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They are often under-paid, under-educated and largely unprepared for the work they find themselves doing. Last year, pioneering research — led by Faculty of Social Work professor Dr. Jeannette Waegemakers Schiff, PhD, RSW — showed that many of them were also very traumatized by their work.

• Pictured above: Jeannette Waegemakers Schiff. Photo by David Kotsibie

Her research showed that more than a third of frontline workers doing invaluable service in homeless shelters, women’s emergency shelters, Indigenous shelters and outreach programs reported signs of traumatic stress injury. That’s more than police, firefighters, paramedics and nurses.

And that was before COVID-19.

Earlier this month, Canadian Institutes of Health Research announced that Waegemakers Schiff will receive funding under a new research operating grant for her project COVID-19 Mental Health and Substance Use Service Needs and Delivery Program.

The grant will allow Waegemakers Schiff to expand her research nationally, as she’ll be collecting data from thousands of frontline workers in Calgary, Edmonton, Thunder Bay, Toronto, St. John, Moncton and Fredericton. She’ll be collaborating with academics and key frontline service administrators in each city.

New perspectives on trauma in the workplace

This followup research will allow Waegemakers Schiff to see how the additional stress of COVID-19 is impacting frontline caregivers, and also allowing her new perspectives on best interventions to support this essential workforce.

“I think we’ll find that in some organizations there's going to be an escalation of stress and an increase of sick leave and disability leave,” says Waegemakers Schiff. “In other organizations — where they've actively implemented some supports for staff — I would expect that the supports would help to balance things out and there won't be as big an impact.”

She says that the data might allow her to consider other factors that could help organizations better support workers. For example, Victor Davis, Toronto’s largest homeless-serving shelter, has 21 different programs with different requirements for staff. About half its several hundred employees are required to work directly, in face-to-face activities, with a large range of homeless individuals. However, in the other programs staff can decide when and where they are going to have face-to-face interaction with clients.

Anecdotally she's heard that teams with control over their work environment and hours did much better than those who were told when and where they had to work. This, she says, aligns with the theory that shows people who have experienced trauma do better when they have more control over their lives.

“So, if we can actually demonstrate differences in staff stress depending on the level of trauma-informed care, that would be wonderful,” she says. “It would make a great contribution because we're then not just saying, 'these people are traumatized.' We can show that in a work situation, where management and rules are the same, that different working conditions can make a difference in their performance. Well that makes a huge statement. So, I'm all fired up!”

“I think we’ll find that in some organizations there's going to be an escalation of stress and an increase of sick leave and disability leave. In other organizations — where they've actively implemented some staff supports for staff — I would expect that the supports would help to balance things out and there won't be as big an impact.”

Rare window into economic cost of trauma related to COVID

The study will also allow for a comparison of data about primary traumatic stress from her 2018 study, providing pre- and post-COVID data and also a chance to look at other issues like the cost of stress leave and staff turnover. In sending out invitations to participate in the study, Waegemakers Schiff was struck at how many people had already left the organization.

Her data will also be augmented by sick leave data which should give insight into the impact of traumatic stress, and perhaps a window into other hidden costs of the pandemic. Waegemakers Schiff says the Workers’ Compensation Board has agreed to provide data on disability leave utilization and compensation benefits for the Alberta organizations in her study, before and after COVID-19.

“Because I've got data on how they (staff) were doing before the shutdown, it will be a very nice comparison,” she says. “And there are very few occupations for which anybody has data on staff performance before the shutdown and now.”

Research helped change the landscape

The ripples from Waegemakers Schiff’s previous research continue to be felt. She points out that as a result of her work, Statistics Canada moved to identify frontline shelter workers as a distinct work group within the federal government. Similarly, when the Alberta government declared Post Traumatic Stress Awareness Day, they included frontline workers along with police, firefighters, EMT and members of the military.  

The government recently included frontline workers in a call for research proposals on how to mitigate traumatic stress injury among that group, indicating that frontline workers are now firmly entrenched within Alberta as a group that is at risk for traumatic injuries on the job.

More importantly, Waegemakers Schiff says her research really seems to have moved the needle on organizations accepting — and taking seriously — what is now being called traumatic stress injury.

“When I started this research five years ago, and presented to senior leaders at agencies in Edmonton, there was some support, but some skepticism,” she says. “I think the world has really turned around and there's a lot more understanding of the need for worker support and the extent to which psychological stressors are really hard on people working frontline. COVID has really amplified that as well.”

This competition was a partnership between the Canadian Institutes of Health Research, Institute of Aging, Institute of Neurosciences, Mental Health and Addiction, the Canadian Drugs and Substances Strategy, the Michael Smith Foundation for Health Research, the New Brunswick Health Research Foundation, the Ontario Ministry of Health and Long Term Care and the Saskatchewan Health Research Foundation.