Social Work in Action

Introduction

The effects of the COVID-19 pandemic have been undoubtedly great; from health and economic outcomes, to the areas of social functioning and daily life that have drastically changed. While the focus on these impacts has been largely related to physical health, researchers have also highlighted the effects on other areas of life such as mental health and emotional wellbeing. While pandemic-related outcomes should continue to be examined, the effects of quarantine measures more specifically must also be examined. With a deeper look at the various aspects of wellbeing, the impact of these changes on social connectivity should begin to be considered. How have these changes in the world altered social network connections to one another? Each person can likely think of an example of how quarantine measures have altered their social networks, but what about those underserved populations that have already been pushed to the fringes of mainstream society? How have quarantine measures affected their connections to social supports? As research begins to explore the greater effects of this pandemic, the people serving at-risk populations (including the author of this article) must also be cognizant of the impact of the loss of connectivity on the communities with which they work. One such underserved demographic that faces a number of risk factors are homeless populations.^1,2 While the focus has been on containing the spread of the disease among this and other populations, it must also be asked if the social needs of homeless individuals are adequately being addressed, given the importance of social network connections on their wellbeing. As is the case with so many aspects of this pandemic and quarantine, this article will ask more questions than it will answer. However, its purpose is not to answer scientific questions, but to encourage the public and mental health professionals to consider the importance of social network connectivity among homeless individuals given this very uncertain time.

Impact

In the short period of the COVID-19 pandemic and quarantine, new lines of research have begun to examine its impacts. One specific area of inquiry has focused on the psychosocial impact of quarantine measures. Quarantine measures generally include a number of disease control strategies such as home curfew, restrictions on group assemblies, cancellation of public events, and travel restrictions.³ And while these measures often vary by region, they are generally intended to separate individuals to slow the spread of disease. Studies have found that individuals living in quarantine conditions largely experience feelings of anxiety, fear, loneliness, panic, depression, obsessive behaviors, hoarding, anger, exhaustion, poor concentration, irritability, and insomnia among an array of additional symptoms.^3–6 And while the intent of quarantine measures are to reduce the spread of disease, preserving health overall, the effects of the isolation caused by quarantine must also be examined. But amidst all the increased risks associated with quarantine, why focus on this specific issue of social connectedness? Studies have found that during times of adverse events, the need for social support is greatest, and inability to access this support when it is needed most can threaten the sense of connectedness, impacting mental health.^7–26 Thus, it appears that this issue of support and connectedness may have far-reaching consequences for health, requiring additional attention.

For many populations, social network connectedness and social supports serve as important gatekeepers to health and wellbeing,^8–10 with social networks impacting a variety of risk and protective factors. Social networks have been shown to be particularly important in at-risk populations where engagement with members of one's social network, such as social supports, can influence an individuals’ engagement in a variety of behaviors such as engagement in drug and sex risk behaviors.^11–14 Thus, in a world where social networks have been greatly impacted by an event such as a pandemic, social network ties may potentially mitigate risk. However, when measures, such as quarantine, interrupt those connections, vulnerable populations might be expected to incur even higher rates of risk.

For a particularly high-risk population such as homeless populations, social networks can be expected to be an extremely important factor in an individual's life. The research supports this assumption in a variety of ways, with social networks impacting the lives of homeless individuals with regard to their mental health, substance use, length of time spent homeless, experiences of interpersonal violence, and HIV risk behaviors among others.^15–20,28 Studies have repeatedly found social networks to impact the health, mental health, and risk experiences among homeless individuals.^20,28 For example, among homeless populations, social networks have been shown to impact condom use and mental health of youth adults, as well as the physical health of adult men.²⁸ As a result, it goes to argue that the social isolation caused by a pandemic's quarantine measures may greatly impact this populations’ social networks, thusly effecting their health, safety, and wellbeing.

Where To Go From Here?

Given what is known about the role of social networks in the lives of homeless individuals, how might the pandemic and resulting quarantine measures impact these individuals in the future? As medical professionals, public health workers, social workers, and researchers, how might these impacts be addressed to help those at-risk? Thus far, the majority of the research on homelessness and risks presented by the current pandemic have focused on the susceptibility of this population to the disease, or the ability of local government to adequately protect them.^21–23 Fewer studies have examined the impact of the social isolation of quarantine on this population more generally, but research has established that social isolation not only increases the likelihood of becoming homeless, but for individuals already facing mental health issues, the social isolation from the quarantine measures may worsen their condition. Homelessness already puts individuals at an increased risk for poor health and poor mental health outcomes; the pandemic is likely to increase these risks.^24–26 Some additional risks presented by the pandemic and resulting quarantine measures are the result of service-providing organizations closing or limiting services provided or hours of operation, where reduction of services put people at potential risk for increased unsafe substance use and intimate partner violence.²⁷

What remains to be determined, and yet is vitally important for health and wellbeing, is the impact of the pandemic and quarantine measures on the social networks of homeless individuals and how these impacts affect behavioral health outcomes. Additionally, there are a number of factors that will affects these outcomes that have yet to be discussed. While it is known that the social networks of homeless individuals are associated with health outcomes, it is not known how the pandemic and resulting quarantine measures will impact smaller segments of the homeless population: adults compared to youth, racial/ethnic subgroups, and variations in age, gender and sexual orientation just to name a few. Quarantine measures may affect these groups differently, or may impact their health outcomes differently. Additionally, as previously discussed, quarantine measures may interrupt services that homeless individuals usually receive. And while this disruption may directly impact service receipt such as health care, STI testing, and food/shelter, among others, this disruption may also interrupt very important social network ties. Studies have indicated that particularly among homeless youth and young adults, connections to service providers such as social workers or drop-in/shelter staff impact an individuals’ engagement in risk behaviors.^28–29 These relationships have likely been altered in some way as a result of the pandemic, and exactly how these relationships have been altered or how these alterations have changed is currently unknown. Similarly, researchers often look at the number or proportion of social network ties that represent positive or negative socializing agents.³⁰ In other words, what percentage or proportion of an individual's social network engage in prosocial or anti-social behaviors that may influence their own risk or protective behaviors. This number of positive or negative socializing agents must also be examined in light of the pandemic. The actions and behaviors of individuals’ connections (friends, family, staff, etc.) may influence the engagement of risk behaviors of the individual, and should be examined as a result.

While many questions remain unanswered, the current pandemic also presents a number of implications and potential for future interventions with at-risk communities. Understanding the general impact of the pandemic and quarantine measures on homeless populations is essential for keeping the population healthy, but health, medical and social work professionals should also continue to improve their understanding of the importance, and the impact, of social networks and connectivity on homeless and other vulnerable populations. Understanding how the social network disruption caused by quarantine measures influence this and other populations will help us to tailor interventions during and after quarantine to provide the social and emotional supports needed for physical and mental health. Additionally, it is a reminder that the impact of social isolation may have lasting effects on this population, as dealing with the aftermath of these disruptions may take time and intervention for resolution. It can also inform future crises by calling attention to the need for additional supports to be put in place, as well as establishing more diverse social support networks should networks experience disruption. If nothing more, shedding light on the importance of connectivity among homeless populations during times of crisis may help both clinicians and researchers alike in assisting clients as holistic persons, focusing on the inclusion of social and emotional needs in treatment and intervention.