Table 4.

Most challenging aspects during COVID-19

Open-ended responses (n = 93)		Participant quotes
Staff Challenges	33 (38%)a	"Staff experiencing the same stress/community trauma alongside their clients. Every normal life stress has been 10 × harder."
Personal Challenges	16 (48%)b	"We're all struggling to stay motivated and positive."
Structural Challenges	14 (42%)b	"Performing several extra job duties that were never listed on employment application that are not being compensated for."
Other	5 (15%)b	"Managing fears of staff and patients in light of incompletely understood pandemic."
Client Challenges	60 (69%)a	“Connecting and engaging clients during phone sessions. Interpreting client message without the benefit of body language and eye contact.”
Lack of Accountability	27 (45%)c	"As great as telehealth has been for me as a clinician, the client can always ignore the phone call."
Difficulties Establishing Rapport	14 (23%)c	"The lack of personal interaction with patient while supporting his/her needs."
Technology Access/Digital Literacy Issues	12 (20%)c	"Getting them on the phone for their services due to lack of cell service, minutes, and poor or outdated phones."
Other	17 (28%)c	"Making sure that everyone is mindful of safety and educated on the safety guidelines."

^aPercentage out of Total Excerpts (N = 93T)

^bPercentage out of Parent Code “Staff Challenges”

^cPercentage out of Parent Code “Client Challenges”

Parent codes for enjoyment of work are not mutually exclusive (n = 9 assigned more than 1 applicable code); Subcodes for challenges not mutually exclusive (n = 17 assigned more than 1 applicable code)