Understanding the use of telehealth in the context of the Family Nurse Partnership and other early years home visiting programmes: A rapid review

A comparison of virtual versus in-person delivery of SafeCare on parent and implementation outcomes

BACKGROUND

Evidence-based prevention services for child abuse and neglect (CAN), typically delivered via home visiting (HV), pivoted to virtual delivery in 2020 to continue family services while adhering to the COVID-19 public health guidelines.

OBJECTIVE

The study aims are to compare parent and implementation outcomes for the HV program, SafeCare©, delivered virtually versus in-person, across a 2-year period.

METHODS

Three data sources were used to examine parent program engagement and skill mastery, as well as provider fidelity. Sources included: 1) quantitative service data collected as part of routine SafeCare implementation (in-person families, n = 923; virtual families, n = 1978), 2) qualitative survey data collected from SafeCare providers (n = 212) and 3) focus group data with SafeCare Providers (n = 9).

RESULTS

Service data were examined using mixed models due to the nesting of the data, with all analyses controlling for time. Qualitative data from the survey and focus groups were analyzed using thematic coding. Data were triangulated from the three sources to answer the primary research question. Findings suggest that virtual delivery of SafeCare holds promise, with parents who participated virtually completing more modules at a faster pace than in-person clients. SafeCare parents demonstrated positive programmatic outcomes regardless of whether they participated in the program virtually or in-person. Provider fidelity remained high in the transition to virtual delivery. However, technology-related logistical issues and provider self-efficacy related to virtual delivery presented challenges to program success.

CONCLUSIONS

The study has multiple implications for the HV field about the viability of virtual service delivery. Further research is warranted with data collected directly from parents, and a more critical analysis of what works best for whom and when to further advance the field.

A Qualitative Analysis of the Effects of COVID-19 on Home Visiting Service Provision

Home visiting programs have been found to improve parenting practices and to reduce negative child outcomes. The 2019 coronavirus disease (COVID-19) resulted in an abrupt transition to telehealth services for many home visiting services. Limited research has examined the impacts of delivering home visiting services via telehealth, and the effects of this abrupt transition during COVID-19 is understudied as well. This study examined the impact of the abrupt transition to telehealth as a result of COVID-19 on home visiting service provision in one mid-sized midwestern community from the perspective of clients and providers. We conducted semi-structured interviews with both home visiting clients and providers (N = 26) in prevention-focused home visiting services. Although some benefits to telehealth were reported, providers discussed challenges with regard to engaging clients in services and difficulties in completing important home visiting tasks (i.e., assessment of child development, teaching parent-child interaction). Providers and clients also noted that they missed face-to-face interactions. Effective use of telehealth in home visiting requires provision of devices that allow for video-chatting as well as development of effective methods to engage in observation and teaching tasks.

Perinatal Telehealth: Meeting Patients Where They Are

INTRODUCTION

Prior to the coronavirus disease 2019 (COVID-19) pandemic, studies of innovative telehealth perinatal care models showed similar clinical outcomes and perceived quality of care between groups receiving a combination of virtual video and in-person visits. However, these studies included primarily White, English-speaking participants, excluding those who were economically disenfranchised or did not speak English. The purpose of this qualitative study was to describe perinatal patients' and providers' experiences with telehealth during and after the acute phase of the COVID-19 pandemic to inform future utilization of telehealth to drive the delivery of high-quality, accessible, and equitable perinatal care to diverse communities.

METHODS

This descriptive qualitative study included a purposive sample of 14 patients and 17 providers who received or provided perinatal care via telehealth in either a certified nurse-midwifery practice or the nurse-family partnership care model between March 2020 and April 2022. Maximum variation sampling offered a diverse population based on race, ethnicity, and rurality. Researchers conducted 2 rounds of semistructured interviews with a focus on understanding social and geographic context.

RESULTS

Six themes were identified through inductive analysis: (1) unexpected advantages of telehealth, (2) patient empowerment, (3) providers' fear of adverse outcomes, (4) concern for equitable care, (5) strategies to enhance the telehealth experience, and (6) strategies to address access to perinatal telehealth. Patients appreciated the increased ease and reduced cost of accessing visits, which led to fewer missed appointments. Health care providers saw great opportunity in telehealth but expressed concerns about accessibility for patients with language barriers or limited resources.

DISCUSSION

This study provides insight into priorities for continued telehealth utilization focused on providing equitable access to perinatal care. Rather than returning to practices from before the COVID-19 pandemic formed from longstanding routines and perceived limitations, providers are encouraged to capitalize on the rapid innovations in telehealth to build a more effective, equitable, and patient-centered approach to perinatal care.