1. Measuring the impact of loneliness interventions Development Workshop

2. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Welcome and Introductions

3. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Workshop Outcome To have completed the preparatory stages of developing a tool to measure the impact of various interventions on loneliness. Specifically, to have:- Developed an outcome framework Mapped the most common interventions onto the outcome framework To have developed a range of possible questions to be included in a survey tool(s)

4. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Agenda The task – an outline of what the project is seeking to achieve and key issues involved (15mins) Developing an outcome framework (45 mins) Mapping interventions to outcomes (30 mins) Developing the questions (45 mins) Next steps (15 mins)

5. www.campaigntoendloneliness.org.uk // @EndLonelinessUK The Task To develop a new tool, or set of tools, to help service providers to measure the impact of their work on levels of loneliness in older people.

6. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Project Output Tool should:- Be simple Be flexible Produce comparable results Be sensitive Be practical Be empowering Be valid

7. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Key Issues What is being measured – loneliness / isolation / wellbeing? For what purpose:- Practitioner Performance management Commissioner / Funder evaluation (cost and quality) Academic study What context is measurement like to take place? How are we to measure? baseline, when, what type, how asked, how many How valid will measurement be? What is our ‘theory of change’?

8. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Outcomes Expressed in the positive As specific as possible Within area of influence Able to be measured

9. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Developing outcome framework 1.Identify a realistic and definite goal - the ultimate long term vision 2.Work backwards to develop the intermediate outcomes. Persistently ask the question – “What has to happen in order for this to be achieved?”. Think about the causes and protective factors of loneliness. What things need to be increased / decreased to achieve the desired outcome? 3.Establish the links between outcomes and their order by working out causes and effects. Persistently ask the question – “Does this outcome really lead to the next?” 4.Clarify the assumptions behind each link. What are your beliefs about how change might happen

10. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Example of an outcome framework Long Term Vision Outcome Intermediate Outcome Outcome Intermediate Outcome Supported by assumptions about:- -Different types of loneliness -Causes and Protective factors – what needs to be increased or decreased -How people might address their loneliness

11. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Long Term Vision Older people have the volume and quality of social contact that they want.

12. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Mapping the intervention Work out which interventions or activities need to be deployed in order to bring about each outcome - think about intensity and frequency Will the intervention change the risk and protective factors and if so, why? Are there circumstances where the intervention might not work. Is there research to back up the assumption? Identify what else is needed for the intervention to work – for example, what would completely derail the intervention? Develop a narrative which incorporates the outcomes and interventions framework.

13. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Existing survey tool analysis Main existing survey tools Friendship scale Warwick Edinburgh Mental Wellbeing Scale UCLA (various versions) Social Wellbeing Scale Public Health Outcome Indicator De Jong Gierveld ASCOT Ryff Scale Older People’s Outcome Star Abbreviated Duke Social Support Index 101 different questions identified

14. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Categorisation of questions About competence to make and sustain relationships About loneliness feeling About number of social contacts About change in situation About quality of social contact About 'fitting in' About availability of support in a crisis About personality type About engagement in wider community

15. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Types of questions Question Classification I am no longer close to anyone Change I find my circle of friends too limited Number My interests and ideas are not shared by those around me Fitting in There is no one I can turn to Support I cannot tolerate being so alone Feeling I am an outgoing person Personality I feel like I belong to something I call community Community It is difficult for me to make friends Competence

16. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Perspectives PractitionerManagerCommissioner SimpleGroup 1Group 2Group 3 ComplexGroup 4Group 5Group 6

17. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Views of older people 4 focus groups 36 older people Semi structured discussions, addressing Perceptions of lonely people Language used to talk about loneliness Type of questions used How questions should be asked and frequency

18. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Perceptions of lonely people Lots of fear:- I fear of getting into a tied commitment Some who are desperately lonely cling on It’s too much for ordinary people, needs professional involvement When some people say they are lonely other people back off Concern about ability to help:- Some people who are lonely just aren't that friendly and it is therefore difficult to deal with them I feel powerless because you cant help them

19. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Perceptions of lonely people Some distaste:- Sometimes people just want others to "do everything for them" - and you can get a bit tired of that. Some of them you can see why people don't want to go visit them Sometimes they are not pleasant people to visit Some compassion:- I feel sorry for them They have no communication with other people which is sad They can be frightened of expressing how they feel Lonely people can worry about being a nuisance An older person who is lonely still has something to offer

20. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Language Sometimes when people say they are lonely other people back away - I think it would be different if we could find other language Other words IsolatedForgottenFeeling unhappy InsecureAbandoned Talk instead about:- ‘wanting more company’ ‘what would you like to do more of’ Help people understand where they get their energy from - some people (introverts) get it from internal reflection - others (extroverts) get it from other people - there is no 'shame' attached to this way of framing things

21. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Types of questions Question ScoreClassification I am no longer close to anyone 19Change I have little social contact with people 16Number My interests and ideas are not shared by those around me 14Fitting in There is no one I can turn to 14Support I cannot tolerate being so alone 13Feeling I feel as if nobody really understands me 10Fitting in I am unhappy being so withdrawn 8Personality I am unable to reach out and communicate with those around me 7Community It is difficult for me to make friends 7Competence

22. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Questioning Type of questioning:- Better for questions to be constructed 'positively' - otherwise unlikely to be answered honestly by the person because it is like they would be admitting that there is something wrong with them Negative questions can make you feel extremely vulnerable

23. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Questioning How many:- Depends on the question Depends on the person asking and their attitude It is so important that they are not patronising You need to allow people to ask quite a few questions if they are then going to be able to help you Ask as many as you like – I wouldn’t mind Being able to give some context to my answer would be important Have a list and just ‘go with the flow’ until the person asks you to stop

24. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Questioning How many:- Depends on the question Depends on the person asking and their attitude It is so important that they are not patronising You need to allow people to ask quite a few questions if they are then going to be able to help you Ask as many as you like – I wouldn’t mind Being able to give some context to my answer would be important Have a list and just ‘go with the flow’ until the person asks you to stop

25. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Questioning When to ask:- Wouldn't ask any questions on the first visit - would need to be 'in the early stages, which could be several weeks in before it would be appropriate Ask them to reflect on their experience - how had it gone? Has it made a difference? Likely to get the best answers ten or twelve weeks down the line when they are mote engaged and more confident about the difference in how they are feeling Not on the first meeting, but in the “early stages” Maybe after a week or so, but only 3 or 4 questions at this stage If early on, focus on practical rather than personal questions – try to not be too threatening When someone feels that they belong, you could ask around 10-12 questions

26. www.campaigntoendloneliness.org.uk // @EndLonelinessUK Questioning How to ask- Use a spectrum of "smiley faces" as a measure that people can judge themselves against Don't expect that you can get someone to fill a form and sign it Mustn’t complete the questions as a type of ‘tick box’ approach