Making Your Meal Program 

THRIVE

Addressing Ageist Cultures and Practices 

Lisa O’Neill, DBH, MPH

loneill@arizona.edu
Objectives

• Identify socialization challenges that older adults encounter in 

communal settings

• Describe the evidence-based public-school program, Positive 

Behavior Intervention and Support (PBIS)

• Explain how to adapt evidence-based school strategies to communal 

settings to build a safe and inclusive culture
In High School I Was...

A) was popular

B) had a few close friends

C) was a bit of a loner
In High School, at Lunch I...

Y/N answer each question

1) sat with the same friends everyday

2) felt comfortable eating with kids I 

didn‘t know

3) felt comfortable eating alone

4) would skip lunch if my friends were 

absent
How Similar are High School cafeterias 

and Congregate Meal Sites? 
Project THRIVE 

Focused on how Independent and Assisted 

Living Facilities could ensure an emotionally 

safe, supportive, and inclusive environment 

Challenges included:

• Diversity (culture, ethnicity, age, health, 

personality, health beliefs)

• Age-related changes and personal 

experience

• Ageism
Project THRIVE Continued

Goal: Develop a culture building 

model where residents felt 

welcome, comfortable and 

engaged

Method: Adapt an evidence-based 

public-school program focused on 

culture-building and inclusivity 
To Reduce Isolation, Build Community and 

Improve Quality of Life

Are There Lessons We Can Learn from Schools?
Positive Behavioral Interventions 

and Supports (PBIS)

https://www.pbis.org/
Results of PBIS in Schools

• Decrease in bullying and 

harassment

• Increase in feelings of 

belongingness

• Decrease in violent and 

aggressive acts

• Positive effect on climate for 

teachers, staff, and students
PBIS is a Framework

Not a Program or Model
Language Frames • Frames = Mental Models = How 

we see the world

oFrames are expressed in language

• Using language, we can create new 

frames

• Behavior is an expression of our 

mental models

• If we can adapt mental models, we 

can influence behavior
How does this make you feel? 
Is This Better?

Join your fellow 

citizens in helping to 

save our 

environment. 

Please re-use towels. 
Culture:

• Culture: the learned and shared 

values, beliefs, norms and 

lifeways carried by a group of 

people which guides their 

decisions, thinking and actions

• PBIS links language to behaviors 

and beliefs = community 

building
Language Frames Continued

The goal is to have 

the new language 

frames become a 

shared norm 

throughout the site, 

with everyone 

modeling desired 

behaviors 
Language Frames Continued 2

Problem: Residents want to 

have access to their mobility aids, but they crowd the 

dining area & create a fall hazard

Solution: Park the ‘vehicles’ 

outside the room and give access as needed

Language change/new verb: Valet
Develop

*Develop a vision and shared 

norms to bring about culture 

change 

*Develop a system to match that 

vision, using language as the 

connection to emotion, and 

ultimately to the desired behavior 
Goals *Teach, model and practice new 

language frames

*Reinforce with strategic 

messaging

*Use incentives to initiate and 

sustain changes

*Monitor, evaluate, adjust
Goals Continued

*One of the most effective ways 

to combat negative behavior is to 

increase the efficacy of bystanders
Effective Culture Change

Culture building mindset:

we are creating a vision of 

a community that we 

desire, and we are taking 

coordinated and 

deliberate targeted steps 

to achieve it
Empathy Training

Empathy is being aware of and 

sensitive to another person’s 

emotions—vicariously 

experiencing and understanding 

those feelings.

We have a 1-hour interactive 

training that we used with all staff 

and residents 
Unfair Hearing Test

During this portion of Dr. O’Neills presentation she 

played an unfair hearing test. You may find one to listen 

to or include in a presentation of your own by searching 

“Unfair Hearing Test” on YouTube.
The Loss Game

Directions: 

Give everyone 5 small pieces of paper

Ask them to write one thing on each piece of paper that is important to 

them; something in their life that you really enjoy (pets, friend, family, 

possessions, etc.), makes life meaningful

Once they have one thing written on all five sheets, hold them up like a 

hand of cards
Congregate Meal Sites

To make meaningful changes, it’s 

important to take a deep dive 

into a site’s unique culture 

Potential Idea: Host 1-2 separate 

focus groups for participants and 

staff to discover if/where/when 

unwanted situations are 

occurring and discover more 

about the attitudes behind the 

negative behavior
Congregate Meal Sites Continued

• Is your site as welcoming as you 

think it is?

• Do you ask the diners if they feel 

welcome? 

• Do you ask if they feel 

comfortable? 

• What is your New Guest process? 
Congregate Meal Sites Continued 2

• Do you allow saved seats?

• If so, what do people say if 

someone wants to sit at their 

table? 

• Do you give them guidance on how 

to phase things? 

• Do you have cliques? 
Storytime
Data Gathering

• Keep it simple 

• If needed, implement an 

Intervention

• Evaluate: 

• Do we have a process that works? 

• Is the intervention making a 

difference?
Intervention Ideas

Pick a handful of tables that always 

have 2 seats open for new people

Have a WELCOME table where new 

people sit for several visits and 

encourage other diners to share a 

meal with them

Have a few people who act as a meal 

buddy for new people
Intervention Ideas: Environment

Normalize use of pocket talkers at 

tables

Minimize center pieces to 

facilitate lip reading

Use place cards for conversation 

starters and rotate them around 

the tables
PBIS Framework Example for Congregate Meal 

Sites

1. Identify a problem area

2. How is current situation not meeting the needs of your community?

3. Is there any resistance to change? Look at current beliefs and 

behaviors

4. What message will communicate desired result and create new 

social norms?

5. How will new expectations be reinforced?

6. How will new expectations be monitored?
Key Points

Don’t assume your current culture is 

working for everyone

Don’t assume because you feel 

welcome and comfortable that 

everyone does

Don’t assume things don’t change 

Don’t get hung up on the data 

gathering process – keep it quick and simple 
Thank you

for helping to build the WORLD we are all 

growing old in
Any Questions?

loneill@arizona.edu