Implementing and Testing RISE: Addressing a Gap in Community-Based Elder Abuse Response Intervention

Elder abuse and self-neglect (EASN) are recognized by researchers, clinicians, and policymakers as pervasive problems with serious consequences for the aging population. EA is defined as an intentional act or lack of action by a person in a relationship involving an expectation of trust causing harm or risk of harm to an older adult; it comprises abuse (emotional/psychological, physical, sexual), neglect, and financial exploitation. SN, closely associated with EA, refers to the failure or inability of a person to satisfy their basic needs and protect themselves from harm. About 10% to 28% of community-dwelling older adults in Canada or around the world experience EASN each year. EASN is associated with serious consequences, such as premature mortality, poor physical and mental health, increased healthcare costs and utilization, and nursing home placement. Without effective prevention and intervention strategies, the absolute scope of EASN will expand with the growth in the older adult population.

Despite the scope and seriousness of EASN, our understanding of effective interventions to address this problem in the community remains limited. Systematic reviews routinely find that the quality of EASN intervention research is weak and, in turn, strength of evidence is limited. RISE was developed as a community-based EASN intervention model to address this gap. RISE is informed by an ecological-systems intervention perspective, suggesting that effective models of EA intervention should have the capacity to work with both older adult victims and alleged harmers, their relationships, as well as to strengthen social supports surrounding them to address the full scope of risk factors that characterize a case. RISE is also grounded in a person-led, relational practice orientation that prioritizes the development of client autonomy and self-determination through a collaborative, trusting client-practitioner relationship. Its core modalities seek to Repair Harm (restorative approaches), Inspire Change (motivational interviewing), Support Connection (teaming), and Empower Choice (supported decision-making). Through these approaches, RISE aims to elevate a sense of agency and self-efficacy within older adult victims of EASN and strengthen the social support infrastructure surrounding them to help build the intra- and inter-personal protective mechanisms necessary to prevent re-victimization.

To date, RISE has demonstrated evidence of feasibility, acceptability, and effectiveness in the U.S., where it has been implemented as a part of a complementary partnership with Adult Protective Services (APS). In this context, APS receives and conducts investigations of EASN allegation reports as a part of a mandatory EASN reporting system that exists in all states. Following APS investigation, cases indicating a high risk of or actual EASN and requiring ongoing support are referred to RISE for longer-term intervention. Cases receiving this complementary RISE-APS model have shown a significantly lower likelihood of re-investigation (recidivism) back in the APS system compared to cases receiving APS services alone, and this protective effect of RISE applied to nearly all forms and combinations of EASN. In a qualitative evaluation of RISE, APS caseworkers perceived that the client-led, relational practice orientation of RISE and its capacity to work with both the older adult and alleged harmer contributed to a reduction in repeat APS cases. Based on these findings, the RISE APS model has been replicated in several US contexts, including X, Y, and Z and has been selected by the World Health Organization as one of six EASN interventions, worldwide, to receive funding for testing in other countries.

Despite the success of the RISE-APS model in the U.S., most countries around the world do not have a formalized EASN APS response system. The current study sought to test the effectiveness of RISE as a stand-alone model in a different context, Ontario, Canada, which lacks formal systemic EASN response infrastructure. In partnership with Elder Abuse Prevention Ontario (EAPO), which serves as the EA advocacy/education body in Ontario, the current study developed a relatively straightforward provincial community-based EASN response framework, centered in RISE. Specifically, we instituted a free, centralized telephone number at EAPO that could be accessed by older adults, family members, or service providers with EASN concerns. Intake consultants were trained to receive these calls and provide an initial 45-minute consultation including resource sharing, as well as conduct brief screening to identify older adults at risk of or experiencing EASN and, in turn, eligible for RISE. Eligible older adults were randomly assigned to receive the RISE intervention (treatment group) or remain as a part of a control group having received the initial consultation and resource-sharing. The current study sought to determine whether older adults receiving RISE experienced greater improvements in well-being compared to those receiving brief consultation and resource-sharing.