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Journal of Elder Abuse & Neglect

ISSN: 0894-6566 (Print) 1540-4129 (Online) Journal homepage: http://www.tandfonline.com/loi/wean20

Best Practices for Working with Rape Crisis Centers to Address Elder Sexual Abuse

Karla Vierthaler MPA

To cite this article: Karla Vierthaler MPA (2008) Best Practices for Working with Rape Crisis Centers to Address Elder Sexual Abuse, Journal of Elder Abuse & Neglect, 20:4, 306-322, DOI: 10.1080/08946560802359235

To link to this article: https://doi.org/10.1080/08946560802359235

Published online: 11 Oct 2008.

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Journal of Elder Abuse & Neglect, Vol. 20(4) 2008 Available online at http://www.haworthpress.com © 2008 by The Haworth Press. All rights reserved.

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WEAN0894-65661540-4129Journal of Elder Abuse & Neglect, Vol. 20, No. 4, August 2008: pp. 1–23Journal of Elder Abuse & Neglect

Best Practices for Working with Rape Crisis Centers to Address Elder Sexual Abuse

Karla VierthalerJOURNAL OF ELDER ABUSE & NEGLECT

Karla Vierthaler, MPA

ABSTRACT. Sexual violence perpetrated on elders is a significant problem. Elder sexual assault victims often need more assistance than younger victims, yet they typically receive fewer services. Rape crisis centers have faced a multitude of barriers in addressing elder sexual abuse. This article provides an overview of the rape crisis movement and discusses why elders have been both overlooked as potential targets of sexual assault and underserved as victims. Recommendations are made to encourage collaboration between elder and rape crisis advocates. This article describes a Pennsylvania project to cross-train Department of Aging protective service workers and rape crisis advocates.

KEYWORDS. Barriers, elder sexual abuse, rape crisis movement, service provision, sexual violence, rape crisis counseling, protective services

Sexual violence committed against elders is a growing problem both in the United States and globally. Elder victims, like all victims of sexual abuse, often experience severe emotional and physical trauma. The rape crisis movement, which began as a grassroots feminist response to sexual

Karla Vierthaler, MPA, is the Outreach Coordinator for the Pennsylvania Coalition Against Rape, 125 North Enola Drive, Enola, PA 17025 (E-mail: [email protected]).

Note: All materials developed by the Pennsylvania Department of Aging and the Pennsylvania Coalition Against Rape, as well as information about the elder sexual abuse project, are available from Karla Vierthaler.

Address correspondence to: Karla Vierthaler at the above address.

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violence, has sought to provide victims with systemic advocacy in the community as well as emotional support throughout the healing process. Unfortunately, both the movement’s roots and society’s perpetuation of rape myths have excluded elders from the image of victims of sexual violence and have left them without an appropriate community response when they are victimized. Thus, while elder sexual assault victims may require more assistance and specialized help because of age-related disabilities and other factors, they often receive fewer services and intervention than younger victims. In an attempt to understand this pattern, the history of the rape crisis movement and the continuation of rape myths in our society will be explored.

HISTORY OF THE RAPE CRISIS MOVEMENT

Today, across the United States, victims of sexual violence have free and generally confidential access to rape crisis services. Victims of sexual violence and their significant others have access to various forms of crisis intervention depending on the services offered in their state/community: 24-hour hotline services; individual and support group counseling; hospi- tal, court, and police accompaniment; prevention education within schools and the community; and information and referral. These services are avail- able to anyone regardless of age, gender, race, ability, class, sexual identity, time of the assault, and willingness to cooperate with police.

Funding for rape crisis centers has come from many sources, which vary across the country. State public welfare funds are the main source of funding in many areas, as well as local United Way agencies and commu- nity support. The passage of the Violence Against Women Act in 1995 began the provision of federal grant programs to support rape crisis cen- ters. Housed in the U.S. Department of Justice, the Office of Violence Against Women offers one formula grant program and 11 discretionary grant programs to support programs seeking to end domestic violence, dating violence, sexual assault, and stalking. To date, the office has dis- pensed nearly $2 billion to these programs (U.S. Department of Justice, 2007). Despite state, federal, and community funding, the movement remains largely grassroots. Most rape crisis centers depend on the services of volunteers, rely heavily on fundraising and donations, and remain staffed by individuals committed to social change. Unfortunately, many centers struggle to pay employees a competitive wage, meet the demand for services, and, for some, to keep their doors open.

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The rape crisis movement came about on the heels of the so-called second wave of the women’s rights movement in the early to mid 1960s, a turbu- lent time in American history. The country was involved in an unpopular war, a number of prominent politicians were assassinated, and the civil rights movement was gaining momentum. During this time, several pivotal incidents fueled the women’s rights movement.

In 1963 the Department of Labor released the statistics that women could expect to make 59 cents for every dollar a man made, and certain fields such as medicine, law, and business, were all but closed to women because of gender discrimination. Betty Friedan’s The Feminine Mystique also was published in 1963, providing insight into the emotional and intel- lectual oppression of middle-class educated women that was the result of limited life options.

During the 1960s, married women were not issued credit cards and could not get bank loans without a male cosigner. Married women were not encouraged to work outside of the home, and unmarried women were steered toward administrative positions to keep them busy and to avoid their becoming financial burdens on their parents before their marriage. These realities refer mainly to White middle- class women; women living in poverty and women of color were further subjugated to life sentences in service positions and gender discrimination.

At this time, rape laws remained based on English Common Laws, which viewed women as men’s property—either their father’s or husband’s— depending on the woman’s marital status. Marital rape technically could not exist because a wife could not legally refuse sex with her husband (Rape [law], 2007).

Women began publicly to voice concerns about their inequality. They formed consciousness-raising all-female groups and shared taboo stories and concerns not previously voiced. These discussions led to the politici- zation of the issue of sexual assault. Many who had been assaulted orga- nized to provide support for fellow victims, and a grassroots movement was formed.

The first rape crisis centers were founded in the early 1970s in large cities (Greensite, 2007). The movement has been successful in raising awareness and erasing the stigma of sexual violence; however, it remains steeped in the tradition of its founders: White middle-class vic- tims. This perpetuated the beginnings of what is now known to be a myth: young, White, middle-class women are the primary victims of sexual violence.

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It didn’t occur to either the founders of the rape crisis movement or society at large to include elder women, or others who weren’t young, White, and female. Today’s elder victims grew up in a world of sexism, where even the rape crisis movement discriminated on the basis of age, race, and gender. This affects how elders experience and view sexual victimiza- tion, and how society and professions dealing with crime victims respond to elder victims.

THE LINK BETWEEN OPPRESSION AND SEXUAL VIOLENCE

Females are victims of rape and sexual assault at a rate of 7.5 times greater than males (Rennison, 2000). However, statistics show that all groups in our society that lack power are sexually victimized at higher rates. Consider the following:

One of every 6 American women and 1 of every 33 American men has been the victim of an attempted or completed rape (Tjaden & Thoennes, 1998).

One in 4 girls and 1 in 6 boys will be sexually assaulted by age 18 (Finkelhor, Hotaling, Lewis, & Smith, 1990).

Among adults who are developmentally disabled, as many as 83% of the females and 32% of the males are the victims of sexual assault (Johnson & Sigler, 2000).

Of people with developmental disabilities who are victims of sexual vio- lence, 49% experience 10 or more abusive incidents (Valenti-Hein & Schwartz, 1995).

American Indians were twice as likely as others to experience rape or sexual assault (Perry, 2004).

Perpetrators of sexual violence seek vulnerable victims. They look for victims who are easy to overpower and manipulate, who will not report the crime, and who will not be believed if they do. Studies illustrate that children of both sexes and people with developmental disabilities—both extremely vulnerable populations—are victims of sexual violence at much higher rates then women over age 18.

The myth that victims of sexual violence are almost always young White women inevitably links sexual violence to sexual attraction. In

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mainstream U.S. culture, young white women are the demographic ideal of sexual attraction. If this group is believed to be the primary target for perpetrators of sexual violence, vulnerable populations such as children, people with disabilities, people of color, and elders are not viewed as possible victims because they do not fit the culturally prescribed description of sexual attractiveness. Also, if sexual violence is framed as an act of sexual desire and not of violence, its significance can be minimized by society and victims are easier to blame. Elders, particu- larly those with age-related disabilities, are clearly a vulnerable popula- tion. Statistics, along with understanding sexual violence in terms of oppression, demonstrate why elders are both victimized and ignored as victims. Available studies report that elder sexual abuse victims tend to be of advanced age, frail, and dependent on others for care. Sexual pred- ators view elders as perfect victims, especially those who are older and dependent on others for assistance.

People do not talk about rape. Victims often are not believed or are blamed for their rape when they do come forward. Many victims do not tell anyone about the crime, and fewer report it to law enforce- ment. From 1992 to 2000, on average only 31% of all rapes and sexual victimizations were reported to the police. The highest category of victimization not reported to police was attempted rape (Hart & Rennison, 2003). Thus, sexual crimes are difficult to track and it is not possible to accurately report prevalence. Elders, perhaps more then any other population, tend to feel extreme fear and shame after sexual victimization. Isolation, dependence on care, fear of removal from home or nursing facility, fear of reprisal, and generational beliefs such as the value of keeping information private, along with shame and guilt, keep many elderly sexual assault victims in a solitary web of misery and depression.

It is essential that these dynamics are understood when addressing elder sexual violence because they affect service provision. Elder victims face many barriers to seeking aid. Age-related disabilities and conditions make elders especially vulnerable to sexual violence. However, because elders are viewed by society as unlikely targets for sex crimes, those closest to them often do not recognize sexual vic- timization when it occurs. The criminal justice system and social ser- vice agencies, including rape crisis centers, have fallen short in addressing sexual violence against elders. Both victims and other involved parties, including mandated reporters, vastly underreport these crimes.

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CURRENT TRENDS IN THE RAPE CRISIS MOVEMENT

As the rape crisis movement evolved, it grew from grassroots activism and local service provision to state- and national-level advocacy of victims. Rape crisis centers organized to form statewide coalitions to promote funding for centers and to ensure that the voices of victims are heard by the legislature. Nearly all states now have an anti–sexual violence coali- tion. Their funding and structures vary; nonetheless, the coalitions all pro- mote the goals of their community-based member centers that do direct service work with victims. Many coalitions provide training and technical assistance for member centers and for other professionals. They develop resources and curriculums, work on state and national policy develop- ment, and provide legal advocacy and representation for victims.

National organizations, including the National Alliance to End Sexual Violence and the National Organization for Sisters of Color Ending Sexual Assault, engage in national advocacy for the rape crisis movement. The National Sexual Violence Resource Center, founded in 2000, is a clear- inghouse for information on sexual violence that is funded by the Centers for Disease Control.

Outreach to Elders and Others

The rape crisis movement recognized its shortcomings. As the link between sexual violence and all forms of oppression became clear, cen- ters noticed that the statistics did not match the faces of the victims they were serving. Center clients were still disproportionately White women and children. Men, people with disabilities, people of color, and older individuals were simply not presenting to rape crisis centers for services. To address this, sexual violence coalitions and rape crisis centers have created materials and campaigns to reach underserved populations. These efforts are nationwide and include training, creation of public awareness materials, media campaigns, and legislative efforts. As part of this work, the rape crisis movement is collaborating with organizations that have not been traditional allies.

Many sexual assault coalitions and rape crisis centers throughout the country now recognize the need to better serve elder victims of sexual vio- lence. The need to collaborate with professionals working with and on behalf of elders has been identified. Collaboration between rape crisis cen- ters and aging services is challenging because these agencies have differing philosophies and methods of advocacy. Before exploring best practices for

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collaboration and how Pennsylvania coordinated the efforts of Department of Aging protective service workers and rape crisis advocates, it is impor- tant to examine how the rape crisis movement traditionally provides service.

Services Provided by Rape Crisis Centers

Rape crisis centers offer a variety of services including education and outreach, systems advocacy, and counseling. Services include various forms of crisis intervention including 24-hour hotline services; individual and support group counseling; hospital, court, and police accompaniment; prevention education within schools and the community; and information about and referral to other services offered in the state and community.

Empowerment Counseling

Counseling is one of the most important services offered by rape crisis centers. Counseling generally is offered as group and/or individual sessions over a short or long period of time, depending on the center and state. Counseling is free, confidential, and open to anyone seeking services. Short-term counseling often is done over the hotline.

The counseling offered mirrors the model developed by the rape crisis movement. Founders of the movement viewed sexual violence as an act in which a perpetrator takes away a victim’s power—a violent crime uti- lizing sex as a weapon. To help victims regain their power, most rape crisis advocates use the empowerment model of counseling.

Empowerment counseling is “a process through which those who have been oppressed or victimized learn to know their strengths and recognize themselves as the experts of their own lives, needs, strengths, compe- tency, and dreams” (Pennsylvania Coalition Against Rape, 2000, p. 195). This method utilizes reflective listening and options counseling. It pro- motes a victim’s right to make decisions, take control of making desired changes, and choose to heal, thus moving from victim to survivor. Victims are provided information with which to make decisions. A goal is to increase knowledge and thereby help victims identify internalized oppression.

The empowerment model requires victims to take the first step by seeking services at rape crisis centers. For that reason, others, such as parents, friends, and professionals, cannot enlist victims for services; victims must seek the services themselves. This model asks victims not only to contact the rape cri- sis center themselves but also to travel to the center to receive services. Advocates generally do not travel to victims. This is done not only to encour- age empowerment but also to ensure the safety of both victims and advocates.

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Education and Outreach

Education and outreach consist of educational programs and public aware- ness efforts. Centers offer prevention education programs within schools and other community organizations. Presentations about sexual violence and center services are offered to community groups and other professionals. Participation in or hosting community events is part of outreach efforts. For example, many centers plan a “Take Back the Night” march or speak-out so that survivors can share their stories in a supportive environment.

Advocacy

Advocacy is performed on both a systems and individual basis. Many rape crisis advocates provide medical and legal advocacy for victims. Advocacy can involve providing a referral to a victim on the hotline, sitting with a victim through a four-hour rape examination in a hospital emergency room, or accompanying a victim to a police station for an interview.

When victims enter into any system following sexual assault, advocates are available to accompany them throughout the process. Rape crisis cen- ter personnel can provide emotional support, information about medical care, referral to mental health services, options counseling, help with safety concerns, support for significant others, and information regarding finan- cial and housing issues.

If a victim goes to a hospital from 72 to 120 hours after being sexually assaulted, a forensic rape exam is normally conducted to collect DNA and other physical evidence. Treatment is provided for internal and external injury. Victims are asked if they want to cooperate with the police investi- gation of the crime. If so, interviews occur at the hospital and victims also may be asked to go to police stations for follow-up interviews.

Victims also may report sexual crimes after 120 hours have passed. If the assault was recent, medical treatment for internal and external injuries can be administered. Dependent on each state’s statute of limitations, the crime also may be reported without medical examination days, months, or even years after the assault. If the district attorney’s office chooses to prosecute the case, the victim will likely testify in court about the incident. Each step through the system requires victims to discuss their assaults in detail and essentially relive the traumatic and invasive experience of sexual violence.

Advocates who provide accompaniment inform victims about medical procedures, police processes, and their legal rights. Rape crisis advocates

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are knowledgeable about common reactions to sexual victimization, and are trained to provide ongoing support to victims and their significant others through whichever processes they choose to pursue.

SART Teams

Many communities across the United States have created sexual assault response teams (SART) to encourage collaboration among involved systems and professionals. A SART is a multidisciplinary team that works collaboratively to provide specialized services for victims of sexual assault.

SART teams often include a medical director, sexual assault forensic examiner, rape crisis advocate, law enforcement representative, and pros- ecutor. Other members of the community can be part of the team, such as children and youth representatives. While many communities have a formal SART that meets regularly, each professional’s role remains the same regardless of whether a team exists. Following are the roles of profession- als involved in emergency response to sexual assaults.

1. A SAFE (sexual assault forensic examiner) or SANE (sexual assault nurse examiner) is a registered nurse or physician specifically trained to provide comprehensive care, timely collection of forensic evidence, and testimony in sexual assault cases. If a SAFE or SANE is unavail- able, a doctor or nurse with experience in treating sexual assault victims and conducting forensic rape exams should be utilized.

2. As discussed previously, the rape crisis advocate is available to pro- vide support, assistance, and information to the victim and involved professionals. The advocate helps the victim obtain necessary care and information from health professionals, law enforcement, and prosecutors. With the victim’s permission, the advocate is present during the interview and forensic exam. In many states, communi- cation between victims and advocates is privileged and confidential. The advocate links other involved professionals to make the inter- vention process easier for the victim.

3. The law enforcement officer responds to the crime, interviews the victim (often in conjunction with the SAFE, SANE, or health care personnel), and investigates the assault. If a forensic exam is con- ducted, the examiner gives the completed and sealed forensic evidence collected to the officer to maintain the chain of evidence. A crime lab processes the evidence from the sexual assault.

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4. During a sexual assault investigation, the prosecutor works with law enforcement officers to direct the investigation and determine if there is sufficient cause to arrest a suspect. The primary responsibil- ity of the district attorney’s office is to prosecute criminal charges and to hold the defendant accountable (Hart & Rennison, 2003).

Discussing and formalizing these roles helps ensure that services are effective and victim sensitive. The presence of a SART facilitates collab- oration among the involved professionals and agencies.

BARRIERS TO ELDERS RECEIVING SEXUAL ASSAULT SERVICES

Despite the widespread availability of rape crisis services, elders gener- ally are not seeking or being linked to these services when they are sexually assaulted. There are a variety of reasons for this.

Rape Myths

Today’s 75-year-old woman was 10 years old in 1932. She grew up in the culture that the rape crisis movement sought to change. Women were consid- ered men’s property and were only given the right to vote 12 years previously. Today’s generation of adults over age 60 just started to come of age when soci- ety began to recognize its widespread discrimination against women. Hence, the elders of today were raised in a sexist and racist society. Girls were taught to fear strangers, especially men of color, as rapists. It was taught that boys had uncontrollable libidos, which girls were expected not to tempt. If rape occurred between two peers (generally revealed only because of a pregnancy), the girl was shamed. Boys and men were not considered possible victims of sexual vio- lence, and any such victimization would label them as weak or homosexual.

Because of these societal beliefs, many who were sexually victimized in this generation did not tell anyone about the crime and experienced extreme feelings of guilt and shame. For elder victims, these values and feelings carry over to today. Many feel overwhelmingly ashamed. For example, when questioned about suspected sexual abuse, an elder victim living in a nursing home revealed that a nurse aid had raped her, and commented, “I don’t know what I could have done to lead him on.” This example and the others that follow are taken from stories shared by advocates, social workers, police, and medical professionals.

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Failure to Recognize Elderly Victims of Sexual Violence

Another barrier to providing sexual assault services to elder victims is the lack of understanding of legal definitions of sexual violence by elders, elder advocates, and health care professionals, as well as the gen- eral public. This leads to a lack of recognition of sexual crimes involving elders. All states have varying definitions of rape, sexual assault, sexual battery, consent, and so on. Many people do not realize that in most juris- dictions sexual violence includes groping, which does not require that the victim fight back. In many cases of groping and other nonconsensual sexual acts neither the victims nor professionals recognize the severity of the crime and thus do not report it to law enforcement or seek victims’ services.

For example, a woman, whose husband had Alzheimer’s disease, was frequently groped by him when she visited him in his nursing home. This visibly upset her. Nursing home staff witnessed this but did not intervene because they assumed that an incompetent person could not be a sexual perpetrator. Furthermore, they did not know if sexual aggressiveness within a marriage was legally acceptable. The nursing home had no proto- col for responding to suspected sexual abuse involving residents as either victims or perpetrators. Nothing was done to restrain the husband. Although he was not competent, the husband’s acts were illegal. The nursing home had a responsibility to protect the wife from victimization and should have referred her to a rape crisis center.

Mirroring the assumptions of mainstream U.S. culture, many elder vic- tims do not report sexual crimes or seek services because they do not think that older people can be victims of sexual violence. One victim said, “I didn’t think old women could be raped.” She knew about the local rape crisis center, but thought that it served only younger women and children. Elder men report the same barriers, and often do not think men can be victims of sexual crimes.

The Empowerment Model

Although the empowerment model is effective with victims of sexual violence, it poses problems for people with disabilities. Victims who are elderly or disabled may be unable to use a telephone to call a rape crisis center to request assistance. The may reside in care facilities where they do not have access to a telephone. Some are unable to communicate. Addition- ally, travel to the rape crisis center for services can be impossible. Many elders no longer drive or have access to a vehicle; some rely on others

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(often the perpetrator) for transportation. Those with severe disabilities may require transportation by ambulance or other special vehicles.

Professionals working with elder victims may have little knowledge of rape crisis center philosophies. Often, professionals call to request that an advocate work with an elderly victim. Without background information about the victim’s limitations, the center may respond by saying that the victim make the request for services. Some professionals have called rape crisis centers and requested that advocates travel to vic- tims. These requests often have been denied. Most centers will do what they can to work with victims with disabilities or other situations that limit their ability to come in for counseling. However, this requires an understanding of the situation and a creative approach to providing rape crisis services.

POSITIVE PRACTICES FOR SERVING ELDER VICTIMS

The most effective strategy to serve elder victims of sexual violence is to bring professionals in the rape crisis and aging fields together. Because elder sexual abuse historically has been unrecognized, neither rape crisis nor aging services professionals have sufficient knowledge of each other to know how to best work together. Following are suggestions for encour- aging collaboration.

Agency Cross Training

Hosting training for a network of agencies is the best way to open lines of communication with other organizations that are not typical col- laborators. For example, the rape crisis center could invite the profes- sionals who serve elders (protective service workers, social workers from nursing homes, in-home health care workers, etc.) to a meeting or open house where their services are described. A discussion about possi- ble collaboration could follow and would allow the audience an opportu- nity to enhance mutual understanding by explaining the laws and regulations under which they operate.

Inclusion of (Older) Adult Protective Services in the SART Team

If the community has a SART team, adult protective services workers and other professionals working with elders should be members. Because sexual

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violence affects everyone in the community, those protecting specific popu- lations are essential to the effectiveness of the team.

Training on Elder Sexual Abuse

Training on elder sexual abuse is a key component of collaboration. Resources on elder sexual abuse are available on the Internet (see the Ref- erence list) and in the professional literature, providing case examples and information on prevalence, victims, and perpetrators. It is important for professionals to recognize that elder sexual abuse is a problem and to understand how to identify cases.

PENNSYLVANIA’S EXPERIENCE

While these activities can encourage relationships between profession- als in the rape crisis and aging fields, time, resources, and philosophical differences in approaches to care may hinder collaborative relationships. The State of Pennsylvania embarked on a 3-year project, The Pennsylvania Elder Sexual Abuse Project, to encourage professional collaboration regard- ing elder sexual abuse. The lessons learned in the project are offered to guide communities around the country.

In Pennsylvania, the Department of Aging and the Commission on Crime and Delinquency recognized that there was a lack of service provi- sion to elder victims of sexual abuse. To address this, the two agencies funded the Pennsylvania Coalition Against Rape (PCAR) to administer a project to encourage collaboration between rape crisis centers and adult protective service workers at Area Agencies on Aging. Pennsylvania is one of few states with an Older Adult Protective Services Act, which exclu- sively serves vulnerable adults over age 60. Pennsylvania’s project focused solely on older adults.

The Pennsylvania Elder Sexual Abuse Project

The Pennsylvania Elder Sexual Abuse Project began with a qualitative study to determine how to best utilize grant funding. In-depth interviews were conducted with 28 staff members at Pennsylvania rape crisis centers, nursing homes, personal care agencies, home health care agencies, and com- munity service agencies administering programs serving seniors. The results indicated not only that all groups had little contact with elder sexual abuse victims but also that they knew very little about signs and symptoms of elder

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sexual assault. The groups had received no education on the topic. They were interested in training, specifically, in signs of abuse and distinctions between abuse and consenting sexual relations (The Melior Group, 2003).

A cross-training curriculum for rape crisis staff, older adult protective ser- vice workers, elder care staff, police, and district attorneys was developed. It was designed to serve as an introduction to elder sexual abuse and was made up of six modules.

1. An overview of sexual violence and rape crisis centers 2. An overview of the elder population and Area Agency on Aging

services 3. Statistics and information on elder sexual abuse 4. Detection of elder sexual abuse and brief information on medical

care and handling sexual abuse disclosures 5. An overview of Pennsylvania laws on sexual violence, elder abuse,

and mandated reporting 6. Collaboration models for communities to address elder sexual abuse

Training sessions were offered at no charge to participants at six loca- tions throughout the state. All participants received a copy of the curricu- lum, which included PowerPoint presentations, trainers’ notes, and activities for each module.

The grant also funded an elder abuse awareness campaign. Posters and print advertisements that read “Sexual Assault Knows No Age Limit” were sent to rape crisis centers and Area Agencies on Aging and appeared in newspapers and senior papers across the state. The posters also were produced in Spanish.

The Pennsylvania Coalition Against Rape also produced two brochures on elder sexual abuse. One was on elder sexual abuse in general, and the second was geared toward seniors and titled “Are You At Risk?” The bro- chures were translated into Spanish and sent to the agencies previously mentioned. Dr. Ann Burgess and Jill Hoexter, assistant district attorney, Manhattan District Attorney’s Office, authored a booklet titled, “Preparing and Prosecuting Elder Sexual Abuse,” which PCAR distributed to the Pennsylvania agencies and nationally through the National College of District Attorneys.

Another segment of the project was the development of a curriculum to train elders about sexual abuse. An advisory council comprised of rape crisis staff, adult protective service workers, and PCAR staff created the curriculum. It was designed for training sessions of 1–2 hours. The goal was to dispel myths about rape and provide an overview of sexual abuse and available services.

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Additionally, elder sexual abuse technical assistance guides were created for adult protective service workers and rape crisis advocates. The guides were designed to provide a quick reference for professionals dealing with an elderly victim.

Reaction to the Project

Rape crisis centers appreciated the free materials on elder sexual abuse, but the adult protective service workers, initially unfamiliar with PCAR, were at first leery regarding participation in the project. As protective per- sonnel became involved, however, positive feedback emerged, especially from those who attended the “train the trainer” sessions for the cross- training curriculum. Adult protective service workers expressed apprecia- tion for the detailed explanation of sexual violence laws and the refresher on the sexual abuse section of the Older Adult Protective Service Act. They valued the information regarding detecting elder sexual abuse and tips on discussing sexual abuse with victims. Many protective service workers had at least one sexual abuse case, and recognized that the tools provided might help them conduct case investigations. While both protec- tive service workers and rape crisis advocates had basic information about each other prior to the trainings, learning more about the systems in a neutral environment put people at ease. Many connections were made among professionals at the county level.

Feedback from professionals following trainings demonstrated that these sessions increased community collaboration. Several rape crisis advocates were invited to join county elder abuse task forces, which focus primarily on financial exploitation. Rape crisis advocates shared information about sexual violence with other members of the task forces.

One county invited a protective services representative to participate in their SART team. Initially, tension arose between the groups because a protective service worker suggested that a rape crisis advocate go to the home of an elderly woman who had been sexually abused by her son. The protective service worker had tried to intervene to assist the victim. How- ever, the victim was competent and chose to remain in her situation and refused protective services. An explanation of empowerment counseling led to the tension subsiding.

The project’s multifaceted approach contributed to its success. With three years of generous funding, Area Agencies on Aging across Pennsylvania were inundated with materials: brochures, posters, pamphlets, training

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opportunities, and curriculums. Relationships among rape crisis centers and protective services agencies in the majority of Pennsylvania’s 67 counties have been strengthened because of the grant.

CONCLUSIONS

Statistics indicate that elder sexual abuse occurs; however, infre- quent detection and reporting of cases remain barriers to providing effective services to victims. Community collaboration is challenging in part because few cases come into the public eye. However, this col- laboration is essential to the treatment and healing of elder sexual abuse victims.

The Pennsylvania project seemed to accomplish the goal of increas- ing community collaboration on behalf of elder sexual abuse victims. Moreover, there were also national and even international benefits. The Pennsylvania Coalition Against Rape and the Pennsylvania Department of Aging put all the materials related to the project online for free down- load, and the response was overwhelming (http://www.aging.state.pa.us/aging/ cwp/view.asp?a=558&q=254614&agingNav=I&agingNav_GID=607). Rape crisis centers around the country utilized the curriculum to conduct train- ings. Elder abuse organizations adapted the fact sheets and materials to bring attention to the problem of elder sexual abuse. The Pennsylvania project director was invited to write articles on elder sexual abuse for newsletters around the country and to provide training at national elder abuse and sexual violence conferences.

Although the materials produced by this project are of a high quality, its success is largely the result of the lack of information about elder sexual abuse. When the project began, few studies existed. Only 10–20 research articles were available, and there were few experts in the field of elder sexual abuse.

What set this project apart from those in other states was the focus on elderly victims. Most states’ protective services laws cover vulnerable adults over age 18 and their sexual abuse awareness curriculums focus on younger people with disabilities and the elderly. While these are valuable resources, people seeking information specifically about elder sexual abuse could find limited information.

Sexual abuse, the most underreported form of elder abuse, has become a topic of interest in both sexual violence and elder advocacy communi- ties. Placing the elder sexual abuse resources that we developed on the Internet in a user-friendly format filled an important need.

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REFERENCES

Finkelhor, D., Hotaling, G., Lewis, I., & Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse and Neglect, 14, 19–28.

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