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Collective impact addressing social isolation for older adults living independently in the community; a capstone innovation project

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Collective impact addressing social isolation for older adults living independently in the community; a capstone innovation project

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Content Running Head COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Collective Impact Addressing Social Isolation for Older Adults, Living Independently in the Community; A Capstone Innovation Project JanaLee Wagner, LICSW, MSW, DSW Candidate University of Southern California Annalisa Enrile, PhD, MSW SOWK 722, Implementing Your Capstone and Re-envisioning Your Career Doctor of Social Work December 2019 1 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 2 Table of Contents Executive Summary 4 Introduction 8 The Grand Challenge; Eradicate Social Isolation 8 Social Isolation for Older Adults; Conceptual Framework 11 Contextual Framework 15 Current Programs 1 7 Current Gaps in Addressing Social Isolation for Older Adults 18 Innovation 19 Value Proposition of Innovation 21 Theory of Change; Climbing the Mountain 23 Implementation Plan 25 Evaluation of Readiness to Change and Establish Commitment from Partners 26 Preparation for Impact; Establish Foundations 28 Strategic Activities 29 Sustainment and Scale 31 Potential Barriers and Facilitators 32 Conclusion 34 References 36 Appendix A: Walla Walla Coalition to Fight Isolation Articles of Incorporation 48 Appendix B: Walla Walla Coalition to Fight Isolation Bylaws 51 Appendix C: Coalition Meeting Notes 61 Appendix D: Theory of Change; Mountain Visual 66 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Appendix E: Communication Plan Appendix F: Collective Impact Process Plan Appendix G: Board of Directors Meeting Minutes Appendix H: Pilot Plan Proposal Appendix I: Qualitative Survey Appendix J: Patient Health Questionnaire 9 Item Appendix K: Geriatric Anxiety Scale 10 Item Appendix L: Lubben Social Network Scale 6 Item Appendix M: Pilot Initial Summary Appendix N: Line Item Budget Appendix 0: Community Survey Appendix P: EPIS Table Appendix Q: Vision & Mission Statement Appendix R: Gannt Chart Appendix S: Alice, My Inspiration 67 68 69 75 76 77 79 81 83 85 86 87 88 89 90 3 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 4 Executive Summary Walla Walla Coalition to Fight Isolation (WWCFI) is a non-profit created and established as a backbone organization for a collective impact initiative addressing social isolation. As American society has evolved into a more individualistic nation, obtaining supportive close relationships has become more difficult and social isolation and loneliness have become more prevalent (Cornwell, Schumm, Laumann, Kirn, & Kirn, 2014). Social isolation, defined as the absence of social connections measured both by quantity and quality, has had a monumental effect on physical, emotional and cognitive health in America (Elder & Retrurn, 2012). Social isolation has been linked to society's most complicated and serious problems including addictions (Van Dyke, Kirn, & Thom, 2018), suicides (Stone et al, 2018), dementia (Donovan et al, 2017) and the high cost of medical care (Flowers et al, 2017). American Academy of Social Work and Social Welfare has deemed Eradicating Social Isolation as one of the Grand Challenges for Social Work and a request has been made to innovate effective solutions (Lubben, Gironda, Sabbath, Kong, & Johnson, 2015). Though social isolation affects all genders, socioeconomic groups, ethnicities, and ages, and touches every continent on the earth (Lubben et al, 2015), older adults have unique challenges with isolation because they also must cope with normal aging processes which can also be isolating (Courtin & Knapp, 2017). The cyclical relationship social isolation has with wellbeing (Li & Zang, 2015) is intensified for older adults who often find themselves alone and separated from their families who tend to live at a distance (Cornwell et al, 2014). The United States Census Bureau has estimated 37% of adults age 75 and older live alone (Vespa, 2017). Because older adults are high risk for systemic declines due to natural aging, there is a large number who remain in their homes, only venturing out for necessities (Camey, Fujiwara, Emmert, Liberman, & Paris, 2016). This creates a hidden population separated from family, COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION neighbors, and the services that could improve their lives. There is a need to have a process to identify hidden isolated older adults and connect them to services which can create necessary networks to sustain their lives (McDaid, 2019). 5 This innovation is to establish WWCFI as the backbone organization to lead a collective impact initiative, partnering with community agencies, services and interested community members to subvert the norm that insists social needs are the least important. This initiative will reshape practices for older adults to provide assessment and interventions for socialization in order to improve whole health. The Grand Challenges have called for the need to identify the isolated, provide effective interventions, and work toward policy change to ensure these measures are sustained (Brown, 2016). There is a call for a complicated multi-level change which can be scaled. Collective impact has been proven to be effective to provide a catalyst for complicated multi-level changes, with participation from multi-level agencies, services and community members (Kania & Kramer, 2013). WWCFI will lead a collective impact initiative to address each of these levels of need simultaneously. Collective impact is different than a collaboration in that participating partners identify a shared agenda, create shared goals with shared metrics collected in a shared data system for full program analysis (Prange, Allen, & Reiter-Palmon, 2016). Additionally, collective impact encourages non-traditional partners, who touch the lives of beneficiaries in unexpected ways, to participate in the innovation process. There is also a partnership established with beneficiaries, making sure their interests are taken into account. The backbone organization leads all partners to not only collaborate together, but create together, providing ownership in the goals as well as the outcomes (Karp & Lundy-Wagner, 2016). Because these activities are led by a backbone organization, service delivery is not interrupted and momentum is allowed to grow. This process COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION allows for rapid prototyping and quick discovery of best practices which can then be adopted in multiple communities (Gallagher, 2014). 6 The backbone organization for collective impact leads partners through five stages from evaluation ofreadiness to change to sustainability (Edmondson & Zimpher, 2014). In preparation for this innovation, study of the contextual framework has been completed revealing a social and political environment ready for change. A sense of urgency and commitment has been identified. Partnerships with key stakeholders, agencies that currently lead the community in services for older adults, have been confirmed, trust in the leaderships' expertise and ability to lead has been established. The shared agenda, goals and base measurements have been identified and initial foundations created. The next steps will be to secure funding, identify strategic activities, and establish infrastructure for large scale data collection. Once these activities have been completed, WWCFI will guide partners to begin the important work of initiating strategic activities, evaluation and adjustments to practices, and continued recruitment of additional partners. Community education will be paramount in this stage as community support is strengthened and participation cemented. This innovation builds on the practices of large companies, such as Mars Inc. (Desai, 2017), and Procter & Gamble (Luca, 2016), who have utilized collective impact to collaborate with communities and increase their profits. It also advances current collective impact initiatives created for social change by establishing activities which impact simultaneous solutions at multiple layers. Finally, by partnering with agencies who serve multiple counties, WWCFI is strategically situated to initiate the process in multiple communities for scalability. The shared data analysis will provide evidence to advocate for state policy and eventually federal policy. WWCFI will lead a collective impact movement which will create a full-scale process from COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION identification of isolated individuals to program delivery and expansion. This innovation will be established in small, rural America and grow to address isolation and loneliness for all older adults across the country. 7 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Collective Impact Addressing Social Isolation for Older Adults Living Independently in the Community; A Capstone Project 8 Across the globe, people are suffering from social isolation and loneliness (Cudjoe, et al, 2018). Some isolate out of fear so intense it keeps them from leaving their homes (Bowker et al, 2019). Others isolate because of self-doubt, believing no one is interested in interacting with them. Still others isolate from their circumstances be it financial, health, safety, or geographical location (Samuel, Alkire, Zavaleta, Mills, & Hammock, 2017). There are also those who just simply do not have anyone in their lives they can interact with. Finally, there are others who feel isolated, with a perception of being alone, in the midst of a crowd (Hawlkley & Capitani 0 , 2015). Regardless of the reason, social isolation has significant negative effects on individuals and society and there is a need to identify solutions to eradicate this wicked problem. It is for this reason Eradicating Social Isolation has been deemed by the American Academy of Social Work and Social Welfare (AASWSW) as one of the Grand Challenges for Social Work (Lubben et al, 2015) and this innovation has been created as a solution. Grand Challenge; Eradicate Social Isolation Social isolation, defined as the absence of social connections measured both by quantity and quality, has become prevalent in society (Elder & Retrum, 2012). Social isolation effects all genders, socioeconomic groups, ethnicities, and ages, and touches every continent on the earth (Lubben et al, 2015). In the United States, the number of people who report having even one person they feel close enough to confide in had reduced by a third from 1966 to 1984 (McPherson, Smith-Lovin, & Brashears, 2006). Today, the quality of connections has decreased, with a wide variety of surface social networks, but few, if any, deep confidants (Parigi & Henson, 2014). The negative effects of social isolation influence today' s most complicated and COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION serious problems including addictions (Van Dyke, Kim, & Thorn, 2018), pain management (Karayannis et al, 2018), dementia (Donovan et al, 2017), suicides (Stone et al, 2018) and the challenges due to the growing older adult population. 9 Social isolation has been identified as a health crisis by the World Health Organization (WHO) and is found to intensify chronic illnesses and symptoms of declining health (World Health Organization [WHO], 2017a). Those who are socially isolated have an increased risk for heart disease, diabetes, hypertension, and obesity (Valtora, Kanaan, Goilbody, Ronzi and Hanratty, 2016). Social isolation has also been found to have significant impacts on cerebrovascular disease leading to possible strokes (Friedler, Crapser, & McCullough, 2015). In addition, socially isolated individuals have a higher risk of mortality from chronic disease (Pantell, Rehkopf, Jutte, Syme, Balmes, & Adler, 2013). Similarly, studies have shown the risk of death from an acute illness is more prevalent in those who are socially isolated (Pantell et al, 2013). Individuals who do recover have longer recovery periods for those with minimal or no social networks (Landeiro, Leal & Gray, 2016). Decreased physical health can also cause social isolation, introducing a cyclical relationship of increased rate for disease processes and increased isolation (Li & Zhang, 2015). This same cyclical relationship has been found to impact cognitive abilities (Rohde, D' Ambrosio, Tang, Rao, 2016). Individuals who are isolated and alone have less opportunity for conversational interaction, which has been recognized as an important activity to maintain cognitive functioning (Zuelsdorff et al, 2017). Others will isolate, because of their declining cognitive abilities and are embarrassed or worried about what may happen, again compounding the cycle (Kotwol, Kim, Waite, Dale, 2016). Utilizing communication and engaging in social connections increase one' s ability for executive functioning, the ability to organize and manage COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 10 one' s life independently (Zuelsdorff et al, 2017). Relationships with others increase one' s ability to maintain intercommunications as well as probability to engage in active endeavors. Engagement in extracurricular activities with cognitive stimulation, also enhances one's cognitive abilities (Friedler, 2014). Those with mild cognitive impairments have increased probability of mood disorders which can cause a decrease in social interaction, resulting in a cyclical correlation for further isolation (Beutel et al, 2017). Social isolation impacts emotional health with a similar cyclical relationship causing increased risks for depression, anxiety, and suicides (Rohde et al, 2016). Individuals battling mood disorders may isolate themselves as a symptom of their emotional distress or often lack the motivation to be around others (Rohde et al, 2016). This intensifies their symptoms, causing increased isolation. However, individuals who have a strong support system maintain better coping skills to manage their moods (Findlay, Lloyd, & Finucane, 2017). People engaged in various social roles feel better about themselves and the impact they have on society (Yates, Clare, Woods, & Wales, 2017). Those who feel a strong support system report a greater satisfaction with life and are less likely to have thoughts of suicide (Beutel et al, 2017). Social interaction can provide one a sense of belonging and relationships provide increased reasons for living. Conversely, when one feels alone, dissatisfied with their situation, and hopeless, contemplations of one' s purpose and reason for living become centered in their thoughts (Beutel et al, 2017). Research indicates there is a corelated relationship between levels of isolation and suicidal ideation (Beutel et al, 2017) Of individuals who report severe isolation, over 45% have suicidal thoughts (Beutel et al, 2017). When one is isolated and alone, depressed, and trying to find their purpose, they are not only more likely to think about death, but have increased risk for COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 11 suicide attempts. It has been noted 42% of suicides in the United States are related to relationships (Stone, Hindman, & Mony, 2018). Reports released June 2018 indicate there was a 50% increase in suicides in the United States (Stone, et al, 2018). The Center for Disease Control and Prevention (CDC) has recognized the significant impact social isolation has on suicide rates citing building social connections needs to be a part of the solution to this crisis (Gunn, Goldstein, & Gager, 2018). Social isolation has been caught up in a cycle of impairments which cause increased isolation, causing increased impairments, making this a monumental health crisis in America. Though these negative impacts affect everyone, older adults have unique challenges with isolation because they also must cope with normal aging processes (United States Senate [US Senate], 2018). The cyclical relationship social isolation has is intensified for older adults because they are already high risk for systemic declines. This risk is also increased as an increased number of older adults find themselves separated from their families and living alone (Carney, 2016). This creates a hidden population separated from services that could improve their lives and current practices do not focus on a need to assess for isolation, maintaining the concealment. Social Isolation for Older Adults; Conceptual Framework Older adults have natural changes to their physical condition making them susceptible to many chronic diseases. They have changes in their functional abilities as natural aging processes affect hand dexterity, mobility, vision, hearing, and overall strength (Courtin. 2017). These impact a person' s ability to remain independent and accomplish their activities of daily living. Again, social isolation has been noted to cause decreased functional ability quickening the loss of independence as assistance is required (Shankar, McMunn, Demakakos, Hamer, & Steptoe, COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 12 2017). Additionally, those with small or no social networks do not have adequate supports to provide for this assistance, requiring professionals to be hired if there are funds to do so. When the needs go unmet, deterioration continues at a heightened speed and, sadly these individuals go into crisis and either face premature institutionalization or suffer an early death (Shankar et al, 2017). Older adults may have increased difficulty leaving their homes. This can be because of inability to drive causing transportation difficulties, mobility challenges, financial constraints, illnesses, or even extensive caregiving responsibilities as they care for a spouse. With these difficulties of venturing out into the community, they become more isolated. Isolated individuals tend to care for themselves less and physiological changes are intensified due to isolation impacting disease processes (D' Agostino, Kattan & Canli, 2018). This causes a cycle of increased physical challenges which increases isolation. Older adults deal with losses of family and friends at an increased rate because of the age of their friends and immediate family. They also are required to cope with grieving the loss of their independence, functioning, and previous interests (Gitterman, & Knight, 2019). As they attempt to endure grieving from these losses, they often experience depression and anxiety. When one has a network of friends to provide support and encouragement, grieving is made more bearable (Rohde et al, 2016). Without this support, depression and anxiety intensify. Older adults with a strong support system are less likely to have exacerbations of depression or anxiety because they are engaged in interactions with others thus providing a distraction from impaired mood and grieving (Mcgarrigle, Layte, McGarrigle, 2015). The same phenomenon is true for older adults suffering from mental illnesses which they were able to manage in their active younger years, but are challenged to cope alone as they age COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 13 (Taylor, Taylor, Nguyen & Chatters, 2018). Older adults often will not express they have anxiety or depression, but will instead visit their primary provider or seek emergency medical services (Smith et al., 2016). They complain of pain, fatigue, loss of appetite, dizziness, or chest pain (Smith et al., 2016). In the process of looking for a physical cause of these physical symptoms, emotional distress is undiagnosed and untreated, and pain medications are often prescribed (WHO, 2017b). CDC estimates one in every three older adults has depression, 32% have anxiety, and 5% have dementia (Aldrich, 2018). Current reports indicate more than 50% rise in suicide rates for male older adults and 60% rise in older adult females (Warrell, 2018). It is estimated that in every 4 older adult suicide attempts, there is one completion (Conejero, Olie, Courtet, Calati, 2018). Emotional distress for older adults is a serious problem intensified by isolation and loneliness which in turn is increasing suicide rates. The results of increased usage of high cost medical services has a profound impact on the economy. One study reported there was $6.7 billion additional expenditures to Medicare in one year because of social isolation (Flowers et al, 2017). Longer stays in rehabilitation centers also drive costs up, as do premature institutionalization (Landeiro et al, 2016). Older adults calling emergency services in the middle of the night complaining of physical symptoms but later noted to have nothing physically wrong, still have a large bill, with no resolution. Therefore, they call again, inducing another cycle. When increased social interaction is provided, individuals use fewer medical services and self-report being healthier (Hand et al, 2014). Additionally, interventions for socialization are more cost effective. A pilot program in Houston found that when interventions to build connections were utilized, the total cost of health care for 39 patients dropped from $2.3 million to $1 million after only 6 months of interventions (Holton-Burke, & COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Buck, 2017). Interventions for social isolation cost far less than the negative effects loneliness has inflicted (McDaid et al, 2017). 14 There is an increasing number of older adults who are hidden from society and suffering the effects of social isolation (Goodman, Adams, & Swift, 2015). The culture in the United States has changed over the past century, moving from one of community toward greater individualism (Grossmann & Varnum, 2015). Families live farther apart and neighborhoods have become the location of our houses where we remain behind closed doors. Widows and widowers find themselves living alone, often with family living in another state (Cornwell et al, 2014). The United States Census Bureau indicates 23% of those aged 65-74 live alone and 37% of those aged 75 and older live alone (Vespa, 2017). Many older adults are noted to have difficulty with leaving their homes because of transportation, functional abilities, the tasks of caring for a spouse, or limited income. Consequently, there is a growing older adult population that is isolated and hidden, venturing out only for groceries and other necessities or medical appointments (Broome, 2016). No one knows they are in need of services, and they don't know there are services available that could help them build connections within their homes, or in the community. The population of older adults is growing at an exceptional rate. The USCB reported the population of adults age 65 and older in 2015 was 48 million. This is expected to nearly double by 2060 with an estimated 98 million (United States Census Bureau [USCB], 2018b). By 2030 the older adult population is expected to be greater than the working class (USCB, 2018b ). This creates a necessity for infrastructures and programs to be established which ensure older adults are at their healthiest and most independent for as long as possible. It is imperative the needs of older adults are addressed to maintain their independence, allow them to continue to contribute COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 15 to society, and enhance their dignity in order to continue or improve the balance of society as it is now known. Isolated older adults are hidden, suffering from physical, emotional, cognitive, and financial declines, intensified by social isolation, and are not aware of services to meet this need (Carney et a, 2016). Establishing infrastructures and processes which will identify isolated older adults and connect them to services which can increase social interactions are important aspects to enhance their lives as well as society. Contextual Framework Current cultural shifts in American Society create an environment ripe for addressing the needs of older adults. There is much concern about what will happen as a result of the expected older adult population boom creating a political climate ready to initiate change. Congress understands the stakes are high and will affect all people in America (US Senate, 2018). The potential Social Security and Medicare crisis is no longer seen as sometime in the future, but it is now (US Senate, 2018). We need answers and Congress is ready to listen to ideas. Addressing social isolation for older adults will not only enhance connections, but also address the most profound issues of our day including the opioid crisis, suicides, and the high cost of medical care. Medical culture is changing as whole health approaches are being not only adopted by clinics, but encouraged by Centers for Medicare and Medicaid Services. Medicare practices for payment are changing to promote positive health outcomes that include emotional and social health (Applegate, Ouslander, & Kuchel, 2018). Medical professionals are recognizing the impact isolation and loneliness has on disease processes as well as care seeking practices, but don' t know what to do about it (Andermann, 2016). There is an understanding of the need to address social and emotional needs in order to meet all health outcome measures that will ensure COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 16 medical practices remain financially stable (Andermann, 2016). The healthcare industry is ready to seek and provide answers outside of their usual practices. Facilities, providing higher level of care, have been recognized over the last decade as an answer to the growing needs of older adults. However, according to Aging and Long Term Care (ALTC) staff, older adults are pushing back, with a desire to remain in their own homes (personal communication, June, 2019). Many do not see institutionalization as an answer and show increased depression, anxiety, and behavioral symptoms once admitted to a facility (Mayo Wilson et al, 2014). County Health Department staff has identified this as a contributing factor to isolation as older adults within the facilities are withdrawn and those at home hide their needs, facing fears they will be taken from their homes if they admit to them (personal communication, August 2018). WHO has recognized there is a necessity to create age friendly communities, decreasing premature use of these facilities while increasing quality of life for older adults (WHO, 2018). Many communities have joined this campaign and are working toward incorporating infrastructures and programs that will reach across the generations (WHO, 2018). Interventions and programs which address the problem of social isolation have the potential to increase the health and independence of older adults and thus decrease use of high cost medical services, higher level of care facilities, and personal care assistance. When older adults can maintain active lives connected to their communities, they also have increased self esteem, dignity, and emotional health thus having the potential to decrease older adult suicides (Poscia et al, 2018). Active older adults are better equipped to stave off severe physical changes as well as manage disease processes (Buettner, & Skemp, 2016). This leads to a healthier geriatric population, able to maintain independence and continue to contribute to society for COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 17 longer periods of time (Buettner, & Skemp, 2016). However, in order for these services to be provided, hidden, isolated older adults need to be identified and connected to available services. Current Programs Age-Friendly Cities. WHO identified a Global Age-Friendly Cities Guide, formulated and published in 2007, as a blueprint for individuals or communities to utilize in making their cities inclusive and active for all generations (WHO, 2017a). This program encourages older adults to participate in active aging to benefit the individual as well as the community and supports an inclusive framework to enable multi-generation interactions. In age-friendly cities older adults continue to be active in community government, programing, and planned events acting as mentors for those who are younger, but also receiving reverse mentorship and support from younger generations. Thirty-three cities, representing every continent, participated in the pilot research program and development of the guide. (WHO, 2017a). It is now reported 760 communities have membership in the project of which 124 are currently in the action phase (WHO, 2018). Facilitating older adults to be involved in community and make connections has had significant effects on reducing isolation and it is expected to have continued profound impacts as the recommended implementations are put into place (Delatorre, & Neal, 2017). However, this solution does not have a means to identify those older adults who are already isolated and hidden from society and the full adoption is expected to be 25 years in the making for each participating city (Delatorre, & Neal, 2017). Campaign to End Loneliness. A second intervention implemented to eradicate social isolation for older adults is the United Kingdom's Campaign to End Loneliness. Included in this program are lobbying to commissioners, educating and training the public, facilitating programing through community organizations, research, and encouraging older adult' s COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 18 participation in leisure, skills development, and volunteering (Japling & Vasileiou, 2015). Educating the public is one of the most important interventions in alerting community members, such as postal workers, grocers, banks, and anyone who would interact with older adults naturally of the risks involved with social isolation (Broome, 2016). Education includes indicators of loneliness to be aware of to identify when someone may need interventions (Broome, 2016). This not only helps in identifying needs, but also naturally assists communities to return to a culture of connectedness. Though the UK' s Campaign includes a focus on identifying isolation risk, there continues to be a gap in connecting individuals to appropriate services and they continue to research a means for standardized screening (McDaid et al, 2018). Suggestions have been made for screening in medical clinics, but this has not been successfully implemented (Broome, 2016). Additionally, the campaign comes up with interventions, without the participation of organizations, and then recruits organizations to implement them. Connect2Eff ect. AARP has created an online platform to provide education about social isolation for older adults (AARP Foundation, 2019). The platform provides information about social isolation and its effects, inspirational stories of innovations put into practice, a data base for searching possible programs in a given community, and a self-administered screening tool to determine your own level of risk or the risk for someone you know (AARP Foundation, 2019). AARP has invested in research and continues to pilot programs to fight isolation (AARP Foundation, 2019). Similar to the UK' s Campaign, these programs are developed and then offered to communities to initiate. It is difficult to establish and maintain an online data base for community programs across the nation for completeness. Current Gaps to Address Social Isolation Campaigns to educate and address social isolation are in process across the globe. COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 19 Though the above-mentioned programs, and others, have been initiated successfully, there continues to be a gap in identifying the highest risk population, and a clear process from referral to intervention plan initiation. Multiple types of programs have been evaluated for their effects on social isolation with positive results (Poscia et al, 2018). Interventions are proven to be successful and are available in most communities. Screens have been developed to assess for social isolation, tested for validity and reliability but have mostly been used in research projects (Taylor, Herbers, Talisman, & Morrow-Howell, 2016). There is a need to utilize screens consistently in practical applications and practice with a process to create individualized intervention plans to address the results (McDaid et al, 2019). To offer interventions, without identifying isolated individuals, will certainly improve the lives of older adults who maintain some level of connection, but will not impact those with the highest risk. Therefore, a full process is required for a multi-level impact with partnerships from multiple agencies, services, and interested community members. There is a need to recognize the importance of addressing social isolation in the like manner physical care needs are, and have a process to intervene. A standardized process is needed to identify hidden isolated older adults, refer them to services for assessment and intervention planning, and provide case management. This is a multi-layer problem and requires a multi-layer solution. Innovation This innovation is a non-profit organization, Walla Walla Coalition to Fight Isolation (WWCFI), created to lead an innovative collective impact initiative addressing social isolation for older adults. (See Appendix A & B for incorporation documents). Collective impact theory was first labeled as such by the Foundation Strategy Group in 2011 with the suggestion that when businesses combine efforts rather than continue in individual silos, greater success is COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 20 established (Edmondson, & Zimpher, 2014). It provides a catalyst for complicated multi-level changes, with participation from multi-level agencies, services and community members (Edmondson, & Zimpher, 2014). Collective impact utilizes a backbone organization to lead, guide, and manage the impact, and encourage partners to maintain momentum with participation in strategic activities. Collective impact theory suggests five conditions to ensure success in large scale community change; 1) a common agenda 2) shared measurement outcomes 3) reinforcing activities 4) good communication between partners, and 5) leadership from a backbone organization to coordinate the efforts (Hanleybrown, Kania, & Kramer, 2012). Following this theory, WWCFI, as the backbone organization, will lead and mobilize community partners, provide encouragement, ensure effective communication between partners, and complete back stage activities to maintain the movement. Collective impact is different than a collaboration creating a means for the community to work on an identified shared goal together (Prange et al, 2016). Collaborations usually involve agencies working individually toward addressing the identified problem, while creating individual goals, maintaining individual data, measurements, and strategies (Prange et al, 2016). Each individually work toward addressing the problem, within their current processes. Collective impact mobilizes identification of a shared goal with shared measurements collected in a shared data system and together identify the strategic activities to meet this goal (De Chiara, 2017). Additionally, collective impact partners with community members who may not traditionally be involved in the stated goal, including the program beneficiaries (De Chiara, 2017). In this way, it COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION becomes a community project, organized and lead by an established infrastructure to keep it gomg. 21 In formulating the prototype, WWCFI's Executive Director led key stakeholders and community members to define a shared agenda. (See Appendix C for Coalition meeting minutes). The goal is to subvert the norm, holding practices in place that provide for assessment and service delivery for nutrition, transportation, personal care needs, and even caregiver support, but fail to address social isolation for older adults. Though the Older American' s Act mentions social needs, it only designates dollars and time to meeting physical needs. Social needs are expected to be met with volunteers and fundraising efforts (Older American' s Act of 1965). Research supports interventions for social isolation will affect many concerns for older adults and may decrease costs (Broome, 2016). Collective Impact allows participating agencies and services to focus on the activities of service delivery while the backbone organization provides the infrastructure to lead change. Activities, identified by the partners, are implemented quickly, studied for effects, and adjusted to provide the highest impact (Edmondson, 2014). Partnerships are created with current agencies, services, and community members to not only collaborate together, but create together. It builds from the current services and expertise already in place, augmented toward a shared agenda (Edmondson, 2014). Value Proposition of Innovation Current initiatives to address social isolation either address only one aspect of social isolation, or recruit organizations or individuals to implement one aspect of problem resolution. There has not been a program created to address social isolation in partnership with those who will implement and use the program at multi-levels simultaneously. There is not an initiative in COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 22 place addressing social isolation for older adults using human centered design practices of rapid prototyping, allowing for quick discovery of workable practices. Collective impact provides the means to simultaneously impact a solution at multiple layers while initiating rapid prototyping at each of those layers (Brown, Rizzuto, & Singh, 2019). Collective impact has been used in the business world to increase profits as well as social gains. Many businesses have recognized when there is collaboration, all those involved receive benefits and revenue is increased. Advancing toward this effort, businesses have become the backbone organization leading and managing change. The Women's Business Enterprise South celebrated 25 years of collective impact this year lauding increased revenue for women business owners (Metairie, 2019). Mars Inc, the well-known maker of America' s favorite chocolate candies, applied collective impact to save their industry (Knez, 2016). When cocoa farming yields stagnated, Mars knew something innovative needed to be done in order to maintain their profits and launched Sustainable Cocoa Initiative to mutually promote the farmers, their communities, and the chocolate sales (Knez, 2016). Proctor & Gamble has partnered with communities and non-profit organizations for many years in order to create sustainable change while increasing their sales and brand (Luca, 2016). Within the business world successful companies have stepped outside of their silos to partner with communities and strengthened their sales along the way (Neilson, & McKenzie, 2106). They have proven collective impact creates sustainability for all partners involved. Collective Impact has been applied successfully to several social problems with one of the largest collective impacts led by StriveTogether in Cincinnati. StriveTogether has changed the educational system in Cincinnati to increase the success of their children from cradle to career and continues to implement improvements (Edmondson, & Zimpher, 2014). They have COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 23 been able to scale their initiative across the country, assisting many communities and states to apply this approach (Edmondson, & Zimpher, 2014). They have proven the effectiveness of collective impact for social change. Though, other collective impact movements have been applied to other social issues on a smaller scale, this process has not been used to address older adults, social isolation, or in implementation of a full-scale process at one time. StriveTogether solutions are applied to children and school systems and will follow the child as they advance in the school in a continuum of care (Edmondson, & Zimpher, 2014). WWCFI plans to create a full-scale process that will be implemented for each individual older adult simultaneously, not over several years, to be continued for long-term change. This innovation is to be implemented in Walla Walla, Washington, a small rural town in Southeastern Washington, with a population of 32,800 in Walla Walla proper and 60,600 in the county (USCB, 2017). It is estimated 18% are 65 or older (USCB, 2017). Walla Walla is rich in resources for the size of the community, but no one is currently asking questions and assessing for social isolation, though all interested parties indicate this is a need. Additionally, many of the seniors living alone are unaware of these opportunities. AL TC staff report most of their referrals are received to intervene for a crisis, but feel great impact can be made if they were to receive referrals earlier (personal communication, August 21, 2018). There is a great need to identify the hidden isolated, educate them on the availability of services, and work with them to overcome the barriers they face to participate in interventions before a crisis occurs. Theory of Change; Climbing the Mountain WWCFI will form the bridge between community members and services to enhance service delivery as well as provide mobilization for change to continue. Walla Walla is a tight knit community and often works on projects in collaboration, but has never utilized collective COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 24 impact. One example was an initiative to create a Gate Keeper Program. Community partners met together monthly to collaborate for this problem and each organization identified their activities to contribute to the solution. The program was initiated successfully, but gradually failed. Though the project died, it is still talked about as a great idea. However, it failed because it lacked a leader, clear pathway, and the road map to guide the direction. WWCFI, as the backbone organization leading collective impact, will provide the necessary management to assure the initiative continues to be a success. Eradicating social isolation is a monumental task, likened to climbing a mountain, with multiple layers, variances in terrain, and barriers to overcome along the way. (See Appendix D for theory of change visual). WWCFI will act as the trail guide to provide the leadership, direction, and encouragement to find answers to overcome barriers experienced along the way. WWCFI will lead community partners through a strategic process that begins with establishing trust relationships and evolves into co-creation of processes. Providing the additional layer of shared measurements in a shared data system will enable partners to identify effective change activities, adjust the less successful activities, and continue to gain momentum for advancing to the next level. WWCFI will provide partners with effective communication that will enable full knowledge of the advancement of strategic activities, shifts in planning, and analysis of the data collected. (See Appendix E for Communication Plan). This will allow partners to create more effective road maps as the process identifies better pathways to follow. Climbing upward through the process of collective impact will enable small victories which will lead to larger victories, eventually leading to the ability to impact national changes with established evidence of success. Utilizing WWCFI as a backbone organization to provide the administrative activities will build the bridges between community partners, service delivery, and hidden isolated older adults. COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 25 When communities are continually educated about the problems, the goals, and the identified strategic activities, momentum is not lost. WWCFI will be able to continue to recruit new partners, enabling advancement of activities and growth of the movement to occur. WWCFI will be able to provide evidence of barriers and successes, that will establish direction for advancement. Data analysis will provide the means to identify areas where pivots in strategic activities need to occur for greater success. Enthusiasm and commitment to the movement will be cemented as collective data shows progress and the positive effects experienced in the lives of older adults. Implementation Plan Following collective impact theory, WWCFI will lead the community through five stages; 1) Evaluate readiness for change, 2) Establishing committed partnerships, 3) Establish partnership foundations, 4) Initiate strategic activities, and 5) Sustainment and scale. (Kania, 2013). (See Appendix F for Process Plan). In stages one and two, the initial prototype was established to test the community' s readiness to initiate collective impact. (See Appendices A, B, C, & G for prototype packet). This included evaluation of key stakeholder's perceptions of the level of urgency, their commitments to the process, and their perceptions of the expertise and trust in the Executive Director to lead. It was important to identify influential champions who were willing to assist in leading the movement and recruitment of additional partners in order to establish an environment conducive to readiness for large scale, multi-level change. COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 26 Evaluate Readiness for Change and Establish Committed Partners Key stakeholders, essential to the success of a collective impact movement for older adults, were identified as AL TC, The Center at the Park (Senior Center), CHD, and a local primary medical provider. ALTC is the Area Agency on Aging, Seniors and Disabilities Resource Center for Walla Walla and four other surrounding counties. They are the first line referral agency for issues with older adults. Within their practice, they conduct an intake assessment for all referrals received. ALTC then connects individuals to appropriate services and agencies, or when eligible, provides services within their agency. Their current practices do not include assessment of social networks or assistance to establish social connections. The Center at the Park, is the local senior center who provides most of the centralized programming for older adults. This includes the nutrition programs, Home Delivered and Senior Round Table Meals. They also offer classes, entertainment, Adult Day Health, and a clubhouse environment for seniors. Their service area includes the five counties AL TC serves. Most of the individuals who utilize their programs are already active, or low to moderate risk of social isolation. The CHD prevention specialist leads in community education addressing the most pertinent health issues as designated by CDC. The CHD promotes best practices to maintain whole health outcomes for individuals within the county and spearheads several community health fairs and forums as part of their educational campaigns. Though social isolation contributes to suicides and opioid use, CHD does not currently address this concern. Medical practitioners are a vital part of any issues centered around older adults. It is therefore necessary to include the medical community when addressing these issues. A local physician whose practice comprises mostly of older adults was recruited with the support of the COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 27 clinic manager. Emotional health outcomes are included in the whole health outcome reports and medical providers are required to reach established standards. Social isolation impacts these standards, but social networks are not consistently assessed or discussed beyond emergency contacts. Individual interviews were completed to establish the level of commitment and vision for involvement from each of the identified key stakeholders. Group meetings, with all interested partners, were then held to identify the level of commitment to working together toward stated shared agendas and the collective urgency was established. Key stakeholders worked together to first choose a name, finalize a mission and vision statement, and practice the skill of formulating shared decisions (See Appendix C for Coalition meeting minutes). Through the process of recruitment, the expertise and leadership ability of the Executive Director was established. Each of the key stakeholders offered their commitment to the agenda and vested their trust in the Executive Director to lead. The process to incorporate as a non-profit organization was started with recruitment of the initial Board of Directors. Board of Directors were chosen carefully to be established champions for the initiative as well as possess crucial skills. The President of the Board has extensive experience in leading non-profit organizations and fundraising. The Treasurer has extensive knowledge of social programs and experience in maintaining beneficiaries at the center of programing. The Secretary has experience working within communication and the medical profession. Each board member has extensive community network and social equity. The board met regularly to make strategic decisions regarding the initial infrastructure and WWCFI bylaws were written. (See Appendix G for Board meeting minutes). While the board worked on the bylaws and incorporation process, Executive Director led key stakeholders COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 28 to brainstorm and identify shared goals as well as possible strategic activities necessary to work toward stated goals. Together, key stakeholders chartered a pilot program to test the process. (See Appendix H - L for pilot plan). Key stakeholders established their commitment, identified an initial screening and referral process, and began a 3-month test period. Goals and metrics were established to evaluate the success of the process as well as the impact on the older adults served. The pilot increased the level of commitment from key stakeholders, initiating a recruitment of additional stakeholders, cemented trust in the shared data collection process, and generated a heightened sense of urgency. (See Appendix M for pilot summary). The participating partners now express a sense of ownership in the movement, excitement for the process, and a heightened level of urgency has been identified. Preparation for Impact, Establish Foundations Having worked through the first stages in the collective impact theory, evaluate readiness for change and establish committed partnerships, the third stage, establish foundation, was started. WWCFI has been incorporated as a non-profit organization with an acting Board of Directors. With the establishment as a non-profit organization funding can now be secured and in preparation a line item budget was developed. (See Appendix N for line item budget). It was determined the government fiscal year will be used to be in alignment with governmental agencies who are key partners. The budget has been established showing the largest expenses as personnel $154k, statistician consultation $13k, and technology for statistical analysis $5k. Personnel expenses have been offset by in-kind donations of volunteer time from college students totaling $36k. A local printing business has offered their resources for marketing and printed materials with a total value of $2.4k and utilizing a partnership with university statistics COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 29 department will offset the expenses of statistician consultant. Other significant expenses will be for business startup and other consultants. However, utilizing consultants will provide an overall savings in salaries which includes cementing the partnership with a university statistics department to assist with data analysis and reporting. Fundraising efforts will include grant writing, obtaining corporate support from local businesses, and community donations. Continuing in foundational activities, partners will be guided to identify strategic activities which will move the needle forward to goal attainment. A shared data collection and infrastructure, with the ability to sustain growth, will be established. Community engagement will become a focus in this stage, as public will and commitment are formulated. Finally, this stage will cement the shared metrics for data collection and program evaluation to include an initial community survey establishing a baseline of knowledge about and participation in social isolation activities. (See Appendix O for Community survey). Metrics which will be utilized will include screens and data currently collected in the natural process of care for older adults. These metrics were determined and used for the pilot. (See Appendix J - L for screens). This includes the screens AL TC completes in their intake assessments and health outcome measures collected from medical providers. The qualitative interview to assess the ease of the process and effectiveness from the perspective of the beneficiaries will also continue to be used. (See Appendix I for qualitative interview). Strategic Activities Stage four is where the meat of the program is instituted. In this stage the strategic activities will be implemented, there will be continued recruitment of additional partners, and ongoing program evaluations with data collection and analysis will begin. The screening tools will be utilized for pre- and post-intervention metrics as will the social isolation screen. Health COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 30 outcome measures will be collected as a natural process of utilization of medical services to show before and after metrics. The community survey will be repeated to obtain levels of change in community knowledge and involvement. (See appendix O for community survey). The qualitative interview with beneficiaries and partners will be conducted at intervals for ongoing assessment of processes as well as impact on social isolation. There will be continued expansion of the original pilot, recruiting additional physicians as well as clinics in the process. Congruently, non-traditional partners will be brought into the process to find innovative ways toward goal achievement. An example is a partnership with a local grocery store to provide training for their clerks in the signs of isolation and what to do when this is noted. WWCFI will continue to collect the agreed upon measures and analyze the data to identify where more work needs to be done and where the successes are. Quick prototyping with the ability to make adjustments will provide further encouragement to continue on the pathway. This process of analysis and amendments will continue until partners are satisfied with the practice processes to be introduced as best practices. This will include extending to a second clinic who provides care to the largest Hispanic population. This will encourage partnerships within this subgroup, ensuring diversification of the project is obtained. This will further enable evaluation of the diversification in current programs available in the community and where program development for multiple cultures needs to occur. Public education will also be an important activity continued in this stage. This will include a marketing and training campaign, in partnership with the CHD, to assure wide community knowledge is obtained. Strategic activities will be led to include written information, speaking engagements and workshops as well as engaging the community at local festivals. COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 31 Social media will be utilized with the development of a website, Face book page, and blog. These will be used to provide additional information, maintain communication, and generate ongoing support. In partnership with local universities and the CHD, trainings will be provided to other interested parties in the community. Trainings will provide information about social isolation, how to recognize it, and the strategic activities identified by partners. Community education will enable the entire community to participate in the efforts and continue in sustainment. Sustainment & Scale The important activities leading to sustainment include community education, taking advantage of the social equity for each committed partner, and the continual efforts of evaluation and necessary practice process amendments identified by the partnership. Utilizing a shared data system will enable real evaluation for the shared goals in each activity being conducted. This allows for the emergence of solutions identified by those who are providing as well as receiving them. Part of the value of a collective impact is that a collection of interested parties continually assesses the issues from multiple lenses while working toward the shared goal (Kania & Kramer, 2013). This enables new resources to be discovered. With the continued process loop of implementation, evaluation, and amendments, new learning is made available. This also provides a strong sense of ownership in the goals as well as the outcomes to coalition partners including interested community members and beneficiaries (Brown, 2019). Because WWCFI will be managing and communicating the results of data analysis, ongoing adjustment to activities, and community education, while service delivery continues, momentum toward established agendas will be maintained. Built into this innovation is the continual expansion to new partners and communities. AL TC and the Senior Center are identified as key partners who have established their COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 32 commitment to this initiative, and play integral roles in the process. They also serve five counties providing the opportunity for changes in their agency practices to naturally expand to multiple communities within their service areas. Once standardized practice processes have been identified, tested for effectiveness, and initiated in multiple communities, there will be opportunity to advocate for state adoption of the processes as new evidence-based practices. WWCFI will continue to partner with communities to lobby for state policy development and initiation. Washington state has often been a leader in addressing social needs and there is anticipation this practice will continue (Patty Murray, 2019). Evidence from the effects of this process in Washington State can then be used to lobby for federal support to assess for and meet social isolation needs across the nation. A long-term goal is for federal policy to be in place that will ensure opportunity for every isolated individual in the nation to be identified and given intervention options as they are connected to available resources. Once the Older American' s Act is expanded to further address social isolation for older adults, all Americans will have opportunity to meet this need. Potential Barriers and Facilitators Potential barriers to implementing this innovation include funding challenges, adequate community support, participation of older adults, and the lack of government policy or funding for meeting social needs. (See appendix P for EPIS chart). However, given the current community context for this innovation, these barriers can be overcome with a focus on identified facilitators. Studies indicate, collective impact model has shown the best results for large scale, sustainable change, using a backbone organization to coordinate community partnerships working toward a shared goal (Hanleybrown et al, 2012). Philanthropy organizations, who have expressed an interest in supporting programs to eradicate social isolation, will have the evidence COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION demonstrating the high-level potential of return on investment for this project. Given the supportive research as well as the alignment this project has with the efforts of Walla Walla towards the Blue Zone Initiative (Buettner, & Skemp, 2016), a community project to increase health and longevity, large local community funding toward this effort can also be obtained. 33 Champions have been established with a local physician and medical clinic manager who have already begun to utilize their networking to recruit additional medical community support toward this effort. Other champions have been established with key community members including, Emergency Response, Police Department, banks and grocery stores. Commitments have been received from partnering government funded agencies who recognize the identified need and express a high readiness for change. Working in a community effort, there is great support to fully initiate this process and eventually lead to a change in government policy. The level of influence and perceived expertise of the Executive Director and Board of Directors have been confirmed, cementing commitment for long-term participation in collective impact initiative. For many older adults the concept of planning interventions to build connections will be new and there may be resistance to the efforts (Waycott et al, 2016). However, in the pilot, initial findings indicate large number of those offered assistance in formulating an intervention plan and addressing barriers, accepted help. To decrease resistance, the variety of intervention opportunities currently available will be offered to include community programs, support groups, clubs or classes in varying interests, and visitations or phone calls allowing the recipient to remain at home while still receiving new connections. The political climate, along with the evidence of the urgency for this issue, has established the interest in government policy change (US Senate, 2018). Washington State COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 34 Senator, Patty Murray, has expressed interest in expanding the Older American's Act to more fully address social needs for older adults (Patty Murray, 2019). Because of her commitment, she has appointed a team to work on this issue through the Health, Education, Labor, & Pensions committee. As the Ranking Member of this committee, she is in a place to influence real changes in this realm (US Senate, 2019). Providing evidence of effective programing that enhances the lives of older adults at a lower cost than medical services will give the committee the ammunition needed to effect change at government levels. In so doing the government focus can be shifted to recognize the importance of social needs and decrease the negative impacts isolation has on individuals and the economy. Conclusion The Grand Challenges have called for the need to identify the isolated, provide effective interventions, and work toward policy change to ensure these measures are sustained (Brown et al, 2016). There has been an identified need for a multi-level change to occur for social isolation to be eradicated. To effectively address social isolation for older adults a multi-level solution must be implemented which will simultaneously provide solutions to each of these elements. This requires an innovation which can be effective for large-scale, multi-level change. Collective impact has been used successfully by thriving companies to boost their profits. It has been shown to be effective in application of a continuum of change. Collective impact can be applied successfully to this wicked problem, creating a simultaneous full-scale process of intervention and change which will subvert the current norms and raise social isolation as a crucial piece for individual wellbeing. WWCFI has been created, established with influential board members and Executive Director to lead this innovative movement, as the backbone organization. Key stakeholders have been identified and offered their commitment to WWCFI and the collective COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 35 impact process. 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Social isolation in America: Changes in core discussion networks over two decades. American Sociological Review, 71(3), 353-375. Retrieved from http://www.jstor.org.libproxyl.usc.edu/stable/30038995 Metairie, La. (2019). Women' s Business Enterprise Council South celebrates 25 years of collective impact. Cision PR Newswire, July 19, 2019. Retrieved from https://www.prnewswire.com/news-releases/womens-business-enterprise-council-south celebrates-25-years-of-collective-impact-300887778 .html Neilson, J., & McKenzie, F. (2016). Business-oriented outreach programs for sustainable cocoa production in Indonesia: An institutional innovation. Innovative Markets for Sustainable Agriculture: How Innovations in Market Institutions Encourage Sustainable Agriculture in Developing Countries, 17-35. Older Americans Act of 1965.XML, 42 USC §§330c-d, as amended through PL 114-144, Enacted April 19, 2016. Pantell, Matthew, MD, MS, Rehkopf, David, ScD, MPH, Jutte, Douglas, MD, MPH, Syme, S. L., PhD, Balmes, J., MD, & Adler, N., PhD. (2013). Social isolation: A predictor of mortality comparable to traditional clinical risk factors. American Journal of Public Health, 103(11), 2056-62. Retrieved from http://libproxy.usc.edu/login?url=https://search proquest-com.1ibproxy2.usc.edu/docview/1448190985?accountid=14749 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Parigi, P., & Henson, W. (2014). Social isolation in America. Annual Review of Sociology, 40, 153-171. Patty Murray. (2019) [Website] Retrieved from https:/ /www.murray.senate.gov/public/index.cfm/issues Poscia, A., Stojanovic, J., La Milia, D. I., Duplaga, M., Grysztar, M., Moscato, U., ... Magnavita, N. (2018). Interventions targeting loneliness and social isolation among the older people: An update systematic review. Experimental Gerontology, 102, 133-144. doi:10.1016/j.exger.2017.11.017 Prange, K., Allen, J. A., & Reiter-Palmon, R. (2016). Collective impact versus collaboration: Sides of the same coin OR different phenomenon? Metropolitan Universities, 27(1), 86. 44 Rohde, N., D'Ambrosio, C., Tang, K. K., & Rao, P. (2016). Estimating the mental health effects of social isolation. Applied Research in Quality of Life, 11(3), 853-869. doi: 10.1007/sl 1482- 015-9401-3 Samuel, K., Alkire, S., Zavaleta, D., Mills, C., & Hammock, J. (2018). Social isolation and its relationship to multidimensional poverty. Oxford Development Studies, 46(1), 83-97. Senate (special committee on) aging committee hearing; "aging without community: The consequences of isolation and loneliness": Aging Committee Hearing, U.S. Senate, (Testimony of Lenard Kaye) (2017). Retrieved from https://www.aging.senate.gov/imo/media/doc/SCA_Kaye_04_27 _17.pdf COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Shankar, A., McMunn, A., Demakakos, P., Hamer, M., & Steptoe, A. (2017). Social isolation and loneliness: Prospective associations with functional status in older adults. Health Psychology, 36(2), 179. 45 Smith, P. D., Becker, K., Roberts, L., Walker, J., & Szanton, S. L. (2016). Associations among pain, depression, and functional limitation in low-income, home-dwelling older adults: An analysis of baseline data from CAPABLE. Geriatric Nursing, 37(5), 348-352. Stone, D. M., Simon, T. R., Fowler, K. A., Kegler, S. R., Yuan, K., Holland, K. M., ... Crosby, A. E. (2018). Vital signs: Trends in state suicide Rates-United states, 1999-2016 and circumstances contributing to Suicide-27 states, 2015. Morbidity and Mortality Weekly Report, 67(22), 617. Stone, D. M., Hindman, J., & Mony, N. (2018). Rising suicide rates across the US. CDC News Room. Retrieved from https:/ /www.cdc.gov/media/releases/2018/p0607-suicide prevention.html Taylor, H. 0., Herbers, S., Talisman, S., & Morrow-Howell, N. (2016). Assessing social isolation: Pilot testing different methods. Journal of Gerontological Social Work, 59(3), 228-233. doi:10.1080/01634372.2016.1197354 Taylor, H. 0., Taylor, R. J., Nguyen, A. W., & Chatters, L. (2018). Social isolation, depression, and psychological distress among older adults. Journal of Aging and Health, 30(2), 229- 246. United States Census Bureau. (2018). Older people projected to outnumber childrenfor first time in U S. history. (Report number CB 18-41 ed.) COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 46 U.S. Government Publishing Office. (2018). Aging without community: The consequences of isolation and loneliness: Hearing before the special committee on aging, united states senate, one hundred fifteenth congress, first session, Washington, DC, April 27, 2017 (2018). Washington: U.S. Government Publishing Office. U.S. Senate Committee on Health, Education, Labor & Pensions (2019) Ranking member' s newsroom. [Webpage]. Retrieved from https://www.help.senate.gov/ranking/newsroom Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S., & Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: Systematic review and meta analysis of longitudinal observational studies. Heart, 102(13), 1009-1016. Van Dyke, B., Kim, M., & Thom, B. (2018). Longitudinal relationships between perceived social support and quality-of-life among patients with chronic pain. The Journal of Pain, 19(3), S39. Vespa, J. (2017). Historical living arrangements of older adults: 1967-2016. United States Census Bureau Working Papers. April 2017. Retrieved from https:/ /www.census.gov/library/working-papers/2017/demo/SEHSD-WP2017-30.html Warrell, M. (2018). The rise and rise of suicide: We must remove the stigma of mental illness. Retrieved from http ://www. social worker .com/nonprofit/management/forming-and-running a-coalition/ Waycott, J., Vetere, F., Pedell, S., Morgans, A., Ozanne, E., & Kulik, L. (2016). Not for me: Older adults choosing not to participate in a social isolation intervention. Paper presented at the Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems, 745-757. COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 47 World Health Organization. (2017a). No title. Global Age-Friendly Cities: A Guide.Geneva: WHO; 2007. World Health Organization. (2017b). Mental health of older adults. Fact Sheets, December 12, 2017. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-health-of older-adults World Health Organization. (2018). No title. The Global Network for Age-Friendly Cities and Communities: Looking Back Over the Last Decade, Looking Forward to the Next. Retrieved from https:/ /www.who.int/ ageing/publications/ gnafcc-report-2018/ en/ Yates, J. A., Clare, L., Woods, R. T., & Wales, The Cognitive Function and Ageing Study. (2017). "You've got a friend in me": Can social networks mediate the relationship between mood and MCI? BMC Geriatrics, 17 doi:10.1186/s12877-017-0542-0 Zuelsdorff, M. L., Koscik, R. L., Okonkwo, 0. C., Peppard, P. E., Hermann, B. P., Sager, M. A., ... Engelman, C. D. (2017). Social support and verbal interaction are differentially associated with cognitive function in midlife and older age. Aging, Neuropsychology, and Cognition, 0(0), 1-17. doi: 10.1080/13825585.2017.1414769 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION @ sns Office of the Secretaiy of state Corporations & Charities Division (360) 72S-03'77 I '""'"°'•'lll'lL&OVlcerps 801 Capitol Way S, 01.ympla, WA ,SSO+-CJ2M D Fling Fee $30 o Fillng Fee with Espedlted Service $80 APPENDIX A ARTICLES OF INCORPORATION Washington Nonprofit Corporation RCW24.03 DoyoualreadyhaveaUBTNumber?(Checlcone) oYos No IfYea,providcUBT# ________ _ lfNo, a new UBI# will be issued to you upon successful completion of 1hCI tiling. Tf)'OII have JINMOllSly filed 'With another slate agen.:y (frlr 111U1111Jl11; !hlS tlcputmc:nt of~ di(; 'Dcpaltri,e1lt afLabor and Tncluwles, or the EmploymenlSecnrityDq)m1mmt), you may alreadybavu 9 digit UB[Niimber1hatyou e:111 mtc: abovc.P1-do DOt cme.dic UBINumb~ofa &:Ile Pmprlelllrshfp (1c aenm..1 PartlWlbip. If yon do IIClthaYe a UBI Nnmber, pJease select ''no· above and COIIUIIII$ with the iiliDJ. NAME OF CORPORATION: Does the entity have a oame reserved? (Cieck OAe) CJ Yes II No If Yes, provide the Name: Reservalion Nwnbcr and Name I!No, provide only the oaine Res«vation Number. _____ _ Name: Walla W1Ih1 Coll.ition to Fight l$olatlon For name reqotnments review the followin& RCW(s): NonprofitBusine&s Corperatiob - Rg»'. :M-~ (tl PURPOSE OF CORPORATION: Puq,ose for which the nonprofit~ organized: ( if nec,eaw:y, attach additional information) to slffliBlhen c:omm.unities by bw1ding connections that will fight social isolation, providing ~c leadetshlp. Any otherprovisiOtl.9: ___________________________ _ PERIOD OF DURATION: Please check .Q!g_ofthe following This Cwpu:ration shall have a perpetual duration (ddiwl1} a This C<nporation shall have a duration of ___ years. c Tlus Coiporatioo shall e:q,ire on _____ _ Art!cles of lncarporatiorl • Nonprofit Pg1 I Rmtlsed?.2018 48 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION REGISTERED AGENT: Is the Registered Agent a Commercial Registered Agent? � Yes !!I No If Yes, provide the name oftbe Commercial Registered Agent: _____________ _ A Commercial Registered Agent is an entity or individual that is registered with the Office of the Secretary of State to receive legal documents on behalf of a corporation. A Commercial Registered Agent has the entities/individual's address on record with the office. A Registered Agent consent Is still required for a Commercial Registered Agent located below. If No, please continue below Please complete ONE type of Registered Agent below, be sure to include the name below the checked box. Then continue to provide the required street address. Mailing address if needed. Individual JanaLcc Wagner D Entity � Office or Position First and last name of a Non~ommcrcial Registered Agent (Any person not registered as a Commercial Registered Agent) Name of a Non=mmercial Registered Agent ( Any business not registered as a Commercial Registered Agent.) List the Office or Position serves as agent. (Only if using the specific office ot position as the registered agent, no matter who holds the position like: Secretary, Member or Treasurer.) Phone: 509-520-2701 Registered Agent Street Address (required) (Must be a physical address No PO Box or PMB) Country: United States Address : 116 S Hussey St State: Washington .lJp: 99362 City: Walla Walla I Email: janalcew@usc.edu Registered Agent Mailing Address (optional) Check If malling address II the same u street address Country: United States State: Washington Address : _______________ _ .lJp: ____ City: _________ _ CONSENT TO SERVE AS REGISTERED AGENT - REQUIRED FOR ALL TYPES I hereby consent to serve as Registered Agent in the State of Washington for the named entity. I understand it will be my responsibility to accept service of process, notices, and demands on behalf of the entity; to forward mail to the entity; and to immediately notify the Office of the Secretary of State ifl resign or change the Registered Office Address. f MIJ2ie d..,-, :i;....i .. ~. Eb 'lj;,..7J,w.,1, ;:::; R~ d Agent Printed Name/Title Date Articles of Incorporation - Nonprofit Pg 2 I Revised 7 .2018 49 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION EFFECTIVE DATE: Please check ONE of the following: � Date of filing Specify a Date 10/01/2019 cannot be more than 90 days following received date INITIAL BOARD OF DIRECTORS: Name and addresses or each Initial director are required, attach additional sheets If necessary. Name: Kirsten Schober City Walla Walla Name: Edward Parker City Walla Walla Name: Cindy Loiacono-Zahl City Walla Walla Address: 1601 Pleasant State WA Zip _99_3_6_2 __ _ Address: 1826 Leonard Dr. State WA Zip _99_3_6_2 __ _ Address: 2930 Plaza Way State WA Zip _99_3_6_2 __ _ INCORPORATOR INFORMATION: Name, address, and signature required. Attach additional sheets irnecessary. This record Is hereby executed under penalties or perjury, and Is, to the best of my knowledge, true and correct. Address: 116 S Hussey St City Walla Walla State WA Zip _99_3_6_2 __ _ J. _ _ ~ ._._ ( \ Janalee Wagner, ED !'""f!P\C::~b.~•~J -------------- -------- 09/27/2019 Signature orE:xecutor/lncorporator Printed Name/fide Date DISTRIBUTION OF ASSETS: In the event of voluntary dissolution, the net assets will be distributed as follows: ( if necessary, attach additional information) to an organization dedicated to similar non-profit purposes which bas established its tax-exempt status pursuant to Section 50l(c) of the Code. RETURN ADDRESS FOR TIBS FILING: (Optio11o/J This address will be sent document( s) regarding this specific filing in addition to document (s) being sent to the Registered Agent's street/mailing address. Attention to: JanaLec Wagner Email: janalee@newpulsccounseling.com Address: 5 W Alder, Suite 315 City Walla Walla Artfcles of Incorporation - Nonprofit Pg 3 I Relllsed 7.2018 State _w_A ___ Zip 99362 50 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIXB Walla Walla Coalition to Fight Isolation Bylaws Article I -Name and Purpose Section I - Name The name of the organization is Walla Walla Coalition to Fight Isolation. Section 2 - Purpose This organization is established within the meaning ofIRS Publication 557 Section 501(c)(3) Organization of the Internal Revenue Code of 1986, as amended (the "Code") or corresponding section of any future federal tax code and shall be operated exclusively for organizing community collective impact to fight social isolation. In addition, this Organization has been formed for the purpose of performing all things incidental to or appropriate in, the foregoing specific and primary purposes as set forth in the attached Articles of Incorporation. However, the Organization shall not, except to insubstantial degree, engage in any activity or the exercise of any powers which are not in furtherance of its primary non-profit purposes. The Organization shall hold and may exercise all such powers as may be conferred upon any non-profit organization by the laws of the State of Washington and as may be necessary or expedient for the administration of the affairs and attainment of the purposes of the Organization. At no time and in no event shall the Organization participate in any activities which have not been permitted to be carried out by an Organization exempt under Section 50 I ( c) of the Internal Revenue Code of 1986 (the "Code"). Article II - Members This Organization has no members. Article III - Dedication of Assets The properties and assets of the Corporation/Organization are irrevocably dedicated to and for non-profit purposes only. No part of the net earnings, properties, or assets of this Corporation/Organization, on dissolution or otherwise, shall inure to the benefit of any person or any member, director, or officer of this Corporation/Organization. On liquidation or dissolution, all remaining properties and assets of the Corporation/Organization shall be distributed and paid over to an organization dedicated to similar non profit purposes which has established its tax-exempt status pursuant to Section 501(c) of the Code. Article IV - Board of Directors Section I - General Powers and Responsibilities The Organization shall be governed by a Board of Directors (the "Board"), which shall have all the rights, powers, privileges and limitations of liability of directors of a non-profit organization under the Non-Profit Corporation Act of Washington. The Board shall establish policies and directives governing business and programs of the Organization and shall delegate to the Executive Director and Organization staff , subject to the provisions of these Bylaws, authority and responsibility to see that the policies and directives are appropriately followed. 51 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Section 2 - Number and Qualifications The Board shall have up to 5, but no fewer than 3, Board members. The number of Board members may be increased beyond 5 members by the atTmnative vote of a two-thirds majority of the then serving Board of Directors. A Board member need not be a resident of the State of Washington. In addition to the regular membership of the Board, representative of such other organizations or individuals as the Board may deem advisable to elect shall be Ex-Officio Board Members, which will have the same rights and obligations, including voting power, as the other directors. Section 3 - Board Compensation The Board shall receive no compensation other than for reasonable expenses. However, provided the compensation structure complies with Sections relating to "Contracts Involving Board Members and/or Officers" as stipulated under these Bylaws, nothing in these Bylaws shall be construed to preclude any Board member from serving the Organization in any other capacity and receiving compensation for services rendered. Section 4 - Board Elections & Terms of Board The Governance committee shall review and submit nominations for renewing and new Board members at the board meeting immediately preceding the beginning of the next fiscal year. Recommendations from the Governance Committee shall be made known to the Board in writing before the meeting. New and renewing Board members shall be approved by a majority of those Board members at a Board meeting at which a quorum is present. All appointments to the Board shall be for a term of 2 years. No person shall serve more than 2 consecutive terms unless a majority of the Board, during the course of a Board meeting at which a quorum is present, votes to appoint a Board member to I additional year. No person shall serve more than 5 consecutive years. After serving the maximum total number of consecutive years on the Board, a member may be eligible for reconsideration as a Board member after I year has passed since the conclusion of such Board member's service. Section 5 - Vacancies A vacancy on the Board of Directors may exist at the occurrence of the following conditions: a) The death, resignation, or removal of any director; b) The declaration by resolution of the Board of a vacancy in the office of a director who has been declared of unsound mind by a final order of court, convicted of a felony, found by final order or judgment of any court to have breached a duty pursuant to the Corporation Code and/or Act of the law dealing with the standards of conduct for a director, or has had unexcused consecutive absences to meetings of the Board of Directors, or a total of 2 unexcused absences of the Board during any one fiscal year; c) An increase in the authorized number of directors; or d) The failure of the directors, at any annual or other meeting of directors at which director(s) are to be elected, to elect the full authorized number of directors. A Board member may be removed, with or without cause, at any duly constituted meeting of the Board, by the affirmative vote of a two-thirds majority of then-serving Board members provided that the director to be removed has been notified in writing in the manner set forth in Article IV - Meetings that such action would be considered at the meeting. 52 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Except as provided in this paragraph, any director may resign effective upon giving written notice to the President of the Board, the Executive Director of the Organization, the secretary of the Board, or the Board of Directors. Unless otherwise specified in the notice, acceptance of such resignation shall take effect upon receipt thereof. If the resignation is specified effective at a future time within the notice, a successor may be designated to take office when the resignation becomes effective. Unless the Attorney General of Washington is first notified, no director may resign when the Organization would then be left without a duly elected director in charge of its affairs. Any vacancy on the Board may be filled by vote of a two-thirds majority of the directors then in office, whether or not the number of directors then in office is less than a quorum or by vote of a sole remaining director. No reduction of the authorized number of directors shall have the effect of removing any director before that director's term of office expires. A Board member elected to fill a vacancy shall be elected for the unexpired term of his or her predecessor in office. Upon completion of the unexpired term, the elected Board member may be elected to serve 2 consecutive, 2-year terms by a majority vote of the current Board. Section 6 - Meetings The Board's regular meetings may be held at such time and place as shall be determined by the Board of Directors. The President of the Board or any 3 regular Board members may call a special meeting of the Board with I days' written notice provided to each member of the Board. The notice shall be served upon each Board member via hand delivery, regular mail, email, or text. The person(s) authorized to call such special meetings of the Board may also establish the place the meeting is to be conducted, so long as it is a reasonable place to hold any special meeting of the Board. Section 7 - Minutes The Secretary of the Board shall be responsible for the recording of all minutes of each and every meeting of the Board in which business shall be transacted in such order as the Board may determine from time to time. However, in the event that the Secretary is unavailable, the President of the Board shall appoint an individual to act as Secretary at the meeting. The Secretary, or the individual appointed to act as Secretary, shall prepare the minutes of the meetings, which shall be delivered to the Organization to be placed in the minute's books. A copy of the minutes shall be delivered to each Board member via either hand delivered, regular mail, or emailed within 30 business days prior to the close of each Board meeting. Section 8 - Action by Written Consent Any action required by law to be taken at a meeting of the Board, or any action that may be taken at a meeting of the Board, may be taken without a meeting if consent in writing setting forth the action so taken shall be signed by all Board members. The number of directors in office must constitute a quorum for an action taken by unanimous written consent. Such consent shall be placed in the minute book of the Organization and shall have the same force and effect as a unanimous vote of the Board taken at an actual meeting. The Board members' written consent may be executed in multiple counterparts or copies, each of which shall be deemed an original for all purposes. In addition, electronic signatures or other electronic "consent click" acknowledgements shall be effective as original signatures. Section 9- Quorum, Voting and Attendance At each meeting of the Board of Directors or Board Committees, the presence of no less than 3 persons, or 50% of the number of current Board members if more than 3, shall constitute a quorum for the transaction of business. If at any time the Board consists of an even number of members and a vote results in a tie, then 53 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION the vote of the President of the Board shall be the deciding vote. The act of the majority of the Board members serving on the Board or Board Committees and present at a meeting in which there is a quorum shall be the act of the Board or Board Committees, unless otherwise provided by the Articles of Incorporation, these Bylaws, or a Jaw specifically requiring otherwise. If a quorum is not present at a meeting, the Board members present may adjourn the meeting from time to time without further notice until a quorum shall be present. However, a Board member shall be considered present at any meeting of the Board or Board Committees if during the meeting he or she is present via telephone or web conferencing with the other Board members participating in the meeting. Each Board member shall only have one vote. Board members shall not be allowed to vote by written proxy. An elected Board Member who has unexcused absences from consecutive regular meetings of the Board during a fiscal year shall be encouraged to reevaluate with the President of the Board, his/her commitment to the Organization. The board may deem a Board member who has consecutive unexcused absences without such a reevaluation with the President to have resigned from the Board. Article V - Officers of the Board Section 1 - Election and Resignation The board shall elect officers of the Organization which shall include a President, Vice President, Secretary, Treasurer, and such other officers as the Board may designate by resolution. The same person may hold any number of offices, except that neither the Secretary nor the Treasure may serve concurrently as the President of the Board. In addition to the duties in accordance with this Article, officers shall conduct all other duties typically pertaining o their offices and other such duties which may be required by law, Articles of Incorporation, or by these bylaws, subject to control of the Board of Directors, and they shall perform any other such additional duties which the Board of Directors may assign to them at their discretion. The officers will be selected by the Board at its annual meeting, and shall serve the needs of the Board, subject to all the rights, if any, of any officer who may be under a contract of employment. Therefore, without any bias or predisposition to the rights of any officer that may be under any contract of employment, any officer may be removed with or without cause by the Board. All officers have the right to resign at any time by providing notice in writing to the President of the Board, Secretary of the Board or Executive Director, without bias or predisposition to all rights, if any, of the Organization under any contract to which said officer is a part thereof. All resignations shall become effective upon the date on which the written notice ofresignation is received or at any time later as may be specified within the resignation; and unless otherwise indicated within the written notice, a stated acceptance of the resignation shall not be required to make the resignation effective. Section 2 - President of the Board It shall be the responsibility of the President of the Board, when present, to preside over all meetings of the Board of directors and Executive Committee. The President of the Board is authorized to execute, in the name of the Organization, any and all contracts or other documents which may be authorized, either generally or specifically, by the Board to be executed by the Organization, except when required by Jaw that the Executive Director's signature must be provided. Section 3 - Vice President of the Board In the absence of the President, or in the event of his/her inability or refusal to act, it shall then be the responsibility of the Vice President to perform all the duties of the President, and in doing so shall have all authority and powers of, and shall be subject to all of the restrictions on, the President. 54 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Section 4 - Secretary of the Board The Secretary, or his/her designee, shall be the custodian of all records and documents of the Organization, which are required to be kept at the principal office of the Organization, and shall act as secretary at all meetings of the Board of Directors, and shall keep the minutes of all such meetings on file in hard copy or electronic format. S/he shall attend to the giving and serving of all notices of the Organization and shall see that the seal of the Organization, if any, is affixed to the all documents, the execution of which on behalf of the Organization under its seal is duly authorized in accordance with the provisions of these bylaws. The Secretary shall be responsible for ensuring the deposit of, or cause to be deposited all money and other valuables as may be designated by the Board of Directors at all times, is authorized to receive, deposit, disburse, and account for all receivables for the Organization. Section 5 - Treasurer of the Board It shall be the responsibility of the Treasurer to review and reconcile all financial transactions and accounts on behalf of the Organization, including accounts of its assets, liabilities, receipts, disbursements, gains, losses, capital, retained earnings, and other matters customarily included in financial statements. Section 6 - Executive Director of the Organization It shall be the responsibility of the Executive Director, in general, to supervise and conduct all activities and operations of the Organization. The Board of Directors may place the Executive Director under a contract of employment where appropriate. The Executive Director shall be empowered to act, speak for, or otherwise represent the Organization between meetings of the Board. The Executive Director shall be responsible for hiring and firing of all personnel. The Executive Director shall disburse, or cause to be disbursed, the funds of the Organization, and shall render to the Treasurer and Board of Directors financial reports and accounting of transactions at each regularly scheduled Board meeting or upon request. The Executive Director shall keep the Board of Directors completely informed, shall freely consult with them in relation to all activities of the Organization. Article VI - Board Committees The board of directors may, by resolution adopted by a majority of the directors then in office, provided that a quorum is present, designate one or more committees to exercise all or a portion of the authority of the Board, to the extent of the powers specifically delegated in the resolution of the board or in these bylaws. Each such committee shall consist of one or more directors, and may also include persons who are not on the Board but whom the directors believe to be reliable and competent to serve at the specific committee. However, committees exercising any authority of the Board of Directors may not have any non director members. The Board may designate one or more alternative members of any committee who may replace any absent member at any meeting of the committee. The appointment of members or alternate members of a committee requires the vote of a majority of the directors then in office, provided that a quorum is present. The Board of Directors may also designate one or more advisory committees that do not have the authority of the Board. However, no committee, regardless of Board resolution, may: a) Approve of any action that, pursuant to applicable Law, would also require the affirmative vote of the members of the board if this were a membership vote. b) Fill vacancies on, or remove the members of, the Board of Directors or any committee that has authority of the Board. c) Fix compensation of the directors serving on the Board or on any committee. d) Amend or repeal the Articles of Incorporation or bylaws or adopt new bylaws. e) Amend or repeal any resolution of the Board of Directors that by its express terms is not so amendable or repeal able. 55 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION f) Appoint any other committees of the Board of Directors or their members. g) Approve a plan of merger, consolidation, voluntary dissolution, bankruptcy, or reorganization; o a plan for the sale, lease, or exchange ofall or considerably all of the property and assets of the Organization otherwise than in the usual and regular course of its business; or revoke any such plan. h) Approve any self-dealing transaction, except as provided pursuant to law i) Unless otherwise authorized by the Board of Directors, no committee shall compel the Organization in a contract or agreement or expend Organization funds. Meetings and actions of all committees shall be governed by, and held and taken in accordance with, the provisions of Article IV - Board of Directors, of these bylaws concerning meetings and actions of the directors with such changes in the context of those bylaws as are necessary to substitute the committee and its members of the Board of Directors and its members, except that the time for regular meetings of committees may be determined either by resolution of the Board of Directors or by resolution of the committee. Special meetings of committees may also be called by resolution of the Board of Directors. Notice of special meetings of committees shall also be given to any and all alternate members, who shall have the right to attend all meetings of the committee. Minutes shall be kept of each meeting of any committee and shall be filed with the Organization records. The Board of Directors may adopt rules not consistent with the provisions of these bylaws for the governance of any committee. Article VII - Standard of Care Section I - General In the performance of the duties of a director, a director shall be entitled to rely on information, opinions, reports, or statements, including financial statements and other financial data, in each case prepared or presented by: a) One or more officers or employees of the Organization whom the director deems to be reliable and competent in the matters presented; b) Counsel, independent accountants, or other persons, as to the matters which the director deems to be within such person's professional or expert competence; or c) A committee of the board upon which the director does not serve as to matters within its designated authority, which committee the director deems to merit confidence, so long as in any such case the director acts in good faith, after reasonable inquiry when the need may be indicated by the circumstances, and without knowledge that would cause such reliance to be unwarranted. Except as herein provided in Article VII - Standard of Care, any person who performs the duties of a director in accordance with the above shall have no liability based upon any failure or alleged failure to discharge that person's obligations as a director, including, without limitation of the following, any actions or omissions which exceed or defeat a public or charitable purpose to which the Organization, or assets held by it, are dedicated. Section 2 - Loans The Organization shall not make any loan of money or property to, or guarantee the obligation of, any director or officer, unless approved by the Washington Attorney General; provided, however, that the Organization may advance money to a director or officer of the Organization or any subsidiary for expenses reasonably anticipated to be incurred in the performance of the duties of such officer or director so long as such individual would be entitled to be reimbursed for such expenses absent that advance. 56 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Section 3 - Conflict oflnterest The pwpose of the Conflict of interest policy is to protect the Organization's interest when it is contemplating entering into a transaction or arrangement that might benefit the private interest of one of its officers or directors, or that might otherwise result in a possible excess benefit transaction. This policy is intended to supplement but not replace any applicable state and federal laws governing conflict of interest applicable to nonprofit and charitable organizations and is not intended as an exclusive statement of responsibilities. I) Restriction on Interested Directors Not more than 1% (percent) of the persons serving on the Board of Directors at any time may be interested persons. An interested person is ( I) any person currently being compensated by the Organization for services rendered to it within the previous twelve ( 12) months, whether as a full-time or part-time employee, independent contractor, or otherwise, excluding any reasonable compensation paid to a director; and (2) any brother, sister, parent, ancestor, descendent, spouse, brother-in-law, sister-in-law, mother-in law, or father-in-law, or any equivalent of any such person. However, any violation of the provisions of this section shall not affect the validity or enforceability of any transaction entered into by the interested person. 2) Duty to disclose In connection with any actual or possible conflict of interest, an interested person must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors who are considering the proposed transaction or arrangement. 3) Establishing a Conflict of Interest After the disclosure of the financial interest and all material facts, and after any discussion with the interested person, the interested person shall leave the Board meeting while the potential conflict of interest is discussed and voted upon. The remaining Board members shall decide if a conflict of interest exists. 4) Addressing a Conflict of Interest In the event that the Board should establish that a proposed transaction or arrangement establishes a conflict of interest, the Board shall then proceed with the following actions: a) Any interested person may render a request or report at the Board meeting, but upon completion of said request or report the individual shall be excused while the Board discusses the information and/or material presented and then votes on the transaction or arrangement proposed involving the possible conflict of interest. b) The President of the Board shall if deemed necessary and appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. c) After exercising due diligence, the Board shall determine whether the Organization can obtain with reasonable efforts a more advantageous transaction or arrangement from a person or entity that would not give rise to a conflict of interest. d) If a more advantageous transaction or arrangement is not reasonably possible under circumstances not producing a conflict of interest, the Board shall determine by a majority vote of the disinterested directors whether the transaction or arrangement is in the best interest of the Organization, for its own benefit, and whether it is fair and reasonable. It shall make its decision as to whether to enter into the transaction arrangement in conformity with this determination. 5) Violation of Conflict oflnterest Policy Should the Board have reasonable cause to believe an interested person has failed to disclose actual or possible conflicts of interest, the Board shall then inform the interested person of the basis for such belief and afford the interested person an opportunity to explain the alleged failure to disclose. If, after hearing the interested person's explanation, and after making further investigation as may be warranted in consideration of the circumstances of the Board determines the interested person intentionally 57 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION failed to disclose an actual or possible conflict of interest, it shall take appropriate disciplinary and/or corrective action. 6) Procedures and Records All minutes of the Board meetings, when applicable, shall contain the following information: a) The names of all the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the Board's decision as to whether a conflict of interest in fact existed. b) The names of the persons who were present for discussions and any votes relating to the transaction or arrangement, the content of the discussions, including any alternatives to the proposed transaction or arrangement, and a record of any vote taken in connection with the proceedings. 7) Acknowledgement of Conflict of Interest Policy Each director, principal officer, and member of a committee with Board delegated powers shall be required to sign a statement which affirms that such person: a) Has received a copy of the conflict of interest policy; b) Has read and understands the policy; c) Has agreed to comply with the policy; and d) Understands the Organization is charitable, and in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. Section 4 - Indemnification To the fullest extent permitted by law, the Organization shall indemnify its "agents," as described by law, including its directors, officers, employees and volunteers, and including persons formerly occupying any such position, and their heirs, executors and administrators, against all expenses, judgments, fines, settlements, and other amounts actually and reasonably incurred by them in connection with any "proceeding," and including any action by or in the right of the Organization, by reason of the fact that the person is or was a person as described in the Non-Profit Corporation Act. Such right of indemnification shall not be deemed exclusive of any other right to which such persons may be entitled apart from this Article. To the fullest extent permitted by law, and, except as otherwise determined by the Board in a specific instance, expenses incurred by a person seeking indemnification in defending any "proceeding" shall be advanced by the Organization of an undertaking by or on behalf of that person to repay such amount unless it is ultimately determined that the person is entitled to be indemnified by the Organization for those expenses. The Organization shall have the power to purchase and maintain insurance on behalf of any agent of the Organization, to the fullest extent permitted by law, against any liability asserted against or insured by the agent in such capacity or arising out of the agent's status as such, or to give other indemnification to the extent permitted by law. Article VIII - Execution of Corporate Instruments Section 1- Loans and Contracts 58 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION No loans or advances shall be contracted on behalf of the Organization and no note or other evidence of indebtedness shall be issued in its name unless and except as the specific transaction is authorized by the Board of Directors. Without the express and specific authorization of the Board, no officer or other agent of the Organization may enter into any contract or execute and deliver any instrument in the name of and on behalf of the Organization. Section 2 - Execution of Corporate Instruments The Board of Directors may, at its discretion, determine the method and designate the signatory officer of officers, or other person or persons, to execute any corporate instrument or document, or to sign the corporate name without limitation, except when otherwise provided by law, and such execution or signature shall be binding upon the Organization. Unless otherwise specifically determined by the Board of Directors or otherwise required by law, formal contracts of the Organization, promissory notes, deeds of trust, mortgages, other evidences of indebtedness of the Organization, other organization instruments or documents, memberships in other organizations, and certificates of shares of stock owned by the Organization shall be executed, signed, and/or endorsed by the President, Vice President, or Executive Director. All checks and drafts drawn on banks or other depositories on funds to the credit of the Organization, or in special accounts of the Organization, shall be signed by the President, Vice President, or Executive Director. Article IX - Records and Reports Section l - Maintenance and Inspection Records and Reports The Organization shall keep at its principal agent's address, as well as accessible via electronic cloud, the original or a copy of its a) Articles of Incorporation and bylaws as amended to date which shall be open to inspection by the directors at all reasonable times during office hours. b) Federal tax exemption application and its annual information returns, which shall be open to public inspection and copying to the extent required by law. Section 2 - Maintenance and Inspection of Other Organization Records The Organization shall keep adequate and correct books and records of accounts and written minutes of the proceedings of the Board and committees of the Board. All such records shall be kept in any form capable of being converted into written, typed, or printed form. Upon leaving office, each officer, employee, or agent of the Organization shall turn over to his or her successor or the President of the Board or Executive Director, in good order, such organization monies, books, records, minutes, lists, documents, contracts or other property of the Organization as have been in the custody of such officer, employee, or agent during his or her term of office. Every Board member shall have the absolute right at any reasonable time to inspect all books, records, and documents, as allowed by law, physical properties of the Organization and each of its subsidiary organizations The inspection may be made in person or by an agent or attorney, and shall include the right to copy and make extracts of documents. Section 3 - Preparation of Annual Financial Statements 59 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION The Organization shall prepare annual financial statements using generally accepted accounting principles. The Organization shall make these financial statements available to the Washington Attorney General and members of the public for inspection no later than 60 days after the close of the fiscal year to which the statements related Section 4 - Reports The Executive Director shall ensure an annual report is sent to all Board directors within 60 days after the end of the fiscal year of the Organization, which shall contain the following information: a) The assets and liabilities, including trust funds, of this Organiation at the end of the fiscal year. b) The principal changes in assets and liabilities, including trust funds, during the fiscal year. c) The expenses or disbursements of the Organization for both general and restricted purposes during the fiscal year. d) The information required by Non-Profit Corporation Act concerning certain self-dealing transactions involving more than $S0,000 or indemnifications involving more than $10,000 which took place during the fiscal year. Article X - Fiscal Year The fiscal year for this Organization shall end on September 30 Article XI - Amendments and Revisions These bylaws may be adopted, amended, or repealed by the vote of a two-thirds majority of the directors then in office. Such action is authorized only at a duly called and held meeting of the Board of Directors for which written notice of such meeting, setting forth the proposed bylaw revisions with explanations therefore, is given in accordance with these bylaws. If any provision of these bylaws requires the vote of a larger portion of the Board than is otherwise required by law, that provision may not be altered, amended or repealed by that greater vote. Article XII - Construction and Definitions Unless the context otherwise requires, the general provisions, rules of construction, and definitions contained in the Non-Profit Corporation Act as amended from time to time shall govern the construction of these bylaws. Without limiting the generality of the foregoing, the masculine gender includes the feminine and neuter, the singular number includes the plural and the plural number includes the singular, and the term "person" includes an Organization as well as a natural person. If any competent court of law shall deem any portion of these bylaws invalid or inopemive, then so far as is reasonable and possible (i) the remainder of these bylaws shall be considered valid and operative, and (ii) effect shall be given to the intent manifested by the portion deemed invalid or inoperative. CERTIFICATE OF SECRETARY I, a IN•)~ L. iac i IQ - Pl .. , • certify that I am the current elected and acting Secretary of the benefit Organization, ant µ above bylaws are the bylaws of this Organization as adopted by the Board of Directors on 9 ? q • and that they have not been amended or modified since the above. EXECUTED on this day of ~\_ pi-t ill L_, Washington. , in the County of Walla Walla in the State of 60 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 61 APPENDIXC Meeting Agenda, Feb. 1, 2019 � Why we are here & Introductions: Provide name, agency, interest, and how you want to contribute. AL TC - Regional Director. Many times, referrals are made when there is a crisis. Would like to find a way to receive referrals before the crisis. Intake specialists can do more to assess social connections and direct for interventions. Senior Center - President of the Board. This is a big need. Excited to be a part of this. We have worked together well in the past, but having someone leading from the outside will really help keep us going. The Senior Center wants to be involved any way we can help. We want to build programming to meet the needs of seniors. County Health - Intervention and Prevention Specialist. Working with the opioid and suicide crisis. This really relates to these. Suicide rates in Walla Walla for older adults has really increased and it is scary. We want to help any way we can. Senior Center - Board member, public relations. I want to see how we can work together to make our programs stronger. We can do campaigns together so more people get the word. WW Police - Elder Outreach. We need a good referral system that everyone knows about. I don't always know who to turn to when I am called in to help a senior. Isolation is a big issue that is increasing elder abuse. If we train the police for what to look for and then what to do, it could help. Ombudsman - Ombudsman volunteer. I see isolation everywhere, even in the facilities. This could really help decrease a lot of problems. � Describe Collective Impact & vision for WW - Walla Walla is especially suited for this design. Role of Coalition/ Association - The backbone organization Discussion around the concept. Questions answered. Comments - it is perfect for our community. It can make a big impact here. This problem hasn't been addressed and none of us can do it alone. Everyone expressed interest in continuing participation. � Process needed - identification, assessment, intervention planning, education, programing. All agreed with stated needs. Comments made - need to also address this issue with college students and the schools. We need to get community involved and think about who touches the lives of seniors. COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 62 � Screen - LSNS-6, One example. Is using a screening tool the way to go? Where do you see it being used? Answers - Any tool that has been tested for reliability could be used. It needs to be simple. Possibly use in clinic, emergency rooms, EMTs, churches. � Brochure - other services to include. Everyone help with content for informational brochure. � Measurement questions - qualitative/quantitative measurement design - What do we want to know? How do we get the information? Where do we collect it? Qualitative is important to really know if it is doing what we want. How many referrals, how many connected to services, after 3 & 6 months, are they still going? Health records - ER use, hospitalizations, improved vitals and labs, improved scores on screens ( depression, anxiety, social isolation screen). � Name - Unanimous vote - Walla Walla Coalition to Fight Isolation (association is ok, but coalition seems to make it better understood) � Meeting time - Late in the day. Not on Friday or Monday. Meeting Agenda, March 7, 2019 � Educating the community - brainstorming Where and how do we educate the community. Group exercise with fast pace post-its: UB - advertise, article, Waitsburg Times - advertise, article, Open house at Senior Center - booth, information to present, BMAC - 2-day clinic - contact Kathy Covey Blog, Website, FB, Twitter. ... , My Town WW, ADC-information available for families, Wellness newsletter, Speaking at churches, civic groups, Valley Transit advertisement, Neighborhood block parties, National night out, 4 th in the Park, Sweet Onion Festival, Little Theater, Whitman and WW Colleges, CC? � Opportunities to build connections - think outside the box classes at CC, volunteer - Humane Society, elementary schools, help kids with reading support groups, churches be willing to reach out beyond their members, WW College community day, Whitman College volunteer fair, Senior companion Computer coaching, intergenerational, Intergenerational music - choir, band Bus seniors to school performances, Ask MOW drivers - they see a lot bankers, grocery clerks, EMT, mail/delivery, Group transports, Senior rec - Parks & Rec Adopt a grandparent, Volunteer - hosp, Catholic Charities, Helpline, Senior Center, BMAC, Schools � Services or opportunities available, other contacts COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 63 Services/ opportunities - United Way, volunteer portal, Chamber volunteer list, Whitman fellowship � Pilot study Discussion of process, goals identified, metrics determined. Think about mission & vision statements - what goal are we working toward? Meeting Agenda, April 8, 2019 � Planning Pilot o Screen used LSN-6 o Gerontologist - all patients 60 & + o Referral to AL TC o AL TC intake assessment, intervention plan o Data collected HIPP A compliant email to Coalition email Health outcomes (labs, vitals, medication use) PHQ9 Anxiety Screen Qualitative telephone interview LSNS-6 Begin May 1, 3 months (May - July) Review next steps after initial pilot � Begin Community education campaign - County Health - health forums, � National Night Out � Pilot plan completed - refer to plan COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 64 Meeting Agenda, May 9 � Update on health forums - People show interest. Everyone agrees isolation and loneliness are a problem. They want to know more. Want presentations at schools, churches, social clubs. � Update on pilot initiation - Began 4/29. Process is clear. Physician and RNs are excited. The other doctors in the clinic want to participate. Patients have been willing to complete screen. Referrals made easily via email in encrypted system. � Update on Coalition Incorporation, selecting board - Searching for board members. Need 3 to complete incorporation as non-profit. Have 2 committed. 1 still deciding. Plan to move forward with writing Bylaws once full board is selected. � Next Meeting, 2 months. Activities underway - continued community education, selecting board, pilot, recruiting partners Meeting Agenda, July 18, 2019 � Update on community education - Interest in scheduling speaking engagement. Training and power point to be developed. Libby, Brad & Kirsten willing to help. � Update on pilot initiation - Ongoing. Will finish end of month. Not as many have screened at high risk as was expected. Possible reasons discussed - gerontologist; specialist so already connected, asking right questions, not giving accurate answers - fear of being taken from home. These will be explored when all results are in. � Update on Coalition Incorporation, selecting board - Board has been selected. Kirsten Schober; non-profit fundraiser & director, Ed Parker; LICSW, & Cindy Loiacono-Zahl, RN. Will schedule board meetings to write bylaws. COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Meeting Agenda, Sept 11, 2019 � Update on community education - Presentations scheduled at 3 churches, Rotary, Safeway � Update on pilot initiation - Pilot is completed as far as screening. Shared summary. 65 Intake assessments continue. Still working on telephone interviews. Once full data was compiled results indicated fair number of isolated. These have been referred. Not all have started the intake process. � Board introduced. Looking for 2 other board members now that incorporation has been completed. Interested individuals can email JanaLee to notify of interest. If you want to nominate someone else, email the name and contact information. Running Head COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 66 Problua StlltSIWlt: orly l in older adults U"e isolated lllld alonit. This cawu :u.e;atin eff'ecu 011 physical, emotional, cog11itin, ud fuactiom.l health, bnt tbose with tbe ~lltest needs are bidde11 from liUVkes and tbe co11u111anity, UDawue help is lll'llilablit. APPENDIXD State Policy Federal Policy !Jlllovado.a.: WWCFI is a non-profit organiubOJI tbllt ia leadia~ ll collective impact initiative, to be tbe brid~ betweea ~-cw, aenicu, a:ud COIIIIIIIIJIHy memben lTilO touch the liT of older adults and find tbe hid.du iwlllted. connect tbem to unicea, and prcnide tbe support 11eeded for impluamtation of intervention plaa.s. Thia apriaJded \\ith co. mmwuty eduClldo11 \\ill provide the tnil map to build rellltiomlupa ud atrengthm the commmuty. Running Head COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 67 APPENDIXE Communication Plan Stakeholder Communication Information to be Method of Frequency of Responsible Develop Responsible approval Objectives Qrovided/received Communication Communication/Timing Message & send Board of Directors Awareness Initial project overview Email/Messenger Determined by board President President Approval Status Report Meetings Quarterly Secretary Secretary Commitment Announcements Shared Drive Based on milestones ED ED Final Outcomes Financial Report Program activities Status Report Finances Partners Awareness Initial project overview Email Monthly Volunteer ED Understanding Status Report Meetings Based on milestones ED Approval Announcements Newsletter Based on activities Commitment Final Outcomes Facebook Education Website Community Understanding Awareness Initial Project Overview Presentation Monthly Volunteer ED Commitment Education Workshop Based on activities ED Announcements Newsletter Based on milestones Facebook Website B l og +--- Volunteers Understanding Initial project overview Email Weekly Volunteer ED Awareness Status report Meetings Based on activities ED Commitment Final Outcomes Website Based on milestones Education Facebook Announcements B l og Beneficiaries Awareness Initial project overview Email Monthly Volunteer ED Understanding Education Facebook Based on milestones ED Acceptance Announcements Website Based on activities Commitment Blog Presentation Phone calls Funders Awareness I Initial project overview Status Report Based on funding Volunteer Secretary Approval Status Report requirements Secretary ED 1 Commitment Final Outcomes I ED Format 1 Frequenc}' Announcements I I I I Newsletter, Blog Monthly Based on activities & milestones I Social media posts I Weeki~ Based on activities & milestones I Running Head COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIXF Collective Impact Process Plan: Stage 1 - Evaluate Readiness for Collective Impact • Meet with community agencies, services and interested members (stakeholders) • Identify level of interest and commitment from each with levels of urgency established • Identify problem and gaps in current services • Identify shared goals • Lead community education/outreach regarding goal • Designate pilot test process and complete evaluation of process • Evaluate level of influence • Evaluate effectiveness of shared experience for pilot Stage 2 - Establish Committed Partnerships & Backbone Organization • Recruit key stakeholders as partners • Recruit board of directors and elect officers (champions) • Identify shared agenda and goals • Establish Bylaws • Complete Articles of Incorporation • Identify specific shared measurements toward goal Stage 3 - Preparation for Impact, Establish Foundations • Non-profit incorporation • Establish backbone organization processes • Obtain funding and finalize corporate support (Local businesses, Sherwood Foundation) • Establish common strategy • Complete community baseline survey • Identify strategic activities • Engage community with education and participation in efforts • Establish data collection process and infrastructure Stage 4 - Strategic Activities • Facilitate communication between all partners • Encourage ongoing participation in agreed strategic activities - maintain accountability • Engage community with continued education and marketing campaign • Maintain momentum with recruitment of additional partners • Ongoing evaluation - collect data and analyze, share results with all partners • Re-align strategic activities making changes as evaluations indicate Stage 5 - Sustainment • Ongoing mobilization of funding • Promote policy to advance initiative (local, state, federal) 68 • Continue community involvement, advancing ongoing activities to additional partners, promote to neighboring communities, state • Maintain communication with Senator Murray, AARP, and funders • Maintain accountability in engagement with strategic activities • Ongoing evaluation, (collect data, analyze, and report) sharing beyond partners and community; celebrating successes. Running Head COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIXG Walla Walla Coalition to Fight Isolation Board meeting 7/22/19 Bylaws: 1. Name and purpose: Walla Walla Coalition to Fight Isolation Collective Impact backbone organization to lead community effort to develop and promote processes to address social isolation in our community to include identifying those at risk, assessment, intervention planning, case management, community education and program development. 2. Election, roles, & terms, board structure: President, Vice president, secretary, treasurer, board member at large 69 Serve 2 years, with option of 2 terms, then must have at least 1 year without serving before can serve another term. Initial board will stagger changes, 2, 3, and 4 years. Board elections will be held in conjunction with fiscal year. Board seats will be open for application submitted to a nominating committee. Nominating committee will select candidates to be presented to the board (or all interested?) for a vote. 3. Membership/partners - none. Coalition participation will be open to all interested. 4. Meetings: Meetings will be set by board as often as seen necessary to complete process for nonprofit filing. Once organization is set up, board will meet quarterly unless a special meeting is required for a specified purpose. Quorum will be all 3 members in a board of 3. 3 out of 5 in a board of 5. Meetings will be led by the president or vice president in absence of president. Executive Director will attend meetings and participate, but will not be a voting member. Next meeting: August 6; 6 -7pm COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Walla Walla Coalition to Fight Isolation Board meeting 8/6/19 Bylaws: 4. Name and purpose: Walla Walla Coalition to Fight Isolation Collective Impact backbone organization to lead community effort to develop and promote processes to address social isolation in our community to include identifying those at risk, assessment, intervention planning, case management, community education and program development. 5. Election, roles, & terms, board structure: President, Vice president, secretary, treasurer, board member at large 70 Serve 2 years, with option of 2 terms, then must have at least 1 year without serving before can serve another term. Initial board will stagger changes, 2, 3, and 4 years. Board elections will be held in conjunction with fiscal year. Board seats will be open for application submitted to a nominating committee. Nominating committee will select candidates to be presented to the board (or all interested?) for a vote. 6. Membership/partners - none. Coalition participation will be open to all interested. 4. Meetings: Meetings will be set by board as often as seen necessary to complete process for nonprofit filing. Once organization is set up, board will meet quarterly unless a special meeting is required for a specified purpose. Quorum will be all 3 members in a board of 3. 3 out of 5 in a board of 5. Meetings will be led by the president or vice president in absence of president. Executive Director will attend meetings and participate, but will not be a voting member. 5. Compensation & indemnification No compensation. Fund raising efforts maintained. Volunteer. Board not liable 6. Role of chief executive COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Reports to board, not voting member. Directs - marketing, fund raising, research. Organizes collective impact, motivates, mobilizes. 7. Finances, budget year, type of budget, responsibilities, types of fundraising Oct - Sept; same as government fiscal year to match key partners. Treasurer reconcile statements ED pay bills and present statements and budget, financial reports 2 possible signatures; president & ED Deposits received by secretary. Line item budget Board reviews reports every meeting (1/4) 8. conflict of interest, ethics 71 small town - potential conflicts made known & reviewed. Expected to have relationships 9. Dissolution assets to be transferred to another nonprofit or partnering agency Mission: Find the hidden lonely and connect them to services Vision: Define practice process, implement in multiple counties, promote state and federal policy. (grow to all populations) so that the negative effects of social isolation can be reduced. Walla Walla Coalition to Fight Isolation Board meeting 8/15/19 Bylaws: Reviewed- See attached add changes below Board Elections Individuals interested in serving as a member of the Board shall submit a written application to The Governance Committee. The Governance Committee shall review and submit nominations for renewing and new Board members at the board meeting immediately preceding the beginning of the next fiscal year. Recommendations from the Governance Committee shall be made known to the Board in writing before the meeting. New and renewing Board members shall be approved by a majority of those Board members at a Board meeting at which a quorum is present. COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 72 Officers and Duties The board shall elect officers of the Organization which shall include a President, Vice President, Secretary, Treasurer, and such other officers as the Board may designate by resolution. The same person may ... President of the Board It shall be the responsibility of the President of the Board, when present, to preside over all meetings of the Board of Directors and Executive Committee. The President of the Board is authorized to execute, in the name of the Organization, any and all contracts or other documents which may be authorized, either generally or specifically, by the Board to be executed by the Organization, except when required by law that the Executive Director' s signature must be provided. Vice President of the Board In the absence of the President, or in the event of his/her inability or refusal to act, it shall then be the responsibility of the Vice President to perform all the duties of the President, and in doing so shall have all authority and powers of, and shall be subject to all of the restrictions on, the President. Secretary The Secretary, or his/her designee, shall be the custodian of all records and documents of the Organization, which are required to be kept at the principal office of the Organization, and shall act as secretary at all meetings of the Board of Directors, and shall keep the minutes of all such meetings on file in hard copy or electronic format. S/he shall attend to the giving and serving of all notices of the Organization and shall see that the seal of the Organization, if any, is affixed to all documents, the execution of which on behalf of the Organization under its seal is duly COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 73 authorized in accordance with the provisions of these bylaws. The Secretary shall be responsible for ensuring the deposit of, or cause to be deposited, all money and other valuables as ay be designated by the Board of Directors. at all times, is authorized to receive, deposit, disburse and account for all receivables for the Organization. Treasurer It shall be the responsibility of the Treasurer to review and reconcile all financial transactions and accounts on behalf of the Organization, including accounts of its assets, liabilities, receipts, disbursements, gains, losses, capital, retained earnings, and other matters customarily included in financial statements. Executive Director It shall be the responsibility of the Executive Director, in general, to supervise and conduct all activities and operations of the Organization, subject to the control, advice and consent of the Board of Directors. The Executive Director shall keep the Board of Directors completely informed, shall freely consult with them in relation to all activities of the Organization, and shall see that all orders and/or resolutions of the Board are carried out to the effect intended. The Board of directors may place the Executive Director under a contract of employment where appropriate. The Executive Director shall be empowered to act, speak for, or otherwise represent the Organization between meetings of the Board. The Executive Director shall be responsible for the hiring and firing of all personnel, and shall be responsible for keeping the board informed at all times of staff performance and for implementing any personnel policies which may be adopted and implemented by the Board The Organization, to execute in the name of the Organization all contracts and other documents authorized either generally or specifically by the COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Board to be executed by the Organization, and to negotiate any and all material business transactions of the Organization. 74 The Executive Director is responsible for overseeing the administration, programs and strategic plan of the organization. Other key duties include fundraising, marketing, and community outreach. The position reports directly to the Board of Directors. Walla Walla Coalition to Fight Isolation Board meeting 9/9/ 19 Bylaws: Reviewed Approved. Officers elected: Kirsten Schober - President Ed Parker - Vice President Cindy Loiacono-Zahl - Secretary Bylaws completed. Bring on 2 more board members. Interested parties can email JanaLee. These will be reviewed and a voted on at next meeting 10/21/19. 10/21 I 19 Meeting cancelled due to illnesses. COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIXH Pilot Plan Proposal 75 A medical provider will complete the Lubben Social Network Scale-6 (LSSN6) (Lubben, 2012) on every patient age 60 and older seen in the established 3-month time period. Those who screen positive, will be referred to AL TC for intake assessment and intervention plan. Appropriate referrals will be made to the Senior Center and other programs to build connections. Evaluations will be completed to identify the ease of the process for all partners involved and the commitment to continue in like activities through WWCFI collective impact initiative. Metrics to be collected prior to interventions, and 3, 9, and 12 months post interventions. Metrics will include health outcomes specific to each patient, screens completed by AL TC (PHQ-9, Geriatric Anxiety Scale within the intake assessment), and the LSNS-6. A telephone qualitative interview will be conducted 1 month, 6 months, and 12 months after intake. Goals established: Determine level of commitment from partners Determine level of urgency - what is the prevalence of social isolation Determine success of utilizing shared metrics, data, and working toward shared goals. Determine willingness for older adults to develop intervention plans for isolation COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIX I Qualitative Survey Questions for Social Connection Planning 1. What would make your life easier on a day to day basis? 2. What's most important to you in your life? 3. What part of your day is most annoying/difficult? Why? 4. When do you feel most alive/vibrant? Why? 5. Did you participate in making a plan for social interaction and connection? 1 Yes (go to question 7) 2 Yes, but I'm not following it (go to question 7) 3 No 6. If you did not, what stopped you? (go to question 9) 7. How has your plan been difficult to follow? What has made it easy to follow? 8. Has your quality of life changed as a result of your connection and interaction plan? If it has improved, explain how it has improved. If it has gotten worse, how has it gotten worse? 9. How were you finding connection and interaction before? If you weren't, what stopped you? 10. How many times in the past 3 months have you visited the ER or hospital? 76 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIXJ PATIENT HEAL TH QUESTIONNAIRE (PHQ-9) NAME: ___________________ _ DATE·------- Over the last 2 weeks, how often have you been bothered by any of the following problems? (use •✓• to indicate your answer) ad!lli -· _,. 1. Little interest or pleasure in doing things 2. Feeling down, depressed, or hopeless 3. Trouble falling or staying asleep, or sleeping too much 4. Feeling tired or having little energy 5. Poor appetite or overeating 6. Feeling bad about yourself- or that you are a failure or have let yourself or your family down 7. Trouble concentrating on things, such as reading the newspaper or watching television 8. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so figety or restless that you have been moving around a lot more than usual 9. Thoughts that you would be better off dead, or of hurting yourself (Healthcare professional: For interpretation of TOTAL, please refer to accompanying scoring card). 10. If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? IU I AL: 0 0 0 0 0 Several More than half the - days d""s 1 2 1 2 1 2 1 2 1 2 2 - Not difficult at all Somewhat difficult Very difficult Extremely difficult Nearly eve~day 3 I 3 3 3 3 - Copyright © 1999 Prizer Inc. All rights reserved. Reproduced with pennission. PRIME-MD© is a trademark of Pfizer Inc. A2663B 10-04-2005 77 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION PHQ-9 Patient Depression Questionnaire For initial diagnosis: I. Patient completes PHQ-9 Quick Depression Assessment. 2. If there are at least 4 ✓ s in the shaded section (including Questions # I and #2), consider a depressive disorder. Add score to determine severity. Consider Major Depressive Disorder - if there are at least 5 ✓ s in the shaded section ( one of which corresponds to Question #I or #2) Consider Other Depressive Disorder - if there are 2-4 ✓sin the shaded section (one of which corresponds to Question #I or #2) Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on chnical grounds taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient. Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require impairment of social, occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms. To monitor severity over time for newly diagnosed patients or patients in current treatment for depression: I. Patients may complete questionnaires at baseline and at rejllllar intervals (eg, every 2 weeks) at home and bring them in at their next appointment for sconng or they may complete the questionnaire during each scheduled appointment. 2. Add up ✓s by column. For every✓: Several days = I More than half the days= 2 Nearly every day = 3 3. Add together column scores to get a TOT AL score. 4. Refer to the accompanying PHQ-9 Scoring Box to interpret the TOT AL score. 5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of response, as well as guiding treatment intervention. Scoring: add up all checked boxes on PHQ-9 For every ✓ Not at all = O ; Several days = I; More than half the days = 2; Nearly every day = 3 Interpretation of Total Score Total Score 1-4 5-9 1 0-14 15-19 20-27 Depression Severity Minimal depression Mild depression Moderate depression Moderately severe depression Severe deoression PHQ9 Copyright /0 Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD ® is a trademark of Pfizer Inc. A2662B 10-04-2005 78 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIXK Geriatric Anxiety Scale - 10 Item Version (GAS-10) © Daniel L. Segal, Ph.D., 2015 Below is a list of common symptoms of anxiety or stress. Please read each item in the list carefully. Indicate how often you have experienced each symptom during the PAST WEEK, INCLUDING TODAY by checking under the corresponding answer. I. I was irritable. 2. I felt detached or isolated from others. 3. I felt like I was in a daze. Not at all (0) - Sometimes (1) Most of the time (2) All of the time (3) -- 4. I had a hard time sitting still. ------- 5. I could not control my worry. 6. I felt restless, keyed up, or on edge. -- -- 7. If elt tired. 8. My muscles were tense. 9. I felt like I had no control over my life. l 0. I felt like something terrible was going to happen to me. ---- 79 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION GAS-10 Scoring Instructions Items 1 through 10 are summed to provide a Total Score. Each item ranges from 0 to 3. Score Distribution for GAS-JO (N = 556) Raw T- Percentile Descriptive Score Cate~ory I 42 21 Minimal 2 44 30 Minimal 3 46 34 Minimal 4 48 45 Minimal 5 51 53 Minimal 6 53 63 Minimal 7 55 70 Mild 8 57 75 Mild 9 59 82 Mild 1 0 61 90 Moderate 12 66 95 Severe 14 70 98 Severe 16 74 99 Severe 18 79 99 Severe 24 92 99 Severe 30 104 99 Severe The primary citations for the GAS are as follows: Segal, D. L., June, A., Payne, M., Coolidge, F. L., & Yochim, B. (2010). Development and initial validation of a self-report assessment tool for anxiety among older adults: The Geriatric Anxiety Scale. Journal of Anxiety Disorders, 24, 709-714. Mueller, A. E., Segal, D. L., Gavett, B., Marty, M.A., Yochim, B., June, A., & Coolidge, F. L. (in press). Geriatric Anxiety Scale: Item response theory analysis, differential item functioning, and creation of 10-item short form (GAS-10). lnternational Psychogeriatrics. 80 2 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 81 APPENDIXL LUBBEN SOCIAL NETWORK SCALE - 6 (LSNS-6) Please check your answer: FAMILY: Considering the people to whom you are related by birth, marriage, adoption, etc .... 1. How many relatives do you see or hear from at least once a month? � None D 1 D 2 D 3-4 D 5-8 09 or more 2. How many relatives do you feel at ease with that you can talk about private matters? � None D 1 D 2 D 3-4 D 5-8 09 or more 3. How many relatives do you feel close to such that you could call on them for help? � None D 1 D 2 D 3-4 D 5-8 09 or more FRIENDSHIPS: Considering all of your friends including those who live in your neighborhood 4. How many friends do you see or hear from at least once a month? � None D 1 D 2 D 3-4 D 5-8 09 or more 5. How many friends do you feel at ease with that you can talk about private matters? � None D 1 D 2 D 3-4 D 5-8 09 or more 6. How many friends do you feel close to such that you could call on them for help? � None D 1 D 2 D 3-4 D 5-8 09 or more COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Lubben Social Network Scale Scoring (for provider use only) About: This scale is a self-report measure of social engagement including family and friends. * *Before using this scale, researchers are asked to seek permission. Reliability: Internal reliability for the 6-item scale = .83 Reliability of the family questions= .84 - .89 Reliability of the non-kin questions= .80 - .82 82 Validity: The Lubben Social Network Scale is correlates with mortality, all case hospitalization, health behaviors, depressive symptoms, and overall physical health. Scoring: 1. 0 =None 1= 1 2=2 3= 3-4 4= 5-8 5= 9 or more 2. 0 =None 1= 1 2=2 3= 3-4 4= 5-8 5= 9 or more 3. 0 =None 1 = 1 2= 2 3= 3-4 4= 5-8 5= 9 or more 4. 0 =None 1 = 1 2=2 3= 3-4 4= 5-8 5= 9 or more 5. 0 =None 1= 1 2=2 3= 3-4 4= 5-8 5= 9 or more 6. 0 =None 1= 1 2=2 3= 3-4 4= 5-8 5= 9 or more Add all item answers together. The total score is calculated by finding the sum of the all items. The score ranges between O and 30, with a higher score indicating more social engagement. Please make a referral to ALTC if score is as follows in either section or as a total: • Score is 0-12 please make a referral to ALTC. Indicates high risk. • Score of 12- 20 please make a referral per provider, family or patient preference; moderate risk • Score of 21- 30 indicates good social engagement, no referral needed. Less Social Engagement More Social Engagement I All Questions 0 1 2 3 4 5 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIXM Initial Pilot Summary Walla Walla Coalition to Fight Isolation initiated a pilot to test 1. The level of commitment from community partners to work toward a shared agenda utilizing shared goals, metrics, and data collection. 2. The sense of urgency from community partners. 3. The extent of isolation experienced by adults age 60 and older living within the community. 83 4. The feasibility, reliability and success of screening for social isolation within the medical clinic. Pilot began with a medical provider administering the Lubben Social Network Scale - 6 to all patients age 60 and older seen in clinic between May 1 - July, 30, 2019. Patients whose scores indicated a risk for social isolation were referred to Aging and Long Term Care for intake assessment and possible interventions. After completion of assessment and development for intervention plans, a telephone interview is in process of being completed to ascertain the perceived experience of beneficiaries. Ages Total screened: 79 60-69 70-79 80+ Unknown COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 84 Results of the pilot were collected and reviewed. The level of commitment and sense of urgency was determined to be strong as evidenced by follow through from all participating partners as well as their expressed desire to expand the study. The prevalence of risk for isolation in this small sample is noted to be significant and interventions could mitigate crisis. Following is a brief summary of findings. Screening within the medical clinic is one means to identify isolation; however, it is not adequate. Other means of screening and identification of isolation also need to be discovered and utilized Levels of Risk for Social Isolation so 45 40 35 30 25 20 15 10 5 0 HIGH RISK High Risk Moderate Risk Low Risk Social Isolation Risk MODERATE RISK LOW RISK Family Support � Friend Support � Total COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 85 APPENDIXN Line Item Budget Revenue Totals Notes Contributions 35k Fundraising, private contributions Foundation Grants 110 AARP, Sherwood, WW Development Corporate Grants 25 Local businesses (BB, Key, 3River) In Kind Contributions 53 Volunteer, printing Total 223k Expenses Personnel Executive Director 78 40 hour/week Student Interns 36 In-kind, volunteer Benefits 40 Total 154k Startup Expenses Office furnishing 2.5 Technolo!!v Equipment 5 Computers, printer, software Total 7.5k Operating Expenses Rent/Utilities 2.5 Office supplies 2.4 Consultants 26.2 Accountant, Legal, Web design, Stats Telephone 3.6 Lines & Service Marketing 2.4 Brochures, bulk mail Hospitality 2.4 Refreshments; meetings, forums, festivals 39.5k 201k Surplus 22k COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIXO Community Survey; Social Isolation For each of the items below, please circle your level of knowledge: ONo 1 Slight 2 Moderate 3 Very 4 Extremely 1. What social isolation is. � 0 � 1 � 2 � 3 � 4 2. The negative effects of social isolation. � 0 � 1 � 2 � 3 � 4 3. Signs that indicate social isolation. � 0 � 1 � 2 � 3 � 4 3. The prevalence of social isolation in the community. � 0 � 1 � 2 � 3 � 4 4. Interventions available to address social isolation. � 0 � 1 � 2 � 3 � 4 Please answer the following questions: 5. Does your company/organization do anything to build connections? � yes � no If yes, describe: _______________________ _ 6. Have you personally participated in any programs/services to build connections? � yes � no If yes, describe: _______________________ _ 7. Would you be interested in learning more about social isolation, the negative effects, signs, or what you can do about it? � yes � no Name (optional): _____________ Organization: ________ _ 86 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION Preparation Implementation Sustainment APPENDIXP EPIS Table • Outer Context • Barrier: AAA policies do not pay for activities to promote connections, no legislation promoting screening for isolation risk, requirements for physicians to move patients through quickly and get numbers up. • Facilitator: AARP and Cigna advocacy for creating opportunities to address social isolation, Many advocacy groups interested in building programs for older adults provide funding, Partners advocate for change and network with other agencies to participate • Inner Context • Barrier: New organization building culture • Facilitator: leadership, board advocates for change among their social equity, strong knowledge base, strong reputations to build on using networking. Individual adopters see need to address isolation. • Outer Context • Barrier: Evidence of pilot needs to appeal to multidiciplines • Facilitator: Local community and government advocating for age friendly community, AAA grants looking at enhancing older adult lives and extending context of funding. • Inner Context • Barrier: Maintaining momentum through "Good Ol'Boy culture." • Facilitator: Small size with each person offering their expertise, strong value system and dedication to the mission, strong leadership • Outer Context • Barrier: Sustaining fiscal support, continued engagement of partners in implementation • Facilitator: Partners are dedicated to mission, strong community commitment and funding, key champions • Inner Context • Barrier: Understanding of Collective Impact activities is minimal in partners • Facilitator: Readiness for change, large older adult population, goals made clear with priorities set by board, history of attempts to collaborate, ongoing data analysis to identify success and areas for pivot • Outer Context • Barrier: Current policy and federal initiatives extending to state initiatives • Facilitator: Movement toward adopting new state and federal policy, Local government supportive of new policy, Local philanthropists interested in supporting sustainment, advocate with advocacy organizations for policy developement, Personal accounts from older adults benefiting from program • Inner Context • Barrier: Maintaining board members and volunteers • Facilitator: Local SW school available for continual feed into staffing, Partnering with school for training and coaching, Continue to build on social equity from partners and board, evidence of CIP success 87 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 88 APPENDIXQ Vision and Mission Statement Bringing community partners together to fight social isolation Many older adults in our community are alone and isolated. This causes declines in their health, mood, and functional ability affecting their independence. We are building a supportive process to meet this need. We value all participation. Please join us and see how you can help us make connections. Mission: Create a full-scale process to find isolated, lonely individuals, provide assessment, intervention planning, and connect them to services. Vision: Build meaningful relationships in everyone's life. Coordinated by Janalee Wagner, LICSW, MSW, DSW Candidate For more information; 509-240-9546 or janaleew@usc.edu isolationfiles.com COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION APPENDIXR 89 COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 90 APPENDIX S Alice, My Inspiration I believe relationships make life worth living. Alice is one reason why. I met Alice when her husband was a patient of mine in the nursing home. She was so inspirational. She was 79 years old and blind, but she'd gotten a volunteer from her church to drive her around so she could volunteer. She visited the nursing home every day, and not just her husband, but made her rounds to other patients. She visited shut ins from her church in their homes. She started a book club at the library for the homeless. She sang in her church choir and coordinated them to sing in local nursing homes, at the soup kitchen, and for the foster care Christmas party. Even after her husband died, she continued these activities. But, as Alice got older, she had to begin using a walker. Any using a walker for a blind person is very debilitating. Alice began to confine herself to her home. She quit her volunteering and church attendance and dismissed her volunteer. Her health declined more rapidly. She eventually was confined to her bed. She frequently called 911 in the middle of the night saying she was having chest pain. The paramedics would come, take her to the ER where she would have several tests done. But nothing was ever found to be wrong. After this had been going on for many months, a wise paramedic decided something else needed to be done and asked me to get involved. When I visited Alice in her home, she remembered me and was happy to reconnect. She was 98 years old and she said to me "I don't know why I am still here. I don't want to be here. Why can't I close my eyes and never wake up?" Many of her friends had died. She was widowed. Her only son and grandchildren lived on the East coast. Talking to them on the phone was difficult because of her hearing loss. She could no longer write letters and had no one to dictate to or read her mail. She was alone, and ready to die. I reminded Alice of all the good she had done with the library and her church. I wondered if it was her turn to receive some of those services. She didn't think anyone would see the importance of spending time with a blind old lady, but agreed to let me make some calls. The librarian Alice did the book club with agreed to make home deliveries. Each time she' d bring Alice a new book on tape, she'd take time to discuss the previous book with her. Alice' s church began to make home visits including pastoral visits from the pastor. The church choir was looking for a place to have their monthly potlucks and Alice was happy to hostess. We found a volunteer to help her with her mail, read to her 3 days a week and assist with a Skype call to her son every other week. Her grandchildren, who were now in college began reaching out with video calls as well. At Alice' s 102 nd birthday party, surrounded by 20 people in her living room, she grabbed my hand and said, "I'm so glad I am here. Look at all my friends." Relationships make life worth living. I've learned that the cost of social isolation and loneliness is profound, but interventions are often low cost or free and the impact that can be made is huge. Studies indicate a wide variety of interventions are effective and range from groups focused on a hobby or support, COLLECTIVE IMPACT ADDRESSING SOCIAL ISOLATION 91 taking a class or getting involved in a club, a simple regular visitation or telephone call. But also, just taking the time to say hello can make a huge difference.

Abstract (if available)

Abstract This paper provides a brief literature review outlining the negative effects of social isolation specifically for older adults living alone in the community. It further defines a capstone project that applies collective impact to engage the community in co-creation of processes addressing this need. The plans for implementation of the project are described as is research supporting the theory of change behind the capstone. This paper suggests that to eradicate social isolation, a full-scale simultaneous process needs to be implemented. The process should identify isolated individuals, refer them for assessment, intervention planning, and implementation, provide case management to assures barriers are addressed and promote policy for sustainment of the process. This capstone engages collective impact as the catalyst to create this process with full community participation.

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University of Southern California Dissertations and Theses

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Asset Metadata

Creator Wagner, JanaLee (author)

Core Title Collective impact addressing social isolation for older adults living independently in the community; a capstone innovation project

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 12/16/2019

Defense Date 11/22/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag collective impact,community partnership,elder orphan,Isolation,Loneliness,OAI-PMH Harvest,older adults,social isolation

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Enrile, Annalisa V. (committee chair), Arriaran, Karla P. (committee member), Islam, Nadia (committee member)

Creator Email j.lavender@hotmail.com,janalee@newpulsecounseling.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-253518

Unique identifier UC11674142

Identifier etd-WagnerJana-8077.pdf (filename),usctheses-c89-253518 (legacy record id)

Legacy Identifier etd-WagnerJana-8077.pdf

Dmrecord 253518

Document Type Capstone project

Rights Wagner, JanaLee

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA