Accident or Incident, Disabled Care Facility Social Coursework

In this scenario a physically disabled man with mild cognitive impairment was injured some time during the night shift when there was only one staff member on duty. In the original scenario, the victim was described as having a mild cognitive disorder and fairly clear speech, but for the purposes of this module you should imagine that he has spastic version of cerebral palsy, little control of his limbs, and finds speaking very difficult. While he seems comfortable speaking with his daytime caregivers who have known him for many years, he is shy around strangers. When you ask him to tell you what happened, he turns his head away, looks down at his lap, and just shakes his head. Since he has a private room, there were no witnesses around. His caregivers have told you that he undoubtedly knows what happened, but is afraid to tell anyone. When the possible perpetrator's name is mentioned, he shakes his head, rolls his eyes, and moves his limbs in an agitated manner. The daytime staff are convinced that he was mistreated. The overnight staff member denies any wrong doing, claims that he was unaware of any bruises, and has implied that the marks had either been sustained while the day shift was on duty or had been self-inflicted. You want answers, but are unsure how to proceed. Review the material on interviewing the disabled from earlier in the course. What would you do?
What techniques do you think work best with willing but disabled subjects? Mary Ann, his usual caregiver during the day shift volunteers to work with you as a kind of "interpreter". She assures you that she has worked with Adam for several years and knows how to interpret his gestures, facial expressions, and verbalizations. You would like to have her present, but are not sure whether it is ethical. Address the pros and cons of having her present during the interview.
Create a discussion response of 2 to 3 pages and talk with others.
(Look at the upload)

M6 Content guide

7. Interviewing elderly subjects 

Interviewing techniques presented in textbooks or during seminars generally assume that the person being interviewed is an emotionally healthy and mature individual with a normal IQ. Twenty-five years ago, when the epidemic of unreported child sexual abuse attracted national attention, specific interviewing techniques were developed to address the special circumstances of eliciting information from a child. Contemporary interviewers are now dealing with a new special interest group. As our population ages, interviewers are faced with the task of frequently interviewing elderly witnesses, victims and suspects.

Unlike children, who reach psychological and physiological benchmarks within a year or two of established norms, the deteriorating effects of aging have a wide range. There are 80-year-old subjects with remarkable cognitive and physical abilities and, conversely, 65-year-old subjects with noticeably impaired memory and affected physiological functions. Consequently, the first goal when interviewing an elderly subject is to make an initial assessment of the person's age-related functions. In particular, the interviewer needs to assess the subject's senses and memory function.

Evaluating the Subject's Senses

Assessing a subject's eyesight and hearing is obviously important with respect to credibility if that individual claims to be a witness or victim of a crime. Furthermore, failure to recognize vision or hearing problems within a subject may cause misleading behavior symptoms during an interview.

An interviewer should not approach an elderly subject with any expectation of physical or mental impairment. In other words, it would be improper for the interviewer to initially talk loudly, to use simple words, or to over-explain the situation. Rather, when interviewing an elderly subject the interviewer should have a heightened awareness of the individual's possible sensory limitations and be prepared to adjust interviewing techniques accordingly.

Simple observation may reveal that a subject wears strong eyeglasses or hearing aids. Observing the subject during conversation may indicate a tendency for the subject to turn a "good ear" toward the interviewer when a question is asked or to offer an inappropriate response to a question that was asked when the subject was not facing the interviewer. When sight or hearing is important to the subject's testimony, it is important to establish whether or not the subject was wearing glasses or hearing aids at the time an event occurred.

As one ages, often more light is required for the eyes to focus and discern particular features. When an elderly subject is offering eye witness evidence, the interviewer should carefully document the amount of light present at the time of the initial event. For the same reason, if an elderly subject is asked to identify a photograph or the signature on a canceled check, for example, the document or object should be well lighted.

When interviewing an elderly person with affected hearing there is a tendency to make two errors. The first is for the interviewer to significantly increase his volume when asking a question, and second, to treat the subject as if a hearing impairment also decreases the subject's IQ. If a subject has impaired hearing, the interviewer should maintain a normal volume when asking questions but slow down the rate of speaking words — under this circumstance carefully enunciating each word is often sufficient to allow the subject to understand the interviewer. It is also important for the interviewer to maintain direct eye contact when asking questions as many hearing impaired individuals will rely on visual cues to interpret verbal communication. Finally, the interviewer's vocabulary or sentence structure should not be affected merely because a subject has impaired hearing.

While sight and hearing may be diminished with an elderly subject, the person's olfactory senses may be heightened. In this regard, it is especially important for the interviewer to make certain that his or her breath is fresh and also be aware of possibly offensive odors on clothing such as tobacco or strong cooking odors.

Finally, an interviewer should not be shy in asking an elderly subject about failing sight, hearing or other relevant medical issues. It is not at all unprofessional or insulting for an interviewer to sincerely ask an elderly subject, "Andy are you able to understand me all right?" or, "Julie is there enough light for you to see these pictures?"

Affected Memory

All memories eventually decay to the point of being irretrievable, or perhaps, even erased. A person at age ten who is asked to recall memories of their first day of kindergarten will be able to provide many more specific recollections than when given the same task at age 30. This gradual inability to recall long-term events occurs, more or less, on an even continuum throughout our lives, provided the individual is not suffering from a disease that abnormally impairs memory, e.g., Alzheimer's disease. Similarly, as a person ages short-term memory also decreases. Since most daily tasks require short-term memory ("Where did I park the car?" "Did I buy milk yesterday?"), this type of memory loss is most apparent and bothersome. Because distortions or omissions in long-term memory are typically unverifiable and have no immediate consequence, the perception is that long-term memory remains intact in the elderly, when in fact, it may also be affected.

During an interview, both a subject's long and short-term memory can significantly affect the quantity and accuracy of information learned. The accuracy of long-term memory would certainly be important for an interviewer who is working a case and wants to interview a 70-year-old man who witnessed an incident 5 years ago. With respect to short-term memory, consider a 70-year-old woman who was the victim of physical abuse that occurred 30 minutes ago. In both scenarios the subject's age will almost certainly affect the person's memory, at least to some extent. To address affected memories, there are two procedures an interviewer should use when interviewing an elderly subject. The first is to gauge the subject's accuracy for long-term recall and second is to use techniques to enhance the subject's memory.

When an interview involves long-term memory, the interviewer should ask corroborative questions to help assess the trustworthiness of the subject's memory. Corroborative questions request information that can be independently verified. For example, when discussing a robbery that occurred 25 years ago, the subject may be asked what his home address was, who his immediate supervisor was or what the weather conditions were on the day of the robbery. It is not significant if the subject is unable to recall these details. However, if the subject claims to recall this type of information and subsequent checking indicates that their recall was faulty, this finding suggests possible other errors in the subject's recollections. Including corroborative questions during an interview of an elderly subject may also be beneficial during court testimony in that the interviewer will be able to describe to the court why he found the subject's memory trustworthy.

Interviewing Guidelines

In addition to aging neuro-pathways and diminished blood supply to parts of the brain, other factors contribute to an elderly person's inability to immediately recall information. Some of these include intense emotional states such as anxiety, distrust or fear. Environmental distractions (sounds, movement) can also inhibit the ability to recall information. While some memory loss is unavoidable, an interviewer can increase the amount of information recalled by an elderly subject during an interview by following these guidelines:

1. Most people can relate to the high school experience of sitting down for a final examination and initially being unable to recall anything that was studied. Anxiety, apprehension and fear all greatly reduce a person's ability to recall information. Thus, at the outset of the interview the interviewer should take time to establish rapport. Especially with an elderly subject it is important to establish a level of trust and emotional comfort before discussing the issue under investigation. To do this, the interviewer could exhibit a sincere interest in some aspect of the subject's life. The conversation may center around the subject's career, family, neighborhood, house or yard.
2. Diminish outside distractions. Any subject's cognitive functioning will be higher in an environment that is quiet and free from visual stimulation such as moving people or multiple interviewers asking questions. This guideline operates ten-fold for the elderly.
3. Just as it takes elderly subjects longer to move from one place to another or to finish a meal, it also takes them longer to retrieve memories. Interviewers must literally allow elderly subjects more time to recall information asked during an interview. If an interviewer asks questions rapidly or exhibits nonverbal symptoms of being inpatient, this will enhance the subject's level of anxiety, and consequently, decrease his or her ability to recall information. A slow, methodical questioning technique is much more appropriate for an elderly subject.
4. Do not suggest possible answers. A cooperative subject often wants to please the interviewer by providing requested information. However, if the subject cannot recall the requested information, he or she may be very willing to agree with an answer suggested by the interviewer. When a cooperative subject states that he or she cannot recall specific information, consider these options:
   1. Skip over the incident and return to it later. The topic may be too sensitive for the subject to discuss at the present time or simply be too trivial for the subject to recall. Frequently, by returning to the topic later during the interview, the subject will provide the requested information.
   2. If appropriate, explore prior memory connections to stimulate recall. Examples of this would be: "Did the person remind you of anyone you know?" "Did the person talk like anyone you know?" "Were you aware of any familiar smells that reminded you of someone or somewhere else?" If the subject answers "yes" to this type of question, obviously the interviewer would first pursue the prior memory and then tie it in to the current event, e.g., "Why did this man remind you of your nephew in California?"
   3. At the conclusion of the interview ask the subject to think about the requested information and to call the interviewer if anything else comes to mind. This procedure is also beneficial when the subject is reluctant to reveal information in front of another person present during the interview, e.g., a spouse or relative.

In summary, there are unique issues relating to the interview of elderly subjects interviewers need to be aware of and, if possible, compensate for. When showing an elderly person a photograph or other document, make certain there is sufficient light in the room. When speaking to a subject with impaired hearing, the interviewer should slow down the rate of speaking and maintain eye contact. The interviewer should not talk to the subject as though the person is mentally deficient.

Diminished memory function is a natural part of the aging process. The interviewer should test the elderly subject's memory by asking corroborative questions during an interview. In addition, certain interview procedures should be followed to increase the subject's ability to recall information. In this regard, the interviewer should make an effort to reduce anxiety by establishing a rapport with the subject, allow sufficient time for the subject to remember and not force or suggest answers when the subject initially claims not to be able to remember something.

Interview and Interrogation Tips and Case Studies
with John E. Reid & Associates, Inc.

http://www.policeone.com/police-products/investigation/articles/1688448-Interviewing-elderly-subjects/ 

There may be times, however, when the recall and communication abilities of the disabled individual is much lower than those shown on the instructional video. These individuals will require a slightly different skill set.

Many disabled individuals are not able to communicate in a manner most of us can readily understand. Anyone who has worked with disabled clients knows that while they may not “speak” as we know it, they nonetheless can and do communicate.

There may be times when you are not able to understand the communication of the disabled individual. In these instances, the interviewer should allow someone who has already built a relationship and is more able to communicate with the disabled individual to participate in the interviewing process. Individuals who have a history of working with specific disabled clients can act as “interpreters” for the interviewer. Care must be taken by the human service interviewer to document that a caretaker/interpreter was used to help them communicate with the interviewee.

As with most disabled individuals, patience is your best tool. Questions may sometimes have to be asked in several different ways before the interviewee is able to comprehend and respond appropriately.

As with all people, disabled individuals have many of the same traits as children of wanting to please the interviewer. This is normal. As with children, care should be taken to ensure the responses the interviewer is receiving are as factual and truthful as they can be.

Interviewers must be mindful to not use their own “interpretation” of what the disabled interviewee is sharing, but to factually document what is actually being stated.

Working with disabled individuals can be challenging, yet extremely rewarding. With training and experience, your interactions with this special population will become more effective.