"So many extra safety layers:" Virtual service provision and implementing social distancing in interpersonal violence service agencies during COVID-19.

The coronavirus pandemic necessitated rapid shifts in approach for service providers working with survivors of interpersonal violence. To reduce the spread of the virus, providers and agencies implemented a rapid and unplanned expansion of virtual services while also developing new protocols to support safe and socially distant in-person services. To understand how these shifts have impacted victim service professionals and the survivors they serve, to provide guidance for on-going efforts, and to inform planning for future public health emergencies, this study asks the question: What approaches did the interpersonal violence workforce use to address social distancing needs during COVID-19? Semi-structured interviews were conducted from July to December 2020 with 33 interpersonal violence service providers from across the United States, and data were analyzed via conventional content analysis with additional steps for data credibility. Findings fall within two primary categories: 1) Technology and Virtual Service Provision; and 2) Social Distancing for In-person Services. Within each category, a number of themes emerged illustrating strengths and challenges of each approach, and the complex web of technological, safety, and public health considerations being balanced in interpersonal violence service agencies. These results provide guidance for the implementation of virtual services in an on-going manner, as well as underscoring the importance of future planning to facilitate effective in-person but physically distant services. There is also a clear need for agencies to support the interpersonal violence workforce to reduce occupational stress and enhance skills and capacities with new forms of services.

Decreased economic stability, increased family stress, prolonged exposure to abusive partners, and reductions in services capacity, among other factors have all been cited as contributors to an estimated 8% increase in intimate partner violence (IPV) early in the coronavirus pandemic (McClay, 2021; Nnawulezi & Hacskaylo, 2021; Piquero et al., 2020; Piquero et al., 2021; Wood, Baumler, et al., 2021a). The pandemic and resulting stay-at-home orders, which began in March 2020 in the United States, required interpersonal violence service providers (such as intimate partner violence shelters and rape crisis centers) to adopt new intervention frameworks and modalities (Wood et al., 2020a). These changes included quickly shifting to virtual services and implementing strategies to facilitate socially distanced in-person services (Kaukinen, 2020). While implementing these adaptations, service providers faced significant strain as first responders to an evolving crisis. To understand the changes being implemented within the service sector and provide evidence to inform future public health responses, this study explores the experiences of interpersonal violence service providers implementing virtual services and social distancing guidelines during the first year of the COVID-19 pandemic response in the United States.

Background

The Centers for Disease Control and Prevention estimate that 81 million Americans will experience sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime (Breiding et al., 2014). Experiencing interpersonal violence creates a wide range of serious physical and mental health impacts for survivors and their families, as well as short and long term economic, educational, and intergenerational consequences (Castro et al., 2017: Chisholm et al., 2017; Postmus et al., 2012; Sedziaofa et al., 2016; Soleimani et al., 2017; Valera & Kucyi, 2017). Survivors of interpersonal violence, including intimate partner violence (IPV), sexual assault (SA), and child abuse and neglect (CA&N) engage in support provided by a network of community-based service agencies. These agencies provide a wide range of survivor-centered services, including advocacy, counseling for children and adults, housing, legal, and economic supports, all focused on the needs and goals of the individual survivor and their family (Macy et al., 2009; NNEDV, 2021; Sullivan & Goodman, 2019; Wilson et al., 2015). Guided by these tenets, community-based agencies seek to provide voluntary services aiming to facilitate survivor-defined participation in formal services as needed (Nnawelezi et al., 2018; Wilson et al., 2015). These services have been demonstrated to reduce the risk of future violence and increase well-being, emphasizing survivor goals within a trauma-informed and culturally relevant approach (Nnawelezi et al., 2018; Rivas et al., 2019).

Social Distancing During COVID-19

In the United States, interpersonal violence service providers were faced with rapidly implementing social distancing strategies to reduce contact between infected and non-infected persons in order to stop disease transmission, along with other interventions to control the spread of COVID-19, with most jurisdictions beginning the implementation of these practices in March of 2020 (USHHS, 2020). Public health guidance focused on effective strategies to stop and reduce the spread of infectious droplets, particularly indoors and in communal settings. These included physical distancing, staying away from others when sick, isolation and quarantining of infected cases and close contacts, and the use of appropriate Personal Protective Equipment (PPE; e.g., face masks and shields) (Collignon, 2021). Initially, guidelines evolved quickly as more was learned about the transmission of COVID-19 (Badr et al., 2020), and ultimately a wide range of measures were put in place across settings, with government agencies highlighting the need to use strategies in combination to reduce risk and control disease spread (Collignon, 2021). For interpersonal violence service providers, this often led to the need to make difficult decisions, such as reducing service capacity or closing key services, and the need to continually review and shift agency policies and procedures (Wood et al., 2020). In particular, emergency shelter for IPV survivors has long been a critical, life-saving service and front door for accessing other services and supports. This necessarily in-person support has frequently been offered in formats that are not easily aligned with social distancing expectations, including having multiple families share rooms or bathrooms, communal living spaces, and joint meals. Evidence from service-providers suggests that adjustments to shelter capacity, format, and processes were among the largest initial challenges to adjusting to social distancing guidance (Wood et al., 2020).

Virtual Services

In the years prior to the pandemic, virtual services were already gaining attention as an additional tool for victim service providers, as the proliferation of internet and smartphone use changed the way people communicate and build relationships (Merolli et al., 2014; Voth Schrag et al., 2021). With the service sector’s focus on providing individualized services built around the preferences and needs of each survivor, agencies had begun to build virtual services, such as chat and text-based crisis hotlines, to allow individuals to engage with services using modes of communication most comfortable for them (Nesmith, 2018; Wood, Hairston, et al., 2021b). Initial data suggest that these services can fill an important gap. For example, an outcomes assessment of a youth crisis-text hotline found that 65% of users had positive outcomes (Nesmith, 2018). Further, there is evidence that virtual services may have specific benefits in terms of reducing barriers to service entry, with evidence of a “disinhibition effect” reducing the perceived stigma of disclosure, allowing for greater engagement, particularly among youth (Budinger et al., 2015).

However, due to a combination of factors, including concerns over the potential safety risks created by digital surveillance by an abusive partner, the cost of technology infrastructure, and an already stretched-thin workforce, the interpersonal violence services field had not widely adopted virtual services prior to the Coronavirus pandemic (Brignone & Edleson, 2019). Indeed, quantitative research with providers in the first months of the pandemic indicate that under 10% of service providers were using video conferencing technologies prior to March 2020, and that this increased to nearly 60% by July 2020 (Wood, Baumler, et al., 2021a). This research similarly demonstrates a 15% increase in texting with clients, an 18% increase in computer chat, and a 12% increase in facetiming with clients over the same period (Wood, Baumler, et al., 2021a). Such significant shifts in services would typically occur over much longer timeframes, and with substantial financial outlay in terms of staff training, hardware, software, and evaluative research, yet the context of the pandemic made this impossible. Further, some forms of virtual services which rely on text rather than voice-based communication (e.g., chat, text, and e-mail) also provide a potentially safer way to reach out for survivors who are in close proximity to an abusive or unsupportive individual, making them uniquely applicable in the context of COVID-19 social distancing and stay-at-home orders (Wood, Baumler, et al., 2021a).

Current Study

The coronavirus pandemic, and need to implement social distancing guidance while maintaining service access in the face of escalating violence, created a perfect storm for the rapid expansion of virtual services within interpersonal violence service agencies, in concert with new protocols to support safe and socially distant in-person services. To capture these rapid changes, this study asks the question: What approaches did the interpersonal violence workforce use to address social distancing needs during COVID-19? It seeks to understand the strategies that evolved within community-based interpersonal violence services to meet public health guidance related to social distancing in the wake of the COVID-19 pandemic, as well as the experiences of the anti-violence service professionals faced with implementing those service adaptations.

Methods

The data for this study were collected as part of a mixed-methods project which documented the experiences of interpersonal violence survivors and service providers from April to December 2020 in the United States. The project included an initial quantitative survey with nearly 500 survivors and service providers fielded from April to June 2020, which aimed to capture a quick snapshot of safety and service experiences during the initial phase of the COVID response (see  Wood, Baumler et al., 2021a; Wood et al., 2020 for detailed study information). With partnerships from national IPV and SA advocacy agencies, such as the National Coalition Against Domestic Violence, as well as regional partners including the Texas Council on Family Violence, the Texas Association Against Sexual Assault, and professional networks across several states, participants were recruited into the initial web-based survey via social media posts and professional list-serve distributions. The survey concluded by asking if participants were willing to be re-contacted for a semi-structured interview. The data for the current study come from those interviews with (n = 33) service providers from across the United States, which were conducted from July to December 2020.

Procedure

Interviews were conducted via ZOOM video conference or over the phone based on the preference of the participant. Interviews lasted between 35 and 90 minutes and were professionally transcribed. All interviews were conducted by study team members who have previous experience with both qualitative interviewing and victims service provision. Prior to the outset of data collection, study procedures were approved by the institutional review board of the sponsoring university. All participants provided verbal consent and permission for audio recording prior to the beginning of data collection, and participants received a $25 gift card.

The interview protocol queried participant demographics, personal experiences with the pandemic, client safety and service use during the pandemic, as well as agency approaches to social distancing and health guidance, and occupational stress. Example questions that elicited data related to technology use or social distancing adaptations included the following: How has your job changed during the Coronavirus Pandemic? and How has your use of technology for work with clients changed during the Coronavirus Pandemic?

Participants

Service providers (n = 33) in intimate partner violence, sexual assault, child abuse, or human trafficking focused community-based agencies participated in semi-structured interviews. Inclusion criteria included being at least 18 years of age, being able to complete an interview in English or Spanish, and working in a paid role in advocacy, direct client service, or agency leadership in community-based victim serving agencies during the first phase of the COVID-19 pandemic response in the United States (March-July 2020). Participants ranged in age from 28 to 65, and most identified as female, with others identifying as male or non-binary. Twenty participants identified as White, with six identifying as Hispanic/Latinx and others identifying as Black or Asian. Participants described their job tasks as including survivor advocacy, housing services, legal services, prevention education, and agency leadership. Participants came from across the United States, with the plurality from the state of Texas.

Results

The data reflected two primary categories of service adaptations: 1). Technology and Virtual Service Provision; and 2) Social Distancing for In-person Services. A visual depiction of key categories and findings is in Table 1. Within each category, a number of themes emerged illustrating the complex web of technological, safety, and public health considerations being balanced by service providers in interpersonal violence service agencies.