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.

Elder Services Case Management Prevention Intervention 

Alaska Division of Senior and Disabilities Services 

The short and long-term outcomes of the intervention are to increase 

elders’ independence, social support, and sense of safety and to reduce 

the risk for abuse and likelihood of re-referral to APS. The intervention also 

expects to increase awareness among community partners and to 

strengthen partnerships. 

The Alaska DSDS is the lead agency in the intervention. Established 

in1982, the APS unit of DSDS is the primary state agency responsible for 

the prevention of vulnerable adult abuse and the investigation of suspected 

cases of abuse, neglect, and exploitation in Alaska. 

Other organizations involved in addressing elder abuse, neglect, and 

exploitation in the community include the Office of the Long-Term Care 

Ombudsman, the Office of Public Advocacy, Certification and Licensing for 

assisted living, Alaska Commission on Aging, the Veterans’ Administration, 

Alaska Native Medical Center, Rescue Mission (homeless shelter) 

Department of Behavioral Health, Catholic Social Services, Medicaid Fraud 

Control Unit (part of the Attorney General’s Office), Senior Medicare Patrol, 

and AARP as well as local police departments and hospitals. 

The role of community partners is to provide feedback and expertise during 

the Monthly Elder Services Case Management Community Partners 

Meeting on how to better serve the more challenging cases that are being 

handled by the intervention.

OVERVIEW 

The Alaska Division of Senior and Disability Services (DSDS) through the 

Adult Protective Services Unit (APS) and in partnership with other key 

community partners is implementing, testing and measuring the 

performance of the Critical Time Intervention case management model to 

prevent elder abuse, neglect and exploitation. 

The project targets services to both victims and where possible, caregivers.

KEY FINDINGS TO DATE 1

Theoretical/Clinical Basis of Prevention Intervention 

The Alaska DSDS intervention uses an evidence-based case management 

model known as Critical Time Intervention (CTI) to provide time-limited 

support services to elders and their caregivers with the goal of empowering

them to be independent. CTI helps vulnerable people during times of 

transition by strengthening their networks of support in their community, 

with an emphasis on community integration and continuity of care.2 CTI 

has been successful in preventing homelessness among individuals with 

mental illness following institutional discharge. Alaska’s pilot represents the 

first time CTI is being applied to vulnerable older adults. Alaska DSDS has 

long identified a need for APS client case management and the AoA grant 

provided an opportunity for the agency to implement the intervention to 

provide services not offered by APS. 

Prevention Intervention 

The CTI case management model uses a client-centered approach when 

case managers work with clients. Support is provided over three prescribed 

phases of the nine month intervention: 1) transition; 2) try-out; and 3) 

transfer. During the first three months (transition phase), case managers 

provide specialized intensive support and focus on setting goals with the 

client and addressing immediate critical needs. The try-out phase (months 

4 – 7) involves identifying informal and formal supports to meet client 

needs and transferring more responsibility to the client, identified caregiver, 

or providers. During the transfer phase of the intervention (last two 

months), case managers transfer care to the long-term support system 

created for the client. 

Case managers are supported through monthly community partners 

meetings which provide an opportunity to solicit feedback on current 

cases being handled by case managers. 

Outcomes 3

INFRASTRUCTURE 

ELDER ABUSE 

Based on 2012 APS data, the Anchorage region received 514 allegations 

of elder abuse, neglect, or exploitation, 167 of which were substantiated. In 

Anchorage, 37% of adults over the age of 60 had a repeated intake within 

6 months and 39% had a repeated intake within 12 months.4 A significant 

portion of these adults were brought to the attention of APS but their issues 

could not be resolved through current APS supportive services. 

Approximately 65% of the overall intake involves adults age 60 years and 

older. There tends to be more cases of abuse involving women than men 

as well as those with low incomes. Individuals who are at highest risk are 

those who live in rural areas where there are minimal services. 

INTERVENTION 

Target Population

The target population for the intervention is elders 60 years of age and 

older residing in the municipality of Anchorage who experience at least one 

of the following conditions: 1) cognitive impairment or dementia; 2) physical 

impairment or health problems; and 3) abuser dependency on the victim. 

Evaluation of AoA’s Elder Abuse Prevention Intervention Demonstrations | July 2015 | Page 1 
Alaska Division of Senior and Disabilities Services Elder Services Case Management Prevention Intervention

Participants are largely drawn from the community but the program also 

serves those living in residential settings. 

Elders must be competent enough to provide informed consent or the 

guardian must be aware of their participation in the larger research effort. 

As of June 30, 2014, the program received over 90 referrals. Currently, 41 

elders are engaged in elder services case management.5 Caseloads range 

between 10 and 13 per case manager. Thus far, many clients served by 

the intervention have health problems, mental health issues, cognitive 

impairment, depression, substance abuse issues, and are homeless and/or 

have no family or support system in place. 

Elder Services Case Management (ESCM) Prevention 

Intervention 

The prevention intervention includes multiple components: referral and 

intake; informed consent; a nine-month case management intervention; 

and monthly community partner meetings. 

Referral and Intake: Sources for referrals into the intervention include 

reports of harm (ROH) that are filed with APS’ central intake. The program 

manager screens the ROH and then assigns the case to information and 

referral (INR), if protective services are not needed or to APS investigation. 

INR cases are then screened by case managers who call the senior to 

determine if the case is appropriate for case management and seek 

permission for participation. 

Cases that are assigned to APS investigation must first be completed and 

closed (and the client’s safety established) prior to being referred to ESCM 

by the APS investigator. At that point, the program manger assigns the 

case to one of the three case managers providing support for the 

intervention.

Intervention: The CTI case management model uses a client-centered 

approach in working with clients. Support is provided over three phases of 

the nine month intervention: 1) transition, 2) try-out, and 3) transfer. 

■ Transition Phase: During the first three months, case managers

provide specialized intense support and focus on setting goals with

the client and addressing immediate critical needs. This often includes

obtaining food, housing, transportation, or medical attention for the

client. Client contact is very high and involves frequent home visits

and phone calls.

■ Try-out Phase: Months 4 – 7 involve identifying informal and formal

supports to meet client needs. Case managers transfer more

responsibility to the client, identified caregiver, or connected service

providers to take responsibility for service provision. Regular contact

through phone calls and home visits continue.

■ Transfer Phase: During the last two months of the intervention, the

case managers transfer care to the long-term support system created

for the client. Contact with the client is reduced to monthly conference

meetings. Throughout the process, a case manager may also

generate an ROH if the client is in need of APS services, particularly

with issues involving legal action (such as guardianship) which care

managers do not have the authority to undertake. In these instances,

the client would be receiving both case management and APS

services.

Service Utilization: Common services provided include assistance with 

applications and referrals for personal attendant care, Alaska resident 

benefits (an annual payment from the state’s investment earnings of 

mineral royalties), and medical services 

Community Partners Meeting: The meetings provide case managers 

an opportunity to solicit feedback on current cases being handled, and to 

provide support for concerns with difficult clients or situations.

IMPLEMENTATION 

While there have been minor adjustments to the project related to 

paperwork and the referral process, the intervention has largely been 

implemented as intended. No unintended consequences have been 

observed. 

A key facilitator to the implementation of the intervention was the 

separation between case management services and APS services (where 

investigators are often not well-received), allowing case managers to enter 

clients’ lives as friendly visitors. The client-driven approach of the 

intervention also is appealing to both clients and case managers and 

facilitates engagement and participation. 

Even if client needs have been 

identified, the intervention 

relies on existing services 

which are sometimes difficult to 

access. Transportation and 

affordable housing were 

identified as service gaps in the 

Anchorage area. 

An unexpected ongoing challenge of the project concerns generating 

regular referrals to the intervention. This was understood to be partially due 

to the newness of the program and the perception on the part of some 

investigators that clients may not need continued case management 

because they were no longer facing imminent risk. The eligibility criteria 

were also reported as contributing to lower than expected referrals. 

Clients and caregivers can become attached to case managers. It 

becomes difficult to transition elders off of case management, particularly 

those who had little social contact prior to the intervention. 

LESSONS LEARNED 

The ESCM prevention intervention appears to benefit some groups and 

types of abuse more so than others. The program has seen more progress 

with cases of self-neglect and INRs (those that have not risen to the level 

of needed protective services) and is less successful for people 

experiencing significant mental health issues, dementia, substance abuse 

issues, ongoing physical abuse, sexual abuse, and domestic violence. 

Cases with public guardians who have conflicting goals with their wards or 

where the abusing caregiver remains in the home also tend to be less 

successful. 

Small acts of support can make a huge difference in the lives of elders. It is 

also important to adjust to seniors’ needs and timeline and support their 

decisions when they are ready, particularly as habits have been strongly 

formed over a lifetime. 

Communication and sharing information between case managers and 

community partners’ staff is important to managing referrals and service 

transitions.

According to stakeholders, major accomplishments of the intervention 

include demonstrating the value of and need for case management to 

support APS (adults are not cycling back in), connecting an array of 

services to clients that they did not previously know existed or had the 

wherewithal to access, and helping vulnerable adults live independently, 

safer and for the long-term.

FOR MORE INFORMATION CONTACT

■ Kelda Barstad, Health Program Manager 3, Senior and Disabilities

Services, Alaska Division of Senior and Disabilities Services

Kelda.barstad@alaska.gov 907.269.3666 (main number)

Suggested Citation: Nguyen, K., Hafford, C. & Henning, S. June 2015. Elder Services 

Case Management Prevention Intervention. 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 a two-day site visit to Alaska Division of Senior and Disabilities Services in October 2014 to learn about planning, infrastructure and implementation of the prevention 

intervention and progress to date. Key informant interviews were conducted with the statewide program manager/project director, two protective services managers, the grant manager, three case managers 

and the research analyst providing data-related support to the project. Program documents and protocols were reviewed. NORC thanks AK DSDS for hosting the visit. 2 http://sssw.hunter.cuny.edu/cti/cti-model 3 Outcome data will be analyzed in mid-2015. 4 These data were obtained from the grantee’s original application.

5 These data were obtained from the grantee’s semi-annual progress report to the AoA. 

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

Case managers stated that elders are 

grateful for the services provided. For 

some elders participating in the 

intervention, the case manager was the 

only person in their lives. One exclaimed, 

“I wouldn’t be alive without you.”