This keynote provides the implementation and results of a Partially-Nested Randomized Control Trial with older adults as part of a federally funded research grant (DHHS). Emphasis is placed on the treatment employed, as well as the rigorous methodology – i.e. a two-level structure of clients nested within treatment providers (offering two treatments). Since client outcomes from the same provider may be similar, the use of multilevel modeling accounted for these data dependencies. The longitudinal effects of receiving treatment(s) (or control) on outcomes (social isolation, depression, suicidality) while controlling for baseline are provided. Client outcomes are also considered in regards to how providers utilized specific intervention skills over time.
This is innovative as older adults are the most suicide-at-risk age cohort, yet no evidence-based suicide intervention exists for them specifically in the United States. This clinical trial was intentionally designed around the aging network, to garner the evidence needed to ensure the evidence-based suicide intervention gets on the National Council of Aging's Evidence Based Registry. Further, unique strategies for accessing those older adults at the margins of the margins (i.e. with chronic conditions, receiving home and community-based services) are provided. Through relationships with >25 senior centers, our team learned about the challenges of working in the aging network, digital literacy challenges older adults face, gaps for receiving mental health services, and the impact of providing a standardized, manualized, 8 week treatment to them.
Emphasis is placed on the treatment, research tools needed, tracking of intervention data, the importance of running a clinical trial in “cohorts” (or 4 waves as we did) which enabled needed adjustments during the trial, and lessons learned from working with a vulnerable population and the Aging Services Network.