Development of a brief elder abuse and neglect screener for Emergency Medical Services: Detection of Elder abuse Through Emergency Care Technicians (DETECT)

According to recent population-based estimates, roughly 11% of older adults experienced abuse and/or neglect (EA) each year. In 2013, MedStar Mobile Healthcare responded to almost 30,000 calls to assist older adults in Fort Worth, TX; however, only 23 of these calls resulted in potential incidents of EA being reported to Adult Protective Services (APS). Based on the number of calls made to assist older adults, it may be reasonably estimated that almost 3,000 additional cases of elder abuse and/or neglect were not detected or reported. Preliminary focus group data suggest that moral anxiety and fear of incorrectly reporting potential EA was the most important reason why MedStar's Emergency Medical Technicians (EMTs) did not report potential EA to APS. There is a growing literature that suggests that EA is systematically under-reported, and there are several reasons why the most effective way to increase detection may be screening older adults in their residence. Given that EMTs often have unique access to the homes of older adults, we propose in this study to create, pilot, and validate a brief screening tool that will be used by EMTs to increase the detection and reporting of potential cases of EA to APS. Focus groups and stakeholders will provide data to design a tool relevant to practitioners, and a brief pilot test will be conducted to empirically estimate the predictive validity of the screening tool. MedStar, the primary 9-1-1 emergency services provider in the research area, will then implement the screening tool as a part of their protocol for new EMTs. An experimental trial will be conducted to determine whether this tool increases reporting of potential cases of EA. Finally, in order to ensure that the tool is not simply increasing unsubstantiated reports of EA, data obtained directly from APS (linked to EMT reports) will be used for cross-validation of the tool. This tool will direct EMTs to report EA based upon a quantitative score, rather than their subjective judgment (thus, removing any emotional guilt and other barriers from the reporting process). We expect that implementation of this tool will increase the number of substantiated cases of abuse and neglect reported to APS. Results of this study will be disseminated to the larger practitioner community. If successful, future studies may extend the breadth of this idea to create a similar tool for other first responders, including police officers and fire fighters. ca/ncf