Stakeholder Perspectives on Virtual Engagement: Facilitators and Barriers to Implementing Family Connects Chicago during COVID-19

Full Description: Racial and ethnic disparities in maternal and infant outcomes persist in the City of Chicago despite the diverse array of available perinatal support services. These services have historically focused on ‘at-risk’ families with availability and geographic accessibility varying across neighborhoods and communities. To address persistent disparities and differential access to services, in early 2020, the Chicago Department of Public Health (CDPH) initiated the Family Connects Chicago (FCC) pilot program at 4 hospitals to offer universal postpartum services for families. The “Family Connects” model, developed by Family Connects International, includes hospital-based recruitment and a universal early postpartum home visit by a nurse that includes physical health assessments of mother and infant, systematic assessments of family risks and needs, and education and referrals to services based on family needs and preferences. The model also convenes community organizations to engage in “community alignment boards” (CABs), charged with identifying referral resources for families and addressing resource gaps. In Chicago, a Citywide Advisory Council also provides implementation oversight. Shortly after FCC began, the COVID-19 pandemic started, which led to “stay at home” and “social distancing” mandates, requiring adaptations to FCC. Hospital-based recruitment stopped; in-home visits shifted to virtual visits, conducted by phone and telehealth; and the CABs and Citywide Advisory Council shifted to virtual engagement. As part of an evaluation of the early implementation of FCC, 45 key informant interviews were conducted with nurse home visitors (NHV) (n=16), CAB members (n=10), Citywide Advisory Council members (n=4), and CDPH and hospital staff (n=15). These semi-structured interviews were analyzed using Dedoose software and a deductive coding approach. Preliminary analysis identified both barriers and facilitators to FCC implementation during the COVID-19 pandemic. The shift from in-home visiting to telehealth limited the ability to perform physical assessments of the mother and infant, but allowed NHVs to increase their caseloads and potentially improve program accessibility. Collaborating organizations and CAB members found it hard to develop, strengthen and sustain relationships with one another during the pandemic, but appreciated the flexibility of virtual engagement and were driven to support FCC’s success at a time where families needed it most. Study findings can be used to inform the city-wide expansion of FCC and provide lessons learned with respect to best practices for other home-visiting programs that have transitioned or will transition to a virtual or hybrid format.

Abbreviated Description: In early 2020, the Chicago Department of Public Health (CDPH) initiated the Family Connects Chicago (FCC) pilot program which offers universal postpartum services for families. Shortly after FCC began, the COVID-19 pandemic started, requiring adaptations to FCC and a shift to telehealth and virtual engagement. The evaluation of the early implementation of FCC included 45 semi-structured interviews with nurse home visitors (n=16), Community Alignment Board members (n=10), Citywide Advisory Council members (n=4), and CDPH and hospital staff (n=15). Interviews were analyzed using a deductive coding approach. Preliminary analysis identified barriers and facilitators related to the shift to virtual engagement by FCC during the pandemic.