The impact of client death on frontline workers in homelessness services: a systematic review and narrative synthesis

Abstract

Frontline workers in homelessness services are frequently exposed to unexpected death. While burnout and compassion fatigue have been documented, there is a lack of exploration into the impact of these deaths on homelessness workers. This review aims to understand stressors faced by homelessness workers exposed to premature death, and to identify evidence-based interventions providing support to workers managing the psychological impact of these experiences. Six databases were searched using predefined terms (CINAHL, Health Source, MEDLINE, PsychINFO, SocINDEX, Web of Science). Titles, abstracts, and full texts were screened by two reviewers, with disagreements resolved by a third. Data were extracted and thematically analyzed using NVivo, with findings synthesized narratively. Six studies met inclusion criteria. Workers reported various impacts, including psychological distress, grief complicated by stigma, heightened stress/burnout, and the effect of professional identity. No formal interventions beyond organizational support were identified. Workers utilized formal and informal organizational support, as well as personal coping strategies including boundary setting, finding closure, reframing death, and anticipating death. Repeated exposure to client death psychologically impacts homelessness workers. Lack of structured, evidence-based support highlights an urgent need for targeted interventions to support staff wellbeing.