1
|
Steele B, Shastri P, Moses C, Tremblay E, Arcenal M, O'Campo P, Mason R, Du Mont J, Hujbregts M, Sim A, Yakubovich AR. The mental health of staff at violence against women organizations during the COVID-19 pandemic: Findings from a mixed-methods study of service providers in Canada's largest city. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024:10.17269/s41997-024-00904-7. [PMID: 39073552 DOI: 10.17269/s41997-024-00904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/27/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES Staff at violence against women (VAW) organizations provide essential services for survivors of violence. The increase in VAW during the COVID-19 pandemic placed additional pressures on VAW staff. We investigated the impacts of the pandemic on the mental health of VAW staff in the Greater Toronto Area to inform recommendations for policy and practice. METHODS We conducted a community-based, mixed-methods study on the processes, experiences, and outcomes of adapting VAW programming during the pandemic using a sequential explanatory approach. Throughout 2021, we conducted a survey of direct support and leadership staff who worked on VAW services ("VAW staff") followed by semi-structured interviews with VAW staff purposively sampled from the survey. We descriptively analyzed quantitative survey data on the mental health of 127 VAW staff. We then applied thematic analysis to qualitative data from 18 interviews with VAW staff. We used the qualitative data to support interpretation and enrich the quantitative findings regarding staff mental health. RESULTS In the survey, 81% of leadership and 61% of direct support staff indicated that their work was more distressing during the pandemic. Participants reported moderate symptoms of vicarious trauma and mild symptoms of anxiety and depression. We generated three themes from the qualitative data to help explain these findings: (1) challenges related to changing work environments; (2) distress over not meeting client needs; and (3) difficulties in adapting self-care strategies in response to pandemic stressors. CONCLUSION VAW organizations require increased resources and flexible funding to hire and retain more staff to respond to higher and more complex caseloads during public health emergencies. With more structural supports in place, VAW organizations could create more time and space to develop their trauma-informed organizational practices: for example, establishing a culture of connection and learning among staff virtually and in-person and facilitating a range of self-care opportunities.
Collapse
Affiliation(s)
- Bridget Steele
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
| | - Priya Shastri
- Woman Abuse Council of Toronto, Toronto, ON, Canada
- Toronto Region Violence Against Women Coordinating Committee, Toronto, ON, Canada
| | - Catherine Moses
- Woman Abuse Council of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Tremblay
- Woman Abuse Council of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Monique Arcenal
- Woman Abuse Council of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Robin Mason
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Janice Du Mont
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Maria Hujbregts
- Family Service Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amanda Sim
- McMaster University, Hamilton, ON, Canada
| | - Alexa R Yakubovich
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Nova Scotia Health, Halifax, NS, Canada
| |
Collapse
|
2
|
Burd C, McLean I, MacGregor JCD, Mantler T, Veenendaal J, Wathen CN. "Our services are not the same": the impact of the COVID-19 pandemic on care interactions in women's shelters. BMC Womens Health 2023; 23:427. [PMID: 37568155 PMCID: PMC10422783 DOI: 10.1186/s12905-023-02541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 07/12/2023] [Indexed: 08/13/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Caitlin Burd
- Faculty of Information and Media Studies, Western University, 1151 Richmond St, N6A 5B7, London, ON, Canada.
| | - Isobel McLean
- School of Architecture and Landscape Architecture, University of British Columbia, Vancouver, BC, Canada
| | | | - Tara Mantler
- School of Health Studies, Western University, London, ON, Canada
| | - Jill Veenendaal
- Faculty of Information and Media Studies, Western University, 1151 Richmond St, N6A 5B7, London, ON, Canada
| | - C Nadine Wathen
- Mobilizing Knowledge on Gender-Based Violence, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| |
Collapse
|
3
|
Shroff FMC. Flames of transformation: Igniting better mental and physical health for racialized and gendered North Americans. Front Glob Womens Health 2023; 4:1126934. [PMID: 36860346 PMCID: PMC9968936 DOI: 10.3389/fgwh.2023.1126934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/05/2023] [Indexed: 02/15/2023] Open
Abstract
COVID-19 is catalyzing both crises and opportunities for communities of color. The crisis of high mental and physical morbidities and mortalities exposes persistent inequities while providing opportunities to celebrate the power of rejuvenated anti-racism movements, fueled partly in response to the extremism of ultra-conservative governments, the circumstances to reflect deeply on racism because of forced stay-at-home-orders, and digital technologies primarily driven by youth. In marking this historical moment of longstanding anti-racism and decolonial struggles, I assert the importance of foregrounding women's needs. In analyzing racism, rooted in colonialism and white supremacy, and its impacts on mental and physical health status, I focus on improving racialized women's lives within the larger context, concentrating on the determinants of health. I contend that fanning the flames to scathe the racist and sexist foundations of North American society will break new ground for sharing wealth, bolstering solidarity and sisterhood, and ultimately improving Black, Indigenous, and Women of Color (BIWOC) health. Canadian BIWOC earn approximately 59 cents to the dollar earned by non-racialized men, creating vulnerabilities to economic downturns, such as the one Canada is currently in. BIWOC care aides, at the bottom of the healthcare hierarchy, are emblematic of other Black, Indigenous, and People of Color (BIPOC), who face risks of frontline work, low wages, poor job security, unpaid sick days and so forth. To that end, policy recommendations include employment equity initiatives that hire groups of racialized women who consciously express solidarity with each other. Cultural shifts within institutions will be key to providing safe environments. Improving food security, internet access and BIWOC-related data collection linked to community-based programming while prioritizing research on BIWOC will go a long way toward improving BIWOC health. Addressing racism and sexism within the healthcare system, aiming for equitable diagnostic and treatment foci, will require transformative efforts including determined leadership and buy-in from all levels of staff, long-term training and evaluation programs, audited by BIPOC communities.
Collapse
Affiliation(s)
- Farah Mahrukh Coomi Shroff
- Department of Family Practice and School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada,Maternal and Infant Health Canada, Vancouver, BC, Canada,Correspondence: Farah Mahrukh Coomi Shroff
| |
Collapse
|
4
|
Mantler T, Shillington KJ, Yates J, Tryphonopoulos P, Jackson KT, Ford-Gilboe M. Resilience is more than Nature: An Exploration of the Conditions that Nurture Resilience Among Rural Women who have Experienced IPV. JOURNAL OF FAMILY VIOLENCE 2022:1-11. [PMID: 36530539 PMCID: PMC9734538 DOI: 10.1007/s10896-022-00479-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Purpose Intimate partner violence (IPV) is a significant public health concern exacerbated by the pandemic. Experiences of violence vary based on geographic location and living in rural communities has been found, in some contexts, to amplify consequences of IPV. Resilience, the ability to survive and thrive despite facing adversity, has long been a dominant narrative within IPV literature, yet little is known about how resilience is cultivated among rural women experiencing violence. The purpose of this study was to explore how rural women experiencing IPV cultivate resilience. Methods Using Interpretive Description, in-depth qualitative interviews were conducted with 14 women who experienced IPV and 12 staff from women's shelters across rural communities in Ontario, Canada to elicit perspectives about women's resilience and environmental conditions that may shape resilience in the context of IPV. Results Women's resilience was cultivated by personal changes aimed at surviving or thriving, and aspects of their environment that enabled or created barriers for resilience. Women adopted a positive, hopeful mindset and bolstered their inner strength through living from a place of integrity, being resolute in decisions, and using mental resistance when faced with doubt. Women faced barriers to resilience in the form of unhelpful help and COVID-19 public health guidelines. Paradoxically, living in a rural community both cultivated and undermined resilience. Conclusions Supporting women to cultivate resilience through modifying environmental factors to enable personal strengths to flourish is paramount in supporting women who have experienced IPV, particularly in rural contexts.
Collapse
Affiliation(s)
- Tara Mantler
- School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, HSB Room 332, 1151 Richmond Street, London, Ontario N6A 5B9 Canada
| | - Katie J. Shillington
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| | - Julia Yates
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| | - Panagiota Tryphonopoulos
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| | - Kimberley T. Jackson
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| |
Collapse
|
5
|
Wathen CN, Mantler T. Trauma- and Violence-Informed Care: Orienting Intimate Partner Violence Interventions to Equity. CURR EPIDEMIOL REP 2022; 9:233-244. [PMID: 36212738 PMCID: PMC9527731 DOI: 10.1007/s40471-022-00307-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/01/2022]
Abstract
Purposeof Review Intimate partner violence (IPV) is a complex traumatic experience that often co-occurs, or is causally linked, with other forms of structural violence and oppression. However, few IPV interventions integrate this social-ecological perspective. We examine trauma- and violence-informed care (TVIC) in the context of existing IPV interventions as an explicitly equity-oriented approach to IPV prevention and response. Recent Findings Systematic reviews of IPV interventions along the public health prevention spectrum show mixed findings, with those with a theoretically grounded, structural approach that integrates a trauma lens more likely to show benefit. Summary TVIC, embedded in survivor-centered protocols with an explicit theory of change, is emerging as an equity-promoting approach underpinning IPV intervention. Explicit attention to structural violence and the complexity of IPV, systems and sites of intervention, and survivors’ diverse and intersectional lived experiences has significant potential to transform policy and practice.
Collapse
Affiliation(s)
- C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, Room 2307, London, ON N6A 5B9 Canada
| | - Tara Mantler
- School of Health Studies, Western University, London, Canada
| |
Collapse
|
6
|
Wathen CN, Burd C, MacGregor JCD, Veenendaal J, McLean I, Mantler T. "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. BMC Public Health 2022; 22:1175. [PMID: 35698104 PMCID: PMC9189787 DOI: 10.1186/s12889-022-13550-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- C Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, ON, N6A 5B9, London, Canada.
| | - Caitlin Burd
- Faculty of Information & Media Studies, Western University, ON, London, Canada
| | | | - Jill Veenendaal
- Faculty of Information & Media Studies, Western University, ON, London, Canada
| | - Isobel McLean
- School of Architecture & Landscape Architecture, University of British Columbia, 402 - 6333 Memorial Road, BC, V6T 1Z2, Vancouver, Canada
| | - Tara Mantler
- School of Health Studies, Western University, ON, London, Canada
| |
Collapse
|