The 'hole' is greater than the sum of its parts: How conducting home visits during a pandemic revealed gaps in an educational system

Covid-19 turned the world upside down. What started as an impossible situation turned into a problem with new possibilities. Individuals, families, communities, and states worked tirelessly to restore balance to overworked systems. Using semi-structured interviews with teachers and administrators, this high school social worker set out to examine how COVID-19 challenged staff to rethink current educational practices like home visits. This qualitative ethno-infused phenomenological study examines the experiences of home visits by a school social worker during COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Home Visitation Program Staff Attitudes and Intentions Towards Using Digital Technology to Educate Families About Preventing Early Childhood Obesity: A Qualitative Study.

INTRODUCTION: Home visitation programs that reach families of young children offer a unique opportunity for large-scale early childhood obesity prevention efforts. The objective of this qualitative research was to determine stakeholder attitudes, subjective norms, perceived ease of use and usefulness, behavioral control, and behavioral intentions towards utilizing technology in a home visitation program targeting early childhood obesity prevention. METHODS: Staff from the Florida Maternal, Infant, and Early Childhood Home Visiting Program (n = 27) were interviewed individually by a trained research assistant using a semi-structured script based on constructs from the Technology Acceptance Model and Theory of Planned Behavior. Demographic and technology use information were collected. Interviews were recorded and transcribed verbatim, with data extracted and coded by two trained researchers using a theoretical thematic analysis approach. RESULTS: Most of the home visiting staff (78%) were white and non-Hispanic and employed for an average of 5 years with the program. Most staff (85%) indicated they were currently using videoconferencing for home visits. Themes and subthemes emerged, including positive attitudes towards technology as a flexible and time-efficient program alternative for childhood obesity prevention with recommendations to keep content short, at a low literacy level, and available in more than one language for ease of use. Participants recommended developing training tutorials to improve program implementation. Internet access and potential social disconnect were cited as concerns for using technology. DISCUSSION: Overall, home visitation staff had positive attitudes and intentions for using technology in home visiting programs with families for early childhood obesity prevention.

Registered care home managers' experiences of responding to the national care home visiting guidance in England during the Covid-19 pandemic; a multi-method qualitative study.

BACKGROUND: Visiting restrictions in care homes in England and many comparable countries during the Covid-19 pandemic were extensive and prolonged. We examined how care home managers experienced, understood and responded to the national care home visiting guidance in England in developing their visiting policies. METHODS: A diverse sample of 121 care home managers across England, recruited through varied sources including the NIHR ENRICH network of care homes, completed a 10-item qualitative survey. Follow-up, in-depth qualitative interviews were conducted with a purposive sub-sample of 40 managers. Data were analysed thematically using Framework, a theoretically and methodologically flexible tool for data analysis in multiple researcher teams. FINDINGS: Some viewed the national guidance positively; as supporting the restrictive measures they felt necessary to protect residents and staff from infection, or as setting a broad policy framework while allowing local discretion. More commonly, however, managers experienced challenges. These included the guidance being issued late; the initial document and frequent, media-led updates not being user-friendly; important gaps, particularly in relation to dementia and the risks and harms associated with restrictions; guidance being unhelpfully open to interpretation while restrictive interpretations by regulators limited apparent scope for discretion; fragmented systems of local governance and poor central-local coordination; inconsistent access and quality of support from local regulators wider sources of information, advice and support that, while often valued, were experienced as uncoordinated, duplicative and sometimes confusing; and insufficient account taken of workforce challenges. CONCLUSIONS: Underlying many of the challenges experienced were structural issues, for which there have been longstanding calls for investment and strategic reform. For increasing sector resilience, these should be are urgently addressed. Future guidance would also be significantly strengthened by gathering better data, supporting well-facilitated peer exchange, engaging the sector more fully and dynamically in policy-making and learning from care home managers' and staff's experiences, particularly of assessing, managing and mitigating the wider risks and harms associated with visiting restrictions.

The interplay of home visitors' personal and professional identities in effectively screening and supporting women around sensitive topics

Home visiting programs provide information, support, resources, and tools that empower new parents to promote positive maternal and child health outcomes. During home visits, there is a unique opportunity to screen for intimate partner violence (IPV), reproductive coercion, and unintended pregnancy with women in unguarded settings (i.e., the women's homes) while providing ongoing services via a therapeutic relationship. Using individual interviews and a deliberative discussion focus group, the current study examined the research question, to what degree do home visiting staff members' personal and professional identities impact their ability to effectively screen and support pregnant women and new mothers around the topics of unintended pregnancy and intimate partner violence including reproductive coercion? Interviews and a deliberative discussion focus group were conducted virtually with staff members from Healthy Families America (HFA) programs in Maryland. Six major themes emerged from the interviews and focus group: personal versus professional experience, therapeutic alliance building, keeping families engaged, use of supervision, addressing intimate partner violence/reproductive coercion in families, and home visiting in the time of a health pandemic. Participants shared how their personal and professional identities helped shape their perceptions of their roles within the home visiting field including the terms, its meaning, and the expectations of that role. The findings suggest that home visitors need additional training around reproductive health since they routinely interact with pregnant women and new mothers who are at-risk for poor pregnancy-related health outcomes that may be due to the lack of control or intention related to reproduction. Participants expressed general knowledge, comfort, safety plan creation, and resource linking around the issue of IPV. Participants had received extensive training on administering the Relationship Assessment Tool (RAT), which is the IPV screener for HFA. However, relatively few program recipients endorsed that their HFA program recipients are experiencing IPV using the RAT. Therefore, HFA staff would benefit from advanced level training utilizing more clinical skills around the topic of IPV including advanced screening skills. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Interpreter use in sustained nurse home visiting: interpreter experience and support.

BACKGROUND: The aim of this study was to explore the experiences of healthcare interpreters working with child and family health nurses (CFHNs) in providing child and family health nursing (CFHN) services and sustained nurse home visiting (SNHV) programs to culturally and linguistically diverse (CALD) families with limited English proficiency. METHODS: A mixed methods longitudinal research design was conducted to develop, implement and evaluate a training and practice support model for healthcare interpreters working with nurses and CALD families in providing CFHN services and SNHV programs in three major local health services in Sydney, Australia. One pre-training survey with 24 healthcare interpreters was conducted; field notes were recorded during training and implementation; and a post-implementation focus group with six healthcare interpreters was conducted. Quantitative survey data were analysed descriptively using Alchemer. The focus group was audio-recorded for transcription purposes, and this and the field notes were thematically analysed applying a socioecological framework. RESULTS: Three themes were identified from the initial, pre-training survey: facilitate communication and delivery accurately; a bridge linking the clients and the healthcare practitioners; and make everybody feel comfortable. Practice support implementation was negatively impact by system and COVID-19 related barriers. Four themes were developed from evaluative phase of the study including: system-related issues; interpreters' challenges; working with nurses; and client session related issues. CONCLUSION: Quality interpreting was favourably influenced by adequate time for interpreting the session including a pre- and post-briefing session with CFHNs, an appropriate mode of interpretation, allocation of female interpreters and the same interpreters with CALD mothers and clarity about interpreter role and cultural comfort. These strategies support the quality of communication and relationships in delivery of CFHN services and SNHV programs to CALD mothers with limited English proficiency.

Facilitating parent-child interaction in home visiting: Staff experiences and supervisory support

The infant and early childhood home visiting field intends to mitigate the detrimental effects of poverty on young children's development by using a two-generational approach that supports both children and their caregivers. One of the central goals of home visiting is promoting positive parent-child interaction. A best practice for home visitors in working to achieve this goal is the facilitation of parent-child interaction, or parent-child coaching, which provides parents an opportunity to learn through modeling, practice, feedback, and reflection. The limited research on parent-child coaching in the home visiting field has found that home visits often lose focus on this topic area. However, very little is known about staff experiences with coaching in the home and what supports they receive in this area (i.e., supervision and ongoing professional learning). This study used an explanatory, sequential mixed-methods approach to explore staff's beliefs, attitudes, and experiences with coaching and their existing and desired training and support in this area. Forty-one home visitors and supervisors from Early Head Start (EHS) and Healthy Families America (HFA) programs throughout Maryland completed online surveys, and 15 completed virtual interviews. Surveys revealed a high self-reported frequency of coaching in home visits, and interviews revealed beliefs and attitudes consistent with a family-centered, parent empowerment approach to supporting parent-child interaction. Interviews also revealed nuances in coaching frequency, with variation due primarily to family stressors, family attitudes and expectations, and most notably, disruptions to home visits during the COVID-19 pandemic. Home visiting staff generally reported feeling satisfied with the training they've received in parent-child coaching (or supervising this activity), and home visitors reported feeling well-supported by their supervisors, with some room for improvement in the quality of professional coaching. Limitations are discussed with regard to small sample size, lack of observational data, and complications in data collection and interpretation due to the ongoing pandemic. This study, however, makes an important contribution to the limited literature and can inform training developers and program administrators on how to best support their staff in achieving this key program goal and, ultimately, improving family outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The interplay of home visitors' personal and professional identities in effectively screening and supporting women around sensitive topics

Home visiting programs provide information, support, resources, and tools that empower new parents to promote positive maternal and child health outcomes. During home visits, there is a unique opportunity to screen for intimate partner violence (IPV), reproductive coercion, and unintended pregnancy with women in unguarded settings (i.e., the women's homes) while providing ongoing services via a therapeutic relationship. Using individual interviews and a deliberative discussion focus group, the current study examined the research question, to what degree do home visiting staff members' personal and professional identities impact their ability to effectively screen and support pregnant women and new mothers around the topics of unintended pregnancy and intimate partner violence including reproductive coercion? Interviews and a deliberative discussion focus group were conducted virtually with staff members from Healthy Families America (HFA) programs in Maryland. Six major themes emerged from the interviews and focus group: personal versus professional experience, therapeutic alliance building, keeping families engaged, use of supervision, addressing intimate partner violence/reproductive coercion in families, and home visiting in the time of a health pandemic. Participants shared how their personal and professional identities helped shape their perceptions of their roles within the home visiting field including the terms, its meaning, and the expectations of that role. The findings suggest that home visitors need additional training around reproductive health since they routinely interact with pregnant women and new mothers who are at-risk for poor pregnancy-related health outcomes that may be due to the lack of control or intention related to reproduction. Participants expressed general knowledge, comfort, safety plan creation, and resource linking around the issue of IPV. Participants had received extensive training on administering the Relationship Assessment Tool (RAT), which is the IPV screener for HFA. However, relatively few program recipients endorsed that their HFA program recipients are experiencing IPV using the RAT. Therefore, HFA staff would benefit from advanced level training utilizing more clinical skills around the topic of IPV including advanced screening skills. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Post-partum Women's Anxiety and Parenting Stress: Home-Visiting Protective Effect During the COVID-19 Pandemic.

OBJECTIVES: The COVID-19 pandemic resulted in a particularly adverse and stressful environment for expecting mothers, possibly enhancing feelings of anxiety and parenting stress. The present work assesses mothers' anxiety levels at delivery and parenting stress after 3 months as moderated by home-visiting sessions. METHODS: Women (n = 177) in their second or third trimester of pregnancy during the COVID-19 lockdown were enrolled in northern Italy and split into those who did and did not receive home visits. After 3 months, the association between anxiety at delivery and parenting stress was assessed with bivariate correlations in the whole sample and comparing the two groups. RESULTS: Higher anxiety at birth correlated with greater perceived stress after 3 months. Mothers who received at least one home-visiting session reported lower parenting stress at 3 months than counterparts who did not receive home visits. CONCLUSIONS FOR PRACTICE: The perinatal period is a sensitive time window for mother-infant health, especially during a critical time like the COVID-19 pandemic. We suggest that home-visiting programs could be beneficial during global healthcare emergencies to promote maternal well-being after delivery.

Home Visiting Services During the COVID-19 Pandemic: Program Activity Analysis for Family Connects.

PURPOSE: Early reports highlighted challenges in delivering home visiting programs virtually during the COVID-19 pandemic but the extent of the changes in program implementation and their implications remains unknown. We examine program activity and families' perceptions of virtual home visiting during the first nine months of the pandemic using implementation data for Family Connects (FC), an evidence-based and MIECHV-eligible, postpartum nurse home visiting program. DESCRIPTION: Aggregate program implementation data for five FC sites for January-November of 2019 and 2020 are compared. The COVID-19 Modification Survey is used to analyze families' reactions to virtual program delivery. ASSESSMENT: Post-pandemic onset, FC's program completion rates amounted to 86% of the pre-pandemic activity level. Activity in key components of the intervention-home-visitor education and referrals to community agencies-was maintained at 98% and 87% of the pre-pandemic level respectively. However, education and referrals rates declined among families of color and low-income families. Finally, families reported a positive response to the program, with declines in feelings of isolation and increases in positive attitudes toward in-person medical care-seeking due to FC visits. CONCLUSIONS: During the first nine months of the COVID-19 pandemic, families' interest in home visiting remained strong, performance metrics were maintained at high levels, and families responded positively to the virtual delivery of home visiting. Home visiting programs should continue implementation with virtual modifications during the remainder of the pandemic but attention is needed to address growing disparities in access to home visiting benefits among marginalized communities.

Introduction of Special Section of Infant Mental Health Journal: Meeting the needs of vulnerable infants and families during COVID-19: Moving to a telehealth approach for home visiting implementation and research.

Parents of infants and young children who experience harsh circumstances are among those most vulnerable to the added stressors associated with COVID-19. Home visiting models have been shown to enhance outcomes for parents and infants when delivered in person, but in many parts of the world, the pandemic rendered in-person home visits difficult or impossible. In this special section, we examine adaptations made by home visiting programs to allow continued service delivery through telehealth, and strategies for assessing whether interventions maintain reach and fidelity when implemented remotely. In the first paper, Bullinger et al. (program implementers of SafeCare) provide evidence of the increased risk of maltreatment during COVID-19 for many families, and thus the need for home visiting services. Rybinska et al., developers and implementers of Family Connects, present evidence regarding their success in reaching families through telehealth. Roben and colleagues, in the third paper, report that clinicians implementing Attachment and Biobehavioral Catch-up through telehealth maintained fidelity at similar rates seen through in-person implementation. Finally, Tabachnick et al. describe procedures for collecting physiological data from infants and parents while conducting assessments remotely.

Transitioning to virtual interaction during the COVID-19 pandemic: Impact on the family connects postpartum home visiting program activity.

In this paper, we analyze program activity for Family Connects (FC), an evidence-based postpartum home-visiting intervention, during the COVID-19 pandemic. When the pandemic began, FC transitioned to a virtual protocol which maintains key psychosocial components of the in-person protocol and adjusts health assessments to address the lack of in-person contact. Program performance is contrasted for periods before the pandemic onset (April 2019-March 2020) and after the onset (April 2020-March 2021), involving 10,280 scheduled visits and 6696 visited families (46% non-Hispanic white; 20% non-Hispanic Black; 23% Hispanic; and 10% other race). Post-pandemic onset, FC program participation rates were at 89.8% of pre-pandemic levels. Home visitors observed post-onset increases in families' concerns about home safety but declines in families' needs related to infant care. Community connections were facilitated for 42.9% of visited families post-pandemic onset compared to 51.1% pre-pandemic onset. We conclude that post-pandemic onset virtual delivery rates of FC declined but are high enough to merit continued implementation during a period when some families will decline in-person visits. When in-person visits are deemed safe per public health guidelines, the findings suggest a hybrid approach that could maximize program outreach by prioritizing in-person contact and offering virtual delivery as a second choice.

En este ensayo, analizamos la actividad de programación de Conexión de Familia (FC), una intervención de visitas a casa posteriores al parto con base en la evidencia, durante la pandemia COVID-19. Cuando comenzó la pandemia, FC pasó a un protocolo virtual el cual mantiene componentes sicosociales claves del protocolo presencial y ajusta las evaluaciones de salud para considerar la falta de contacto personal. La actuación del programa se contrasta por períodos antes del comienzo de la pandemia (abril 2019 - marzo 2020) y después del comienzo (abril 2020 - marzo 2021), lo cual involucra 10,280 visitas y 6,696 familias visitadas (46% blancas no hispanas, 20% negras no hispanas, 23% hispanas, 10% de otras razas). Al comienzo de la postpandemia, el nivel de participación en el programa FC estaba al 89.8% del nivel de prepandemia. Los visitantes a casa observaron aumentos posteriores al comienzo en preocupaciones de las familias sobre la seguridad del hogar, pero bajas en necesidades familiares relacionadas con el cuidado de los infantes. Las conexiones comunitarias se facilitaron para el 42.9% de las familias visitadas después del comienzo de la pandemia, comparadas con el 51.1% antes del comienzo de la pandemia. En resumen, la actividad de programación de FC declinó después del comienzo de la pandemia, pero se mantuvo suficientemente alta como para ameritar la continuación de la implementación durante un período cuando algunas familias rechazaron las visitas en persona. Cuando las visitas en persona se estiman seguras según las directrices de salud pública, los resultados indican que un acercamiento híbrido pudiera conducir al máximo el alcance del programa por medio de darle prioridad al contacto en persona y ofrecer el servicio virtual como segunda opción.

Dans cet article nous analysons l'activité de programme pour une Family Connects (FC), une intervention postpartum à domicile fondée sur des données probantes, durant la pandémie du COVID-19. Lorsque la pandémie a commencé la FC a transitionné à protocole virtuel qui maintient les composantes psychosociales clé du protocole en personne et ajusté les évaluations de santé afin de répondre au manque de contact en personne. La performance du programme est comparée pour des périodes avant le début de la pandémie (avril 2019-mars 2020) et après le début de la pandémie (avril 2020-mars 2021), comprenant 10280 visites programmées et 6696 familles visitées (46% de blancs n'étant pas hispaniques, 20% de noirs n'étant pas hispaniques, 23% d'hispaniques et 10% d'autres races). Les taux de participation au programme FC, après le début de la pandémie, étaient à 89,8% des niveaux avant pandémie. Les visiteurs à domicile ont observé des augmentations des inquiétudes des familles à propos de la sécurité à la maison après le début de la pandémie mais des déclins dans les besoins familiaux liés au soin du nourrisson. Les liens avec la communauté ont été facilités pour 42,9% des familles visitées après le début de la pandémie, comparé à 51,1% avant le début de la pandémie. Pour conclure, l'activité de programme du FC a décliné après le début de la pandémie mais est restée suffisamment élevée pour mériter une exécution continue durant une période où certaines familles ont décliné les visites à domicile. Quand les visites à domicile ont été estimées sûres suivant les directives de santé publique les résultats suggèrent qu'une approche hybride pourrait maximiser la sensibilisation au programme en privilégiant le contact en personne et en offrant une prestation virtuelle comme second choix.

Evaluating child maltreatment and family violence risk during the COVID-19 Pandemic: Using a telehealth home visiting program as a conduit to families.

The COVID-19 pandemic has affected many child maltreatment risk factors and may have affected maltreatment among vulnerable families. We surveyed 258 certified providers of an evidence-based home visiting program, SafeCare, about their perception of the impact of the pandemic on the families they serve. We examined if the providers perceived an overall change in child maltreatment and family violence risk among the families with young children they served and factors that may have contributed to changes. Regressions estimated the relationship between providers' assessment of families' ability to social distance, emotional struggles, and access to public resources/services with providers' perception of child maltreatment and family violence risk in the home. Findings indicate that 87% of providers believed maltreatment risk had increased during the pandemic. Providers serving families who were unable to social distance due to employment were more likely to report increased supervisory neglect and material neglect among the families they serve. Providers reporting that families were struggling with elevated frustration levels also reported more family conflict and material neglect among the families they serve. Results from this research can inform strategic decision-making for policies and programs that address the challenges low-income families with young children face in emergency situations.

La pandemia del COVID-19 ha afectado muchos factores de riesgo de maltrato del niño y pudiera haber afectado el maltrato en familias vulnerables. Les preguntamos en una encuesta a 258 proveedores certificados de un programa de visitas a casa con base en la evidencia, SafeCare®, acerca de sus percepciones del impacto de la pandemia en las familias a quienes les ofrecían el servicio. Examinamos si los proveedores percibían un cambio general en el maltrato del niño y el riesgo de violencia familiar en familias con niños pequeños a las que les servían y los factores que pudieran haber contribuido a los cambios. Las regresiones calcularon la relación entre la evaluación de los proveedores acerca de la habilidad de la familia para mantener la distancia social física, los problemas emocionales, así como el acceso a recursos y servicios públicos, con la percepción de los proveedores acerca del maltrato infantil y el riesgo de violencia familiar en la casa. Los resultados indican que el 87 por ciento de los proveedores creía que el riesgo de maltrato había aumentado durante la pandemia. Aquellos proveedores que les servían a familias que no podían mantener la distancia social física debido al empleo, estuvieron más propensas a reportar el aumento en la negligencia de supervisión y la negación de material en las familias a quienes les servían. Los proveedores que reportaron que las familias estaban luchando con elevados niveles de frustración también reportaron más conflicto familiar y negación de material en las familias a las que les servían. Los resultados de esta investigación pueden apoyar la toma de decisiones estratégica para políticas y programas que se enfoquen en los retos que enfrentan las familias de bajos recursos con niños pequeños en situaciones de emergencia.

La pandémie du COVID-19 a affecté bien des facteurs de risque de la maltraitance de l'enfant et peut avoir affecté la maltraitance chez les familles vulnérables. Nous avons questionné 258 prestataires certifiés d'un programme de visite à domicile fondé sur des données probantes, SafeCare®, sur leur perception de l'impact de la pandémie sur les familles qu'ils servent. Nous avons examiné si les prestataires ont perçu un changement général de la maltraitance de l'enfant et dans le risque de violence familiale au sein des familles avec les jeunes enfants qu'ils servaient et les facteurs qui ont pu contribuer à ces changements. Des régressions ont estimé la relation entre l'évaluation qu'ont fait les prestataires de la capacité des familles à assurer la distanciation sociale, des difficutés émotionnelles et de l'accès aux resources/services publiques avec la perception des prestataires de la maltraitance de l'enfant et du risque de violence familiale à la maison. Les résultats indiquent que 87 pourcent des prestataires pensaient que le risque de maltraitance avait augmenté durant la pandémie. Les prestataires servant les familles qui ne pouvaient pas assurer la distanciation sociale à cause de leur emploi étaient plus à même de faire état d'une négligence acrue de la supervision et de négligence matérielle chez les familles qu'ils servent. Les prestataires indiquant que les familles faisaient face à des difficultés avec des niveaux de frustration élevés ont aussi fait état de plus de conflit familial et de néglicence matérielle chez les familles qu'ils servent. Les résultats de ces recherches peuvent aider les prises de décision stratégiques pour les politiques et les programmes qui répondent aux défis des familles défavorisées avec de jeunes enfants dans des situations d'urgence.

Covid-19 and pathways to health inequities for families in a socioeconomically disadvantaged area of Sweden - qualitative analysis of home visitors' observations.

BACKGROUND: Lack of control over life situations is an important social determinant that may negatively affect parental and child health. This study took place in an area of Stockholm, Sweden with high indications of socioeconomic disadvantage, a large part of the population with foreign background, as well as higher levels of poor health than the county average. It investigated staff perceptions of pathways from situations of low control, potentially leading to health inequities, affecting families enrolled in an early childhood home visiting programme during the Covid-19 pandemic. METHODS: Semi-structured interviews were carried out with 23 child health care nurses and parental advisors working in a home visiting programme. The data was analysed using Reflexive Thematic Analysis. RESULTS: The analysis resulted in five pathways on two explanatory levels, affecting parents' health and parenting capacity and children's health and well-being, potentially damaging health and leading to health inequities. The first four pathways related to control at the personal explanatory level: Families facing instability and insecurity; Caring for children in crowded and poor housing conditions; Experiencing restricted access to resources; and Parenting with limited social support. The fifth pathway, Living in a segregated society, covered the collective experience of lack of control on community level. The Covid-19 pandemic was observed to negatively affect all pathways and thus potentially aggravate health inequities for this population. The pandemic has also limited the delivery of home visits to the families which creates further barriers in families' access to resources and increases isolation for parents with already limited social support. CONCLUSIONS: The diversity of pathways connected to health inequities presented in this study highlights the importance of considering this variety of influences when designing interventions for socioeconomically disadvantaged areas. The additional negative consequences of Covid-19 indicate the need for sustainable preventive early childhood interventions for families in such areas. The study also emphasizes the need for further research as well as policy action on possible long-term effects of changing behaviours during the Covid-19 period on child health and health equity. TRIAL REGISTRATION: The study was retrospectively registered (11 August 2016) in the ISRCTN registry ( ISRCTN11832097 ).

Shifting from in-person to virtual home visiting in Los Angeles County: Impact on programmatic outcomes.

PURPOSE: This paper describes the effect that the COVID-19 pandemic, and subsequent shift from in-person to virtual (video-based) home visiting, had on the Los Angeles County Welcome Baby Home Visiting Program. DESCRIPTION: The Welcome Baby (WB) Program is a voluntary, universal home visiting program for expectant women and women with infants in Los Angeles County implemented in 14 hospitals in Los Angeles County. Oversight of the program is managed by LA Best Babies Network (LABBN) and funded by First 5 LA. The COVID-19 pandemic forced Welcome Baby Home visitors to shift from in-person home visits to virtual visits, which had an impact on programmatic outcomes. ASSESSMENT: LABBN manages a database utilized by WB sites. In assessing data trends before and during the pandemic, shifting to virtual visits resulted in an increase in both missed visits and completed visits, and a decrease in overall visit length. Completion of required assessments and overall client program completion were not affected by the COVID-19 pandemic. CONCLUSION: The Welcome Baby sites across Los Angeles County were able to successfully migrate in-person visits to a virtual platform, proving that virtual visits are possible and do provide some programmatic benefits. However, the long-term efficacy of virtual visits remains to be seen, and further research is warranted.

Statewide Implementation of Virtual Perinatal Home Visiting During COVID-19.

PURPOSE: This evaluation describes efforts taken by MIECHV administrators and staff during the pandemic using data collected from 60 MIECHV staff surveys and nine statewide weekly focus groups. DESCRIPTION: The Florida Maternal, Infant and Early Childhood Home Visiting (MIECHV) Initiative funds perinatal home visiting for pregnant women and families with infants throughout the state. Florida MIECHV has shown resilience to disasters and times of crises in the past, while generating a culture of adaptation and continuous quality improvement among local implementing agencies. Florida MIECHV responded to the COVID-19 pandemic crisis within the first few days of the first reported case in Florida by providing guidance on virtual home visits and working remotely. ASSESSMENT: Findings highlight the role of administrative leadership and communication, staff willingness/morale, logistical considerations, and the needs of enrolled families who face hardships during the pandemic such as job loss, limited supplies, food insecurity, technology limitations, and stress. Home visitors support enrolled families by connecting them with resources, providing public health education and delivering evidence-based home visiting curricula virtually. They also recognized the emotional burden surrounding COVID-19 impacts and uncertainties along with achieving work-life balance by caring for their own children. CONCLUSION: This evaluation helped in understanding the impact of the pandemic on this maternal and child health program and fundamentals of transition to virtual home visiting services. Virtual home visiting appears to be feasible and provides an essential connection to supports for families who may not otherwise have the means or knowledge to access them.