Effectiveness of RISE as a Community-Based Stand-Alone Elder Abuse Intervention Model

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

The goal of this randomized clinical trial is to learn if the RISE intervention can improve the well being of older adults who are at risk of or experiencing elder abuse or self-neglect (EASN). The main questions it aims to answer are:

• Do older adults who go through the RISE intervention experience improvements in their well-being?
• Are older adults who go through RISE satisfied with this program? Researchers will compare older adults who receive a one-time consultation and resource-sharing service to older adults who receive the multi-session RISE intervention to see if there are differences in their well-being.

Participants will engage in the RISE intervention over several months by telephone or in person to work on goals that are designed to reduce the risk of elder abuse or self-neglect, and they will participate in telephone-based surveys at three different times.

Study Overview

• Status: Completed
• Conditions: Elder Abuse; Self Neglect
• Intervention / Treatment: Behavioral: RISE Model; Behavioral: Brief Consultation and Resource Sharing

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 114
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M2K 2Y5
      • Elder Abuse Prevention Ontario
    • Toronto, Ontario, Canada, M5S 1V4
      • Factor-Inwentash Faculty of Social Work

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 60+
• At risk of or experiencing EASN
• Cognitive capacity
• Lives in community

Exclusion Criteria:

• Lives in long-term care setting
• Cognitive impairment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treatment Group; RISE Model	Behavioral: RISE Model; RISE works with cases involving older adults who are at risk of (prevention) or experiencing (response intervention) EASN. The model operates at Relational, Individual, Social, and Environmental levels and, through its core modalities, the intervention seeks to Repair Harm (restorative approaches), Inspire Change (motivational interviewing), Support Connection (teaming), and Empower Choice (supported decision making). RISE intervenes with the individual older adult EASN victim and alleged harmer (when appropriate), their relationship, and strengthens their informal and formal social supports.
Active Comparator: Control Group; Brief Consultation and Resource Sharing	Behavioral: Brief Consultation and Resource Sharing; A brief 45-minute telephone consultation involving active listening skills and referral resource sharing

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Life Satisfaction	A life satisfaction index comprising 7 key EASN intervention targets each measured on a Likert scale from 1 (never) to 4 (always), including satisfaction with: physical safety, overall health, social life, mood, financial situation, housing situation, and family life. This index is measured as a part of a telephone-based survey across three time points: baseline, 3-month follow-up, and 6-month follow-up.	From enrollment to 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PROMIS Perceived Stress	Perceived stress is measured using four items from the Patient-Reported Outcomes Measurement Information System (PROMIS) toolbox and assessed using a Likert scale with response options from 0 (Never) to 4 (Always). This outcome is measured as a part of a telephone-based survey across three time points: baseline, 3-month follow-up, and 6-month follow-up.	From enrollment to 6 months
PROMIS General Self-Efficacy	General self-efficacy is measured using four items from the Patient-Reported Outcomes Measurement Information System (PROMIS) toolbox and assessed using a Likert scale with response options from 0 (Never) to 4 (Always). This outcome is measured as a part of a telephone-based survey across three time points: baseline, 3-month follow-up, and 6-month follow-up.	From enrollment to 6 months
PROMIS Social Interaction Self-Efficacy	Social interaction self-efficacy is measured using four items from the Patient-Reported Outcomes Measurement Information System (PROMIS) toolbox and assessed using a Likert scale with response options from 0 (Never) to 4 (Always). This outcome is measured as a part of a telephone-based survey across three time points: baseline, 3-month follow-up, and 6-month follow-up.	From enrollment to 6 months
PROMIS Emotional Social Support	Emotional social suppport is measured using four items from the Patient-Reported Outcomes Measurement Information System (PROMIS) toolbox and assessed using a Likert scale with response options from 0 (Never) to 4 (Always). This outcome is measured as a part of a telephone-based survey across three time points: baseline, 3-month follow-up, and 6-month follow-up.	From enrollment to 6 months
PROMIS Information Social Support	Informational social suppport is measured using four items from the Patient-Reported Outcomes Measurement Information System (PROMIS) toolbox and assessed with response options from 0 (Never) to 4 (Always). This outcome is measured as a part of a telephone-based survey across three time points: baseline, 3-month follow-up, and 6-month follow-up.	From enrollment to 6 months
Program Satisfaction	Program satisfaction is measured using three items from the Client Satisfaction Questionnaire (CSQ-3) and assessed using a Likert scale with response options from 0 (Never) to 4 (Always). This outcome is measured as a part of a telephone-based survey across three time points: baseline, 3-month follow-up, and 6-month follow-up.	From enrollment to 6 months
Problem Impact	Perceived problem impact is measured using two items capturing perceived worry about the EASN issue and perceived impact of the EASN issue on well-being. Items are assessed using a Likert scale with response options from 0 (Never) to 4 (Always). This outcome is measured as a part of a telephone-based survey across three time points: baseline, 3-month follow-up, and 6-month follow-up.	From enrollment to six months

Collaborators and Investigators

• Sponsor: RISE Collaborative
• Collaborators: University of Toronto; Public Health Agency of Canada (PHAC); Social Sciences and Humanities Research Council of Canada

Publications and helpful links

General Publications

• MacNeil A, Connolly MT, Salvo E, Kimball PF, Rogers G, Lewis S, Burnes D. Use of Motivational Interviewing by Advocates in the Context of an Elder Abuse Response Intervention: The RISE Project. J Fam Violence. 2023 Apr 27:1-11. doi: 10.1007/s10896-023-00563-1. Online ahead of print.
• Campo-Tena L, Herbst JH, Choo WY, Burnes D, Couture M, Estebsari F, Kafando CSL, Rouamba G, Simbreni MM, Yan E, Yon Y, Mikton C. Seven candidate interventions to address abuse of older people. Age Ageing. 2025 Aug 29;54(9):afaf248. doi: 10.1093/ageing/afaf248.
• Burnes D, Connolly MT, Salvo E, Kimball PF, Rogers G, Lewis S. RISE: A Conceptual Model of Integrated and Restorative Elder Abuse Intervention. Gerontologist. 2023 Jul 18;63(6):966-973. doi: 10.1093/geront/gnac083.
• Lewis S, Connolly MT, Salvo E, Kimball PF, Rogers G, MacNeil A, Burnes D. Effect of an elder abuse and self-neglect intervention on repeat investigations by adult protective services: RISE project. J Am Geriatr Soc. 2023 Nov;71(11):3403-3412. doi: 10.1111/jgs.18506. Epub 2023 Jul 10.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2023
• Primary Completion (Actual): July 31, 2025
• Study Completion (Actual): July 31, 2025

Study Registration Dates

• First Submitted: April 7, 2026
• First Submitted That Met QC Criteria: April 7, 2026
• First Posted (Actual): April 14, 2026

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 7, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Prevention; Intervention; RISE; Elder Abuse; Self Neglect
• Other Study ID Numbers: 2223-HQ-000382

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data (IPD), limited to data used in the results publication, is available to other researchers, following publication, who are affiliated with an accredited post-secondary institution upon request to the principal investigator.
• IPD Sharing Time Frame: Beginning 6 months and ending 3 years after the publication of results
• IPD Sharing Access Criteria: Researchers who are affiliated with an accredited post-secondary institution may request access to de-identified quantitative or qualitative data through written proposal to the principal investigator, which describes aims and analytic plan. The proposal will be reviewed by a RISE Collaborative research team and approval will be subject to an inter-institutional data sharing agreement.
• IPD Sharing Supporting Information Type: SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No