As community members practice social distancing due to the COVID-19 pandemic, the home visiting field—which serves many families that face challenges related to economic hardship, mental health, and substance use—can no longer meet with families in person. Research shows that child abuse, intimate partner violence, and substance abuse increase during times of crisis, so it is now more important than ever to provide support to families who may face barriers to accessing services. Some service providers and states are implementing remote services, including virtual home visits, on which home visitors can learn from their peers in medicine and behavioral health.
Two fields—medicine and behavioral health—have explored the use of telehealth, defined as the use of electronic platforms such as video, texting, or online content to support long-distance health services. Studies comparing in-person and telehealth models have generally found similar outcomes across the two modes of service. Because of the overlap between the kinds of services that both telehealth services and home visiting programs provide—including assessment, information sharing, and support—lessons learned from telehealth can be valuable to home visiting.
The following research-supported technological outreach strategies may be options for home visiting:
- Video calls. Many home visiting models and states are allowing home visitors to use video calls to parents to address families’ needs for support. Other service providers, including child welfare caseworkers, are also moving toward the use of video-conferencing to reach families. Parents as Teachers has partnered with the University of Southern California to test the use of video calls to offer home visiting services; preliminary research shows high rates of parent satisfaction. While video calls are a great way to reach families, not all families will be able to take advantage, and home visitors can support families through other means.
- Texting and messaging apps. Telehealth may also include providing supports using texting or messaging services, and some research finds that these technologies enhance the effectiveness of traditional home visiting programs. Texting that accompanied a home visiting program increased responsive parenting and use of parenting strategies, and decreased incidences of children acting out and parental depression.
- Online content. Telehealth may also involve home visitors providing relevant information online. Some parenting programs that typically offer information to parents in a group-based setting have offered online versions of their programs to reduce barriers to access, finding that outcomes were the same for in-person and web participation. Programs that use online content for parents have found that online versions of parent support can improve outcomes for families and for children. Parent engagement with online content can be strengthened when providers check in with parents about the content and reinforce ideas.
Home visitors may need to adjust typical service delivery strategies to best recognize and meet the needs of families. For example:
- Families and home visitors need technology support. When using video conferencing, technology glitches may affect the quality of home visitors’ interactions with families. Home visiting programs should provide support to both staff and parents to troubleshoot problems. Not all families will have regular access to web-supported devices for virtual visits (although some providers are offering open access to wifi during the crisis), so programs should provide a range of telehealth support.
- Home visitors must be even more attentive to privacy concerns than usual during virtual visits, particularly around challenging topics such as depression or intimate partner violence. For example, a parent’s risk is potentially amplified given that they or other family members may be in close contact with an abuser who is also practicing social distancing. Home visitors must be able to communicate with other practitioners who have expertise in these difficult topics and can provide additional services to families—both of which can be done remotely.
While the field is learning how to best implement telehealth, home visiting programs can also adapt strategies from traditional home visiting as they move to virtual home visits during the COVID-19 crisis.
- Good communication skills remain important to engage with families. To communicate well using video, providers should set up equipment to allow eye contact with the family to strengthen rapport. They should minimize distractions such as background noise and think carefully about what is in their background (for example, choose a blank wall as a backdrop).
- Support to parents extends beyond the home visit. Programs can text to check in on parents or reinforce content between meetings. Texting to support parents can increase their overall engagement in the program.
- It’s important to create day and time boundaries for communication with families. Since telehealth technology is available around the clock, home visitors must be supported by programs to clearly set expectations and boundaries when they engage with families.
Families’ needs during the COVID-19 crisis will likely change day to day: Many families will lose supports and services or face modified services and become even more at risk. Telehealth options are a promising opportunity to ensure that families receive vital support in this difficult time.
Telehealth in infant mental health home visiting
Specific model guidance to date: ABC, Family Spirit, Healthy Families America, HIPPY, Nurse Family Partnership, Parents as Teachers
HHS guidance relaxing HIPAA requirements about confidentiality