InPractice: Lessons for and from Practitioners
Conducting Home Visits Without Visiting Homes
How Child First Is Adapting to the COVID-19 Pandemic
Home visiting programs have long been recognized as a vital support system for families facing challenges such as homelessness, poverty, drug abuse, and maternal depression. At-risk families are paired with a dedicated home visitor or a home visiting team that connects them to needed services, helps them learn how better to nurture their children, and provides therapy to help them overcome their trauma — all from the ease of home.
But since the onset of the COVID-19 pandemic earlier this year, stay-at-home orders and social distancing guidelines have presented the home visiting field with a new challenge: How do you serve families when you can no longer visit them at home? Early into the crisis, a national survey of home visiting programs showed that nearly nine out of ten of them were required to stop in-person home visits. With such practices paused for the foreseeable future, many programs have turned to telehealth technology — using phones or videoconferencing to provide treatment.
One such program is Child First, a comprehensive, therapeutic home visiting program that serves vulnerable children and families in a coordinated system of care. MDRC is conducting a randomized controlled trial in an effort to replicate findings from an earlier study that found that Child First improved children’s language and social-emotional skills, reduced caregivers’ depressive symptoms, and decreased families’ involvement in the child welfare system.
As the pandemic unfolded and shelter-in-place orders and other restrictions took effect, Child First teams were quick to transition to telehealth services to maintain their relationships with families and provide them with needed supports. While the program has always been an important resource, families are relying on the organization now more than ever as they navigate new challenges and new uncertainties.
How are Child First’s home visitors adapting to telehealth? What is working for families? To find out, we asked 10 Child First programs in Connecticut, North Carolina, and Florida for their insights and solutions.
How have Child First services changed during the COVID-19 crisis?
Prior to the pandemic, Child First teams typically visited families for one hour once or twice a week. Now, teams are engaging with their clients much more frequently, using a combination of text messages, phone calls, and videoconferencing. By leveraging these platforms, teams have developed new strategies for communicating with their families. For instance, some teams are using videoconferencing features like screen share to connect. As one Child First staff member noted:
What I like about telehealth is that we can share our screens to show an article or a checklist that the caregiver can easily do.
Teams are also finding creative ways to use the resources and materials they have on hand in order to deliver the Child First intervention. For instance, in typical practice, the Child First team provides play therapy in the home, bringing toys to help children address their fears or anger. Now teams have come up with workarounds in virtual sessions:
Now we improvise and create cardboard toys and have families create these toys with whatever materials they have, so that they can play along.
What’s different is that we don’t have the toys, so you have to think of something that the kids can relate to and join in. We do funny stuff [onscreen] like: ‘Throw it to me and I’ll throw it to you.’
In addition to telehealth appointments, what other ways are home visiting teams serving families?
Child First teams are continuing to help people access the resources they need. For instance, one team member has a homeless client who has nowhere to store her food. To address this, Child First picks up and stores the client’s food for her and delivers it to her in portions she can manage, taking proper social distancing precautions. Child First teams are also dropping off boxes of diapers, delivering grocery store gift cards, providing tablets for children to use for online instruction through their schools, helping caregivers pay for utilities, and scheduling rideshare pickups and drop-offs for their families. Teams are constantly searching online and checking social media to see what other resources they can provide.
What accommodations have home visiting teams had to make for telehealth to work well for families?
While the basic format of telehealth is roughly the same for everyone (that is, a phone call or a video chat), different levels of comfort with telehealth and varied home situations mean that no one approach works for everyone. As such, the teams are tailoring their sessions to meet individual needs, particularly in terms of privacy and flexibility:
Sometimes caregivers want to talk about things without little ears [overhearing], so sometimes we do our session over the phone [instead of on video].
During a session with the child and her mother via telehealth, [it was] noticed that child began to get a little fussy. After supporting mom in assessing child’s needs in the moment, mom reported that child wanted to nurse. Mom seemed a little uneasy and expressed a desire to move forward with session. [We] encouraged mom to put her phone down so she can freely nurse child as session continued, resulting in both mom and child’s needs being met.
What other obstacles have Child First teams encountered in pivoting to telehealth?
One of the biggest challenges that Child First teams have faced is getting a true understanding of a family’s home environment without in-person visits:
Getting a sense of what home life is like is difficult through telehealth. We can have someone walk us around and give us that visual, but it’s different to be in there and see what’s going on, and who is in the family.
To address this, teams have encouraged caregivers to describe their home and home life. What is their daily routine? Where do they like to spend time?
Another limitation is that teams can no longer be in the home to help with intense situations, such as coping with a child’s tantrum. Previously, the Child First home visitor would work with the caregiver and the child to guide them through the episode. But helping parents and children cope can be difficult if the team member is not there in person:
You end up having to do it more with the parent than the child because the parent is more attuned…. You have to handhold the parent a little bit more because they have to do it on their own and you’re not able to access the child that much. We’ve shifted to empowering the parent to stay calm — and that’s harder. Either they walk away from the camera or the camera’s shaking around because the kid is having a tantrum, and that’s hard.
How have families responded to connecting via telehealth?
For the most part, Child First teams have seen a positive response from families about telehealth. Many families say they appreciate that they’re still able to participate in the Child First program and have time to share their feelings and feel supported. Few families, if any, have disengaged from Child First services. For some, telehealth has even reduced barriers to therapy:
For families who are still anxious about contact with others, this has been really helpful because they feel safe engaging in therapy.
As the COVID-19 pandemic continues and recommendations for social distancing remain in place, Child First teams will continue practicing telehealth for the foreseeable future. Although this remote approach isn’t quite business as usual for the home visiting program, the Child First teams have shown creativity and dedication in their efforts to continue serving their families during this difficult time.
Thank you to the following Child First programs for taking the time to share their insights with us: Bridgeport Hospital; the Child and Family Agency of Southeastern Connecticut; Child Guidance Center of Mid-Fairfield County; InterCommunity in East Hartford, CT; United Community and Family Services in New London County and in Norwich, CT; The Village for Families and Children in Vernon, CT; Wheeler Clinic in New Britain, CT; Coastal Horizons Center in Wilmington, NC; and Families First of Palm Beach County, FL, via Child First’s “Practice Spotlight,” a memo shared across the Child First network that highlights different elements of the program.