Survivor Experiences Living in an Intimate Partner Violence Shelter in the United States in 2022: Implications for the COVID-19 Endemic and Beyond

Abstract

This study examines the lived experiences of survivors of IPV (n = 13) living in IPV shelters in the Southern United States in 2022 during the COVID-19 pandemic. This study makes recommendations for researchers and service providers that can be applied to other public health and environmental emergencies. Descriptive statistics were analyzed for the demographic questions and the participants’ responses to the COVID-19 impact scale. Thematic analysis was used to analyze the interviews. Most participants reported moderate to severe impact. Thematic analysis yielded three key themes: (a) ongoing COVID-19 disruptions, (b) COVID-19 policy implementation, and (c) consequences of social distancing. As COVID-19 is constantly evolving and the United States is experiencing new outbreaks of other infectious diseases, shelters should consider developing and reviewing general infectious disease and disaster protocols, leveraging technology, and utilizing outdoor space when available.

Keywords

coronavirus intimate partner violence domestic violence help-seeking

Natural disasters and stressful situations such as epidemics or public health emergencies can create unequivocal pressure on individuals. For example, natural disasters like Hurricane Harvey in 2017 and the 2008 earthquake in Sichuan, China, can add tremendous pressure on families. Individuals may be forced to stay within the confines of their homes or at camps, causing strain in relationships and limiting outside interaction (Chan & Zhang, 2011; First et al., 2022; Parkinson & Zara, 2013; Serrata & Alvarado, 2019).

Scholars have documented an association between public health emergencies and natural disasters and increased instances and severity of intimate partner violence (IPV; K. Evans et al., 2023; First et al., 2022; Medzhitova et al., 2023; Wood et al., 2023). Although the COVID-19 pandemic has become endemic, meaning that it will continue to circulate indefinitely, this does not mean that it is benign and without consequences (Bartles, 2024; Colarossi, 2024). It continues to be a global health risk, with 2,000 people dying every week from COVID-19 in the United States (Bartles, 2024). Epidemiologists assert that although not all future outbreaks may be as severe as COVID-19, the rate of various outbreaks over the past 20 years suggests that they will become an increasing phenomenon (Association for Professionals in Infection Control and Epidemiology [APIC, 2022]; Parachini et al., 2022). Presently, there are measles cases in 17 states, with an outbreak in a migrant shelter in Chicago that has spread to the public school system (Centers for Disease Control and Prevention [CDC], 2024; Pathieu et al., 2024), making public health crises an ongoing challenge for shelters. In addition, experts assert that storms, wildfires, and other nature disasters are becoming more frequent and extreme due to climate change (Woelfl et al., 2024).

IPV includes the experience of physical, emotional, sexual, or verbal violence, or stalking by a current or prior intimate partner (Breiding et al., 2015). Statistics by the U.S. National Violent Death Reporting System show that about one in four women and 1 in 10 men have experienced physical violence, sexual violence, and/or stalking by an intimate partner when looking at lifetime victimization rates (Smith et al., 2018). Although both men and women can experience IPV victimization (Kolbe & Büttner, 2020; Rai & Choi, 2022; Rai et al., 2024), Davis et al. (2020) reported that men were twice as likely as women to perpetrate IPV early in the COVID-19 pandemic. IPV victimization can have long-term impacts on mental and physical health (Coker et al., 2002; Karakurt et al., 2014). IPV can also affect abused individuals economically (see review by Johnson et al., 2022). Some individuals who have experienced IPV may be hesitant to seek help, prolonging their time spent in abusive relationships (e.g., Hogan et al., 2021).

IPV has been a national problem, but the severity of this issue worsened during the shelter-in-place orders and beyond amid the COVID-19 global pandemic (Peitzmeier et al., 2022; Wood et al., 2023). During the time of social distancing, individuals were forced to cohabit with their partners, increasing their likelihood of experiencing IPV (K. Evans et al., 2023; Ravi et al., 2022). The Council on Criminal Justice reported an 8.1% increase in reported IPV following the lockdowns in 2020 (Warren, n.d.). Research demonstrates that the COVID-19 pandemic was associated with new instances of IPV in relationships or intensified violence in existing violent relationships (Peitzmeier et al., 2022; Ravi et al., 2022; Wycoff et al., 2023). Extant research highlights the difficulties of seeking help early in the COVID-19 pandemic due to closures, limited mobility, and uncertain shelter access (Leat et al., 2024; Ravi et al., 2022; Wycoff et al., 2023). Therefore, given these unique experiences of IPV survivors during the COVID-19 pandemic, our study aims to examine how survivors utilized shelters in 2022 and their experiences within shelters to enhance implications for service providers for future public health and environmental crises.

A novel aspect of this study is the research design. This is the first study to our knowledge that utilized a validated COVID-19 impact scale (Stoddard et al., 2023) and a community-based participatory research design (Holkup et al., 2004; Israel et al., 2005) to understand the lived experiences of survivors of IPV in shelters in 2022 and to make recommendations for researchers and service providers. The study was developed in partnership with an IPV service organization in the Southern United States. Specifically, the service organization co-led the development of the research question(s), study design, and interview guide and participated in the dissemination of results, including this article. Furthermore, it adds to the existing knowledge base of literature on COVID-19; as to the authors’ knowledge, only studies from the providers’ perspectives are available documenting survivors’ experiences during 2022 (e.g., Nahar et al., 2023). It is essential that survivors’ voices are amplified and included in research and policy decisions. Ultimately, this study provides recommendations for shelters, which can be utilized in current and future public health crises or emergencies.

Literature Review

For survivors of IPV, seeking safety and help can be a very complex and challenging process, exacerbated by the COVID-19 pandemic (Wood, Baumler, et al., 2022). The fast beginning of the COVID-19 pandemic and subsequent lockdowns quickly changed the lives of IPV survivors, introducing changes and challenges to safety and accessing resources. In some instances, the 2020 lockdown forced many IPV survivors to be trapped with their abuser, contributing to feelings of isolation, lack of safe spaces due to workplace shutdowns or remote work, and limited access to possible formal or informal support structures (K. Evans et al., 2023; Sharma & Borah, 2020; Wood, Baumler, et al., 2022). In concurrence with increases in IPV perpetration during the pandemic (Bullinger et al., 2021), there have also been changes in help-seeking behaviors among survivors of IPV. The National Domestic Violence Hotline found a national increase of 9% in calls from survivors in 2020 compared with 2019 (The Hotline, 2021). In addition, urban areas observed an increase in calls (Avila & Cardenas, 2020; Piquero et al., 2021; Salazar, 2020), and some rural areas observed resource limitations with increased demand or a decrease in help-seeking, particularly in areas with a lack of public transportation and greater geographic distances (Avila & Cardenas, 2020; K. Evans et al., 2023). K. Evans and colleagues (2023) found that women IPV survivors had an increased fear of seeking shelter services with their children, which contributed to these survivors staying longer in unsafe homes and some incurring more severe injuries.

IPV survivors also reported that the initial closure of legal and social services led to long-term delays in accessing services and support lasting over two years, with some reporting not knowing where to go for help (Nahar et al., 2023; Wood, Baumler, et al., 2022). K. Evans and colleagues (2023) noted similar challenges and changes in funding, disease prevention, employee burnout, and effectively managing client crises across various victim service agencies during the COVID-19 pandemic. Although there was an increase in accessible virtual resources like 24/7 hotlines and remote counseling during lockdown, there were mixed opinions on using these services, with some survivors preferring the option of staying at home and others reporting these services feeling too detached (Emezue, 2020; Wood, Baumler, et al., 2022). Despite there being limited research on how these changes may have persisted, there was a clear impact of the pandemic on help-seeking in its early stages.

COVID-19 Impact on IPV Shelter Services

During the pandemic’s beginning, IPV shelter service providers reported that short-term and long-term housing and shelter were the most requested services by survivors (Nnawulezi & Hacskaylo, 2022). Although there has been an increase in IPV hotline calls and virtual services that have continued after the lockdown (Lipp & Johnson, 2022), access to in-person services like shelters has continued to be challenging. Early in the pandemic, shelters were reportedly over-crowded, with some closing down, reducing occupancy, reducing duration periods of providing shelter, or even removing current residents, particularly in large cities (Engleton et al., 2022; Leat et al., 2024; Pless et al., 2023; Wood, Voth Schrag, et al., 2022).

Pless and colleagues (2023), who conducted a study with 368 IPV shelter staff from across the United States, describe the preventive measures that included reducing capacity, housing residents and individual families in separate rooms rather than with roommates, requiring masking, implementing remote service provision as well as suspending group programming and community meals. Regarding addressing positive cases, shelters typically responded by isolating the survivor to a specific part of the shelter and increasing shelter cleaning (Pless et al., 2023). In some cases, the shelters would close the shelter to new residents or close it entirely and relocate residents. In 2022, shelter providers continued to report difficulties with telehealth services regarding lack of reliable Internet access and lack of privacy using virtual services with others being in the home and potentially overhearing counseling sessions; however, virtual services have been noted to increase access for survivors (Nahar et al., 2023). In addition, service providers reported survivors experienced barriers to accessing social and legal services due to extensive waitlists and periodic shutdowns (Nahar et al., 2023).

Experiences of Survivors of IPV in Shelters

Existing research highlights a diversity of experiences reported among IPV survivors who have been able to access shelters during the COVID-19 pandemic. Some survivors have compared shelter rules and lockdown restrictions early in the pandemic to the oppressive conditions when living with their abusers, with some even wanting to go back home (Ravi et al., 2022). Earlier in the pandemic, shelter service providers reported monitoring survivors, implementing lockdowns, and not allowing them to leave the shelter unless they have medical or emergency needs to reduce the risk of the spread of COVID-19 (Nahar et al., 2023; Ravi et al., 2022). Shelter service providers have also reported that some survivors feared contracting the virus, with some residents finding the increased control in communal living shelters more distressing than staying with their abusers (Leat et al., 2024). Other residents reported that the controlled conditions in shelters were worth the elevated distress compared with higher levels of distress experienced at home with their abusive partner (Dekel & Abrahams, 2021).

Before the pandemic, there were qualitative studies about the impact of rules and policies on shelter residents (Glenn & Goodman, 2015; Wood, Voth Schrag, et al., 2022), where survivors report having felt “caged up” (Wood et al., 2020, p. 4649) and like “there’s people on top of you” (Wood et al., 2020, p. 4649). In the United States, shelters may unintentionally isolate survivors from loved ones, and resources may cause further distress and even be reminiscent of abusive conditions survivors are escaping (Glenn & Goodman, 2015). It appears that the COVID-19 pandemic may have exacerbated these sentiments, with survivors in shelters early in the pandemic expressing frustration about being unable to leave shelters due to lockdown restrictions because of the high risk for the spread of COVID-19 (Leat et al., 2024; Ravi et al., 2022).

Although some IPV survivors have reported feeling a loss of control and support due to the COVID-19 pandemic restrictions in shelters, several have reported appreciating shelter staff for working with the extra challenges and work that came with those restrictions (Leat et al., 2024; Ravi et al., 2022; Wood, Baumler, et al., 2022). In addition, many survivors have reported a strong desire for in-person services (MacGregor et al., 2022) and felt supported by shelters during the early pandemic (Ravi et al., 2022; Wood, Baumler, et al., 2022). Some even report that the isolation due to lockdown restrictions allowed for introspection and provided the space and time to focus on healing (Ravi et al., 2022).

Strengths and Limitations of Existing Research

Although there have been numerous studies on how the COVID-19 pandemic has affected IPV (K. Evans et al., 2023; Ravi et al., 2022; Warren, n.d.) and help-seeking from survivors for virtual services and legal services (Baldwin et al., 2020; Leat et al., 2024; Piquero et al., 2021), there is less focus on the firsthand experiences of survivors who have sought help through housing and shelters. Although housing instability has had less of an impact on the well-being of survivors in the COVID-19 endemic compared with the acute COVID-19 pandemic phase, the housing instability and restrictions placed on shelters continue to be seen throughout and have been related to deteriorating mental health among survivors (Chiaramonte et al., 2022). Furthermore, even though some studies have focused on survivors’ firsthand experiences in shelters (Leat et al., 2024; Ravi et al., 2022; Wood, Baumler, et al., 2022), most of these studies have been conducted since the beginning of the COVID-19 pandemic and lockdown conditions. In addition, many studies have focused on the experiences of service providers and what they have seen among survivors who come to their shelters and not the survivors themselves (Murugan et al., 2022; Nnawulezi & Hacskaylo, 2022; Voth Schrag et al., 2023).

The Current Study

Experiences of survivors in supportive housing like shelters have been studied before and during the beginning of the COVID-19 pandemic. With restrictions lifting and increases in demand for in-person services, it is imperative that we understand the longer-term experiences of survivors in shelters in 2022. This is important given the unfolding and long-term effects of the pandemic on IPV survivors and the impact on shelters, and may be beneficial for future public health emergencies. Existing research focuses on survivors’ experiences early in the pandemic, and less is known about their experiences during the COVID-19 endemic phase. Given previous studies observing difficulties such as distress due to lockdown restrictions (Leat et al., 2024; Nahar et al., 2023; Ravi et al., 2022) when examining the impact of the pandemic on shelters, further examination of challenges during the COVID-19 endemic provides insight into how these difficulties may have changed or maintained over time. This information could be helpful in preparing for future responses to public health emergencies.

Method

This study was conducted from January 2022 to June 2022 (Figure 1) after obtaining university institutional review board (IRB) approval (IRB Protocol #: 2020-0305.4). Most interviews (73%) were conducted during January and February 2022 during the Delta and Omicron surge in COVID-19 cases, and the number of confirmed cases peaked at 5.6 million in the United States (CDC, n.d.; World Health Organization, n.d.). The timing of data collection during a surge in COVID-19 cases highlights the potential for a COVID-19 resurgence. An IPV service organization contacted the researchers to conduct a follow-up to their previous study (Ravi et al., 2022) that explored the impact of the COVID-19 pandemic on IPV service utilization in the Southern United States. The IPV agency was interested to find out how their COVID-19 response had changed since 2020 and how it affected survivors living in the shelter. The researchers adopted an explanatory mixed methods approach to inquiry for this study (Creswell & Plano-Clark, 2011). The participants completed a web-based survey that included a validated COVID-19 impact scale (Stoddard et al., 2023) and had the opportunity to participate in a follow-up semistructured interview with the second author. Thirteen survivors of IPV receiving services from two urban IPV shelters in the Southern United States participated in the study (13 completed the survey, and 11 participated in both the survey and the interview, with an 85% retention rate). The interview included questions related to what living in an IPV shelter was like during the COVID-19 pandemic, the rules and policies that the shelter enforced, and how the participants felt about them.

Measures

COVID-19 impact was measured using the Coronavirus Impact Scale (Stoddard et al., 2021). The Coronavirus Impact Scale consists of 12 items, and scores range from 0 to 32. The first eight items asked participants to rate how much the COVID-19 pandemic has changed their lives: routines, family income, food access, medical health care access, mental health care access, and access to social support. Response options include (0 = no change, 1 = mild, change in one area of work, education, social life, hobbies, and religious activities, 2 = moderate, change in two areas, 3 = severe, change in three or more areas). Items 9 to 11 focus on whether the participants or their family members experienced the COVID-19 illness themselves. Item 12 is an open-ended question not included with the scaled scores and allows the participants to provide additional information about how COVID-19 affected their lives. Reliability analyses were not conducted due to the small sample size (Kennedy, 2022).

Data Collection

Upon receiving university IRB approval, the researchers recruited a convenience sample by providing fliers to the IPV agency leadership. The agency staff posted the flyers at both of their IPV shelter locations. Interested survivors scanned the QR code on the flyer, which sent them to a consent form in Qualtrics that included consent for the web survey and the follow-up interview. The participants provided their contact information on the consent form. The researchers created separate links for the consent form and the web survey. The researchers included the phone number of the second author if the survivors had any questions about the study before consenting to participate. After the participants consented to participate in the study, they were directed to a separate link that contained the web survey. The second author contacted the participants by email who completed the web survey and consented to participate in the follow-up interview. Topics included in the interview included questions about their experiences living in an IPV shelter during COVID-19 in 2022. Participants were asked to reflect on their experiences with staff and other residents and what rules and policies the shelter was implementing. Participants received a $10 Walmart e-gift card for completing the web survey and an additional $20 gift card for completing the follow-up interview.

The interviews were conducted over the phone or via Zoom and lasted between 17 and 48 min. The second author recorded the interviews using a handheld recorder or the Zoom audio recording feature. The recordings were then on a secure cloud-based storage system and sent to Rev.com, a professional transcription company trained in confidentiality.

Trustworthiness

The authors increased the trustworthiness of the analysis by engaging in reflexivity and reflecting on their positionality (Adler, 2022). First, the authors reflected on their own experiences during the COVID-19 pandemic to mitigate the influence of their personal experiences during the pandemic. Second, the authors stated their positionality as it relates to the topic and the population. The first author is a white, cisgender IPV scholar with 10 years of IPV research and practice experience who has not experienced IPV personally. The second author is a white, cisgender IPV scholar with 9 years of IPV practice and research. The third author is an immigrant female scholar of color with over 10 years of research and practice experience with individuals experiencing IPV and culturally responsive approaches. The fourth author is a Latinx, cisgender trainee scholar with 4 years of trauma research experience and 2 years of IPV practice and research experience. The fifth author is a Black victim services practitioner who has worked in the nonprofit sector, serving women and children in crisis for 20 years, and spent the last 8 years as chief services officer for a large nonprofit providing services to victims of IPV. She is presently the executive director of an IPV shelter in the Southern United States. The sixth author is a Black practitioner who has served as the Vice President of Emergency Services for an IPV agency, where she oversaw ees advocacy and intervention services for survivors and their children, including two emergency shelters and a 24/7 hotline intervention support line.

Data Analysis

Descriptive statistics were analyzed for the demographic questions and the participants’ responses to the COVID-19 impact scale (Stoddard et al., 2021). The first and second authors contributed to the qualitative data analysis process using codebook thematic analysis (Braun & Clarke, 2022). They each read the transcripts twice and completed coding to formulate a codebook. The authors then used the codebook to code the transcripts and independently generated initial themes based on their coding. The first and second authors met for an hour and a half to review and refine the themes. The findings were also discussed and triangulated with the shelter leadership. Saturation was evaluated using code frequency counts and code meanings (Hennink & Kaiser, 2022).

Results

Participant Description

Table 1 displays the participants’ demographic characteristics. Their ages ranged from 23 to 55 (Md = 31.00). Ten of the participants identified as female, and three identified as transwomen. The sample consisted of 38.5% (n = 5) participants who identified as Black or African American, 38.5% (n = 5) identified as white, and 15.4% (n = 2) identified as multiracial, and one participant selected the option “prefer not to say.” Most participants were unemployed but were looking for work (n = 8). Three participants were employed for wages and two could not work. Most of the participants had children (69.2%, n = 10). Their stay in the shelter ranged from 4 days to 2 months.

Table 1.

Sample Demographics (N = 13).

Variable	Mdn	% (n)
Age	31.00
Gender
Female		77% (n = 10)
Transwoman		33% (n = 3)
Race
Black		38.5% (n = 5)
White		38.5% (n = 5)
Multiracial		15.4% (n = 2)
Employment status
Unemployed and looking for work		62% (n = 8)
Employed		15.4% (n = 2)
Unable to work		15.4% (n = 2)

COVID-19 Impact

The scores from the Coronavirus Impact Scale ranged from 8 to 32 (M = 24.53, SD = 6.45), indicating a moderate to severe impact. A total of 77% (n = 10) of the participants reported having contracted COVID-19. The number of immediate family members who contracted COVID-19 ranged from two to eight (M = 4.15, SD = 2.34), and the number of extended family members ranged from 0 to 20 (M = 6.46, SD = 5.77).

Most participants reported moderate to severe impact on each domain (Table 2). Approximately 85% of the participants reported moderate (30.8%, n = 4) to severe (53.8%, n = 7) changes in routines. Similarly, 85% of participants reported moderate (38.5%, n = 5) to severe (46.2%, n = 6) impacts on their family income or employment. Most of the participants experienced difficulty accessing medical and mental health services. The impact on mental health service access was slightly higher than physical health treatment. Over 60% of participants experienced moderate (15.4%, n = 2) to severe (46.2%, n = 6) impacts on their access to physical health care, and 69.3% experienced moderate (23.1%, n = 3) to severe (42.6%, n = 6) impacts on accessing mental health care. Over half of the participants had a moderate (7.7%, n = 1) or severe (46.2%, n = 6) change in access to social support. The vast majority of participants reported moderate to severe changes in stress (84.6%, n = 11) and discord (84.7%, n = 11) in their families related to COVID-19.

Table 2.

COVID-19 Impact on Participants (N = 13).

Type of impact	M (SD)	% (n)
Routines
No change		7.7% (n = 1)
Mild		7.7% (n = 1)
Moderate		30.8% (n = 4)
Severe		53.8% (n = 7)
Family income/employment
No change		7.7% (n = 1)
Mild		7.7% (n = 1)
Moderate		38.5 (n = 5)
Severe		46.2 (n = 6)
Food access
No change		23.1% (n = 3)
Mild		23.1% (n = 3)
Moderate		23.1% (n = 3)
Severe		30.8% (n = 4)
Medical health care access
No change		23.1% (n = 3)
Mild		15.4% (n = 2)
Moderate		15.4% (n = 2)
Severe		46.2 (n = 6)
Mental health treatment access
No change		15.4% (n = 2)
Mild		15.4% (n = 2)
Moderate		23.1% (n = 3)
Severe		46.2 (n = 6)
Access to social support
No change		15.4% (n = 2)
Mild		30.8% (n = 4)
Moderate		7.7% (n = 1)
Severe		46.2 (n = 6)
Experiences of stress related to COVID-19
None		7.7% (n = 1)
Mild		7.7% (n = 1)
Moderate		7.7% (n = 1)
Severe		76.9% (n = 10)
Stress and discord in the family
None		15.4% (n = 2)
Mild		0%
Moderate		38.5 (n = 5)
Severe		46.2 (n = 6)
Participant contracted COVID-19		77% (n = 10)
Number of immediate family members that contracted COVID-19	4.15 (2.34)
Number of extended family members that contracted COVID-19	6.46 (5.77)

Of the seven participants who answered the open-ended question, several (n = 4) shared financial concerns related to not being able to work or access government benefits in person. One participant was dismayed that her doctors would require her to go to the emergency room instead of seeing her in their office. Another participant explained her transportation limitations as her family and friends were reluctant to drive her to places due to COVID-19.

Qualitative Thematic Analysis

Thematic analysis of the results yielded three key themes: (a) ongoing COVID-19 disruptions, (b) COVID-19 policy implementation, and (c) consequences of social distancing.

The themes and their accompanying subthemes are presented below. Participant pseudonyms were created to represent the month the interview was conducted since data were collected over six months and experiences within the shelter and shelter policies continued to evolve in response to the pandemic. The first letter of the name indicates the month the interview was conducted (e.g., Fiona was interviewed in February 2022). For January and June, the first two letters represent the month (e.g., Jane was interviewed in January, and June was interviewed in June).

Theme 1: Ongoing COVID-19 Disruptions

When asked how the COVID-19 pandemic affected their lives in the shelter, participants frequently commented on the continued inability to access resources and services, which significantly affected their abilities to accomplish their goals. This finding is critical because it shows that even two years after the start of the COVID-19 pandemic, social services agencies are affected, which can affect the survivors’ service access. Participants explained that even in 2022, due to the pandemic most agencies and organizations were either closed or were significantly delayed in their response times. Jane (white female) described her experience, saying, “It’s taken a lot longer for that because all of the social security offices and stuff are closed, so you can’t go up there in person. You have to wait for the mail, and that takes even longer.” Participants frequently described their challenges navigating whether an organization was open for business, given that many organizations did not indicate their COVID-19 procedure on their website. Participants with children struggled to find activities to do with their children outside of the shelter because most places were closed. Jane (white female) relayed her experience, saying,

Well, there really hasn’t been many activities that we can go do. A lot of the places have shut down, and once they got shut down, it’s harder for you to find places to take the kids that are open, or the kids can actually be free to do what it is that they want.

Similarly, Felicity (Black female) reported challenges getting to and from the shelter to access services because ride-share transportation networks were not operating as usual. She said,

They were going to let me know which location I was going to, and the hospital actually got me a cab, but they had to go through like four or five different cars. I guess Lyft knew the situation, and they would transfer someone that has Covid because they know they need to get transferred to the shelter for quarantine. But five different people refused to take me because they didn’t want to catch it or something like that. But one car person said, ‘Okay, as long as we keep the windows down, I’ll take her,’ That was the only problem that I had, was getting to the shelter. A lot of people turned it down.

In addition to agencies and organizations outside of the shelter being closed, activities within the shelter were also limited due to social distancing requirements to limit exposure. One participant described the shelter staff’s efforts, saying, “I think that they’re trying to do stuff, but since the COVID-19 [surge] has locked the whole shelter down, there really hasn’t been anything” (Jane, white female). Participants reported staff members were trying to hold groups still, but residents were contracting COVID-19, so they eventually had to discontinue group meetings at the shelter. Farah, a Black female, shared her experience, saying,

I loved the groups. They were very comforting, but it was very seldom. And then, during Covid, they was doing group, but the groups kind of ended for a month because when they first found out someone had COVID-19, they had to quarantine them. Then they found out another person. And then they was like, ‘Oh no, we got to let everybody know that they’ve been exposed.’

Finally, participants commented they frequently encountered barriers to communicating with their case manager outside the shelter. Farah (Black female) said,

I didn’t get housing or anything, and I don’t know if my case worker got it set up. She said she did, but they kind of just told me you’d been exposed to COVID, you need to go get tested. So, I went to the emergency room, and sure enough, I had it. And then we were on quarantine. Nobody could come in or go out for ten days. And my case worker wasn’t coming in because I think she had COVID too. I never heard anything until four days right before it was time for me to leave.

These disruptions created by the COVID-19 pandemic created barriers to participants achieving their goals and connecting with services inside and outside the shelter.

Theme 2: COVID-19 Policy Implementation

The second theme identified by researchers is related to the confusion participants expressed about different policies that emerged and the enforcement of those policies developed in response to the COVID-19 pandemic. According to participants, shelter staff did excellent with cleanliness and enforcing policies related to sanitizing the shelter environment. However, staff struggled to implement other mask-wearing and social distancing policies due to residents’ differing views of safety.

First, participants reported they were pleased with the overall cleanliness of the shelter space. Frances (white female) said, “Everything is absolutely clean, almost too clean. Since COVID, I think they’ve really gotten clean.” Participants commented that staff members were actively engaged in ensuring residents were assigned chores to help keep the shelter clean, and they were enforcing those policies even if some residents did not see the importance of keeping the shelter space clean. Frances (white female) continued to describe the staff member’s efforts, saying, “Some of us, we’re not that clean. But they have staff who do nothing but clean.” Some participants also indicated they actively worked with staff to clean and sanitize their spaces. Mary (white female) described her efforts, saying, “I’ve been doing a lot of mopping and wiping, sanitizing. Since it’s COVID, I’ve been spraying down the door handles and sanitizing a lot the bathrooms.” Overall, participants felt that staff were united in ensuring the shelter environment was clean.

Second, participants indicated confusion over policy enforcement related to wearing face masks. Since the participants were interviewed over several months, it appeared that as time passed, there was less enforcement of face mask-wearing, which created confusion for participants. In the early interviews, there was clear enforcement of mask-wearing policies. For instance, Felicity (Black female) said, “You must have your mask on. If you come out your room and they [staff] see you don’t, they’re like, you can’t come out your room without your mask.” Frances (white female) described her experience interacting with staff, saying,

Lord, yes, we can’t even approach the staff without a mask on. If you do, they’ll say, “Can you please talk to me with a mask on?” They provide boxes of masks, so there’s no “why you don’t have a mask on?” because there’s a box in front of the staff at the window, there’s a box of them in the hallway, there’s a box of them in the computer room, a box of them in the cafeteria and they keep them stocked.

However, there was increasing confusion over whether residents were required to wear a face mask in the shelter as time passed. Farah (Black female) described the challenging enforcement of the policy, saying,

They [staff] trying to make people wear their mask at all times, but as soon as someone feels or sees someone without their mask or a kid without their mask, they feel comfortable not wearing their mask just to the restroom, “I’m just going to the bathroom. Why I got to put on a mask?”

Participants also indicated that as time progressed, the mask requirement became optional and then nonexistent. However, this information was not always clearly communicated to residents, so there was confusion about what was required. When asked if masking was required, June (Black female) said, “I’m not sure. I’m honestly not sure. Like I said, they don’t even test, so how would you know? You know what I mean?” Mary (white female) described the current state of the masking policy, saying,

Yeah, people have kind of stopped wearing them. They did suggest if you’re feeling sick, to take your temperature. They have a temperature machine up front where everyone’s supposed to take their temperature, especially if you’re feeling sick, and they will give you masks. I just tell my kids to wear masks.

The evolving enforcement of masking policies confused participants and led some participants to cease wearing masks and others who continued to wear masks to keep themselves safe.

Finally, participants described confusion related to the enforcement of social distancing and quarantine policies. Due to changing social distancing guidelines from the Centers for Disease Control (CDC) and capacity challenges, participants experienced inconsistent enforcement of quarantine policies within the shelter. Participants reported that staff would change the number of days they needed to quarantine and the policies surrounding their ability to move throughout the shelter. Jane (white female) described her experience, saying,

Well, speaking as somebody that had COVID-19, and I’m on my last couple days in quarantine, it’s been rough just because the quarantine policies have changed from the CDC. It was two weeks quarantine, and then they changed it to 10 days. And then, just a couple days ago, it was changed again to five days. Me with three little kids who are begging me to go outside every single day; they, for some reason, have not wanted to lift my quarantine, even though I have been self-quarantine before I was even diagnosed with it for three days, so I’ve been in quarantine now for seven days.

In addition, participants struggled to understand policies around their movement throughout the shelter. Some participants believed they would stay exclusively in their rooms if diagnosed with COVID-19. However, some participants were told they could leave their rooms if they complied with masking and sanitation policies. Jane (white female) described her frustration, saying,

I have had COVID-19, so I’ve had to quarantine myself, and for most of the other people around here, they’re supposed to be delivering food. Anytime you call up there, if you need something, they’re supposed to bring it to you. Well, for me, they tell me to go get it myself, to leave the room and do it myself.

Participants also noted capacity issues that made it challenging for staff to enforce social distancing policies. Fiona (Black female) described what she observed: “They just don’t separate us. I guess it’s not enough room to just separate, and I understand that. But it’s like one minute somebody’s sick with coronavirus, and everybody has it next.” Participants expressed that staff members were attempting to enforce quarantine guidelines, but changing guidelines from the CDC and limitations in space created confusion. Farah (Black female) described the challenges staff faced with quarantine policies, saying,

They’re [staff] just putting them [residents] in their room and feeding them in their room, and there’s really nothing they can do because they can’t keep them from going to the bathroom. And then if someone needs something, they can’t keep them from coming to the front, and that’s just spreading it, transferring it airborne.

Theme 3: Consequences of Social Distancing

The last theme identified during the data analysis is related to the consequences of social distancing that participants expressed. Participants noted additional challenges related to social distancing policies that created barriers for them in the shelter. The first consequence reported by participants was limited access to shared spaces due to social distancing requirements. Social distancing policies led some participants to describe increased feelings of isolation and loneliness. Participants relayed they felt increased feelings of isolation as they had come from abusive relationships that were isolating and lonely. Unable to interact with other residents made participants feel more isolated than before they entered the shelter. One participant expressed her feelings by saying,

Yeah, and the whole building is designed around us coming together and making friends and to feel like everything’s going to be okay. But in the age of Covid, it’s made the shelter where it repels you away from others. And it’s made it so much worse than the way it was designed to be. (Frances, white female)

Necessary social distancing policies caused unintended consequences for participants. They faced additional barriers to completing their goals during their stay within the shelter and accessing recreational activities that the survivors used for relaxation. Participants struggled most with sharing the televisions, the computers, and the outdoor smoking area at the shelter. Due to the social distancing policy, the shelter staff created a system that allowed residents to request a television in their room for an hour. However, this created tension for some participants because the television often had long wait times. Florence (white female) described her experience, saying,

So, we have to sign up for a television, which is only two, and there’s 50 girls here, and you’re lucky to be able to get a television, and it’s wheeled into your room, and you get it for an hour or two, and then you have to give it to someone else. Because we cannot all come together in a TV room and watch the same show.

Participants also faced challenges sharing the computers provided by the shelter. Participants commented that the computers were located in a small room, which was not appropriate for social distancing. Therefore, only one person was allowed in the computer space at a time. This caused participants distress because they often needed the computer to accomplish tasks necessary to help them leave the shelter. Florence (white female) described the computer situation, saying,

Well, since Covid-19, the only rule they have is they limited the amount of people in computer room, or outside, or in the smoke area. . . And then, on the computer situation, they only allow one person in the computer room at a time. So, that makes it very hard for people to take care of their business.

Another barrier created by social distancing policies was the participants’ inability to eat meals in the shelter cafeteria. Participants reported that a social distancing policy was created, which required residents to eat in their rooms. Felicity (Black female) described the policy saying,

You have to go get your food and go back to your room. They don’t have chairs in the room. They don’t have a little table in the room. So, you have to eat on the bed, and you have to risk getting something dirty and having to wash.

Finally, participants struggled with operationalizing this policy as the rooms did not have tables or space to eat besides the beds or the floor. Participants with kids especially struggled to keep the beds clear of food. Florence (white female) reported her experience, saying, “It is because I have kids, and since they’re not able to eat at a table, they’re eating in a room, and it causes bugs and stuff to be inside your room.” The requirement to eat in the room led some participants to experience additional stressors and conflict with their children because they did not have safe places to eat.

Discussion

The purpose of this study was to add to the literature on experiences of living in an IPV shelter in 2022 during the COVID-19 pandemic, which became endemic. This study was a follow-up to Ravi and colleagues (2022), which explored survivors’ experiences living in an IPV shelter in early (March 2020) during the COVID-19 pandemic. The community-based participatory research-based approach incorporated within this study has allowed for community voice to take priority and add to evidence that will be most beneficial to providers and community members. The quantitative findings from the survey indicated that survivors were moderately to severely affected by COVID-19. Specific domains of impact included routines, family income or employment, difficulty accessing physical and mental health services, social support, family stress, and discord. The qualitative themes centered around COVID-19 disruptions in services and their ability to accomplish goals, COVID-19 policy confusion, and the unintended consequences of COVID-19 on survivors living in an IPV shelter.

Ongoing COVID-19 Disruptions

Survivors’ reports of COVID-19 impact mirror survivors’ experiences reported earlier in the pandemic (2020), such as difficulties accessing physical and mental health services and meeting basic needs (Nahar et al., 2023; Ragavan et al., 2022). Survivors in this study still reported a loss of social support and difficulty accessing social services and government offices (Sharma & Borah, 2020; Wood, Baumler, et al., 2022). This finding is similar to survivor experiences earlier in the pandemic, where participants noted long wait times and challenges accessing services due to businesses being shut down (Nahar et al., 2023). The finding is not surprising since almost three-quarters of the interviews were conducted during Delta and Omicron surges. It demonstrates that despite time elapsing, COVID-19 surges, and other public health crises are a valid concern that require preparation.

Similarly, several survivors had difficulties accomplishing their service goals due to continued social service delays or closures even in the third year of the pandemic, especially in the winter during spikes in COVID-19. At times, therapeutic and recreational activities such as group therapy or congregating in social spaces at the shelter were paused due to rising rates of COVID-19. Survivors were not always able to participate in group therapy, which often provides an area of comfort and connection and is an important intervention for survivors (Kelly & Pich, 2014; Ogbe et al., 2020). Shelter staff were likely trying to balance safety and normalcy in programming, which has been a common issue among IPV service providers (Nnawulezi & Hacskaylo, 2022). Due to closure, survivors also had difficulty finding activities to do with their children outside the shelter. However, as other studies have highlighted, they did not report any limitations of activities for children in the shelter (Øverlien, 2020). A difference between the disruptions in 2022 and earlier in the pandemic was that in 2022, they seemed to be temporary and mirrored the current COVID-19 rates in the shelter and the community.

Some survivors also faced difficulties communicating with their case managers due to case managers working remotely. Before the COVID-19 pandemic, advocates and case managers were typically more accessible to reach as they worked onsite, full-time. Existing research has shown that during the pandemic, 79.5% of case managers and advocates worked at least part of the time remotely (Wood, Voth Schrag, et al., 2022). In addition to working remotely, case managers have been affected by illness and burnout related to COVID-19, affecting their physical and emotional availability to survivors (Williams et al., 2021; Wood, Voth Schrag et al., 2022). This finding is critical as survivors’ relationship with their case managers is vital for social support and achieving their goals (Ogbe et al., 2020).

COVID-19 Policy Implementation

One of the most discussed topics in the qualitative interviews was the confusion around the COVID-19 policies. Survivors consistently discussed the policy confusion around face masks and quarantine. Early in 2022, during COVID-19 peaks, shelters were consistently enforcing masking. However, over time, mask policies were enforced less, and masking became optional. Research conducted during the earlier phases of the COVID-19 pandemic points to the need for providers’ flexibility in implementing state-level pandemic policies due to the changing numbers of coronavirus diagnoses (Nahar & Runnels, 2023). The policies transitioned to identifying survivors who were unwell. This evolution of the policy change likely reflects the changing CDC recommendations related to masking and the community levels of COVID-19. Survivors reported varying descriptions of the quarantine policy. In some cases, they reported they had to stay in their rooms and were only allowed to eat in their rooms, whereas others reported that they could move around the shelter as long as they were masked.

These variations in the quarantine policies likely reflect the time frame of the interviews, as shelter policies are frequently being updated to keep up with CDC recommendations. In some cases, these changing recommendations and policies affected survivors who were in quarantine during CDC policy changes, and shelters seemed to err on the side of caution with longer quarantine policies. However, it is possible that residents were aware of the shift in quarantine policies, and the change in shelter quarantine policy took time to be disseminated to staff.

Consequences of Social Distancing

Although the COVID-19-related policies were designed to keep the residents and the staff safe, they resulted in unintended consequences, including social isolation, tension among the residents, difficulty completing their goals, and difficulty eating in their rooms. Unintended consequences are inevitable with public health policies (Oliver et al., 2019). These findings align with similar research conducted during the pandemic, which emphasized increased social isolation from friends, family, and other sources of support due to social distancing state-level policies (Nahar & Runnels, 2023). By identifying and understanding the unintended consequences of policies within the shelter, policymakers and practitioners can amend the policy or provide solutions to address the unintentional consequences (Oliver et al., 2019).

Strengths and Limitations of the Study

It is important to acknowledge both the strengths and limitations of this study. To the authors’ knowledge, this is the first study to document survivors’ experiences in an IPV shelter during the endemic phase of COVID-19. The COVID-19 impact scale (Stoddard et al., 2021), which added novelty to the study as previous studies did not use a validated COVID-19 impact scale. However, it does not prompt participants to reflect on a specific period, so there is a possibility that they were reflecting on their experiences early in the pandemic phase.

The transferability of the study’s findings is limited due to the qualitative nature of the study, which aims to provide a thick and rich description rather than transferring the findings to other populations, which is possible with sample sizes as small as nine (Hennink & Kaiser, 2022; Merriam & Grenier, 2019). The study was conducted with two shelters in one urban area in a southern state. In addition, although the sample was somewhat racially diverse, it did not include Latino or Asian American survivors or immigrant survivors. Furthermore, the study did not explore differences based on demographic differences such as race and ethnicity due to its qualitative focus. Despite the researchers collecting data over a 6-month period, providing a broader lens for how the shelters were adapting to the changing status of the pandemic, this study did not explicitly compare the differences in the experiences of survivors who participated in the study in early 2022 with those who participated later in 2022.

Implications for Research and Future Directions

Despite the strengths of this research study, it is imperative that future research on the topic include a multistate comparison of shelter participants across the United States for greater and more diverse samples (e.g., men, Latinos, immigrants) to increase transferability. Additional research should include differences in experiences based on demographic characteristics such as race and ethnicity. Future studies are needed to speak with IPV survivors who lived in an IPV during the COVID-19 pandemic to explore the long-term outcomes following the disruption in help-seeking and isolation. In addition, future research could test new effective ways of disseminating shelter policies related to illness and other important information to residents.

Implications for IPV Shelter Policy and Social Work Practice

As COVID-19 is constantly evolving and the United States will likely continue to see peaks throughout the years to come, shelter leadership will continue to have to adjust their policies related to minimizing the effects of COVID-19 and other illnesses such as flu, respiratory syncytial virus (RSV), and more recently, measles. The following are suggestions that IPV shelters may already implement or could implement in the future.

It is imperative that IPV service providers continue to ask questions about exposure to COVID-19 and other communicable diseases during the screening process during the hotline call and explain the shelter’s infectious disease policies. Moreover, although COVID-19 has reached the endemic phase, epidemiologists predict future outbreaks are likely (APIC, 2022; Parachini et al., 2022). It is critical that IPV shelters have a general infectious disease protocol (e.g., scabies, measles, norovirus, influenza, RSV) that they create and periodically update with the assistance of the local health department that includes shutdown procedures. It is important that any infectious disease protocol information is disseminated consistently to shelter residents and that residents are aware that the policies can change depending on community levels of illness, as well as promptly updating the residents when changes occur (Nahar et al., 2023). Similarly, it is important that shelters have disaster policies in place and that the protocol is effectively communicated to the survivors to ensure survivor safety and well-being at each disaster phase (First et al., 2017).

Having a transparent communication system for disseminating the changes to shelter staff and survivors could be beneficial to ensure that both staff and survivors are informed of the policy changes. Association for Professionals in Infection Control and Epidemiology argues that there are inherent challenges in communicating scientific information about novel pathogens prevention and control guidance as the information evolves rapidly with science and newly available data (APIC, 2022). Furthermore, they recommend encouraging staff to embrace changes rather than debating whether previous recommendations were adequate (APIC, 2022). Holding multiple house meetings with staggered attendance could be utilized as a space to announce updates to the policy. When it is not safe to meet in person, virtual house meetings could be a viable option to discuss policy changes and other shelter-related issues. Posting information in common areas, where a limited number of residents can congregate at a time with social distancing, could be another strategy to keep survivors informed.

Regarding masking policies, providing survivors with the choice to wear a mask and emphasizing that residents and staff should respect individuals’ personal choices could help streamline the marking policy. Transparency and choice are key elements of trauma-informed social work and are beneficial when making and implementing policy (Center for Disease Control and Prevention Center for Preparedness and Response, 2020; Levenson, 2020). This implication of transparent communication is also relevant beyond disseminating information about illness policies and could be used to provide information about other types of disruptions in the shelter, such as changes in leadership, staffing shortages, maintenance or construction disruptions, or the loss of a key community resource.

In addition, shelters can consider applying for grants for incentives for vaccinations for COVID-19 and other infectious diseases from local homeless coalitions and state and federal agencies such as the Office for Disease Prevention and Health Promotion and the Administration for Community Living (Guide to Community Preventive Services, 2015). Furthermore, it is imperative that policymakers and funders continue to offer vaccination incentive programs, especially during public health emergencies.

Providing group services in multiple smaller groups would potentially allow for more social distancing to minimize the disruption of activities such as support groups due to COVID-19 and the need for social distance. In addition, social workers employed in shelters should consider leveraging outdoor space to the extent possible. For instance, holding groups and house meetings outdoors and activities for survivors and their children could help maintain programming and recreational activities. Scholars and practitioners of nature-based therapy recognize that nature can facilitate the therapeutic process (Varning Poulsen et al., 2020). Hosting outings to a local park and outdoor recreation areas may provide opportunities to reduce isolation and strengthen bonding and connections (Reizvikh, 2016; Zhang et al., 2023). Moreover, nature engagement has been shown to promote well-being and healing among survivors of IPV and sexual assault (Moore & Van Vliet, 2019; Reizvikh, 2016).

Some of the unintended consequences of social distancing may be mitigated by leveraging technology (Nahar et al., 2023), making furniture adjustments, and increasing the use of outdoor spaces. To address the technology-related challenges, funders need to continue to provide grants for IPV shelters to purchase the needed technology and supplies as they did during the beginning of the COVID-19 pandemic through state and federal grants such as American Rescue Plan and Health and Human Service Funds. Additional nonemergency funding for bolstering shelter technology should be a priority. This funding could be used to purchase tablets and laptops, if funding is available, that survivors can check out to make progress on their goals, such as looking for housing, employment, or participating in virtual meetings with a case manager or therapist.

Ensuring that survivors have the necessary furniture in their rooms when they need to eat in their rooms could help survivors and their families feel more comfortable. Having the resources required for survivors in their rooms helps create a comfortable environment and improves survivors’ well-being (Grieder & Chanmugam, 2013; Leat, 2021). As one of the survivors pointed out, IPV shelters are typically created to build a sense of community and connection (Wilson et al., 2015), which is difficult to do indoors during a pandemic. Providing picnic tables for survivors and their children to eat meals promotes a sense of community that survivors typically would experience in a dining room or cafeteria. These recommendations are critical for shelters currently and in the future to provide ongoing support to clients and improve functioning.

Conclusion

The findings of the study demonstrate that the COVID-19 pandemic was still disrupting the live survivors’ seeking refuge in IPV shelters in 2022. COVID-19 outbreaks, as well as other types of infectious diseases and environmental emergencies, will likely continue to affect shelters for years to come. Findings from this study add to the existing knowledge about the impacts of the COVID-19 pandemic and provide suggestions to improve future responses to public health and environmental emergencies as well as other shelter and community resource changes. It is imperative that social workers employed in IPV shelters adopt a flexible, trauma-informed approach to implementing policy and think creatively about how to continue to provide support and build connections among survivors.

Footnotes

Disposition editor: Cristina Mogro-Wilson

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Kristen E. Ravi

Sarah Leat

Abha Rai

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