Crisis Impact: Social Workers Confront Pandemic While Caring for Others

By Alison Laurio

woman stands looking at huge coronavirus molecules

The first case of COVID-19 in the United States was reported in January. On June 1, the Johns Hopkins University of Medicine Coronavirus Resource Center stated more than 1.9 million cases had been reported in the U.S., and at least 110,047 people had died.

The pandemic has been a nationwide crisis for most of this year, and though social workers are deemed essential workers, they have remained largely in the background. But many have raised awareness about what social workers do and how their skills are more relevant than ever. They’ve done this by way of interviews with major media outlets and by writing their own opinion pieces for newspapers and other publications.

Social workers also continue caring for their clients during this pandemic, and many are on the front lines in hospitals or nursing homes, helping the families of those who are ill as well as the doctors and nurses who treat them. Social workers, too, face personal protective equipment shortages and the fears of taking the virus home to their families.

Impact on Social Workers

As NASW-Virginia Executive Director Debra Riggs wrote in an op-ed piece in Virginia’s Richmond-Times Dispatch: “No one is holding drive-by recognition parades for social workers, with their professional culture of modesty and deep discretion.”

Riggs said she wrote the op-ed because she wanted to be a voice for social workers. “Everybody experiences all the horrors and tragedies in our communities, the results of this COVID virus. I started to really get frustrated that social workers do so much and are so misunderstood. They have no true voice, and the public doesn’t understand who they are and what they do for the community.”

As a chapter executive director, Riggs has received calls from members who don’t want to lose their jobs but also don’t want to go to work without proper PPE. One thing is, social workers think they shouldn’t campaign for themselves, Riggs said. “In school, we learn to be an advocate and change agent, and if you do that for yourself, you’re selling your social work soul. But that guidance, those ethics, do help (us) help clients.”

Riggs, who is executive director for both the Virginia and Washington, D.C., chapters of NASW, said “the system often disenfranchises (social workers) or gives them less money or allows them no voice, so I decided that I’m going to be their voice.”

We Are Not Alone

Sandra A. Lopez, MSW, LCSW, ACSW, DCSW, a retired clinical professor from the University of Houston Graduate College of Social Work, has an active clinical and consulting practice in Houston. She offers training in self-care and resiliency, trauma-informed care, grief and trauma, and clinical supervision. She works primarily with individuals who have experienced tragic loss or trauma.

“All of us in this nation and globally are experiencing significant impact,” Lopez said. “The uncertainty likely is the most disturbing piece for most of us... yet all of us are impacted.”

Everyone has faced losses and adjustments, both in our personal and professional lives, and things are not the way they were before. That has caused increased levels of stress, frustration, worry and grief for many of us, she said. “The uncertainty likely is the most disturbing piece for most of us to manage, given that there are so many unknowns about when we will be totally back to even a ‘new normal.’”

The level of impact depends heavily on variables such as where someone practices, the type of work they do, and the level of administrative support. Those who see clients in office settings, for example, may be facing lost income.

“What I believe is the most challenging for us as social workers is that we have all been thrust into a dual world where we are in the role of helper and the role of griever, as the pandemic is impacting us as human beings as well,” Lopez said. “This has placed us in a unique role of helping others at a time when we may be needing our own support. This clearly emphasizes the need for all of us to heighten and maximize our self-care practices to face these pandemic times.”

Considering the importance of stress prevention, it is important “to heighten and harness our self-care strategies,” she said. “It does help to have self-care strategies that reflect all of our various life dimensions, like physical, recreational, social, spiritual, interpersonal, professional, nutritional, psychological and emotional. It is time for us to especially call upon effective practices such as self-compassion, mindfulness, gratitude and optimism.”

“Staying focused, grounded and present in our work or home life is important to living life to its fullest — even in times of great uncertainty,” Lopez said. “Above all else, we must accept and honor our emotional experiences, as we will all have moments of sadness, distress, grief, anger and more.”

Texas Impact "Complicated"

The overall impact on social workers in Texas is “complicated,” said Will Francis, NASW-Texas executive director. There is “anxiety and concern” over how they can respond and support their families and communities while staying safe.

Gov. Greg Abbott’s phased reopening plan began in April, and Francis said the chapter was providing information to members as reopening continued. “We were called essential workers, but that means risky situations for some.”

Clients face inequities, and members are wondering, “how can I help, how can I respond, and how can I keep myself safe?” he said. “When you think about best practices and safety, you always have to put safety first.”

The chapter is providing a lot of information, and most of the questions are about telehealth — a big issue for the many members who moved to it, Francis said. “There is a lot of anxiety, and a lot of people are anxious to go back to the office,” although many don’t want to, he said.

Overall, the virus “exposed a lot of problems,” Francis said, and “people of color have been hit hard. There are a lot of social justice issues from this pandemic.”

Some members who live in smaller towns say when they wear masks in public, “it’s considered a political stunt,” he said.

Many Texans think it all has passed. “Here in Texas, it’s a balance between liberty and community, and there is tension between those,” Francis said.

Frontline Voices

While sheltering in place at home, Laura S. Abrams started wondering how her school’s graduates were doing.

“It all started when a colleague, a nurse practitioner, said she didn’t want to go back to work because she was nervous,” Abrams said. “I started thinking we have social workers out there. Do they have to work? I wanted to know what’s going on.”

That became the inspiration for a project with a colleague. Abrams, MSW, PhD, and chair and director of Social Welfare at the UCLA Meyer and Rene Luskin School of Public Affairs in Los Angeles, contacted Alan J. Dettlaff, dean and Maconda Brown O’Connor Endowed Dean’s Chair at the University of Houston College of Social Work.

Zoom interviews were done with graduates, and the pair wrote “Voices from the Frontlines: Social Workers Confront the COVID-19 Pandemic,” which NASW Press is publishing. They write in introductory remarks that late in March as cases began spiking, shelter in place orders were “implemented in all but eight states,” and “essential services,” including health care and social services agencies, were mainly exempted.

“Within these essential services, many social workers are putting themselves, and their loved ones, at risk of infection as they continue to perform their work with clients and organizations,” they wrote. “Yet compared with coverage of other helping professionals, the media has reported almost no information about social workers’ risks, access to personal protective equipment or professional responses to the pandemic. We believe social work is more vital than ever, and as such, social workers’ experiences on the frontlines of the pandemic warrant deep attention.”

The 16 people interviewed are MSW alumni of both schools, and the goal was not a “traditional qualitative research study,” but to present information from alumni working “in a variety of settings and involved in direct services, organizations, and policy work during the height of the pandemic.”

The findings include direct service practitioners, some who are with dying patients because their families and friends cannot be there. One palliative care social worker described the emotional toll while trying to connect patients with families via technology “while knowing that people are still suffering and dying alone.”

“Social workers also are aware that they will see their clients become infected, lose access to quality health care, and die without recognition,” Abrams and Luskin wrote. One of those, a social worker doing outreach on the Los Angeles streets, “has prepared her team for the reality that they may be the last people to witness and honor their clients’ core humanity.”

“She stated that due to the unprecedented nature of the pandemic, social workers are ‘building the bridge as they are crossing it.’”

Abrams said they would like for students to see it, and it’s an oral history capturing two weeks of what was going on at that time.

“We can learn from it,” she said. “We know what social workers were going through the first few weeks of COVID-19, and that’s interesting. It’s an historical record.”

Human Resilience

People already were facing increased stress in a global context before the COVID-19 pandemic hit and the murder of George Floyd happened on a Minneapolis street, but those two major events took an additional toll, said Kristen Lee, MS, Ed.D., associate teaching professor and lead faculty, Behavioral Sciences, at Northeastern University College of Professional Studies in Boston.

She’s calling this an age of anxiety, and lists as drivers financial instability, competing roles and responses, an increasing level of social awareness and, over the last decade, a 33 percent rise in perfectionism.

“One of the driving factors is social comparison,” Lee said. “I think that’s because of our social media world.”

Those were defining stress levels before the pandemic hit, creating fears over loss of health, life, livelihood and mobility. Some daily stress can be good. It can help you focus and get something done, Lee said. Disruptive stress, however, affects a person’s quality of life and well-being.

“The levels of stress right now can feel unprecedented,” she said. The impact on mental health from the pandemic is “very intensive across the spectrum.”

“What we’re seeing is loss of identity, people in job roles feel the loss of regular routines and rhythms, there’s a sense of fear about life and livelihood, and a great deal of anxiety for our own well-being and that of those we love,” she said. People also are confronted with a broken health care system and inequalities, and are seeing those “on a grander scale.”

“One of the main concerns as social workers is the ethos and mission — to protect the underserved and marginalized population. And that is most affected during this time,” Lee said. Our brains are wired so having a plan, a structure can help us endure something, no matter how long, she said, but our brains do not do well with anxiety, and now the anxiety is palpable. “I think social workers are extraordinary in their commitment to be on the front line at this time,” Lee said. “There’s a tremendous opportunity for service, and at the same time, a tremendous burden on social work.”

Resilience is known as the process of adaption while enduring hardship and adversity, she said. “We all are wired so we’re capable of cultivating it. That comes through deliberate action, through mindsets, attitudes and behavior.”

“Some people think they’re born with it — or not — or it’s a matter of being really strong or tough or gritty. From what we know, it is the ability to be agile in difficult circumstances, the ability to leverage what is called protective factors.”

Those nudge you toward well-being and mental health, and include sustaining relationships, community, a sense of humor, faith, hope and optimism, she said. What challenges that are things Americans are commonly told, including: suck it up, pretend you’re OK, or that’s just how you’re wired.

“There’s a lot we can do to protect ourselves,” Lee said. “All of us are capable of harnessing resilience. I think social workers should give themselves permission to cultivate resilience.”

This can be developed through activities the field already is aware of and uses, including self-care, mindfulness, meditation, getting therapy for ourselves, assuring a strong support system is in place and attentiveness to mind, body and soul. Resilience happens in community, in relationships and in communication with people and purpose, she said. “It’s a strength-based perspective which we can build off of, and we are wired for it. It helps sustain us.”

We Must Remember

We know one prior pandemic — the 1918 Spanish flu — returned with a vengeance after the initial outbreak. COVID-19 may not return, but it — or another one — could. What must we remember if this virus returns, or the next time something like this happens?

Riggs: Remember to be flexible.
“From an association perspective, an executive director needs to provide services and programs. Being flexible is really important. When things happen you can’t always operate the way you did. You have to be flexible and have a vision to operate in whatever vision that is. You have to be nimble and willing to take a risk.”

Lopez: Remember we know how to instill and maintain hope.
“I think the hard lesson here is that we have learned through the pandemic that our lives can be changed in a split second. We learn, too, that although we live our lives as if we have complete control, at times like this, we see we have little control. In the end though, we are social workers, and we learn early on how to instill hope and to maintain hope even in times where there is a great sense of hopelessness and despair.”

Abrams: Remember people helped others.
“A lot of people came together to provide meals for the elderly and their neighbors, which changed that environment. And we saw a lot of counties, cities and states let out a lot of people from jails. Why don’t we do that all the time?”

Francis: Remember we need a national plan.
“We need to remember that testing is vital, and that we need to develop and retain a national plan for dealing with a pandemic. We need strong leadership that places safety and well-being first, as opposed to a fractured response across the states. Medical guidance should be the policy driver, and not economics or a dismissive skepticism. I hope that ultimately what we learn from this is that a coordinated response by a strong leader will save more lives.”

Lee: Remember to address inequalities to lessen future damage.
“Because the pandemic exposes the inequities in our society, we need macro work to prevent and mitigate future crises. If we’re always working for justice, always working toward equality, assuring people have housing and education, that’s vital because the pandemic exposes inequities. We need to not react to the crisis but work to prevent and mitigate future crises. That’s critical.”


Code of Ethics Firm Amid Coronavirus Chaos

Many things are changing during the coronavirus pandemic, but social work ethics are not one of them. NASW’s Office of Ethics and Professional Review provides free individual ethics consultations as an NASW membership benefit.

NASW Senior Ethics Associate Andrea Murray recently wrote on the Social Work Blog that the pandemic has brought about ethical dilemmas that “would have been considered fodder for a disaster movie plot not too long ago, yet today these dilemmas are reality.”

States and employers have initiated various requirements, guidance and demands, and family concerns are always in mind.

But “the NASW Code of Ethics stands unwavering,” Murray wrote. “When you open the Code in the face of a complex ethical dilemma, you can still find the ingredients necessary to come up with an ethical solution.”

Members who need help or guidance can call 800-742-4089 Mondays and Wednesdays from 1 to 4 p.m., and on Tuesdays and Thursdays between 10 a.m. and 1 p.m.

Calls are not prescheduled. Allow 24 hours for a return call, due to high call volume.

Read "Social Work Ethics During the Time of Pandemic".

Social Justice Brief on COVID-19 Covers Issues, Offers Resources

NASW’s Social Justice Brief, Implications of Coronavirus (COVID-19) for America’s Vulnerable and Marginalized Populations, was published in April 2020.

Senior Policy Consultant Mel Wilson states that his overview in the brief “succinctly discusses several major population groups who are at high risk of exposure to or contracting the novel coronavirus.” Also included are two “very important intersectional events (the 2020 elections and the 2020 Census), both of which could have a negative impact on those who are marginalized.”

In each of 10 separate subject areas, Wilson addresses issues that include the population groups at high risk; issues and impacts for them; any additional factors; the consequences; and what is needed to help. Additional resources, including links, also follow each subject area. The subject areas are:

  • Economic Impact on Low-income Americans
  • Incarcerated, Detained and Justice-Involved Individuals
  • Detained Immigrants
  • Immigrant Families
  • Homeless Populations
  • Older Americans and Long-Term Care Facilities
  • Child Welfare and Foster Care
  • COVID-19 Social Determinants of Health
  • The 2020 Census
  • Voting Rights

In summarizing, Wilson wrote that the pandemic “is a threat to the physical well-being of Americans, but will, with certainty, disrupt the economic and social stability of many individuals and families. This means that vulnerable and marginalized populations are at very high risk for bearing the brunt of the pandemic. Given social work’s long history of social action to help mitigate the negative impact of national public health crises on those with less resources, we are again asked to respond.”

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