Victim service agencies felt widespread impacts from the COVID-19 pandemic on their staff, organizational practices, and client populations. This study offers a qualitative exploration of the impact of the COVID-19 pandemic across a broad spectrum of victim service settings, including court-based, mental health, medical, child welfare, interpersonal violence, and advocacy agencies. An electronic survey was completed by Ohio agency workers (N = 170) serving child and young adult victims of trauma. Codebook thematic analysis was used to identify agency and staff experiences, client needs, and changes to service delivery during the pandemic. Results revealed victim impacts in six categories: increases in mental/behavioral health needs, challenges resulting from school closures, safety concerns for victims of interpersonal violence, higher levels of crisis needs, isolation/stress, and service access issues. Agency-level impacts focused on the transition to virtual services, challenges with staffing and resources, worker burnout/stress, and resilience and flexibility. Implications are discussed for organizational staffing and trauma-informed training needs, burnout prevention and mitigation, and client service gaps. Future research should continue exploration of system- and organizational-level adaptation in response to the pandemic, as well as the long-term implementation of trauma-informed organizational practices as a strategy to enhance victim service worker satisfaction and retention.