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From Silos to Bridges714.ppt

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From Silos to Bridges714.ppt

  1. 1. From Silos to Bridges: Improving the Multidisciplinary Response to Elder Abuse 19 th Annual NAPSA Conference August 27, 2008 Chicago, Illinois
  2. 2. <ul><li>Page Ulrey </li></ul><ul><ul><li>Senior Deputy Prosecuting Attorney </li></ul></ul><ul><ul><li>King County Prosecutor’s Office </li></ul></ul><ul><ul><li>Seattle, Washington </li></ul></ul><ul><li>Mike LaRiviere </li></ul><ul><ul><li>Police Officer </li></ul></ul><ul><ul><li>Salem Police Department </li></ul></ul><ul><ul><li>Salem, Massachusetts </li></ul></ul>
  3. 3. Crimes Against the Elderly and What We Need to Prove Them
  4. 4. Categories of Elder Abuse <ul><li>Physical/Verbal Abuse </li></ul><ul><li>Neglect/Abandonment </li></ul><ul><li>Sexual Abuse </li></ul><ul><li>Financial Exploitation </li></ul>
  5. 5. Crimes Involving Elder Physical/Verbal Abuse <ul><li>Assault </li></ul><ul><ul><li>Force feeding </li></ul></ul><ul><ul><li>Smothering </li></ul></ul><ul><ul><li>Overmedicating </li></ul></ul><ul><li>Unlawful Imprisonment </li></ul><ul><ul><li>Restraining </li></ul></ul><ul><li>Harassment </li></ul>
  6. 6. Evidence Unique to Elder Physical Abuse <ul><li>Restraints </li></ul><ul><li>Medications </li></ul><ul><li>Medical records </li></ul><ul><ul><li>Emergency Room </li></ul></ul><ul><ul><li>Treating Physician </li></ul></ul><ul><li>Financial records </li></ul><ul><li>Patterned injuries/bruising (photographs) </li></ul>
  7. 7. Bruising <ul><li>Bruises may appear more severe because of medications, circulation and skin changes </li></ul><ul><li>Cupping or coining can cause bruising </li></ul><ul><li>Bruises can take days to appear </li></ul><ul><li>Age of bruise cannot be determined by color </li></ul><ul><li>Bruising on trunk area is much less likely to be accidental than on extremities </li></ul><ul><li>Bruises can be affected by pigmentation </li></ul>
  8. 8. Crimes of Neglect/Abandonment <ul><li>Failure of caregiver </li></ul><ul><li>To provide basic necessities of life </li></ul><ul><li>Recklessly/negligently </li></ul><ul><li>Cause injury/death or imminent risk of injury/death </li></ul><ul><li>To a dependent person </li></ul>
  9. 9. Evidence in a Neglect Case <ul><li>Photographs of suspect’s and victim’s living arrangements </li></ul><ul><li>Restraints </li></ul><ul><li>Soiled clothing </li></ul><ul><li>Bandages (or absence of needed bandages) </li></ul><ul><li>Bedding (or absence of bedding) </li></ul><ul><li>Contract for care </li></ul>
  10. 10. Evidence in a Neglect Case, cont’d. <ul><li>Inappropriate clothing </li></ul><ul><li>Lack of appropriate assistive devices </li></ul><ul><li>Lack of food, food that is inappropriate given the victim’s dietary needs, or spoiled food </li></ul><ul><li>Medical records, including nursing and social worker notes </li></ul><ul><li>Prescriptions and medicine bottles </li></ul><ul><li>Financial records </li></ul>
  11. 11. Crimes Involving Elder Sexual Abuse <ul><li>Rape </li></ul><ul><ul><li>To engage in sexual intercourse with another: </li></ul></ul><ul><ul><ul><li>Who is a resident of a facility </li></ul></ul></ul><ul><ul><ul><li>Who is DD </li></ul></ul></ul><ul><ul><ul><li>Who is incapable of consent </li></ul></ul></ul><ul><ul><ul><li>Who is a frail elder/vulnerable adult </li></ul></ul></ul>
  12. 12. Crimes Involving Elder Sexual Abuse, cont’d. <ul><li>Indecent Liberties </li></ul><ul><ul><li>To knowingly have sexual contact with another: </li></ul></ul><ul><ul><ul><li>Who is DD </li></ul></ul></ul><ul><ul><ul><li>Who is mentally incapacitated </li></ul></ul></ul><ul><ul><ul><li>Who is physically helpless </li></ul></ul></ul>
  13. 13. Crimes Involving Elder Sexual Abuse, cont’d. <ul><li>Luring </li></ul><ul><ul><li>To lure a DD person into a </li></ul></ul><ul><ul><li>Structure or motor vehicle </li></ul></ul><ul><ul><li>Without guardian’s consent </li></ul></ul>
  14. 14. Evidence in a Sexual Assault Case <ul><li>Infections, pain, tearing or bleeding in genital areas or mouth </li></ul><ul><li>Torn, stained, and/or bloody clothing including underwear, diapers, sheets, furnishings </li></ul><ul><li>Used condoms </li></ul><ul><li>DNA swabs for semen, vaginal fluid </li></ul>
  15. 15. Evidence in a Sexual Assault Case, cont’d. <ul><li>Bruises to outer arms, chest, mouth, genitals, abdomen, pelvis, or inside thighs </li></ul><ul><li>Bite marks </li></ul><ul><li>Unexplained STDs or HIV </li></ul><ul><li>Capacity evaluation of victim </li></ul><ul><li>If in facility, records such as logs, suspect’s personnel file, victim’s medical records </li></ul>
  16. 16. Crimes Involving Elder Financial Exploitation <ul><li>Theft </li></ul><ul><ul><li>To knowingly obtain </li></ul></ul><ul><ul><li>Property of another </li></ul></ul><ul><ul><li>With intent to deprive </li></ul></ul><ul><li>Embezzlement (by PoA, guardian, attorney, etc.) </li></ul><ul><ul><li>To knowingly exert unauthorized control over </li></ul></ul><ul><ul><li>Property of another </li></ul></ul><ul><ul><li>With intent to deprive </li></ul></ul>
  17. 17. Crimes Involving Elder Financial Exploitation, cont’d. <ul><li>Identity Theft </li></ul><ul><ul><li>To knowingly obtain, possess, use or transfer </li></ul></ul><ul><ul><li>Identification or financial information of another </li></ul></ul><ul><ul><li>With intent to commit any crime </li></ul></ul><ul><li>Forgery </li></ul><ul><ul><li>To falsely make, complete, alter </li></ul></ul><ul><ul><li>Written instrument </li></ul></ul><ul><ul><li>With intent to injure or defraud </li></ul></ul>
  18. 18. Theft by Undue Influence <ul><li>Developing relationship with vulnerable adult </li></ul><ul><li>In order to obtain “consent” to transfer of his/her assets </li></ul><ul><li>By creating and exploiting trust, dependency, and fear of vulnerable adult </li></ul>
  19. 19. Who Perpetrates Theft by Undue Influence? <ul><li>Family members, trusted friends, or others who have an ongoing relationship with the victim </li></ul><ul><li>Caregivers </li></ul><ul><li>Fiduciaries who have gained an older adult’s trust and confidence </li></ul><ul><li>Opportunists </li></ul><ul><li>Career criminals </li></ul>
  20. 20. What Makes One Susceptible to Undue Influence? <ul><li>Physical and cognitive disabilities </li></ul><ul><li>Adverse life events </li></ul><ul><li>Difficulty speaking English </li></ul><ul><li>Isolation or dependence </li></ul><ul><li>Lack of financial expertise </li></ul><ul><li>Loneliness, fatigue or fear </li></ul><ul><li>Trauma </li></ul>
  21. 21. Undue Influence: Common Tactics Copyright pending. Do not copy or disseminate. Financial Exploitation
  22. 22. Evidence in a Financial Exploitation Case <ul><li>Will </li></ul><ul><li>Advanced Care Directive </li></ul><ul><li>Victim’s and suspect’s bank statements, cancelled checks </li></ul><ul><li>Victim’s/suspect’s credit card statements </li></ul><ul><li>Power of Attorney document </li></ul><ul><li>Guardianship documents </li></ul><ul><li>Victim’s attorney’s case file </li></ul>
  23. 23. Evidence in a Financial Exploitation Case, cont’d. <ul><li>Evaluation of victim’s capacity </li></ul><ul><li>Victim’s unpaid bills </li></ul><ul><li>Contract for care </li></ul><ul><li>Checkbooks </li></ul><ul><li>Tax records </li></ul><ul><li>Property deeds, title company file </li></ul><ul><li>Car title </li></ul>
  24. 24. The Players in the Criminal Justice System
  25. 25. The Patrol Officer <ul><li>First one to the scene </li></ul><ul><li>Conducts initial interviews of victim, witnesses, suspect </li></ul><ul><li>Determines need for others at scene: </li></ul><ul><ul><li>EMTs </li></ul></ul><ul><ul><li>Medical Examiner </li></ul></ul><ul><ul><li>Crime Scene Investigator </li></ul></ul><ul><ul><li>Tracking Dog </li></ul></ul><ul><ul><li>Detective </li></ul></ul><ul><li>Testifies at trial </li></ul>
  26. 26. The Reality of the Patrol Officer <ul><li>Wide range of experience </li></ul><ul><li>In smaller jurisdictions, may conduct entire investigation </li></ul><ul><li>Often under pressure to wrap up call </li></ul><ul><li>LE culture may undervalue elder abuse cases </li></ul>
  27. 27. The Detective <ul><li>Receives case after initial investigation by patrol </li></ul><ul><li>Conducts in-depth investigation by: </li></ul><ul><ul><li>Interviewing suspect, victim, witnesses </li></ul></ul><ul><ul><li>Ordering forensic testing </li></ul></ul><ul><ul><li>Working with prosecutor </li></ul></ul>
  28. 28. The Detective, cont’d. <ul><li>Writes search warrants for: </li></ul><ul><ul><li>Medical records </li></ul></ul><ul><ul><li>Bank records </li></ul></ul><ul><ul><li>Search of home, computer of suspect, victim </li></ul></ul><ul><ul><li>Other relevant evidence </li></ul></ul><ul><li>Refers case to prosecutor </li></ul><ul><li>Conducts additional investigation for trial </li></ul>
  29. 29. The Detective, cont’d. <ul><li>Assists prosecutor in procuring witnesses </li></ul><ul><li>Sits with prosecutor through trial </li></ul><ul><li>Testifies </li></ul>
  30. 30. The Prosecutor <ul><li>Works with law enforcement as they investigate case </li></ul><ul><li>Reviews case referred by LE and: </li></ul><ul><ul><li>files charges; </li></ul></ul><ul><ul><li>declines case for insufficient evidence or because no crime; </li></ul></ul><ul><ul><li>requests additional investigation </li></ul></ul>
  31. 31. The Prosecutor, cont’d. <ul><li>If charges filed: </li></ul><ul><ul><li>Arraignment </li></ul></ul><ul><ul><ul><li>Not guilty plea entered </li></ul></ul></ul><ul><ul><ul><li>Bail/bond set </li></ul></ul></ul><ul><ul><li>Casesetting </li></ul></ul><ul><ul><ul><li>Set for: </li></ul></ul></ul><ul><ul><ul><ul><li>Guilty plea/sentencing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Trial </li></ul></ul></ul></ul>
  32. 32. Trial <ul><li>Jury Selection </li></ul><ul><li>Opening Statement </li></ul><ul><li>State’s Witnesses </li></ul><ul><ul><li>Direct </li></ul></ul><ul><ul><li>Cross </li></ul></ul><ul><ul><li>Redirect, etc. </li></ul></ul><ul><li>Defense Witnesses </li></ul><ul><li>Closing Argument </li></ul><ul><li>Verdict </li></ul><ul><li>(Sentencing) </li></ul>
  33. 33. Why APS is Essential to a Criminal Case
  34. 34. Case Example
  35. 35. APS <ul><li>Is often the first agency to scene of crime </li></ul><ul><li>May have significant prior contacts with victim, suspect </li></ul><ul><li>May find parties much more willing to talk than does LE </li></ul><ul><li>Has easier access to records </li></ul>
  36. 36. APS, cont’d. <ul><li>Has greater knowledge of facilities, roles of various players, records that may be relevant, state regulations </li></ul><ul><li>May have greater insight into case dynamics </li></ul><ul><li>Has important perspective on relative seriousness of case </li></ul>
  37. 37. How APS Can Help LE <ul><li>Involve LE as soon as possible if case may be criminal </li></ul><ul><li>Make sure physical evidence is left undisturbed until LE arrives </li></ul><ul><li>Take detailed notes of conversations with victim, suspect, witnesses </li></ul><ul><li>Document signs of abuse, photograph if possible </li></ul>
  38. 38. How APS Can Help LE, cont’d. <ul><li>Document victim’s environment if neglect, photograph if possible </li></ul><ul><li>Update LE with new information obtained during course of investigation </li></ul><ul><li>Offer to conduct joint interviews with victim, witnesses </li></ul><ul><li>Share discovery </li></ul>
  39. 39. Collaboration
  40. 40. Strategies for Improving Collaboration in Your Community <ul><li>Start a Multidisciplinary Team </li></ul><ul><ul><li>To staff cases </li></ul></ul><ul><ul><li>To address systemic issues </li></ul></ul><ul><li>Invite: </li></ul><ul><ul><li>Senior Services </li></ul></ul><ul><ul><li>Aging and Disability Services </li></ul></ul><ul><ul><li>Mental Health </li></ul></ul>
  41. 41. Strategies for Improving Collaboration in Your Community, cont’d. <ul><ul><li>Prosecutors </li></ul></ul><ul><ul><ul><li>If no specialized prosecutors, contact elected prosecutor and request that he/she select representative to participate </li></ul></ul></ul><ul><ul><li>Detectives </li></ul></ul><ul><ul><ul><li>If no specialized detectives, contact chief/s of police and request representative </li></ul></ul></ul>
  42. 42. Strategies for Improving Collaboration in Your Community, cont’d. <ul><ul><li>Ombudsman </li></ul></ul><ul><ul><li>Long Term Care Providers </li></ul></ul><ul><ul><li>Geriatricians/Nurses </li></ul></ul><ul><ul><li>Medical/Nursing School Faculty </li></ul></ul><ul><ul><li>Public Health </li></ul></ul><ul><ul><li>AG’s Office </li></ul></ul><ul><ul><li>Legal services attorneys </li></ul></ul>
  43. 43. Strategies for Improving Collaboration in Your Community, cont’d. <ul><ul><li>If unsuccessful, request one meeting with head of APS, elected prosecutor, police chief </li></ul></ul><ul><ul><ul><li>Use example of high-profile case </li></ul></ul></ul><ul><ul><ul><li>Cite other successful MDTs in nearby communities </li></ul></ul></ul><ul><ul><ul><li>Cite press’ interest in these cases, in MDTs </li></ul></ul></ul><ul><ul><ul><li>Provide numbers of population over 65 in your county, statistics on prevalence of elder abuse </li></ul></ul></ul>
  44. 44. Strategies for Inspiring LE and Prosecutors to Take an Interest in Your Case <ul><li>Hold a Multidisciplinary Team Meeting to Staff Case </li></ul><ul><ul><ul><li>Invite all parties involved in case--patrol officer, detective, social service provider, medical provider, case worker </li></ul></ul></ul><ul><ul><ul><li>If no LE interest, call prosecutor personally to request assistance </li></ul></ul></ul><ul><ul><ul><li>If no interest by prosecutor, ask LE to contact or have supervisor contact elected prosecutor </li></ul></ul></ul>
  45. 45. Strategies for Inspiring LE and Prosecutors to Take an Interest in Your Case, cont’d. <ul><li>Get press involved </li></ul><ul><li>Use contacts, create peer pressure--call a detective or prosecutor whom you know, even if from a different jurisdiction </li></ul><ul><li>Contact other members of the community who might have some influence </li></ul>
  46. 46. There is Hope… <ul><li>OVW’s Elder Abuse Training Grant </li></ul><ul><ul><li>Funds teams of APS, advocates, prosecutors, detectives from across the country </li></ul></ul><ul><ul><ul><li>To provide extensive training to LE, APS, Prosecutors, Judges, Advocates in their communities </li></ul></ul></ul><ul><ul><ul><li>To improve Coordinated Community Response to elder abuse in their areas </li></ul></ul></ul><ul><ul><ul><li>To improve victim services </li></ul></ul></ul>
  47. 47. OVW’s Training Grant, cont’d. <ul><li>Emphasis on multidisciplinary response to cases </li></ul><ul><li>Requires disciplines to apply, train, work together </li></ul><ul><li>Provides substantial resources, ongoing support </li></ul>
  48. 48. Feel Free to Contact Us <ul><li>Page Ulrey </li></ul><ul><li>[email_address] </li></ul><ul><li>(206)296-9539 </li></ul><ul><li>Mike LaRiviere </li></ul><ul><li>[email_address] </li></ul><ul><li>*thanks to Office on Violence Against Women, Department of Justice </li></ul>

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