In this CVR podcast series, we talk with those doing research and serving victims and learn about the work they've done together.

Tell Us About It Episode 31: Learn from NAPSA’s Research to Practice Team: Collaboration is Key

A convo with Marian Liu and Mariah FrearkOct 01Time: 30:00

Summary: Marian Liu, an assistant professor at  Purdue University, and Mariah Freark of the Massachusetts Disabled Persons Protection Commission join Susan to discuss how the National Adult Protective Services Association (NAPSA) uses data and research to study adult victimization. Marian and Mariah’s relationship through the Research to Practice Interest Group brings practitioners and researchers together to better understand and more fully comprehend the various aspects of — and how to improve — adult protective services.

Transcript:

Susan: [00:00:00] Welcome to “Tell Us About It: Victim Research Convos,” a podcast from the Center for Victim Research with support from the Office for Victims of Crime. On each episode of “Tell Us About It,” we talk to researchers and practitioners about their work, the tools being built for use in the field, and how we can work together to build an evidence base for victim services.

Susan: [00:00:19] Today, we’re talking with two members of the Research to Practice Interest Group at the National Adult Protective Services Association, or NAPSA. With me are Marian Liu, assistant professor in the school of nursing within the Center on Aging and the Life Course at Purdue University, and Mariah Freark, assistant general counsel for the Commonwealth of Massachusetts Disabled Persons Protection Commission. Welcome to you both. Let’s start with learning a little bit about NAPSA and the role that each of you have within the organization. Marian, why don’t you start?

Marian: [00:00:56] Absolutely. So NAPSA, the National Adult Protective Services Association, is a national non-profit organization with members in 50 states. So NAPSA provides adult protective services, which are referred to as APS. So the APS program is a form of sharing information, solving problems, and improving the quality of services for victims of older and vulnerable adults of mistreatment. APS agencies operate on state, local, or county level, and they receive, investigate, and provide services to vulnerable adults and older adults who experience abuse, neglect, exploitation, and self-neglect. So our NAPSA Research to Practice Interest Group is one of the NAPSA’s committees. So we have two co-chairs. So Carol Dayton represents the practitioners, and myself, Marian Liu, I represent the research part of the arm. So as a researcher, my academic affiliation, as mentioned, is with Purdue University. I am an assistant professor on training psychology and I’m working at the school of nursing. So as our co-chair structure shows, our group welcomes both practitioners and researchers. Members of our research group include current and retired APS administrators, practitioners working on vulnerable adult and justice issues, federal government officers, agency researchers, and academic researchers. And we welcome new members interested in vulnerable and older adult justice issues.

Susan: [00:02:27] Marian, how long have you been with — been part of this interest group, or even how long you been with NAPSA?

Marian: [00:02:33] So I joined the research, this interest group, back in 2013 I believe. And I became one of the co-chairs in 2014 when the research co-chair retired at the time.

Susan: [00:02:47] Okay. Mariah, how about you? What is your connection to NAPSA and how long have you been with the organization?

Mariah: [00:02:54] So I’ve been a member of NAPSA and the Research to Practice Group for a couple of years. I want to say 2015, 2016, something like that. So I’m one of the attorneys at the Disabled Persons Protection Commission in Massachusetts, and Massachusetts is unique in that we have a bifurcated APS system. So my agency has jurisdiction over adults with disabilities between the ages of 18 and 59 who are abused or neglected by their caregivers. And then there’s a separate state agency, the Executive Office of Elder Affairs, that handles abuse of older adults. So and that kind of ties to my role in the Research to Practice group, I’m obviously not a researcher, I’m very much a practitioner. So mostly I participate by listening and thinking about things and maybe providing input from my perspective as a practitioner, but as a lot of the group members will tell you, one of the things that I do pretty frequently is to advocate to ensure that the interests of all vulnerable adults and not just older adults are considered in our research to practice projects. I think a lot of times — and this is just the way the field sort of grew up — people use adult protective services and elder protective services to kind of mean the same thing, and I am, I am there to remind them that that’s not always the case, and we have a more broad population of people we work to protect.

Susan: [00:04:18] Alright, thank you. Marian, at NAPSA, what was the impetus or the driving force behind creating this research to practice interest group?

Marian: [00:04:28] Absolutely. So the mission of our interest group is to provide guidance, expertise, and feedback regarding data collection, data analysis, and other research activities with the goal of creating a strong link between research to practice. So I believe our research group was dormant for some time until our co-chair, Carol Dayton, got invited to reactivate the group by invitation of NAPSA about 10 years ago. So I want to say it was around 2007. So the research group demonstrated NAPSA’s commitment to add good research to the field of APS work. So, Carol Dayton proposed that we have this practitioner and researcher co-chair model, and she invited researchers from the National Committee for the Prevention of Elder Abuse to join the committee. So you could probably say that the efforts to bring both researchers and practitioners together, it was intentional from the very get go.

Susan: [00:05:25] The field of elder and vulnerable adult abuse prevention and response has always been stretched thin. Marian, how does this Research to Practice Interest Group work with very busy practitioners to get them to engage with research?

Marian: [00:05:41] So starting with our committee members, no matter with practitioners or researchers, since both groups are very busy, so we meet only once a month. We have active committee members devoting their time to organize journal clubs — that happens every other month and webinars that happens quarterly. I also serve as a liaison between the research group and the APS regional representatives by attending their monthly meetings to keep APS administrators informed about the research activities that, that’s hosted by our research group, but I also report back the APS regional representatives’ activities to our research group so that it stays a little bit of the time for both groups.

Susan: [00:06:28] Mariah?

Mariah: [00:06:28] Oh, so we also work to raise awareness of how practitioners can start exploring the possibility of working with researchers through two documents that we’ve created that we have on the NAPSA website. So the first is Guiding Principles for Research in APS. And then we have another one about resources on evidence-based and evidence-informed practice in APS. Because a lot of times for practitioners, examining professional practice, like looking at risk assessment tools or client outcomes, is — can be an uncomfortable, like, proposition just because you’re concerned about client privacy. And one thing that’s unique about the world of APS is unlike other public health fields like child protective services or domestic violence, there’s no federal funding for APS, so we are funded exclusively on state and local levels. And practitioners fear that if research is done, there might be, the outcomes of that research might be something that’s perceived as negative, which could then negatively impact funding for APS, which is already pretty limited. So we work with practitioners to try to help them understand the benefits of working with researchers and working to calm their fears about, you know, if they want to interview people who receive APS services, it’s standard practice to have informed consent before you do those interviews. They’re not just going to, like, start calling people up and asking questions willy-nilly. And then also to help emphasize that outcomes can be used to support requests to your local funder, your legislature, whoever, for additional funds. They can show the need that APS has for that extra money. So we really work as a group to balance the practitioners’ concerns with the need for increased knowledge and ultimately improved protection for vulnerable and older adults.

Susan: [00:08:34] That’s great. And you know, those barriers that you mentioned for practitioners, that just really rings true across victimizations. There are so many settings where practitioners who are not accustomed to working with or having a good relationship with researchers aren’t sure whether to trust the process or what the results will be. And I think most of our listeners probably did not understand that APS does not get federal funding, that the funding is so precarious, even though that population is, has such need for strong protective service.

Marian: [00:09:10] So, yeah, so you know what, as a researcher who works with local and state APS, I would say that I would try to be very mindful of the time constraint of our practitioners and I would explain how the result would be beneficial to the client and to APS programs. It is not always easy. I would say that what I would try to do is I try to say, well, research is not a one-time deal. You don’t go in and come out and get everything that you want. It should be a collaborative process to learn from each other. So what I as a researcher, I would try to make sure that I envision the risks that might come in the way of APS, and I try to explain that as clearly as possible as I can to APS.

Mariah: [00:09:57] And then as a practitioner, I personally really realized the practical importance of research when I started writing grants. I just noted that there’s not a federal, dedicated federal funding stream for APS, but there have been a couple of rounds of grant funding. So 2015 was a big deal because that was when the first round of funds became available. And I had a really tough time writing our problem statement because I’m not a researcher. So for me, there was so much about our proposed project that was intuitive. Of course, people with disabilities are more vulnerable to sexual abuse. Of course, people with intellectual or developmental disabilities would benefit from trauma-informed services after abuse. Of course, a collaborative approach to service provision is going to work better than one agency trying to solve all these problems. But my executive director told me that federal funders would not be swayed by my internal logic and I needed to find some sources. So that was what I really started paying attention to the research that was out there. Any successful grant application needs to be grounded in something. And I struggled because there’s not a lot out there on APS or on abuse of vulnerable adults, and, and there’s even less available on abuse specifically of our population of younger adults. A lot of it skews toward abuse of older adults. So now I’ve got a standard footnote that I include in the grants that I write explaining that the research we’re relying on isn’t on point and it is not exactly up to date, but it’s it’s what I got. It’s what’s available and it’s the best I can do. So for me, having more research that does specifically address the issues that we’re having and that has been generated and even in the last decade is something that’s really exciting.

Susan: [00:11:43] Those were all excellent points. Now let’s talk about the researchers. Marian, as a researcher and as someone who works with researchers, how does the Research to Practice Interest Group or NAPSA help researchers understand the context or the practice side of what they’re researching so that they are looking at the right questions or they’re understanding what they’re seeing? How do you even broach that?

Marian: [00:12:14] That is a fascinating question, because, I mean, that’s part of it, that’s kind of what I do as a researcher. But I guess I can start with what our committee’s efforts are. So in addition to the documents prepared for APS programs, our group also developed this document called Stages of Research Collaboration with Adult Protective Services Organizations. So it would be kind of like a researcher’s guide to understand how to start working with APS. Just kind of my personal point of view would be that researchers should understand APS practitioners’ time constraint and fear of research that Mariah just talked about, um, be collaborative partners and conduct mutually beneficial studies. So stepping outside of the ivory tower and really listening to what APS wants to learn is very critical because, I mean, in the real world, researchers, we should listen. So, I mean, I would really not want to hear any of my collaborators, researchers say anything like, oh, I know what APS should do, let’s go ahead and see if they’re doing it, because that’s just ignorant.

Mariah: [00:13:25] One research project that I’m working on now actually started because a researcher reached out to Nancy Alterio, my agency’s executive director. In early 2018, Joe Shapiro did a national public radio series called Abused and Betrayed about sexual abuse of people with intellectual and developmental disabilities. And this researcher is a professor of computer science, and he had heard the series and he was so shocked by what he learned and that he started to think about how he could use his skill set to do something about it. So he had some ideas about how technology could be harnessed to try to help people with disabilities recognize, report, and respond to abuse. And so that right there is a really great tip for researchers. He reached out to some of his connections who were able to point him in the direction of the Disabled Persons Protection Commission. And we put it in a grant application, and we’re two years into this project. And one of the best things about working with this researcher, the co-researcher he brought on to their team, is that they know where their expertise lies and then where it ends. So they’ve been really active about educating themselves about the APS system, about the people that we serve, and doing that rather than proceeding from assumptions that were unchecked. So they had, they had all the time had come in with ideas about a possible project, but they’ve been able to be humble and flexible enough to tweak those ideas to make sure that they work for our reality and the reality of the people ultimately that we serve. And so this really helps us guarantee a successful project for both sides, for the researchers and the practitioners.

Marian: [00:15:07] I think that’s a great example Mariah, and I would like to add a couple of my personal points about this. I think researchers should not study and leave, so in your example, it sounds like you have a collaborative relationship with this researcher and that could kind of sustain for a long period of time. So I think for us researchers thinking about just publishing the results in some academic journal, that’s not good enough, right? So what our group, our committee values is the research to practice link. And that’s why we have a journal club, we have webinars, we have briefs, everything that we put out there, we ask researchers to make a direct connection from their research to practice. So sometimes I think journal articles intimidate some people, especially practitioners, so the events that we put together stress the active learning process for our practitioners instead of talking in statistics, in scientific jargons. What does it mean in plain English is usually what we try to tell the researchers to focus on and explain a little bit more on how the research finding, how does that impact APS? And also, we try to engage junior researchers. There are not a lot of undergraduate or graduate students who get to learn about APS. Even elder abuse researchers like myself, I have to admit that I didn’t get to understand how APS works until after graduate school, until I started actually working with them as my research partner. So when we have the opportunity to work with APS, I mean, when I had the opportunity to work with APS, I stayed. So I’m also trying to kind of foster that relationship for the junior scholars to get more involved in the area of research.

Susan: [00:17:03] Sounds like NAPSA is doing so much to try to bridge this gap between research and practice. Of all of NAPSA’s efforts in this area to try to integrate research and practice, Marian, what are one or two activities you would hold up as real successes?

Marian: [00:17:20] I am so excited to talk about this, because Mariah and I, we have been involved with the NAPSA research committee for the past couple years. So we have our quarterly Research to Practice webinars and we have our bi-monthly journal club meetings that brings researchers and practitioners together. So when we bring the two groups together, we’re talking about research so they can, you know, practitioners can learn from researchers. But also at the same time, researchers learn from practitioners on what’s important, what did you value, so on and so forth. In recent years, we also have been hosting this informal networking session at the NAPSA’s annual conference. So in the past couple of years, this networking session has been sponsored by NCCD and FINRA Foundation. So we aim to make research accessible to the NAPSA attendees, but also at the same time, this is where practitioners and researchers, they can meet in person and to chat about what they would like to learn and how to accomplish the goals together. So as you can probably tell, I mean, this year is going to be a little bit tricky in terms of our upcoming conference in November. Due to the pandemic, the conference is going to be virtual.

Susan: [00:18:39] Marian, what are some of the current hot topics in research about abuse of vulnerable and older adults?

Marian: [00:18:47] Ooh my, my, my, where to start? The kind of the maltreatment or mistreatment studies is — they’re very complex. There are many types of abuse from physical, sexual, psychological, emotional, financial exploitation, fraud and scam, caregiving neglect, self-neglect also included. So the consensus on how these types of abuse, the definition of them, really vary. So that’s the first challenge already. And not to mention, depending on what types of abuse are you going to study is self-neglect going to be part of that or not because there’s no perpetrator or abuser? Those are all really some of the first things that conducting a research project, that would be some of the first things to decide. But also the definition of abuse can, can it be different across cultural and racial groups? Possibly, right? What the mainstream society considers as mistreatment, it may not be the case for some minority groups. So this brings up the next question about who’s our study population. So in addition to the different cultural, racial, ethnic groups, Mariah also represents always talking about we’re not just looking at elder abuse, not just older adults, but what about people who are vulnerable with disabilities? Are we looking at both groups, older and both vulnerable adults with disabilities, or just focusing one, on one of them?

Mariah: [00:20:17] Outcomes are another biggie because whether they’re positive or negative, they’re pretty undefined. So the example that I like to use is if APS was involved in an adult, excuse me, involved with an adult last year and a new investigation was opened up again this year on that same person, is that a negative outcome because the system quote didn’t work and that person is being abused again? What if their caregiving circumstances had changed and their needs for support had just kind of outstripped their caregiver’s ability to to provide for those needs? Would it be a more positive outcome if it were a different perpetrator? What if the adult, him or herself, had reported the abuse to adult protective services? We are a system built to respect self-determination of individuals, so if somebody competently refuses services and chooses to return to a risky situation, but they later reach out to APS for assistance, isn’t — isn’t actively seeking help from the system something that should be viewed as a positive? So just trying to articulate even how you frame an outcome once you’ve wrestled with the definition of abuse, there, just like — there are a lot of layers to think through.

Marian: [00:21:35] And just kind of to piggyback on what Mariah just talked about, something that complicates the outcomes conversation even more is the fact that APS clients are different from kids from, who child protective services work with. APS works with adults. So with adults, as long as they have capacity, they have self-determination. So that means adults, they should be able to understand risks and they may decide that safety is not their top priority. And APS needs to honor that decision while striving to keep the client safe because abusers, perpetrators, a lot of the times they are family members. So maintaining that relationship may be the top priority of the clients. So this probably means that an outcome that seems negative, such as an adult who chooses to remain in their home with the abusive spouse or daughter or son is, in fact, what the adult wants.

Mariah: [00:22:39] Another hot topic aside from outcomes, is multidisciplinary teams, so as Marian said, abuse of vulnerable adults can happen in a variety of different ways and that abuse can have impacts on people in different areas of their lives. So, again, me with my practitioner intuition, having specialized teams of experts to address specific types of abuse like financial exploitation or sexual assault make sense to me. But there are currently research projects underway to help provide evidence-based evaluations of the differences that that kind of holistic approach can make for victims of abuse.

Marian: [00:23:21] The other hot topic that I thought about is regarding caseload, so the size of the cases that’s being processed by APS caseworkers or investigators, that has been talked about. What’s the ideal caseload? The goal really is to define the ideal caseload size for effective practice, because we don’t want the APS caseworkers, investigators to take on too many of the cases where they cannot really serve their clients well. There has been no study whatsoever, I should say, no national study for sure, but also there are not a lot of the rigorous projects trying to figure out what’s the ideal caseload.

Mariah: [00:24:03] And then last but not least, you can’t ignore this pandemic, right? So we know that especially for older adults, loneliness is one of the biggest risk factors for a variety of negative health outcomes. So we’ve been concerned with COVID and the feelings of loneliness that have accompanied all of the, the self-isolating and the quarantine and the stay at home orders. And, and so the importance of social support really makes us worry about the vulnerable and older adults who are impacted by that right now. And then we’ve also kind of seen and been wrestling with how to adapt services to be carried out virtually or not. Either — whether it’s providing day program services for individuals in the community or even APS itself has been impacted in how they are able to continue to do their work in a way that keeps people safe.

Susan: [00:25:02] So, so many important research needs right now that you could really use answers immediately and it sounds like maybe they’re not quite enough researchers in this field or researcher-practitioner partnerships to get all this done. So even though there’s already this huge need right now, looking forward five years, what would you hope to see in five years? What kind of landscape changes in the field of vulnerable adult and elder abuse prevention and response research or data advances would you like to see?

Marian: [00:25:41] So I would like to get started with the effortss accomplished by the Administration for Community Living. So this is an organization that’s part of the U.S. Department of Health and Human Services. They have started collecting national APS data in this new database called the National Adult Maltreatment Reporting System, NAMRS. So NAMRS, the trends and patterns in many of the areas of APS practice should generate some interesting, new research questions. So one of the key questions that remain — remains unanswered is what does success look like in APS? So protecting the competent adults, their right to refuse services, it adds to the complexity in answering this question, like what we talked about earlier. So as well as we know, there are many forms of mistreatment, maltreatment and the variety of state APS laws. So the Administration for Community Living is kind of gathering all of these information, and hopefully in the next five years, we will be able to answer some of those questions and move forward in generating new research questions. Another very exciting action item that the Administration for Community Living has been taking on is to generate a national research agenda for APS to build a stronger evidence base of best practices. So this represents the comprehensive look at the research needs of the APS field, in which many of the audiences from APS all the way to the public, all of us have provided input on this agenda. So we’re hoping to see that in five years, many of the research projects will have full funding and be initiated by practitioners of interest and curiosity in terms of questions they want answers for. So creating and maintaining the culture of curiosity is essential to generate a successful search for answers.

Mariah: [00:27:45] My agency, the Disabled Persons Protection Commission, gets excited about research that acknowledges the different needs of the populations, the different populations that are protected by APS. So for a lot of older adults, moving out of the family home is defined as a negative outcome. But if you think about a younger adult with a disability like Down’s syndrome, moving out of the family home can be a positive outcome that leads to increased life skills, increased independence, increased socialization. So those kinds of nuances are important for the big picture of agency funding, but they also really affect the day-to-day work of how our field staff can best help people heal from abuse and can help set people up for a safer future.

Susan: [00:28:31] Well, thank you. It has been so enlightening to hear from both of you about the work of NAPSA and this working group, and the ways you all are looking to leverage research to really improve the response to elder and vulnerable adult victims. And you all shared so many good ideas, so many great tools that are out there. I do want to note that we will provide links to a lot of those tools on our website, the CVR’s website, when we post this, when we have this podcast. I want to thank you both for your time today.

Mariah: [00:29:10] Susan, thanks for having us. We were delighted.

Susan: [00:29:15] We hope you enjoyed this episode of “Tell Us About It.” If there are research or practice experts you’d like us to interview or research tools you’d like us to feature on this podcast, email us at podcasts@victimresearch.org.

Closing: [00:29:29] “Tell Us About It” is a production of the Center for Victim Research, funded by the Office for Victims of Crime’s Vision 21 Initiative through Cooperative Agreement Number 2016-XVGX-K006. The Office for Victims of Crime is part of the U.S. Department of Justice’s Office of Justice Programs. However, the points of view and opinions discussed on this podcast are those of the host and expert contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.