History of NYC Elder Abuse Center

    The NYC Elder Abuse Center: A History

    Financial exploitation. Physical abuse. Psychological Abuse. Abandonment. Neglect. All are aspects of elder abuse, increasingly common nationwide, with approximately 120,000 older adults victimized in their own homes each year in NYC alone - and 96% of these cases go unreported.

    The cases are heartbreaking and complex, requiring innovative solutions. As a result, the NYC Elder Abuse Center (NYCEAC) was launched in 2009 to improve the way professionals, organizations and systems respond to elder abuse, neglect and financial exploitation. It accomplishes this through an unprecedented level of collaboration and coordination in partnership with NYC’s government and non-profit agencies. Now, through NYCEAC, these organizations provide a streamlined and rapid response to elder abuse cases. In addition, the depth and breadth of expertise and resources of the participating agencies reduces fragmentation of systems and minimizes gaps or overlap of services. Additionally, NYCEAC works to educate key decision-makers and elected officials about elder abuse and seeks to improve legislation to better protect the safety and well-being of New York City’s older adults.

    Prior to the launching of the NYC Elder Abuse Center in 2009, elder abuse cases in NYC were largely handled by individual workers siloed within their own organizations and systems. NYCEAC has implemented an effective paradigm for collaboration and coordination between New York City’s many government and non-profit agencies and organizations.

    Background

    This need to develop a systematic, collaborative response to the growing number of complex elder abuse cases in NYC was the impetus for the development of the NYC Elder Abuse Center. Although elder abuse centers have been created in other parts of the United States over the past decade, it seemed that no single center model could be directly transposed to the NYC environment, unique in its size, complexity and diversity. Thus, in April 2008, the Weill Cornell Medical College’s Division of Geriatrics and Palliative Medicine (the Division), in partnership with the Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale (The Weinberg Center) and the New York City Elder Abuse Network (NYCEAN), initiated the NYC Elder Abuse Center Planning Project.

    First, a multidisciplinary Advisory Council was formed, comprised of 25 members from a broad-range of non-profit and government organizations, including criminal justice, academia, social services, health care, domestic violence, banking, aging services, mental health and advocacy. Then, the Advisory Council conducted extensive research to determine the NYCEAC’s priorities, identify stakeholders’ interests and needs and to create a structure for it.

    This research utilized a five-pronged strategy intended to build on the success of other models of elder abuse service while soliciting ideas and creating as broad a consensus as possible among the local elder abuse community. An additional benefit to this multi-faceted approach was that we successfully engaged strategic stakeholders important for future partnership development. (Weill Cornell Medical College’s Institutional Review Board approved this research.) The five planning methods utilized were:

    • Concept Mapping. Concept mapping is a qualitative and quantitative consensus building methodology in which a broad group of stakeholders with an interest in a particular topic are identified, their views elicited, and their ideas prioritized for implementation. In response to a prompt (which in this case was, “The most important goal of a New York City Elder Abuse Center to combat elder abuse is….”), the group “brainstorms” to create as many unique ideas relevant to the prompt as possible. These are then sorted by the group into discrete idea areas, and then ranked in terms of priority and feasibility. (Click here for a copy of the NYCEAC’s concept map.)

    • Site Visits to Relevant Centers. Members of the Advisory Council made site visits to nice existing elder abuse and child advocacy centers throughout the country to see what activities and components of those centers had relevance to the creation of a NYC Elder Abuse Center.

    • One-on-One Interviews with Major Stakeholders. Major stakeholders, pioneers and opinion leaders in NYC were interviewed directly by members of the Advisory Council to solicit their input (e.g. government officials, leaders from the fields of aging and domestic violence.) These interviews typically lasted in excess of one hour.

    • Survey of the Existing Elder Abuse Case Coordination and Review Team. Members of an on-going monthly Manhattan-based case discussion group, the Elder Abuse Case Coordination and Review Team (EACCRT), were surveyed via an online process to solicit their specific opinions about the mission and function of a putative NYCEAC.

    • Review of the literature. An extensive literature search was conducted and national elder abuse listservs were queried to identify best practices and models.

    The Advisory Council synthesized and analyzed the data gathered. Utilizing a democratic and transparent process, the Advisory Council determined the NYCEAC’s structure, governance, priorities, activities and funding needs.

    Current Operations

    NYCEAC began operations in November 2009. A concept more than a place, NYCEAC is decentralized and without walls. It efficiently utilizes existing spaces and leverages other extant resources to avoid unnecessary capital expenditures and effectively builds on the strengths of the existing elder abuse and elder service networks in NYC.

    NYCEAC is being created in phases. During Phase 1, activities are divided into two “cores”: An Administrative Core, which oversees NYCEAC’s operations and a Clinical Services and Education Core, focused on providing direct services and professional training. This model has built-in elasticity. Existing cores can be expanded as needs arise, and contracted as goals are achieved. Additional cores can be established as new priorities emerge.

    • The Administrative Core provides leadership to all aspects of the Center. Risa Breckman, LCSW, is the Executive Director of NYCEAC and Assistant Professor at Weill Cornell Medical College Division of Geriatrics and Palliative Care; Mark Lachs, MD, MPH is the Medical Director of NYCEAC and and Co-Chief of WCMC’s Division of Geriatrics and Palliative Care.

    While the Division has overall responsibility for the project, activities are conducted by numerous organizations, many of which make significant in-kind contributions. Each of these organizations contributes specific expertise in one or more areas; many have experience working together during the planning project and in other NYC elder abuse-focused activities and volunteered to play an active role on NYCEAC’s Steering Committee.*

    The Steering Committee developed governance policies and procedures, and built and maintained an infrastructure comprised of important stakeholders from NYC’s many diverse community-based, government, health care, criminal justice, legal and academic institutions. The Steering Committee met quarterly, provides guidance on future directions and forms subcommittees as needed (e.g., Development; Personnel; Marketing/PR) which report back to the larger group.

    • Through the Clinical Services and Education Core, NYCEAC utilizes a multidisciplinary team (MDT) approach to coordinate care and create solutions for the growing number of complex cases of elder abuse in NYC.

    NYCEAC coordinates and facilitates three teams, two in Manhattan and one in Brooklyn. These offer a central response point for the agencies and people working on elder abuse cases in the community. The MDTs also serve as an important informational resource for professionals working in the health, mental health, justice/legal, victim assistance and social service systems.

    Although the three teams are designed differently, they all utilize a case consultation model to improve the health and quality of life for older adults. This is accomplished through: reviewing, discussing and coordinating cases of elder abuse and neglect; identifying systemic and resource problems that can be brought to the attention of others for strategizing and intervention; and identifying research needs. The following briefly describes the NYCEAC’s MDTs:

    • The Manhattan Elder Abuse Case Consultation and Review Team (EACCRT) is an interdisciplinary group of over 40 NYC professionals from a broad spectrum of public and not-for-profit organizations. These professionals, representing diverse fields—social work, medicine, law, nursing and psychiatry—meet monthly for 1.5 hours at different locations throughout Manhattan. Originally, 2-3 cases were discussed at each meeting and follow-ups on previous cases were also discussed. EACCRT membership is open to any professional representing an organization serving Manhattan elders.

    • The enhanced Manhattan MDT (EMDT) has a focus on financial exploitation (as well as co-occurring abuses). The team meets twice monthly for 2 hours at Manhattan APS and is comprised of selected representatives from the following organizations:

    The Manhattan EMDT’s representatives are knowledgeable about elder abuse and neglect and collectively represent the fields of medicine, psychiatry, law, criminal justice, social work, banking, forensic accounting and adult protective services. Additional consultants from other fields can be brought in on a case-by-case basis.

    • The Brooklyn MDT meets 2x/month for 2 hours at the Brooklyn APS Office and is comprised of selected representatives from the following organizations.

    The Brooklyn MDT’s representatives are knowledgeable about elder abuse and neglect and collectively represent the fields of medicine, nursing, law, criminal justice, social work and adult protective services. Additional consultants from other fields can be brought in on a case-by-case basis.

    For more information about either of these three MDTs, including how to refer a case for expert review and recommendations, or for technical assistance in starting an MDT in your area, please contact NYCEAC’s Program Assistant, Kasey Brown at [email protected] or at (212) 746-1416.

    Conclusion

    In conclusion, the NYC Elder Abuse Center is forged by a highly collaborative and thorough planning process. This involved an extensive literature review, consultations and site visits, and an intensive, democratic decision-making approach in which hundreds of ideas from members of the local elder-serving community were considered and prioritized. From this planning process emerged a solid plan and realistic expectations for NYCEAC’s first phase of operations.

    As it moves forward, NYCEAC will utilize a collaborative approach to problem solving to overcome obstacles and plan for the future. The Steering Committee is confident that ultimately, NYCEAC will improve care for the growing number of NYC elder abuse victims—while also serving as a significant resource for elder abuse technical assistance, innovative best practices, multidisciplinary training, research, and policy development, both locally and nationally.

    For more information about the NYC Elder Abuse Center, please contact:

    Risa Breckman, LCSW
    Executive Director, NYCEAC
    Weill Cornell Medical College
    Division of Geriatrics and Gerontology
    525 East 68th Street, Box 39
    New York, NY 10065
    212-746-1674
    [email protected]

    * Steering Committee members represented the following organizations: Alzheimer’s Association, NYC Chapter, Archaeos, Bronx DA’s Office, Brookdale Center for Healthy Aging & Longevity, the Carter Burden Center for the Aging, CONNECT, Council of Senior Centers and Services, Fordham University Institute for Women and Girls, Geriatric Mental Health Alliance of NY, Heights and Hills, JASA, Kings County’s DA’s Office, Mount Sinai Hospital - Elder Abuse Program, NY County District Attorney’s Office, Neighborhood SHOPP, NYC Department for the Aging, NYC Housing Authority, NYC Human Resources Administration Adult Protective Services, New York Legal Assistance Group, Queens DA’s Office, UJA-Federation of NY, Renaissance Economic Development Corporation, United Federation of Teachers, The Harry & Jeanette Weinberg Center for Elder Abuse Prevention, Intervention and Research in Elder Abuse at the Hebrew Home at Riverdale, and Weill Cornell Medical Center’s Division of Geriatrics and Gerontology.