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Pivoting from Traditional On-Ground to Virtual Home Visiting

Adapting a home visiting model for families with young children from an on-ground to a virtual service delivery model.

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When families are stressed and cannot access resources like parent coaching, their chances of experiencing negative outcomes increase significantly. 

9 million U.S. families are experiencing two or more stressors, including poverty, parental mental illness, being very young parents, etc. These families could benefit from home visiting, yet only 300,000 are reached. Currently, even those 300,000 cannot be reached in the traditional way.  So we are having to find new ways to work with families, including ones who are experiencing even greater dysregulation than before, while the new “normal” due to the COVID-19 pandemic is evolving almost daily.

The solution, both immediate and longer term, is Virtual Home Visiting, a combination of the Parents as Teachers model and proven Telehealth practices. This innovation was developed in partnership with Dr. Dorian Traube at the University of Southern California (USC).

Through a pilot project with USC we already demonstrated that Virtual Home Visiting (VHV) is feasible and desirable.  Parents who participated in VHV increased their knowledge of child development and were motivated to try new parenting strategies; these exciting results mirror those found with traditional home visiting.

VHV increases access. It makes it possible to reach underserved families such as those who are in the military, medically fragile, housing insecure, or live in hard to reach areas.  And currently, it is the best and safest way to reach all families that were already engaged in on-ground home visiting prior to the COVID-19 crisis and to serve new families, at a time when many other kinds of supports are simply not available or accessible while the need for support is likely even greater than ever before.

Virtual home visiting improves efficiency.  By eliminating travel time, caseloads can potentially increase.  The best thing about virtual home visiting is that parents love it and it is a match for this generation of parents looking for real-time support.

Parents are ready. They are looking for parenting advice online and connecting through screens to loved ones and healthcare providers.

Implementing organizations are ready.  Over just a five-week period since the COVID-19 crisis really hit, PAT affiliates in at least 37 states have scheduled and completed over 47,500 virtual events via interactive video conferencing or telecommunication  (both personal visits and group meetings), benefiting thousands of families across the country.

States are ready. Currently, all 50 states reimburse for live-video telehealth services and early interventions like occupational therapy. Home visiting can be next.  And in fact, the COVID-19 crisis has propelled many local, state, and federal funders to allow, for the first time, organizations to be reimbursed or funded to deliver home visiting services virtually.

We acknowledge that there are barriers to full implementation of this solution, primarily related to a lack of equitable access to what is increasingly a basic need for everyone:  internet access, sufficient data plans, and the hardware needed to access it (the digital divide).  Partnerships with internet providers, Telehealth clinics, national funders and policy makers will be needed for full scaling of this solution.

What is the need are you focusing on?

Parents as Teachers has demonstrated the impact of home visiting on preventing child maltreatment, promoting child screening and health care, improving parenting practices and increasing school readiness. 

Even before COVID-19, millions of U.S. families were experiencing two or more stressors, and could benefit from home visiting to mitigate stress and preserve family functioning.  Due to the COVID-19 crisis, this number is growing, families are even more dysregulated, and some children are now at even greater risk for negative outcomes.  The need for the support that PAT home visits provide has never been greater.  At the same time, access to traditional home visiting has all but stopped.

 We are focusing on the need to provide home visiting services to vulnerable and/or underserved families that cannot or are not inclined to participate in the traditional on-ground service delivery model, by pivoting to virtual service delivery.

Which type of submission are you sharing?

  • Sharing an actual pivot your organization has already made

Describe the business pivot or adaptation in 3-4 sentences.

The pivot is Virtual Home Visiting, a combination of the Parents as Teachers model and proven Telehealth practices. Parents as Teachers has adapted implementation guidelines and technical assistance for its affiliates to support the delivery of the evidence-based PAT model in a way that maintains quality and fidelity, and hundreds of affiliates have already provided tens of thousands of virtual visits and groups to families across the country. We have also pivoted to offering core training virtually and increased the number of other supports for affiliates we provide virtually (live and recorded webinars and additional downloadable resources, communities of practice) to support service delivery and staff support and supervision. There is tremendous potential for this approach to impact hundreds of thousands of families, not only in the current crisis situation, but for years to come.

Do you plan to implement this solution?

  • Yes

Describe the impact that this solution will create in the world.

The PAT model improves maternal and child outcomes, child immunization and well-child visit completion rates, and school success at kindergarten entry and on into elementary school, and lowers incidence of child maltreatment. Communities/populations that stand to benefit the most from VHV are underserved, medically fragile, housing insecure, live in hard to reach areas and/or may be in the military. PAT reaches nearly 100,000 families in 49 states and in 115 tribal communities, a high percentage of which have stressors such as low income, low educational attainment, mental health issues, and being a young or teen parent. The COVID-19 crisis is going to cause a spike in the number of vulnerable families and the number and types of stressors they are facing. The timeline for impact on parenting behaviors can happen within a few months of onset of services; impact on school success naturally takes longer to demonstrate. However, the timeline for implementation is NOW.

What is the name of your business or organization?

Parents as Teachers National Center

What does your business/company do? Whose needs does your business/company address? Who do you serve?

The Parents as Teachers (PAT) evidence-based parent education and family support approach works to improve children’s school readiness and health, improve parenting practices, and reduce child abuse and neglect. PAT model components - personal visits, group connections, child health/developmental and family well-being screenings, and resource referral network - work together to support whole family well-being. PAT home visitors work closely with families to build a trusting relationship, and to address critical parenting issues and behaviors that promote protective factors. 1,031 PAT affiliates served more than 92,500 families last year; 79% of whom had at least one high needs characteristic. Website

What is your profession?

Project and Grants Manager

Where are you located (country)?


Where are you located (region)?

  • North America

What industry is your business/company in?

  • Non-Profit/Philanthropy

How many people does your business/company employ?

  • 50-249

How old is your business/company?

  • 10 or more years old

Which classification describes your organization/business?

  • Nonprofit/NGO

What kind of stakeholders and partnerships are needed to pursue this solution?

  • Funding- Grants
  • Stakeholders/Partnerships- NGOs
  • Stakeholders/Partnerships- Private Sector
  • Stakeholders/Partnerships- Government

Do you need help building partnerships and finding partners?

  • Yes

If Yes to the above, please share 1-2 sentences describing the specific help you desire.

Scaling of this solution has begun. We need partners to engage with us in the following ways: • Scaling for implementation and research in geographic areas, vulnerable or hard to reach families while deepening our understanding of implementation of virtual model components. • Building of infrastructure to support virtual training, professional development, implementation guidance, and evaluation of virtual delivery. • Evaluating on-ground and virtual hybrid service delivery

What do you think are the main barriers to implementing this solution?

There are three primary barriers to implanting this solution: 1) Family and program-level access to reliable internet and wi-fi connectivity, sufficient smartphone data plans, and the hardware (e.g. tablets, laptops) to fully engage in virtual home visits. The COVID-19 crisis is highlighting the extent to which these things are basic needs in today’s society and it is a matter of equity to get these resources into all families’ hands. 2) The current lack of a rigorous research base demonstrating the effectiveness of the solution. 3) The need for state and federal policies to make virtual service delivery a more broadly acceptable way to provide prevention and intervention services to families and to make funding available.

If you are currently working on a pivot, what have you learned so far?

From the USC pilot we learned that delivering the four-component PAT model virtually is feasible; families engage and develop meaningful relationships with the parent educator; and preliminary data showed positive parenting outcomes. Since launching virtual PAT home visiting nationally, we have learned: • About 37% of families are receiving virtual services via telephone only due to insufficient access to broadband or internet, wifi, data, and/or web-enabled hardware. • Virtual visits and groups (over 47,000 completed in about 5 weeks) are lasting the same amount of time as on-ground visits. • In the midst of a lot of uncertainty and fear, parents value the stability and reassurance and resources their parent educator is able to provide. • Increased parent empowerment and collaboration with the parent educator seems to be a positive consequence of the use of virtual visits during the health crisis.

Are you aware of any open source efforts, hackathons or other collaborative efforts related to your solution? Are you participating in these efforts?

Hackathon: We plan to host a hackathon during our 2020 PAT conference, inviting teams to help develop a parent access portal – a tool that would benefit the virtual home visit solution. Collaborative Efforts: In response to COVID-19, leaders in the national home visiting field have formed the Rapid Response Virtual Home Visiting collaborative to create and support the dissemination of free resources on virtual family interactions for home visitors.

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Photo of Isaac Jumba

Hello Kate McGilly exciting to see the work you are doing around virtual home visiting.

We thought it might exciting to have you be part of the COVID-19 Reimagine Learning Challenge: where you could re-share your concept, learnings and connect with other community members (such as schools, educators, students and innovators) re-imagining learning at this time and beyond.

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