Important Home Visiting Information During COVID-19

Updated: 7/30/2021

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 continue to 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 while others are returning to in-person visits.

The Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program, and 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. As more home visitors return to in-person home visits, CDC offers guidance on how to do so safety while also considering local situations. Home visitors can provide families with information about the importance of COVID-19 vaccination as the most effective prevention strategy as well as other mitigation approaches.

Read our joint letter (PDF - 59 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
COVID-19 Vaccination
Handwashing and Respiratory Etiquette
Staying at Home When Sick
Emergency Operations Plans
Self-Care and Managing Stress
Routine Preventative Care
American Rescue Plan Act of 2021
FAQs on the Consolidated Appropriations Act
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. Home visitors develop trusted relationships with families and home visiting programs have a reach into communities experiencing disparities. As a result, home visitors and home visiting programs play important roles in addressing the potential impacts of the emergency on pregnant people and families’ health and well-being, and promoting access to critical health, early care and education, and family economic supports.

National, state and local guidance, policies and regulations, including mask mandates are subject to change. It is important for home visiting programs to coordinate with their state and local health departments and frequently review the CDC website for updated information. Vaccination is currently the leading public health prevention strategy to end the COVID-19 pandemic. Promoting vaccination among eligible individuals can help home visiting programs protect staff and children in their care, as well as their families. Localities should monitor community transmission, vaccination coverage, the occurrence of outbreaks, and local policies and regulations to guide decisions on the use of layered prevention strategies.

Home Visitors and/or Home Visiting Programs are encouraged to:

  • Coordinate with the medical home to ensure that children are up to date with well-child visits and all routine preventive care and that birthing people are up to date with pregnancy-related and routine preventive care.
  • Inform families about current public health recommendations related to COVID-19 and vaccinations.
  • Encourage COVID vaccination among staff and eligible clients/family members.
  • Identify strategies for managing family stress and family basic needs, and support family engagement.
  • Partner with other service systems and providers to promote access to resources such as child-care, early intervention, economic and mental health supports.
  • Develop emergency operations plans related to COVID-19.
  • Address health disparities, family and community needs and social and structural determinants of health.
  • Engage in home visitor self-care.

Specific CDC guidance on COVID-19 that might be of particular interest to Home Visiting Programs include: (note CDC guidance does not replace state and local guidance)

COVID-19 Vaccination

(Adapted from Operating Early Care and Education/Child Care Programs)

Home Visiting programs are well-positioned to promote vaccination and preventive care among families and staff:

  • Infant and Early Childhood Home Visiting programs serve children under the age of five who are not yet eligible for the COVID-19 vaccine; however, families including parents, caregivers, extended family and siblings over the age of 12 as well as staff are eligible.
  • Encourage staff and families, including extended family members that have frequent contact with children in the home visiting program to get vaccinated against COVID-19 as soon as they can.
  • Adapt key messages to help families and staff become more confident about the vaccine using language, tone, and format that fits the needs of the community and is responsive to concerns.
  • Use CDC COVID-19 Vaccination Toolkits to educate families and providers and promote COVID-19 vaccination. CDC’s Workers COVID-19 Vaccine Toolkit is also available to employers to educate their workers about COVID-19 vaccines, raise awareness about vaccination benefits, and address common questions and concerns.
  • Host information sessions to connect parents and guardians with information about the COVID-19 vaccine. Home visiting staff and health professionals can be trusted sources to explain the safety, efficacy, and benefits of COVID-19 vaccines and answer frequently asked questions.
  • Identify potential barriers that may be unique to the home visiting workforce and implement policies and practices to address them. The Workplace Vaccination Program has information for employers on recommended policies and practices for encouraging COVID-19 vaccination uptake among workers.
  • Offer flexible, supportive sick leave options (e.g., paid sick leave) for employees to get vaccinated or who have side effects after vaccination. See CDC’s Post-vaccination Considerations for Workplaces.
  • Promote vaccination information as part of enrollment activities for families entering the home visiting programs.
  • Visit vaccines.gov to find local vaccination sites where staff and families can get vaccinated against COVID-19.

CDC resources on vaccination:

Handwashing and Respiratory Etiquette

People should practice handwashing and respiratory etiquette (covering coughs and sneezes) to keep from getting and spreading infectious illnesses including COVID-19. Home visitors can use best-practices in handwashing. Home visitors can implement these practices and encourage clients to do so. 

Staying Home When Sick

(Adapted from Operating Early Care and Education/Child Care Programs)

Families and staff who have symptoms of infectious illness, such as influenza (flu) or COVID-19, should stay home and be referred to their healthcare provider for testing and care. Staying home when sick with COVID-19 is essential to keep COVID-19 infections under control and prevent spread to others. CDC provides guidance on isolation for COVID-19, and state and local health department regulations should be followed. Home visiting programs are encouraged to allow flexible, non-punitive, and supportive paid sick leave policies and practices that encourage sick workers to stay home without fear of retaliation, loss of pay, or loss of employment. Employers should ensure that workers are aware of and understand these policies.

The overlap between COVID-19 symptoms with other common illnesses means that some people with symptoms of COVID-19 could be ill with something else. This is even more likely in young children, who typically have multiple viral illnesses each year. Although COVID-19, colds, and flu illnesses have similar symptoms, they are different diseases. Families should be made aware to notify their home visitor if somebody in the home has symptoms and the home visitor should arrange for virtual or telephonic visits and other ways to provide services to meet family need during that time. Home Visitors should encourage families to be on the alert for signs of illness in children and any family member that lives or will be in the home and to notify the home visitor when they are sick. Parents should pay particular attention to:

  • Fever (temperature 100.4 ºF or higher)
  • Sore throat
  • New uncontrolled cough that causes difficulty breathing (for a child with chronic allergic/asthmatic cough, see if there is a change from their usual cough)
  • Diarrhea, vomiting, or stomachache
  • New onset of severe headache, especially with a fever

Emergency Operations Plans

(Adapted from Operating Early Care and Education/Child Care Programs)

Home Visiting programs are encouraged to have an Emergency Operations Plan (EOP) in place to protect children, staff, and families from the spread of illness and other emergencies. The EOP should:

  • Describe COVID-19 prevention strategies to be implemented by the program.
  • Describe steps to take when a child, family or staff member has been exposed to someone with COVID-19, has symptoms of COVID-19, or tests positive for COVID-19.
  • Document policy or protocol differences for people who are fully vaccinated for COVID-19 versus those who are not fully vaccinated.
  • Be developed in collaboration with regulatory agencies and state, local, territorial, and tribal public health departments, and comply with state and local regulations.
  • Be developed with involvement of staff, parents and guardians, and other community partners (for example, health centers).
  • Describe how staff will be trained on the home visiting program’s COVID-19 safety protocols.
  • Plan for back-up staffing.
  • Consider the range of needs among staff, children, and families, including children’s developmental needs, children with disabilities, children with healthcare needs, and children experiencing homelessness.

Self-Care and Managing Stress

During the COVID-19 pandemic home visitors and other home visiting program staff are experiencing increased levels of stress and anxiety. Considerations for home visiting staff and supervisors include:

  • Emotional reactions to stressful situations such as this public health emergency are expected.
  • Home visitors and other program staff should take self-care measures and be proactive in stress management.

Routine Preventive Care

Home visitors should be aware of recent gaps in general preventive care for children and partner with providers and families to make sure children catch up on their preventive well-child visits.

American Rescue Plan Act of 2021

On March 11, 2021, the American Rescue Plan Act of 2021 (P.L. 117-2) (PDF - 681 KB) (ARP) was signed into law. ARP appropriated $150 million for MIECHV awardees to address the needs of expectant parents and families with young children during the COVID-19 public health emergency. ARP identifies seven categories of required uses of funding, which are service delivery, hazard pay or other staff costs, home visitor training, technology, emergency supplies, diaper bank coordination, and prepaid grocery cards.

ARP Awards - May 2021

On May 10, 2021, HRSA awarded approximately $40 million in ARP funds to funding provided by the American Rescue Plan Act (PDF - 681 KB) (ARP) to 56 states, territories, and nonprofit organizations currently funded through the MIECHV Program to support home visiting activities that address immediate needs of parents, children, and families related to the COVID-19 public health emergency.

An additional round of ARP awards is planned for early FY 2022 to continue to support MIECHV recipients in responding to ongoing COVID-19-related needs, including the expansion of services for families.

More information on the MIECHV ARP awards, including program guidance and Frequently Asked Questions, is available on the MIECHV Technical Assistant webpage.

Round 2 ARP Awards

HRSA intends to issue an additional round of ARP awards in early fiscal year (FY) 2022—as early as December 2021—to continue to support recipients in responding to ongoing COVID-related needs, including the expansion of services for families residing in at-risk communities as identified in the current approved needs assessment update. HRSA anticipates the second round of MIECHV ARP awards will be available through September 30, 2024.

Recipients are encouraged to consider how they might leverage these one-time ARP funds, in coordination with formula funds, to support the expansion of services to families residing in at-risk communities. HRSA anticipates utilizing the same or similar formula approach as the first round of MIECHV ARP awards for the second round, and anticipates awarding approximately $80 million. The remaining ARP funds will be used to support research, evaluation and technical assistance activities, tribal awards, and competitive innovation awards.

FAQs on the Consolidated Appropriations Act

What is the Consolidated Appropriations Act, 2021 (P.L. 116-260) and what are implications for MIECHV?

On December 27, 2020, the President signed into law the Consolidated Appropriations Act, 2021 (P.L. 116-260). This bill provides for funding of the federal government for fiscal year 2021 and additional provisions to respond to the ongoing COVID-19 public health emergency. Among many other provisions, the bill includes language specific to the MIECHV Program and home visiting’s response to COVID-19.

What are the allowable uses for MIECHV funds under this new statutory provision?

P.L. 116-260 includes statutory language providing new authorities to MIECHV awardees to assist in their response to the COVID-19 public health emergency. The law allows awardees to use MIECHV funds during the COVID-19 public health emergency period to:

  • Train home visitors in conducting virtual home visits (see below for a definition of virtual home visit) and in emergency preparedness and response planning for families;
  • Acquire the technological means as needed to conduct and support a virtual home visit for families enrolled in the program; and
  • Provide emergency supplies to families enrolled in the program, regardless of whether the provision of such supplies is within the scope of the approved program, such as diapers, formula, non-perishable food, water, hand soap, and hand sanitizer.

As with all other costs paid using MIECHV grant funds, awardees must ensure that funds are used for authorized purposes in compliance with applicable statute, regulations, policies, program requirements and the terms and conditions of the award. MIECHV awardees should ensure that they comply with their own organizational policies when incorporating these new authorities, as well as federal requirements such as:

For allowability considerations and awardee responsibilities related to subaward costs, please refer to the Important Home Visiting Information During COVID-19 FAQ on how MIECHV grant recipients can support subrecipients during a public health emergency.

Can I re-budget FY 2019 and FY 2020 MIECHV formula grant funds for these purposes?

Yes, MIECHV awardees can choose to re-budget FY 2019 and FY 2020 MIECHV funds for costs related to the above-described activities. If the re-budget amount is below 25% of their total approved budget and within funded categories, a Prior Approval is not required but the recipient may submit a courtesy email to their HRSA Grants Management Specialist and Project Officer indicating their intent to re-budget. If a recipient needs to re-budget grant funds over 25% of their approved budget or rebudget grant funds to an unfunded category, a Prior Approval request is required. It is advisable for recipients to submit a revised re-budgeting request no later than 60 days prior to the expiration of the period of availability. This will help to ensure timely processing of the request and prompt obligation of grant funds. 

Reach out to your HRSA Project Officer and Grants Management Specialist with questions.

Will I be able to use FY 2021 MIECHV formula grant funds for these purposes? 

Yes, pending the continuation of the COVID-19 public health emergency, MIECHV awardees can choose to budget MIECHV funds for costs related to the new MIECHV funding allowances. The forthcoming FY 2021 MIECHV Formula Notice of Funding Opportunity will provide additional instructions.

How long will the authority be available?

The Consolidated Appropriations Act, 2021, specifies that the additional authorities are only available “during the COVID–19 public health emergency period” and therefore will be discontinued at the conclusion of the declared COVID-19 public health emergency. At that time, any unobligated grant funds budgeted for activities related to the COVID-19 authorities described above must be re-budgeted for other allowable activities.

Will HRSA be extending any statutory deadlines in response to this legislation?

P.L. 116-260 provides the authority for the Secretary to extend the deadline by which a requirement of section 511 of the Social Security Act must be met, by such period of time as the Secretary deems appropriate. At this time, HRSA does not anticipate extending any deadlines in response to this new authority. Deadlines associated with the submission of FY 2020 annual performance data and the 2020 needs assessment update will not be extended as the relevant deadlines have already passed.

Can virtual home visits be used in lieu of face-to-face home visits during the COVID-19 public health emergency?

During the COVID-19 public health emergency period, virtual home visits are considered home visits. P.L. 116-260 defines a virtual home visit as “a home visit, as described in an applicable service delivery model that is conducted solely by the use of electronic information and telecommunications technologies.”

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.

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 annual performance reporting process or forms (Forms 1 and 2), as result of COVID-19?

No, there will not be any changes to the performance reporting process or forms. Please note that participants supported through American Rescue Plan (ARP) funds must be included in your Annual Performance Report.  Data across all active grants (X10 and X11) must be consolidated into one Annual Performance Report submission. Please visit the MIECHV Data, Evaluation, and Continuous Quality Improvement website for more information on ARP reporting.

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. 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:  July 2021