Effect of Pandemic on Home Visitation Service Delivery Method: Past Practices, Current Experience, and Future Direction

Full Description: The Bureau for Medical Services (Medicaid) and the Office of Maternal, Child and Family Health (OMCFH), together have worked to provide support services to women and infants to reduce adverse health outcomes. Right From the Start (RFTS) is West Virginia’s Medicaid eligible home visitation program, providing comprehensive care to low-income women and children. RFTS was initially developed to cater to prenatal and infant clients, in July 2021 it expanded its services to include postpartum clients for up to one year. The goal of the program is to “achieve the healthiest possible outcomes during pregnancy, postpartum, and infancy.” RFTS promotes healthy living and influences families to make healthier choices, using the research-based curriculum, Partners for Healthy Baby (PHB). PHB covers topics: improved prenatal health, positive parenting, enhanced child health and development, healthy lifestyles, etc. A licensed registered nurse or a licensed social worker visits homes of clients, and provide support, education, screenings and facilitate access to other service providers.

Before the pandemic, RFTS almost exclusively used the in-person delivery method to provide services such as client enrollment, screening for depression, and providing education for safe sleep. Depending on the need, a client received multiple visits throughout the month, each lasting between 15 to 60 minutes. During the initial phase of the pandemic, RFTS made major changes to its mode of delivery, adapting virtual means which allowed the program to continue providing care to clients, evading major disruptions. The crisis enabled service providers to use this era of technology to learn ways to accommodate not only clients but the staff as well. Services were delivered virtually utilizing online tools and phones. As the pandemic evolved and as mitigation efforts and vaccines became widely available, RFTS adapted a hybrid approach.

In April and May of 2019, 132 prenatal clients enrolled in the program and 96 clients remained in the program at least until delivery (72.7%), including four spontaneous abortions. A year later, at the start of the pandemic, in April and May of 2020, 105 prenatal clients enrolled in the program, virtually, and 76 clients remained in the program at least until delivery (72.4%), including three spontaneous abortions. Compared 2019 to 2020, the enrollment rate decreased by 20.5%. This may be due to the uncertainty and unique circumstances at the peak of the pandemic.

While there are drawbacks to some changes, the benefit outweighs the negative implications of the hybrid approach. This unpredictable public health crisis has prompted RFTS to shape the future with a blended form of service which allows for continuous delivery of meaningful service. In comparing client’s retention rate pre-pandemic to retention rate during pandemic, it’s apparent the addition of virtual method has not changed the outcome and therefore deemed a usable method of delivery.

Abbreviated Description: The Right From The Start program serves to improve maternal and infant health in the Medicaid population. Clients enrolled in this program are prenatal women, infants, and more recently postpartum women. This analysis highlights the importance of structuring service delivery (either face-to-face, virtual, or hybrid) depending on the benefits to the clients, needs of the clients, the availability of staffs, and other barriers. There are pros and cons in all methods of delivery. However, the addition of virtual services only provides access to more clients. Clients receiving face-to-face services will have the option to continue in the same manner, law (crisis, pandemic etc.) permitting.