Table 1.

How the Intervention Addressed Challenges Related to Isolation, Loneliness, and Program Implementation.

Intervention component	Challenges and barriers	Strategies used to overcome challenges and barriers
Identifying, recruiting, and matching clients with peers	• Finding isolated clients	• Outreach to community organizations
	• Stigma from self-identifying as lonely or isolated	• Referrals from other organizations, service providers, and friends of clients.
	• Distrust or unfamiliarity with peers	• Direct outreach in group settings (e.g., lobbies of housing) “Soft approach” to initial visits
	• Difficulty recruiting diverse peers	• Broad recruitment strategy/hiring staff to reflect population being served
	• Small pool of peers	• Flexible matching process based on background, shared interests, and client preferences
		• Soft approach to recruiting clients and building rapport
Building rapport	• History of mistrust or elder abuse	• Identifying shared or unique interests (e.g., art, music)
	• Difficulty reaching homebound older adults or individuals with severe mental illness (e.g., depression)	• Discussing shared challenges (e.g., loneliness, mental health, homelessness, addiction)
		• Flexibility of visit schedule
Addressing barriers that contribute to isolation and loneliness connecting with services	• Maladaptive social cognition (e.g., loss of social skills or social anxiety)	• Providing opportunities for small group interactions (e.g., meals) to facilitate friendships and build confidence
	• Limited mobility; neighborhood safety	• Accompanying clients on walks or errands
	• Peers are not service providers	• Motivational interviewing, utilizing community resources
		• Suggesting, reminding, and accompanying clients to needed services
		• Reactivating existing relationships between clients and services
		• Coordination with caregivers
		• Sharing knowledge of available community resources
Maintenance of connection through program flexibility	• Maintaining boundaries with clients	• Ongoing training, supervision and mentorship
	• Unanticipated events (e.g., death of client, witnessed elder abuse, etc.)	• Responsive training sessions (e.g., grief counseling, harm reduction, aging education, diet and nutrition courses)
		• Regular collection and incorporation of feedback from peers and clients
		• Flexible design of program
Maintaining connections during COVID-19	• Limitations on in-person interactions	• Regular phone calls with clients. Continuing to share experiences, albeit virtually (e.g., watching the same show and then discussing over the phone, playing music together over the phone)