Important Home Visiting Information During COVID-19

Updated: 6/02/2020

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

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:  June 2020