Background
The COVID-19 pandemic has severely impacted everyday life across all social contexts and work sectors, especially the health and social service sector. However, vulnerable groups, including women experiencing violence, have been disproportionately affected [
1]. Gender-based violence (GBV) is a major public health issue and human rights violation with estimates that 65% of women are exposed, either directly or indirectly, to at least one form of GBV in their lifetime [
2]. Evidence demonstrates that survivors suffer a range of negative health impacts as a result of experiencing violence [
3,
4]. Experiences of GBV, in both frequency and severity, increased during the pandemic [
2,
5‐
7] with pandemic protocols, such as stay-at-home orders, increasing risks for women at home [
8‐
11]. Thus, for many women and children experiencing violence, home was not a safe place to be. Many agencies and crisis lines reported a higher need for services for women and children as a result of the pandemic; however, pandemic protocols limited the ability of GBV agencies to provide what felt like adequate and/or sufficient services [
7,
10‐
13]. Historically, GBV services, and specifically women’s shelters, have faced the difficult task of trying to stretch limited resources within a fragmented social service system to provide quality care to clients and meet their needs [
14,
15] the pandemic exacerbated these challenges and changed the way the work could be done [
2,
7,
9,
11].
Women’s shelters are one crucial part of system services instituted to support the health and wellbeing of women and children experiencing violence, and serve as a key referral point to and from other services, including health services [
14,
16,
17]. Though the literature is sparse on the topic of women’s shelter spaces and care interactions, it is known that communal spaces (e.g., kitchens, living rooms) are important for the development of a sense of safety and community [
18]. Guidelines for shelter design based on a comprehensive literature review of women’s experiences in shelters across North America also listed ‘Creating a Sense of Community’ [
19,
20] as one of the key aspects of designing supportive spaces for GBV survivors. However, research has demonstrated the negative impact of the pandemic on fostering a sense of community through communal spaces; pandemic restrictions reduced available communal spaces in shelters by 48% [
21] and sparked safety concerns with the use of alternative spaces, like motels/hotels, as well as concerns about how quality care and empowerment can be maintained under pandemic conditions [
22,
23].
Research has outlined the importance of relationship building and connection in women’s shelters, such as the importance of ‘caring citizenship’ [
24,
25], the dialogue between givers and receivers of care, which contributes to an environment of quality social care [
25]. Research from care-focused professions, such as counseling, has shown that therapeutic relationships were negatively impacted during the pandemic by mask mandates that impeded the exchange of visual cues between counsellors and clients [
26]. Furthermore, in the GBV sector, research has demonstrated that isolation requirements for those accessing services felt restrictive and controlling, and, for some survivors, replicated core aspects of the abusive relationship from which they were seeking refuge [
27,
28]. These findings highlight conflict between ‘one size fits all’ pandemic protocols and the core values of most GBV agencies, such as trauma- and violence-informed, feminist and anti-oppressive care, all of which center reducing the risk of further harm through understanding the impacts of trauma, prioritizing all forms of safety, and promoting capacity-building, collaboration, and choice [
29]. This conflict between the realities of service provision during the pandemic and the core values of GBV services runs the risk of re-traumatizing women and their children [
7,
15,
28].
Some research has explored the use of alternative modes of service delivery to adhere to pandemic protocols and how this impacts the quality of service. For example, research on the use of alternative spaces by GBV agencies showed that connections between clients and staff were significantly hindered, in part because it was difficult to get in touch with clients or effectively work on transitional housing plans together [
11,
22]. A few studies in the United States have explored the use of virtual services as alternatives to in-person service (e.g., emailing with clients) and the impact on service accessibility, client satisfaction, and staff perceptions. This research has demonstrated that the rapid shift to remote or virtual services was useful in ensuring clients continued receiving support [
30] and tended to be received positively by clients [
15,
31]. However, there were challenges with online service models, such as safety risks, device security, the creation of extra work for counsellors [
30], access to technology [
9,
15], and difficulties for rapport-building and emotional connection, particularly for clients with disabilities or those who did not speak English [
15,
31]. Similar Canadian findings showed that virtual or remote services were perceived as the best option to continue to support clients but presented challenges for building rapport and maintaining connection [
32]. A Canadian survey of women accessing GBV outreach services found that some women experienced remote service delivery methods (video, phone, text) as more accessible, while others hoped to return to in-person care [
9]. Complicating the move to virtual or other creative service formats, some research suggests that during the pandemic clients were presenting with more complex cases and compounding issues (e.g., mental health, addictions, severe trauma) that were not easily supported by these new service models. Additionally, services often suffered when clients struggled with equipment, technology (e.g., stable internet connection), and technological skills required for virtual care [
13,
15].
Most research to date on the impact of the pandemic and associated guidelines on service delivery in the GBV sector has focused on new and innovative ways to connect with clients when pandemic protocols limited in-person services. While some research has described the impacts for women of isolation requirements and restrictions on space in GBV residential care, there has been little attention on how other requirements, such as masking, physical distancing, and restrictions on communal spaces, affected service provision for women in shelters. Given this gap in the literature, the current paper aims to provide further understanding on how COVID-19 pandemic protocols impacted care interactions within women’s shelters in Ontario, Canada.
Discussion
Our research describes how the COVID-19 pandemic and corresponding precautions affected the quality of formal and informal care and connections that could be provided in women’s shelters and other services supporting GBV survivors. Furthermore, our research illuminates how the pandemic challenged the ability of women’s shelter staff to support women and their children experiencing violence and facilitate referrals to other services, which is well-documented in other research as an important function of women’s shelters [
14,
17]. Research has established the importance of support and relationship-building between GBV service staff and survivors of violence, including women and their children [
16,
38]. Our findings underscored that the pandemic impacted the ability of EDs, staff, women, and children to form strong and supportive bonds that are the basis of the care provided in women’s shelters.
In line with previous research [
7,
11], our study found drastic changes to service provision in shelters, and other GBV services, due to pandemic guidelines, such as requirements for isolation, the transition to virtual services, and the reduction in available space and referrals. Our findings demonstrated how pandemic guidelines were often in conflict with the core values of GBV service organizations, which is consistent with recent research on isolation requirements and trauma-informed care [
27]. Furthermore, research has highlighted the importance of the core value of Feminism in women’s shelters, something that our research found was challenged during the pandemic [
39]. It is important to note that previous research has demonstrated challenges to underlying values in the GBV sector outside of the context of the pandemic, particularly for trauma-
and violence-informed care (TVIC), such as structural and systemic barriers (e.g., lack of housing), or complex client needs (e.g., providing shelter to women actively using substances or in acute mental health distress while also providing a safe and calm environment for others in the shelter) [
29,
40]. Nonetheless, our research highlighted how pandemic guidelines intensified challenges to care that was trauma-informed, particularly for isolation and quarantine requirements that mirrored the abusive behaviour that women and children were leaving behind. Our research also highlighted the complexity of intersectional factors, such as those related to mental health, disability, and gender, and the impact of experiencing multiple forms of oppression or vulnerability during a pandemic within the context of a women’s shelter. A companion paper from our data explores in more detail how the co-occurrence of the COVID-19 pandemic, the GBV pandemic, the opioid crisis, and systemic racism exacerbated challenges to the provision of services and the implementation of core values in practice [
41].
Our research also highlighted the negative impact of pandemic protocols, specifically masking guidelines and physical distancing, in services with highly traumatized clients. We found that masking guidelines were difficult to implement when clients were experiencing trauma or had anxiety related to mask-wearing, and that social and visual cues were harder to read with masks, which aligns with findings from a non-GBV, therapeutic setting [
26]. Furthermore, physical distancing guidelines reduced the number of available spots and clients in shelters (and encouraged the use of alternative spaces) and women and children in shelters were isolated to their rooms, requiring staff to use phone or virtual platforms to reach clients, which felt impersonal and impractical. We have explored the application of pandemic rules in the GBV sector elsewhere [
28], however the current paper demonstrates that the quality of care interactions was greatly hindered by these rules and new processes. An important finding from our research is that a few staff felt that reduced capacity on-site in shelters meant fewer women on each counsellor’s caseload, allowing staff and women to spend more time together working through crucial issues like future goals and trauma. This finding suggests that funding for more staff at women’s shelters would be useful in dividing caseloads and allowing counsellors and their clients more available time to form connections, build rapport, and tailor support to the individual needs of each woman and child, supporting women’s paths to healing and moving on with life.
We have also detailed in companion analyses the use of alternative spaces, like hotel rooms, due to pandemic restrictions in women’s shelters [
22] and how communal spaces were limited or eliminated in shelters [
21]. The current analysis goes further to demonstrate how losses in these spaces challenged the quality of care that staff could provide to women and children, and hindered opportunities for connection, bonding, and support. These findings are novel in the context of the COVID-19 pandemic, but align with pre-pandemic research that has described the importance of communal spaces in women’s shelters [
18,
20] and the importance of care interactions that take place in communal shelter spaces that fit the definition of ‘communal citizenship’ [
25] as used in other literature on community-building in shelters [
24]. Staff and leaders were also not immune to feeling the effects of the pandemic on their personal lives and own well-being, something which is explored in greater depth in another paper from this research [
32].
Staff and EDs in our study used various strategies to try to maintain care quality, something that has been documented in other research with a more specific focus on technologically-mediated service [
30,
31]. Overall, our findings support the growing evidence base on COVID-19 and difficulties with providing services virtually, including women and staff members’ varied skills and comfort with technology, as well as concerns related to safety, accessibility, and establishing rapport [
13,
30,
31]. Our study also highlights novel findings related to specific, creative workarounds that staff used to reclaim care interactions with clients, such as meeting outside with lawn chairs, adjustments to harm reduction policies, TVs in shelter rooms, etc., which illuminates staff and EDs’ ongoing commitment to providing values-based, woman-centered care despite external COVID-19 guidelines that seemingly undermined these goals. A companion analysis from our research outlined the tenacity of leaders in the sector; as the pandemic pressed on, leaders began sharing their strategies with one another for how to best use, and share, resources to keep their work going [
41]. The transition to new and creative strategies, however, required resources (e.g., funding or fundraising dollars, donations, supplies) that not all had access to, depending on their size and location, which ultimately limited the ability of some agencies to successfully adapt care to pandemic guidelines. Furthermore, variations in public health and funding ministry guidelines from region to region also meant variations for individual agencies in the creative workarounds that could be implemented.
Limitations and future research
Much of our data collection took place during the first wave of the COVID-19 pandemic; research that extends beyond this period would reveal how impacts on care interactions with shelters continued as the pandemic, and related guidelines, evolved. Further, other research that extends beyond the context of women’s shelters, for example non-residential and sexual assault services, would be useful to understand how other types of GBV services were impacted.
Policy & practice implications
Our methodologies, interpretive description and integrated knowledge mobilization, require a focus on knowledge-for-impact; we therefore offer the following recommendations to enhance care interactions now and during future crises that might alter the service landscape.
1.
Pandemic protocols must consider the kind of work undertaken in shelters; changes must be grounded in core values, not be retraumatizing to women and children, and promote physical, cultural and emotional safety, including finding ways to allow ongoing formal and ideally in-person counseling, while also providing safe ways for women and children to interact informally with each other, and with staff [
28]. Government and public health agencies need to work closely with GBV agencies to ensure that guidelines are implemented in a way that maintains quality of care delivered to women and their children.
2.
As an integral part of positive shelter experiences, communal spaces need to be able to operate in at least some capacity during times of crisis, such as the COVID-19 pandemic. The findings of this study, in conjunction with a companion analysis [
21], highlight the need for more research and funding for GBV shelter services to design new spaces that meet the existing and new needs of these organizations in ways that do not compromise the level of care and community they have historically provided.
3.
What GBV services do for women and children at a time of high risk needs to be better understood by the public, government funders, and other health and social care providers. Help-seeking for violence, and especially emergency shelter stays, often activate a range of needs for families, including safe and affordable housing, physical and mental health supports, income stability, criminal justice and family legal supports, schooling changes or accommodations, etc., requiring enhanced system navigation and service access, while prioritizing physical and emotional safety. This role, uniquely performed by GBV services, is often unrecognized and under-valued [
14,
24,
40].
4.
New service models, while useful to many, must be developed and supported in ways that are accessible and equitable, including resources for sustainability (e.g., in software and hardware upgrades). For example, moving to technology-facilitated interactions when many women do not have stable internet access, or a safe place to have these conversations, means that in-person interactions, including shelter stays, will always be required.
5.
Coordination and cooperation among agencies and services needs improvement, both in the context of an ongoing crisis, and for post-crisis planning. Closures in one part of the system, for example housing or income support offices, have serious impacts on the length of shelter stays.
Conclusion
GBV is a serious public health issue and human rights violation that continues to negatively impact the health and wellbeing of women and children globally. Care provided in women’s shelters and related GBV services is a critical aspect of system services for women and children experiencing violence and can help mitigate impacts, such as long-term health consequences and economic hardship. However, care interactions were negatively impacted due to protocols implemented in response to the COVID-19 pandemic, ultimately, in most cases, leading to a reduction in the quality of care for survivors of violence. These impacts were most common in the usually-invisible work that shelter staff and women undertake to promote healing, develop new skills, and re-learn how to form positive and healthy relationships through supportive bonds between staff and women, and among women and children in shelters. This was acutely felt when shelters, adhering to strict physical distancing guidelines, closed communal areas that foster the sense of community and informal support that is characteristic of these spaces, and reduced, by limiting face-to-face counselling and group sessions, the ability of staff to engage in trauma work. Future emergency planning affecting the GBV sector must be done in consultation with GBV and related agencies to ensure that the predictable negative impacts of service changes can be mitigated and supportive care interactions can be prioritized.
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