Important Home Visiting Information During COVID-19

Updated: 9/21/2020

HRSA’s Maternal and Child Health Bureau is committed to supporting state and local early childhood home visiting programs and providers in outlining safeguards for home visitors and families during the COVID-19 public health emergency. Some states suspended home visits, and recommend the use of telephone and/or video communication in lieu of face-to-face home visits to protect the health and safety of families and the home visiting workforce.

The Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program, and a number of evidence-based home visiting service delivery model developers have released guidance Exit Disclaimer to encourage using telephone and/or video technology to maintain contact with families during an emergency.

States, tribes, territories, and local implementing agencies are encouraged to follow CDC, state and local health department, and home visiting model guidance, and use appropriate alternate methods to conduct home visits in alignment with model quality standards.

Read our joint letter (PDF - 62 KB) with the Administration for Children and Families to encourage family support programs to offer prevention and family strengthening strategies virtually and through other safe means during the COVID-19 pandemic.

Jump to:
The Role of Home Visiting During a Public Health Emergency
Identifying Risks
Precautions for Home Visitors
Self-Care and Managing Stress
FAQs for Home Visiting Grantees
Additional Resources


The Role of Home Visiting During a Public Health Emergency

During the COVID-19 public health emergency, home visiting programs continue to play a vital role in addressing the needs of pregnant women, young children, and families, whether in-person or virtually. The potential impacts of the emergency on pregnant women and families’ access to critical health, early care and education, and family economic supports make continued connections with families essential.

Home visitors can support families by identifying local and national COVID-19 related resources, including CDC’s up to date recommendations about COVID-19 and pregnant women to determine when added precautions are needed. In addition, home visitors can:

  • Connect families to needed health, mental health, child care and other services
  • Identify strategies for managing family stress and social isolation
  • Keep families informed about current public health recommendations related to COVID-19
  • Promote family emergency planning strategies

Identifying Risks

In states and jurisdictions that have not suspended face-to-face home visits, home visiting programs may identify a need to visit under resourced families to provide ongoing support or deliver necessary supplies (e.g. diapers, groceries, infant formula). Prior to making home visits in these cases, home visitor staff should first identify their own risk of transmitting infection and risk of complications if they get infected. They should also identify family members in the visited home who may be at greater risk of transmitting infection or having complications if infected with COVID-19. Home visiting programs should contact families (e.g. by telephone, email, text) prior to the home visit and ask about the following:

  • Signs or symptoms of a respiratory infection, such as a fever (subjective or confirmed >100.4 degrees F), cough, sore throat, or shortness of breath.
  • Contact, within the last 14 days, with someone with or under investigation for COVID-19, or ill with respiratory illness.
  • The immune status/risk of household members; those who have a weakened immune system, over the age of 60 years, have chronic health conditions (e.g. heart disease, lung disease, diabetes), or other COVID-19 risk factors.

If the response is yes to any of the questions above, the home visiting program should reconsider the face-to-face visit and proceed with an alternative mode for the visit (i.e. telephone and/or video communication).

Learn more about people who are at higher risk for severe illness.

Precautions for Home Visitors

If none of the indicators are positive for the above, and a decision is made that going into the home is within the best interest of the family, then home visitors and staff should continue to take precautions to prevent the spread of COVID-19.

As a precaution, the home visitor should:

  • Maintain a distance of at least 6 feet between the home visitor and family members during a visit, and if possible, the home visit can take place outside.
  • Use cloth face coverings to prevent asymptomatic spread of the disease and provide protection when social distancing measures are difficult to maintain.
  • Perform daily measurements of temperature for fever and an assessment of symptoms of infection prior to entering the home.
  • Exit the home immediately and notify the home visiting program supervisor if any person is found to be ill within the home
  • Minimize contacting frequently-touched surfaces at the home.
  • Wash your hands with soap and water for at least 20 seconds before entering the home and after exiting.
  • Use a hand sanitizer that contains at least 60% alcohol if soap and water are not available.
  • Avoid touching eyes, nose, and mouth.

Self-Care and Managing Stress

This can be a stressful time for home visitors and other home visiting program staff. Here are some considerations for home visiting staff and supervisors:

  • Any home visitor with signs and symptoms of a respiratory illness or other related illnesses should not report to work.
  • Staff at higher risk of severe COVID-19 complications (those who are older or have underlying health conditions) should not conduct in-person home visits with sick clients.
  • If a home visitor develops signs and symptoms of illness while on the job, they should stop working, notify their supervisor, follow state and local health department protocols, and self-isolate at home immediately.
  • If after delivering a home visit, a home visitor is identified as being positive for COVID-19, they should notify their supervisor and follow current CDC and local and state health department guidance.
  • Emotional reactions to stressful situations such as this public health emergency are expected. Home visitors and other program staff should take self-care measures (PDF - 166 KB) and be proactive in stress management.

For additional information, states should contact their state health department and frequently review the CDC website on COVID-19.

FAQs for Home Visiting Grantees

What flexibility is available regarding the requirement to demonstrate improvement in the MIECHV benchmark areas?

HRSA recognizes that this is a challenging time and the COVID-19 public health emergency is impacting home visiting service delivery in multiple ways, including the suspension of home visiting or alternative approaches to conducting visits. As previously noted, the deadline for reporting data demonstrating improvement in 4 of 6 benchmark areas is October 30, 2020. This is a statutory deadline; therefore, HRSA does not have discretion to delay or waive it. Awardees should submit their Form 1 and Form 2 Annual Performance Report reflecting the Fiscal Year (FY) 2020 reporting period by this deadline.

As outlined in the Guidance on Meeting Requirements to Demonstrate Improvement in Benchmark Areas (PDF - 364 KB), HRSA will use the Form 2 Annual Performance Report submission for the purposes of conducting the demonstration of improvement. We understand that programs may be operating at limited capacity or not at all. The use of virtual technology changes the way models are implemented, and technology and internet connectivity may provide obstacles to conducting home visits with families. These challenges may impact the reporting on the benchmark performance data and should be noted in the performance report submission.

Awardees that do not meet the demonstration of improvement criteria using this data submission will have the option to submit revised Form 2 data that provides quantifiable justification of meeting the improvement criteria. This may include submitting reports that exclude certain data, such as excluding the portion of the FY subject to COVID-19-related service disruptions or excluding certain participants, LIAs, or models that were adversely impacted by COVID-19 responses. Awardees will be contacted by HRSA and provided information on how to submit a revised Form 2 submission if alternative data are required to demonstrate improvement after reviewing the Annual Performance Report submission. An example is provided below.

Example:

An awardee that began to experience service disruptions in March of 2020 may choose to submit a revised Form 2 submission for demonstration of improvement purposes that reflects a performance period of October 1, 2019 through March 1, 2020. This data would be submitted as part of the steps outlined in the Demonstration of Improvement Guidance for providing additional information (step 5).

Should well-child telehealth visits be included in performance reporting?

Well-child telehealth visits completed according to the AAP schedule can be included as meeting the numerator criteria for performance measure 4. The AAP has issued guidance on providing well-child care vis telehealth during COVID-19 Exit Disclaimer. We recognize that not all providers may offer well-child visits, in person or via telehealth, during this time. Awardees should continue to report on well-child visit completion following directions and information in the Form 2 toolkit (PDF - 1 MB) and FAQs (PDF - 997 KB).

Will there be any changes to the FY 2020 annual performance reporting process or forms (Forms 1 and 2), as result of COVID-19?

No, there will not be any changes to the FY 2020 performance reporting process or forms. However, if awardees are able to, you may provide additional information related to COVID-19 in the comments section for a particular table or measure where relevant. For example, while all home visits (both in person and virtual) should be reported in Table 15: Service Utilization (Form 1), an awardee may also want to include the number of visits conducted virtually in the comment sections. Awardees may also use the comments section to provide contextual information related to COVID-19 impacts related to a particular table or measure, (e.g. service disruptions impacting referrals). Please note that this is a voluntary option, this is not a requirement.

How should MIECHV awardees report virtual screenings for the purposes of annual performance measurement reporting?

All families screened with a validated tool should be included in the numerator and denominator per the measure definitions (Measure 3, Measure 12, and Measure 14). MIECHV awardees should consult with tool developers to determine appropriateness and criteria for virtual/remote screening. Please note that awardees should not report the number families screened virtually separately; however, awardees may voluntarily provide additional information related to virtual screenings in the comments section. The same information applies for reporting of virtual observations for Measure 10 (Parent-Child Interaction).  For more information and tips on conducting virtual screenings, please review this HV CoIIN memo HRSA Exit Disclaimer.

Should postpartum telehealth visits be included in Performance Reporting?

Postpartum telehealth visits that meet the criteria defined in Form 2 (PDF - 489 KB) can be included in the numerator for measure 5. The American College of Obstetricians and Gynecologists Exit Disclaimer recommends that women connect with their health care provider to discuss how their postpartum care visits may change during this time, including a shift to telemedicine or telehealth.

How can MIECHV grant recipients support subrecipients during a public health emergency?

Below are some considerations for States and Territories (recipients) as you work with local implementing agencies (subrecipients) during a public health emergency. It is critical that you carry out your responsibilities related to subrecipient monitoring and management to ensure that disruptions to the program are managed and minimized during a public health emergency.

Responsibilities

As a MIECHV recipient, you are responsible for overseeing the fiscal and program activities of your subrecipient to ensure the subaward is used for authorized purposes in compliance with applicable statute, regulations, policies, program requirements and the terms and conditions of the award. (See 45 CFR §§ 75.351-353).

It is required that you have a subrecipient monitoring plan, and having an adequate plan in place will help ensure that you are able to respond and adapt to public health emergency. You must ensure that your subrecipients:

  • Have appropriate procedures in place for the use and accounting of all grant funds.
  • Adhere to grant requirements in determining allowable costs that may be charged to a HRSA award. Costs must be necessary and reasonable to carry out approved grant project activities, allocable to the funded grant project, and allowable under the Cost Principles, or otherwise authorized by the grant program statute. (See 45 CFR Part 75, Subpart E–Cost Principles).
  • Document that they are following their organizational policy (including internal controls and documentation) to conduct grant activities during all circumstances, including unexpected and extraordinary circumstances.
  • Maintain appropriate records and cost documentation to substantiate the charging of any salaries and other project activities costs related to interruption of operations or services. (See 45 CFR § 75.302 and 45 CFR § 75.361).

Reminders

You should ensure that your organization and your subrecipients have policies in place to continue operations and use of MIECHV funds for authorized activities during public health emergencies. If such policies are not in place, adequate policies should be immediately developed and officially adopted.

You are responsible for your subrecipient’s determinations and interpretations of all applicable regulations and cost principles related to grant funds and should maintain documentation where determinations vary from normal operations.  This includes when you make determinations on the allowability of subrecipient costs. Both you and your subrecipients must document that you are following your respective organizational policies as well as HHS/HRSA grants policy.

The Grants Management Specialist listed on your most recent Notice of Award can provide further assistance if sufficient funding is available, or if re-budgeting is necessary and if a Prior Approval Request to HRSA is necessary. You should not assume that additional funds for unanticipated costs will be made available if a funds shortage results from the re-budgeting request.

The MIECHV Program provides technical assistance support and resources for recipients. You are encouraged to reach out to your Project Officer to connect with a Technical Assistance Specialist to assist with strengthening fiscal policies and procedures. Additional resources that are available include:

What support is available for MIECHV home visitor mitigation of risk?

HRSA recognizes that maintaining the safety of the early childhood workforce, including MIECHV home visitors, is essential during the COVID-19 public health emergency. As states and territories begin planning for safely re-establishing essential services in their communities, HRSA is providing additional information Exit Disclaimer (PDF - 369 KB) to support decision-makers with those efforts. This information on home visitor mitigation of risk has been developed by HRSA, in consultation with the Centers for Disease Control and Prevention (CDC), and should be considered alongside guidance provided by state and local government, public health leaders, and home visiting model developers. HRSA is committed to ensuring the overall safety of home visitors and families during the COVID-19 public health emergency*.* 

How will home visiting programs be expected to manage MIECHV program deliverables?

HRSA recognizes that this is a challenging time and the COVID-19 public health emergency is impacting home visiting service delivery in multiple ways, including the suspension of home visiting or alternative approaches to conducting home visits. HRSA acknowledges that even with the growing availability of virtual home visiting, many awardees and local programs will continue to experience major service delivery disruptions. MIECHV awardees may be concerned about the impact of these changes on their grant activities, including upcoming deadlines and deliverables. Below, HRSA addresses several upcoming requirements:

  • The deadline for submitting the FY 2020 MIECHV Non-Competing Continuation funding application has been extended from April 24 to May 29, 2020 at 11:59pm ET.
  • The deadline for submitting the MIECHV Quarter 2 Performance Report has been extended 30 days from May 15 to June 15, 2020 at 11:59pm ET.
  • HRSA is aware that MIECHV awardees may be concerned about their ability to spend FY 2018 grant funds prior to their expiration at the end of FY 2020 (September 30, 2020) due to suspension or cancellation of grant activities. Because the deadline for the use of funds by eligible entities is a statutory deadline, HRSA does not have discretion to delay or waive it or allow for carryover of funds. HRSA will make every effort to minimize impacts on awardees that result from deobligated funds from FY 2018 awards.
  • The deadline for updating the MIECHV Statewide Needs Assessment Update by October 1, 2020 is also statutory; therefore, HRSA does not have discretion to delay or waive it. Additionally, because the award of Title V Maternal and Child Health Block Grant funds is conditioned by the MIECHV statute on submission of an updated MIECHV Statewide Needs Assessment, HRSA does not have discretion to delay or waive this requirement. HRSA is exploring all available flexibilities within the applicable legal requirements to ensure MIECHV awardees have sufficient time and resources to complete an updated, high-quality needs assessment. HRSA anticipates providing more information in the near future.
  • The deadline for reporting data demonstrating improvement in 4 of 6 benchmark areas by October 30, 2020 is also statutory; therefore, HRSA does not have discretion to delay or waive it. HRSA will continue to explore all available flexibilities within the applicable legal requirements to ensure awardees have sufficient time and resources to provide the required information to HRSA. HRSA anticipates providing more guidance in the near future.
  • Please continue to check the MCHB COVID-19 Frequently Asked Questions webpage for the most up-to-date information.

Will there be an extension of the MIECHV period of availability?

HRSA recognizes that some MIECHV grant activities may be on hold or unable to be completed due to the ongoing impacts of COVID-19. MIECHV statute requires that funds be made available to awardees only until the end of the second succeeding fiscal year after the award is made. Therefore, HRSA is unable to offer no-cost extensions for MIECHV awards beyond the existing period of availability. Specifically, FY 2018 MIECHV awards will end on 9/29/2020 with no option for extension beyond that date. HRSA will make every effort to minimize impacts on awardees that results from deobligations from FY 2018 awards. Please note that all FY2018 deobligations will be returned to HRSA to be used for future MIECHV awards and activities.

How will home visiting programs be expected to manage performance measurement plan updates?

HRSA recognizes that this is a challenging time and the COVID-19 public health emergency is impacting home visiting service delivery in multiple ways, including the suspension of home visiting or alternative approaches to conducing visits. In the event that these changes in service delivery also impact how Form 2 performance data is collected and reported as outlined in an awardee's approved Performance Measurement Plan (PMP), HRSA is temporarily waiving the requirement that these changes be documented in the PMP and approved by HRSA before implementation. While performance measurement and reporting remain key hallmarks of learning and accountability for the MIECHV Program, awardees will not be required to submit updated PMPs at this time. However, we do recommend you discuss proposed changes with your PM/CQI Technical Assistance Specialist. Please reach out to your HRSA Project Officer if you have any additional questions or concerns.

How will home visiting programs be expected to manage continuous quality improvement plan updates?

HRSA recognizes that this is a challenging time and the COVID-19 public health emergency is impacting home visiting service delivery in multiple ways, including the suspension of home visiting or alternative approaches to conducting visits. In the event that these changes in service delivery also impact your continuous quality improvement (CQI) activities as outlined in an awardee's approved CQI Plan, HRSA is temporarily waiving the requirement that these changes be documented in the CQI Plan and approved by HRSA before implementation. While continuous quality improvement remains a vital strategy for the MIECHV Program, awardees will not be required to submit updated CQI Plans at this time. However, we do recommend you discuss proposed changes with your PM/CQI Technical Assistance Specialist. Please reach out to your HRSA Project Officer if you have any additional questions or concerns.

How will home visiting programs be expected to handle screenings and referrals?

HRSA recognizes that this is a challenging time and the COVID-19 public health emergency is impacting home visiting service delivery in multiple ways, including the suspension of home visiting or alternative approaches to conducting visits, such as through virtual service delivery methods.

We understand the unique barriers these challenges may pose related to the MIECHV screening and referral performance measures, particularly related to conducting intimate partner violence (IPV) screenings with caregivers.

HRSA encourages awardees to continue to work with their state and local partners and model developers to provide services to families. They should also use available resources, such as the Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) Memo Exit Disclaimer (PDF - 335 KB), that outline best practices, tips, and resources for IPV and maternal depression screenings and referrals. Note that data for performance measures, including data for the IPV screening and referral measures, will be reviewed and interpreted with the recognition that many programs will continue to experience significant challenges with completing these screenings during this time.

Can MIECHV funds to be used to keep wages and benefits steady for local implementing agency (LIA) staff to ensure continuity of service?

HRSA recognizes that many state and local programs are facing disruptions to service delivery, including temporary closings of MIECHV-funded LIAs during the COVID-19 public health emergency. HRSA remains committed to ensuring MIECHV-funded activities continue with the least disruption possible to mothers, children, and families during this time, including the use of alternative service delivery strategies, in alignment with model fidelity standards. MIECHV funds must continue to be used to support approved activities within the scope of the MIECHV grant. Approved MIECHV activities may include funding for staff salaries and benefits for staff performing work under the grant. Please note that MIECHV grant funding cannot be used to support salary costs for MIECHV-funded staff that are reassigned to non-MIECHV duties. Contact your Project Officer and Grants Management Specialist if you have any questions regarding appropriate use of grant funds.

Are MIECHV staff allowed to be reassigned to support COVID-19 response?

If MIECHV-funded staff are reassigned to support non-MIECHV state and/or local emergency response efforts, they may not continue to be paid with MIECHV funds. All MIECHV funding must support approved MIECHV activities. Note: Some emergency response activities, such as assisting families in emergency planning and providing parenting and other supports during this time of social isolation, are within the scope of the MIECHV grant. Please reach out to your project officer and/or grants management specialist for clarification if needed. If MIECHV-funded staff are reassigned to support state or local level response efforts, please inform your project officer and if key personnel have been reassigned, identify an appropriate alternative point of contact to ensure continuity of communication.

How will home visiting programs be expected to manage performance measurement and reporting?

HRSA recognizes that this is a challenging time and the COVID-19 public health emergency is impacting home visiting service delivery in multiple ways, including the suspension of home visiting or alternative approaches to conducting visits. Performance measurement and reporting remain key hallmarks of learning and accountability for the MIECHV Program. Fiscal Year 2020 performance data, including participants served, benchmark performance measures, and caseload capacity data will be reviewed and interpreted with the recognition that many programs will continue to experience major service delivery disruptions. Even with the growing availability of virtual home visits, lower caseloads and interrupted service are to be expected in many locations and programs. We encourage all awardees to continue using all available flexibilities and work with their state and local partners and model developers to provide services to families, as best you can. Please reach out to your HRSA Project Officer if you have any additional questions or concerns.

How are states supporting home visiting services while maintaining social distancing as a COVID-19 safety precaution?

HRSA is aware of the impacts the COVID-19 public health emergency has and will continue to have on service delivery to families. We understand that some states have suspended face-to-face home visits to protect the health and safety of families and recommend the use of telephone and/or video communication in lieu of face-to-face home visits. 

Are alternative methods to conduct home visits consistent with home visiting service delivery model fidelity standards?

A number of home visiting service delivery models have disseminated guidance to states and local organizations related to precautions and safeguards during a public health emergency. Model developer guidance may indicate that use of telephone and/or video technology to maintain contact with families during an emergency is consistent with model fidelity standards. 

Can face-to-face home visits be suspended at this time?

During the COVID-19 public health emergency, HRSA encourages awardees and local implementing agencies (LIAs) to follow CDC, state and local health department, and model guidance, and supports appropriate use of alternate methods to conduct home visits in alignment with model fidelity standards. Please alert your Project Officer if the state and/or LIAs suspend home visits and/or temporarily change the service delivery strategy. Follow model developer guidance about definitions of completed home visits for the purposes of performance reporting, if service delivery adaptations are being instituted.

Do OMB flexibilities granting the option for no-cost extensions for awards ending before 12/31/2020 apply for MIECHV awardees?

HRSA recognizes that some MIECHV grant activities may be on hold or unable to be completed due to the ongoing impacts of COVID-19. MIECHV statute requires that funds be made available to awardees only until the end of the second succeeding fiscal year after the award is made. Therefore, HRSA is unable to offer no-cost extensions for MIECHV awards beyond the existing period of availability. Specifically, FY 2018 MIECHV awards will end on 9/29/2020 with no option for extension beyond that date. HRSA will make every effort to minimize impacts on awardees that results from deobligations from FY 2018 awards. Please note that all FY2018 deobligations will be returned to HRSA for use in future MIECHV awards and activities.

Additional Resources

MIECHV Resources and Technical Assistance

Adapting to a Rapidly Changing Environment (PDF - 275 KB)

HRSA Resources

HRSA Coronavirus Information
Maternal and Child Health Bureau Frequently Asked Questions

We recommend referring to the Centers for Disease Control and Prevention (CDC) as a resource for all up-to-date information for:

Communities and Healthcare Professionals:

Pregnant Women & Families

Households

Social Service Providers

General prevention:

Date Last Reviewed:  September 2020