Evidence & Methods
RISE is built on a design–test–refine cycle, not a fixed model, so we keep learning.
Many interventions are designed once and then remain static. RISE treats every implementation as a chance to learn. We:
adapt the model with new partners and in new settings,
test it in the field,
study what happens, and
incorporate the lessons into the next project.[6]
RISE’s evidence base grows with every project, rather than resting on one early study, or on no study at all.
55%
Reduction of re-investigations in Maine APS’s most complex cases
2,000+
Cases handled by RISE advocates across sites
85%
Of clients choose to stay enrolled in RISE
RISE Data System (“RISEWrite”)
We built a new Salesforce data system adapted to the unique needs and contexts of RISE and of the issues it aims to address. The system facilitates case management, reveals case numbers and flow, enables research, fidelity, and outcome analysis, and allows us to build a body of evidence unprecedented in the elder justice field.
Our Research Designs
RISE operates across very different systems — APS, health care, housing, victim services, guardianship, criminal justice, and free-standing community programs.
The core philosophy stays the same, but no single research design fits every site. We use various evaluation methods across our network, including:
Randomized Controlled Trial (RCT)
Study. We used a pragmatic RCT to compare outcomes of clients receiving RISE versus the standard consultation and resource-sharing services provided by through a community-based telephone help-line.
Findings. Persons receiving RISE showed significant improvements in life satisfaction, stress, social support, and self-efficacy. They also reported much higher program satisfaction. (This study also revealed insights regarding the mechanisms of change.)
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Studies. We are using a parallel cluster randomized hybrid type 2 effectiveness-implementation design in our RISE-APS Replication and Evaluation project. In this project, randomization occurs at the level of APS offices/units (clusters), since random assignment at the level of individual cases within APS offices is not possible.
Findings. Data collection is ongoing.
Implementation Science
(to study the process of change in the real world)
Studies. We use implementation science (including the Consolidated Framework for Implementation Research (CFIR) and the Practical, Robust Implementation and Sustainability Model (PRISM)) to understand how to best adapt and integrate RISE in new contexts and settings. This lens helps us assess barriers and facilitators to effective RISE implementation, develop strategies to help overcome barriers or leverage facilitators, and examine implementation outcomes related to RISE adaptation, adoption, fidelity, and sustainment.
Findings. Data collection is ongoing.
Retrospective Observational Studies Using Administrative Data
Studies. Researchers analyze APS administrative data to understand the effect of RISE on outcomes such as APS repeat investigations (recidivism) over time.
Findings. In Maine, we found that APS workers referred their most complex, intractable cases to RISE. Repeat investigations (also called “recidivism”) were 55% lower among RISE clients[1] involving all forms of elder abuse as well as self-neglect.[7]
Qualitative Evaluation
Studies. Qualitative interviews and analyses with APS workers and RISE advocates have examined how RISE addresses gaps in the existing service system,[3] how advocates use motivational interviewing in practice,[5] how “teaming” (building formal and informal social supports) functions in real cases, and to explore APS workers’ views of RISE and working with advocates.[4]
Findings. APS workers reported favorable views of RISE because RISE could address issues outside APS purview, help them help their clients’, and improved APS worker well-being. Other findings will be forthcoming.
Feasibility and Acceptability
Study. We study feasibility and acceptability of each new model in each location before moving to replication, for example the model embedding RISE in Montana APS with social service workers (SSWs).
Findings. Feasibility and acceptability were demonstrated in each location, including the model in Montana, where SSWs in Montana’s APS program provide RISE services to APS clients as well as to persons subject to guardianship.
What We Measure
RISE evaluations draw on several types of outcomes to help understand its impact:
Client-Level Outcomes
We examine individual-level outcomes related to elder abuse itself (e.g., magnitude, risk), psychosocial well-being (e.g., life satisfaction, stress, depression, social support, self-efficacy), health status, and goal achievement. We also examine individual-level outcomes related to risk factors for elder abuse, such as self-neglect and isolation.
Relational-Level Outcomes
Recognizing the critical role of relationships, we examine relational-level outcomes and interpersonal conflict, such as within an older adult’s family, social network, community, and their relationships with “collaterals.”
System-Level Outcomes
We examine the effect of RISE on systems – both those charged with addressing elder abuse (like APS), and those that must address its fallout (like EMTs). For example, we measure the impact of RISE on Adult Protective Services rates of reinvestigation (or “recidivism”) and RISE’s impact on alleviating burden that elder abuse creates for adjacent crisis/response systems such as emergency services (e.g., 911 calls, emergency transports) and health system/insurance use.
System Personnel Outcomes
We examine the effect of RISE on direct service providers and their supervisors, for example APS workers, on their well-being and their perceived ability to help their clients.
Implementation Science Outcomes
Our implementation outcomes include those related to adoption (uptake of RISE), fidelity (extent that RISE is being delivered as intended), and sustainability (continuation of RISE).
Feasibility and Acceptability
We are continuously measuring and monitoring RISE feasibility and acceptability process outcomes related to client recruitment, service acceptance and retention, and program satisfaction.
Goal Setting
A measurement approach successfully tested for feasibility in early RISE research[2] examined whether clients move toward the goals that clients themselves identify rather than a one-size-fits-all definition of “resolved.”
We examine the effect of RISE on direct service providers and their supervisors, for example APS workers, on their well-being and their perceived ability to help their clients.
