The Impact of the COVID-19 Pandemic on Intimate Partner Violence Advocates and Agencies

Living in an Intimate Partner Violence Shelter During a Pandemic: Perspectives from Advocates and Survivors

PURPOSE

With state-wide quarantine policies during the COVID-19 pandemic like those implemented in the state of Texas, intimate partner violence (IPV) shelter staff were forced to incorporate new safety measures to keep survivors and advocates safe. To understand the impact of these adaptations fully, authors interviewed shelter staff and residents to capture both of their experiences living and working in the same shelter during the height of the coronavirus pandemic (summer 2020) to understand how changes in policy and procedure in shelters impacted survivors and advocates.

MATERIALS AND METHODS

A qualitative phenomenological design was utilized to collect and analyze data from 10 staff and 10 survivors to develop both a textual and a structural description of participant experiences living in an IPV shelter.

RESULTS

The current study captured the survivors' and advocates' perspectives related to the 1) vacillating views of shelter social distancing and quarantine policies, 2) shelter occupancy and staffing unpredictability, 3) the broader challenges related to environmental stressors and 4) mobility challenges.

DISCUSSION

Results of this study highlight factors related to interpersonal relationships within the shelter and structural factors of shelter which contributed to stress for participants.

CONCLUSION

The coronavirus is continuing to present challenges for shelters. Implications can be drawn from provider and client experiences that can inform policies and procedures for future health crises, including the need to mitigate environmental stress and transportation challenges, as well as considerations for maintaining social support should social distancing be necessary in future epidemics.

Impacts of COVID-19 on Intimate Partner Violence Service Provision

COVID-19 policies like stay-at-home orders impacted intimate partner violence (IPV) service provision in Alberta. Using intersectionality and qualitative semi-structured interviews, this article situates IPV and access to services and supports within multiple overlapping factors such as race, gender, class, and ethnic minority status. Two main themes were identified. First, the challenges within IPV service provision reflect the sectors' traditional and binary understanding and response to violence. Second, the move to virtual services brought challenges related to access to telecommunication facilities and zoom fatigue. Thematic analysis also shows the impact of the pandemic in a sector with existing structural/institutional challenges. We conclude by recommending a multi-level intersectional approach to IPV service provision in Alberta.

Impacts of the COVID-19 Response on the Domestic Violence Workforce

Many frontline and essential workers faced increased levels of stress, anxiety, depression, and even suicide ideation during the pandemic response. These and other factors led to burnout, shifts into non-patient or client-facing roles, or leaving an occupation altogether. Domestic violence advocates experienced increases in many types of stressors as they continued to provide essential services to victims and survivors during the pandemic. However, in most cases they did so without protections offered to essential workers, like priority access to personal protective equipment (PPE) or vaccines. Executive directors of U.S. State and Territorial Domestic Violence Coalitions were identified using the National Network to End Domestic Violence website and contacted via email to schedule key informant interviews. Interviews were conducted, recorded, and transcribed using Zoom. Themes were identified using both inductive and deductive coding. Twenty-five of 56 (45%) coalition executive directors completed an interview. Three main themes related to workforce were identified, including an accelerated rate of job turnover among both leadership and staff; a lack of essential worker status for domestic violence advocates; and unsustainable levels of stress, fear, and exhaustion. While familiar challenges drove these outcomes for this predominantly female, low-wage workforce, such as a lack of access to childcare, other factors, including the lack of access to PPE, training, and hazard pay for those working in person, highlighted inequities facing the domestic violence workforce. The factors identified as impacting the domestic violence workforce-turnover, low status, and high levels of stress, fear, and exhaustion-made the already challenging provision of advocacy and services more difficult. Domestic violence advocates are essential first responders and must be supported in ways that increase the resilience of empowerment-based services for victims and survivors.

Health and Wellness Outcomes of Intimate Partner Violence Support Workers: A Narrative Review

Workers who support survivors of intimate partner violence (IPV) witness some of the most traumatic acts of violence in their everyday work life. These experiences may cause distress that has implications for health and their ability to cope. This narrative literature review sought to explore what is known about the health, wellness, and coping strategies of IPV workers in diverse settings. A comprehensive academic literature search of five databases for peer-reviewed journal articles, available in English, published between January 2000 and October 2023 was conducted. A total of 34 articles on workers' experiences in relation to health, wellness, and coping strategies were included in the review. Thematic analysis generated the following themes: (a) diversity of IPV workplace settings and roles; (b) meaningful aspects of IPV support work including purpose and fulfillment, compassion satisfaction, rewarding and valuable work; (c) adverse experiences such as psychological distress and physiological discomfort, interpersonal social challenges, environment and organizational challenges, burnout, compassion fatigue and secondary trauma; and (d) coping strategies that considered coping behaviors and self-care, workplace support and accommodation, and meaningful sacrifice and adaptation. While the review provided important insights regarding the meaningful aspects of IPV support work and coping strategies, the adverse experiences of supporting survivors significantly dominated the literature. Unfortunately, the majority of studies did not clarify the context of workplaces, and this represents a gap in understanding workers' experiences. Future research is needed to understand context-related experiences of IPV support workers in relation to health and coping. The current review provides unique insights on diverse IPV support work settings and roles, work-related issues that may influence workers' wellness, and rewarding aspects of IPV support work.

Creating Healing-Centered Spaces for Intimate Partner Violence Survivors in the Postpartum Unit: Examining Current Practices and Desired Resources Among Health Care Providers and Postpartum People

Background: Intimate partner violence (IPV) has negative health impacts for pregnant people and their infants. Although inpatient postpartum units offer an opportunity to provide support and resources for IPV survivors and their families, to our knowledge, such interventions exist. The goal of this study is to explore (1) how IPV is currently discussed with postpartum people in the postpartum unit; (2) what content should be included and how an IPV intervention should be delivered; (3) how best to support survivors who disclose IPV; and (4) implementation barriers and facilitators. Materials and Methods: We used individual, semistructured interviews with postpartum people and health care providers (HCPs). Interview transcripts were coded and analyzed using an inductive-deductive thematic analysis. Results: While HCPs reported using a variety of practices to support survivors, postpartum people reported that they did not recall receiving resources or education related to IPV while in the inpatient postpartum unit. While HCPs identified a need for screening and disclosure-driven resource provision, postpartum people identified a need for universal IPV resource provision in the postpartum unit to postpartum people and their partners. Participants identified several barriers (i.e., staff capacity, education already provided in the postpartum unit, and COVID-19 pandemic) and facilitators (i.e., continuity of care, various HCPs) to supporting survivors in the postpartum unit. Conclusion: The inpatient postpartum unit is a promising setting to implement an intervention to support IPV survivors and their infants. Future research and intervention development should focus on facilitating universal education and promoting resource provision to IPV survivors.

Domestic firearm violence against women (2018-2021)

Background

Over 50 % of US female homicides occur during domestic violence, with half involving firearms. Public health measures to control COVID-19 may have isolated individuals with abusive partners at a time when firearm sales and new firearm ownership surged. This study sought to evaluate trends in domestic firearm violence (DFV) over time, hypothesizing that rates of DFV increased in the wake of COVID-19.

Materials and methods

A retrospective query of the Gun Violence Archive (2018-2021) was conducted for incidents of DFV. The primary outcome was the number of DFV-related shootings. Statistical testing, including one-way and two-way ANOVAs, was performed to compare monthly rates of DFV over time and to compare DFV per 100,000 women in states with strong versus weak gun laws.

Results

Average monthly DFV incidents rose nationwide during this study's time period, though injuries and fatalities did not. States with weaker gun laws had increased incidents, deaths, and injuries from 2018 to 2021 (all p<0.05). In a two-way ANOVA, stronger gun laws were associated with fewer incidents of DFV when compared with weaker gun law states. We also found that the use of a long gun in DFV more often resulted in a victim's death when compared to a handgun (p<0.01).

Conclusion

DFV incidents increased over time. States with weaker gun laws bore the brunt of the violence, demonstrating that DFV may be curtailed through legislative efforts. Methods of injury prevention aimed at preventing and reducing domestic violence and improving firearm safety may curtail DFV.

"It's Like Being a Parent at Work": Antiviolence Frontline Work, Boundaries, and Intimacy During COVID-19

COVID-19 profoundly shaped how service providers in the antiviolence sector interact with clients, coworkers, and community stakeholders. In addition to stressors inherent in antiviolence work, service providers negotiated new, challenging social distancing and remote communication strategies. In this paper, we analyze interviews with 23 antiviolence workers in the US Great Plains region, focusing on participants' descriptions of workplace boundaries and intimacy. We demonstrate how COVID-19 both expanded and contracted public/private boundaries and formal/informal connections in antiviolence workers' daily experiences. Pandemic conditions revealed the pressing need for frontline workers to exercise discretion over levels of intimate engagement with coworkers and clients.

Domestic Violence in the Context of the COVID-19 Pandemic: A Synthesis of Systematic Reviews

The current systematic meta-review aimed to map out, characterize, analyze, and synthesize the overarching findings of systematic reviews on domestic violence (DV) in the context of COVID-19. Specifically, a systematic meta-review was conducted with three main objectives: (1) to identify what types and aspects of DV during COVID-19 have been reviewed systematically to date (research trends), (2) to synthesize the findings from recent systematic reviews of the theoretical and empirical literature (main findings), and (3) to discuss what systematic reviewers have proposed about implications for policy and practice as well as for future primary research (implications). We identified, appraised, and synthesized the evidence contained in systematic reviews by means of a so-called systematic meta-review. In all, 15 systematic reviews were found to be eligible for inclusion in the current review. Thematic codes were applied to each finding or implication in accordance with a set of predetermined categories informed by the DV literature. The findings of this review provide clear insight into current knowledge of prevalence, incidence, and contributing factors, which could help to develop evidence-informed DV prevention and intervention strategies during COVID-19 and future extreme events. This systematic meta-review does offer a first comprehensive overview of the research landscape on this subject. It allows scholars, practitioners, and policymakers to recognize initial patterns in DV during COVID-19, identify overlooked areas that need to be investigated and understood further, and adjust research methods that will lead to more robust studies.

Lessons Learned From the COVID-19 Pandemic in the United States by Domestic Violence Coalition Leaders

This U.S. study explores lessons learned about domestic violence service delivery during the COVID-19 pandemic identified by state, territory, and tribal coalition leadership to advance preparedness and guide structural improvements for future disasters. Semi-structured interviews with 25 Coalition leaders identified public health control measures and victim-centered strategies used to mitigate the pandemic's impacts on services and advocacy. Three main themes emerged: workforce innovations, system empowerment, and the simultaneous pandemic of racial injustice. The COVID-19 pandemic inspired Coalitions to respond creatively and highlighted resources needed to support survivors and the domestic violence (DV) workforce going forward, including reassessing the current state of the DV movement.

Characterizing Intimate Partner Violence in the United States During the COVID-19 Pandemic: A Systematic Review

Intimate partner violence (IPV) is a significant global health concern. Numerous research studies document increases in IPV since the onset of the COVID-19 pandemic in March 2020. Despite this widespread recognition, research around the nature of this violence is still growing. This systematic review summarizes the existing literature documenting the prevalence and characteristics of IPV during the COVID-19 pandemic. Inclusion criteria are as follows: reported original data empirical study, assessed for IPV among adult population in the United States, and was published in English between December 2019 and March 2022. A total of 53 articles were then independently reviewed and sorted into four thematic subcategories: victimization, perpetration, articles addressing victimization and perpetration, and provider perspectives. Studies document consistent increases in the prevalence of IPV victimization and perpetration. Providers within agencies providing support to individuals impacted by IPV also documented increased strain on the agencies.

Receptivity towards Remote Service Delivery among Social Work Clients and Practitioners during COVID Times: A Systematic Review

PURPOSE

This systematic review aims to identify and synthesize the available evidence on the receptivity toward, perceived advantages and challenges of remote service delivery among social work clients and practitioners during the context of COVID-19.

METHOD

Two electronic databases were searched from 2020 to 2022. Identified papers were screened against the established eligibility criteria, yielding 15 papers. Two additional papers were further identified through hand-search. As heterogeneity of studies was high, a narrative synthesis was performed to summarize the overall evidence.

RESULTS

Our review provides evidence that remote service delivery holds the potential to increase access to services among selected client populations as well as promote a sense of empowerment for clients and opportunities for practice enhancement for practitioners.

DISCUSSION & CONCLUSION

The findings from our study highlighted the need for innovative solutions and practical considerations for ongoing remote service, including the careful considerations of social work clients' and practitioners' suitability, the need for provision of training and ongoing support to optimize practitioners' well-being. As the delivery of services transition to face-to-face or remain remote, further research is needed to assess the promise of remote practice in optimizing overall service delivery, while maintaining client-reported satisfaction.

Characterizing the impacts of public health control measures on domestic violence services: qualitative interviews with domestic violence coalition leaders

BACKGROUND

Prior to the availability of pharmaceutical control measures, non-pharmaceutical control measures, including travel restrictions, physical distancing, isolation and quarantine, closure of schools and workplaces, and the use of personal protective equipment were the only tools available to public health authorities to control the spread of COVID-19. The implementation of these non-pharmaceutical control measures had unintended impacts on the ability of state and territorial domestic violence coalitions to provide services to victims.

METHODS

A semi-structured interview guide to assess how the COVID-19 pandemic impacted service provision and advocacy generally, and how COVID-19 control measures specifically, created barriers to services and advocacy, was developed, pilot tested, and revised based on feedback. Interviews with state and territorial domestic violence coalition executive directors were conducted between November 2021 and March 2022. Transcripts were inductively and deductively coded using both hand-coding and qualitative software.

RESULTS

Forty-five percent (25 of 56) of state and territorial domestic violence coalition executive directors representing all 8 National Network to End Domestic Violence (NNEDV) regions were interviewed. Five themes related to the use of non-pharmaceutical pandemic control measures with impacts on the provision of services and advocacy were identified.

CONCLUSIONS

The use of non-pharmaceutical control measures early in the COVID-19 pandemic had negative impacts on the health and safety of some vulnerable groups, including domestic violence victims. Organizations that provide services and advocacy to victims faced many unique challenges in carrying out their missions while adhering to required public health control measures. Policy and preparedness plan changes are needed to prevent unintended consequences of control measure implementation among vulnerable groups as well as to identify lessons learned that should be applied in future disasters and emergencies.

"Our services are not the same": the impact of the COVID-19 pandemic on care interactions in women's shelters

BACKGROUND

Guidelines and regulations in response to the COVID-19 pandemic have significantly impacted the health care sector. We explore these impacts in the gender-based violence (GBV) services sector and, more specifically, in the context of women's shelters.

METHODS

Using an interpretive description and integrated knowledge mobilization approach, we interviewed 8 women's shelter clients, 26 staff, and conducted focus groups with 24 Executive Directors.

RESULTS

We found that pandemic responses challenged longstanding values that guide work in women's shelters, specifically feminist and anti-oppressive practices. Physical distancing, masking, and closure of communal spaces intended to slow or stop the spread of the novel coronavirus created barriers to the provision of care, made it difficult to maintain or create positive connections with and among women and children, and re-traumatized some women and children. Despite these challenges, staff and leaders were creative in their attempts to provide quality care, though these efforts, including workarounds, were not without their own challenges.

CONCLUSIONS

This research highlights the need to tailor crisis response to sector-specific realities that support service values and standards of care.

Epidemiologic Pattern and Injury Mechanism of Intimate Partner Violence-Related Ocular Trauma in the US

Importance

Intimate partner violence (IPV) is an important cause of death and disability worldwide. The literature estimates that 45% of IPV injuries involve the eyes. Many medical fields have increased IPV-related research; however, ophthalmology IPV research remains rare.

Objective

To evaluate the epidemiologic pattern and injury mechanism of IPV related to ocular trauma.

Design, Setting, and Participants

This study was a retrospective cross-sectional analysis with deidentified data using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes from the National Trauma Data Bank (NTDB), which is a data set collected by the American College of Surgeons. The NTDB is the largest US hospitalized trauma case database with submissions from more than 900 US facilities. Included in this analysis were the IPV-related ocular injuries of patients hospitalized between 2017 and 2019. Study data were analyzed from April 20 to October 15, 2022.

Exposures

IPV-related ocular injuries.

Main Outcomes and Measures

Ocular injuries and adult IPV trauma survivors were identified with the ICD-10-CM codes. The following demographic data were collected: sex, age, race and ethnicity, health insurance plan, substance misuse screening results, trauma level of hospital, the emergency department disposition, the total Glasgow Coma Scale score, the abbreviated injury scale, and caregiver at discharge.

Results

A total of 2598 of the recorded ocular injuries were associated with IPV. Patients had a mean (SD) age of 45.2 (18.4) years, and 1618 were female (62.3%). Most patients in the population sample (1195 [46.0%]) were aged 18 to 39 years. The race and ethnicity distribution was as follows: 629 Black (24.2%), 296 Hispanic (11.4%), 1358 White (52.3%), 229 other (8.8%), and 86 missing (3.3%). Insurance statuses were Medicaid (847 [32.6%]), Medicare (524 [20.2%]), private insurance (524 [20.2%]), and self-pay (488 [18.8%]). Women had greater odds of testing positive during alcohol screening (odds ratio [OR], 1.42; 95% CI, 1.21-1.67; P < .001). Black patients were most likely to have Medicaid (OR, 1.64; 95% CI, 1.35-1.99; P < .001), Hispanic patients were most likely to self-pay (OR, 1.96, 95% CI, 1.48-2.58; P < .001), and White patients were most likely to use Medicare (OR, 2.94, 95% CI, 2.33-3.73; P < .001).

Conclusions and Relevance

Social determinants of health were identified as key risk factors for IPV-related ocular injuries. Study findings highlight identifiable risk factors associated with IPV and ocular trauma that can contribute to IPV awareness among ophthalmologists.

Changes in Mental Health, Emotional Distress, and Substance Use Affecting Women Experiencing Violence and Their Service Providers during COVID-19 in a U.S. Southern State

Research conducted during the COVID-19 pandemic has revealed many unintended consequences of mandated safety precautions, including increased perpetration of intimate partner violence (IPV), increases in substance use, and worsening mental health conditions. We conducted a repeated, cross-sectional survey of survivors of IPV, a longitudinal survey of service providers working in an IPV shelter, and interviews with both. We conducted surveys at the beginning of the pandemic and nearly half a year later to assess mental health and, for clients, substance use. Results showed that two small samples of survivors living in the shelter in 2020 and 2021 experienced both mental health decline and increased use of substances. Qualitative data from in-depth interviews suggest that COVID-19-related restrictions mirrored survivors' experiences of power and control in violent relationships. Further, IPV service providers-essential workers during COVID-19-experienced stress associated with reports of burnout and mental fatigue. This study suggests that community-based organizations can help mitigate the impacts of COVID-19 on survivors of IPV but should avoid adding additional work for staff as service providers experienced mental and emotional stress.

Identifying the Preparedness Components for Sexual Violence in Natural Disasters: A Systematic Review

Background: The probability of sexual violence in areas affected by natural disasters may increase. An increase in the rate of unwanted pregnancies and subsequent intentional abortions, physical and mental injuries, and death can be the consequences of sexual violence. One of the characteristics of natural disasters is their unpredictability and ambiguity. Since decisions must be made quickly during the response, there must be adequate planning in advance, and preparedness in the community will reduce surprises in the responding organizations. This study aimed to identify the factors affecting the preparedness against sexual violence in natural disasters. Methods: In this study, an electronic search was performed in the MEDLINE (PubMed), Scopus, Web of Science, and ProQuest databases. Other search resources, such as Science.gov, Scienceopen.cond Meta-search engines, organizational websites, including UNICEF, UNFPA, and IFRC, as well as key journals and the International Disaster and Risk Conference were hand-searched from 1/1/1990 to 8/29/2021. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was used to select the studies, and the findings were finally analyzed by thematic analysis method using MAXQDA10 software. Results: A total of 40 papers out of a total of 2978 studies were considered in this analysis. Macropolicies, empowerment, contextualization, management and organization, command community-based, and responsive planning were the five primary categories that were found. Conclusion: Preparedness measures are highly important to respond promptly and effectively to sexual violence and should be integrated into disaster preparedness programs. The findings of this study can be used by disaster response managers and policymakers in developing and improving preparedness programs.

Effect of COVID-19 Italian Lockdown on Maxillofacial Trauma Related to Domestic Violence: A Retrospective Cohort Study

Background: This retrospective study aims to identify the potential reasons for the increase in maxillofacial trauma from domestic violence in the first COVID-19 lockdown and propose some strategies that could be effective in fighting it during any future pandemic events. Materials and Methods: The study was conducted on patients with maxillofacial trauma who arrived at the Maxillofacial Unit of the Magna Graecia University of Catanzaro from 9 March to 3 May 2020, who were compared with those registered in the same period in 2019. Inclusion criteria were: patients of both sexes and admission diagnosed with maxillofacial trauma with or without bone fracture. Exclusion criteria were: patients less than 7 years of age, maxillofacial trauma that occurred outside the established period, and patients unconscious or with unclear clinical history. Patients were divided into two groups according to the mechanism of injury (MOI): “domestic” and “non-domestic” trauma. Both descriptive and regressive statistical analysis was conducted using a Student’s t-test with a significance level set at p < 0.05. Results: The total number of maxillofacial fractures in 2020 was similar to 2019 (31 pcs in 2020 vs. 38 pcs in 2019). Before the lockdown, most of the trauma occurred in non-domestic settings (25% in 2020 vs. 76.67% in 2019), especially in road accidents (4.17% in 2020 vs. 20% in 2019). During the lockdown, most of the trauma occurred in a domestic setting (75% in 2020 vs. 23.33% in 2019), especially interpersonal violence (31.58% in 2020 vs. 14.28% in 2019). There were 7 cases of interpersonal violence recorded in 2020 (1 male and 6 female), compared to only one case (female) recorded in 2019, with a statistically significant p-Value (0.0475). Conclusions: The first COVID-19 lockdown has provided the opportunity to study the aetiology of domestic trauma due to interpersonal violence attributable to economic and social problems, all of which were aggravated by the impediment to requesting help due to the difficulty of contacting the services and the general slowdown in the ways out of violence. The analysis conducted and compared with data in the literature suggests the adoption of a proactive (and non-reactive) approach to combat domestic violence during pandemic events.

The impact of COVID-19 on domestic violence agency functioning: A case study

Initial evidence suggests that rates of intimate partner violence (IPV) increased at the beginning of the COVID-19 pandemic. However, much of the prevalence research has focused on survivors' experiences of IPV during the initial lockdown period from March to June 2020. The current study adds to this initial research by centering the experience of a domestic violence agency located in the United States, 3-months prior to, during, and after the COVID-19 lockdown. The results suggest a similar pattern across service utilization (e.g., total clients served, calls, safe house capacity) and survivor demographics (e.g., race/ethnicity, cisgender women and men), with an initial decrease in service utilization from pre-lockdown to lockdown and an increase, surpassing pre-lockdown, post-lockdown. The only deviations from this pattern of service utilization were for sexual minority individuals, whose service utilization continued to decline post-lockdown and Asian American/Pacific Islander and trans/gender-nonbinary survivors who rarely utilized services across the time period. Additionally, the domestic violence agency relied heavily on their existing finances, well-rounded staff training, and staff wellbeing throughout the pandemic. The unique challenges that COVID-19 provided demanded flexibility, increased technological utilization, and additional funding particularly for safe housing. Implications for future research, intervention, and policy change are provided below.

"At the Root of COVID Grew a More Complicated Situation": A Qualitative Analysis of the Guatemalan Gender-Based Violence Prevention and Response System during the COVID-19 Pandemic

A growing body of literature has documented an increased risk of gender-based violence (GBV) within the context of COVID-19 and service providers' reduced capacity to address this vulnerability. Less examined are the system-level impacts of the pandemic on the GBV sector in low- and middle-income countries. Drawing on the perspectives of 18 service providers working across various GBV-related sectors in Guatemala, we explored how the Guatemalan GBV prevention and response system operated during the COVID-19 pandemic. Findings highlight that the pandemic reinforced survivors' existing adversities (inadequate transportation access, food insecurity, digital divides), which subsequently reduced access to reporting, justice, and support. Consequently, the GBV prevention and response system had to absorb the responsibility of securing survivors' essential social determinants of health, further limiting already inflexible budgets. The pandemic also imposed new challenges, such as service gridlocks, that negatively affected survivors' system navigation and impaired service providers' abilities to efficiently receive reports and mobilize harm reduction and prevention programming. The findings underscore the systemic challenges faced by GBV service providers and the need to incorporate gender mainstreaming across public service sectors-namely, transportation and information/communication-to improve lifesaving GBV service delivery for Guatemalan survivors, particularly survivors in rural/remote regions.

Addressing the Behavioral Health Needs of Sexual and Gender Minorities During the COVID-19 Pandemic: a Review of the Expanding Role of Digital Health Technologies

PURPOSE OF REVIEW

To review the role of digital health technologies in behavioral health treatment and promotion for sexual and gender minorities (SGM).

RECENT FINDINGS

Digital technologies have advantages and limitations at multiple levels in addressing SGM's behavioral health needs. For patients, digital technologies improve convenience and may reduce stigma; however, privacy concerns in the home may limit their utilization. Providers also benefit from the convenience of these technologies; however, not all providers are comfortable delivering virtual care to SGM. For society, digital technologies reduce transportation-related costs and increase access to healthcare in an increasingly hostile political climate for SGM; however, these advantages are limited by technological access and anti-SGM policies. Digital technologies can improve the behavioral health of SGM at the patient, provider, and systemic levels. Further efforts are necessary to standardize provider training, improve SUD-specific care delivery, and increase quality and accessibility of these technologies.

The impact of the COVID-19 pandemic on child protective services caseworkers and administrators

BACKGROUND

The COVID-19 pandemic has impacted children and young people experiencing child abuse and neglect. Child Protective Services (CPS) has played an important role in supporting children and families during the COVID-19 pandemic. Few studies to-date have evaluated the impact of the pandemic on CPS caseworkers and administrators in the United States.

OBJECTIVES

We conducted interviews to explore CPS caseworkers' and administrators' experiences working and serving families during the pandemic.

METHODS

Participants were U.S.-based CPS caseworkers and administrators. We conducted semi-structured virtual interviews with participants and used an inductive thematic analysis approach.

RESULTS

We conducted 37 interviews. Participants discussed how the COVID-19 pandemic has changed the way they conduct investigations and provide services to families in the CPS system. Several services were adapted to occur virtually, providing challenges and unique opportunities. Participants also described the personal barriers they faced during the pandemic, including working remotely, experiencing burnout, and challenges obtaining personal protective equipment. Finally, participants shared creative solutions they engaged in to support children and families during the COVID-19 pandemic, including expanding collaborations with other community-based organizations.

DISCUSSION

This study suggests the important role that CPS has played during the pandemic and challenges individual CPS workers felt, in terms of both experiencing burnout and difficulty obtaining personalized protective equipment. Inclusion of the CPS system in emergency preparedness planning for future pandemics or natural disasters will ensure continuation of these vital services.

"We're so limited with what we actually can do if we follow all the rules": a qualitative study of the impact of COVID-19 public health protocols on violence against women services

Background

Violence against women (VAW) is a major public health problem that grew worse during the COVID-19 pandemic. While all services were impacted by changing pandemic guidance, VAW shelters, as congregate settings with multiple funders and regulators, faced unique challenges.

Methods

We conducted a qualitative analysis of interviews with 26 women’s shelter staff and eight women accessing care, as well as 10 focus groups (five each at two time points approximately a year apart) involving 24 leaders from VAW and related services in Ontario, Canada.

Results

We identified eight overlapping themes specific to government and public health COVID-19 regulations and their application in women’s shelters. Overall, inconsistency or lack of clarity in rules, and how they were communicated, caused significant stress for women using, and staff providing, services. Staff and leaders were very concerned about rules that isolated women or replicated other aspects of abusive relationships. Women wanted to understand what options were available and what was expected of them and their children in these spaces. Leaders sought clarity and consistency from their various government funders, and from public health authorities, in the face of ever-evolving directives. As in the broader public, there was often the perception that the rules did not apply equally to everyone, for example, for women of colour using VAW services, or those whose first language was not English.

Conclusions

In the absence of consistent pandemic guidance and how to implement it, many VAW services devised tailored solutions to balance safety from COVID-19 with women’s physical and emotional safety from abuse and its impacts. However, this was difficult and exhausting. A key policy implication is that women’s shelters are a distinct form of congregate housing; they are very different in terms of services provided, size, type and age of facilities from other congregate settings and this must be reflected in public health directives. Better communication and synchronization of policies among government funders and public health authorities, in consultation with VAW sector leaders, would mean protocols tailored to minimize harm to women and children while protecting health and safety.

Crisis Work Embedded in a Global Crisis: The Early Phase Impact of COVID-19 on Survivors of Intimate Partner Violence and Service Provisions

COVID-19, as a global pandemic, was a public health inflection point for individuals affected by intimate partner violence (IPV) and those who provide IPV services. Public health guidelines that were intended to reduce risk of exposure to the virus impacted vulnerability factors for IPV survivors and associated systems of services. We aimed to (1) explore the effect of COVID-19 on survivors of IPV; (2) assess the effect of COVID-19 on IPV-related service provisions and service providers; and (3) explore challenges and opportunities in the wake of COVID-19 on broader IPV services and advocacy.

METHOD

Twelve directors of IPV shelter, criminal justice, and other advocacy services within a diverse, Midwestern metropolitan area were recruited to participate in in-depth, semi-structured interviews in June-August 2020. Interviews were transcribed verbatim and analyzed using Dedoose. Data were coded and analyzed through thematic analysis.

RESULTS

Four major themes, contextualized by COVID-19 and racial injustice, emerged from the data analysis: (1) IPV-related trends; (2) impact on IPV survivors, services, and agency morale; (3) inter-agency collaborations; and (4) future opportunities for innovative service delivery. Gaps and opportunities for developing culturally congruent, trauma-informed services were identified.

CONCLUSION

Findings suggest that responsive and accessible IPV resources and associated advocacy services can make the difference between life and death for survivors.

Parental intimate partner violence and abuse during the COVID-19 pandemic: Learning from remote and hybrid working to influence future support

OBJECTIVES

The COVID-19 pandemic has exacerbated intimate partner violence and abuse. Incidents of intimate partner violence and abuse have increased as a result of household tensions due to enforced coexistence (multiple national lockdowns and working from home practices), economic stress related to loss of income, the disruption of social and protective networks and the decreased access to support services. This study aimed to understand how female survivors of parental intimate partner violence and abuse have experienced the adapted multi-agency response to intimate partner violence and abuse during the pandemic and consider learning from remote and hybrid working to influence future support.

METHOD

This study adopted a qualitative research design, utilizing semi-structured interviews and a focus group. Data collection took place between March and September 2021. In total, 17 female survivors of intimate partner violence and abuse took part in the project; we conducted the semi-structured interviews via telephone (n = 9) and conducted an online focus group (n = 8).

RESULTS

Findings identified that services for those experiencing intimate partner violence and abuse need to be innovative, flexible and adaptable and 'reach out' to survivors rather than waiting for survivors to 'reach in' and ask for support. Findings show that the digital space highlights 'missed opportunities' for engagement with both professionals and peers and the potential for digital poverty is a key implication, which risks entrenching existing inequalities.

CONCLUSION

In-depth consideration needs to be given to the design, delivery and evaluation of online interventions and provision of support to improve access and acceptability of services, maximize their effectiveness and to support the safety of survivors.