EDITORIAL

Research, Practice, and Policy Strategies to
Eradicate Social Isolation
Christine M. Rine and Charles LaBarre

doi: 10.1093/hsw/hlaa031

C 2020 National Association of Social Workers
V

ing guidelines (Brooke & Jackson, 2020). As we
reel from the shockwaves of the virus and various
forms of seclusion imposed with different degrees
of self-determination, we are yet to discover the
consequences of this drastic increase in social isolation. Although there is not a great deal of study
specific to COVID-19 at present, early literature
and that which extrapolates from research on previous viral outbreaks suggest that although social
isolation is effective in reducing exposure risk, it
increases acute stress, neurological disorders, depression, anxiety, posttraumatic stress disorder,
insomnia, and other specified trauma and stressorrelated disorders (Banerjee & Rai, 2020; Brooke
& Jackson, 2020; Brooks et al., 2020; Torales,
O’Higgins, Mauricio, Castaldelli-Maia, & Ventriglio, 2020). These findings spur a host of
recommendations for the development of focused
community-based psychosocial interventions aimed
at reducing symptoms that can be remotely dispatched. When considering more recent developments, coupled with an increase in social isolation
marked by fewer close interpersonal connections,
this grand challenge is a significant problem that
requires immediate attention.
The social work profession has long recognized
the importance of social ties in maintaining one’s
overall well-being, emotional strength, and resilience. Through this lens, we are well positioned to
reduce social isolation through research, practice,
and policy efforts for micro-, mezzo-, and macrolevel change. Social isolation bears broad and substantial negative effects on well-being across the
life span; yet, disparity is overwhelming in childhood and older adulthood (Lubben et al., 2015).
Therefore, to meet the challenge of eradicating social isolation we must address the particular needs
of those who are disproportionately at risk at each
end of the developmental spectrum. Childhood is

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T

he Grand Challenges for Social Work
outlined by the American Academy of
Social Work and Social Welfare offer a
multitude of opportunities for our profession to
develop active responses for pressing societal ails.
Each challenge charges social workers to engage
in innovative and wide-reaching professional
endeavors that span research, practice, and policy.
Efforts for addressing the grand challenge to
“eradicate social isolation” rely on the uniquely
“social” dimension of our work pertinent to increasing and strengthening connections across
diverse demographic groups (Lubben, Gironda,
Sabbath, Kong, & Johnson, 2015). Although social
isolation may sound like an innocuous concern,
deficiencies in social connections have been associated with a host of sweeping and significant adverse
psychosocial, mental, and physical health outcomes that are well documented across varied disciplines (Dickens, Richards, Greaves, & Campbell,
2011; Nicholson, 2012). Social isolation has been
described as a “potent killer” that negatively affects
morbidity, mortality, mental health, psychological
distress, health behaviors, loneliness, stress, disease,
and disability (Lubben et al., 2015). Discrete agespecific affects have also been identified at both
ends of the continuum. Among youths, social
isolation is associated with increased risk for low
self-esteem, behavioral problems, future health
concerns, depressive symptoms, and suicide attempts. For older adults, social isolation is associated
with increased risk for victimization, mistreatment,
abuse, fraud, financial difficulties, poor mental
health, intellectual and somatic problems, struggles
with tasks of daily living, and succumbing to catastrophic events (Lubben et al., 2015). At the time
of writing, social isolation has been heightened by
the coronavirus disease (COVID-19) pandemic
and accompanying quarantine and social distanc-

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ary, community-based, and participatory study
(Lubben et al., 2015). Addressing the impact of
COVID-19, studies suggest that digital communication and technologies can act as a vital means of
social connection, service provision, and treatment
for those affected by quarantine and social distancing guidelines (Banerjee & Rai, 2020; Brooke &
Jackson, 2020; Brooks et al., 2020; Torales et al.,
2020). Social work research, along with allied
health care disciplines, should use this unprecedented time in history to further examine how
technology can enhance social connectedness and
service delivery. Further study in this area also
affords practitioners the ability to refine interventions to meet the emergent needs of diverse client
populations resulting from the COVID-19 pandemic. With ever-evolving trends in technology, a
newfound interest in remote approaches, and a
strong empirical knowledge base from which to
build on, researchers have an abundance of avenues to explore means to eradicate social isolation.
Practice efforts to address social isolation hinge
on interdisciplinary collaboration, service integration, and implementation of novel interventions.
Practitioners are poised to translate the growing
body of research into services across settings. Social
workers can realize changes in practice methods by
developing, testing, and continually refining approaches that effectively use communication, social
media, and mobile technologies vital to creating
and sustaining lifelines for isolated individuals of all
ages (Lubben et al., 2015). Ways in which practitioners can diminish social isolation are as varied as
the settings in which they work. Although primary
care providers have made substantial strides to address mental health concerns along with physical
ailments, social workers in these settings can be
pivotal in expanding their first-line reach to assess
the social health and well-being of patients. Such
an undertaking may require much-needed systemic change and a paradigm shift; yet, the establishment and expansion of health homes has
already done much to lay the groundwork for coordinated care that recognizes the whole person
(Institute of Medicine [IOM], 2014). Changes of
this nature also call for assessment methods that further incorporate one’s social health, recognizing
the full scope of the biopsychosocial model. Current geriatric assessment instruments often lack adequate appraisal of social health, indicating a need
for measures that integrate this aspect of well-

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when the propensity for psychosocial, mental, and
physical health problems that are encountered later
in life are first established, whereas older adulthood
is when these consequences can be fatal. Specific
to social work research, studies are needed that
examine social isolation through interdisciplinary,
community-based, person-centered, and participatory methods reflective of the values that underlie the profession. Practice efforts to eradicate
social isolation require interdisciplinary collaboration, service integration, social health assessment,
novel interventions, and disaster preparedness
(Lubben et al., 2015). On legislative levels, social
workers are key to the advancement of policies
that strengthen ties to the community through initiatives that recognize interconnections between
physical, mental, and social health throughout the
life span, particularly for those most vulnerable to
social isolation (Brown et al., 2016). The COVID19 pandemic has brought to light the need to reimagine service access and delivery that require the
support of research and policy. Social work efforts
to address this challenge are needed now more
than ever before.
To eradicate social isolation, social work researchers are called on to lead studies that focus on
diverse and marginalized groups through interdisciplinary and multisystem approaches that consider
the individual, family, community, and larger society. Previous research on this topic emphasizes
correlations between morbidity, mortality, and
various aspects of social networks and has found
that familial and community connections significantly affect health outcomes among the general
population (Lubben et al., 2015). Research also
suggests that childhood is a critical period during
which supportive social ties are more likely to
translate into positive long-term psychosocial,
mental, and physical health outcomes (Berkman,
2009; Lubben et al., 2015). Yet, further study of
social isolation with large diverse samples is needed
that addresses cultural differences; individuals with
chronic mental illness; identification of isolated
adults in crisis situations; direct, indirect, and multicomponent interventions; self-determination;
concept operationalization; measurement precision; and virtual social contact (Sabir et al., 2009;
Wang et al., 2017). Social work researchers are
particularly fit to address these knowledge gaps due
to established partnerships and alliances with other
professionals and a strong history of interdisciplin-

gains by supporting parental efforts to manage employment and varied life responsibilities that can
positively affect outcomes for both caregivers and
children (Brown et al., 2016). A major policy recommendation aimed at reducing social isolation
among older adults is through initiatives for agefriendly communities that support active aging and
strengthen social connections. Socially isolated
older adults are at increased risk for various health
concerns, financial fraud, mistreatment, and neurocognitive disorders (Brown et al., 2016). Many
of these risk factors have been exacerbated by the
COVID-19 pandemic (Brooke & Jackson, 2020).
Some contemporary programs to reduce social isolation among this demographic have shown potential and inform policy initiatives for the future. For
example, the American Association of Retired
Persons (known as AARP) helps municipalities
make universal modifications as an affiliate of the
World Health Organization’s (WHO’s) Global
Age-Friendly Communities program (Brown et al.,
2016). An age-friendly community “adapts its
structures and services to be accessible to and inclusive of older people with varying needs and capacities” (WHO, 2007, p. 1). Expansion of primary
prevention efforts holds promise for reducing social isolation for older populations. COVID-19 has
changed the landscape of service provision and
presents social workers with an array of opportunities to influence policy to reduce social isolation
moving forward. In response to the pandemic,
many states, insurance carriers, and service providers hastily developed legislation, allowances,
and guidelines to quickly react to the widespread
decrease in access to various resources and services
by leveraging technology for remote contact. Although this may have lessened barriers for some,
new policies are needed to shape proactive and
comprehensive responses for situations in which
in-person contact is not possible. To meet this
need, providers require funding, infrastructure development, and training to effectively implement
technology-based services (IOM, 2014).
The social work profession is summoned to
eradicate social isolation through our preparedness
to affect changes across research, practice, and policy. In response to the COVID-19 pandemic and
increasing social isolation throughout the population as a whole, this challenge is critical and timely.
Collaborative research that considers diverse populations, practice methods that place social health

RINE AND LABARRE / Research, Practice, and Policy Strategies to Eradicate Social Isolation

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being. Community health nurses and health home
personnel screen clients for social isolation; yet, increased interdisciplinary collaboration between social workers and other professionals is necessary to
support the social health of the larger population
(Lubben et al., 2015). COVID-19 spurs a duty for
social work practitioners to consider access in a
manner that has gone largely unrecognized. Although the Patient Protection and Affordable Care
Act encourages disaster preparedness, expansion of
telehealth, and social health information exchange
initiatives that mobilize community-based service
providers “to focus on the whole person during a
disaster response, addressing acute medical needs as
well as housing, shelter, and other needs that impact health” (IOM, 2014, p. 79), recent events indicate that these opportunities have not been well
developed. In partnership with health care professionals, social workers can significantly advance
practice by adopting various remote and telehealth
approaches that improve service access, decrease
social isolation, and recognize the diverse implications of the pandemic. Particular areas for intervention have already been identified in early
literature indicating the need to address psychosocial, mental, physical, and economic needs (Brooks
et al., 2020). Those in direct practice are well
suited to reduce social isolation and refocus attention on social health across settings.
Policies to reduce social isolation seek to bridge
the divide between diverse populations and their
communities through access and reform that considers the mounting links between social health
and other areas of well-being. Due to the increased
risk for social isolation in childhood and older
adulthood, policies specific to these populations
are primary. Increased access to high-quality child
care that strengthens social connections is an essential and well-supported recommendation (Brown
et al., 2016). Early attachment and engagement
theories have been empirically supported, suggesting that connections formed early in life have a significant influence on one’s future patterns of social
interaction (Brown et al., 2016; Lubben et al.,
2015). Research increasingly indicates that the developmental stage in which crucial social connections are shaped occurs earlier than previously
believed, demonstrating the need for high-quality
child care that promotes healthy social development from the start (Berkman, 2009; Brown et al.,
2016). Such child care options bring secondary

at their center, and policy innovations that focus
on factors underpinning social isolation are among
the tasks for the profession. The COVID-19 pandemic continues to deepen, transform, and expand
our understanding of social isolation, calling for immediate attention to research, practice, and policy advancement that supports service access and delivery in
times of disaster and public health crises. HSW

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Christine M. Rine, PhD, is associate professor, Social Work
Department, Edinboro University of Pennsylvania, 235
Scotland Road, Hendricks Hall G-37, Edinboro, PA 16444;
e-mail: crine@edinboro.edu. Charles LaBarre, MSW, is a
PhD student, School of Social Work, University at Buffalo,
Buffalo, NY.
Advance Access Publication December 21, 2020

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REFERENCES
Banerjee, D., & Rai, M. (2020, April). Social isolation in
Covid-19: The impact of loneliness [Editorial]. International Journal of Social Psychiatry. Advance online
publication. doi:10.1177/0020764020922269
Berkman, L. F. (2009). Social epidemiology: Social determinants of health in the United States: Are we losing
ground? Annual Review of Public Health, 30, 27–41.
Brooke, J., & Jackson, D. (2020, April). Older people and
COVID-19: Isolation, risk and ageism [Editorial].
Journal of Clinical Nursing. Advance online publication.
doi:10.1111/jocn.15274
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L.,
Wessely, S., Greenberg, N., & Rubin, G. J. (2020,
March). The psychological impact of quarantine and
how to reduce it: Rapid review of the evidence. Lancet, 395, 912–920. doi:10.1016/S0140-6736(20)
30460-8
Brown, S., Casey, E. A., Crewe, S. E., Gironda, M., Johnson, C., Lubben, J., et al. (2016, September). Policy
recommendations for meeting the Grand Challenge to Eradicate Social Isolation (Grand Challenges for Social Work
Initiative Policy Brief No. 5). Cleveland: American
Academy of Social Work & Social Welfare. Retrieved
from https://openscholarship.wustl.edu/cgi/viewcon
tent.cgi?article¼1790&context¼csd_research
Dickens, A. P., Richards, S. H., Greaves, C. J., & Campbell, J. L. (2011). Interventions targeting social isolation in older people: A systematic review. BioMed
Central Public Health, 11, Article 647. doi:10.1186/
1471-2458-11-647
Institute of Medicine. (2014). The impacts of the Affordable
Care Act on preparedness resources and programs: Workshop
summary. Retrieved from https://www.ncbi.nlm.nih
.gov/books/NBK241392/pdf/Bookshelf_NBK241392
.pdf
Lubben, J., Gironda, M., Sabbath, E., Kong, J., & Johnson,
C. (2015). Social isolation presents a grand challenge for social work (Grand Challenges for Social Work Initiative
Working Paper No. 7). Cleveland: American Academy of Social Work and Social Welfare. Retrieved
from https://grandchallengesforsocialwork.org/wpcontent/uploads/2015/12/WP7-with-cover.pdf
Nicholson, N. R. (2012). A review of social isolation: An
important but underassessed condition in older adults.
Journal of Primary Prevention, 33(2–3), 137–152.
Sabir, M., Wethington, E., Breckman, R., Meador, R.,
Reid, M. C., & Pillemer, K. A. (2009). Communitybased participatory critique of social isolation intervention research for community-dwelling older
adults. Journal of Applied Gerontology, 28, 218–234.
Torales, J., O’Higgins, M., Mauricio, J., Castaldelli-Maia,
J. M., & Ventriglio, A. (2020, March). The outbreak
of COVID-19 coronavirus and its impact on global

mental health. International Journal of Social Psychiatry,
66, 317–320. doi:10.1177/0020764020915212
Wang, J., Lloyd-Evans, B., Giacco, D., Forsyth, R., Nebo,
C., Mann, F., & Johnson, S. (2017). Social isolation
in mental health: A conceptual and methodological
review. Social Psychiatry and Psychiatric Epidemiology,
52, 1451–1461. Retrieved from https://www.ncbi
.nlm.nih.gov/pmc/articles/PMC5702385/pdf/127_
2017_Article_1446.pdf
World Health Organization. (2007). Global age-friendly cities: A guide. Retrieved from http://www.who.int/age
ing/publications/age_friendly_cities_guide/en/