Community Complex Case Response Team (C3RT)

At the Yale School of Medicine, efforts are being concentrated into alleviating the health repercussions of elder abuse and neglect (EA/N). EA/N is now deemed a public health and safety epidemic given outcomes linking to increased emergency department utilization, nursing home placement, financial loss incurrence, and mortality risk. Hence, the starker presence of EA/N necessitates a more integrated, and efficient standard to aid EA/N survivors.

In this project, the Community Complex Case Response Team (C3RT) helps provide e-referral, coordinated case management, and multi-sector service delivery for EA/N survivors and those at risk for EA/N. C3RT operates from the rationale of reducing individual vulnerability and increasing individual capacity for self-care and interdependence. Vital component processes of the C3RT model also include obtaining uniform consent, client data sharing, secure electronic case management, and referrals from agencies that often interact with an older adult cohort.

The project received funding from the Robert Wood Johnson Foundation (RWJF), Systems for Action, US Department of Justice’s Office of Violence Against Women, and the Hartford Foundation and in collaboration with Christopher D. Maxwell, PhD (Michigan State University), Carolyn E. Z. Pickering, PhD, RN(University of Texas Health Science Center at San Antonio), and Fuad Abujarad, PhD (Yale University)

Professor and Chair of the Department of Emergency Medicine at Yale University and Physician-in Chief of the Emergency Services at Yale-New Haven Hospital.

Dr. D’Onofrio has extensive experience as a leader, independent NIH funded researcher, and mentor. For almost 25 years, she has conducted clinical trials that have changed clinical practice related to improving the care of patients with unhealthy alcohol, tobacco and drug use and other topics such as treatment of renal colic and physician education. In addition, she has studied sex specific variations in the prevention and treatment of patients with heart disease. As a senior investigator, Dr. D’Onofrio has designed, implemented and directed the analyses of large federally funded clinical trials involving substance abuse, and women’s heath, and have considerable experience mentoring junior faculty and others to establish the next generation of clinical researchers. She has formally mentored a substantial number of faculty at Yale and nationally, who have become successful, independently funded investigators. Dr. D’Onofrio is consistently part of NIH review committees and global initiatives regarding EM. Additionally, she is a founding member of the American Board of Addiction Medicine and had a leadership role in the development of Addiction Medicine as a specialty (O'Connor JAMA Intern Med 2014). She has successfully used the Brief Negotiation Interview (BNI), a tool developed here at Yale, to encourage ED patients to address harmful behavior like drinking and drug use. The technique uses motivational interviewing, and prompts patients to think of their own reasons for wanting to address their substance abuse issues. In summary, Dr. D’Onofrio’s extensive experience as a leader, independently funded investigator and mentor uniquely position me to serve as a co-investigator on the proposed application.

Dr. Pantalon is a clinical psychologist and Senior Research Scientist in the Department of Emergency Medicine at the Yale School of Medicine. He is an expert in motivational interviewing, information technology based interventions, and measuring the fidelity of behavioral interventions. As a Co-investigator on this project he will work with Dr. Abujarad on the development of an effective and motivational brief intervention based on the Brief Negotiation Interview (BNI), an ultra-brief adaptation of Motivational Interviewing. Over the last 15 years he has worked and collaborated several researchers on the development, refinement and testing of the BNI which has been used in 3 large-scale randomized controlled trials. Recently, he collaborated with Dr. Abujarad on the develop automated, web-based applications used to train physicians on the BNI in the ED. In this this proposed project, he will work with the PI and Dr. Pickering on the content development of the BNI intervention to motivate older adults to self-discloses EA/N. He will also assist the research team with the review and analysis of the focus groups findings and will contribute to the test and development of VOICES

Dr. Dziura is a Professor in the Department of Emergency Medicine and is Deputy Director of the Yale Center for Analytical Sciences. He will serve as a co-investigator on this project. Dr. Dziura is trained in epidemiology and has led the biostatistics group of the Yale Center for Clinical Investigation (Yale CTSA). Dr. Dziura specific role will be to assist the research team in the evaluation of the feasibility of using VOICES in a real world setting. Mainly, he will be responsible for providing biostatical input into the development of VOICES system, writing the statistical analysis plan, monitoring the conduct of the VOICES study and analyzing, summarizing and interpreting the results. He worked with the PI on his previous project developing the Virtual Informed Consent, a project that shares similarities with the current proposal in terms of examining the utility and benefit of a comprehensive, usable tool that can improve care and clinical research. Dr. Dziura has experience developing and evaluating interventions employed in the ED setting. His background in biostatistics and epidemiology, combined with over a decade in the design and analysis of clinical research studies, enables him to add value to this project in multiple ways including the assessment of the feasibility in real world settings

Dr. Pickering is an Assistant Professor at the School of Nursing at the University of Texas. She is an expert on elder abuse and neglect prevention, and a recognized expert in innovative technology-based interventions to support identification of victimized and at-risk older adults. Her past experience recruiting older adults from the emergency department and conducting and analyzing focus groups with ED providers will help support Dr. Abujarad with the implementation of this proposed pilot project. Drs. Pickering and Abujarad have an ongoing collaborative relationship which further ensures success of this proposed project. In working together Drs. Pickering and Abujarad have observed the difficulty community agencies have in connecting with victims and at-risk older adults, spurring the idea for VOICES.

Dr. Choo is and emergency medicine physician and core research faculty in the Center for Policy & Research, Department of Emergency Medicine, Oregon Health & Science University. Her research has focused intimate partner abuse on the detection and interventions for drug use in the emergency department. Dr. Choo develop BSAFER, a Web-based, tablet computer-delivered intervention for women with coexisting intimate partner abuse and substance use. She is experienced in designing and testing clinical interventions, employing qualitative and mixed method study designs, using technology for screening and interventions, optimizing the success of interventions implemented in the emergency care setting, and overcoming potential challenges of conducting research involving patients in the ED. Overall, her training and experiences have provided her with the skills and knowledge to lead the proposed project successfully. Dr. Choo will serve as co-investigator and assist in the development and refinement of the intervention, design of the pilot study, development of the interview guides for qualitative work, analysis and coding of transcripts, and interpretation of results, and will contribute to the preparation of manuscripts and reports from this work.