Early childhood home visiting's initial transition to virtual visits in response to the COVID-19 pandemic

Background: A reliance on in-home service delivery rendered early childhood home visiting vulnerable to the disruptions caused by the COVID-19 pandemic. Local programs transitioned rapidly from in-home visits to virtual contact with families. Objectives: To assess how local programs adapted to changes in staffing, supervision, and connecting with families and the prevalence and strength of associations of program, home visitor, and family-level factors influencing local programs’ transition to virtual visits using interactive video conferencing (IVC). The study also assessed whether adaptations and factors for IVC varied by use of an evidence-based model of home visiting and federal funding. Methods: This national, cross-sectional study used a short, web-based survey to elicit local programs’ operational adaptations to social distancing policies, and challenges they encountered in transitioning to virtual contact with families. A total of 1154 program managers completed the survey, reporting on 1310 unduplicated, model-specific, local programs. Responding programs were located throughout the United States and represented over 30 different home visiting models. Results: Local programs swiftly transitioned to alternatives to in-home visits to maintain contact with families. While programs quickly transitioned to remote visits, they reported challenges in connecting with families via IVC. Major challenges in local program resources, visitor and family receptivity and technology were associated with significantly fewer families reached by IVC. Implementing an evidence-based model and federal funding support were associated with adapting to changes in staffing, supervision, and connecting with families by IVC. While programs reported more technology challenges for families than for visitors, major challenges in visitor technology also impacted the percent of families reached by IVC. Conclusions: With its reach into communities experiencing disparities, home visiting is well-positioned to serve the families most adversely impacted by COVID-19. This survey demonstrated that programs swiftly transitioned to alternatives to in-home visits to maintain contact with families. This study highlighted major challenges in access to technology for families and the significant impacts of visitor and family technology challenges on reaching families by IVC. Strategies for ensuring access to technology are necessary to decrease disparities in access to home visiting. As home visiting programs adopt IVC as a more permanent option for service delivery, additional research is needed to determine the implications for reaching families, achieving model fidelity, addressing staff and family concerns, preparing the workforce to deliver IVC services effectively, and addressing enduring challenges to the use of IVC.