TEAM Institute Clinical and Forensic Evaluation Division

This division began as an in-home assessment program to provide a single region of Texas APS caseworkers and their clients with access to geriatric medical and social work experts for the purpose of aligning protective service planning with client’s biopsychosocial needs. In 2015, this division expanded to provide statewide assistance in abuse, neglect and exploitation cases for Texas APS and the Texas Department of Health and Human Services (HHS) through the implementation of the TEAM-Forensic Assessment Center Network (TEAM-FACN). This program leverages web-based technology and readily available telehealth modalities to connect APS specialists and HHS investigators, anywhere in the state (urban or rural) with elder abuse, geriatric and forensic experts located in the heart of the Texas Medical Center; making TEAM experts accessible to all APS clients in need. Available services include mental health capacity assessments, case consultations, forensic records reviews for abuse determinations, guardianship assessments, limited medical assessments and employee misconduct registry reviews. When necessary, the TEAM members will provide court testimony. The TEAM-FACN is the first program in the U.S. to utilize telehealth modalities to increase APS caseworker and client access to elder abuse and geriatric experts. This program has garnered national interest from the U.S. Administration on Aging, the Department of Justice and the Elder Justice Coordinating Council. For more information on the program please go to www.facntx.org.  

  

 

  • Clinical an Forensic Evaluation Division

    TEAM Institute Clinical and Forensic Evaluation Division

    This division began as an in-home assessment program to provide a single region of Texas APS caseworkers and their clients with access to geriatric medical and social work experts for the purpose of aligning protective service planning with client’s biopsychosocial needs. In 2015, this division expanded to provide statewide assistance in abuse, neglect and exploitation cases for Texas APS and the Texas Department of Health and Human Services (HHS) through the implementation of the TEAM-Forensic Assessment Center Network (TEAM-FACN). This program leverages web-based technology and readily available telehealth modalities to connect APS specialists and HHS investigators, anywhere in the state (urban or rural) with elder abuse, geriatric and forensic experts located in the heart of the Texas Medical Center; making TEAM experts accessible to all APS clients in need. Available services include mental health capacity assessments, case consultations, forensic records reviews for abuse determinations, guardianship assessments, limited medical assessments and employee misconduct registry reviews. When necessary, the TEAM members will provide court testimony. The TEAM-FACN is the first program in the U.S. to utilize telehealth modalities to increase APS caseworker and client access to elder abuse and geriatric experts. This program has garnered national interest from the U.S. Administration on Aging, the Department of Justice and the Elder Justice Coordinating Council. For more information on the program please go to www.facntx.org.  

      

     

  • Education and Outreach Division

    TEAM Institute Education and Outreach Division

    This division provides up-to-date education on the reality of elder abuse and best practices for reporting, prevention, detection and response. Members of TEAM have provided hundreds of local, state and national presentations.  Notably, TEAM has presented to agencies such as the U.S. Senate, American Medical Association, U.S. Elder Justice Coordinating Council, and the U.S. Department of Justice. Through education grants, the TEAM Institute has educated over 35,000 professionals and non-professionals including social workers, medical students, physicians, community agencies, legal / judicial entities, universities, home health agencies, hospice agencies, civic clubs, law enforcement and state and federal governmental agencies. Each year, the TEAM is involved with honoring Older Americans Month and World Elder Abuse Day by participating in local and statewide events targeting the education of the community and professionals about issues that affect older adults and promoting elder abuse awareness.

    Please see below for a routinely updated list of past and current TEAM elder abuse educational activities and contributions.

    If your organization is interested in scheduling a presentation by the TEAM Institute to learn more about  elder abuse, neglect and exploitation or the the services provided by TEAM and Adult Protective Services, please contact Leslie Clark at 713.500.3802 or Leslie.E.Clark@uth.tmc.edu.  


     

  • Research and Evaluation Division

    TEAM Institute Research and Program Evaluation Division

    This division secures private and federal grant funding to study elder abuse and conduct rigorous elder abuse program evaluations. TEAM has become one of the most well-funded elder abuse research programs in the nation. Through these projects the TEAM has been able to advance the field in the areas of epidemiology, forensic medicine, public health, geriatric medicine, clinical intervention, health promotion, screening and detection and program evaluation.  Major contributions include some of the earliest findings linking elder abuse and self-neglect to dementia and depression diagnoses; identifying cognitive, functional, social, nutritional and medical risk factors for self-neglect; development of the only clinical evidence-based etiologic model for elder self-neglect now supported by other studies; forensic markers of elder abuse and self-neglect; differential mortality rates between elder abuse types; development and psychometric testing of self-neglect and elder abuse screening measures; and the association between elder self-neglect medication adherence and factors that impact adherence. Moreover, TEAM conducted the earliest intervention trials in older adults who self-neglect resulting in newfound knowledge regarding ethical and strategic recruitment considerations, intervention feasibility and amenable targets and approaches for reducing poor outcomes in this population. All of these studies were made possible through access to both APS clients and their archived investigational data, a critical strength of the TEAM collaboration.   

    Please see below for a routinely updated list of past and current TEAM research activities and contributions.

    Current and Past Grant Support

    The National Institute of Justice Office for Victims of Crimes:  2014-2016

    • Exploring Elder Financial Exploitation Victimization: Identifying Unique Risk Profiles and Factors to Enhance Detection, Prevention and Intervention

    The U.S. Department of Health and Human Services - Administration on Aging:  2012-2016

    • Intervention to Reduce Medication Non-Adherence in Community-Dwelling Elders Who Self-Neglect

    Albert and Ethel Herzstein Charitable Foundation Geriatric Studies for Junior Faculty Program:  2012-2014

    • Estimating Differential Mortality Rates for Elder Mistreatment and Self-Neglect Types: A Road to More Efficient Service Delivery

    Agency for Healthcare Research and Quality (AHRQ):  2010-2012

    • Multidimensional Assessment of Elder Self-neglect

    National Institute on Aging (NIA):  2009-2011

    • Vitamin D Replacement in Vulnerable Older Adults

    Borchard Foundation Center on Law and Aging: 2009

    • Forensic Markers and Risk Factors for Death Associated with Cases Reported to Adult Protective Services

    National Institutes of Health (NIH):  2005-2008

    • Consortium for Research in Elder Self-Neglect of Texas (CREST)

    TEAM Publications

    Books:

    Brandl B, Dyer CB, Heisler CJ, Otto J, Stiegel L, Thomas R: Elder Abuse Detection and Intervention: A Collaborative Approach.  2006 Springer.

    Chapters

    Chapter editor – “Delirium, Dementia and Other Cognitive Disorders”, Psychiatric Mental Health Nursing, Mosby-Year Book, Inc.

    Dyer CB, Silverman E, Nguyen T, McCullough L: “Ethical Patient Care”, A Casebook for Geriatric Health Care Teams, Cassell, Mezey, and Fulmer eds. January 2002.

    Spencer J, Hersch G, Shelton M, Ripple J, Spencer C, Dyer CB, Murphy K.: "Functional Outcomes and Daily Life Activities of African-American Elders After Hospitalization" Geriatric Issues in Occupational Therapy, Corcoran MA, ed. AOTA Press, Maryland, 2003.

    Dyer CB, Kim LC: "Elder Mistreatment: Abuse, Neglect, & Exploitation" Current Geriatric Diagnosis & Treatment, Landefeld, Palmer, Johnson, Johnston, and Lyons eds. McGraw-Hill, 2004.

    Mehta MM, Dyer CB: “A Practical Approach to Elder Abuse, Neglect, and Exploitation”, Practice of Geriatrics, 4th Edition, 2007.

    Kim L, Dyer CB: “Assessment of older adults in their home.” Handbook of Geriatric Assessment, Gallo, Fulmer, Paveza and Bogner, eds. Jones and Bartlett, Publisher, Inc. 2005.

    Dyer CB, Regev M, Whitmore SP: “Older Adults in Disasters”. Geriatric Education for Emergency Medical Services. AGS and the National Council of State EMS Training Coordinators. American Geriatrics Society and Jones and Bartlett Publishers, Inc., 2007.

    Ostwald, Sharon & Dyer, Carmel (2011) Fostering resilience, promoting health, and preventing disease in older adults (Chapter 3, pp. 48-86) in Introduction to Gerontology (Ed: Ian Stuart-Hamilton), Cambridge, UK: Cambridge University Press.

    Dyer, Carmel & Ostwald, Sharon (2011) Ageing and Health:  Managing co-morbidities and functional disability in older people (Chapter 4, pp. 87-125) in Introduction to Gerontology (Ed: Ian Stuart-Hamilton), Cambridge, UK: Cambridge University Press.

    Reyes-Ortiz CA, Burnett J, Flores DV, Halphen JM, Dyer CB. Medical implications of elder abuse: self-neglect. Clin Geriatr Med. 2014 Nov;30(4):807-23.

    Burnett J, Achenbaum WA, Murphy KP. Early Identification and Prevention of Elder Abuse.  Clin Geriatr Med. 2014 Nov; 30(4):743-759.

    Papers

    Monograph on Elder Abuse and Neglect, the Texas Medical Association, November 1998.

    Dyer CB, Hyman DJ, Pavlik V, Murphy KP, Gleason MS: Elder Neglect: A Collaboration Between a Geriatrics Assessment Team and Adult Protective Services. Southern Medical Journal. 92(2):242-244. 1999.

    Dyer CB, Pavlik VN, Portal B, Hyman DJ, Barth J, Murphy KP, Gleason MS: A Case Study of Abused or Neglected Elders Treated by an Interdisciplinary Geriatric Team. Journal of Elder Abuse and Neglect. 10(3/4):131-139. 1999.

    Dyer CB, Goins A: The Value of Interdisciplinary Teams in the Management of Elder Abuse and Neglect. Generations, 24(2):23-27, 2000.

    Dyer CB, Pavlik VN, Murphy KP, Hyman DJ: The high prevalence of depression and dementia in elder neglect. Journal of the American Geriatric Society, 48(2):205-208, 2000.

    Vicioso B, Dyer CB: Elder mistreatment – What should dentists know? Texas Dental Journal, October 2000.

    Discussion Elder Justice: Medical Forensic Issues Concerning Abuse and Neglect. National Institute of Justice, Washington, D.C., October 18, 2000. Available: http://www.ojp.usdoj.gov/nij/elderjust

    Pavlik VN, Festa NA, Hyman DJ, Dyer CB: Quantifying the problem of abuse and neglect in adults-analysis of a statewide database. Journal of the American Geriatrics Society, 49:45-48, 2001.

    Harrell R, Toronjo C, Pavlik VN, Hyman DJ, McLaughlin J, Dyer CB: How geriatricians identify elder abuse and neglect. Am J of Med Sci, 323(1):34-38, 2002.

    Heath JM, Dyer CB, Kerzner LJ, Mosqueda L, Murphy C: Four models of medical education about elder mistreatment. Acad Med, 77(11):1101-1106, 2002.

    Dyer CB, Connolly MT, McFeeley P: The medical forensics of elder abuse and neglect in elder mistreatment: Abuse, neglect and exploitation in an aging America. Bonnie and Wallace eds. National Academic Press, pp. 339-381, 2002.

    Fisher JW, Dyer CB: The hidden health menace of elder abuse. Postgrad Med, 113(4):21-24,30, 2003.

    Fulmer T, Dyer CB, Connolly MT, Guadango L: Progress in elder abuse assessment instruments. J Am Geriatr Soc 52(2):297-304, 2004.

    Jogerst GJ, Brady MJ, Dyer CB: Elder abuse and law: New science, new tools. J. Law Med Ethics, 32(4 Suppl):62-63, 2004.

    Dyer CB, Heisler CJ, Hill CA, Kim LC: Community approaches to elder abuse. Clin Geriatr Med, 21(2):429-447, 2005.

    Dyer CB, Pavlik VN, Toronjo C, Cunningham M, Poythress EL, Searle N, Hyman DJ: The Key Elements of Self-Neglect. Journal of Abuse and Neglect. 17(4):1-10, 2005.

    Dyer CB: Neglect Assessment in Elderly Persons, invited editorial. J Gerontol A Biol Sci Med Sci., Aug 60(8):1000-1, 2005.

    Brandl B, Dyer CB, Heisler CJ, Otto J, Stiegel L, Thomas R Enhancing Victim Safety Through Collaboration. Journal of Care Management, 13(4):64-72, 2006.

    Smith SM, Mathews Oliver SA, Zwart SR, Kelly PA, Goodwin JS, and Dyer CB: Nutritional status assessment of the self-neglecting elderly. J Nutrition.136(10):2534-41, 2006.

    Dyer CB, Prati LL. Self-Neglect: On the CREST of New Discoveries: Introduction. J Elder Abuse Negl 2006;18(4):1-3.

    Poythress EL, Burnett J, Naik AD, Pickens S, Dyer CB. Severe Self-Neglect: An Epidemiological and Historical Perspective. J Elder Abuse Negl 2006; 18(4):5-12.

    Dyer CB, Kelly PA, Pavlik VN, Lee J, Doody RS, Regev T, Pickens S, Burnett J, Smith SM. The Making of a Self-Neglect Severity Scale, J Elder Abuse Negl 2006; 18(4):13-23.

    Burnett J, Coverdale J, Pickens S, Dyer CB. What is the Association Between Self-Neglect, Depressive Symptoms and Untreated Medical Conditions? J Elder Abuse Negl 2006; 18(4):25-34.

    Burnett J, Regev T, Pickens S, Prati LL, Aung K, Moore J, Dyer CB. Social Networks: a profile of the elder who self-neglect. J Elder Abuse Negl 2006; 18(4):35-49.

    Pickens S, Burnett J, Naik AD, Holmes HH, Dyer CB. Is Pain a     Significant Factor in Elder Self-Neglect? J Elder Abuse Negl 2006; 18(4):51-61.

    Aung K, Burnett J, Smith SM, Dyer CB. Vitamin D Deficiency associated with Self-Neglect in the Elderly. J Elder Abuse Negl 2006; 18(4):63-78.

    Naik AD, Pickens S, Burnett J, Lai JM, Dyer CB. Assessing Capacity in the Setting of Self-Neglect: Development of a novel screening tool for decision making capacity. J Elder Abuse Negl 2006; 18(4):79-91.

    Pickens-Pace, S., Naik, A., Burnett, J., Kelly, P.A., Gleason, M., Dyer, CB. “The Utility of the KELS Test is Associated with Substantiated Cases of Elder Self-neglect”. J Am Acad Nurse Prac 2007;19(3):137-142.

    Dyer CB, Pickens S, Burnett J. “Vulnerable elders: When it is no longer safe to live alone”. JAMA, 2007 September 26;298(12):1448-50.

    Dyer CB, Goodwin JS, Vogel M, Regev T, Pickens-Pace S, Burnett J, Baum GP, Kelly PA. Characterizing Self-neglect: A Report of Over 500 Cases Seen By a Geriatric Medicine Team. Amer J Public Health, 2007 Sept; 97(9):1671-6.

    Franzini L, Dyer CB. “Health care costs and utilization of vulnerable elders reported               to adult protective services for self-neglect”, Journal of the American Geriatrics Society. 2008;56(4):667-76.

    Naik NA, Burnet J, Pickens S, Dyer CB. Impairment in instrumental activities of daily living and the geriatric syndrome of self-neglect. Gerontologist. 2008 Jun;48(3):388-93.

    Naik NA, Lai JM, Kunik M, Dyer CB. Assessing capacity in suspected cases of self-neglect. Geriatrics. 2008 Feb;63(2):24-31.

    Naik AN, Teal CR, Pavlik VN, Dyer CB, McCullough LB. Conceptual Challenges and Practical Approaches to Screening for Capacity for Self Care and Protection in Vulnerable Adults. Journal of the American Geriatrics Society 2008, S266-270.

    Dyer CB, Franzini L, Watson M, Sanchez L, Prati L, Mitchell S, Wallace R, Pickens S. Future research: a prospective longitudinal study of elder self-neglect. J Am Geriatr Soc. 2008 Nov;56 Suppl 2:S261-5. Review.

    Kelly PA, Dyer CB, Pavlik V, Doody R, Jogerst G. Exploring self-neglect in older adults: preliminary findings of the self-neglect severity scale and next steps. J Am Geriatr Soc. 2008 Nov;56 Suppl 2:S253-60. Review.

    Dyer CB, Marcus M, Burnett J. Introduction: the consortium for research in elder self-neglect. J Am Geriatr Soc. 2008 Nov;56 Suppl 2:S239-40.

    Naik AD, Dyer CB, Kunik ME, McCullough LB. Patient Autonomy for the Management of Chronic Conditions: A two-component re-conceptualization. American Journal of Bioethics. 2009,9(2):23-30. IF 3.93.

    Naik AD, Dyer CB, Kunik ME, McCullough LB. Response to Commentaries on Patient Autonomy for the Management of Chronic Conditions: A two-component re-conceptualization. American Journal of Bioethics. 2009,9(2):W3-W5.

    Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L, Dyer C, Paveza G, Evans D. Elder self-neglect and abuse and mortality risk in a community-dwelling population. JAMA. 2009 Aug 5; 302(5):517-26.

    Burnett J, Cully J, Achenbaum WA, Dyer CB, Naik A. Assessing Self- Efficacy for safe and independent living: a cross-sectional study in vulnerable older adults. Journal of Applied Gerontology. First Published April 22, 2010 Online.

    Burnett J, Dyer C, Naik A. Convergent validation of the Kohlman Evaluation of Living Skills (KELS) as a screening tool of older adults’ capacity to live safely and independently in the community. Archives of Physical Medicine and Rehabilitation, 2009;90(11):1948-1952.

    Culberson J, Ticker R, Burnett J, Marcus M, Pickens S, Dyer CB: Prescription Medication Use Among Self-Neglecting Elderly; Journal of Addictions Nursing; 2011; 22:63-68.

    Pickens SN, Halphen JM, Dyer CB: Elder Mistreatment in the Long Term Care Setting; Annals of Long-Term Care: Clinical Care and Aging. 2011; 19[8]:30-35.

    Turner A, Burnett J, Hochschild A, Zulfiqar A, Dyer CB. A High Proportion of Medication Non-Adherence in a Sample of Community-Dwelling Older Adults with Adult Protective Services Validated Self-Neglect; Drugs and Aging, Drugs Aging. 2012 Sep; 29(9):741-9.

    Burnett J, Achenbaum A, Flores DV, Hayes L, Kao D, Hochschild A, Halphen, JM & Dyer CB. Improving Clinical Surveillance and Prevention Efforts in Elder Self-Neglect. Aging Health. 2012; 8(6): 1-9.

    Burnett J, Mitchell RA Jr., Cloyd EA, Halphen JM, Diamond PM, Hochschild AE, Booker JA, & Dyer CB. Forensic Markers Associated with Elder Mistreatment and Self-neglect: A Case-Control Study. Academic Forensic Pathology, 2013:3(4) a-b.

    Pickens, S., Ostwald, SK., Pace Murphy, K., Diamond, P., Burnett, J., Dyer, CB. Assessing Dimensions of Executive Function in Community-Dwelling Older Adults with Self-Neglect. Journal Clinical Nursing Studies. 2014; 2(1):17-29.

    Halphen JM, Burnett J. Elder Abuse and Neglect: Appearances Can Be Deceptive. Psychiatric Times. August 2014;31(8): 14-16.

    Burnett J, Dyer CB, Booker J, Flores DV, Green CE, Diamond PM. Community-Based Risk Assessment of Elder Mistreatment and Self-Neglect: Evidence of Construct Validity and Measurement Invariance Across Gender and Ethnicity. Journal of the Society for Social Work and Research. 2014 Sept; 5(3):291-319.

    Flores DV, Burnett J, Booker J, Dyer CB. Uncomfortably Numb: Substance Use Associated With Elder Mistreatment. Drug and Alcohol Dependence. 2015 Jan 1; 146:e279

    Lee J, Burnett J, & Dyer CB. Frailty in Self-Neglecting Older Adults: A Secondary Analysis. Journal of Elder Abuse and Neglect. (In Press)

    Hansen M, Flores DV, Coverdale JH, Diamond PM & Burnett J. Correlates of Depression in Community-dwelling Older Adults with Adult Protective Services Substantiated Self-Neglect. Journal of Elder Abuse and Neglect. 2016; 28:1, 41-56.

    Burnett J, Jackson SL, Sinha A, Aschenbrenner AR, Xia R, Murphy KP & Diamond PM. Differential Mortality across Five Types of Substantiated Elder Abuse. Journal of Elder Abuse and Neglect. 2016; 28:2, 59-75.

  • Senior Justice Division

    TEAM Institute Senior Justice Division

    This division promotes justice for older adults through three multidisciplinary teams which are the 1) Harris County Elder Abuse Fatality Review Team (EFFORT), 2) Houston Financial Abuse Specialist Team (FAST), and the 3) Senior Justice Assessment Center (SJAC). Brief descriptions of each team are provided below.

    The Harris County Elder Abuse Fatality Review Team (EAFRT, pronounced “EFFORT”)

    EFFORT was formed in 2003 with a small seed grant awarded to the TEAM Institute from the American Bar Association.  EFFORT operates under the auspices of the Texas Health and Safety Code (Chapter 672) and is a subcommittee of the Harris County Domestic Violence Coordinating Council.  EFFORT meets monthly to review deaths of elderly that are the result of or related to abuse, neglect or exploitation. This group works to enhance victim services by identifying systemic problems related to the death of an older adult that can be addressed to prevent future deaths. This team consists of APS, the Harris County District Attorney’s Office, geriatricians, nurse practitioners, social work, public health, the Houston Police Department, Department of Health and Human Services, Harris County Sheriff’s Office, Harris County Institute of Forensic Sciences (i.e. medical examiners) and trauma and injury specialists. This team produces bi-annual written set of recommendations to the Harris County Commissioners.  These reports are public documents and can be viewed by clicking X.

    Houston's Financial Abuse Specialist Team (FAST)

    The H-FAST team is led by the Houston Better Business Bureau and includes a group of professionals from various disciplines who meet monthly regularly to discuss cases of financial abuse, current scams, develop educational material, train frontline workers and community members and provide consultation on specific cases of elder financial exploitation. Professionals involved with H-FAST include, the better business bureau, geriatric social work, APS, court investigators, geriatric medicine, law enforcement, long-term care ombudsman, mental health professionals, clergy and others. Utilizing the different professionals and leveraging resources and practices this group is able to provide a multidisciplinary approach to investigation, prevention and intervention.

    Senior Justice Assessment Center (SJAC)

    The SJAC began in 2017 as a “one-stop-shop” for older adults who are victims of crimes in Harris County. This team include the Harris County District Attorney’s Office, the Texas Office of the Attorney General, Houston Police Department, APS, UTHealth geriatric medicine and psychiatry, Forensic Nursing, social work, guardianship, county protective services and public health. This group works to minimize the re-victimization of older adult victims of elder abuse by coordinating a comprehensive assessment and interview of the senior victim, at a single location, and then working together to implement a robust response that includes medical, social and legal as necessary. This group has had significant success in increasing justice for victims including prosecutions, restitution and coordinating safe long-term environments.   

TEAM Institute logoTexas Elder Abuse & Mistreatment

The Texas Elder Abuse and Mistreatment Institute (TEAM) is a 17-year multidisciplinary collaboration between academic medicine geriatric health care specialists and the Texas Department of Family and Protective Services, Division of Adult Protective Services (APS). Its mission is to improve the lives of abused and neglected vulnerable adults through evidence-based multidisciplinary clinical assessment and care planning. As the first formal collaboration between a medical school and a state APS program, the TEAM Institute has provided multidisciplinary clinical assessments and short- and long-term care plans for more than 2000 abused and neglected older adults. The TEAM Institute multidisciplinary clinical team comprises members from geriatric medicine, nursing, social work, APS and physical and occupational therapy working together to provide comprehensive care plans.

Historically, the TEAM Institute clinical services were limited to in-home, face-to-face medical and mental health capacity assessments of APS clients living locally near Houston, Texas. Through a statewide virtual services program called the Forensic Assessment Center Network (FACN), the TEAM Institute services have been extended to APS clients across Texas. This expansion will improve APS investigations and client outcomes through increased access to geriatric health care specialists. This new program has helped overcome geographic boundaries and shortages of specialty care providers by implementing telemedicine mental health capacity assessments, assessments of abused and neglected older adult’s mobility, mood, memory, medications, and medical and social history as well as client staffing consults with APS caseworkers. In addition, the FACN also includes forensic assessments of facility based abuse cases and employee misconduct registry reviews to assist with the determination of abuse and protection of older adults against future abuse.

TEAM Institute organization chart

For more information about TEAM Institute, contact Leslie Clark at Leslie.E.Clark@uth.tmc.edu or 713-873-4683.