Evaluating the Cost Effectiveness of the Elder Abuse Forensic Center Model

Over the last several decades, there has been increasing recognition that elder abuse is a growing social problem that results in significant personal and societal costs. One model to address the most complex cases of abuse is the elder abuse forensic center (EAFC), four of which are currently operating in California. Using a multidisciplinary team approach, the EAFC model brings together diverse professionals from a variety of fields within the justice system, health care, protective services, and mental health.

The team meets weekly to address the most complex cases of elder abuse. Costs for victims can include serious physical injuries, emotional pain and suffering, shame, depression, shattered trust, financial ruin, and increased risk of mortality. Social costs, which are largely unmeasured, potentially include increasing the burden on the delivery system, including health and social services and first responders, increasing the likelihood of spend down and dependency on public benefits, and increasing foreclosures.

Two studies are currently underway to measure and evaluate the effectiveness of the EAFC model and its various components. The first, funded by NIJ, uses a rigorous research design: a propensity score matched comparison group to evaluate the effectiveness of the Los Angeles County EAFC in achieving important outcomes. A second study, funded by the Archstone Foundation, compares and contrasts the structure, process, and outputs of the four centers in California.

This study, led by an economist new to the field of elder abuse, allows an expert elder abuse research team to build on these two studies to examine cost effectiveness by: 1) Systematically evaluating the cost effectiveness of the EAFC model building on the current study of the robust, well-developed Los Angeles County Elder Abuse Forensic Center; 2) Examining the range of costs to implement and maintain the model drawing on four different models in California; 3) Identifying, and where feasible, testing approaches/promising practices that have the potential to improve cost effectiveness and provide recommendations for further cost effectiveness; 4) Developing a cost effectiveness tool kit that includes measures and methods that can be used by other researchers to evaluate EAFCs.

Statistical analyses will be performed throughout the project and upon the completion of data collection, to ascertain the benefit of EAFC evaluation over treatment-as-usual. Analysis will be on several levels, using various statistical techniques to generate descriptive statistics, independent sample t-tests, and ANOVA/multiple regression. Building on the current NIJ study to capture intermediate cost outcomes (e.g, prosecution, restitution, safety), a variety of approaches will be used to expand program evaluation and measure cost effectiveness (e.g, difference-in difference statistics, developing and applying a state transition model). Finally, a dataset without identifying information will be compiled for dissemination through NIJ, and an instructive guide will be constructed to guide future EAFCs through the process of performing an evaluation. ca/ncf