Abstract: How Do We Keep Everyone Safe?: Client and Provider Perspectives on the Implementation and Impact of COVID-19 Safety Protocols in Los Angeles County Homeless Shelters (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

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How Do We Keep Everyone Safe?: Client and Provider Perspectives on the Implementation and Impact of COVID-19 Safety Protocols in Los Angeles County Homeless Shelters

Friday, January 13, 2023
Camelback A, 2nd Level (Sheraton Phoenix Downtown)
* noted as presenting author
Bikki Tran Smith, Phd, Postdoctoral Fellow, University of Wisconsin-Madison, WI
Howard Padwa, PhD, Research Scientist, University of California, Los Angeles, Los Angeles, CA
Roya Ijadi-Maghsoodi, MD, Assistant Professor - in Residence, University of California, Los Angeles
Anna Darby, MD, MPH, Postdoctoral Fellow, University of California, Los Angeles
Taylor E. Harris, PhD, Postdoctoral Fellow, Veterans Affairs Greater Los Angeles Healthcare System
Maria Patanwala, MD, Postdoctoral Fellow, University of California, Los Angeles
Lillian Gelberg, MD, Professor, University of California, Los Angeles, Los Angeles, CA
Ben Henwood, PhD, Associate Professor, University of Southern California, Los Angeles, CA
Background and Purpose: People experiencing homelessness (PEH) are at higher risk of COVID-19 related hospitalization and death than the rest of the general population due to higher rates of underlying health comorbidities. Ironically, accessing shelter as opposed to staying unsheltered, which may normally be a health protective factor, could have increased the risk of COVID-19 infection during the pandemic. Thus, it was important to develop effective policies and practices within shelters to help better ensure the safety of providers and service recipients. As part of a larger mixed-methods study on the comparative effectiveness of scatter-site vs. place-based permanent supportive housing on COVID-19-related health and social outcomes for adults experiencing homelessness in Los Angeles County, this inquiry examines housing service providers and clients’ perspectives on the implementation and experiences of COVID-19 safety protocols within the shelter system.

Methods: We conducted individual in-depth interviews (N=28) with persons experiencing homelessness, and focus groups (N=8) with shelter providers from across four supportive housing services agencies. Interviews and focus groups were on average 45 and 90 minutes long, respectively. Interview recordings were transcribed verbatim and entered into Dedoose for data management and analysis. Transcripts were analyzed using hybrid thematic analysis.

Results: Themes developed related to barriers and facilitators of safety protocol implementation included: 1) contradictions within safety protocols, 2) technological barriers, and 3) competing priorities. Corresponding themes for clients’ experiences of shelter COVID-19 safety policies were: 1) confusion and fear, 2) delays/interruptions in service provision, and 3) foregoing risk mitigation strategies. The aforementioned implementation factors and the experiences of them were largely influenced by space constraints and grant funding support. Altogether, these have resulted in increased risks of contracting COVID-19 for both staff and clients, and in some cases, becoming acutely sick from COVID-19.

Conclusion and Implications: Even as the U.S. has moved toward treating COVID-19 as endemic, the ebbs and flows of the virus are unknown, and persons experiencing homelessness remain a vulnerable group. Therefore, learning from how COVID-19 safety policies have been implemented in shelters throughout the course of the pandemic and the impact of these measures on clients and providers will enable us to develop shelter safety protocol best practices and leverage available resources to better protect their health and safety now and in the future should a more virulent strain of the coronavirus arise.