texas elder abuse prevention and intervention grants aging in texas conference june 17, 2013
DESCRIPTION
Texas Elder Abuse Prevention and Intervention Grants Aging in Texas conference June 17, 2013. Texas Department of Family and Protective Services WellMed Charitable Foundation University of Texas Health Science Center at Houston. Organization overview ACL Grant Overview Grant Projects - PowerPoint PPT PresentationTRANSCRIPT
TEXAS ELDER ABUSE PREVENTION AND
INTERVENTION GRANTS
AGING IN TEXAS CONFERENCEJUNE 17, 2013
Texas Department of Family and Protective ServicesWellMed Charitable FoundationUniversity of Texas Health Science Center at Houston
• Organization overview
• ACL Grant Overview
• Grant Projects– DFPS/WellMed– TEAM Institute
• Outcome Measures
WORKSHOP OVERVIEW
• The mission of Adult Protective Services is to protect older adults and people with disabilities from abuse, neglect and exploitation
• In Texas, elderly is defined as 65 and older and a disabled adult is aged 18-64
ORGANIZATION OVERVIEW
ADULT PROTECTIVE SERVICES
• Investigative Authority: Texas Human Resources Code, Chapter 48– Mandates investigations of
abuse, neglect and exploitation
– Requires mandatory reporting– Provides immunity for
cooperating with the investigation
– Provides confidentiality protection for the reporter
– Provides APS with access to all records (banking, medical, etc.)
ORGANIZATION OVERVIEW
ADULT PROTECTIVE SERVICES
HOW TO MAKE A REPORT:
Statewide Intake (24/7):1-800-252-5400
(APS/CPS/CCL)
Online reporting:www.txabusehotline.org
(not anonymous/checked infrequently)
If an emergency, dial 9-1-1
ORGANIZATION OVERVIEW
ADULT PROTECTIVE SERVICES
• In-home investigations:– Private residences– Room and board homes not
subject to licensure by DADS– Adult foster care homes with
three or fewer residents
• Facility investigations:– State supported living
centers– State hospitals– Community centers– Facility and community
center contractors (HCS homes)
– Privately operated ICF-IDD’s
ORGANIZATION OVERVIEW
ADULT PROTECTIVE SERVICES
2012 STATISTICS
• Completed In-Home Investigations:– 87,487
• Validated In-Home Investigations:– 59,595
• Most common person reporting A/N/E:– Medical personnel (20.8%)
• Most common allegation validated:– Physical neglect (66.5%)
• Most common validated perpetrator:– Relationship: Adult children
(40.8%)– Gender: Male (51.1%)– Age: Over 45 (50.7%)
• Most common client characteristic:– Gender: Female (60.5%)– Age: Over 65 (50.2%)
http://www.dfps.state.tx.us
ORGANIZATION OVERVIEW
ADULT PROTECTIVE SERVICES
50 primary care clinics (in-house lab, x-ray, pharmacy) with more than 100 physicians in Texas and Florida.
WellMed – Organization Overview
WELLMED - ORGANIZATION OVERVIEW
Specializes in Medicare-eligible Seniors – responsible for 87,000 lives
Manages Full-Risk Capitated Insurance Contracts
Primary Care Centric Medical Group (Family Practice, Internal Medicine + added Podiatry, Dermatology, Cardiology, Oncology, Pain Medicine)
Contracts for all Medical Services (Specialty, Hospital, Ancillary, Hospice)• Fully functional primary care centric, patient centered medical home (PCMH) functioning as an accountable care organization (ACO)
Shared incentives with physicians measured by annual quality metrics
One Team, One Goal
Community
Resources
The
Wel
lMed
Car
e M
odel
11
“Stoplight” Stratification Process
Red5 % of
Panel: Highest Risk Patients
Yello
w10% of Panel: Elevated Risk Patients
Gre
en85% of Panel: Average Risk Patients
Approach for identifying the acuity level or hospitalization risk of a patient
HEA
LTH
Y LI
FEST
YLE
PLAN
Healthy Lifestyle Plan EATI NG BETTER WEI GHT TAKE MY
MANAGEMENT MEDICINE
COPING WITH EXERCI SE REDUCING STRESS UNHEALTHY HABITS
My Goal: (What I want to do – example: start exercising) ________________________________________________________ My Healthy Lifestyle Plan: (How I will do this – example: walking) ________________________________________________________ My Commitment to a healthy lifestyle: I , ___ ________________________ , agree to begin to ________________________________________________________ (activity, how often, length of time – example: walk 4x/week for 30 minutes) by _ _____________________ (set a start date). I will discuss my progress at my next clinic visit. Patient signature ____________________ Date _ ________________
WELLMED OVERVIEW
ROBERT GRAHAM CENTER STUDY
• The Robert Graham Center: Policy Studies in Family Medicine and Primary Care, the research arm of the American Academy of Family Physicians studies 10 years of WellMed patient data
• Found that the “mortality rate was consistently and considerably” lower than the Texas senior population as a whole according to the article published in the Journal of Ambulatory Care
• Aggressive chronic disease management decreases hospitalizations, decreases morbidity, decreases mortality and yields high quality outcomes
• Funds were awarded by the Administration on Community Living/ Administration on Aging
• Funds will be used to implement, test and measure performance of new approaches to identify, intervene and prevent elder abuse, neglect, and exploitation
• Review risk factors related to elder abuse, neglect or exploitation to enhance future prevention efforts
GRANT OVERVIEW
GRANT PERIOD:
SEPTEMBER 2012-OCTOBER 2015
• Alaska – Department of Health and Social Services
• California – University of California, Irvine
• New York – New York State Office for the Aging
• Texas – Department of Family and Protective Services/WellMed AND University of Texas Health Science Center, Houston
GRANT OVERVIEW
FIVE STATES RECEIVED AWARDS
TEXAS RECEIVED TWO
• Validate a short 6-item screening tool to identify and prevent elder abuse and neglect in a primary care setting (EASI)
• Develop and test protocols for screening seniors at risk of elder abuse in a primary care setting including:– Embedding two APS staff into
the WellMed system– Referrals to APS for “high-risk”
patients and follow-up– Monitor patients at “low-risk”
of abuse– Referrals to community
resources
DFPS/WELLMEDGRANT OVERVIEW
PROJECT GOALS
• Delivery of training to WellMed clinical staff on:– Elder abuse risk factors– APS referrals mechanisms– APS reporting requirements– Identification of risk factors
• Delivery of education materials to patients and caregivers on:– Targeted information to
patients at risk of abuse based on EASI tool
– General patient population
DFPS/WELLMED GRANT OVERVIEW
PROJECT GOALS
• Elder Abuse Suspicion Index
• Developed in Montreal, Canada at McGill University and CSSS Cavendish to raise suspicion about elder abuse
• Validated in ambulatory clinical settings in Canada with cognitively intact seniors
• 6 question survey administered by a clinician
• Adopted by the World Health Organization
EASI TOOL
OVERVIEW
• Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?
• Has anyone prevented you from getting food, clothes, medication, glasses, hearing aides or medical care, or from being with people you wanted to be with?
• Have you been upset because someone talked to you in a way that made you feel shamed or threatened?
EASI TOOL
QUESTIONS 1-3
• Has anyone tried to force you to sign papers or to use your money against your will?
• Has anyone made you afraid, touched you in ways that you did not want, or hurt your physically?
• Doctor: Elder abuse may be associated with findings such as: poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues. Did you notice any of these today or in the last 12 months?
EASI TOOL
QUESTIONS 4-6
• DFPS/Adult Protective Services• WellMed Charitable Foundation• WellMed Medical Management,
Inc.• Margret Blenkner Research
Institute, Benjamin Rose Institute on Aging
• Elder Justice Coalition• Department of Aging and
Disability Services• Area Agencies on Aging in Austin
and El Paso• Lucy Barylak, MSW• San Antonio Police Department• Bexar County Sheriff’s Department• Bexar County District Attorney’s
Office
DFPS/WELLMED GRANT
PARTNERS
The main objective is to pilot a tailored
health promotion intervention to
reduce medication non-adherence
among (n=100) frail older adults in
Harris County who self neglect.
TEAM INSTITUTE AWARD
MAIN OBJECTIVE
• Change personal and environmental determinants of medication non-adherence
• Increase active participation in the self-management of chronic diseases
• Reduce social isolation
• Implement environmental supports
TEAM INSTITUTE AWARD
SECONDARY OBJECTIVES
TEAM INSTITUTE AWARD
INTERVENTION BACKGROUND
• Elder Self Neglect– Most common referral in
APS Region VI– Myriad chronic and acute
diseases– High mortality rates
• High prevalence of medication non adherence in a sample of community dwelling older adults with Adult Protective Services – validated self neglect
• Carmel Dyer, MD – UT Health Houston
• Jason Burnett, PhD – UT Health Houston
• Pamela Diamond, PhD – UT Health Houston
• Dawn Velligan, PhD – UT Health Houston
• Beini Zhu, MPH – UH Health Houston• Sarah Schwaller, MPH – UT Health
Houston• Leslie Clark, RN – UT Health Houston• James Booker, MA – TX DFPS/APS• Deborah Moore, MBA – Harris County
Agency on Aging• Lynne Parsons, JD – Harris County
District Attorney’s Office
TEAM INSTITUTEAWARD
TEAM MEMBERS
• 65 years of age and older
• English and/or Spanish speaking
• Community dweller in Harris County
• 2 or more referrals to APS Region VI for self neglect
TEAM INSTITUTE AWARD
TARGET POPULATION
• Home visits– Weekly visits to elders’ homes– In-home education sessions –
medications, health conditions, use of environmental supports
– In depth assessments
• Evidence based intervention mapping approach– Increase knowledge, self-
efficacy, outcome expectations, perceived control, skills
TEAM INSTITUTE AWARD
ACTIVITIES, METHODS AND STRATEGIES
WELCOME TO THE MATRIXPerformance Objectives
Knowledge Self-efficacy and Skills
Outcome Expectation
s
Perceived Control
PO1. Decide to become an active participant in managing medications.
PO1. K1. Explain the role of an active participant in managing medications.
PO1. SE1. State high confidence in becoming an active participant.
PO1. OE1. State positive outcomes of becoming an active participant.
PO1. PC1. State control over specific aspects of managing medications.
PO2. Set specific goals to achieve medication adherence.
PO2. K2. Identify important health management behaviors, e.g. medication adherence, routine physician visits.
PO2. SE2. Express self-confidence in performing specific self-management goals.
PO2. OE2. State positive outcomes of achieving these goals.
PO3. Develop a personalized medication management action plan with RN/CHW.
PO3.K3. Explain the purpose of a medication management action plan.
PO3. PC3. Explain how this action plan facilitates control.
PO4. Perform specific self-management tasks.
PO4. K4. List steps for managing medications, e.g. taking meds on time, not missing doses.
PO4. SE4. Demonstrate specific and accurate medication management behaviors, e.g. opening pill bottles.
PO5. OE5. Believe that performing medication management tasks will increase health status.
• National Evaluator for the grant project – NORC at the University of Chicago
• Conduct evaluation of grantee prevention interventions
• Move the field of elder abuse prevention forward
• Data analysis, data collection, infrastructure, implementation, data sharing and reporting
EVALUATION AND OUTCOMES
• 10,000 Patients screened over the grant period
• 10,000 Patients provided with education materials (approximately 10% of WellMed’s annual patient population)
• 600 Clinical staff trained over the grant period
• Improved knowledge by clinicians’ of identification of abuse, neglect and exploitation and referral sources based on pre and post training surveys
• Validation of the EASI tool for use in a clinical setting
DFPS/WELLMEDOUTCOMES
PERFORMANCE OBJECTIVES
• Validated screening tool that can be replicated in the United States (EASI)
• Establish protocols for screening seniors at risk of abuse, neglect and exploitation in a clinical care setting
• Increased collaborative relationships between team members and agencies
• Decrease in elder abuse
DFPS/WELLMED
OUTCOMES
• Decide to become an active participant in managing medications
• Set specific goals to achieve medication adherence
• Develop a personalized medication management action plan with a RN/CHW
• Perform specific self-management tasks
TEAM INSTITUTE
PERFORMANCE OBJECTIVES
• Increased medication adherence
• Decreased social isolation
• Decreased dependence
• Decreased health problems
• Reduced likelihood of re-referral to APS
TEAM INSTITUTE
OUTCOMES
Rachel Duer, MAAdult Protective [email protected]
Carol ZernialWellMed Charitable [email protected]
Jason Burnett, Ph.D.TEAM [email protected]
CONTACT INFORMATION