Recognizing and Addressing Elder Abuse in Tribal Communities

Good afternoon, everyone, and welcome to the first webinar in our Tribal series. This one is Recognizing and Addressing Elder Abuse in Tribal Communities. My name is Keeley, and I just have a couple tech things to go over with you today. Your microphone and video have been disabled and will remain off. The PowerPoint and recording will be posted on the Elder Justice Initiative website in the following week, so keep an eye out for that. Closed captioning is available via the show captions button at the bottom of your screen. ASL interpretation is available via the interpretation button at the bottom of your screen. And if you need any technical assistance during this webinar, please use the chat to message our technical support specialist, Bess Hoskins. And now I will pass it over to Talitha Guinshaper from the Elder Justice Initiative to get us started. Hi, everyone. This is Talitha. It's nice to have you here today. Thought we would start with a couple of polls. I'm wondering if you could let us know what your profession is so we can get a sense for our speakers of who is in the room with us today and maybe tailor some of our content towards your needs. So you can go ahead and fill out that poll. In case you are having difficulty seeing the poll, your options here are an administrative professional, attorney, law enforcement representative, a medical professional, a psychological services professional, social services, including adult protective services, or a victim services specialist. And then whenever we have enough votes in, you can let me see the results and we'll review those. Okay, great. So it looks like we have lots social services here today, some law enforcement, victim specialists. I love seeing our victim specialists join us. That's a group we've really worked hard to bring into the fold. So thank you all for being here so much. Let's go ahead and move to the second poll. If you are law enforcement, we're wondering if you can let us know if you work with a tribal agency or a non-tribal agency. This is intended to be a cross-training and we'll have content both for tribal and non-tribal law enforcement personnel. It would be good to get a sense of who's in the room. And then Keely, when you're ready, you can share the results. Okay, great. So mostly non-tribal personnel, but thank you for everybody who has joined today. And then we have one final poll. And for everyone else, we're wondering if you could please let us know if you have worked with tribal communities, worked or are working with tribal communities. And again, Keely, you can show us the results whenever you're ready. Oh, great. Well, we're pretty evenly split there. So this is wonderful. We can go ahead and move to the next slide. I think one of the goals of the training today is really looking at the cross education where we can all learn from one another and work better with Native communities. I work with the Elder Justice Initiative. We're hosting this particular webinar. And specifically, I work with the MDT Technical Assistance Center. You can go to the next slide. We have lots of resources available on our website for every profession that might intersect with the older adult population. Some of the highlights I wanted to bring to your attention are our MDT guide and toolkit to help you start and sustain your elder abuse MDT. We have a link to important research, prosecutor's videos, outreach materials that you can take and customize and use in your community, and links to other webinars and trainings that are recorded that you can find on our website. Next slide. I wanted to go ahead and introduce our speakers today. We'll be hearing from two speakers. The first is Margaret Carson. She's worked with elders for over 40 years and is a licensed mental health counselor and geriatric mental health specialist in Washington State. She has over 20 years experience with Adult Protective Services and has helped the Muckleshoot Indian Tribe implement their own APS program where she is now manager. She is also a consultant for the International Association for Indigenous Aging, or IASquared, and her interest is in utilizing restorative justice approaches. After her presentation, you'll get to hear from Judith Kozlowski, who is an independent elder justice consultant. She's been on lots of our webinars here. She might recognize her from many places, but from our trainings as well. She is currently an advisor for IASquared, and she is a senior fellow at the Women's Institute for a Secure Retirement. She is a former state and federal prosecutor, and ran a federal elder abuse multidisciplinary team for over a decade. She has done elder justice policy work at a variety of federal agencies, including ACL, and she is a frequent speaker on issues of elder justice and women's economic security. So, thank you both so much for being here today. We really look forward to the expertise that you can bring to this topic, and I'll turn it over now to Margaret. Hi, I'm Margaret, and thank you all for coming. As we mentioned, I'm also a consultant for IASquared, which is the International Association for Indigenous Aging. The IASquared was created in 2002 by Bill Vinson and Dave Baldridge as a small non-profit. The organization began its 20-year history, and they're making significant policy and practical contributions in the field of American Indian and Alaskan Native elder abuse and elder well-being, topics that still command significant national attention. They've continued the innovative leadership roles and aging advocacy today. It's a non-profit, and the goals are to ensure the provision of appropriate quality services and resources for Indigenous elders, expand opportunities for elders' involvement in environmentalism, community participation, health maintenance, volunteerism, civic engagement, consumerism, and senior enterprise, enhance the protection of the rights of elders, including their freedom from abuse and neglect, and their right to autonomy, and then an education focus on educating the public policy makers and practitioners about the status of Indigenous elders and improving the status of older people worldwide, especially Indigenous populations. The initiatives of IASquared currently are brain health, wandering, caregiving, vaccines, and elder justice. Today, I'm going to be focusing on elder abuse in tribal communities, and we'll start with a little bit of a definition and some parameters about what elder abuse is. According to the National Center on Elder Abuse, it's estimated that for every reported case of elder abuse, there's about five more incidents that go unreported. So we estimate that it's a very underreported issue. Part of it is that there's some cultural issues about reporting elder abuse, that there's just some concern that it still is being underreported. The rates of elder abuse are higher among elder Native Americans, both on and off tribal land. There's higher prevalence of neglect by a caregiver, higher prevalence of financial exploitation by a stranger, higher prevalence of emotional abuse, which is also mental and psychological abuse, and higher prevalence of abuse over a lifetime. Almost one quarter of older Native Americans and Alaska Natives reported emotional abuse, and a factor is low social support is a significant factor in elder abuse. The maltreatments or types of abuse are, and I'm sure that all of you, Adult Protective Services staff know the maltreatments, but we'll specifically go over these for law enforcement, because one issue that there's the maltreatments may not correspond directly with a crime. And so some of the things we investigate and look into may not be criminal activity, but they may be things where we may have an issue where we could do family meetings or a protection order or another kind of an intervention for the various types of maltreatments. And the types of abuse are physical abuse, which it correlates pretty much with assault. It needs to be something that's done willfully or on purpose rather than an accident. Neglect, which would be the criminal, would be like a criminal mistreatment chart that basically is not taking care of an elder or vulnerable adult. Sexual abuse, non-consensual sexual activity, and spiritual abuse, which is interfering with the spiritual beliefs and practices of our Native American elders and vulnerable adults. And it's something that we included in Indian country because it's really an important aspect. Financial abuse, which is the criminal, would be theft or fraud. Abandonment would be leaving an elder or vulnerable adult without care. And then self-neglect would be if an elder or vulnerable adult is not taking care of themselves, particularly if they lack the ability to make their own decisions. And one of the big issues with the maltreatments is that it's often that the maltreatments will occur at the same time, so there'll be more than one maltreatment at a time. For instance, there may be financial exploitation, but also neglect going on or spiritual abuse or mental abuse. So it's not one and only, but it's a combination of things that occur that Adult Protective Services takes a look at and tries to do positive interventions in the community. In the domestic violence world, we generally look at the power and control wheel. And the power and control wheel was originally devised for victims of domestic violence. And the power and control wheel here is the power and control wheel that was devised by the National Clearinghouse of Abuse and Later Life. And it was particularly created for issues relating with elders rather than with younger women. And so there are some specific issues that come up. We're going to go over the issues in the power and control wheel in detail, but I wanted to point out, next slide, that in Indian country, we would only put something sacred inside of a wheel. So we really don't use a wheel. Instead, we look at a triangle shape and put the issues in a triangle instead of a wheel, because it's more respectful. And so we have two different types of triangles that are available to us. And there's this one that you'll see in front of you. I know it's a little bit fuzzy. And then the next one, next slide, is from the National Indigenous Women's Resource Center. So there's two that have been created. We'll go over each of some of the issues involved, some of the dynamics involved. Next slide. So some of the dynamics that are involved is that the wrongdoer or the person creating the problem, the person that's creating harm, would isolate. And they would do this through, they would deny communication through phone, computer, or transportation. They would limit time with family and friends. They wouldn't allow participation in cultural activities or ceremonies. So basically isolating activity from other people. And they would use this as a method of control and power. The next way would be they're using privilege. They would make aegis remarks, comments and assumptions, stating that someone might have a dementia process because they're an elder, saying that someone didn't have the right to make their own decisions because they're older, and would step in and make decisions for elders. When the elder is perfectly capable of making their own decisions, they would step in and be controlling and try to control the situation. They would use family members. They would deny the access to adults, children, and grandchildren. This is really an important thing is that someone, a common thing that would come up is that someone, we might get a report that the alleged perpetrator could say something like, if you don't do what I want, give me money, or go along with what I want, that you can't see the grandchildren or the children. So they would use that as a tactic to get control. They wouldn't provide all the information to family members about illnesses or conditions, and there could be threats towards family members. The exploiting financially would be stealing money, using money for personal needs or wants instead of using the money to benefit the elder, and then not providing information or updates on the elder's finances. So stepping in and taking control of everything, using money to benefit them. The definition of financial exploitation usually includes that the person uses the money for their own benefit rather than for the benefit of the elder and vulnerable adult. There could be ridicule, ridicule of the personal cultural values, using religious and personal views and values to control, for example, of divorce, threatening divorce, using tribal beliefs and customs with bad intentions, using one's tribal affiliations against a person, not allowing one to honor their cultural values. And this is under spiritual abuse, denying access to spiritual events and traditions, preventing the elder from attending and practicing cultural, spiritual, and religious events and ceremonies. Or even simple, like interfering with the elder setting up a traditional altar in their own home, or taking heritage personal property, such as drums or fishing equipment, and selling that. So this would also be an example of spiritual abuse. So who commits elder abuse? Well, a lot of our cases indicates that it's family members are the ones that are often named, but there's also caregivers, a person with a special relationship with the elder. So this would be defined as using undue influence or using the relationship as a way to gain control. Adult children, grandchildren, and then of course spouses or partners. Some of the barriers around getting help are there's cultural values and protections that there's often a, there's often, there's a reluctance to come forward to admit because of shame or because of the cultural values to admit that it actually occurred, to come forward and to trust somebody with that information. There's fear, being afraid of repercussions, such as using the grandchildren, or there's often there will, would be a threat to put somebody in a nursing home or a facility, being a battered or being abused. There's hopelessness, despair, and depression that comes from being abused. There's health concerns, having a medical problem to where the elder or vulnerable adult would need help and that would have fear that if they would come forward that their health concerns would not be addressed. And also having being in a vulnerable state or a condition where that somebody would be in a weakened condition and wouldn't be as strong as they were maybe when they were elder because of their, because of some physical problem. And then financial concerns. One of the exercises that we often do in our workshops is that we give people, we break them into groups and we have, we give them a certain amount of slips of paper that represent money. Then we have the, we have some different scenarios that we set up. What would you do if you only had a certain amount of money and you're, would you stay in a hotel? Would you go stay with a family member? So particularly in cases of financial exploitation where the person has stepped in and has taken control of the finances, there's some real financial barriers around, around assisting or getting help or getting out of the situation. So some of the barriers are that the question that is often asked of us is why don't they just leave? And these are some of the reasons, but I think the financial concerns is a very important barrier because if somebody doesn't have money, then they have to reach out and possibly get a protection order or assistance from an agency or from our tribe to get out of the situation. In general, in working with tribes, if you come across someone who is, you think might be a tribal member, but you aren't sure, ask which tribe which they're enrolled in or connected to. And this is important because each tribe has their own policies and procedures and resources. So you would want to, rather than connecting somebody with just an individual resource, there's, of course, we have our resources, but if somebody is a tribal member, you would want to contact the tribe or the tribal representative, but always ask and get permission before contacting them. And there might be a memorandum of understanding, memorandum of agreement, or some kind of a cooperative agreement as there may be procedures that are already in place or contact people that you should notify. So just ask what tribe they're affiliated with and then go from there. I could need permission so you can connect the person with an appropriate tribal resource to make sure that the cultural issues are addressed. And some of the things we've done here with the Muckleshoot tribe is that I have helped the tribe create their own elder protection program, but there's a real difference. I worked for the state of Washington for many years, and we really offer different services. We provide a restorative justice focus here, and we do some things that are very different than in the outside community. And so some of the things we do specifically that are enhanced services that we do that the outside community doesn't is that we have a policy where there's a need to, if there's a need or a desire to make a police report after a crime, because of the trust issues involved, we have our advocates and our adult protective services investigator will have them assist to make an elder or vulnerable adult to make the police report. And so they'll actually make the call for them or with them and then stay during the interview. And this is really important because there's a number of barriers about involving the police, particularly lack of trust or lack of outside systems because of historical trauma. This historical trauma would include the mistrust of government in general because of the past history. So it's really important not just to assume the person wants to make a police report, or if they do, to assume that they're just going to call and not have issues about trust. So we have policies and procedures where we actually will assist an elder to make a police report and stay during the interview. We also coordinate services and referrals, including assisting an elder with banking after fraud or theft. So if there's an issue, how would the person change their banking around? So we would provide transportation to the bank and we would go and we would assist in creating and working on those issues. We also have our own, we have like a credit counselors, we would help the person to make reports to the credit agencies and to make sure there isn't identity theft. So we have some enhanced services in terms of our social services, not only through adult protective services, but we also have victim services and then specific people at the tribe that we make referrals to that assist us with the restorative justice. And then there's a number of different types of meetings that we have that are specific. The state usually has, they have the MDTs, the multidisciplinary teams. We have a number of different types of interventions for meetings. We have the family meetings, we have the case staffings. Our case staffings are what I think that in the outside community, they would call the MDTs. The case staffings would be a set meeting with a number of individuals that would meet week after week. And then we specifically have a elder protection team meeting and the elder protection team meetings are meetings where we would involve the elder in a specific intervention where we would have, where we would ask the elder what they would like to do in terms of creating some kind of a situation where they would decide what would happen. So we would have an elder protection team meeting and these are set up in terms of that the elder would get to decide who comes to the meeting. And we would have a, it would be a concern. Everybody at the meeting would be similar to a circle approach where everyone at the meeting would contribute about what the concerns would be, what ideas would be to resolve the situation. And then in terms of coming up with a plan, the elder would choose a plan. So we might do something that would be very innovative like doing an intervention. It would be something where we would offer a number of different options that the elder would get to choose what their plan would be rather than us choosing a plan for them. We also use ban lists. These are things that came out of the, actually our elder protection team meetings that came out of something is that some of the elders wanted to have a list of people that were coming to their homes. And so we would create a ban list and post it on their door. And we found these to be actually very effective so that the, you could go around on the reservation and see a list that was posted on the door at the elder's, at the elder's request that certain people would not be allowed. And if they continued to come to the home, we could offer a protection order. And these are things that actually, even though it's an innovative approach, it has been very effective on the reservation so that an elder won't be bothered or harassed by certain individuals because there's a sign on their door. Do not, don't knock, don't bother me. And this has been a specific tribal intervention that we've created. The other thing that we create is we create our house rules and informal agreements. So at the elder protection team meeting, we might come up with a list of house rules and then we would go to the home and we would give the house rules to everyone that would be there. And typical house rules might be that, that everyone would, the people in the home would need to either be, they'd need to be productive. They would need to be either in school or have a job or have some kind of a, something productive. There'd be no thieving in the home, no drug use. There might even be a provision where there would be no visitors after a certain amount, a certain period of times. For instance, the, like, there couldn't be someone coming like maybe at, at 10 o'clock at night, all doors and windows would be locked. And all of these interventions are things that are worked here. So the reason I'm giving the examples of the enhanced services is that each tribe could come up with their own plan or their own interventions that could be creative, but it doesn't have to necessarily just be the, what's offered in the, in the outside community. We do a lot of, of tribal protection orders follow up in monitoring. So not only do we get a lot of the, the, we do a lot of tribal protection orders. We, we only have 350 tribal members, tribal elders, and we have that amount per year, but we do over, we monitor between 50 and a hundred elders with our elder abuse hotline. So someone would go in and we get a protection order. We do at least 50 per year. They could ban someone from their home, but the idea is not to ban them and just close out. Our case would be to follow and to make sure that the provision would be set, that they would be getting, that the family member or someone would, would pay restitution. And they could also get assistance in terms of, of following up with weekly phone calls to make sure that, that the protection order was working and that then make referrals to other agencies, including the, for drug and alcohol treatment. And then when the person completed their treatment, then the order could be lifted. So it's really a restorative justice approach, why we do so many protection orders. And the, we also have, we have no soliciting signs. So we have signs that we post at the particular, the, if an elder is having problem with people coming and asking for money, we'll create these, we'll create a yellow, no soliciting sign and put them on their door. Next slide. And then the, some of the concerns with the interfering in the interviewing and trauma concerns is that the, it's just important to interview the elder only once to not re-traumatize the elder and vulnerable adult. So when, when police particularly are interviewing, it would be important to, to contact victim services or adult protective services for assistance and to have some cultural sensitivity and privacy as elders can be embarrassed about what happened and not want to disclose. And there's also cultural factors about not wanting to talk about problems, especially if family members are involved. So thank you for attending. There's a link to the, to the website, which I would encourage everyone to, to, to access and to also to look at this. There's some additional resources, some really valuable resources. So you can download the resources, you can learn about our cutting edge efforts, and you can also subscribe to the IA Square website. Thank you. And the next person is Judith. So Judith, take it away. Thank you, Margaret. We are going to talk a little bit this afternoon about some of the, our approach at IA Square to discussing restorative justice and looking at some of the jurisdictional issues that all the tribes face when dealing with elder abuse. Next. So what are some of the things that we, we consider in, in discussing the issues of elder abuse with tribes? One is recognizing that elder abuse is, is complex. It is not a singular event. And respecting tribal sovereignty of each tribe. As Margaret pointed out, every tribe has their own approach. And in respecting their tribal sovereignty, it's important to understand where the tribe is coming from on that particular issue. And next, we also are, we've had very good discussions with many different tribes on the issue of data sovereignty, because I'm sure as many of you are aware, sovereignty data from tribes has historically been misused when obtained or used by the community, by others outside the community. And tribes are very careful to maintain the control and over the data of any member of their tribe with regard to anything. But particularly with regard to elder abuse, it is an extremely sensitive topic within each tribe. And there is a very important under, you need to have a very important understanding about why we need to maintain or help the tribe, rather, support the tribe in maintaining that data sovereignty. Also, we also look at the, tribal history and culture to be able to understand where the tribe is on the continuum of discussing elder abuse and traditionally how elders were treated and revered within that culture. And understanding the historical and cultural role of restorative justice at each tribe. Because, as Margaret pointed out, in many cases of elder abuse in tribal nations, the first response is to look at what is the best restorative justice approach to dealing with each and every case. And they are different from tribe to tribe. And also understanding where each tribe is with regard to recognizing elder abuse. We provide support to the tribes in helping to create and supporting and supportive responses to elder abuse within the tribes. And that also includes sometimes using resources outside the community to be able to support the response that the tribe seeks. Next. So, here are some of our also challenges to some of the jurisdictional issues. We have been supporting the tribes in using MOUs and cooperative agreements with local and state law enforcement in tribal elder abuse cases. And helping them, and we're trying to create a group of sample MOUs and cooperative agreements that have been successful between tribes and states in which they are. But again, we have to go back to the issues of tribal sovereignty and discuss whether the tribe wants that information disclosed. If so, how? We are providing support to tribal APS. And we've been working very much and we're very interested in supporting the tribal APS now that there is some limited funding to create tribal APSs in tribes across the country. And to work with the tribe, with the local and the state law enforcement and the state adult protective services workers to be able to address the elder abuse cases that may occur in the tribe. And we're supporting relationships between tribes and the federal government and federal law enforcement in recognizing elder abuse. We have been providing support to urban Indians as well in creating supportive responses to elder abuse across those jurisdictions. And as you may well know, those jurisdictional challenges can become extremely complicated. But we have been very active in working with urban Indian groups to be able to provide support on this particular issue. Next. So what are some of the challenges? The big question is how does the tribe wish to proceed? That's number one. And what are the issues to be considered? And what is the role of restorative justice in this particular case with this particular tribe in this particular moment? So as I said, we are very respectful of tribal sovereignty, including tribal data sovereignty. Another question is, is the tribe, the public law 280 tribe, and therefore required in some way to work with the state? And that could be through cooperative agreements. Sometimes it's ceding some of the jurisdictional control to the state or the federal government. So I think that it's very important when approaching these cases to understand if you're dealing with a 280 tribe. And the question, of course, is who has been harmed and who caused the harm? And from what tribes are those individuals? Often they are from the same tribe. Often they're not. So it's very important to understand the cultural and historical basis of both the person who was harmed and the who caused the harm. So where did the harm occur? Was it on tribal lands? Was it not? Was it an urban elder who was not on tribal lands at the time something occurred? But what does that mean as far as what case would be or how a case would proceed and understanding the jurisdictional issues with the tribe of the person who was harmed? So all of those factors will determine in large part how jurisdiction can be decided. And there are special considerations, as I said, for urban Indians. We've worked in training the state and APS workers asking to ask specifically about tribal membership because, as Margaret pointed out as well, it's very important to ascertain whether an individual has a tribal membership and, if so, how that tribe would deal with an elder and what would be the role of how that tribe would wish to address any issue concerning any of the elders from that tribe. Next. So we've been working quite a bit with tribes looking at their tribal codes. Some have elder protection codes that are incorporated into the tribal codes. Some of them have elder protection codes that travel independently of the tribal code, although consistently in parallel to that. And some tribes do not have elder codes or elder do not have codes or elder protection codes. Instead, they may have a resolution that will have to do something with elder protection or recognition of the special place of