Evaluation of AoA’s Elder Abuse Prevention 

Intervention Demonstrations

ASPE | July 2015

Research Brief

Enacted as part of the Patient Protection and Affordable Care Act in March of 2010, the Elder Justice Act 

represents the most comprehensive federal elder abuse prevention law to date, calling national attention to 

the millions of vulnerable older Americans who are victims of abuse, neglect, and exploitation. The Elder 

Abuse Prevention Interventions demonstration, authorized by the Elder Justice Act and funded by the 

Administration on Aging (AoA), U.S. Department of Health and Human Services (HHS) in FY 2013, provided 

funding to five state grantees to test interventions designed to prevent elder abuse, neglect, and exploitation. 

The HHS Office of the Assistant Secretary for Planning and Evaluation has contracted with NORC at the 

University of Chicago to design and conduct an evaluation of the interventions being tested through this 

demonstration. The purpose of the evaluation is to study the development and implementation of the state 

grantees’ elder abuse interventions and report findings on the characteristics of victims and perpetrators of 

elder abuse or those at-risk, the use of prevention services, and outcomes. 

The states participating in the demonstration and evaluation are: Alaska Division of Senior and Disabilities Services; New York State Office for the 

Aging; University of Southern California; University of Texas Health Science Center at Houston; and Texas Department of Family and Protective 

Services and WellMed Charitable Foundation. This Research Brief is one of five summarizing the tested interventions and findings to date.

Enhanced Multi-Disciplinary Teams 

New York State Office for the Aging

PROJECT OVERVIEW 

Through the Elder Abuse Prevention Interventions grant initiative in New 

York State, multiple partners are implementing enhanced multi-disciplinary 

teams (E-MDT) in two pilot locations, incorporating forensic accountants 

and geriatric psychiatrists to investigate and intervene in complex cases of 

elder financial exploitation and elder abuse. The aim of the EAPI project is 

to improve systems collaboration and awareness of signs of financial 

exploitation through a partnership among public, private, and not-for profit 

organizations, and to protect victim safety and assets. E-MDTS have been 

implemented in Manhattan through the New York City Elder Abuse Center 

(NYCEAC) at Weill-Cornell Medical College, and in seven counties 

(Monroe, Cayuga, Livingston, Ontario, Seneca, Wayne, and Yates) in the 

Finger Lakes region of New York through the Monroe County Office for the 

Aging (MCOFA) and Lifespan of Greater Rochester Inc. (Lifespan).

KEY FINDINGS TO DATE 1

Theoretical/Clinical Basis of Prevention Intervention 

Findings from the 2011 Under the Radar: New York State Elder Abuse 

Prevalence Study: Self-Reported Prevalence and Documented Case 

Surveys (Prevalence Study) 2 indicate that the highest rate of elder 

mistreatment in New York occurred for major financial exploitation (i.e., 

theft of money or property, using items without permission, impersonation 

to get access, forcing or misleading to get items such as money, bank 

cards, accounts, power of attorney) with a rate of 41 per 1,000 surveyed.3

Spouses or partners and adult children were perpetrators for 40 percent of 

the mistreatment episodes, as self-reported by elders.4

 

The E-MDTs address the financial exploitation of older adults by bringing 

together professionals from various disciplines to investigate, intervene, 

and prevent abuse. The model is “enhanced” as it includes the services of 

a forensic accountant and geriatric psychiatrist, resources not commonly 

found on elder abuse case coordination and review teams. The E-MDT 

was modelled on NYCEAC’s Brooklyn MDT developed and launched in 

2010, and emphasizes cross-system collaboration.

Prevention Intervention 

Core membership of the Finger Lakes and Manhattan E-MDTs draws on 

professionals from aging and social services, the financial industry, legal 

services, law enforcement, including a forensic accountant and a geriatric 

psychiatrist as available to each team. 

Most E-MDT members serve as part of their job responsibilities; their 

participation is an in-kind donation from their organizations. Forensic 

accountants and geriatric psychiatrists are retained on a fee-for service 

basis. Local APS units in the Finger Lakes region and in Manhattan 

participate. APS is a primary source of case referrals.

Outcomes 5

The immediate outcome of an E-MDT intervention is to ensure the safety 

and well-being of victimized elders and the protection of their assets, with a 

longer term goal of restitution of assets and reduced risk of further 

exploitation. On an individual level, early outcomes of the E-MDT 

intervention show improved safety of elders and the protection of assets.

INFRASTRUCTURE 

The lead entity for the project is the New York State Office for the Aging 

(NYSOFA). The Bureau of Adult Services within the New York State Office 

of Children and Family Services (OCFS) supports the participation of local 

APS units in the E-MDTs in Manhattan and the Finger Lakes Region, and 

is a partner in training financial professionals as part of this grant initiative.

The Monroe County Office for the Aging (MCOFA) serves as the local 

contract monitor and fiscal entity. Lifespan, located in Monroe County, NY, 

is a non-profit agency founded in 1971. It serves older adults and operates 

more than 30 programs, including the nationally recognized Elder Abuse 

Prevention Program, care management, Long Term Care Ombudsman, 

and guardianship programs. NYCEAC, located in New York City, was

established in 2009 and is housed within the Weill-Cornell Medical College, 

Division of Geriatrics and Palliative Medicine. NYCEAC seeks to prevent 

abuse and assists abused and at-risk elders by helping to improve 

professional, organizational, and systems response. 

ELDER ABUSE

Findings from the Prevalence Study indicate that financial exploitation of 

older adults is a common, serious, and under-reported problem. The study 

found an elder abuse incidence rate in New York State that was nearly 24 

times greater than the number of cases referred to social services, law 

enforcement or legal authorities. An estimated 260,000 older adults in the 

state had been victims of at least one form of elder abuse in 2008-2009.

INTERVENTION 

Target Population

Victims age 60 or older with detectable signs of possible financial 

exploitation present are eligible for services with the Finger Lakes and 

NYCEAC E-MDTs. They must also have at least one of the following 

characteristics: 1) health or mental health problems and/or physical

impairments; 2) possible cognitive impairment and/or dementia; and 3) 

social isolation and/or inadequate social support. 

As of January 2015, the Finger Lakes E-MDTs received 110 referrals with 

the majority originating from Monroe County. From May 2013-January 

2015, 78 new cases were presented to the E-MDTs and 75 meetings held. 

In Manhattan, between April 2013- January 2015, NYCEAC provided case 

Evaluation of AoA’s Elder Abuse Prevention Intervention Demonstrations | July 2015 | Page 1 
Enhanced Multi-Disciplinary Teams: New York State Office for the Aging

consultations on 135 unique cases with 36 of these cases then triaged to 

the E-MDT (about one-half of the referrals originated from APS).

This initiative includes victims that are over age 60, with some victims age 

75 and older. Many are widowed and socially isolated. At NYCEAC, 

although financial exploitation is the primary basis for the referral, cooccurring abuse is prevalent in many cases. Victims in 80 percent of cases 

have required medical and/or mental assessments and treatment.

E-MDT Meetings: Financial Exploitation Case Presentation 

Generally, E-MDTs meet twice per month. In some of the smaller counties 

of the Finger Lakes, E-MDTs meet monthly or on an as needed basis.

Meetings are generally scheduled for 1.5 to 2 hours, and are facilitated by 

the E-MDT coordinator. Participation in the meetings is required of the core 

members of the E-MDTs. All E-MDT participants and observers are 

required to sign a confidentiality statement. The E-MDT coordinator 

facilitates case presentations by preparing key information about the 

presenting issue(s), alleged perpetrator(s), reason for referral, the nature of 

abuse, and interventions provided to date. Information is included in a 

presentation slide so that all E-MDT participants can see the details of the 

case while they are being discussed (cases are de-identified in 

Manhattan). Participants discuss the case and identify barriers, resources, 

and action steps. An informal risk assessment helps prioritize cases for 

intervention on a scale of no risk, low risk, medium risk, or high risk.

The E-MDT coordinator prepares an action plan for each case using a 

“coordinated, person-centered care” approach. Services are tailored to 

elder’s needs (e.g., safety plan, order of protection, physical or mental 

health treatment referrals, guardianship, respite, temporary housing or 

shelter, or APS home visits). Service plans are prepared and the E-MDT 

coordinator facilitates assignment of roles, action items, and follow up 

steps. Depending on the fact pattern of the case and forensic accountant 

review, criminal prosecution of the suspected perpetrator may be pursued.

Plans and supports are revisited at subsequent E-MDT meetings. All EMDT members are held accountable for following through with assigned 

action items to ensure the case moves forward in a timely manner. 

Key Roles

■ E-MDT Coordinators: Full-time E-MDT coordinators were

established at Lifespan and NYCEAC. The coordinators lead the E- MDTs, and each has similar duties. They receive referrals, provide

consultation to referral sources, and obtain information through public,

bank, and medical records. They organize regularly scheduled E-MDT

meetings, prepare case presentations, develop action plans, and

track cases. In addition, the E-MDT coordinators provide case

consults to professionals, maintain contact with APS and partners,

and conduct outreach to develop service linkages. The Lifespan E- MDT coordinator established and works with seven county-based EMDTs in the Finger Lakes region. The NYCEAC E-MDT coordinator

also convenes the Brooklyn MDT and another multidisciplinary team

based in Manhattan.

■ Forensic Accountant: The forensic accountant role constitutes the

primary enhancement piloted through this initiative. For complex

cases, the forensic accountant conducts in-depth reviews of bank,

credit card, and investment statements, analyzing transactions to

determine the exploitation of victim assets. In the Finger Lakes pilot,

the forensic accountant prepares a report of findings and provides

recommendations to the E-MDT, and testifies in court, if needed. A

private/community-based forensic accountant works with the Finger

Lakes E-MDTs. In Manhattan, the forensic accountants for the

NYCEAC E-MDT are Manhattan District Attorney’s office staff, and

work within the parameters of this office.

■ Geriatric psychiatrist: The geriatric psychiatrist participates on the

E-MDTs and is the second enhancement to the model. The role of the

geriatric psychiatrist varies, depending on the needs of the case and

can include: reviewing psychiatric evaluations conducted; consulting

on developing a meaningful response based on the mental health and

cognitive status of client; making suggestions for referrals for

treatment and services; assisting with follow-up concerning such

referrals; and providing direct assessments, when needed.

IMPLEMENTATION 

Commitment, strategic leadership, and an emphasis on continuous 

improvement helped drive successful implementation. Longstanding 

partners and recognized leaders in elder abuse prevention and advocacy, 

NYSOFA, Lifespan, and NYCEAC engaged their partners and obtained 

buy-in in each jurisdiction. Having APS “on board from the get-go” was 

instrumental and made possible through OCFS as a key partner. 

Key components of the E-MDT model that are being implemented as 

intended include the roles of the E-MDT coordinators, use of the forensic 

accountants and geriatric psychiatrists, and creation of documents, 

including a training curriculum for use in training financial professionals, 

and E-MDT policies and procedures. There have been no unintended 

consequences observed or breaches of confidentiality. 

One component modified from the initial concept is establishing E-MDTs in 

all of the Finger Lakes counties rather than creating a hub E-MDT and 

using technology for “satellite” locations. Early implementation findings 

indicated that technology was not a viable substitute for in-person 

meetings. Another recent modification concerns use of forensic 

accountants based in the NY District Attorney’s (DA) office. Constraints on 

reporting activities to the E-MDT, owing to their role in the DA’s office, 

require community services instead. 

Project partners have noted the 

effectiveness of the E-MDTs in 

the prevention of exploitation of 

older adults and in the 

prosecution of criminal cases. 

Preliminary results show positive 

outcomes in terms of stopping the 

exploitation, managing risk of future victimization, and recovery of lost 

assets. In the Finger Lakes site alone, $514,000 has been directed to be 

repaid by a court or agreed upon in repayment plans, and over $130,000 

has been repaid to victims to date. Forensic accountant services have

facilitated the prosecution of perpetrators in exploitation cases brought to 

the E-MDTs, as well as in civil actions brought to stop exploitation and to 

prevent further victimization. Forensic accountant reports have been useful 

in establishing the need for the appointment of a guardian under New York 

State Mental Hygiene Law.

Collecting evidence to lead to a criminal case is challenging given that 

prosecution demands a high standard of proof. The District Attorney’s 

Offices provide advice about the kinds of information that would facilitate 

prosecution, such as the findings of the forensic accountant’s analysis. 

LESSONS LEARNED 

The E-MDT involves problem-solving across systems. Developing trust, 

together with fostering an atmosphere of respect and collegiality, is 

essential to the E-MDT’s functioning. The E-MDT coordinators are key to 

facilitating the work, and the meetings enable cross-systems collaboration 

to address needs of vulnerable older adults who are victims of financial 

exploitation and other abuse. Ongoing implementation takes effort to foster 

culture change, sustained engagement, coordination, and sustainability. 

FOR MORE INFORMATION CONTACT ■ Jennifer Rosenbaum, Assistant Director, New York State Office for

the Aging, Division of Policy, Program, Planning, and Outcomes

Jennifer.rosenbaum@aging.ny.gov 518.473.4936

■ Paul Caccamise, LMSW, ACSW, Vice President for Program,

Lifespan of Greater Rochester pcaccamise@lifespan-roch.org

585.244.8400 ■ Risa Breckman, LCSW, Director, NYC Elder Abuse Center:

rbreckman@med.cornell.edu 212.746.1674 ■ Perry Brown, Contract Monitor, Monroe County Office for the Aging

PBrown@monroecounty.gov 585.753.6520

Suggested Citation: Hafford, C., Nguyen, K. & Henning, S. June 2015. New York State Office 

for the Aging: Enhanced Multi-Disciplinary Teams. Elder Abuse Prevention Intervention 

Program. Washington, DC: Assistant Secretary for Planning and Evaluation, U.S. Department 

of Health and Human Services: NORC at the University of Chicago.

1 The findings to date are derived from site visits to Lifespan of Greater Rochester and to NYCEAC in January 2015 to learn about planning, infrastructure and implementation of the prevention intervention and 

progress to date. Key informant interviews were conducted with Lifespan and NYCEAC leaders and staff. Program documents and protocols were reviewed. NORC attended two E-MDTs, one at Lifespan and 

the other at the Manhattan District Attorney’s Office, and signed confidentiality statements at each meeting. NORC thanks NYSOFA, Lifespan, and NYCEAC for hosting the visits. 2 Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, and New York City Department for the Aging. (May 2011). Under the Radar: New York State Elder Abuse Prevalence 

Study Self-Reported Prevalence and Documented Case Surveys, Final Report. Rochester, NY: Authors. 3 Ibid. page 3. 4 Ibid. page 34. 5 Outcome data from the Lifespan and NYCEAC E-MDTs will be analyzed in late 2015. 

Evaluation of AoA’s Elder Abuse Prevention Intervention Demonstrations | July 2015 | Page 2 

A key informant remarked on the EMDT process: “This is very exposed, 

public work. It’s all about working 

together and respecting the ethos of the 

group. These cases are serious.”