Training to raise awareness and develop prevention, detection and intervention measures - PowerPoint Presentation

Slide1

 Training to raise awareness and develop prevention, detection and intervention measures to counter older adult mistreatment

Adaptation of training offered by: Ligne Aide Abus Aînés (eldermistreatment help line)Prepared by: West-Central Montreal Health/Ligne AAA and FNQLHSSC

1Slide2

Objective of the trainingBy the end of this training, participants will be able to

transmit knowledge and skills related to older adult mistreatment

prevention,

detection and

intervention measures

to people

who have relationships with elders in their community.

2Slide3
Structure of the training

3

Module 1: Context and definition of

mistreatment

Module 2:

Types of mistreatment

Module 3:

Detecting mistreatment

Module 4:

Intervening in situations of mistreatment

Module 5:

Key points

Preparing to become a trainer

Module 6:

Facilitation skillsSlide4

This training is an adaptation of the training offered by West-Central Montreal Health, Ligne Aide Abus Aînés (elder mistreatment help line).Governmental action plan to counter elder mistreatment (2010-2015, MFA)Awareness campaignResearch chair (Sherbrooke University)Regional

coordinators Ligne Aide Abus Aînés (provincial helpline)4

History of the trainingSlide5

Project: Québec Ami D

es Aînés (QADA) Projects with a direct impact on elders (Quebec gov’t.)

Opportunity to adapt and provide this training for trainersThis training promotes active participation, which reflects the approach of the FNQLHSSC

5

Context of the training for the first nationsSlide6

It is important

not to give names or details

making it possible to

identify

who is being discussed.

For this training and also for interventions in the community,

confidentiality is essential

.

6Slide7

Introductory activity7

Myths and realitiesSlide8

Myths and realitiesElders are mistreated by people they don’t know.In reality, older adult mistreatment is committed more often by people they know.

8

Adapted from: Maltraitance envers les aînés, Gouvernement du QuébecSlide9

Myths and realitiesElders will quickly tell someone about their situation of mistreatment.In reality, elders subject to mistreatment are generally torn between the feelings they have for the person causing the mistreatment and the desire to make their situation known

. 9

Adapted from: Maltraitance envers les aînés, Gouvernement du QuébecSlide10

Myths and realitiesThe risk of being mistreated varies according to the elder’s level of income.In reality, any elder can be subject to mistreatment, regardless of social status or income. However, the lack of financial resources constitutes a risk factor that can increase elders’ vulnerability to mistreatment.

10

Adapted from: Maltraitance envers les aînés, Gouvernement du QuébecSlide11

The four needs of first nations’ elders11

1. S __ __ U __ __ T YE

C

R

I

2. S U __ P __ __ T A N D C __ __ E

3. R E __ O __ N I T I __ __

4. I N __ O __ V __ M __ __ T

C

G

O N

Source: Brief: Our Elders… Our Identity

(2007)

E

V

E

N

L

O

R

P

A

RSlide12

Module 112

Context and definition of older adult mistreatmentSlide13

Objective of the moduleBy the end of this module, participants will

know the basic concepts related to older adult mistreatment.

13

Module 1: Context and definition of mistreatmentSlide14

Components of module 1Unit 1.1: ContextUnit 1.2: Main theoriesUnit 1.3: What is older adult mistreatment?

14Module 1: Context and definition of mistreatmentSlide15

Unit 1.1Context15Slide16

Some statisticsWhich percentage do you think represents the population aged 65 and older?16

Unit 1.1 Context

10.2%

Source: Statistics Canada 2011

5.3%

Canada

first NationsSlide17

Some statisticsWhich percentage do you think is the estimated percentage of the population aged 65 and older in 2031?

17Unit 1.1 Context

Canada

first

Nations

≈

24%

Source:

Statistics

Canada

≈

13%Slide18

Prevalence of mistreatmentIn your opinion, what is the proportion of elders who report being victims of mistreatment in Canada?

18Unit 1.1 Context

4%

to

7%

Source:

Government action plan to counter elder abuse

(2010)Slide19

% of reported mistreatment: according to international studies19

Unit 1.1 Context

Spain (2009) 16%

England (2009) 8.6

%

Israel

(2009) 26%Slide20

Unit 1.2: Main theories regarding older adult mistreatment20Slide21

21

Does it need water?

Does it need light?

Does it have insects

?

Should the soil be changed

?

Do the cats use it as a litterbox

?

Unit 1.2: Main theories

The story of the houseplantSlide22

Theories allow us to establish some foundations for understanding the origin of older adult mistreatment.But no theory by itself accounts for all aspects; practitioners thus need:More than one theoretical framework

More than one intervention approachCollaborative action with partners22

Unit 1.2: Main theories

Why more than one theory

?Slide23

Main theories regarding mistreatment1

st statement:This theory is based on the fact that a caregiver can become burned out, and from there become inadequate in the role of caregiver while finding it difficult to carry out all the responsibilities related to that role.Caregiver stress

23

Unit 1.2: Main theoriesSlide24

Caregiver stress

IMPORTANT: A caregiver can experience a great deal of stress without becoming inadequate.A caregiver can also be the one who is being mistreated.24

Unit 1.2: Main theoriesSlide25

Main theories regarding mistreatment2nd statement:

This theory assumes that a dynamic of conjugal violence in a couple’s relationship will generally be maintained as the couple gets older.Conjugal violence25

Unit 1.2: Main theoriesSlide26

Conjugal violence

IMPORTANT:The women are not always the ‘victims’ and the men are not always the ‘abusers.’26

Unit 1.2: Main theoriesSlide27

Main theories regarding mistreatment3rd

statement:According to this theory, relationships are built on a principle of balance between the ‘costs’ and ‘benefits’ of the relationship for each of the individuals involved. An unbalanced relationship may lead to the vulnerability of one individual.Interdependence

27

Unit 1.2: Main theoriesSlide28

InterdependenceIMPORTANT:

It may be difficult for an outside person to evaluate the ‘costs’ and ‘benefits’, which are very subjective (assumptions must be validated with the person concerned).28

Unit 1.2: Main theoriesSlide29

Main theories regarding mistreatment4th

statement:According to this theory, it is necessary to identify the personal characteristics, among the elder and the person who mistreats, which may put the elder at greater risk of being in a situation where mistreatment is present. Pathology

29

Unit 1.2: Main theoriesSlide30

PathologyIMPORTANT:If improperly used, this theory can lead practitioners to hasty and possibly wrong conclusions, and result in the labelling of individuals

.30

Unit 1.2: Main theoriesSlide31

Victim

Labelling

Any generalization concerning

mistreatment

is dangerous. Be careful not to jump to conclusions and label people; this can be very

harmful

.

31

Unit 1.2: Main theories

AbuserSlide32

32

 Honesty Lying

Dynamic

Withdrawn

Effective

Lazy

Hard-working

Late

Intelligent

Aggressive

Positive

Ignorant

Calm

Quarrelsome

Courageous

NegativeSlide33

Unit 1.3: What is older adult mistreatment?33Slide34

How do we define mistreatment?“Older adult mistreatment is a single or repeated

act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm

or distress to an older person

.”

(Adapted from World Health Organization, 2002)

34

Unit 1.3: What is

mistreatment?Slide35

Two main forms of mistreatment Violence

Treat an older adult badly or force an older adult to act against his/her will, through the use of force and/or intimidationNeglect

Fail to show concern for an older adult, in particular due to a lack of appropriate action for meeting his/her needs.

35

Unit 1.3: What is

mistreatment?Slide36

intentional mistreatment vs. unintentional mistreatmentUnintentional

The person does not want to harm the older adult or does not understand the harm being caused.

IntentionalThe person who is mistreating an older adult

wants to harm him/her.

36

Unit 1.3: What is mistreatment?

Difference

in the intentions

of the person presumed to be mistreating the elderSlide37

Module 237

Types of mistreatmentSlide38

Objective of the module38Module 2: Types of mistreatment

By the end of this module, participants will be able to

recognize

and

distinguish between

the various types of mistreatment and to

know

their

harmful effects

on the elder

.Slide39

Components of module 2Unit 2.1: Psychological mistreatmentUnit 2.2: Physical and sexual mistreatmentUnit 2.3: Material or financial mistreatment

Unit 2.4: Violation of rights and organizational mistreatmentUnit 2.5: Ageism39

Module 2: Types of mistreatmentSlide40
For any type of mistreatment

Regardless of the type of mistreatment, the consequences for the elder must never be under-estimated.The types of mistreatment are not all exclusive

and may be superimposed on one another.We need to be aware of signs of mistreatment, but without being tempted to jump too quickly to conclusion.

40Slide41

Distinguish between signs and indicators41

Signs

Indicators

Observable facts requiring evaluation to know if they are linked to a situation of mistreatment.

Observable facts that have been evaluated and confirm the existence of a situation of mistreatment

.Slide42

42Types of mistreatment

Module 2: Types of mistreatmentSlide43
Unit 2.1: Psychological mistreatment

Gestures, words or attitudes which harm psychological well-being or integrity

.Violence: Emotional blackmail, manipulation, humiliation, insults, infantilization, belittlement verbal and non-verbal threats, disempowerment, excessive monitoring of activities, etc.

Neglect: Rejection, indifference, social isolation, etc.

43Slide44
Examples of possible signs of

psychological mistreatment signsFear;Apathy;

Anxiety;Symptoms of depression;Withdrawal into oneself;Hesitation to speak openly;

Mistrust;Interacts fearfully with one or more persons;

Rapid decline of cognitive capacities;

Suicidal ideas;Suicide;

Etc.

44Slide45

Psychological mistreatment – what to keep in mind:

Psychological mistreatment is probably the most frequent type of mistreatment. It very often accompanies the other types of mistreatment.45Slide46

Unit 2.2: Physical mistreatment46

Inappropriate gestures or actions, or absence of appropriate actions, which harm physical well-being or integrityViolence: shoving, bullying, hitting, burning, force-feeding, inadequate administration of medications, inappropriate use of restraints (physical or chemical), etc.

Neglect: Deprivation of reasonable conditions for ensuring comfort or safety; no support provided for eating, getting dressed, hygiene or taking medications when one is responsible for another person in a situation of dependency, etc. Slide47
Examples of possible signs of

physical mistreatment signs:Bruises;Injuries;

Weight loss;Deteriorating health;Poor hygiene;Undue delay in changing of incontinence pads;

Skin conditions;

Unsanitary living environment;Atrophy;

Use of contraints;Premature or suspicious death;

Etc

.

47Slide48

Physical mistreatment – what to keep in mind:

We may at times, and wrongly, believe that older people’s capacity for being aggressive diminishes with age. Indications of physical violence may be interpreted as symptoms of certain medical conditions. 48Slide49

Sexual mistreatmentGratuitous gestures, actions, words or attitudes with sexual connotations, which are harmful to sexual well-being, integrity or identity.

Violence: Suggestive comments or attitudes, jokes or insults with sexual connotations, promiscuity, exhibitionist behaviours, aggressive actions of a sexual nature (unwanted touching or caresses, non-consensual sex), etc.Neglect: Deprivation of privacy, non-recognition or denial of sexuality and sexual orientation,

etc.

49Slide50

Examples of possible signs of sexual mistreatmentInfections; Genital and/or wounds;Anxiety when being examined or given care;Mistrust;Withdrawal into oneself;

Depression;Sexual disinhibition;Sudden onset of highly sexualised language;Denial of the older adult sex life;Etc. 50Slide51

51

Sexual mistreatment – what to keep in mind:

Not recognizing an elder’s sexuality prevents the observing and reporting of sexual mistreatment

Cognitive impairment may lead to disinhibition, in turn leading to inappropriate sexual behaviours.

Sexual aggression is above all an act of domination.Slide52

Unit 2.3: Material or financial mistreatmentFraudulent, illegal, unauthorized or dishonest acquisition or use of the person’s property or legal documents; absence of information or misinformation on financial or legal matters.

Violence: Pressure exerted to change a will, bank card used without consent, excessive price demanded for services provided, misappropriation of money or assets, identity theft, etc.Neglect: Failure to manage the person’s assets in his/her best interest or to provide for those under one’s responsibility, failure to evaluate the person’s capacities, understanding and literacy in financial matters,

etc.

52Slide53

Is it exploitation?It is acceptable if:The parent is competent and is in agreement;The needs of the parent are met;The amount is fair in terms of the help provided and in terms of the parent’s financial resources

.53Is it

acceptable to receive money from a parent whom you are helping out?Slide54

Examples of possible signs of mistreatment signsUnusual banking transactions;

Disappearance of valuable objects;Lack of money for ongoing expenses;Limited access to information about management of the person’s assets;Etc.

54Slide55

Financial mistreatment: organized fraudFraud is a form of exploitation that is occurring more and more often.An individual relies on the trust that the elder has in him or an institution in order to trick the elder out of his money

.55Slide56

Financial mistreatment – what to keep in mind:

Financial mistreatment can influence elders’ ability to carry out their daily responsibilities.Elders who present a form of dependency on someone else (physical, emotional, social, etc.) are more at risk of being victims of this type of mistreatment.56Slide57

Unit 2.4 Violation of rightsNot recognizing the fundamental rights of an older adult

(Any infringement of individual & social rights and freedoms).Violence: Imposed medical treatment, denial of the right to: choose, vote, enjoy one’s privacy, take risks, receive telephone calls or visitors, practice one’s religion, live one’s sexual orientation

, etc.

Neglect: Non-information or misinformation concerning the older adult’s rights, failure to provide assistance in exercising his/her rights, non-recognition of his/her capacities, etc.

57Slide58

Examples of possible signs of violations of right

Preventing the older adult from participating in the choices and decisions affecting him/her, Non-respect of the decisions made by the older adult,

Answers given by a family member to questions addressed to the older adult,

Restriction of visits or access to information,Isolation,

Complaints,Etc.

58Slide59

59

Violation of rights- what to keep in mind:

All persons fully retain their rights as they grow older.

Only a judge can declare a person incompetent and appoint a legal representative.

Persons declared incompetent still retain their rights, which they may exercise according to their capacities

.Slide60

Organizational mistreatment (care and services)Any harmful situation created or tolerated by the procedures of institutions responsible for providing care and services, and which compromise users’ exercise of their rights and freedoms.

Violence: Organizational conditions or practices leading to non-respect of user’s choices or rights, lack of personalized care, failure to adapt the institution and services to the individual, etc.

Neglect: Lack of resources (budget, time, staff) and services, inadequate training of staff, etc.

60Slide61

Examples of possible signs of organizational mistreatment

Treating the person as a number;Largely inflexible care schedule;

Needs not met;

Failure to provide assistance for meals or hygiene care;Undue delay in changing of incontinence pads;

Wounds;

Deteriorating health;

Inadequate care;

Etc.

61Slide62

Organizational mistreatment – what to keep in mind:

We need to look critically at the shortcomings of the system, which could harm elders’ rights.It may be necessary to advocate for the rights of older adults. Each organizational structure has a complaints procedure.62Slide63

Unit 2.5 AgeismDiscrimination due to age, resulting in hostile or negative attitudes, harmful actions or social exclusion.

Violence: Imposition of restrictions or social standards due to age, reduction of access to certain resources, prejudice, infantilization, scorn, etc.Neglect: Indifference shown when witnessing ageist practices or comments, etc.

63Slide64

Examples of signs of ageism

Non-recognition of rights;Non-recognition of competencies or knowledge;Condescension;

Etc.

64Slide65

Ageism – what to keep in mind:

We are all influenced, to varying degrees, by negative stereotypes held concerning elders. These are ‘ready to use’ reactions which lead to wrong and hasty conclusions about various social realities.We can combat ageism by being aware that these ‘ready to use’ reactions exist and by identifying them when they appear.65Slide66

Regardless of the type of mistreatment, the consequences for the elder must never be under-estimated.

Shame, humiliation, sadness, angerFear, psychological distressIsolation, marginalization

Poverty, diminished quality of lifeInjuries, illnesses, overall deterioration in health

Depression, suicide, premature death

66

For all types of mistreatmentSlide67

Module 367

Detecting mistreatmentSlide68

Objective of the moduleBy the end of this module, the participants will be aware of the importance of knowing the risk factors for mistreatment and the tools that are available to detect it

.68Module 3: Detecting mistreatmentSlide69

Components of module 3Unit 3.1: Why detect?Unit 3.2: Risk factorsUnit 3.3: Screening tools

69Module 3: Detecting mistreatmentSlide70

Unit 3.1Why detect mistreatment?70Slide71

True or false?

71Slide72

Acts of mistreatment are often committed in public.

72

True or false

?

False

Slide73

Elders who are being mistreated are comfortable with the idea of disclosing the name of the person who is mistreating them.

73

True or false

?

False

Slide74

Mistreatment is a taboo form of violence.

74

True or false

?

True

Slide75

The severity and frequency of acts of mistreatment committed against an elder tend to diminish with time.

75

True or false

?

False

Slide76

Early and adequate intervention can prevent the violence from escalating and limit the consequences for the elder.

76

True or false

?

True Slide77

Advantages of detection

Allows identification of the risks or presence of mistreatmentAllows preventive interventionsAllows evaluation of the risk levelAllows prioritization of future interventions

77

Unit 3.1: Why detect?

Challenges of detection

A

dvantages and challenges of detection

With age, people are more likely to undergo loss of autonomy, which can increase their vulnerability to mistreatment

One must check to see whether

signs

of mistreatment may be linked to other problemsSlide78

Unit 3.2Risk factors78Slide79

Risk factor, sign or indicator?79

Risk factors

Signs

Indicators

Observable facts requiring evaluation to determine if they are linked to a situation of mistreatment

Attributes, characteristics or exposure of a person, which increases the probability of developing a disease or undergoing trauma

Observable and evaluated factsSlide80

Risk factors“A risk factor is an element belonging to an individual or within the environment

that is likely to cause a disease, trauma or any other disruption to a person’s integrity or development.”

Source: Fougeyrollas et al., 1998:34

80Slide81

Risk factorsRisk factors for the elder and/or the person who (allegedly) mistreats:

81Unit 3.2: Risk factors

History of violenceStrained or difficult

family tiesPresence of

cognitive lossesMental health

problems

Addictions

(drugs, alcohol, gambling, etc.)

Social isolation

Insufficient financial resources

Relation of

dependency

on another person

The elder and the abuser

live together

Crisis situation or intense stress

Minority status

Disruptive behavioursSlide82

Risk factorsSpecific to the elderAdvanced age

Problems of mobility or communicationHesitancy to disclose the mistreatment, fear of the public system

Lack of knowledge of one’s rights and what mistreatment isSpecific to the

person who (allegedly) mistreatsBeing in an imposed helping relationship

, not being comfortable with certain forms of care to give Having

little knowledge

about the care to give

82

Unit 3.2: Risk factorsSlide83

Risk factors specific to the first nations’ contextLinguistic barrierDifferent perception of public services

Generation gapRupture of social linksPovertyHousing shortage and overcrowded housingContext of geographical isolation

Diminishing of traditional ways of lifeDiminishing of the traditional role of elders

Residential school experienceComplicated government jurisdictions

.

83

Unit 3.2: Risk

factorsSlide84

Protective factorsIntrinsic to the person

Self-esteemAbility to ask for helpUnderstanding of one’s emotions

Social participation

Ability to learn about self and societyMaintain good lifestyle habits

84

Unit 3.2: Risk

factorsSlide85

Protection factorsExtrinsic to the personNetwork

Environment Financial capacity85

Unit 3.2: Risk factorsSlide86

86Unit 3.3: Screening toolsSlide87

Some analysis and screening tools87Slide88

Some analysis and screening tools

Risk factors checklist for older adult mistreatment with additional factors of vulnerability for First Nations communities. (West-Central Montreal Health

/AAA Help Line/FNQLHSSC

, 2014).

Tool based on risk factors, applicable to all involved persons

.

Risk

Assessment of Persons Living at Home: A Decisional Aid

(CLSC Métro and

Public Curator

,

2004)

Risk analysis grid

: used by workers to situate the risk factors in the context of an intervention plan

Caregiver Abuse Screen (CASE

)

(Namiash and Shrier,1992)

Screening and intervention tool used by caregivers for self-evaluation purposes

Elder

Abuse Suspicion Index

(EASI)

(Yaffe, Lithwick et al., 2006)

Tool

created to allow general practitioners to identify any need for a more in-depth

psychosocial evaluation

.

88Slide89

Tool for recognizing risk factors concerning all persons involved in a situation of mistreatment

(Training by West-Central Montreal Health, Aide Abus Aînés Help Line, 2014)

89

Risk factors

c

hecklist for older adult mistreatment with additional factors of vulnerability for First Nations CommunitiesSlide90

90Risk Assessment of Persons Living at Home: A Decisional Aid

Excerpt from a more generalized tool which includes: checklist, risk analysis grid, criteria from Nova Scotia

Hospitals Act

, and elements for looking at ethical issues

http://

www.lawreform.ns.ca/Downloads/Hospitals_Act_DIS.pdf

Slide91
Identifying risk factors

Clinical exercise

91Unit 3.3: Risk factorsSlide92

CASETool made up of 8 questions 1. Do you sometimes have trouble making [… ] control his/her temper or aggression?2. Do you often feel you are being forced to act out of character or do things you feel badly about?

3. Do you find it difficult to manage [… ] ‘s behaviour?92

Self-evaluation tool developed for

caregiversSlide93
CASE (suite)

4. Do you sometimes feel that you are forced to be rough with [… ]? 5. Do you sometimes feel that you can’t do what is really necessary or what should be done for [… ]?

6. Do you often feel you have to reject or ignore [… ]?7. Do you often feel so tired and exhausted that you cannot meet [… ] ‘s needs?8. Do you often feel you have to yell at [… ]?

93Slide94
CASE: advantages

Shows caregivers that it is normal to experience difficultiesHelps caregivers gain awareness concerning mistreatmentCreates openness (non-judgemental) in order to look at the possible support interventions that a caregiver can engage in

94Unit 3.3: Screening toolsSlide95

EASITool created for family doctors, in order to quickly identify elder at risk of being mistreated.

95Unité 3.3: Screening toolsSlide96
EASI

Question 1 to Q 5: asked of older adult and Q 6 answered by doctor1. Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?

2. 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? 3. Have you been upset because someone talked to you in a way that made you feel shamed or threatened? 96Slide97
Easi (suite)

4. Has anyone tried to force you to sign papers or to use your money against your will?5. Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically? Question 6: answered by doctor.6. Doctor: Elder mistreatment 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?

97Slide98
EASI: Advantages

Covers the main types of mistreatment in just a few questionsProvides words or ways to address mistreatment, directly but in a respectful manner.Very useful for psychosocial intervention and evaluation teams

98Unit 3:3: Screening toolsSlide99

Module 499

Mistreatment interventionSlide100

Objective of the moduleBy the end of this module, participants will be able to integrate the principles

and the approach involved in mistreatment intervention in order to assist elders in making their choices and in taking any necessary related steps.Module 4: M

istreatment intervention

100Slide101

Components of module 4Unit 4.1: Values, principles and attitudesUnit 4.2: Professional responsibilities and approachUnit 4.3: Intervention sectorsUnit 4.4: Specialized resources

Unit 4.5: Specific resourcesModule 4: Mistreatment intervention

101Slide102

Unit 4.1Values, principles and attitudes102Slide103

103Slide104
Intervention principles

104

To provide guidance to practitioners

Respect choices

and promote the dignity of the person;Encourage the

maintenance or improvement

of

family ties (when possible);Seek

human solutions

, supported by the law and ethics;

Reduce social

isolation

;

Promote

collaboration

with your

team members and with community partners.Slide105
attitude of mutual support to adopt

Avoid being a judge or …

105Slide106
attitude of mutual support to adopt

…a saviour

106Slide107

Unit 4.2Professional responsibilities and approach107Slide108

In Quebec, there is no legislation requiring mandatory reporting of situations involving older adult mistreatment. All professionals are bound by adherence to confidentiality and professional secrecy.

Professional responsibilities108Slide109
Professional responsibilities by order of priority

Evaluate the risk and ensure the immediate safety

of the personEvaluate the ability of the person to give his/her consent

to our interventionRespect

protocols, procedures and professional

obligations

.

109Slide110

Contact emergency services (consent should be sought but it is not mandatory)Develop the instinct of thinking about our own safety as well

Immediate risk to safety or integrity110

110Slide111
Person’s decision-making ability

Evaluate the person’s ability to give his/her consent to our interventionAbility to give consent: respect the person’s choices

Inability to give consent: obtain substitute consent and ensure response to the basic needs of the person111Slide112

Respect protocols, procedures and professional obligationsAs established for our workplace

As part of our professional order or association, if applicable

112Slide113
Intervention objectives

Ensure the immediate safety of the personRespect the principle of self-determinationOffer assistance and protection to the elder Offer assistance to the presumed mistreating person

, when possibleAvoid doing harm113Slide114

Three profiles of elders114

Acknowledges the existence of the mistreatment and accepts the

intervention:

Provide assistance for an emergency and establish an emergency plan.Help the person find solutions.

Provide the required services or direct the person to the appropriate resources

.

Stay in touch and continue to monitor the situation;

Reduce the elder’s isolation and create a safety net;

Provide the required services or direct the person to the appropriate services;

Provide assistance in a crisis situation

.

Acknowledges the existence of the mistreatment

but

REFUSES

the intervention

Does not

acknowledge

the existence of the mistreatmentSlide115

The approachAn intervention should be:

MultidisciplinaryMulti-sectorial

Coordinated

115Slide116

Allows you to explore different intervention strategiesAllows for contributions by all intervention sectors involved (medical, legal, social)Ensures better understanding of the practitioner’s limitations and responsibilities vis-à-vis the elder’s rights. Advantages of a collaborative and coordinated intervention

116Slide117

As a practitioner, you are responsible for the means, not the ends.

117Slide118

Mistreatment interventionClinical exercise

118Slide119

Unit 4.3Intervention sectors119Slide120

The different intervention sectors

120Slide121

Family and friends’ network

The family nucleus, including the immediate family, the extended family, friends and even close neighbours

.

121Slide122

Health sector

Refers to the services offered by the

h

ealth centre or nursing station, according to the reality of each community

.

122Slide123

Community

Refers to the available community activities, services and/or resources, with or without the support of the Council or health

c

entre (or other organization).

123Slide124

Medical sector

Refers to medical services in or away from the community

.

124Slide125

Secteur hébergement

Housing sector

Refers, for example, to the living environment in which care is given, when it is no longer possible to maintain the elder at home.

125Slide126

Social

services sector

Refers to the available social services offered in the community

.

126Slide127

Legal sector, including the Band Council

Refers to such services as police, peacekeepers, lawyers, notary, etc

.

127Slide128

Mistreatment may include acts of a criminal nature.Depending on the case, legal intervention may be considered in order to:Protect the elderBring the act in question to an end

Provide compensation for an elder who has been subjected to a criminal actEnsure that the elder learns about the possible consequences of legal intervention (criminal record, ban on contact) and that the elder is directed to the right resourceLegal sector: criminal acts

128

128Slide129

Distinction between criminal and non-criminal actions129Slide130

Unit 4.4Specialized resources130Slide131
List of specialized resources

Quebec Public Curator and consent for care in a context of legal incompetence;CDPDJ (Commission des droits de la personne et des droits de la jeunesse / human rights and youth rights commission);CAVAC (Centre d’aide aux victimes d’actes criminels /crime victims’ assistance centre);

CALACS (Centre d’aide et de lutte contre les agressions à caractère sexuel / centre for relief of sexual assault);Complaints procedure.

131Slide132

Quebec public curatorwww.curateur.gouv.qc.ca1-800-363-9020

(Practitioners must consult the «pivot» (primary contact) appointed for the Public Curator in their CSSS before contacting the Public Curator directly)132Slide133

Quebec public curatorMission:The public Curator is responsible for protecting incapacitated individuals.To ensure that decisions are made in the best interest of the represented individual, taking into consideration the protection of their

rights and the safeguard of their autonomy.133Slide134

IncapacityIncapacity is evaluated medically and socially:Incapacity to person or to property;Partial or total incapacity; Temporary or permanent incapacity.

An individual is considered apt until they are legally declared inapt or incapacitated (by a judge).An individual has a right to refuse a competency evaluation (except in cases of immediate danger to self or others, or when court ordered).134Slide135

Opening of a protective regimeTwo conditions necessary (Article 145)

Determination of incapacity (inability to make decisions related to their person or property);Need for protection (need of assistance to exercise their rights) .

135Slide136

Measures of ProtectionPrivate: the legal representative is a close family member or concerned partyHomologated incapacity mandatePrivate tutorship (partial)

Private curatorship (total to person, to finance)Public: if no family or significant other available or not appropriate, the PC will represent the individualPublic tutorship Public curatorship

136Slide137

Public curatorPossible interventions … Signalement is possible to PC in order to ensure

the safety and well-being of an individual if:The person is under a protective regime (tutorship or curatorship public or private; homologated mandate)

ORA medical and

psychosocial evaluation stating the incapacity of the individual have been completed (the PC will invoke urgent interim measures if necessary while awaiting a final court decision)

137Slide138

«Audi partem Alteram»:The right to be heard Every decision relating to the institution of protective supervision or concerning a protected person of full age shall be in his interest, respect his rights and safeguard his autonomy.

(art. 257)The legal representative should always consult the person they represent and encourage respect for their choices to the extent of their capabilities. 138Slide139
According to Quebec law:

A person can not be subjected to treatment without consent (even if such care is necessary to sustain life), unless there is a court order;The medical team must always obtain the consent of the person before providing treatment (unless consent is impossible to obtain within the context of a life threatening emergency).

Consent to care under the law139Slide140

Regardless of the degree of incapacity (total or partial), the person retains his/her fundamental right to consent or to refuse treatment (exams, tests, treatments, placement, etc.) Distinction between general incapacity «in a sphere» (to property or to person) and the ability to consent to a particular treatment.

Even if a person is incapacitated, under a protective regime or not, we have to evaluate his or her capacity to consent to any new treatment being proposed .Consent for treatment according to the law

140Slide141

Five-pronged Test set out in the Hospitals Act of Nova ScotiaDoes the person understand:Their illness and condition?

The nature and purpose of proposed treatment?The risks associated with the proposed treatment?The risks associated with the refusal of the treatment?

Is the person’s current state or illness effecting their capacity to consent to care?

Evaluation of one’s capacity to consent to care

141Slide142

Civil Code of Quebec (article 16)«The authorization of the court is necessary (… ) where a person of full age who is incapable of giving his consent

categorically refuses to receive care, except in the case of hygienic care or emergency.» Categorical refusal (Kouri et Philips-Nootens, 2003): Firm ‘No’ without ambiguity;

No doubt as to the refusal expressed; Not a result of a biological reflexive response.

Categorical Refusal

142Slide143

Procedure for consent to care (for incapacitated adults)RP = represented personLR = legal representative

Adapted from the Public Curator (2009)by Ligne Aide Abus Aînés

Able to consent according to the Nova Scotia criteria

RP accepts treatment

Under protective regime

RP refuses treatment

Advise LR and provide treatment

Advise LR do not give treatment

Under protective regime

Consult LR

LR and RP accepts treatment

LR and/or RP refuses categorically

Give the treatment

Treating team must obtain court order if they want to give the treatment

Not under protective regime

Consult person who can provide substitute consent

Person who gives consent and RP accepts treatment

Person who gives consent refuses or RP refuses categorically

Treating team must obtain court order if they want to give the treatment

Give the treatment

Incapacitated person requiring treatment

Not able to consent according to the Nova Scotia criteriaSlide144

Procedure for consent to care (for incapacitated adults)Adapted from the Public Curator (2009)by Ligne Aide Abus Aînés

RP = represented personLR = legal representative144

Able to consent according to the Nova Scotia criteria

RP accepts treatment

Under protective regime

RP refuses treatment

Advise LR and give treatment

Advise LR Do not give treatment

Incapacitated person requiring treatmentSlide145

procedure for consent to care (for incapacitated adults) – cont.RP = represented personLR = legal representative

Adapted from the Public Curator (2009)By Ligne Aide Abus Aînés

145

Under protective regime

Consult the LR

LR and RP accepts treatment

LR and/or RP refuses categorically

Give the treatment

Treating team must obtain court order if they want to give the treatment

Incapacitated person requiring treatment

Not able to consent according to the Nova Scotia criteriaSlide146

Procedure for consent to care (for incapacitated adults) – cont.RP = represented personLR = legal representative

Adapted from the Public Curator (2009)By Ligne Aide Abus Aînés

146

Not under protective regime

Consult person who can provide substitute consent

Person who gives consent accepts and RP accepts treatment

Person who gives consent refuses or RP refuses categorically

Treating team must obtain court order if they want to give the treatment

Give treatment

Incapacitated person requiring treatment

Not able to consent according to the Nova Scotia criteriaSlide147

Conflicting perceptions regarding the person’s capacity to consent; Family members’ comprehension of the law;

Disputes between family members regarding «best interests» of the incapacitated person;Challenges and conflicts among the members of the treatment teams…… Clinical challenges in supporting the rights of incapacitated persons

147Slide148

Commission des droits de la personne et des droits de la jeunesse

www.cdpdj.qc.ca1-800-361-6477

148Slide149

Quebec Charter of Human Rights and Freedoms

ARTICLE 48«Every aged person and every handicapped person has a right to protection against any form of exploitation.Such a person also has a right to the protection and security that must be provided to him by his family or the persons acting in their stead.»

149Slide150

Sees to the respect of the principles in the Charter of Human Rights and FreedomsMinistry of Seniors Action Plan (2010):Setting up of a specialized team for treatment of exploitation of seniors cases (article 48)

Free services Role of the Commission150Slide151

The Commission only gets involved in situations of exploitation.“Profit from the state of vulnerability and dependence of the person to satisfy one’s own interests and, by acting this way, causing harm

” All situations of mistreatment are not situations of exploitation in the sense of the Charter of Human Rights.exploitation

151Slide152

Vulnerability of the senior ‘victim’(physical, economic, psychological dependence, etc.)Profit of taking advantage of a situation by a person in a position of strength, of power(monetary benefit or other)Prejudice for the ‘victim’

Exploitation: elements to document152Slide153
Investigation

Following a complaint or on the initiative of the CommissionConsent of the ‘victim’ strongly desired, but not mandatory(e.g., concern for other potential victims)

Expanded legal powers (Act respecting public inquiry commissions)Intervention by the Commission

153Slide154
As needed, submit request to the emergency measures court

Mediation process, amicable agreement Formulation of normal requests by the Commission to: Cease a behaviourProvide financial compensation

Request by the Commission of the Court, to obtain measures that it deems adequate.Possible interventions

154Slide155

Specialized resources

Centre d’aide aux victimes d’actes criminels (CAVAC – crime victims assistance centre)Centre d’aide et de lutte contre les agressions à caractère sexuel (CALACS – centre for relief of sexual assault)

155Slide156

Specialized resources Complaints procedure

Complaints commissionerCentre d’aide et d’assistance aux plaintes (CAAP – complaints assistance centre)Users’ committee

156Slide157

Unit 4.5Specific resources157Slide158

Specific resources concerning older adult mistreatment:- Guide de référence pour contrer la maltraitance envers les personnes aînées (Reference guide to counter older adult mistreatment)- Ligne AAA (elder mistreatment help line)

158Slide159

Guide de rérérence pour contrer la maltraitance envers les personnes aînées (Reference guide to counter older adult mistreatment)

159

https://www.mfa.gouv.qc.ca/fr/publication/Documents/13-830-10F.pdf

To listen to the Web talk on the presentation of the Guide by its creators:

http://caringvoicenetwork.adobeconnect.com/p6349p3pbd6/

159Slide160
Table of contents (p.

XXV)160

Recognize mistreatment

Prevent

Identify

Intervene

Coordinate organizations

Coordinate interveners

Know legal measures

Present solutionsSlide161
Services continuum (p.

4)161Slide162

Ligne Aide Abus Aînés – elder mistreatment help linewww.aideabusaines.ca1-888-489-2287

(514-489-2287)

162Slide163
Services provided by Ligne Aide Abus Aînés

Province-wide telephone service (free and confidential)7 days a week (8 a.m. to 8 p.m.)Services provided by professionalsInformation, listening, support

One-time intervention (crisis intervention if necessary)Guidance/referral to other resourcesClientsElders or other people concerned by a possible situation of mistreatment

163Slide164
Services provided by Ligne Aide Abus Aînés

Professional consultation service(practitioners involved in mistreatment issues/cases)Clinical and ethical discussions

Identification of the elements to evaluateSuggested avenues for action and intervention priorities (to be validated with your team)

164Slide165
Each call for professional consultation is discussed with the clinical supervisor for Ligne AAA

Where necessary, the professionals with Ligne AAA may refer to the Provincial multisectorial consultation team for intervention in older adult mistreatment of West-Central Montreal HealthLinks with West-Central Montreal Health

165165Slide166

The provincial multisectorial consultation team of West-Central Montreal Health

Social worker

Public curator

Notary

Medical representative

Police officers

(City police

&

SQ

)

Hospital and long-term care facility managers

M

istreatment prevention regional coordinator

Lawyers in civil law and criminal law

M

istreatment prevention community organization

Ethicist

166Slide167

Module 5Key points

167Slide168

Objective of the moduleBy the end of this module, the participants will be able to adequately prepare for

training practitioners concerning mistreatment. Module 5: Key points / preparing to become a trainer

168Slide169

A new perspective! Go over the content, section by section, looking through the eyes of a trainer.Taking another look at the content

169Slide170

ContextAgeing populationThe prevalence of mistreatment is difficult to evaluateCaution must be exercised in use of statisticsEven if the prevalence remains the same, more elders risk being victims of mistreatment seeing that the number of elders is increasing

Key points170Slide171
Main theories

Theories provide a framework to organize our analysisIf we have just one framework, our analysis risks being limited or biasedTheories indicate hypotheses (avenues for reflection or questions) to considerIt is the people themselves who have the answers for their own situationKnowing several theories helps us to avoid generalizations and labels

Key points171Slide172

What is mistreatment?4 important elements in the definition of mistreatmentSingle act or repeated actInadequate act or absence of appropriate action (neglect)Relationship of trust between the elder and the abuser

Harm is done to the elder (independent of the presumed mistreating person’s intentions)Avoid the trap of labellingName the situations of mistreatment and the consequences for the elderSearch for solutions to reduce or, if possible, end the harm done to the elder

Key points

172Slide173
Types of mistreatment

They are generally a composite of different types (they are not mutually exclusive)The consequences for the elder must never be taken lightlyKey points

173Slide174
Detecting mistreatment

Importance and time that must be given to detecting mistreatmentIt is a kind of violence seen as a tabooIt is difficult for the elder to disclose a situation of mistreatment and ask for help (fear, shame)Detection makes it possible to intervene in a preventative manner, rather than in a crisis situation

Key points174Slide175
Risk factors / Protective factors

A risk factor can increase people’s vulnerability to undergo (or inflict) mistreatment.It is not an indicator of mistreatment.Risk indicators and factors: avoid prejudicesAlways look at the facts objectivelyImportance of evaluating signs and risk factorsTake nothing for granted

Protective factors: positive influences that can improve the lives of individuals or the safety of a communityKey points

175Slide176
Screening tools

There are several screening tools: you must find the one that suits the situation and the practitionerTools are used to assist you for reference purposes (not to put in the client’s file)Each one has its advantages and limitationsKey points

176Slide177
Approach to mistreatment intervention

Keep sight of our legal responsibilities as practitionersImmediate/imminent safety of the elder and the practitionersEvaluation of the ability to give consentPerson able to do so: respect his or her choices and decisionsPerson unable to do so: consider protective supervision, as deemed necessaryDoubts as to the person’s ability to give consent: evaluate

Avoid judging and labelling peopleIt is the situation of mistreatment that is unacceptable, not the people involvedAvoid threatening or controlling attitudesGet back to the basics in psychosocial interventionCreate a relationship of trust

Don’t forget that the elder is the person you are working with, regardless of the pressure and demands that may come from the elder’s entourage

Key points

177Slide178
Intervention approach in

older adult mistreatmentImportance of joint action and collaboration among sectorsYou cannot intervene on your own: everyone has to be able to contribute their own expertiseIt is not your duty to know everythingYou need to know about existing measures and resources

Key points178Slide179
Intervention sectors

Be careful regarding issues of privacy and consentLegal sector: this is expertise of people in the legal world, not of social workersMistreatment may entail acts of a criminal natureCriminal charges and trials are not the only legal option for elders who are victims of mistreatmentThere are several organizations or professionals who can give information on these different options

Key points179Slide180

Available resourcesTwo specific resources to counter older adult mistreatmentGuide de référence pour contrer la maltraitance envers les personnes aînées (Reference guide to counter older adult mistreatment, available online in french)

Ligne Aide Abus Aînés (elder mistreatment help line)Public service 7 days a week, 8 a.m. to 8 p.m.Professional consultation serviceFor discussion of clinical and ethical issuesSuggestions and intervention strategies must always be discussed with your team (at your institution or facility)

Key points

180Slide181

Module 6Facilitation skills

181Slide182

Objective of the moduleBy the end of this module, the participants will be able to plan and

facilitate a training session. Module 6: Mistreatment intervention

182Slide183

Importance of adequate planningContent and exercises Logistical organization See Appendix 1 (Checklist – Preparing for a Training Session)

Planning183Slide184

Plan with the people in chargeWho are the targeted participants? How many participants will there be? Limit the number of participants if necessary (be careful not to accept groups that are too big

)What do these participants need to know?What will be the length of the training?

184Slide185

Plan with the people in chargeWhat will be the responsibilities of each person?Person(s) in charge vs. trainer(s): who plans what?

What are the internal policies, protocols and mechanisms of the facility to respect if the participants encounter situations of mistreatment? Who should they turn to and who can support them?185Slide186

Planning the contentWhat sections of the material will be presented?Go over all the content to be presentedIdentify the important elements to get across, section by sectionHow to verify that the content was well presented?

What exercises will you give?Check to make sure you follow the schedulePlan to spend half a day preparing for each day of content that will be presented

186Slide187
Planning the use of time

Make sure you have the time required to present the content and do the exercisesGeneral estimations of time required:2 minutes per slide5-10 minutes for animating a

discussion including questions put to the group regarding the content10-20 minutes for a video (including facilitation)30-45 minutes to do a clinical case study187Slide188

Logistical planningDistribute responsibilities among the co-facilitators: management of technical aspects, note-taking, etc.Reserve the roomMake sure the room is adequate for accommodating the participants and planned activitiesMake sure you have all the material and technical equipment you need, particularly if the training is in a building you are not familiar with (Internet access, etc

.) 188Slide189

Logistical planning (cont.)Have the contact info. (cell phone no.) of a resource in the facility. If possible, visit the facility ahead of time.Reserve the necessary equipment (computer, projector, flipchart board and pens, television and DVD player if required)Have a list of participantsPrepare photocopies for the participants’ folder (case studies, brochures, etc.)

If you have a large group, prepare a box that can contain various documents to facilitate their handling and distribution189Slide190
Facilitation

“Is listening enough for learning to take place and is talking enough for teaching to take place?”

- Michel Saint-Onge190Slide191

Participants’ expectationsTrainer’s expectations (confidentiality, respect, etc.)Organization of the training(breaks, questions, etc

.)Establish a group contract191Slide192
Listen attentively to the group

Know how to respond to the group’s needs and expectationsObserve the groupThe body language of the group lets you know if all is going well or if there is something presenting a difficultyBe aware of how you express yourself verbally and non-verbally

Listen and observe192Slide193

It may happen that you will be training colleagues who might have as much or more experience than you doPresent the training as an opportunity to share ideas and knowledgeNever call the participants’ skills into question

Show that you recognize and value the experience of the group193Slide194
Each group is unique and develops its own dynamic

One of the roles of the trainer is to know how to adapt himself or herself to the group’s dynamic in order to enhance the quality of the learningObserve the group’s dynamic

194Slide195
Group where the members don’t take risks

The participants don’t feel comfortable and do not participate fullyGroup where the members talk too much The challenge is to keep the participants focused on the topic and to respect the amount of time availableGroup where the members are too dependantThe trainer is seen as an expert who knows everythingPresence of subgroups in the groupCommunication is reduced to subgroups

Adaptation to the group’s dynamic195Slide196

The participants are interveners who provide concrete examples based on their own workConcrete examples allow for better assimilation of the contentAvoid letting discussions on clinical cases turn into evaluations

Do not take the place of a clinical supervisorBe attentive concerning expectations (more or less explicit) of seeing the trainer as an expert on the topic of mistreatmentBe careful concerning peer judgements

196Slide197

Know how to read between the lines and reframe the discussion if necessaryInterpersonal conflictsMention of dissatisfaction concerning the workTransfer of diverse emotions (feeling of guilt or powerlessness regarding certain interventions, etc.)Critique of the institutional structure or policies

, etc.Pay attention to organizational issues

197Slide198

Choose appropriate exercisesContent to be illustratedAvailable timeLevel of personal comfortGive clear and simple instructions

What do they have to do? How much time do they have?If you ask a question, wait for the answer!!!!Facilitate the exchanges by making links with the content covered (10-20% to be retained)The possible “answers" and questions that are provided are just examples: you must follow the group!

Facilitation of a clinical exercise

198Slide199

“We will look at this aspect later.”“That element is not covered in this training.

”“I don’t know the answer to that question (but here is where you will probably find the answer….).”

Get the group involved in the question.

Avoid giving miracle answers.

Know how to answer questions

199Slide200

Co-facilitation of a training session can be a highly positive and rewarding experience, as much for the trainers as for the participantsBut its success is based on various elements that come into play before, during and after the training.  For successful co-facilitation

200Slide201
Be well prepared (division of the work, links between the parts

)Know and identify the strengths and weaknesses of each co-facilitator (and distribute the content between them to help with the facilitation of the training)Establish an ‘emergency plan’ in case a co-facilitator loses his or her train of thoughtDetermine which person will take the lead in the training overall (for this to work well, you must have agreement on each person’s role)

Set guideposts and clear signs among yourselves , with which you will be comfortable (for purposes of ensuring good communication the length of the training)

Before the training

201Slide202
Be aware of visual contact and/or physical proximity

Be attentive to the group and your co-facilitator when it is his/her turn to speak. The co-facilitators are always and jointly responsible for the effective running of the trainingEnsure that the co-facilitators support each other during the training (manage the order in which participants speak, be aware of changes in the group’s dynamic, manage the time, etc.)

Compensate for or return to questions raised by the groupDuring breaks, don’t hesitate to respectfully mention your co-facilitator’s strong points and the ones to work on (to refocus the training)During the training

202Slide203
Take the time to review the training

Don’t hesitate to respectfully point out the strengths and areas to work on of your co-facilitator (to improve future training experiences)Remember that the success (or the failure) of the training is the responsibility of all the trainers and not just one person!

After the training203Slide204

Prepare properly before each sessionAlways keep in mind the 10-20% of material that you want the participants to retainContact Édith Picard Marcoux (FNQLHSSC) for support and additional information about the trainingsFor professional consultation, contact Ligne Aide Abus Aînés 1-888-489-2287Have confidence in yourself

!For your future training sessions

204Slide205

In conclusion205Slide206

Preparation, design, adaptation and delivery of the training

Édith Picard-Marcoux

Coordinator – Elder mistreatment

Sarita Israël

Coordinator – Leading Practices for the Prevention of

M

istreatment of Older Adults – West-Central Montreal Health

Barbara Boutin

Intervener and Trainer

Ligne Aide Abus Aînés (elder mistreatment help line)

Marie-Eve Manseau-Young

Research agent and Trainer

Ligne Aide Abus Aînés (elder mistreatment help line)

206Slide207
Acknowledgements

Steering Committee – FNQLHSSC

Isabelle Cornet – Nurse – Trainer

Mathieu-Olivier Côté – Research Agent

Denise Picard – Elder, Wendake

Julie Taillon – Educational Advisor

Isabelle Verret – Health Care Liaison Agent

Laurie Villeneuve – Human Resources Agent

207Slide208
Credits

Graphic designMireille GagnonBinder coverIllustration: freepik.com

208