Virtual Home Visiting during the COVID-19 Pandemic: Lessons Learned from Research, Practice, and Policy

Publication Date: February 3, 2023
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  • Published: 2023

Introduction

Home visiting services are inherently in-person, built on the concept that visiting families in their homes provides unique opportunities to support caregivers and children. However, some eligible families may not receive the benefits of evidence-based home visiting programs due to a variety of barriers, including scheduling, geographic distance, and family disengagement. Prior to the COVID-19 pandemic, some home visiting models and programs were using virtual methods to help connect and work with families. With the onset of the COVID-19 pandemic, the majority of home visiting programs needed to make an abrupt shift to delivering services virtually, rather than in person.

There appears to be general agreement amongst those involved in home visiting that virtual service delivery will continue to be a component of home visiting programs moving forward from the COVID-19 pandemic. Therefore, it is important to better understand the benefits, drawbacks, and challenges of virtual home visiting service delivery to ensure that what has been learned during the COVID-19 pandemic can be used to help improve home visiting going forward.

Purpose

To determine national, state, territory, and tribal views regarding the implications of virtual service delivery for home visiting, the Health Resources and Services Administration (HRSA) and the Administration for Children and Families (ACF) conducted a series of three virtual roundtable listening sessions in March 2022. The purpose of the listening sessions was to engage individuals involved with home visiting — including families, home visitors, program administrators, tribal leaders, model developers, researchers, technical assistance providers, advocates, and foundation staff — in conversation about the benefits and drawbacks of virtual home visiting, including how the recent emphasis on a virtual service delivery format due to the COVID-19 pandemic has informed home visiting research, practice, and policy.

The listening sessions focused on identifying lessons learned to date in virtual home visiting, especially during the COVID-19 pandemic; challenges or barriers, as well as innovative approaches to virtual service delivery; and opportunities to inform federal strategies for strengthening the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program.

Key Findings and Highlights

What was learned from the roundtable listening sessions adds support to previous findings suggesting that some aspects of virtual service delivery are considered advantageous by home visiting professionals and families, while other aspects are not seen as sufficient replacements for in-person activities. Key takeaways include the following:

  • Program implementation: Virtual service delivery allowed programs to be flexible in their responses to family needs and to reach new audiences, both in terms of staff and family recruitment. However, implementation barriers that were mentioned included: challenges with building rapport among home visitors and families; difficulties with home visiting staff recruitment, retention, and well-being; and some families’ and staff’s lack of access to and comfort with using technology for virtual service delivery.
  • Program activities: Challenges were identified around completing screenings and assessments, particularly privacy concerns for intimate partner violence screenings and an overreliance on parent reporting when assessing parent-child interactions. Virtual data collection also presented challenges, including issues capturing complex data elements (e.g., observational and environmental data, in-depth forms, complicated questions with multiple responses), adapting data systems and processes for a virtual environment, and concerns around data quality. Benefits related to real-time data collection and increased opportunities for group meetings and participant connections were identified.
  • Equitable service delivery: Participants reported that equity in home visiting, regardless of how services were delivered, required understanding family needs, engaging families as decision-makers in service planning, and “meeting families where they are.” The importance of technology resources in reducing equity gaps in service delivery was also stressed.
  • The future of home visiting: Participants said that virtual and in-person services should be offered in a nonprescriptive, hybrid format — meaning that families should have the opportunity to choose the modality that works best for them.

As home visiting programs continue to emerge from the restrictions of the COVID-19 pandemic, program implementors and policymakers should consider whether there are opportunities to reintroduce in-person elements to programming while retaining aspects of virtual service delivery that are seen as beneficial for home visiting professionals and families. While the information shared in this report can inform programmatic decisions concerning which home visiting elements are more conducive to virtual or to in-person service delivery, the roundtable listening sessions also reveal the importance from an equity perspective of tailoring home visiting service delivery to individual family needs. The information learned during the roundtable discussions and summarized in this report can help inform next steps related to developing and implementing home visiting services virtually and conducting research to understand it.

Methods

ACF and HRSA engaged a contractor, ICF International, Inc., to plan and conduct three virtual roundtable listening sessions. Prior to holding the roundtable listening sessions, ACF and HRSA identified key topics of interest that informed the development of questions that guided large group and breakout session discussions. A total of 121 people participated in the roundtables. The MURAL virtual whiteboard program, Zoom videoconferencing chat feature, meeting notes, and video recordings were used to capture participants’ discussions and feedback. After all sessions were complete, participants’ discussions and responses were examined and grouped around the following six topical themes that surfaced: (1) elements of a virtual home visit; (2) program implementation; (3) program activities; (4) equitable service delivery; (5) research opportunities; and (6) the future of home visiting. To detect potential differences between groups, the information was also coded based on the responding participant’s role, when possible.

Citation

Hadley, A., Hayes, J., Pai-Samant, S., & Stern, F. (2023). Virtual home visiting during the COVID-19 pandemic: Lessons learned from research, practice, and policy, OPRE Report # 2023-005, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Glossary

ACF:
Administration for Children and Families
HRSA:
Health Resources and Services Administration
MIECHV:
Maternal, Infant, and Early Childhood Home Visiting program
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OPRE Research Topics: