GENERATIONS – Journal of the American Society on Aging

started with a research phase, including a lit- erature review of programs and interventions to address EM (Rosen et al., 2019), key infor- mant interviews and focus groups, and in-person meetings to discuss results and reach consensus on the model’s core aspects. The EMED was designed for a variety of set- tings—urban and rural, large and small, and those with and without EM expertise. It consists of the following four elements: 1. A brief survey for ED clinical staff to help identify opportunities and barriers and drive practice change; 2. Training modules for clinical staff and internal champions; 3. Streamlined screening and response tools to identify, document, and report suspected EM and to inform discharge plans to help keep patients safe once they leave the ED; and 4. The Community Connections Toolkit to help hospital emergency departments develop and maintain relationships with community organizations and initiate or join community efforts to mitigate EM. This article focuses on the fourth element, presenting methods and results from key infor- mant interviews, which were instrumental in developing the Community Connections Toolkit. Also, it discusses lessons learned and strategies healthcare systems can apply to build a more coordinated community response to EM. Key Informant Interviews Methods : The interview goals were to document whether or not hospital staff perceived EM to be an urgent issue in the ED; to identify factors that help or hinder staff ability to address EM in the ED; to identify types of training, screening, and response protocols currently in use; and to determine if there was a coordinated community response to EM. The co-authors of this article worked as a team to identify hospitals in Massachusetts that represented a diverse set of potential end-users of the care model, including those that had var-

ied access to EM experts, were and were not affiliated with an academic medical center and- or a large health system, and those that served patients in rural and urban areas. They also identifed APS agencies within these hospitals’ service areas. Key informants included a purpo- sive sample of hospital clinicians, administra- tors, and APS staff. Semi-structured interviews, “I imagine that [elder mistreatment] is probably more prevalent than what we identify,” said an ED medical director. with twenty-two participants, were conducted by phone or in person between April and Sep- tember 2017. At least two article co-authors attended each interview; one facilitated the con- versation and one took notes, which were later supplemented by review of audio recordings to which informants had given consent. Co-authors reviewed and coded the notes, and developed themes based on discussion of key fndings. Key Themes : What follows are three key interview themes and how they informed the Community Connections toolkit development: EM as a priority; gaps and opportunities in cur- rent ED practice; and practicality of a coordi- nated response to EM. Elder mistreatment as a priority Hospital informants felt there was a sense of urgency to better address EM in the setting in which they worked and-or in the community, and that their ability to do so was dependent upon available resources (i.e., access to internal or external EM experts). They reported a lack of protocols to screen for EM beyond a generic question related to feeling safe at home, and sev- eral hospitals suspected that they were missing EM cases. “I think it is one of those things that probably flies under the radar . . . I imagine that it is prob-

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60 | Spring 2020

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