of Colorado was developed and implemented in 2021. Consisting of specialized social workers and geriatricians, our team provides trauma informed care focused on reducing harm for an entire family system experiencing violence. In the first year, our team saw 42 cases and has grown to over 200 cases a year, having served over 700 victims and families to date. Due to changes in clinical volume; the improved recognition of abuse; and the challenges of the COVID 19 pandemic, our team has undergone multiple adaptations to best serve the victims and providers we care for. Our theory of change is that medical providers play a critical role in the response to elder mistreatment but that they are dis-incentivized from doing so by time constraints and a lack of training. Medical consultation teams offload this work, and the accompanying moral distress, thereby improve the recognition of abuse. As our team grew, and recognition grew, our consult numbers outpaced our funding. We have made several adaptations to our workflow to accommodate this while maintaining our core theory of change. These have included: limiting our response to stranger financial abuse; focusing on inpatient versus emergency department consultations; and developing a stepped model of care.