Given the current circumstances of Covid-19, it seems relevant to explore the literature on how social workers can respond to pandemics.  In searching for social work literature, I also included in my search natural disaster response.  While both natural disasters and pandemics are two different streams of life-changing events, both have a commonality of disrupting the standard ways of living. Individuals may experience trauma from epidemics as a result of illness, feelings of powerlessness, and experiences of sudden loss.  The critical component of interest between these two streams was how social workers respond to the disruptions in the regular routines of individuals and communities.  I decided that both situations can provide insight into how a social worker would respond and provide services to individuals.

Challenging Discourses in Health Pandemics

Swinford, Galucia, and Morrow-Howell (2020) suggest applying a gerontological approach to social work practice during a pandemic.  The three guiding principles of this perspective are:

• The (older) population is quite heterogeneous.
• A lifetime of disadvantages culminates in ways that threaten wellbeing throughout the life course (especially later in life).
• A strengths-based approach is central to seeing opportunities for growth and positive development.

One of the relevant points brought up by Swinford, Galucia, and Morrow-Howell (2020) was the current discourse in America that it is acceptable to sacrifice the wellbeing of the vulnerable (especially the elderly) to enhance the welfare of the market.  The authors challenge this stereotype of all elderly being vulnerable and outlines that elderly live beyond the walls of nursing homes.  I believe the point of the authors is to challenge the notion that reducing protections will only impact the elderly and focus on challenging, as Anne Bishop (2015) would put it, the “othering” of the elderly.  Swinford, Galucia, and Morrow-Howell (2020) appropriately acknowledge the impacts of ageing on the immune system — which is a normal process within human development — but note that is an association and that there are still individual variances in age.  Acknowledgement that age is not the only factor in the immune response is an important point to use in advocating for both policies and discourse that broadly speak to compromised/reduced immune function. Looking at multiple immune response changes throughout the lifespan is an important point that social workers may consider providing in an advocate or educator capacity.

Furthermore, from a systems perspective, Swinford, Galucia, and Morrow-Howell (2020) appropriate to make a note of the significant contributions persons over the age of 55 make within the American economy.  Both in paid and unpaid labour, individuals contribute and consume within the current system, and allow for the current system to maintain itself.  Treating persons over the age of 55 as disposable detrimental to the maintenance of the system in the long-run.  As persons over 55 increasingly are involved in volunteer activities, there is a need to consider planning for safe return to activities while also recognizing the impacts that this discourse may have on individuals characterized in this discourse as “old.”  As some individuals volunteer to develop a sense of community or purpose, the loss of such activities needs to be considered in reopening or prolonged public health measures.  At the same time, the unfulfilled unpaid services need to be examined both macro-level system and family system distributions of unpaid labour and support need to be considered in service delivery.

Another point discussed by  Swinford, Galucia, and Morrow-Howell (2020) is intersectionality.  As a heterogenous group, individuals 55 or older may be increased, or decreased risks for adverse outcomes as a result of the socially-constructed attributes that advantage or disadvantage them within the society’s dominant culture.  One thing for social workers to consider is the disproportionate burden of adverse health outcomes for populations who are internationally disadvantaged.  This can be a result of nutrition, lack of access to insurance/healthcare, and other health outcomes that are common in underprivileged communities. This is evident when we see impacts that come from further strains to an individual’s socioeconomic status when there are public health orders that influence economies without sufficient counteracting social policy to ensure basic needs are met (such as job loss).  Advocacy for adequate public health and social welfare programming policies that complement one-another is another route social workers can partake in.  This can include a strengths-based perspective by working with communities or individuals to elevating their voices so that appropriate benefits and service delivery become a part of the response discourse.

Other Interventions

Another consideration that is brought up by Swinford, Galucia, and Morrow-Howell (2020) is the impacts of social isolation.  Letter-writing campaigns, as well as online platforms, provide opportunities for social connection to take place.  Advocating for social policies that encourage the public to partake in social connections from afar may also be an option.  Social workers may also have opportunities to also act in an educational capacity (such as teaching clients how to use zoom, skype, facetime, or other teleconference platforms). This can serve to promote social connection if clients desire and are made aware of the privacy risks associated with teleconferencing platforms.

Disaster Responses in Social Work

Conceptualizing Social Work Practice and Roles

Disasters can impact our physical, social, cultural, political, and psychological wellbeing (Findley, Potlick, & Giordano, 2015).  Part of our profession’s duty is thus to respond and aid in the recovery efforts that can restore balance to those components of wellbeing.  The role assumed by the social worker is to assist in ensuring that basic needs are met while empowering vulnerable individuals to become a part of the response/rebuilding efforts (Findley, Potlick, & Giordano, 2015).  Noteworthy here is the impacts intersectionality has on relief and response from aid – be it government or non-government.  As vulnerable populations often have geographic barriers to receiving resources in disasters, slow delivery has been a historical trend.

Findley, Potlick, & Giordano (2015) highlight the importance of developing or enhancing the connections between service providers to reduce the risks that present when disasters overshadow economic and social justice.  Because experiencing a disaster impacts an individual’s sense of power and control, traumatic stress from disasters can have both immediate and long-term effects.  Implementing trauma-informed care in service delivery seeks to counteract the disempowerment of the initial situation and aid clients in developing a sense of safety in their environment.  Findley, Potlick, & Giordano (2015) recommend a person-in-situation conceptualization – selecting interventions that best suit the client’s needs.  This is especially the case with children risk being exposed to stress without appropriate supports (Alberta Family Wellness Initiative, n.d.).  Beyond the initial disaster event, the disaster itself should be considered in future trauma histories (Findley, Potlick, & Giordano, 2015).

There are many different responses that a practitioner can apply in disaster response practice.  In the realm of mental health, “mental health first aid” and crisis intervention are identified by Findley, Potlick, & Giordano (2015) as critical skills.  Beyond this, however, is first-aid and specialized training in disaster mental health counselling.  Other avenues in America include the Federal Emergency Management Agencies Institute programming, or emergency preparedness and response training in Canada (Findley, Potlick, & Giordano, 2015; Government of Canada, 2019).

A framework for disaster-response curriculum is one that uses quadrants to represent a structural approach to response is something which is proposed by Findley, Potlick, & Giordano (2015).  Each quadrant of the model explores different dimensions of the power-balance between the client(s) and service provider(s).  The first quadrant, “A,” looks at working with clients on their own behalf.  The purpose of this working relationship is to bolster the coping capacity, working in collaboration with first-responders to maintain public order, delivering mental health and concrete services, and support to individuals who have not been considered a “vulnerable” person before.  Quadrant “B” looks at working with clients on behalf of themselves – as well as others similar to them.  Activities under this quadrant include leading support groups within a community to address social problems that emerge, such as substance use or relationship stress.  Support groups here can also serve a function of dealing with the frustration of the response from government agencies for services such as receipt of benefits.  Another role within Quadrant “B” would be an outreach to individuals who are or were reluctant to connect with agencies for services or benefits.  Quadrant “C” looks at working with non-clients on behalf of the clients.  This section includes working with disaster relief and disaster management agencies, working with insurance agencies, and helping complete the required forms for clients.  Living arrangements such as rental units pose a separate series of challenges.  Acting in the role of a mediator, the social worker can intervene around issues that tenants can not directly manage when they are not property owners.  Conflict and negotiation skills can further be used to liaison between landlords and tenants when there is the loss of property (both housing infrastructure and personal items).  Another component of quadrant “C” can include connecting children/youth with school districts for displaced students.  Quadrant “D” looks at working with non-clients on behalf of a selected category(ties) of persons at risk.  In this segment, the social worker would seek to work with regional leaders to do a needs assessment to restore the housing and economic foundations of the city and begin organizing the community around this issue.  Other functions include developing relationships with first responders to ensure that community order and public safety remain.  Another activity includes establishing connections with the healthcare community to address the physical healthcare needs of community members (such as addressing health diagnoses, gaining access to medication, provision of nutrition information, and provide healthcare provider information in the community).  Reflecting on these quadrants, dividing the practice between micro, mezzo, and macro practice is worth considering.  From quadrant “A” through to “D,” we see a transition from the micro to the mezzo and macro levels of practice.  Social work roles included within the model include advocate, educator, councillor, broker/mediator, educator, researcher (of community needs), and organizer.

In Findley, Potlick, & Giordano’s work (2015), themes of needs within impacted communities were identified as housing, counselling, advocacy/assistance, and adjustment issues in the face of adversity (displacement, frustration, and feelings of hopelessness that emerge from government responses).  Case management plays an essential role in assisting the client in addressing these needs. Still, referrals out to other services can also play a significant role in the provision of services.

From a mental health perspective, it is also worthwhile to consider the behavioural, emotional, physical, and cognitive impacts disasters can have on survivors.  Behavioural reactions of persons impacted by disaster included isolation, agitation, and jitteriness were seen as common responses.  Emotional responses included anxiety, hopelessness, frustration, sadness, irritability, and tearfulness. Physical responses included reactions such as difficulty in falling asleep, trouble staying asleep, and fatigue.  Cognitive responses such as nightmares, preoccupation with death/destruction, intrusive thoughts/images, memory difficulties, and suicidal thoughts were not uncommon.  This brings into focus the significance of trauma-informed practice by recognizing the biopsychosocial impacts of experience and acknowledging how it impacts mental wellbeing while establishing safety and creating meaning (Stebnicki, 2017).  One of the careful considerations in disaster response is also considering the allostatic load already present in service providers.  As was the case in Findley, Potlick, & Giordano’s (2015) work, many service providers were also personally impacted by a disaster they were providing a response to.  This raises the awareness of practitioners as potentially co-experiencing trauma with client populations.  The suggestion in the literature is that social workers must evaluate their own feelings in the therapeutic relationship and place them in the context of the environment.  Mutual support and debriefing amongst service providers may be one way to address this issue.

Disaster Preparedness Roles

Another piece of the puzzle in disaster response is the preparation that goes into response planning.  Kusmaul, Gibson, and Leedahl (2018) outline a social worker’s role in the mitigation and preparedness roles for disasters, which can provide a useful application of social work roles in practice.  One of the first outlined components is assessment.  This includes the unique needs, risk factors, and strengths that can be examined both within the community served and the micro components within the community system.  Considerations can vary, and intersectional supports such as aids to daily living need to be considered so that individuals with additional supports are not left behind.  The practitioner wants to think about the individual in their environment. Furthermore, they must consider how the individual will adapt to the environment that is changed by the disaster.

Another preparedness role is that of a facilitator and/or educator.  Helping community members across the lifespan in their own preparedness for sudden disruptions in the community can allow the individuals to mitigate the physical, social, and emotional stress/damage that can occur.  As noted by Kusmaul, Gibson, and Leedahl (2018), most adults have not created an emergency plan.  This leaves the adults vulnerable in accessing basic supplies and knowledge on where to find basic resources.  Being able to refer adults to programs that educate individuals on preparedness is an important piece of knowledge for social workers to have.

Along the facilitation train of thought, social workers can facilitate communication within families — allowing for families to develop their own plans for navigating through a disaster.  Helping individuals build their own customized plan allows the client to reflect on their own needs, networks, existing and potential resources, and (in)formal supports.  Activating community resources provides an opportunity for community development of plans that are more comprehensive than individual responses.

Another response that is brought up by Kusmaul, Gibson, & Leedhal (2018) is the setup or maintenance of assistance registries.  Assistance registries seek to form a list of the especially vulnerable (such as those with disabilities) so that emergency operations know the locations of these individuals and their specific needs in the event of an emergency.  Informed consent of addition to the registry, along with comprehensive efforts to protect the confidentiality (and inevitable limits to privacy) of individuals on such records, is a critical component of ethical practice.

Disaster Response Roles

In the event of a disaster, Kusmaul, Gibson, & Leedhal (2018) outline four key roles that a social worker would partake in.  First is the education of available resources for basic needs, such as shelter and evacuation protocols.  If clients are placed in a situation where they must decide if they evacuate or leave their residence, the client must have information on the choices they have so that a plan can be activated or made.  The data needs to be disseminated throughout the community with widespread public knowledge.  Social workers can partake the role of an advocate and educator by advocating for sufficient resources to promote wellbeing, along with providing information to the public on the resources made available to the community.

A second role, addressing barriers in decision-making,  seeks to remind individuals/families that routines and rituals that provide a sense of normalcy are essential in recovery.  It is, however, important to not have routine supersede the importance of normalcy and/or routines.  Considerations around routines and normalcy must look beyond the immediate client, and consider the client’s larger environment.  Kusmaul, Gibson, & Leedhal (2018) make an important note of the importance pets play in the lives of many.  Pet evacuation should be considered as an essential part of an evacuation plan.  The planning in this role should be aware of the potential for the client to have to permanently relocate and the psychosocial implications of relocation.

Relocation is a significant disruption to routine and normalcy thats impact should not be underestimated.  long-term impacts, in terms of stress, can have adverse health consequences.  Social workers should be conscious of these long-term impacts on wellbeing should be conscious in the mind of a social worker as community members are being moved or evacuated.

Depending on the age and health circumstances of clients, physical and cognitive frailty is another consideration.  Complications that may exist based on health status, socio-economic status, and other intersectional attributes should be considered.  Individuals that are dependent on others because of their health may be dependent on others, and those others may not have training on decision-making for the individual under their care.  Social workers may be able to help navigate the complexities in decision-making that can arise (Kusmaul, Gibson, & Leedhal, 2018).

Disaster Recovery Roles

As one would expect, the period after a disaster marks significant changes in life that may necessitate further social work intervention.  Kusmaul, Gibson, & Leedhal (2018) outline 4 functions a social worker would fulfill during the recovery period post-disaster.  The first role, assessment and treatment of traumatic stress, is a role that social workers trained in disaster mental health could partake in.  Cultural variances would need to be taken into consideration.  Literature can be consulted to examine trends within multicultural responses, such as both the resilience and frustration experienced by immigrant families (see Drolet, McDonald-Harker, Lalani, & Tran, 2015).  Referrals or provision of evidence-based treatments (depending on professional competency) for PTSD and mass trauma can be considered under the social workers’ role of promoting a continuity of care.

Another consideration, assessment of financial stress, examines how financial stability impacts mental wellbeing.  Clients who have lived longer may have experienced more significant financial losses, while also having a shorter period to rebuild their savings.  Social workers can work with clients to assist them in identifying resources that can aid in addressing their financial concerns and advocate government agencies for sufficient financial supports for the client(s).

From a community-oriented perspective, addressing community loss is another vital component of recovery work.  This can include considerations for physical damage, financial loss, and the collective/vicarious grief that results from the shared experience(s) within the community.  Early on, there may a united identity — such as that which emerged from the September 11th, 2001 terrorist attacks (Kasmaul, Gibson, & Leedhal, 2018).  This united front, however, also can become more fragile with time.  If we think of the “myth of scarcity,” divisions over funding, resource allocation, and subsequent directions forward, alliances within communities can quickly transition to adversarial relationships (Mullaly, 2007; Kasmaul, Gibson, & Leedhal, 2018).  Social workers can take on a mediation/conflict resolution role as different community groups take different approaches to recovery.  Working in interdisciplinary teams to gain multiple perspectives on community fragmentation.

The last role, building community resilience, look at supporting the wellbeing of vulnerable community members.  There is a lot of capacity present in communities that can highlight resilience in recovery.  This provides the social worker with an opportunity to draw on the strengths perspective.  However, social workers ideally would facilitate conversations on this topic earlier in community development — during the disaster planning stage (Kasmaul, Gibson, & Leedhal, 2018).

Areas to Explore Further

The changes in both health pandemics and disasters can have a significant impact on the lives of individuals, leaving community members vulnerable to crises, trauma, or has implications on biopsychosocial health.  Worth consideration for practice is theory and methods for crisis counselling, continuing education on or skill development in trauma-informed care, developing competency in the field of disaster mental health, and understanding the systems that are at the forefront of emergency management.  Moving forward, continuing education in each of these domains has skills that will prove valuable in the continuity of care, and allow social workers to perform competently in stressful circumstances.

References

Alberta Family Wellness Initiative. (n.d.) Stress: How positive, tolerable, and toxic stress impact the developing brain. Retrieved from https://www.albertafamilywellness.org/what-we-know/stress

Bishop, A. (2015). Becoming an ally: Breaking the cycle of oppression in people (3rd ed). Winnipeg, MB: Fernwood Publishing.

Drolet, J., McDonald-Harker, C., Lalani, N., & Tran, J. (2015). Impacts of the 2013 flood on immigrant children, youth, and families in Alberta, Canada. International Journal of Social Work, 2(2), 56-74.

Findley, P. A., Pottick, K. J., & Giordano, S. (2017). Educating graduate social work students in disaster response: A real-time case study. Clinical Social Work Journal, 45(2), 159-167.

Government of Canada. (2019). Health Emergency Management. Retrieved from https://training-formation.phac-aspc.gc.ca/course/index.php

Kusmaul, N., Gibson, A., & Leedahl, S. N. (2018). Gerontological social work roles in disaster preparedness and response. Journal of gerontological social work, 61(7), 692-696.

Mullaly, R. (2007). The new structural social work (3rd ed.). Don Mills, ON: Oxford University Press

Stebnicki, M. A. (2017). Disaster mental health counseling: Responding to trauma in a multicultural context. New York, NY: Springer Publishing Company

Swinford, E., Galucia, N., & Morrow-Howell, N. (2020). Applying gerontological social work perspectives to the coronavirus pandemic. Journal of Gerontological Social Work, 1-11.