Telehealth in home visiting for new mothers: Are outcomes different if the first visits are in person? - Summary
Home visiting programs for new mothers have a broad range of goals, including improvements in maternal and
child health, reductions in child maltreatment, and improvements in child development. Over 286,000 families
facing adversity are served annually by 19 evidence-based models throughout the United States, which
provide support, education, and connections to other services. Before 2020, only a small portion of visits were
delivered through tele home visiting (teleHV; phone or video encounters). The Coronavirus Disease-2019
(COVID-19) pandemic required rapid adoption of teleHV; by early April 2020, 99% of home visits were by
teleHV. Prior to 2020, teleHV was recommended only as a partial replacement for in-person visits and only
after a relationship between the home visitor and family was established, because of the importance of the
therapeutic relationship. This relationship is a key element across home visiting programs, because it serves
as the foundation for teaching, mentoring, and collaborating with the family. There is limited evidence regarding
teleHV, although we anticipate many families will use a mix of in-person visits and teleHV after COVID-19
restrictions are lifted due to greater flexibility and other advantages. We propose a secondary data analysis to
make use of this natural experiment and determine if in-person visits during the establishment of the home
visitor-family relationship is associated with better outcomes than teleHV during the establishment of this
relationship. We will also explore if family characteristics associated with better outcomes vary between in-
person home visiting and teleHV, which will contribute to our understanding of both acceptance and
effectiveness of teleHV by family characteristics. We will consider both health outcomes (maternal depressive
symptoms, breastfeeding, intimate partner violence [IPV]) and process outcomes (retention, visit attendance,
screening completion). We will obtain data from a large, evidence-based home visiting program, Nurse-Family
Partnership (NFP). NFP has approximately 260 sites across the United States; 1000 to 1600 pregnant first-
time mothers enroll per month, before their third trimester and receive regular visits (frequency varies by
developmental stage: weekly to monthly) from nurses during pregnancy through the child’s second birthday.
The NFP National Service Office collects data on all enrolled families both at intake and at defined time points
regarding visits, screenings, and outcomes (including maternal and child health). We have previously worked
with these data and are well-positioned to access and analyze them. Our estimated sample size for the primary
aim is 3000 families per group. This will allow sufficient power to conduct regression analyses, controlling for
family, program site, and community characteristics. This project will provide critical new knowledge about the
importance of starting the home visiting relationship in person vs. through teleHV. This knowledge will help
home visiting programs better utilize teleHV in the future, resulting in better outcomes for the families served in
these circumstances, including reductions in health inequities.
