Social isolation and loneliness are now being perceived for what they are, a public health concern with significant impacts on society, public services and the wider economy.

As a city, Glasgow has an undoubted commitment and drive to make itself a great place to grow old and to create preventative services to help alleviate these issues. Community Connectors has spent years striving to understand the different sets of circumstances that can lead to people becoming isolated in this city and we have built a vivid picture of the events, circumstances and life transitions that can leave people vulnerable and isolated.

As we’ve developed our understanding and skills, we’ve been able to make a positive impact on the lives of many people. This thought piece is designed firstly to share what we’ve learned and how we apply it and also to encourage others to consider how this approach could help people in their areas too.

There are many organisations and programmes throughout the city doing great work. As one of those services, we want to share ideas and knowledge and if this article prompts you to contact us with your own experiences and thoughts, we would welcome them as we endeavour to evolve the service to broaden its reach and effectiveness.

 

The Challenges of Social Isolation

At the heart of many of the stories we hear is a common thread of loss, which comes in many forms; the loss of a loved one, the loss of neighbours and friends after moving home, the gradual loss of health and mobility and the eventual loss in confidence to maintain normal activities. This is just a few common examples but what we frequently hear is that they come with a corresponding loss of connection to family, friends and neighbours. These are not the only challenges facing older adults in the city, mental health problems are common as are addictions, language and communications barriers, access to adequate transport and, especially in this age group, long term conditions, all of which contribute to a loss of meaningful connection. In all of these examples, we hear people describe the process of isolation creeping up on them because in the face of challenge, the time needed to adapt, recuperate or rest often consumes them. It is often  following this that people realise they are either losing, or have lost their ability to participate in the life they had before or the one they want the most. In this piece, we share our thoughts on the approach we believe can support people to rebuild or find the connections that they want, including the most powerful connection, which is the connection back to themselves and their best hopes. We’ll talk about why we take the time to invest in this approach and the knock-on impact it can have in saving time and resources in the longer-term.

 

OUR APPROACH

“Signposting alone is a poor predictor of change.” 

Through understanding the circumstances leading to social isolation and loneliness, we recognise that signposting alone is a poor predictor of change and has little or no impact in alleviating the underlying causes unless it is offered at the right time and under the right conditions.

To give an example: If someone has lost their confidence in getting out after a fall, a leaflet about activities in their local area would have little or no effect unless we support that person to improve their confidence in their mobility.

In fact, putting our energies into getting the person to go to an activity with no other preparatory work – which we see a lot – is actually risky and highly likely to fail, meaning wasted time and missed opportunities to create confidence boosting experiences for the person. This is something we call a ‘quick win’, which we’ll come back to later.

It’s worth pointing out that we’re not necessarily risk averse in our approach but we are committed to a coaching approach that maximises a person’s chances of success and minimised unnecessary setbacks. In this piece, we want to bring to life the different approaches we use at different stages that help us work in an intuitive way and to support people to make the changes they want at a pace that suits them.

There are five distinct but interconnected aspects which guide our practice and the work with our clients. They can happen in stages or simultaneously depending on the individual, so you’ll see some similarities across a few of the key points but what this does is give us a framework to be flexible and truly person-centred in how we work with people in recognition that no two people’s journeys are the same.

 

STAGE 1: Preparing people to work collaboratively

“it places the person at the centre of planning from the start”

Our clients tell us themselves that lots of service providers kindly offer huge amounts of information and advice but they also often tell us that they can feel obliged to say yes or no without really understanding what’s on offer or what’s expected of them.

I think we can all relate to this, think about the last time you received unsolicited advice or information without asking for it or being ready to consider it? It’s fair to say that we’ve all felt overwhelmed, patronised or misunderstood. For an older person in need of support but unsure what kind, it can be hard to see the wood from the trees.

It’s particularly relevant to older people because there’s an increased likelihood that they’re already dealing with a number of professionals in various roles and for different reasons. This is why we always put our energy into optimising a persons’ chance of working with us collaboratively. It not only means that, when we do impart information, they can make the most of it but it also means the person understands where we sit alongside other service providers.

What does that look like?

• We avoid jargon and help people understand jargon they may already have heard.
• We send short letters and make introductory calls to provide simple examples of the support on offer e.g. by giving examples of the type of support others have found useful and giving people an idea of how they might prepare for their first appointment.
• We pitch information appropriately and use ‘teach back’ and ‘chunk & check’ methods to make sure we’re breaking information into manageable chunks but also checking for understanding.
• We ensure we leave space for and encourage questions before moving on.
• We use scaling to gauge understanding and confidence.
• We use ‘Good Conversations’ questions to ask people if we have spoken about everything that matters to them or if there’s anything that could be clearer.
• We recap on what’s been agreed.

Why bother?

For the simple reason that these techniques increase a person’s confidence in participating in support. It also helps everyone involved to manage expectations but more importantly, it places the person at the centre of planning from the start.

In the current financial climate, we don’t believe we can afford to work in any other way. For the small investment of time required, these basic steps pay dividends in creating fully engaged clients as well as avoiding passive participation and dependency.

 

STAGE 2: Getting to the heart of what matters most

“It’s ‘what matters?’, not ‘what’s the matter?’” 

This sits at the very heart of our approach and is different from working out ‘what’s the matter’ with people. First, we prioritise listening because we believe it’s important for people to feel heard and to have their circumstances and challenges acknowledged. Actively listening to people, noting their concerns and their needs, helps us avoid making assumptions that could cost us time and rapport later but also means we base our support on facts about a person’s lived experience, skills and hopes.

Of course, we hear a lot about what people don’t want or what isn’t working in their lives and while we always take time to acknowledge the real struggles people face, we also know how practiced people can be in telling you what they don’t want. They rarely need help with that. Where we do find that support is most needed is in working out what people want instead, figuring out what a good or better life looks like and how do they get there.

There’s a lot of talk about connecting people to services which is sorely needed – and a big part of what we do – but often what we find has the biggest impact is the journey of connecting a person back to themselves and their best hopes. How often do we hear ‘aw pal, it’s just part of getting’ auld’? But when we support them to have those conversations about what they want instead, we see people becoming re-energised and more hopeful.

In essence, it’s our strong belief as a team that we can be of most use to people if we can support them to get clear on their best hopes. Supporting people to talk about what they don’t want results in them bringing up pictures of depressing/unsatisfactory situations, which in turn has an impact on mood and on their ability to feel hopeful about their future; making the prospect of change feel like an uphill struggle. The good news is that the opposite is also true, talking about what they want instead conjures positive pictures of the future, generating more energy and drive to be part of the process and to take the necessary steps to make change.

What does that look like?

• We use a lot of questions from the ‘Good Conversations’ model like:
• “What do you hope to gain from our work together?”
• “How will you know if us working together has made a difference? What will be different?”
• “What is your family hoping for?”
• “What do you want more of in your life? What do you want to keep the same?”
• “Have we talked about the things that you wanted to talk about?”
• “Do you get the sense that I understand what’s important to you?”

Why bother?

Because we believe we are all similar. We believe that everyone is motivated for something and that people are best motivated when working towards what they want most. When we have these type of conversations, we see people’s motivation for change increase and as it does, the detail of their preferred future starts to build.

We can all relate to how much of a dredge it can be to make the changes we think we ‘should make’ versus the changes, we ‘want to make’ because we know people have more ownership of the changes they want to make.

When we hear people speak about their preferred futures, rather than what they don’t want or think they should do, we see energy and passion rising. We can capitalise on this to really amplify the benefits of change and layer in questions like:

“What difference would getting out again make?”

“What would you be doing differently?”

“Who would notice? What would they see?”

In short, we support people to visualise the future rather than be weighed down by their past or by barriers.

We’ve said before that signposting alone is a poor predictor of change. By investing in this step and building that rich picture of a person’s preferred future, we are better equipped to match individuals to the services that will create the most meaningful connections.

 

STAGE 3: Meeting the person, not the problem

“People are already well versed in their problems.

They don’t need more conversations to reinforce them.”

This stage overlaps and perfectly complements stage 2. If stage 2 is about building the picture of the preferred future, Stage 3 is where we build the picture of how we get there, making the best use of the resources available.

We know that people are much more than just their problems or their health conditions; this is why we commit to meeting ‘the person’ and not ‘the problem’. We call it choosing ‘who’ we work with. We can choose to think of the person as a list of challenges and barriers to be addressed or we can choose to remind ourselves that everyone, on some level, is inherently resourceful and capable with the right support.

People are already well versed in their problems. They don’t need more conversations to reinforce them. We prefer conversations that acknowledge challenges but remind people that they are much more than their problems or health conditions.

What we want is to structure conversations in a way that encourages a person to see themselves through a lens of coping and resilience and explores their strengths and skills.

What does that look like?

• We use more questions from the ‘Good Conversations’ model like:
• “Given everything you have going on, how have you managed to keep going?”
• “How did you manage to make this appointment?”
• “What’s already working for you?”
• “How have you been coping with…”
• Where we see achievement or coping strategies we want to question more about how they are managing in other areas of their life.
• We use scaling in the areas of a person’s life they want to work on. In an example of someone scoring themselves a four, we want to know “why a four and not a three”? This encourages a person to describe the skills and resources already available to them and helps them reflect on the strengths they already have.

Why bother?

We want to encourage self-reflection and ultimately self-compliment – not always easy for a Glaswegian! When we support people to view their own resilience and skills, we do something powerful; we remind them that they are more than their problems. We remind them that they are a person who achieves and has experience and gifts to give and when that happens, we see a person’s energy and self-belief rise.

This process increases a person’s sense of hope and reinforces that connection back to themselves and now the connection is enhanced by a sense of their own strengths and a realisation that, when they look at their best hopes and how they move towards them, they aren’t starting from scratch. They have existing strengths to call on to help them along the way.

As practitioners, we are now better able to support people to build on those strengths and take those first small steps towards their preferred future.

Deciding to meet ‘the person’ and not ‘the problem’ reinforces the collaborative relationship between ourselves and the client. A relationship that avoids being deficit led and encourages the person to see themselves as an equal partner in the process, with something to bring to the table.

 

STAGE 4: Recognising that small changes lead to big changes

“as the saying goes: “teach a person how to fish…”

Having a clear map of what matters most to a person, as well as the assets they can build on to get themselves there, does create motivation but it doesn’t mean that change can’t still be daunting. Especially for people living with complex challenges. Not only can it be daunting for the person but it can be challenging for us as practitioners too. Thinking about the practitioners for a moment, we talk a lot about isolation but we don’t often talk about professionals feeling isolated in their roles – something that’s common across the city – and the immense pressure they can face in solving complex issues singlehandedly.

To help ease that pressure, we recognise that it’s the small changes that lead to the big changes for our clients. This helps us minimise pressure but also gives us, as well as our clients, permission to plan for change in a staged way, making the journey less intimidating. It also keeps us from accidentally moving a person forward too quickly and creating unnecessary setbacks. Planning for change in small steps, sets the stage for lots of ‘small wins’ and lets us gauge a person’s capacity for change.

We mentioned ‘quick win’ at the beginning, it’s something we’re big on as a service and that’s because we have countless examples of this approach having a huge affirming effect. By simply supporting an individual to make one small change we can use this to reinforce how capable they are of change to build their confidence in us and the process.

What does that look like?

• We prepare people to look for small changes by asking questions like:
• “What would be the smallest sign of progress?”
• “What would let you know that you’ve made that progress?”
• “What would you like to be telling me about the next time I see you?” (describing their preferred future to help increase motivation)
• “What difference would that make?”
• “How confident are you about doing what we’ve talked about? – This also lets us assess whether more support is needed and means we’re connecting people to the right services at the right time.

Why bother?

Approaching change in small steps helps in a number of ways. First, it helps us identify support needs and address any concerns along the way. By this stage in the process we’re usually working with a person whose motivation is high but that doesn’t mean their capability is the same. On the other hand, we can be working with a person who’s capable but their motivation is slipping.

If we move at the right pace, we can spot gaps in knowledge, motivation or capability before it leads to unnecessary setback and lets us layer in the right amount of support and encouragement to keep steady momentum.

Secondly, as we move along at this pace, it gives us a chance to have conversations that continue the theme of self-reflection, this time allowing the person to recognise their part in change, which builds coping strategies useful in the future.

The third benefit of this step is the eventual move towards paradigm shifts. By supporting people to view themselves differently, as resourceful and capable, we see people transform in front of us, often exceeding their own expectations and viewing themselves more as participators and achievers.

We value this step because, as the saying goes: “Teach a person how to fish…”

The current financial climate is always present in our thinking and by investing in this stage, we ensure that we only connecting people to additional support where it’s necessary and where people are ready to accept it. We want to support people to be resourceful and to make the best use of the city’s resources, minimising inappropriate referrals and maximising economic benefit.

 

STAGE 5: Reviewing progress and negotiating endings

“People can feel unprepared for services to end”

To keep that perceptual shift going that people have gained during our work together, we prioritise ongoing review periods to provide further room for reflection and to facilitate smooth endings to our working relationships.

This is something older people tell us most services do not get right and that they often did not feel prepared for services to end. We see reviews as an excellent opportunity to continue to ask questions that elicit what has been changing, to encourage self-compliments and to help people see how far they have come in their journey of change. Reviews of progress let us plan for next steps or to sustain changes and to explore the resource they have employed. It gives us a chance to help people think about what the next signs of change will be to maintain momentum.

What does that look like?

• We use scaling across a wheel at regular points to allow people to depict their progress but also visualise it.
• We ask questions like “given all that you’ve achieved, what has been the most useful to you? What’s made the biggest difference? How did you go about that?

Why bother?

These elements help embed learnings and reduce the likelihood of dependency because the process leaves people in the driving seat. It gives them a clear sense of the resources they’ve employed to effect change and that can serve them in the future. It also gives them a clear understanding of what’s worked and how.

Relapse or changes in circumstances are real concerns for older adults but by working in this way, we’re giving them the tools to adapt, cope and be resilient in the face of challenge.

In essence, our whole approach is about paradigm shifts. If we boil down our practice and look at what sits at the core, it’s this:

Connecting people to services to support self-management and build connections is vital, but leaving people thinking differently about themselves and the assets available to them is paramount to creating communities where people are resilient, independent and are able to maintain connections.

 

Over to you

As we wrote at the start of this article, this is designed to share what we’ve learned and how we apply it and also to encourage others to consider how this approach could help people in other areas too. Please share this freely with anyone who may be interested in what we do and find our approach thought provoking. Get in touch with us with your own experiences and thoughts and let’s work together to make Glasgow truly a great place to grow old.

 

Gillian McCamley
Community Connectors Programme Manager
May 2019