Ten Ways COVID-19 Created the Perfect Storm for Social Worker Burnout (and why I still have hope)
Editor’s note: This post was written by Melanie Sage from the University at Buffalo’s School of Social Work in response to the COVID-19 pandemic. She originally posted it on LinkedIn and is re-published here with her permission. This is a follow-up to her post – A Love Letter to Social Workers on the Front Lines of COVID-19. You can follow Melanie on Twitter at @melaniesage.
In April 2020, just months into the pandemic that changed the landscape of how we work and live globally, and in the face of concerted love to health workers, I wrote a love letter to social workers, the invisible heroes of the emerging pandemic. The letter spread like fire, viewed by more than 100,000 people. Many social workers resonated with the stories I shared and many people who work with social workers also expressed their gratitude for the steady dedication of social workers.
As we move into a new year, I feel called to update people about the state of affairs from my point of view. As a university professor, I do not work with clients directly. However, this past year, I have witnessed the impacts of COVID-19 on students, their families, and their clients. Despite instructors’ flexibility, we’re losing students like never before – they are leaving school, often without a word. Sometimes we hear; a family member has fallen sick or they just can’t manage homeschooling for their children, working from home, AND going to school online. Who can blame them for delaying their educational ambitions to take care of their families? For some, it’s not a matter of choice; it’s a matter of surviving these times.
For those students who have held on, the required social work internships have evolved dramatically. Social work students deliver services online, learn remotely, and show up to social services agencies in deep transition. Undoubtedly some innovation will come from this, but also some workers will leave and not return. Their education did not prepare them for the use of technology, for working from home, for the high risk of infection, for the chronic long term crisis work they face now.
How did COVID-19 create the perfect storm for social worker burnout? Social workers told me.
#1 – Client needs are increasing as services simultaneously decrease. Jamie is a maternal and child social worker in New York. COVID is causing preterm births for pregnant women who become infected with the virus, she says. After birthing a premature baby, some mothers with COVID develop pneumonia, changing the face of the critical period of early parenting. They are sent home with oxygen and a medically fragile newborn. The Neonatal Intensive Care Unit is overflowing with patients. Before COVID, mothers would be able to bunk in a room with their infants who need NICU to promote bonding, but now there are not enough beds for that. Parents are allowed a total of four hours a day in the NICU; two parents can share those hours but must come one at a time. Breastfeeding is nearly impossible. The needs are more intense for new parents at every turn. Still, just one social worker in her hospital covers NICU plus pediatrics, maternity, labor and delivery, and two outpatient OB-GYN clinics. It is too much, especially given the increased intensity of the needs faced by families. Previously, public health home visitors would see high-risk families after discharge, but most of these visits are also on hiatus. Even in the hospital, ancillary services are wiped out by COVID; Jamie can’t even get new babies signed up for medical insurance due to staff shortages. Social workers are like the canaries in the coal mines, detecting trends on the ground before they are detected in any statistical analysis. Jamie knows, absent a report, that these vulnerable families are off to rocky starts and that it will have reverberating impacts.
#2 – Social workers are asked to facilitate services remotely that can’t be managed online, but in-person services also come with untenable risks. Carol, a school social worker, serves youth with serious physical disabilities. She describes a no-win situation: her students are at higher risk of getting COVID, and face potentially life-threatening complications from the illness, but the political pressure in her state is driving children back to school before risks are mitigated for her student population. On the other hand, these students have inadequate support at home; physical and occupational therapists typically use equipment stationed at the school, and behavioral therapists were offered no training in how to deliver services remotely. On top of that, some specialized home medical equipment is growing scarce. If caregivers become ill, it is difficult to fill the caregiving gap. It is well-established that children with disabilities are also at higher risk of abuse and neglect, and so the stressors of COVID leave them more vulnerable in multiple ways.
#3 – Social workers experience none of the hero narratives that keep other frontline workers going as they work with the most vulnerable and marginalized people in society. Penelope, a child welfare worker in Texas, sees the compassion fatigue hitting her colleagues. The cases they are responding to are more severe, and the work is emotionally and physically tolling at the best of times. These are not the best of times. When kids were still in school, teachers or other community providers often noticed who was at risk when the risks were just emerging. Now they do not come to the child protection agency’s attention until things have gotten much worse– often an emergency. The lowest-income families are hit the hardest and then experience the deepest interpersonal stressors. And people in her community are rallying the visible frontline workers, like police and firefighters. But child welfare workers are invisible. People don’t want to see them on their street, they will not be invited to participate in any community car parades. They float silently through their home visits, trying to keep up with the work, but at some point, they will also be exposed as victims of this pandemic in agencies long-fraught with problems of turnover. The World Health Organization and others have called for new investments in the nursing workforce given COVID and the growing health disparities. Again, despite serving as the profession whose primary mission is social justice, social work is mostly absent from these news flashes.
#4 – Unlike frontline medical workers, many social workers have been asked to move their offices into their homes, erasing all work-life boundaries. Aisha, a social worker in the United Kingdom, has made the tough decision to leave her job in the child welfare courts. Before COVID, her home was her place of peace, where she retreated after a day of working with trauma and grief. When she became a remote worker, there was no shaking it off- no boundaries between home and work– “all the boundaries are blurred.” She feels the trauma of the work now in her walls; she tells me there is no coffee break, no colleagues, “even my plants are drowning, my anxiety spilling out into them,” and she has lost sleep, a lot of sleep. She’s chosen a significant pay cut and moved to an agency where she’ll go to work every day in a hospital, which is also scary in these times. She feels guilt. For leaving, for her colleagues who can’t afford to make the choice she’s making. But she knows many who are abandoning child welfare right now for other positions; it’s just too much. The courts are busier than they’ve ever been, but she is trying to save herself to really be there for the people she helps.
#5 – COVID-19 has highlighted the immediate impact of racism in medicine and other spaces, which weighs on social workers and many of those we serve. Compared to white people, Black, Hispanic, and American Indian people in the US are 2.6-2.8 times more likely to die of COVID, and up to 4x more likely to be hospitalized with COVID. We’re the profession of social justice and have much work to do to disrupt racism inside our own profession. We are trying to reckon with that within ourselves and our agencies. The system change required to correct disparities feels almost insurmountable, but it is also our work. Much of the work to transform the profession, as usual, is being undertaken by Black and Brown social workers. Many white social workers feel exhausted because they are living through a pandemic alongside their clients, and getting a flavor for the experience for their BIPOC colleagues who are confronted racist systems constantly, from the highest political governments all the way down to activities of daily living, from sleeping in a house to seeking medical care.
#6 – Social workers are also feeling the effects of unemployment, illness, and mental health concerns related to COVID-19. Of the social workers whose stories I shared in my last letter, one has been laid off, with no expected return to work in sight. Her agency could not sustain services, which is certainly a loss for her, but more so for her rural community. For now, she is making do, caring for fragile elderly relatives as their ability to receive outside care and services is also restricted because of the pandemic. Another whose story I shared contracted COVID at her workplace. How long her symptoms will last is hard to say, but she’s gone months now with a weak raspy voice. We know some are suffering from “long COVID” symptoms that have lasted six months and more, and the toll of this flu on the social work workforce is unknown. Social workers are not on the priority lists of many states’ immunization distribution schemes, despite walking into the homes of some of the most at-risk families, places where there is little control for sanitization. Like the rest of the health workers, social workers are tired, and their mental health is growing worse.
#7 – Social workers feel guilty prioritizing their own well-being in the face of the personal, institutional, and political crises affecting their clients. One social worker said she read my love letter to social workers and felt like a fraud, that she was none of those things, not at all the humble, dedicated heroine. Social workers are sometimes not good at putting themselves first, the work takes so much from them, and they are face to face with people whose needs are so vast; it’s hard to value good sleep when you know the pain of people who have nowhere to sleep at all. So many people are not sleeping well these days and social workers absorb their pain when they have so few people with whom to debrief, which brings me to number eight on this list.
#8 – Social workers have lost the support of their colleagues and have few opportunities to debrief their sensitive work. Because of our mandates and values regarding client privacy, social workers cannot go home and talk to their partner about their day. Even a vague reference to a client’s trauma might show up in the news and exploit confidentiality. In the workplace, social workers can staff a case with a colleague or supervisor on the fly, but these opportunities are much harder to come by now according to several social workers I talked to.
#9 – Social workers were not trained to work in chronic pandemic conditions via technology from home. Like many today, social workers are homeschooling and working at the same time, but the work often includes finding a semi-quiet and private space to staff a case or speak with a client; a place to store sensitive case notes; a way to signal to the kids that mommy can’t talk right now. They may have to find child care while they dart out of the house to check on the safety of someone else’s child. Some professionals have giggled when the random child wanders into a Zoom call, but this is inappropriate in our spaces. Social workers say they do not know how long they will be able to keep this up, serving more people with greater need, with access to fewer resources, while covering multiple positions, and facing riskier situations in the community. They are experiencing new ethical challenges, including maintaining clients’ privacy and confidentiality as they work from home. In the United States, a recently-published 64-page list of ethical standards for practicing with technology is almost entirely out-of-date, including its mandate that social workers should only use technology that they are trained and competent in. Social workers, broadly, were not trained for this kind of technology use. Almost all social work curriculums are absent a course on telehealth. They are learning as they go.
#10 – It feels like no there’s no end to the exhaustion in sight. According to credible sources, if we are to reach herd immunity by this summer, we need to immunize at 25 times our current pace. Given the costs to government agencies of managing the coronavirus, government agencies are experiencing job cuts and hiring freezes. States have begun lifting the eviction moratorium, and if not extended, this will also put families at greater risk in 2021, washing in another wave of despair for people living on the edges. On the macro workforce front, this pandemic has highlighted the lack of practice mobility in the states, which blocks the delivery of critical services in emergency times like these. Although the Association of Social Boards has been working on interstate licensure advocacy for years, little progress has been made. The social divides between those with resources and those without are more profound than ever given the Trump administration’s priorities in the U.S., and I understand this is true in many countries around the world. This too will have a long-lasting impact on the profession.
I am tired too. From my home, after a long day in my dining-room-turned-office, I sit in front of the TV and cringe at the show where people are gathered, closely, in the same indoor space. Nevermind that it was filmed pre-pandemic; my anxious brain is rewired. This may ring familiar for you. I wonder if I will ever be in the classroom with students again. I wonder about how COVID-19 will affect social anxiety and substance use. At my local grocery store, the open salad bar was replaced with six-packs of beer, given both hygiene and demand. My sister, teaching her children and working from home, tells me she is not ok- that parents are not ok. I know many are less ok than her. I wonder how to live through a pandemic and also think past it to the jobs ahead of us: the repair to service systems, the need for advocacy, the ability to bear witness to the stories of loss. I hope that we are up for the challenge.
I apologize for the sad report, but this is important for people to hear. Social workers know that people do not like to hear about sad things, yet here we are. If there is a message in all of this, it is that our most vulnerable families who rely on the support of social workers are even more vulnerable today, and so are the social workers who are there to help them.
Yet I maintain hope. I hold on to hope that here in the U.S., our new White House resident will derive wisdom from his social-work daughter and recognize the value we bring to micro and macro spaces. A promising start is his call to double the number of social workers, amongst other professionals, in schools. They will be much-needed as students return to schools with wide structural gaps in their opportunities to “keep up” with academics and social experiences.
I am hopeful because I know that social workers are experts in resilience. Not “they are resilient people,” that’s not a social worker’s definition of resilience. In our field, resilience means awareness of the protective factors in personal, community, and policy (micro-mezzo-macro) environments that sustain us and the people we work with, and also those that put us at risk. They know that maintaining resilience will involve advocacy for rebuilding protective attributes at all those levels, and they will do it together, hopefully with support and help from their colleagues in allied professions, their agency administrative teams, and their legislators.
I am hopeful because I know that social workers and those who love them will read and share this message, which is one way to increase awareness of this quiet storm that brews beneath the layers of this pandemic’s destruction. You can then use that knowledge to write a letter to the editor of your local paper about the issues shared here and in support of social services funding; buy a social worker a cup of coffee; and comment on this post to thank a social worker.
If you’re a social worker reading this, hold on. Make Zoom dates with colleagues to talk and debrief. Set timers if you are working in front of the computer all day- take your breaks, hydrate. Tell your supervisors what you need.
If you’re not a social worker but made it to the end of this article, thanks for reading. I hope you have a better sense of what we’re up to and how you might offer a little support.
How to cite this blog post:
Sage, M. (2021, January 20). Ten Ways COVID-19 Created the Perfect Storm for Social Worker Burnout (and why I still have hope) [Blog Post]. Retrieved from Teaching & Learning in Social Work Blog: https://laureliversonhitchcock.org/2021/01/20/ten-ways-covid-19-created-the-perfect-storm-for-social-worker-burnout-and-why-i-still-have-hope/
