Introduction

With the emergence of the COVID-19 pandemic in the North-Western United States (NW-US), social service providers had to cope with the consequences of working under pandemic-related conditions, including state and federally mandated shut-downs and/or policy changes that significantly altered service-delivery protocols (Shi et al., 2020). Research has documented that providers working in these and similar circumstances are subject to increased stress and an increased risk for emotional and mental health concerns (Asakura et al., 2023; Holmes et al., 2021; Powell et al., 2019a; Shi et al., 2020). The pandemic, and the risks and stressors associated with it, led to a discussion of factors contributing to resilience specifically among providers who continued to operate in person under pandemic conditions, such as medical personnel working with those affected by COVID-19 (Barzilay et al., 2020; Huffman et al., 2021) and workers in the social services (Benzies et al., 2022; McCoyd et al., 2023). Resilience is considered a significant concept in research on a variety of topics at the individual, organizational, and community levels (Chang & Shinozuka, 2004; Connor & Davidson, 2003; Raetzke et al., 2022). Although some research exists on the resilience of social service providers during the COVID-19 pandemic, it is generally focused on a limited number of variables, such as the role of social or institutional support and/or positive coping skills (Chew et al., 2020; Graves et al., 2023; Miller et al., 2021). What is missing, however, is a focus on several factors in interaction.

This research study was intended to explore the lived experiences of social service providers working in the first year of the COVID-19 pandemic with specific emphasis on understanding adaptive strategies that may have been deployed on both individual and agency levels. A key theme that emerged from the interviews conducted was provider resilience. This paper explores the various intersecting factors that participants identified as either contributing to, or detracting from, their ability to remain resilient while working through the initial wave of shut-downs and policy changes associated with the first year of the COVID-19 pandemic.

Resilience is a complex concept and our understanding of how resilience functions has changed over time. The concept has evolved from being conceptualized as a personality characteristic to a more nuanced understanding of an individual's capacity to handle adverse situations and to learn from them (Richardson & White, 2002). The scientific community is now beginning to expand its understanding of resilience in terms of a holistic view on adversity and resilience at various levels (Chen & Bonanno, 2020).

In this article, we conceive of resilience as the ability to handle problematic or difficult lived experiences, involving an adaptation to new and particularly stressful situations (Connor & Davidson, 2003; Richardson, 2002). This capability to continue to navigate one's circumstances when confronted with problematic stressors is influenced by many factors working in interaction (Kim-Cohen, 2007; Richardson, 2002).

This research study outlines the differences we observed between providers who participated in our study when it came to the degree of resilience they exhibited a year into the pandemic. This article aims to illustrate the continuum of resilience and contributing factors to providers’ levels of resilience by taking a variety of factors into account. Additionally, this article details the clinical significance of these findings and makes recommendations for how these findings can be used to inform policy and practice.

Literature Review

While resilience has been discussed in regards to many topics, such as periods of the life span including transitional periods and mental and physical health concerns (Connor & Davidson, 2003; Malhi et al., 2019; Sagone et al., 2020; Yi et al., 2010), the concept has also emerged as an important variable in research on disasters such as hurricanes, storms, or pandemics. In this literature review, we briefly discuss existing research on the mental health impacts of various natural disasters, and then report findings regarding resilience in the face of these events.

Recent research has identified effects on mental health when social service and/or other frontline disaster relief workers are confronted with various natural and human-induced disasters, including pandemics. Specifically, some have analyzed what contributes to providers’ mental health in natural disaster situations, such as hurricanes and floods (Carroll et al., 2010; Powell et al., 2019b). This research has found evidence of traumatic stress responses in providers working through a disaster. In some cases, the research explores the dual-risk factors of being personally affected by the disaster while simultaneously providing support for others who have been impacted by the same disaster. Jung et al. (2020), for example, studied provider mental health after an outbreak of the Middle East Respiratory Syndrome (MERS) and found that providers were experiencing PTSD at alarming rates. Other effects from working with people affected by natural disasters include higher rates of burnout, increased compassion fatigue, and high levels of secondary trauma in the aftermath (Powell et al., 2019a, 2019b). Studies specifically focused on the COVID-19 pandemic have also found effects such as PTSD, burnout, peritraumatic distress, secondary trauma, and compassion fatigue (Asakura et al., 2023; Davies & Cheung, 2022; Holmes et al., 2021; McCoyd et al., 2023; Miller et al., 2021). Specifically for health care professionals, some studies found that providers experienced insomnia, anxiety or depression, stress, and exhaustion during this global event (Huffman et al., 2021; Labrague & De los Santos, 2020; Lai et al., 2020; Tam et al., 2021). Using survey-based research, McCoyd et al. (2023) discuss how social service providers struggled with the pandemic and the changes it brought, finding that the pandemic led to “disrupted organizational operations” (p. 91), and that providers often moved their services online, which was associated with its own sets of challenges. However, they also found evidence of provider resilience, a topic we turn to next.

Since the outbreak of the COVID-19 pandemic, research on provider resilience has expanded to include research on mental health and well-being outcomes for services providers working through the pandemic. Several studies have been conducted on resilience of medical personnel and social service providers working under pandemic conditions (Asakura et al., 2023; Barzilay et al., 2020; Huffman et al., 2021; Seng et al., 2021). These articles cover the topic of resilience in diverse, and sometimes indirect, ways, often in a quantitative manner. Barzilay et al. (2020) has discovered that a higher degree of worrying about COVID-19, as well as experiencing depression and anxiety during the pandemic, resulted in less provider resilience. Viewing resilience as an intervening factor, Huffman et al. (2021) discussed how healthcare staff who considered themselves resilient reported lower levels of stress, sleeping disturbances, and anxiety than administrators and providers who rated themselves as less resilient.

Research on resilience has also found that the struggles medical providers, first responders, and social service providers encounter during a disaster or pandemic (not only focused on, but including COVID-19) can be mitigated through several variables. For example, Jung et al. (2020) found that supervisor support makes a difference, and other studies have pointed to the role that emotional, social and/or institutional support plays in contributing to provider resilience and/or aspects of well-being (Bender et al., 2021; Graves et al., 2023; Powell et al., 2019b; Prati & Pietrantoni, 2010; Seng et al., 2021; Tam et al., 2021). Labrague and De los Santos (2020) discuss the impact of individual resilience as well as social and “organizational support” on the level of anxiety among nurses working during the pandemic. In addition, some studies have specifically highlighted how positive coping skills (such as contact with co-workers, friends, and family as well as religious coping skills) helped health care providers maintain a certain level of resilience and reduced anxiety (Chew et al., 2020; Labrague, 2021).

Others highlight the role of “mindfulness-focused creative arts management” (Matto & Sullivan, 2021, p. 437) and self care (Miller et al., 2021) in helping emergency providers cope with their distress. Axelrad-Levy et al. (2023) found that among child welfare workers, COVID-19 related restrictions were detrimental to workers’ view of their own work performance. On the other hand, if child welfare workers engaged in supervision and felt they had a certain degree of autonomy at work, they subjectively evaluated their performance more positively.

Existing studies have focused on supports, connections, self care, and other coping skills. Our study contributes to the existing corpus of research through a qualitative, grounded theory approach, by focusing not only on one or two specific variables, but on the process by which an interaction of factors at various levels contributed to or undermined social service providers’ resilience during the first year of the COVID-19 pandemic in the United States. Incidentally, some have called for research that takes a comprehensive view of what contributes to resilience and its role during the pandemic (Chen & Bonanno, 2020).

Methodology

Study Design

In this grounded theory study, we are concerned with the effects of the COVID-19 pandemic on social service providers working with homeless or homeless-adjacent/high-poverty clients during the first year of the outbreak. This study resulted, in part, from our own experiences living through the pandemic, and our interest in how social service providers coped with it. Our sample population included people working in homeless shelters, food banks, soup kitchens, and other agencies prioritizing low-resource client populations. This research examined how organizations were impacted by COVID-19 restrictions or shut-downs and in turn how these organizational changes shaped the daily work experiences or service providers. We examined pandemic-related struggles as reported by research respondents and explored service providers’ ability to cope with both pandemic-related stressors and organizational responses. Our questions focused on the ways providers’ organizations responded to COVID-19, what adaptations were made in response to the pandemic, and how these and other aspects of the experience during the pandemic affected providers. In order to understand the lived experiences of the providers who continued their work with the homeless population, or people who were threatened by homelessness, we utilized semi-structured qualitative interviews (Creswell, 2007).

Participant Recruitment

In total, we interviewed 20 social service providers, consisting of 4 male and 16 female participants. The participants were all between 20 and 65 + years old, and had educational levels ranging from a few years of college to doctoral training. While two of interviewees were tribal members, our overall demographic consisted mostly of white research subjects. Since we wanted to gain a broad picture of provider experiences and resilience, we interviewed providers in a total of three states in the NW-US. Our inclusion criteria dictated participants had to be older than 18 years of age and lived in the region at the time of the interview. All participants worked with people affected by homelessness, or were homeless-adjacent, defined as individuals living with socioeconomic insecurity, food insecurity, economic insecurity, and/or underemployment. All research participants were working in a social work or social service provision job during the first year of the pandemic, defined as March 2020-March 2021. Two of our participants were working in a volunteer capacity but the remaining 18 were working in full or part time paid employment. Our interviews were held with providers from a variety of organizations including homeless shelters and food banks, as well as work rehabilitation programs, soup kitchens, and day outreach facilities. We decided on three states in the NW-US, and within those states, we searched google for nonprofit organizations, creating a list of possible places to contact. More specifically, within each state, we made sure to include diverse nonprofits in urban, ex-urban and rural areas each in order to reach providers in a diversity of nonprofits in the human service areas listed above (which is consistent with a grounded theory approach). Nonprofit providers were cold contacted via phone or email, and a snowball sampling technique was deployed once participants began interviewing.

Data Collection

Once this research study was approved by the Institutional Review Board of the academic institution where both primary investigators are employed, we began conducting the interviews. Participants gave verbal consent prior to the beginning of the interview. In order to conduct our interviews, we collaboratively developed and then utilized an interview guide that addressed the provider’s background, the mission of the organization, the changes that the organization implemented in response to the COVID-19 pandemic, and the personal mental health of the provider due to the pandemic. We asked the question—what was going on in their lives during the pandemic, and how did they cope? The interviews were conducted by both authors as well as a graduate student research assistant. The interview guide was flexible enough to allow us to follow up on interesting insights from earlier interviews, or to dive more deeply into a specific aspect of someone’s experience if something they said stood out. While most interviews were conducted via Zoom, if it was a participant’s preference to conduct an interview via phone, this option was available. All interviews were conducted in 2021 and as a result no interviews were conducted in-person due to COVID-19 related safety concerns. Interviews were recorded and audio transcriptions were generated utilizing transcription software (otter.ai). We checked all transcripts for accuracy by listening to the recording on otter.ai and by correcting mistakes in the transcription. The interviews lasted anywhere from a half hour to an hour and a half. Since this was an explorative study, we did not conduct pilot interviews. After the transcription was complete, we gave every participant a pseudonym to protect their confidentiality.

Data Analysis

The goal of qualitative data analyses is to understand the meaning that participants assign to specific events, interactions, and processes (Creswell, 2007). The analysis in this study was completed following grounded theory guidelines (Corbin & Strauss, 2015), a method that originated from the work of Barney Glaser and Anselm Strauss (2012) in previous decades. Grounded theory is unique in that it allows researchers to understand what findings emerge from a set of data, such as interviews or participant observations. In this case, we aimed to make sense of how social service providers (a) experienced and (b) coped with the pandemic. While there are specific guidelines for grounded theory, flexibility in their application exists (Charmaz & Thornberg, 2021).

All of the interviews were initially coded with an open-coding approach (Corbin & Strauss, 2015). This means that sequences were carefully coded for specific happenings, emotions, behaviors, or processes, which are eventually grouped into themes or categories. Themes or categories, with time, were refined with continued coding. During this process, various initial categories were identified, as well as the overarching theme of “provider resilience.” In the later stages, one looks for connections between the various codes and categories through a process called axial coding, and eventually selective coding (Corbin & Strauss, 2015), which also helps to cultivate a deeper understanding of the data and ultimately refine these categories and the ways they relate to each other. According to Charmaz and Thornberg (2021), during this process, researchers ask: “Do these categories hold up? Can they account for these data, or is something else going on?” (p. 308). Researchers look for connections between categories, and identify how they vary across settings (Corbin & Strauss, 2015). After carefully comparing the sets of categories with each other, a set of factors was identified that, in interaction, contributed to providers’ resilience and its variations.

The analysis process was completed in the following manner: At first, the two authors and the research assistant coded the transcripts, using open coding, and came together to discuss a preliminary list of emerging themes at that time. After (preliminary) emerging themes were identified in the course of the open coding of interviews, the first author went back to the interview analysis, and went through all of the interviews again, employing another round of open, axial and selective coding to flesh out connections between the codes and themes, and to refine them. These findings were noted in a word file (as “memos'') throughout the analysis. During this process, both of the authors met regularly to discuss the emerging findings. The continued back and forth between the data and the list of emerging categories ensures the trustworthiness of the analysis in grounded theory (Charmaz & Thornberg, 2021; Corbin & Strauss, 2015).

Results

In the following section, we illustrate the central themes or categories that arose from our analysis process. Here, we discuss the factors that contributed to provider resilience, comparing providers whose interviews revealed more resilience to the pandemic stress with those whose stories indicated less resilience. In a later section, we will look at the impact of these factors in interaction. But first, we give a brief general overview of the changes and challenges that most of the providers faced during the pandemic. Most of our interviewees reported that when COVID-19 initially emerged in the United States, they had to implement a series of changes within their organizations. Examples included changes to cleaning procedures and increased standards of cleanliness/sterilization, implementation of mask mandates, making sure clients and staff were compliant with masking protocols, having to prepare and serve food differently, and establishing social distancing protocols which often involved a change in capacity of people served at any one time, especially in shelters and food banks. In general, providers had to figure out how to run their organizations when confronted with a rapidly increasing amount of regulations and protocols designed to minimize health-related risks to their clients, their staff, and the organization as a whole.

The Category of Resilience and Factors Impacting Provider Resilience

The social service providers we interviewed almost universally talked about the uncertainty and stress they experienced due to the pandemic, which in turn contributed to feelings of physical fatigue, emotional exhaustion, and burnout. Many also talked about increased working hours, especially the providers who were employed by shelters. While almost all social service providers reported that early in the pandemic they struggled with the feelings of uncertainty and overwhelm, at the time of the interview we found that some fared much better than others. Thus, the category of resilience emerged from our findings. We characterized providers as having a lower degree of resilience when they talked about feeling burnt out, identified themselves as suffering from mental health issues, articulated difficulty coping, and/or had developed a negative view of their agency and the work they were doing as a result of COVID-19 outcomes. In contrast, providers who talked positively about their own work and lives, and projected an image of optimism and confidence, were characterized as being more resilient (on a continuum of low to high resilience). This raised the pressing question of which factors contributed to these differences in provider resilience a year into the pandemic?

Through our grounded theory analysis we discovered several sets of factors (categories) that help distinguish the degree of provider resilience from low to high. These factors, which ranged from the micro to the macro level that contributed to a lower degree of resilience are:

  1. a)

    The amount and extent of the restrictions individuals had to implement in order to keep clients safe and meet state/federal mandates, and the associated feelings of guilt and helplessness. This became particularly true when individuals were asked to implement policies that seemed to exist in direct conflict with the mission of the organization or/and with personal ethical codes.

  2. b)

    The number and extent of COVID-19 outbreaks, the ensuing quarantines both internal and external to the agency, and losses affecting the organization and its staff during the pandemic.

  3. c)

    High levels of isolation from the community, clients, and fellow staff.Footnote 1

  4. d)

    Individual (sometimes pre-existing) risk factors such as personal struggles with mental health and complicated family situations.

While the sample of 20 interviews limits our ability to draw definitive conclusions regarding the cause and effect relationships between these factors and low levels of resilience, an analysis with grounded theory is able to provide some insights into these connections. In the following section, we discuss examples of how each of these factors limited provider resilience, and conversely, how their absence improved provider resilience. Additionally, we examine how all of these factors work together to provide a fuller picture of provider resilience. It should be noted here that we did not find that gender played a significant overall role in providers’ resilience, as both men and women showed higher and lower levels of resilience.

Theme 1: Restrictions Providers had to Implement to Keep Clients Safe and Associated Feelings of Guilt, Helplessness and Stress

Among the stressors that were identified as far-reaching and heavily impactful (as compared to less intense stressors such as amplified cleaning or mask-wearing) among some of the providers working with the homeless was the imposition of rules or regulations that limited the number of services organizations could offer. This included limiting the available number of beds in homeless shelters. When these restrictions went against the mission of the organization and/or against the personal ethics of the providers tasked with implementing the restrictions, there was a detrimental impact on providers. For example, Susan, an executive director of a homeless shelter in the NW-US, a licensed social worker, reported an increase in rules due to COVID-19 which resulted in making the hard decision to limit shelter space. This resulted in Susan’s organization turning some clients away, a move that directly contradicted both the organizational mission and vision statements, as well as Susan’s personal and professional beliefs about providing shelter to those in need. Susan told us:

So it’s really hard for us to suddenly, like, change everything we were doing and increase barriers, right. So we're asking now for people to be screened for symptoms, have their temperature checked when they come into our buildings, we are, we moved from sleeping people three feet apart, or, you know, roughly three feet apart in most of our spaces to six feet apart, which reduced our capacity from 175 to 88 people in our building.

In an attempt to mitigate this conflict, Susan and her organization tried to keep their focus on prioritizing help for those people who were “more likely to also die in the streets.” Later in the pandemic timeline, they worked with other nonprofits to create an emergency shelter to provide housing for those they could not shelter in their regular facility. Despite this, the mandated social distancing in the shelter and the resulting limitations of available bed space weighed on her conscience. This can be seen clearly in the following quote, when she refers directly to the concept of moral injury:

So it was a devastating decision that we had to make pretty early on that I think, has had a lot of implications, just in terms of our staff’s worrying about folks living outside and kind of the moral injury associated with making that decision. But also trying to balance keeping people safe from Covid has been really complicated.

This change was especially hard on her, because the mission of her organization, which she took very seriously, was to provide housing and food to all of the homeless population in the local area. She also struggled with having to go against her personal ethics to do the least harm and to help the vulnerable and oppressed.

The research team observed similar themes emerge from our interview with Jeremy, who is a director of ministries and program director at a religiously affiliated men’s shelter overseeing several of its programs. In the first year of COVID-19 he implemented a series of adaptations in his programs, and often felt frustrated at the outcomes. Like Susan, he described limiting shelter capacity, and discontinuing meal services to those struggling with homelessness and food insecurity in the community (though he also describes a few positive changes, such as being able to house the same people for longer periods of time). He described how these changes affected his and his staff’s mental and emotional well-being, and ultimately, his resilience. He recalls:

As the year went on, I think the difficulty in running an operation with now the focus is limiting the number of people we're serving, it wore on people and so, on staff especially constantly that struggle of, gosh, we want to invite people in, we want to get them the services, but I have to deny them service and every provider in [town] was in that same boat of, you know, having to reject individuals. And then just, just the difficulty with the stress that was involved, right?

Daniela, whose job as executive director of a homeless shelter also entails overseeing permanent supportive housing and rapid rehousing programs, also talked about the adaptations her shelter had to make when confronted with the emergence of COVID-19. They could keep the shelter functioning at the beginning of the crisis, but were advised by a local health agency to “reduce the numbers” of people living in the shelter a few weeks into the pandemic. As a consequence of this, they transferred all the shelter guests to motels in the area. Daniela also recalled that the responsibility of keeping residents in her shelter system safe has “been so hard” and “added a lot of hours.”

However, in contrast to Susan and Jeremy, Daniela felt that she could better cope with the crisis because she found a way to avoid denying shelter services to her program's clients. Since they moved the shelter residents into motels, it allowed them to keep serving the same number of clients they had served prior to COVID-19, something she felt good about.

Eric, also a shelter supervisor and program director of a homeless shelter in a faith-based, high barrier shelter, saw it as the shelter’s mission to help guests address homelessness as well as addictions. He did not necessarily mourn the fact that they could not invite everyone in due to the pandemic. Instead, he focused heavily on the well-being of the current residents of the shelter, and as we will see below, establishing deep relationships with them during the pandemic (and this is in alignment with the mission of this high barrier organization). Consequently, both Eric and Daniela could cope relatively well with the pandemic and its effects.

The stress of safety precautions also impacted some of the social providers’ workloads and thus their stress levels beyond their feelings of guilt about the restrictions. For example, Sally, a case manager at a shelter where they stopped housing their clients in the shelter system and moved them to motels, talked about the effects that the dispersion of clients had on her daily life. She had to “run around” more, which turned out to be stressful. She says:

Oh, it's definitely more exhausting. Because I'm running, I feel like I'm running all over town. Because we provide the food for them. We, you know, we try to help them with food, their hygiene, laundry, so a lot of their needs. So, you know, I'm running over there to do case management, I'm running over there to bring them food, and, you know, whatever they need.

Sandra works as the case manager at a shelter for teenagers, which has the mission to “either reconcile the child back home or to find a family” (as told by the director of the same institution). In their institution, the staff had to reconcile with school shut-downs which prevented teens from going to school. At the same time, they had to actively prevent them from attending or participating in social activities, which ended up being difficult. Sandra mentioned the ways in which the pandemic made it difficult for her teenage clients to receive ongoing, outpatient, mental health treatment at the same time online schooling was implemented. The shift away from in-person education eliminated an entire area of social and emotional support for these teenagers. Thus, the loss of mental health treatment options came at the same time her clients were experiencing a need for additional mental and emotional support. She talked about how this scenario and the ensuing needs of her clients put more pressure on the staff (her experience was similar to Sally’s). Sally and Sandra also had less autonomy in their daily schedule than some executive directors, such as Daniela.

We also spoke with two directors of local food banks from different tribal communities (Rose and Kayla) who both talked about lockdowns and how they impacted their organizations and communities as a whole. Both revealed serious struggles during the pandemic, though they also found ways to cope. The pandemic-related restrictions made it harder for Rose to get the food she needed to meet her community's needs, which impacted her. She mentioned how trucks from out of state were restricted from coming to their tribal lands and unable to deliver much needed food to her community because there had been a single confirmed case of COVID-19 among the truck-drivers involved in food delivery, and Kayla mentioned how the food they received was often spoiled.

It is important to note that our sample population included three states in the NW-US. These three states did not have the same restrictions and mandates in response to the COVID-19 pandemic (an example of a macro-level influence on provider resilience). Instead, the state level government mandates varied significantly regarding things like reduction in shelter sizes, mask mandates, and social distancing policies. And while we do not identify the state the providers’ organizations were located in order to maintain participant confidentiality, it was evident that state lockdown policies, and county and city health guidelines, played a significant role in provider decision making. Providers who were confronted with lockdown policies that were stricter seemed to have less freedom with their implementation than those who could rely on internal decision making structures or the advice of local community-based organizations.

Theme 2: Outbreaks, Quarantines, and Losses Affecting the Organization and Staff During the Pandemic

A second key theme in our data analysis identified that social service providers whose organizations were confronted with extraordinary and stressful events, such as outbreaks or extended periods of quarantine during the pandemic, fared less well overall than providers in institutions where this did not happen.

Susan and Jeremy both reported that the shelter they oversaw experienced (sometimes repeated) outbreaks of COVID-19. These outbreaks involved both clients and staff and as a result they experienced an increased level of professional stressors such as lack of appropriate staffing levels. Susan recalled periods where most of the staff was placed in quarantine, which prevented the shelter from operating under normal conditions:

But there have been a couple of occasions that we've had such a significant quarantine of staff who were close contacts, that we actually had our shelter operated by [another agency] in August for two weeks, which was crazy. And then we also had another kind of a larger quarantine this winter, where you know, both circumstances we were really unsure if we're going to be able to continue to keep our doors open for a time. So it's been very challenging.

In addition, Susan talked about some of her staff’s fears of getting infected with the virus. This exacerbated the crisis mentality they were already in, and she recalls that she was “just trying to, you know, balance all those feelings as well and trying to keep us afloat.” Jeremy similarly recalls this time period and its consequences on his professional life:

But beginning in August, September, it was basically like a firestorm in just one shelter to the next shelter, to the next shelter. And within our organization. We had, one of our women's recovery centers was quarantined for two months, our men's shelter was impacted for about two months. We had smaller outbreaks, in our other two facilities. And so that impacts both clients and staff, right. And so now, we have staff that are sick, we have clients that are sick, we’re not fully staffed anymore. And so we, you get real creative on saying, hey, all of a sudden, at one point at our men's shelter, we had five of 10 shelter staff out sick. And it’s out for two weeks, right? So it's, even if you're feeling better, you’re gone for 14 days. And so getting very creative on how do we, how do we cover staffing? How do we keep our doors open?

Jeremy also talks about how in the men’s shelter, all the volunteers that previously helped out in the shelter left, and how that left the staff member struggling. He likens this series of events to the falling of “dominos.”

At our men’s shelter, our case management team has one staff member that oversees six volunteers. Well, all six of those volunteers left. And so now you have, you know, your one staff member trying to case manage, you know, 50–60 clients, which we know doesn’t work, you know, and so that, that happened all over our ministry. And so it just made a tough job that much more difficult. Which, you know, keep the dominoes keep falling, because now you have staff that are, instead of just stressed moving into stages of burnout, and moving into, some of them having some real mental health issues, you know, in addition to health issues, because of all this, you know, and so it’s, it’s just, you know, one domino keeps impacting another one.

In addition, he says that his clients were also increasingly struggling with mental health problems, and the lack of mental health providers exacerbated this, putting even more strain on his staff. In both of these situations, we can see how the outbreaks within a shelter and quarantine of staff led to stress and anxiety, often driven by the very real fear of potentially having to close the shelter, and of feeling overwhelmed (though he also speaks of recent improvements). This form of increased stress, and stress that is due to vicarious trauma or secondary traumatic stress among providers (also described in theme 1) has been linked to provider burnout (Newell & Machell, 2010).

Others reported that they were lucky to have avoided outbreaks in their organizations. Daniela reported that while her shelter occasionally had someone test positive and quarantine, they never had a full scale outbreak at the shelter, a fact for which she expressed gratitude. She also could largely keep her own routine during these months, as she was able to continue working from her regular office space. Thus, compared to Jeremy and Susan, her life was less disrupted and this contributed to her resilience. Similarly, neither Gretta nor Yasmine, both shelter directors, mentioned any significant outbreaks that happened in their facilities, or significant losses.

While in the scenarios described above, the presence or absence of outbreaks and quarantine were discussed largely in light of their institutional impacts, in other cases the impact can be seen on both the institutional and personal levels. When it came to directing a food bank, for example, the experience of loss stood out in the tribal communities. Both Rose and Kayla talked about how many of their community tribal members, including former or current clients, had passed away. Kayla called the pandemic “another historical trauma” affecting her community, and saw the food she provided them as a way to alleviate the suffering. Rose, who transformed an afterschool club into a food pantry during COVID-19, also mentioned her personal losses and how she felt that she could not really deal with them in the current situation:

Ah, I’ve experienced quite a bit of sadness, largely due to the loss of relatives. And it's kind of almost like, you know, it’s unresolved. It’s unresolved sadness, because how we, how we let a person pass on isn’t really taken care of the way we culturally do. And so it’s almost like you feel like, there’s a lot that still needs to be done, you know, this isn’t settled yet. They haven’t really gone on.

This and the above quotes show the impacts of outbreaks and losses on both the institutional and personal levels.

Theme 3: Lacking Social Connections to the Community, Clients, and Co-Workers

As a third central theme, we identified providers’ positive social connections and supports as making significant contributions to their resilience. We found that social providers with more and better connections to clients, and larger support systems including co-workers, and community supports were better able to adapt to the problems and stress the pandemic created (see here also Graves et al., 2023). Both emotional support and financial or material support were found to be important factors, and contributed to provider resilience. On the other hand, the providers who reported a lack of social connections to and/or support by these groups struggled more during the pandemic, and showed reduced resilience. There were many combinations of this, since some providers had excellent connections to the community, while others had excellent connections to their clients and co-workers during the pandemic (or lacked these in the various areas), but the trend was clear.

As an example of the circumstances in which social providers lacked social connections, let’s look at the circumstances of Debra, who struggled during the pandemic. Debra volunteers in a food pantry in a small community, helping the clients receive boxes of food. She describes the implemented changes due to the pandemic as follows:

Well, we used to have everybody come in and shop and of course, they discourage people. I mean, they wanted to try to cut down the times that you’re too close to people. And so what we’ve done, gosh, for almost a year now, is we make up the boxes, it used to be that people came in and they selected groceries from the shelves.

Instead, she says, now the workers are filling up the boxes with food and are bringing them to their client’s cars. She says that she disliked these changes, because previously when their clients came into the foodbank, the workers could establish a connection with them and get a sense of how their clients were feeling at the moment. In sum, she says that they were missing out on the personal contact and social connections that existed before.

Rose lived and worked on tribal lands as a food pantry director. Besides mourning the loss of specific people due to COVID-19 deaths, she also mourned losing the overall community connection on the tribal lands during the pandemic. The community could not hold funerals or Thanksgiving or Christmas meals during the pandemic, and this, she says, hurt her own well-being and that of the whole community, sentiment that was also shared by Kayla. Rose recalls:

And we did provide Thanksgiving and Christmas meals for our community at the club. But you know, and what we did in the past was, our gym, we had tables out there. And so everybody gets to come in, get their plate and sit down and enjoy time with their family. Well, this time, we just had a drive thru, and you just got a box meal, a meal box. And so that was different. And so these little things like that, where you have social interaction with people were no longer in existence. And so that kind of hindered, my guess, our social lifestyle quite a bit. There’s no more, there’s, there aren’t any pow-wows. And that’s where, you know, a big gathering for us. You can’t sweat in the sweat lodge, because of the closeness within that. And that’s, you know, that’s a missing element too, because that’s where you pray, you pray for others, you know, you kind of cleanse yourself of whatever’s bothering you when you come out. That doesn’t happen anymore. So a lot of the social impacts of COVID are kind of what we deal with right now.

While showing some resilience in her daily work life, Rose definitely struggled with the pandemic losses and their ramifications. Others, such as Carl, a program director of a small supportive housing community in his 30s, struggled predominantly with a lack of social connections at work, specifically his lack of connections to both clients and colleagues.

Some reported intense connections to clients, thus presenting the flip side to those who lacked social and emotional connections to co-workers and clients, which contributed to their resilience during the pandemic. Eric, a program director of a faith-based shelter, decided to join the men by moving into the men’s shelter during the pandemic. As a consequence of this decision, his relationships with his clients became much stronger and impactful, a period he describes as “a unique time.” At the same time, the pandemic also created a form of forced role flexibility in his shelter, in part at least due to the loss of volunteers, but he says that his staff has gained from this experience and that it fostered cohesion among the workers.

Other social service providers reported excellent connections in their community, which often manifested as material support, and contributed to their resilience. In this group, many providers focused on the social connections as well as on the material support they received from their community. This type of support was also helpful in fostering resilience. Helen, a food pantry director living in another city, experienced the pandemic as less intrusive than Debra, who reported a lack of client contact, even though she had to be extremely careful not to contract COVID-19 due to having a vulnerable family member at home. While they initially also brought the food out to the clients’ car, they have now gone back to in-person service, just restricting it to one client at a time. In her interview, she focused especially on community supports that keep her food pantry running. She says:

I just feel like we need to really help our clients. And if we can give them as much food, you know, as we can. And [the town]. has been a wonderful community for helping us, I mean, if it wasn’t for our community, and some of our donors, we wouldn’t be there.

We found a similar pattern in the stories and experiences of shelter directors. For example, Daniela and Gretta, both shelter executive directors, reported social connections as well as excellent community supports, which helped to orient and guide their organizations during the crisis.

Theme 4: The Role of Existing Vulnerabilities such as Personal Struggles with Mental Health or Complicated Personal Situations

Not everyone talked about their own mental health directly apart from how it has been affected by the stressors of COVID-19. However, some discussed what mediated the stress of COVID-19, some discussed factors that either prevented the stress from becoming overwhelming (examples included personal faith, going to therapy, or being able to keep one’s routine), or made it worse for them (examples included pre-existing mental health conditions, and stressful situations at home, e.g. having one’s kids at home at all times, missing personal connections, or having a hard time with any change in general). Those who did not talk about conditions other than the pandemic that impacted them negatively fared better than those who had pre-existing mental health issues or who dealt with a complicated situation at home. In addition, those who could draw on additional strengths, such as personal faith or spirituality, practiced mindfulness, or had a hobby that kept them busy during their time at home, coped better.

For example, Susan, the executive shelter director we met above, also struggled with her own mental health during this time. She recalls:

My own mental health has suffered. For sure. I have experienced all sorts of, kind of cropping up of, you know, my own mental health struggles. You know, I'm a person that has struggled with depression and anxiety my whole life, and found it to be much, much worse. Insomnia, not sleeping.

For others, especially those with children in their care, the pandemic brought its own set of personal challenges. Clara, who works in a kitchen associated with a shelter, talks about the additional stress that she had to cope with because of having her children at home, and having to help them set up their schedule:

And so getting them, you know, online schooling and this and that, and having to adjust my schedule sometimes, to accommodate their schedule has been really difficult. And that’s, you know, it’s just been, it’s just been hard in those kinds of areas, no matter no matter what. It’s just not normal, and it’s difficult to keep that and then my heart goes out to the women that we serve who, most of them, you know, are at home and a lot of their breaks are when their children go to school. And so it's been, you know, and then you have the whole technology thing, because with computers and so on and so forth, and it's just been very, very hard.

Carl, the program director who reported a lack of connection to his clients and coworkers, also alluded to a stressful home situation, due to having his children at home at all times.

On the other hand, for Eric, the shelter director we met above, and Ted, a vice president of a homeless shelter, personal faith contributed to positive mental health during the pandemic. Eric says this about the role of his faith as a source of strength;

And I guess maybe that’s where my faith plays into it, I never really let myself become overwhelmed by it. And I think that’s something, you know, my faith carried me through this. You know, and never let myself get down. You know, or feel so overwhelmed where I didn’t want to move. I never, never felt, you know just so where I needed to medicate again or insulate. So I, so far I’ve weathered the storm very well.

Being single, he also did not have any children at home to take care of during the pandemic. Gretta, an executive director, also illustrated how practicing mindfulness and having a gardening hobby helped her cope when the pandemic hit.

Thus, their stories and personal resilience can be connected to research that illuminates the role of religiosity and spirituality in helping people cope with stressful situations (Choi & Hastings, 2019). In addition, there was also a tendency for those with many more years of experience to higher degrees of resilience. Gretta and Daniela, for example, both had been doing their work for a long time, and their experience and the associated community connections helped them cope.

The Four Themes in Interaction and Their Effects on Provider Resilience

The findings of this study point to an interactive nature between various factors in contributing to or detracting from provider resilience. These risk or protective factors worked together, sometimes exacerbating one another, at other times balancing each other out. The providers who struggled more, such as Susan and Jeremy, experienced more than one of these sets of risk factors. Jeremy, as we have seen, reported struggling with limiting the shelter’s capacity, with outbreaks and a loss of volunteers at his organization, which affected his staff (some of whom experienced burnout), and ultimately himself. He also talked about the lack of personal social connections and how that affected him. As a consequence, he experienced negative mental health outcomes, which in turn limited his own resilience. Susan similarly talked about being overwhelmed by the rapid changes, shelter outbreaks, the need to limit shelter capacity, periods of quarantine, and her staff’s fears. She mentioned that she did not think she could “face another winter with COVID-19 restrictions and having to figure out how to do more with less all the time.” In addition, she mentioned previously existing mental health struggles such as anxiety and depression, and all of these factors undermined her resilience. Daniela and Gretta on the other hand, did not struggle with having to limit their services, did not encounter outbreaks at their organization, and had excellent community relations and support systems to help them cope right at the beginning of the pandemic. Both of them talked about the good collaboration among community partners, about being optimistic and grateful, and highlighted the accomplishments their agency made during this difficult time period. Gretta also mentioned practicing mindfulness and having a gardening hobby, protective factors on the individual level. Daniela and Gretta also had more years of experience in their work than either Susan or Jeremy.

Providers who ended up being less resilient often experienced a spiral of negative events, and some had to devote all their resources to ensure the survival of their institutions. The theory of “cumulative stress” (Mann et al., 2021) posits the problematic cumulative influence of exposure to a series of stressors over time. This theory helps make sense of our findings. As a direct result of the outbreaks and staff being overwhelmed, Susan and Jeremy had to focus on what was most pertinent in the moment, and were worried about having enough resources, which in turn added to their stress. On the other hand, providers whose stories revealed more resilience were able to creatively deal with the crisis in a way that not only ensured safety and survival, but also allowed for new and exciting developments at their organization. Examples of this creativity included moving in with one’s clients during a lockdown, establishing an in-house school, or moving clients out of a shelter into motels to keep them safe.

The findings of this study illuminate internal and external factors that protect professionals, as well as examples that mirror a higher degree of vulnerability. They also illuminate connections between stress and resilience, as well as the ability to resist stress and attain higher resilience. The more stressors one is exposed to, the lower the resilience, and the more providers found a way to deal with the stressor, supported by the agency, the community, and their own personal supports, the higher their resilience. Thus, the institutions providers were involved in also impacted their resilience.

In turn, the degree of resilience might have an influence on providers’ well-being and burnout. For example, Susan, who struggled during the pandemic, also talked about leaving her job within the next few months, a change she clearly attributed to pandemic stressors (while also mentioning earlier ones). Similarly, another study found that the more resilient ICU nurses were, the lower their chances of PTSD as well as burnout (Mealer et al., 2012). In addition, illustrating the relevance of conceptualizing resilience as existing on a continuum, some of the providers experienced risk factors, but also protective factors. For example, Samantha, a program director of an organization that helped people find housing, talked about stressors impacting the organization and about a lack of contact with staff and clients due to COVID-19. But she also had a certain amount of work experience in the human services and was in counseling herself at the time, which balanced the negative experiences. The following figure illustrates the link between resilience and the themes illustrated above (Fig. 1).

Fig. 1
figure 1

Degree of Provider Resilience and the Central Themes

Full size image

Discussion, Study Limitations, and Implications

The findings illustrated above resonate with various observations made in the existing body of literature, especially the literature on social support and provider well-being (Labrague & De los Santos, 2020; Prati & Pietrantoni, 2010; Tam et al., 2021) and the cumulative negative effect of stressful events on provider resilience (McCoyd et al., 2023). Our study adds to this literature by focusing on the experiences of social service providers working with people affected by homelessness and the homeless adjacent populations during the pandemic using a bottom-up, holistic approach, instead of by focusing solely on a few variables. Therefore, it is in line with Chen and Bonanno (2020), who advocate for a resilience model that incorporates “several risk and protective factors related to individual differences, family context, and community characteristics” (p. 52), as well as the theory of “cumulative stress” (Mann et al., 2021), since we show that it is not only one factor that influences the degree of provider’s resilience, but that these factors act in interaction. This has important implications for social service providers in disaster situations, including possible future pandemics.

Limitations

With only 20 interviews, the small sample size of our study is a limitation. While a grounded theory approach is possible with a small sample size, future studies would need to be conducted on this topic to corroborate our findings. While the diverse sample of social service providers allows us to find common factors between them, future studies should be completed with more social service providers working in shelters, soup kitchens, or day centers, and with an ethnically more diverse sample. Due to pandemic restrictions, we conducted the interviews via Zoom which, while working well, also comes with some limitations, such as being harder to establish a personal connection over Zoom than in person.

Implications

Over the course of interviewing research participants, multiple individuals indicated that the pandemic had helped illuminate for their agencies the importance of implementing strategies to minimize the potential for provider burnout or other negative secondary effects of working through a pandemic. This paper is intended to support agency supervisors, policymakers, or frontline social workers and social service providers in this pursuit. A full understanding of the importance that social connections play in provider resilience is also key to implementing effective policies or strategies to support providers. At the same time, understanding how providers are impacted when social circumstances require them to modify their intervention strategies in ways that conflict with either their personal moral codes or/and the stated mission/vision of their agencies is key to minimizing the negative impact of this process. There is a strong case to be made for a more formal investigation into the concept of moral injury and whether or not it applies to social services providers working through the pandemic, since it could have contributed to a crisis experience and influenced the resilience of practitioners during this time. Overall, we argue that it is important to consider all possible factors that either contribute to or detract from providers’ resilience, and that interventions should tailor several of these factors together.

This study also has implications for the social work profession and for social work education. We found that many social workers and providers in general struggled with the changes they had to implement during the pandemic, some of which were experienced as ethical dilemmas. For example, some of the professionals struggled with having to turn some people away from their shelters and other organizations due to pandemic restrictions, and this conflicted with the personal ethics they adhered to. Therefore, clinical social workers who worked directly on the frontlines during the pandemic, or who work with human services professionals affected by it, could also benefit from our findings. Social work programs could also make use of these findings, since the results of this study can be used to teach future social workers who work with people affected by the fallout of the pandemic, or who might be affected by future pandemics.

In addition, the findings of this study highlight the lack of preparedness that the profession faces when it comes to pandemics and other disasters. Thus, inclusion, equity, and justice are relevant topics in this study, since not all agencies (and their staff) were on equal footing when it came to material support from their communities (including financial, informational, and volunteer support) and emotional support. Providers in agencies who had less resources to begin with often struggled more than providers in well supported settings.

It is our hope that by illuminating these key findings we are giving back not only to those who participated in our study, but to the broader collective body of knowledge on this topic. Self-care and minimizing negative mental and emotional well-being outcomes for providers continues to be a topic of concern as this work can inform how we continue to react to the current pandemic as well as future wide-scale forms of social change.