Texas Elder Abuse and Mistreatment Institute (TEAM)

TEAM Institute, established in 1995 to mitigate the growing tide of elder mistreatment in Harris County, is co-directed by Dr. Dyer and James Booker, MA, Director, Adult Protective Services Region VI. TEAM was originally comprised of a group of clinicians, APS workers, prosecutors, attorneys, community groups, researchers, academics, business entities, social service agencies and others, and its purpose was to educate health professionals, community service workers, and the public about elder abuse; to conduct research into factors related to elder abuse; to review cases of elder deaths and financial exploitation to determine the extent that our agencies and service providers can be strengthened and improved; and to provide clinical care and social intervention to abused and neglected elders.

TEAM Institute continues to be the clinical and research arm and is the umbrella organization for EFFORT and H-FAST. The collaborators in the TEAM clinical arm include UTHealth, APS, Harris County Hospital District, and Baylor College of Medicine. TEAM provides comprehensive geriatric assessment to APS-referred clients with substantiated abuse or neglect and with complicated medical needs or questionable capacity.  After the medical assessment, the interdisciplinary team (APS case worker, social worker and TEAM Institute medical team) develops a plan of care for the client. Representatives of the various TEAM collaborators meet monthly to assure efficient and effective operation of the program. APS in Texas Region VI substantiates approximately 1500 cases of abuse or neglect per month and makes between 100-150 referrals per month to TEAM Institute, of which 90% are elders who self-neglect.  Participants for the proposed intervention will be recruited from the clients referred by APS to TEAM Institute.

The TEAM website…


Current Elder Mistreatment and Self-Neglect Grants

In September of 2012, the TEAM Institute received a 3-year grant from the United States Administration on Aging (AoA). This grant utilizes both clinical and behavioral intervention approaches aimed to increase medication adherence in N=100 community-dwelling older adults with Texas Adult Protective Services substantiated self-neglect. The multi-disciplinary research team consisting of public health, geriatric medicine, psychiatry, APS, nursing, law enforcement is led by Dr. Carmel Dyer who is the Principal Investigator for this study.

In October of 2013, the TEAM Institute was awarded a 2-year study to investigate financial exploitation victimization in older community-dwelling adults in Texas. This study, which begins in May 2014, aims to identify individual and community-level risk factor profiles of elderly victims of financial exploitation as well as identify perpetrator profiles that can help APS agencies, law enforcement and helping professions develop better detection methods as well as more targeted prevention and intervention approaches. Research team members from the fields of law enforcement, social work, public health and biostatistics are led by Dr. Carmel Dyer who is the Principal Investigator of this study.


Houston-Financial Abuse Specialist Team (H-FAST)

Financial exploitation is the third most common form of elder abuse by others. Victims may be robbed of the economic foundation for their independence and may suffer psychological distress. The extent of this serious problem is difficult to determine because most cases are not reported, but estimates suggest that there may be millions of older adults who experience financial abuse each year.  The Houston-Financial Abuse Specialist Team (H-FAST) is a network of professionals dedicated to educating families and service providers about prevention, detection, and investigation of exploitation.

The members of H-FAST, established in 2004, are professionals from various backgrounds, training, expertise, and philosophies who promote financial safety for frail older adults in Houston-Harris County. They meet regularly to discuss cases of financial abuse, develop educational material, train front-line workers and community members and provide consultation on specific cases of elder financial exploitation. The Lead of H-FAST  is Ms. Candice Twyman, MSE, Executive Director of the Better Business Bureau Education Foundation. Members represent 33 community agencies, organizations, and professions, including UTHealth, TEAM Institute, Adult Protective Services,  Better Business Bureau Education Foundation, Care for Elders, City of Houston, Harris County District Attorney’s Office, Houston Police Department, Sheltering Arms, AARP, geriatric care managers, elder law attorneys, bank officers, and others.



In 2003, with a small grant from the American Bar Association, TEAM formed the Harris County Elder Abuse Fatality Review Team, known as EFFORT, to review selected cases of unexpected adult deaths that were caused by interpersonal violence including family violence, suicide, neglect or abuse occurring in Houston and Harris County. Although funding ended in 2004, EFFORT has remained an active and dynamic entity in Harris County.  EFFORT operates as a sub-committee of the Harris County Domestic Violence Coordinating Council Adult Violent Death Review Team (AVDRT) in accordance with Chapter 672 of the Health and Safety Code.  EFFORT reports its findings and recommendations to the Harris County Commissioner’s Office every two years.

EFFORT is administratively led by two co-directors.  Ms. Lynne Parsons is an Assistant District Attorney with the Harris County District Attorney’s Office.  Dr. John Halphen is a geriatrician from The University of Texas Medical School at Houston.  Members include the Houston Police Department, the Harris County Sheriff’s Office, the Harris County Medical Examiner’s Office, Adult Protective Services, Director of the Geriatrics and Palliative Care Division at The University of Texas Medical School at Houston, a representative from the Harris County Victim’s Assistance Office, a professor at The University of Texas School of Nursing Aging Institute, Director of the Harris County Ombudsmen Program, a PhD prepared nurse and EFFORT coordinator, a social worker from the BCM-HCHD Geriatrics Program and a geriatric nurse practitioner.

EFFORT strives to be inclusive in its membership and considers new members based on community resources and needs.  These members must reflect the geographical, cultural, racial, ethnic and gender diversity of the county or counties represented.  Also, members should have experience in abuse, neglect, suicide, family violence or elder abuse.

Memorial Hermann Hospital System
Harris Health System
MD Anderson Cancer Center
TIRR Memorial Hermann
Kindred Hospital