A Grand Challenge for Social Work
Isolation seen as critical social problem
By Alison Laurio, News contributor
|Social isolation can occur during any stage of life,
experts say, and is seen as a critical social issue and one of the 12 Grand
Challenges for Social Work.
A child claims to feel sick to avoid going to school. A man
with a chronic illness is not taking his medications because there is no one to
take him to the pharmacy. An older woman living alone becomes depressed because
she has no one to talk to.
These scenarios illustrate some of the effects of social
isolation, and also show it is not just older people who experience it. In
fact, social isolation can take a toll at any stage of life, said James Lubben,
MSW, who also has a Ph.D. in social welfare.
“Isolation is something that occurs throughout the life
course; infants, teens, adults,” said Lubben, inaugural holder of the Louise
McMahon Ahearn Chair in Social Work at Boston College, founding director of the
Boston College Institute on Aging and professor emeritus at UCLA.
Social isolation is not a new problem. But as attention to it
grows, efforts to diagnose and treat it are increasing. And social workers are
on the front line, helping patients, developing treatment techniques and
programs, and calling for cross-discipline attention and action as they work to
help older adults, people with health problems or chronic illnesses, children
and youths, and those isolated because of technology or social media.
“I have a lot of passion for this topic, because I think it’s
so critical,” Lubben said. “It’s finally getting the attention it deserves.”
The impact is critical because social isolation can be a
killer, he said, and the number of people suffering from it are not known.
A ballpark estimate is at least one in 10 older adults is
experiencing at least some form of isolation, Lubben said.
“Those numbers are hard to get, because we don’t have
generational surveys,” he said. “That part of the message is very important,
because the health issues it can create are on par with smoking. It’s something
we don’t always give a proper status to in our regular lives, but it’s just as
critical to our overall health.”
Eradicating social isolation is one of the 12 Grand Challenges
for Social Work, outlined in the national initiative from the American Academy
of Social Work and Social Welfare.
Lubben, an NASW-Massachusetts member who was on the executive
committee that produced the initiative and took the lead on the social
isolation challenge, said another reason the problem is important is because
people are social creatures.
“There’s the idea that Americans are rugged individuals,” he
said, “but none of us is capable of living alone. And those resources are
needed when we have critical needs.”
“The first thing we have to do is recognize (social isolation
is) important,” Lubben said. “Nurses, doctors and social workers need to start
asking about it. That sends a message to clients that it’s important.”
Social isolation needs to be publicized so more people are
aware of it, Lubben said, and he believes the issue can be successfully
“Whether we do or don’t depends on whether we respond to the
grand challenge, mobilize resources and address the problem,” he said.
Numerous studies dating back decades have documented the
impacts of social isolation on health.
A Kaiser Health Care study released in 2008 found social
isolation was predictive of cognitive impairment, Lubben said.
“Some people think if they do crossword puzzles they will keep
their cognitive abilities, but it’s conversation that does that,” he said.
“When you’re in a conversation, first you have to listen, then you have to
think, and then you respond.”
And a 1979 study showed people with weaker social connections
had a greater mortality rate, Lubben said, adding that there is strong evidence
that social health, mental health and physical health are connected.
The American Academy of Social Work and Social Welfare, as
part of its Grand Challenges for Social Work initiative, released Working Paper
No. 7 in February 2015, titled “Social Isolation Presents a Grand Challenge for
Its findings include:
- Social support networks, or the lack of them, affect a
- The connection between social networks and health is
consistent despite the differences in social network definitions and health
care outcome measurements.
- Prevention is possible if protocols are added that include
the importance of social networks, and interdisciplinary and cross-sector
collaboration is necessary.
- Social workers are well positioned to meet the challenge,
but innovation will be required.
In its conclusion, the paper notes the World Health
Organization, National Institutes of Health and AARP have all studied social
isolation and called for it to be addressed because it is a major health-risk
Social workers already are addressing the issue as they treat
the populations they serve.
“I think one of the greatest challenges as we age is, somehow
there’s the misperception it is a time of isolation,” said Sandra Edmonds
Crewe, professor and dean at the Howard University School of Social Work and
director of the Multidisciplinary Gerontology Center at Howard. “It’s seen as
being normal, and it’s only reported as problems emerge from it.”
Crewe believes the extent of social isolation is undercounted
because of this perception that it’s the normal process of aging. It also is
possible that some patients who are diagnosed as having depression really may
be suffering from social isolation, she said.
“They’re not looking at the causes of depression,” said Crewe,
an NASW member. “But just living alone doesn’t mean they’re isolated, because
so many who do (live alone) are OK.”
Carrie Johnson, assistant director of the Hartford Center of
Excellence in Geriatric Social Work at the Boston College School of Social
Work, also is a practicing clinical social worker.
Many of her patients are referred by nurses, physical
therapists and primary care physicians, or when they are being discharged from
hospitals. But the assessments they have undergone have “not happened in an
evidence-based way,” the NASW Massachusetts Chapter member said.
“Typically, older adults are screened for a lot of things, but
social health is not typically being screened for,” Johnson said. “Social
isolation is often not discussed at all. Often times it comes up at a time of
Sometimes factors like living alone or being widowed are used,
so she believes “the problem lies in definition.”
“Too often we’re getting, ‘This person has a son who’s living
locally,’” Johnson said. “The reality may be quite different. The son might be
local but estranged, or he might travel for work.”
“There isn’t a shared language, a definition, a screening tool
that’s shared,” she added.
Crewe agreed that having family members is not always the
final answer; family members need to be available and willing to help. But the
patient also needs to be open to them helping, she said.
“The value of independence seems to be strong in older
persons,” Crewe said. “A lot of baby boomers are independent. That’s a
mind-set. Many don’t want to move in with their children.”
She believes that feeling is more acute now than it was in the
“That was not the expectation of my grandmother,” Crewe said.
“With my grandmother, (moving in) was the expectation. But her children also
were in the same proximity.”
Other social support systems that were once prevalent also
seem to be diminishing, she said, like friends, church members, neighbor
networks and even the mail carrier, who people always used to know,
particularly in rural America.
“We used to call them the gatekeepers,” Crewe said. “I think
that (diminishing) also promotes social isolation.”
Being cut off from social contacts can affect a person both
psychologically and physically, said Janice Berry-Edwards, who has a Ph.D. in
clinical social work.
“When you’re cut off from your social contacts, there is a
deterioration in your mental state,” said Berry-Edwards, an NASW member and
associate professor at Howard University School of Social Work. “Depending on
how the manifestation is, you might also see a deterioration in physical
If a patient is not physically active, they can take on
drastic changes like overeating to the point of heavy weight gains, or the
opposite: not eating or even starving themselves, she said.
What causes social isolation is “one of the major cruxes
of the issue,” Johnson said. “We’re now working with training local agencies on
Screening tools allow a practitioner to “get into more nuanced
categories of social isolation,” she said.
“We’re never going to have a one-size-fits-all, because there
are so many causes,” Johnson said. “Using a screening tool allows us to identify
what pieces of the social network are lacking. We can identify what is unique
about that person and tailor our intervention to that person to address what’s
missing. It is so case-specific.”
Patients often have a variety of needs, she said, like who’s doing
the grocery shopping.
Social workers have multiple tasks when working with this
population, Berry-Edwards said.
“First, you have to identify it,” she said. “You see how the
behavior manifested and find the social components of this person. You have to
know where it comes from, the context of their experience. You can’t treat it
if you don’t know where the behavior comes from.”
“The paradigm is behavior doesn’t occur in a vacuum. Social
workers use all the tools developed in their training to determine where that
behavior comes from. The person didn’t become isolated for no reason.”
One of the biggest challenges is to identify the isolates,
“It’s not like they’re knocking on your door,” he said. “That
requires us in our routine assessments to look out for this issue.”
Johnson agreed and said social workers are “uniquely
positioned because our training has us looking at patients holistically.”
“Medical professionals look at the physical side mainly,” she
said. “Our training has taught us to look deeper, more broadly, at a person’s
situation. Social workers look at social health, mental health and physical
health as a complete picture.”
Health Care and Chronic Illness
|It can be difficult to identify social isolation in
children and youths, social workers say. A clinician can start to determine if
social isolation is a probelm by seeing emotional and social pushback. A child
who is socially isolated also may often make excuses not to attend school.
Health care and chronic illnesses are thought of as risk
factors, Crewe said.
For example, if an older man loses his spouse and she was the
driver, it could be difficult for him to shop for groceries, pick up
medications or go to medical appointments.
“If you’re living alone and have reduced social networks,
transportation — how you get to and fro — really matters,” Crewe said.
“Literature basically states that (health care and chronic illness issues)
really is a growing problem because we have a growing number of older people.”
Where a person lives also could matter, she said. If they feel
vulnerable and hear a knock on the door, or if they live in areas of higher
crime rates, they’re not going to even take the chance of going out or
interfacing with people they don’t know.
“That’s good common sense, but it also can interface with
isolation,” Crewe said. “If they live in high-security buildings, they may be
afraid to go out, so the spontaneity of visiting has been altered. Poor health
is one of the things that contributes to social isolation.”
She said if someone is showing symptoms of dementia or has a
chronic condition, the number of visitors does not increase.
“If you’re ill, you have a number of visitors,” Crewe said.
“If it’s a chronic condition, the number of visitors falls off.”
That’s because visitors often do not know what to do — whether
to visit or not, she said. Conversation with those feeling social isolation or
depression may be truncated, and visitors to nursing homes may feel
“Even if a person is living in their own home and the
conversation is not engaging, visitors do not know what to do, so people don’t
continue to visit,” she said.
Johnson said since people with medical issues who also are
socially isolated are more at risk, checking with other provider agencies —
like the Visiting Nurse Association — could help. And coordination between
social workers and other agencies could ensure that the individual maintains
good health care practices and is eating well.
Children and Youth
These challenges are not limited to the older adult
population; they affect chronically ill children and youths as well, said Drew
Pledger, coordinator of mental health services for the Wake County, N.C.,
“Chronically ill kids are highly prone to having this
struggle,” said Pledger, who serves on the NASW board of directors. “They have
needs that make them stand out, medical situations that cause them to be
Pledger said since people generally don’t respond very well to
people who are different from them, these children often “don’t have the same
opportunities for interaction.”
Ill youngsters do get the opportunity for interaction once
they go out and get to school, he said, and they have access to transportation.
“My school district is very large,” said Pledger. “Kids can
ride the bus an hour or more. Those school friendships they have are important,
and social media makes it easier to keep up with friends while they are at
There are a number of challenges when working on social
isolation issues with children and youths, Pledger said.
“Number one is finding them,” he said, “but social isolation
is so hard to identify.”
Standing apart from others may be a family norm, so it might
be a copy mechanism, Pledger said.
“You need that information from life away from school to make
that determination,” he said. “I think, in general, there is more trauma that
adults and children live through, and trauma can impact your self-concept, and
I think families are struggling to maintain.”
Ana Bonilla-Galdamez, a licensed clinical social worker who
works at Charles Barrett Elementary School in Alexandria, Va., said she has
seen the problem at the high school level.
“Due to gentrification, the student had to move and all of a
sudden was removed from the known environment,” she said. “In elementary …
there’s more social anxiety rather than social isolation.”
“That manifests with general anxiety,” she added. “I’ve had
several cases triggered by one parent being deployed or a parent being sick.
There’s a pushing away and withdrawing.”
Bonilla-Galdamez, who was NASW’s Social Worker of the Year
last year, said it’s difficult to find and identify social isolation in
“Being by yourself and taking a moment to reflect is not a
mental health issue,” she said. “Some children like to spend time with
themselves. That’s not a problem. But over a long period of time, if they no
longer see other people, that leads to the question are they more introverted
or is it a situation of social isolation?”
With children, a clinician can start by seeing emotional and
social pushback, Bonilla-Galdamez said.
“There are a lot of negative thoughts, and because of a
defense mechanism, they’re self-doubting all the time, unwilling to
communicate,” she said.
Other issues can include attendance: They don’t want to come
to school, telling their parents they have a headache or stomach ache,
“Noise in the classroom can become unbearable for them,” she
said. “Usually, that leads to complaints of a headache and going to the school
nurse, who lets them rest then sends them back to class. The more isolated just
want to go home.”
Bonilla-Galdamez believes societal changes play a part.
“Kids are overscheduled, parents are overworked, it’s just one
thing after another,” she said. “When I was growing up, I don’t remember
parents asking for play dates. You’d just go out and play. Now, it’s a
different way of interacting. Now you have to ask for a play date. That’s how
isolated we are.”
Pledger said it all starts at home. If you come from a family
where you are encouraged and exposed — like being taken to church or to the
park — that’s good.
“If parents don’t do that, you not only don’t normalize, but
you don’t have the capacity to do so,” he said.
Schools are stepping up to the challenges, using programs and
techniques to address the problem.
“I think the challenge is the same across the board: learning
how to meet the child where they are, having a genuine acceptance of where they
are that’s not judgmental,” Pledger said. “The first task is establishing
therapeutic alliance and getting them to learn to be present in that time and
space that we’re there with them.”
What’s not helpful is “having someone telling you that’s not
the way the world works,” he said.
One common-sense and useful technique is to teach children to
practice mindfulness, which helps the brain adjust, he said. The brain is not
learning, but it is reviving and growing stronger, which can help with
depression and anxiety, and being able to put trauma in perspective.
“Mindfulness is a skill. It takes practice, and if your
friends don’t do it, if your family doesn’t do it, it’s hard for you to do it —
to explore,” Pledger said. “If it’s used in school, everybody’s doing it, and
you’re going to do it.”
When children enter the classroom every day, if the teacher
begins with “let’s have a moment of quiet” then “let’s have a moment of
stretching,” it becomes normal, he said. “Research shows that it does work, but
it requires practice. We’ve been doing it but not practicing it — like take a
deep breath and count to 10. It’s not like we’re reinventing the wheel.”
Bonilla-Galdamez said she and a school psychologist run an
anxiety group that includes teaching the children how to have positive self
talks, like if your brain tells you you’re scared to go to school, you learn
how to tell your brain it’s OK.
“We give them tools like mindfulness techniques, breathing,
muscle relaxation and learning how to have a flexible brain instead of a rock
brain,” she said.
|‘Superflex’ is a social skills program that teaches
children to be flexible in their thinking instead of overreacting, said Ana
Bonilla-Galdamez, a licensed clinical social worker who works at Charles
Barrett Elementary School in Alexandria, Va.
Trust-building skills are included, as is a social skills
program called “Superflex,” which teaches kids to be flexible in their thinking
instead of over-reacting, Bonilla-Galdamez said.
It teaches that “you know these things are going to happen,
but you know you can deal with them” lesson, she said.
Social workers are the right professionals to help these
students, Bonilla-Galdamez said.
“We have the training, we have the team approach, we have the
resources, we are the bridge between the family, community and the school,” she
said. “Whether it’s doing an interview or going into the home, social workers
have the training to see a child holistically.”
Pledger also believes social workers are in the best place to
help isolated children, because of their roles and training.
“Our basic foundation is based on meeting people as they are
and not being judgmental about where they are,” he said. “We look at their
total environment, their families, their friends, all the things that impact
Pledger thinks universal screening might be a good way to
“If you do it with everybody, then you haven’t isolated
anybody,” he said. “I think it would be an important first step, and I think it
would be easier to work with some students, too.”
When it comes to extreme behavior, like recent incidences of
school shootings, Pledger said, “we’re focused on can we identify and can we
“What we have to do is figure out how to change the
environment so it can’t happen,” he said. “Adults saw that (the shooters)
stayed to themselves, and other kids sometimes know but don’t share, or think
they’re just (joking) and don’t come forward. We have to identify those kids.”
While technology like social media may help students who would
otherwise be isolated stay in contact with friends outside of school, it can
also isolate people.
“Technology gives us more access, but it doesn’t give us
face-to-face access,” Crewe said. “That face-to-face contact has diminished.”
Teenagers sometimes do not see the difference, according to
There’s a snapshot app where they take pictures and exchange
them with their friends who also have the app, she said.
“You perceive that you’re interacting, but in reality you’re
not,” she said. “Now you see technology in preschool — they have tablets.”
There’s one program where you see a duck, she said. They press
the duck and it quacks.
“It used to be that Mom would say, ‘What does a duck say?’ to
get the response from the child,” Bonilla-Galdamez said.
What’s missing is Mom’s voice, the tone of the voice, and the
listening and response on the part of the child, she said. “With the tablet,
it’s not the same thing. It’s not social interaction. But it’s the new normal.”
With a lot of parents working and children having electronics,
they can be isolated and nobody knows it, Bonilla-Galdamez said.
When it comes to social networks, Pledger said “I think
“Kids do a lot of their communication electronically,” he
said. “It’s a matter of degree. I think social networking is changing the
structure of how we communicate, how we’re connected, and I think that changes
our ability to interact.”
It also allows people to think they are well-connected,
When children see a stranger, they know it. But they do not
see that when connecting with a person online. They don’t recognize the
potential danger, he said.
Pledger said you can be sitting with a young person and think
they’re talking to you, while the entire time they’re constantly tapping on
their electronic devices. And you see that everywhere.
“It’s difficult to detect if they’re socially isolated or not
because they’re normal, so to speak,” he said. “Young people have access to
electronic communications across the board. They’ve grown up with it as being
The World Health Organization recognizes the social component
of health, Lubben said.
“Other countries got to this recognition before the United
States,” he said. “They’re ahead of us in recognizing its importance. Various
cultures have developed policies and programs.”
One example, Lubben said, is when they’re building housing,
it’s not enough to just have adequate apartments. There must be access to other
neighborhoods, parks and shopping.
The importance of social health needs to be raised, Johnson
“It’s as important as physical health and mental health, but
we don’t think of social health in the same way,” she said. “We really need to
understand how important social health is for our needs, for our clients and
The role of social workers is vital in tackling social isolation,
“To say social isolation kills draws people’s attention to
it,” he said. “To find out how and why it kills and develop the interventions
that can alleviate it, that’s why the grand challenge is important. Who better
than social workers to address this topic of social isolation?”
Johnson remembers a patient, a woman in her 80s. “She was
widowed and lived alone, so people might think, ‘Oh, she’s socially isolated,’”
Johnson said. “No. She had family locally and she had friends who were able to
look in on her regularly. She had social support.”
Her family often came to see her and check on her, as did a
neighbor, and she received Meals on Wheels. She also had various social
connections supporting her.
“That’s what stands out about her: It was a best-case
scenario,” Johnson said. “That’s what we’re striving for in terms of support.”
Lubben said some athletes think about reserve capacity and
bank some of their energy for later in the game.
“We need the same thing in terms of our social capacity,” he
said. “Some people are OK when things go well. But when they’re skating on thin
ice; these are the ones who sometimes fall through the cracks. The slings and
arrows of life get in their way.”
There are some bright spots in the battle against social isolation,
like a campaign in California that promotes the saying “Friends are good
medicine,” Lubben said.
And, he added, remember what The Beatles said.
“We all get by with a little help from our friends,” Lubben
said. “None of us can go it alone.”
From June 2016 NASW News. © 2016 National
Association of Social Workers. All Rights Reserved. NASW News
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