COVID-19 has disrupted life as we know it, and families with young children may be feeling the effects most deeply. I know that from my personal experience as a mother of a toddler, and from my work with grantees in our Early Impact portfolio. Even in the best of circumstances, parents are stretched thin as they juggle childcare with other responsibilities, but these are not ordinary circumstances and challenges are only exacerbated for families who were already vulnerable before the pandemic.
The work of our grantees, who support parents in using evidence-based positive parenting practices that provide children a strong foundation for early learning and development, is essential during this time. More than half of families have lost childcare and early education opportunities outside the home, leaving parents primarily responsible for supporting their children’s development often while juggling work, navigating unemployment, or caring for their own or their family members’ health.
The pandemic has meant the way home visiting services operated in February is not the way they operate today. But the services home visitors, nurses, early intervention specialists, and other family support workers provide remain crucial.
We know social isolation is associated with parental mental health challenges and increased risk of child abuse and neglect. And we also know many families have experienced or will experience illness, death, separations, job loss, homelessness, food insecurity, or financial hardship as a result of the pandemic, each adding stressors that negatively impact children’s development. In other words, parents need support. But due to the closures of childcare, Head Start, and preschool, they have often found themselves with less help than ever.
During this time, we’re proud to support grantees that operate within the robust ecosystem of early childhood, specifically with a focus on supporting children and families. Of course, the pandemic has meant that the way they operated in February is not the way they operate today. While many of these organizations traditionally saw families in person, that is no longer viable. But the services home visitors, nurses, early intervention specialists, and other family support workers provide remain crucial. To continue their work, many organizations have expanded their services to take place virtually versus in-person. Voluntary home visiting, in particular, has transitioned quickly to offer one-on-one support through contactless video or phone “visits” versus the traditional in-home programming.
Below we highlight just a few organizations in our portfolio that have pivoted to virtual visits to continue supporting families with minimal disruption during this uncertain time.
Family Connects, which we’ve funded since 2019, links over 14,000 new parents with a nurse who visits their home about three weeks after birth. These visits support new parents with evidence-based information and connect families with community resources based on their unique needs. Within weeks of the start of the COVID-19 shutdowns, Family Connects transitioned all their visits to be conducted virtually, ensuring new mothers had support during a crucial postpartum time.
Nurse Family Partnership (NFP), which we’ve funded since 2015, pairs nurses with low-income first-time mothers for two years of intensive prenatal and postnatal home visitation. NFP, which serves 65,000 families, was well-positioned to quickly transition their home visits to telehealth before COVID-19, with 84% of their nurses already conducting at least some visits virtually. Now, most of NFP’s “visits” are done via phone and the demand has only grown during the pandemic.
Parents as Teachers (PAT), a home-visiting program that trains parent educators to support parents in encouraging their children’s development, first piloted a virtual adaptation of its evidence-based home-visiting model in 2015. Over the past several years of testing, refining, and growing their virtual offering alongside their in-person program, PAT found virtual visits were feasible, effective, and most importantly, loved by parents. PAT now reaches nearly 230,000 children and their parents; with years of experience under their belt, they were poised to respond quickly to the COVID-19 crisis. PAT quickly accelerated virtual delivery across its network, scaling from 1,000 visits over three years of the pilot to 12,000 visits in the first month after stay-at-home orders began. This acceleration allowed sites to continue reaching families with minimal interruption and has served as an example for other home-visiting models. And parents are seeing the benefits; in PAT’s annual satisfaction survey, data from March-May 2020 indicates that 92% of parents were satisfied with their video call visits and 86% were satisfied with their phone call visits.
Increased demand for tele-home-visits
Many studies have demonstrated the benefits of voluntary home-visiting for new parents and their infants and toddlers, including improved birth outcomes, health outcomes, and school readiness for children, and increased economic self-sufficiency for families. Research also suggests that telehealth achieves similar results compared to in-person healthcare. While virtual delivery of home-visiting has not been as rigorously studied, the experiences of the organizations above suggest that much of their impact can likely be translated to a virtual setting.
Virtual visits eliminate the need for visitors to spend hours in the car between homes, which increases the number of families they can support. If families move, in-person home-visiting would likely be disrupted or stopped altogether; a virtual relationship can continue seamlessly.
For Family Connects, demand for support and community connection from new parents has only increased in the wake of COVID-19. Mothers have been grateful for the help: 99% of families report high satisfaction, and many have commented about the remote visits helping cope with a sense of isolation and diminished access to other sources of input and advice. Some sites are even finding additional and creative ways to support their communities, such as connecting moms to each other through virtual “baby cafes” or reaching out for additional sessions for program alumni with slightly older infants whose needs for support may have changed since their babies were born.
Georgina Rivera, a manager of Parents as Teachers in Florida, shared that “[Every family] needs support with parenting. They’re more isolated now, those social connections are gone. Keeping that one constant going is important, now more than ever.” During a recent virtual visit, one mother shared with Rivera how thankful she felt just to have someone still checking in. Her 1- and 2-year-old toddlers enjoyed the visit as well, excited to see the familiar face of their Parents as Teachers educator.
NFP has also seen an increase in uptake and demand during the pandemic. Since social distancing guidelines were put in place, they have continued enrolling new mothers into the program and have seen fewer cancellations of appointments, pointing to mothers’ appreciation of the logistical ease tele-visits allow. We know many parents rely heavily on digital devices for information and interaction, which positions a tech-driven approach as a powerful way to engage and support them, whether there’s a public health emergency or not.
Added convenience and cost savings
For some families and home-visitors, virtual connections may also be preferable to in-person visits for the convenience they provide. This is especially true now when leaving home or inviting others in is discouraged in some areas, and stressful even when it is allowed. But even when there’s not a pandemic, in rural areas, for instance, virtual visits eliminate the need for visitors to spend hours in the car between homes, which increases the number of families they can support. And in a traditional home-visit model, if families move, in-person home-visiting would likely be disrupted or stopped altogether; a virtual relationship can continue seamlessly.
In addition to the added convenience, virtual home-visits are more cost-effective for the organization. Without travel time, nurses and home-visitors can stretch their budgets to meet with even more families. In their pilot, Parents as Teachers found that caseload increased by 10%-40% when they introduced a virtual model. The efficiencies of scheduling allowed for greater flexibility not just for visitors, but for families as well, which may help families miss fewer visits or stay enrolled in the programs longer.
Innovation for the future
Open questions remain as to the effectiveness and long-term impact of virtual versus in-person home visits. For evidence-based models, monitoring fidelity ensures that the program is delivered as designed; PAT’s virtual program was able to meet all fidelity measures related to supervision, training, and curriculum delivery, indicating a high likelihood that strong outcomes would follow. We know the many immediate benefits virtual services can provide, but we are eager to learn alongside our grantee partners who are exploring questions of long-term impact as they continue to support children and families in a virtual setting.
As our current situation evolves, and once the threat of the pandemic has passed, we are confident that the innovation these organizations have shown during the crisis will position them to provide even more impactful support to their participants. What that looks like remains to be seen—perhaps it’s a hybrid model that incorporates the best of both in-person or virtual visits, or it could be something else entirely. Either way, we hope the broader early childhood field can learn from these efforts at ensuring that “home” visits continue even if the home is no longer accessible.