One of the things we have learned from the pandemic is who our essential workforce is – the people who keep us healthy, stock our shelves with food, teach our children, and deliver the goods we cannot live without. But who is considered an essential or frontline worker, and is that definition keeping up with today’s health care models?

With social determinants of health (SDOH) now widely recognized as a critical factor in both diagnosis and treatment of disease, social workers are increasingly vital to our mental, physical and behavioral health care systems, bringing a deep understanding of social context combined with their access to a wide range of tools, resources and services. Yet, a new national study led by Julie Cederbaum, associate professor at the USC Suzanne Dworak-Peck School of Social Work – the first comprehensive national survey of U.S.-based social workers in the field ever conducted – finds that during the height of the pandemic, social workers were left out of the protections and support for essential frontline workers. They often did not qualify for frontline worker assistance programs or hazard pay and did not even receive adequate personal protective equipment (PPE) when working directly with patients diagnosed with COVID. No one shouted support for them in nightly cheers, even as they struggled to provide frontline mental and social health care for their patients usually alongside doctors and nurses. Additionally, many social workers were providing emotional support for their colleagues facing burnout, caregiving at home for children and extended family, and battling the effects of financial stress that was more acute for social workers of color and women.

“Lack of recognition of social work during COVID-19 reflects society’s lack of recognition of social care needs,” Cederbaum said. “Amplifying how social workers contribute to frontline essential care will help to focus attention on unmet population needs and widen the lens of pandemic recovery.”

Essential but overlooked

Cederbaum is first author on “’We are on the frontlines too’: A qualitative content analysis of US social workers’ experiences during the COVID-19 pandemic,”  published in Health & Social Care in the Community. It details the study conducted with approval from the National Association of Social Workers (NASW) from June to August 2020 in diverse social work practice settings to find out how social work professionals were faring under COVID-19, and what could be learned for the future. Cederbaum, who chairs the American Public Health Association’s Public Health Social Work (PHSW) Section, partnered with PHSW section colleagues Abigail Ross, assistant professor at the Graduate School of Social Service at Fordham University, Lisa de Saxe Zerden, associate professor at the University of North Carolina at Chapel Hill School of Social Work, Betty J Ruth, clinical professor emerita at Boston University, and Jennifer Zelnick, professor at Touro College Graduate School of Social Work. The team surveyed 3,118 social workers in a variety of specialties and practice settings to solicit their backgrounds, experiences and opinions on how social work was being impacted in the early and overwhelming days of COVID-19. Questions examined overall attitudes, financial health and well-being, and concerns about physical and mental health and PPE access.  The rich dataset from this landmark survey produced three additional papers.

“We were in the midst of the pandemic and we were seeing all this media come out about nurses and physicians and their experiences and we weren't seeing anything on social work,” said Ross, who led the study. “We said, we’ve got to figure this out. So we launched an unfunded survey in partnership with NASW as a brief snapshot of how social workers were faring.”

Perhaps most fascinating is that the frontlines invisibility data arose organically from write-in responses, with no question designed to directly solicit thoughts on the issue. Of the 511 respondents to the open-ended question “What do you wish people knew about social work during the COVID-19 pandemic?” nearly 50% mentioned some form of feeling overlooked. Feelings of invisibility and being undervalued by colleagues were particularly acute for hospital social workers who were part of COVID-19 treatment teams alongside physicians and nurses. In addition, social workers in a variety of practice settings described increased caseloads with no overtime or hazard pay, although interprofessional colleagues in nursing and medicine were frequently offered these benefits. Social workers also described feeling disheartened when left out of campaigns to support ‘health care heroes,’ excluded from media coverage that highlighted other nonmedical providers such as firefighters and police, and generally unappreciated for their labor during the COVID-19 pandemic.

“We are essential…We are still doing home visits and counselling appointments but we are not being provided with PPE, hazard pay, or overtime,” said one social worker in the study specializing in mental health. “The community does not know we are out there, but we are the first line of defense for so many vulnerable groups.”

Respondents also noted that as the pandemic recedes, medical providers will likely see their workload decline, while the mental health related challenges resulting from pandemic-related loss, isolation and economic insecurity would continue to impact the social work profession for years to come.

“When the spate of mental health-related issues takes hold as a result of the pandemic and creates a disproportionate effect on communities of color and the working class in general, social workers will be the frontline of defense against the scourge of joblessness, suicide, PTSD, homelessness and poverty,” said one social worker specializing in the aging population.

As we emerge from the worst of the pandemic, Cederbaum and her colleagues hope that recognition for social workers will increase, allowing providers to better address these challenges without being forced to choose between client care and self-care.

“I think the world underestimated the ability of social workers to really connect, even when doing so remotely,” Cederbaum notes. “Our skills of rapport building and engagement really translate. As we deal with the impact of the COVID-19 pandemic and its aftermath on individuals, families and communities, that adversity is going to have a profound effect and the need for social workers is going to be even greater.”