During this pandemic, families have been dealing with numerous sources of stress–including unemployment, strains on financial resources, and higher levels of anxiety and depression from living in a time of fear and uncertainty. Young children in poverty are much more likely to live in households where the experience of these stressors is chronic and more severe, independent of the COVID pandemic. Children’s developing brains and their future health may be negatively affected by growing up in these conditions.
State program administrators can help parents manage these stressors by strengthening existing services like home visiting and creating new avenues for reaching previously uncontacted families with unmet needs through their pediatric visits. These recommendations are based on the existing evidence of promising strategies, as well as insights from MDRC’s operational and implementation work with programs that serve the nation’s youngest children.
Making the Most of Home Visiting Interventions
Early childhood home visiting programs, including ones evaluated by MDRC that received funding from the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, intervene very early—either during a mother’s pregnancy or shortly after a child’s birth—to support positive parenting and family well-being. These programs typically provide three main types of support: direct information and education on child health and development and positive parenting practices; screening and identification of potential needs, risks, and stressors; and connecting families to resources to address identified risks or to achieve a family’s goals.
However, in stressful times, parents may very easily postpone following through on referrals that home visitors or other professionals provide. Some families may not want to open up or be candid about how they are feeling. Others might understand the importance of, for example, engaging with their child every day, but lack the capacity to do so because of other stressors in their lives.
Helping families follow through on their own goals
Behavioral science by MDRC and other researchers shows that engaging in small strategies of change, including relatively simple adjustments such as reframing a problem to make it more addressable, setting realistic goals, and providing reminders, can help gently nudge individuals to follow through on behavioral changes. Not all strategies will work, but one University of Chicago study found that asking parents to set weekly goals for reading with their child, texting them reminders, offering weekly feedback on how they were doing, and providing social rewards (public recognition by communicating success to other parents), made parents in the group that received these behavioral nudges spent 2.5 times more time reading to their child than parents in the control group.
Addressing more serious parental stress and depression
Other issues, such as a parent who is resistant to opening up or getting support for mental health, may require more than behavioral nudges. Cognitive behavioral therapy techniques helped develop one promising model from the platform of early childhood home visits to improve maternal depression. The Moving Beyond Depression program relies on trained mental health counselors who are brought into clients’ homes specifically to help mothers who are suffering from postpartum depression, which has been shown to be effective at reducing depressive symptoms. Supplemental and scaffolded programs, when one provider builds off of the work of another, may be especially important, because early care and education workers face significant rates of burnout and stress from the demanding nature of their work, so turnover of qualified staff remains a problem.
Leveraging pediatric visits to connect families to other services
Outside of social distancing and quarantine requirements caused by the pandemic, one ongoing challenge for home visiting programs is that not all parents are open to having a service provider come into their home. There are, however, existing examples of programs designed to reach new parents and provide services at a place they most often frequent: the pediatrician’s office.
Critical childhood immunizations are still necessary, and COVID has not stopped the need for them, nor is the pandemic keeping children getting sick from colds and flu. Several programs, including HealthySteps, Reach Out and Read, and the Video Interaction Project, use evidence-based approaches that step outside the home and embed supplemental support for parents within the context of the pediatric or family medicine clinic, making connections when parents bring children for check-ups. Reach Out and Read and the Video Interaction Project are designed to promote and enhance early literacy and parent-child interactions. HealthySteps provides broader parenting support, including infant feeding, parent-child attachment, managing child behaviors (for example, tantrums or sleep habits), parental depression, and family needs. The program places child development specialists in medical practices, where they work with primary care providers as part of the child’s care team. While some well-child care visits during COVID have shifted to telehealth platforms, these programs have also used phone-based and digital platforms as well. This offers new ways to reach parents and continue program engagement with them. If these strategies prove successful, they may offer important lessons for other providers trying to ensure they are reaching the families who could most benefit from their services.
Finding ways to better support and connect with families with young children is crucial to reducing the deleterious effects of common stressors, both in current and post-pandemic conditions. Program administrators can investigate pediatric-based platforms as a means of reaching new families and can adapt evidence-based forms of support, like using behavioral science or investing in more specialized approaches. Programs’ extra efforts to reach and engage parents may help families in need survive, and ultimately thrive during this unprecedented time.