Texas Home Visiting: Assessing Early Experiences with COVID-19

Report | B.042.1020

October 2020
Full Report (PDF)

Executive Summary

The Texas Department of Family and Protective Services (DFPS) Prevention and Early Intervention (PEI) Division receives formula grant funding through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program to oversee the implementation of Texas Home Visiting programs (THV). Grantees funded through PEI implement evidence-based home visiting services, build comprehensive early childhood systems, and enhance service delivery through training, data collection, and evaluation activities.

On March 13, Texas Governor Greg Abbott issued a disaster proclamation for the state of Texas in response to the health and safety concerns associated with the COVID-19 pandemic. Soon after, Governor Abbott implemented social distancing guidelines and limited in-person work and gatherings. As a result, home visiting programs across the state shifted suddenly and almost exclusively to a virtual service delivery model. PEI contracted with Dr. Cynthia Osborne and the Child and Family Research Partnership (CFRP) at the LBJ School of Public Affairs at The University of Texas at Austin to conduct a study of 30 MIECHV-funded home visiting programs in Texas during the COVID-19 pandemic to examine the changes in delivery of services and the evolving needs of Texas families and home visiting providers. CFRP hosted a series of focus groups with home visitors and other home visiting staff and sent out surveys to both home visitors and program leads who were currently implementing either the NFP, PAT, or HIPPY program models.

Our findings show that THV families commonly experienced stress and anxiety and needed support to meet their basic needs during the pandemic. Additionally, home visitors encountered challenges with recruiting new families, keeping families engaged, and adapting and providing services in the virtual environment, highlighting the importance of in-person services. Despite these challenges, home visitors found that overall, most THV families adapted well to virtual services. During this time, programs also made innovations in data entry and service delivery methods that may inform future practices. Specifically, we find:

Family Needs and Experience

1) THV families often needed support during the COVID-19 pandemic to meet their basic needs, including food and housing, and commonly experienced increased stress and anxiety.
2) Home visitors found common reasons why some THV families struggled to stay engaged in home visiting during the pandemic, including because families did not have the tools needed for virtual home visits, did not know how to use video conferencing, or could no longer prioritize home visiting among other demands and new challenges.

Home Visitor Needs and Experience

3) Most home visitors across the state were concerned about the health-risks associated with returning to in-person home visits and faced several common challenges, such as school closures, loss of household income, and difficulty maintaining a healthy work-life balance.
4) A minority of home visitors did not have access to stable Wi-Fi, printers, laptops, and activity materials while working remotely and reported purchasing new supplies using their own funds or using personal supplies.

Changes in Service Delivery

5) Almost all home visitors switched to conducting all home visits virtually in response to the pandemic and continued to provide virtual services through the summer using a variety of modalities across their caseload, including video calls, phone calls, email, and text.
6) Programs generally found the guidance that program models and PEI provided on transitioning to virtual services helpful. However, three key areas in which programs requested more support include adjusting the program’s finances to meet virtual service delivery needs, setting consistent assessment timelines and expectations, and identifying domestic violence and mental health concerns remotely.
7) More than half of programs reported that enrolling new families is more difficult since the pandemic started. As a result, most programs changed their primary recruitment strategy, with new strategies varying by program model.

Advantages and Disadvantages of Virtual Service Delivery

8) Most home visitors struggled to conduct assessments when delivering services virtually.
9) Though home visitors often found the transition to virtual services smooth with existing families, they reported that engaging with and building relationships with new families virtually is an ongoing challenge.
10) Though home visitors felt confident in their ability to provide high-quality services virtually, they acknowledged limitations to identifying and addressing health and safety concerns among approximately one-fourth of THV families and all NFP families.
11) Most home visitors found that THV families adapted well to virtual services and for some families, virtual service delivery improved home visitors’ ability to connect with the family; key reasons included that it was less stressful to not have someone outside the family in their home and virtual visits provided more scheduling flexibility.
Innovations of Virtual Service Delivery
12) Home visitors reported that, in the future, a blended approach of in-person and virtual services after the pandemic would benefit families by providing more scheduling flexibility.
13) Two home visiting programs emphasized the benefits of changing data entry to allow home visitors to directly enter data into their case management system during visits instead of using paper forms.


Moving forward, opportunities for home visiting programs, PEI, and the state and national program model offices include:
1) Supporting home visitors while they are working remotely to avoid burnout and ensure they are equipped with the tools and knowledge to provide services virtually,
2) Seeking ways to support families to maintain engagement in home visiting,
3) Defining clear expectations around budget flexibility and conducting assessments,
4) Collaborating to meet recruitment and enrollment goals, and
5) Identifying and implementing service delivery methods that best address the needs of THV families and home visiting programs during and after the pandemic.

  • Citations
    1.  Because Family Connects and HFA are implemented in only a few sites, we focus the study on PAT, HIPPY, and NFP.
    2.	Harcourt, J., Tamin, A., Lu, X., Kamili, S., Sakthivel, S. K., Murray, J., et al. (2020). Severe Acute Respiratory Syndrome Coronavirus 2 from Patient with Coronavirus Disease, United States. Emerging Infectious Diseases, 26(6), 1266-1273. https://dx.doi.org/10.3201/eid2606.200516. 
    3.	World Health Organization. (2020). Timeline: WHO’s COVID-19 response. Retreived from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline#! 
    4.	Office of the Texas Governor, Greg Abbott. (2020). Coronavirus Executive Orders, Funding and Waivers. Retrieved from https://gov.texas.gov/coronavirus-executive-orders. 
    5.	CFRP sent surveys to a total of 160 home visitors. However, seven emails bounced back and two home visitors were no longer employed at their home visiting program. 
  • Full Report (PDF)