FY2024 Elder Justice Innovations Grant - Option 2

BackgroundThe maltreatment of older adults and adults with disabilities is a complex and pervasive problem in the United States with over 1.3 million referrals of alleged maltreatment made to Adult Protective Services (APS) agencies across the country annually.[i] Allegations of maltreatment may include physical, sexual, emotional, or psychological abuse; neglect; abandonment; and financial exploitation (hereafter referred to as “abuse, neglect, or exploitation” or “ANE”). It is well known that individuals experiencing ANE have serious physical and psychological health consequences and, although many related risk factors and indicators have been identified, ANE frequently goes undetected. Moreover, when ANE is disclosed, intervention and prevention options are limited. APS is the most widely used intervention to address adult maltreatment and trends suggest that reports and caseloads are increasing. However, efforts to determine the efficacy of these interventions on client outcomes have been limited.[ii] Research to develop, test, and evaluate effective prevention and intervention practices are ongoing, however the science behind how and the extent to which these practices address adult maltreatment is in its early stages.[iii] This is due to several factors that complicate adult maltreatment prevention and intervention research. First, interventions lack clear or common definitions and measures of success, specifically from the perspective of the older adult.[iv] Second, many existing adult maltreatment interventions focus on the alleged victims which do not consider the context of complex familial relationships that are usually involved.[v] Moreover, existing intervention efforts are designed to address the emergent needs of the individual and do not follow through to ensure services, support, and resources that are offered are utilized. And, finally, social services agencies (such as APS) may lack the infrastructure or resources to conduct research and evaluation to conduct research that may contribute to evidence-based knowledge. Given that one in six people aged 60 or older living in community settings experience at least one form of maltreatment annually [vi] and that APS workers play a critical role in the intervention and the provision of services to address ANE, embedding evidence-based practices to compliment the APS intervention model shows promise to improve the outcomes of vulnerable adults. In 2018, ACL provided funding to Maine’s Adult Protective Services Program through the Elder Justice State Grants program (Grant No. 90EJSG0031) to implement and evaluate an evidence-based APS service-planning and intervention model that utilizes practices including motivational interviewing, supported decision making, teaming, restorative justice, and goal attainment scaling. The project, later termed RISE (Repair harm; Inspire change; Support connection; Empower choice), is a conceptually based, advocacy-framed, community-based intervention that addresses the spectrum of clients' needs and wishes and existing systems’ limitations. The RISE model project funded by ACL demonstrated success in multiple areas:Feasibility: RISE was initially piloted in two (2) counties, and then successfully expanded to the entire state of Maine (16 county APS programs).Acceptability: Over the course of the implementation phase, 96% of APS clients referred to the program accepted service, and only 4.5% dropped out.Client Outcomes: Participants reported positive outcomes, including 68.9% reporting improved quality of life and 72.9% reporting improved self-efficacy to cope with challenges and make safe decisions.Client-Service Relationships: 88.4% of APS clients believed that advocates respected their choices “much” or “all of the time”.[vii] The framework for the RISE model was developed and guided by the needs and wants of those it aims to serve. RISE has demonstrated the flexibility to work with both the victim of ANE and the accused harmer to strengthen the support surrounding them as individuals and as a dyad. The mechanisms of the approach have demonstrated success in short-term outcomes. However, less is known about the success of the approach in longer intervention phases. In addition, additional research is needed to test the feasibility and implementation of the RISE model in different APS programs, in different communities, serving a diverse population, as well as whether it can be adapted successfully across various socio-cultural contexts. More information about RISE can be found here: https://risecollaborative.org/. Funding Opportunity DescriptionThe purpose of this funding opportunity is to support the continued development of evidence-based practices on elder abuse intervention and response. Specifically, ACL’s objective is to further validate the evidence-informed elder abuse intervention strategy: the RISE -APS model. This funding opportunity will support one (1) grantee to replicate the RISE -APS model in at least three (3) different APS programs/communities, to provide on-going technical assistance to the programs implementing the RISE model, and to evaluate/measure the outcomes of the effort. The successful applicant will demonstrate how they will carry out this project in a manner that meets ACL’s criteria for an evidence-based program as described below. In carrying out this project, the grantee must provide at least $600,000 each budget year in subawards to at least three (3) different sites. Applicants can propose to provide more than $600,000 each year and can propose to support more than the minimum three (3) sites. However, applicants should only propose the number of sites that they can sufficiently support and evaluate. Applications do not receive additional points automatically if they propose more than the minimum. The strongest application will demonstrate rigorous methodology to implement and evaluate the RISE - APS model, following evidence-based programming strategies. Evidence-based programs are essential tools for helping older adults maintain their independence in the community. Since 2003, ACL/AOA has been steadily moving towards wider implementation of programs that are based on scientific evidence and demonstrated to improve the health and well-being of older adults. The FY 2012 Congressional appropriations law included, for the first time, an evidence-based requirement related to Older Americans Act (OAA) Title III-D funds. In response to the new requirement, ACL developed an evidence-based definition to assist states in developing their own guidance. ACL defines Evidence-Based Programs as:Demonstrated through evaluation to be effective for improving health and well-being or reducing disease, disability, and/or injury among older adults; andProven effective with older adult population, using Experimental or Quasi-Experimental Design; andResearch results published in a peer-review journal; andFully translated in one or more community site(s); andIncludes developed dissemination products that are available to the public.(For more discussion on this definition and the terms used, please visit https://acl.gov/programs/health-wellness/disease-prevention.) Application Components:The full list of requirements for an application’s project narrative can be found at Section IV.2 below. At a minimum, in the project narrative applicants must describe:The methodology proposed to replicate the RISE -APS model;How subaward sites will be determined, including:the proposed number of subawards and funding amounts,how sites/applications will be solicited,how sites/applications will be reviewed, andthe proposed selection process;The types, form, and frequency of technical assistance that the grantee will provide to the subaward recipients;The proposed measures of success and the evaluation methodology for individual sites and the overall initiative; andThe deliverables that will be produced, including submission of articles to a peer-reviewed journal. B. Final ReportHHS grants policy requires all recipients of grant funding to submit a final project report. In addition to this report, grantee must submit to ACL a final report, article, or document that discusses the funded project, its results, and implications and suggestions for meeting ACL’s criteria for an evidence-based program. The final written product is expected to be of professional and publishable quality, that is: free of grammatical and spelling errors, written clearly and succinctly, accurate, and appropriately cited. C. Rights in DataApplicants should be aware that under 45 CFR Section 75.322(b), ACL reserves a royalty-free, nonexclusive, and irrevocable right to reproduce, publish, or otherwise use copyrightable works developed (or for which ownership was purchased) under this cooperative agreement for Federal purposes, and to authorize others to do so, including to disseminate the works and findings. The federal government right to such copyrightable works and data are explained further in the HHS Grants Policy Statement. For this funding opportunity, this means that grantees may not withhold from ACL data or information produced from or by this project, except as protected by privacy laws and regulations, including but not limited to outcome and evaluation data. At the conclusion of the grant period, the grantee must provide a final report that includes the data and materials produced by the grant, also defined in the HHS Grants Policy Statement. REFERENCES:McGee, L. & Urban, K. (2022). Adult Maltreatment Data Report 2021. Submitted to the Administration for Community Living, U.S. Department of Health and Human Service. Retrieved from: https://pstrapiubntstorage.blob.core.windows.net/strapib/assets/2021_NA… Center on Elder Abuse (n.d.) Research brief: intervention in elder mistreatment. Retrieved April 15, 2024 from: /https://pstrapiubntstorage.blob.core.windows.net/strapib/assets/NCEA_RB…, C., Teaster, P. B., & Ramsey-Klawsnik, H. (2023). The context of elder maltreatment: an opportunity for prevention science. Prevention science, 24(5), 911-925.Burnes, D., Connolly, M. T., Hamilton, R., & Lachs, M. S. (2018). The feasibility of goal attainment scaling to measure case resolution in elder abuse and neglect adult protective services intervention. Journal of Elder Abuse and Neglect, 30(3), 209–222.Burnes, D., Elman, A., Feir, B. M., Rizzo, V., Chalfy, A., Courtney, E., Breckman, R., Lachs, M. S., & Rosen, T. (2021). Exploring risk of elder abuse revictimization: Development of a model to inform community response interventions. Journal of Applied Gerontology, 40(10), 1226–1230. doi:10.1177/07334648209334321226-1230World Health Organization. (2021). Elder abuse. Retrieved April 10, 2024, from https://www.who.int/news-room/fact-sheets/detail/elder-abuseMaine Adult Protective Services. (2023). Final progress report Appendix F submitted to ACL for Grant No. 90EJSG0031: Development of evidenced-based APS practice: Implementation of a service planning/intervention-phase model and complete NAMRS reporting.