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
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
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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.
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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
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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
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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
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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
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Video ClipVideo Clip
Mother abused by adult son From “A Mother Never Gives Up Hope”
by Terra Nova & NCALL
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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
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Case: DV Signs NoticedCase: DV Signs Noticed
Woman with aphasia & paralysis evidences fear of leaving w/ spouse
Facility response APS response Family response
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Case: DV Signs ObservedCase: DV Signs Observed
Upon return from outings aides repeatedly observe abuse evidence
Facility response APS response Family response
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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
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Strategies for Victim AssistanceStrategies for Victim Assistance
Active listening Crisis-intervention counseling Problem-solving counseling Referrals to other agencies, including
criminal justice
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Active ListeningActive Listening
Client feels heard & understood
Critical in all helping relationships
Foundation of all counseling skills
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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
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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
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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
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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
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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
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Steps con’tSteps con’t
Provide info re: options, resources Help mobilize resources Use problem-solving counseling
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Problem-SolvingProblem-Solving
Analyze problems with client
Help explore options for resolution
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DetermineDetermine
Nature & scope of problem
Steps already taken & outcome
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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
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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
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Respect Self-DeterminationRespect Self-Determination
• Avoid telling clients what to do
• People more likely to implement own choices
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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
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Tearing Down StrengthsTearing Down Strengths
Critical to avoid tearing down victim’s strengths and defenses
Must be able to recognize the + Build on these
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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
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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
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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
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Our Language MattersOur Language Matters
“We work with people who have family problems”
Better…
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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