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A guide to COVID-19 for social workers

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This guide provides background and resource information for social workers during the global COVID-19 pandemic. Social work is classified as essential services by government officials and social workers have continued to serve people and communities during this crisis. However, the way that social workers are performing their day-to-day jobs has changed dramatically. The following resources will address some of those changes and provide more information for social workers during this unprecedented public health crisis.

The impact of the global pandemic caused by COVID-19 is widespread, touching all parts of society. The helping professions, including social work, have mobilized quickly. The response requires new flexible rules and guidance, the ability to provide services during stay-at-home orders and new safety measures to reduce risk for service providers and clients alike. 

Social workers work in a wide range of settings providing support to individuals, families, and communities. The pandemic affects the process of doing business and providing care in almost every industry in one way or another. The following discussion looks at the various ways COVID-19 crisis has impacted the social work field along with some resources for social workers as they navigate the profession during this unprecedented time. 

What is COVID-19?

The Centers for Disease Control (CDC) describes this 2019 novel coronavirus (COVID-19) as “an illness caused by a virus that can spread from person to person. The virus that causes COVID-19 is a new coronavirus that has spread throughout the world. COVID-19 symptoms can range from mild (or no symptoms) to severe illness.” The World Health Organization (WHO) classified this outbreak of the virus as a pandemic.” The CDC states, “Pandemics happen when a new virus emerges to infect people and can spread between people sustainably. Because there is little to no pre-existing immunity against the new virus, it spreads worldwide.” Because this virus is new, scientists and physicians are still learning information, such as who is most at risk for severe symptoms, about how to best treat symptoms and other information about the impact of the virus. 

Since there is still so much unknown and the information about health guidance and regulations changes daily, many countries, including the United States, have modified, significantly decreased, or suspended non-essential activities, such as social gatherings and reduction of retail activity, to prevent unnecessary contact between people. Essential industries, such as healthcare, transportation, and food distribution, are required to put regulations in place to help prevent the spread of the virus. The COVID-19 pandemic has greatly impacted individuals and communities, and currently, there are many unanswered questions moving forward. 

Social workers as essential workers

The Department of Homeland Security (DHS) has developed an advisory list of “Essential Critical Infrastructure Workers” to help bring definition to what parts of the workforce are needed to keep everyone safe as we manage the pandemic. Social workers are part of the “health care and public health” category of essential workers. The executive branch has asked communities to use this list as a way to determine who needs to maintain their ability to work as much as possible for the health and well-being of others.

While the essential worker infrastructure guidance is just an advisory, not law, it provides communities with some guidelines for providing resources to these workers and ensuring they are able to continue their work duties in the safest way possible, both at the work-site and telecommuting, if appropriate. Resources have been provided to workers deemed essential, such as access to childcare and personal protective equipment. 

In addition to federal guidance, much of what is happening locally during the COVID-19 epidemic is being driven by state governments and county public health officials. It is important for social workers to understand the guidelines and regulations in effect at all levels of government. 

Resources for understanding regulations and legislation

State action Coronavirus (COVID-19) The National Conference of State Legislators is a Washington DC-based nonprofit that works to enhance the effectiveness and efficiency of state legislatures. The organization has put together an interactive database that allows users to search for specific COVID-19 legislative actions by state. 

Healthcare and telehealth 

The healthcare industry is at the center of the epidemic and had to ramp up quickly to meet the direct and indirect demands of the new virus. Social workers are employed at all levels of healthcare; hospitals, offices, behavioral health, substance use treatment and a host of other formats of care.

One of the biggest changes has been a move to telehealth. While many patients can still benefit from telehealth, some still need in-person support, especially in environments inpatient or residential settings, where patients are residing at the treatment center while receiving around the clock medical and behavioral health care.  

Within weeks, the government and insurance companies began revising rules related to authorizations for behavioral health treatment during safer at home implementations at the state and local level. The Center for Medicaid and Medicare Services (CMS) changed rules and guidance related to the provision of telehealth services. The guidance discusses the expanded use of asynchronous telehealth, such as patient monitoring or other methods of service provisions that are not in live formats. It also discusses that audio-only live, synchronous interactions are covered for both Medicaid and Medicare patients. The public health emergency also provided the opportunity for people who have been displaced because of the epidemic and now reside temporarily in another state can continue to use the benefits of the state of origin. 

The Department of Health and Human Services (HHS) has also allowed for “enforcement discretion” when it comes to HIPAA policies related to telehealth service provision. This means that while there are typically rules in place about requirements for software and tools used to provide telehealth, these rules may be relaxed to allow for continuity of care. For example, Apple’s FaceTime application can be used to connect with patients, even though that platform is not HIPAA compliant. 

Stay-at-home orders have forced many social workers to move to video conferencing or audio platforms, when appropriate, to conduct business and meet with clients. While social workers working in any setting may be needed to connect via conference software, social workers working with patients in a healthcare capacity need to think carefully about how they transition appropriately. 

While the Department of Human Services has relaxed rules about the provision of telehealth, it’s still in the best interest of both social workers and their clients to provide services in a manner that is HIPAA compliant. Usually, HIPAA compliance requires that the service provider and teleconferencing platform sign a business associate agreement. Again, some of these requirements are relaxed during the pandemic to allow for easy access for clients. For example, while Apple will not sign a business associate agreement for its use of FaceTime, that platform is considered temporarily sufficient during the pandemic. If providers are able to use a HIPAA compliant telehealth conference system, it’s required that they do so. 

Resources for telehealth

HIPAA compliant platforms

While government agencies have loosened restrictions on devices and software used to connect with patients, practitioners are encouraged to use HIPAA compliant software as often as possible. The following list from California Association for Marriage and Family Therapist (CAMFT).

  • Simple Practice is an electronic health record (EHR) for practice practitioners. To access their telehealth platform, you have to sign up for the EHR subscription and you can then add video conferences for an additional $10/month per user.
  • VSee is a patient management service that includes, video calls, chat features, and intake triaging functions for $49/month per user. Larger organizations that need more capacity would need to upgrade to the enterprise version. The cost depends on the size organization.
  • Doxy.me is strictly a telemedicine platform providing video and audio options for individuals and practices. There is a free version of the platform which can be used for telehealth video appointments but has some limitations. The lowest cost platform for practitioners is $35/month per user.
  • SecureVideo is a telehealth plus platform. It has video and audio capabilities along with additional practice management features, like calendar integration and e-documents. 
  • Thera-link is an all-inclusive EHR for practitioners and organizations that includes video access as part of the package. 
  • CounSol.com is another all-inclusive EHR platform that includes a video telehealth platform in addition to managing records, billing, and other features.
  • Zoom Healthcare provides video and audio conferencing access for organizations with 10 users or more. Because they are made of organizations, the software is at a higher price point. 

Telehealth training

Several organizations have provided free training and resources for transitioning to telehealth providing information on a variety of topics. 

Additional telehealth resources 

The following are general resources that may be useful to social workers as they navigate the pandemic. 

Child and social welfare

Social welfare programs, such as child protective services, those that serve victims of domestic violence, and the justice system are not immune to the challenges of navigating the pandemic. These programs continue to determine how to deliver essential services to protect vulnerable populations while keeping both workers and clients safe.

The Children’s Bureau, a component of the US Department of Health and Human Services provided the following guidance for child welfare programs:

“Despite the public health crisis that exists, it is critical that child welfare agencies and courts work together to ensure that the requisite judicial proceedings continue during this time of uncertainty; each is critical to ensuring the safety, permanency, and well-being of children and youth who have been removed from their homes and placed into foster care or who may need to be removed from their homes. Activities such as neglect and abuse investigations, case management home visits, supervised visitation and legal activities such as custody hearings have carried on during the pandemic, with social distancing practices in place.”

Stay at home orders might cause more unreported or underreported violence at home for women, children, and LGBTQ individuals. This lack of reporting may cause what public health officials are calling  “a double pandemic,” indicating the increase of domestic violence incidence due to families sheltering in place together. While cities like Chicago report an increase in calls for help, other cities report lower calls and worry that it’s because victims are unable to make the call safely.

As an essential resource domestic violence shelters remain open and social workers continue to provide services to people in need of support. Many shelters have increased cleaning and sanitizing efforts, have limited visitor activity, and made other process changes to limit spread. 

Social welfare resources

Social workers serving older adults

Over 600,000 social workers provide services in services to older adults in nursing homes and other elder care facilities. Nursing homes have been an epicenter of the pandemic. The President of the Association for Gerontology Education in Social Work (AGESW) wrote the following to members about the pandemic, “Now, more than ever, we can work towards making sure older adults are viewed and discussed with dignity. There is a need to go beyond the counting of cases to acknowledging the lives of everyone affected by the coronavirus.”

With an acute focus on the COVID-19, some professional worry that issues related to other health or social-emotional conditions may be overlooked. The stay-at-home orders may have a disproportionate effect on older adults already at risk for isolation which can lead to other health concerns. 

Resource

Policy and advocacy

Social workers, as always, are the front lines of political and social activities related to the pandemic. Social workers even serve as lead public health officials, like Dr. Barbara Ferrer in California’s Los Angeles County. As it became clear that certain populations were disproportionately seeing the impact of the virus, the NASW began mobilizing efforts to advocate for communities. Here are a few advocacy issues the NASW is involved in:

  • The NASW and the American Psychological Association (APA) combined efforts to advocate for Medicare coverage of audio-only telehealth which was put into place by CMS
  • Strengthen OSHA requirements for healthcare social workers to have access to personal protective equipment (PPE)
  • Increase access to COVID-19 testing and other resources in underserved communities that are having disproportionate rates of infection
  • Advocacy for mental health services provided by social workers in skilled nursing facilities
  • Ensuring the safety of incarcerated people and the staff that provide services in prisons
  • Preventing discrimination of LGBTQ populations and their healthcare needs during the pandemic

Community organizing 

Social workers on the ground in communities continue to be integral in providing services to underserved populations. Due to COVID-19, there have been a number of additional issues in communities. Here are some examples of changes communities are facing:

  • The need for community support has only increased during the pandemic. As of the end of April over 20 million people have lost their job due to COVID, increasing the national unemployment rate to over 14%. 
  • The virus has disproportionately impacted communities of color. While research continues, some preliminary data suggests the increased underlying health issues, jobs that have high rates of contact with others, and discrimination in the healthcare system may be reasons for challenges in these communities. 
  • Food pantries have been inundated with new clients due to the increase in joblessness in communities. Local food banks are reporting an increase of as much as 600% have caused long lines and difficulty keeping up with demand. 
  • Shortage of supplies like personal care items, pantry items, and other necessities at community organizations 
  • Faith organizations and places of worship have had to transition community services such as support groups and community outreach to virtual events or postpone meetings

Resources for community organizers

Licensure and credentialing

For social workers in the middle of their licensure process, the closed offices and exam centers can be a point of stress. Some social workers who recently moved to a new state were caught in limbo when trying to apply for licensure in their new home. The Association of Social Work Boards (ASWB), who administers licensure exams, and state licensure agencies put plans in place to make sure that as many social workers as possible can legally and ethically practice. 

The ASWB is working with applicants to make sure that eligible applicants can apply to take their licensure and file for exam completion extensions. Testing centers are operational in locations where state ordinances allow. 

Each state has its own rules and exemptions to allow social workers to continue to provide services while complying with stay-at-home orders and other new pandemic related policies. Many states have authorized social workers to use telehealth, allowed extensions for expiring licenses, and allow temporary authorizations for social workers who have licensure in other states but have not yet completed their new home licensure process. 

  • For more information about licensure exams, state requirements, and impact of the pandemic, visit: https://www.aswb.org/

How will social work change a result of the pandemic?

While it’s extremely difficult to predict anything in a post-pandemic world, there are a few indications of what’s to come for social workers.

The social and economic recovery will be long and social workers will be an integral part of the process. Social workers are central to the social safety net designed to help the most vulnerable. With Depression-era levels of unemployment, the impact on social services will be great. The direct and indirect impact on physical and mental health is still unknown, but it’s clear that we will continue to see ripple effects play out for some time and social workers will be there to meet the need.

The move to remote work and telehealth seems to be something that will change the way multiple industries do business in the future. Views about telework seem to be shifting and it’s possible that the same can be said for telehealth. Agencies and practitioners have now gotten “up to speed” on implementing telehealth and have learned about how to use it effectively but how it can also benefit clients in unexpected ways. Individuals who were either unable or unwilling to participate in face-to-face therapy now have a wide range of resources. This increase in access will allow social workers and other mental health professionals to provide services to folks who would have otherwise fallen through the cracks. However, concerns still linger about the long-term implications of telehealth on insurance reimbursements, HIPAA compliance, and the efficacy of virtual treatment.

There’s no doubt the future for everyone, including social workers, looks different in a post-COVID-19 pandemic world. Though there is much uncertainty it seems clear that social workers will be just as important if not more so, for sustaining healthy communities.