Home Visitors Left to Check on Parents from Afar

home visitors
An employee at The Children’s Institute prepares lunches to deliver to families. Photo courtesy of The Children’s Institute

Ebony Middlebrook has spent a decade dropping by the homes of Los Angeles newborns and their families as a “home visitor” for Welcome Baby, a free program that coaches moms and dads on issues like early childhood development, breastfeeding, recognizing the signs of postpartum depression, and obtaining medical coverage. 

“It’s not easy just walking into someone’s home and not knowing the backstory,” Middlebrook said. “You have to be empathetic. You have to understand what it means to be trauma-informed and how to go into someone’s home and be non-judgmental of the client at all times.”

For the time being, the COVID-19 pandemic has halted all of Middlebrook’s walks into people’s homes. A source of support for families who might otherwise have little, home visitors have had to keep their distance from vulnerable new parents — physically, anyway. Before the lockdown in mid-March, Middlebrook chatted with moms about how things were going with their newborns. She would notice if the mom appeared dazed and disinterested in the baby, or if the home had hazards, such as a pest infestation, that made it unsafe for children. 

The pandemic, however, has forced these visits to go virtual, a turn of events Middlebrook describes as “a very unique situation.” But she still follows the same protocol — making her observations about families by talking with moms via videoconferencing software like Zoom. 

“We haven’t dropped the ball with the Zoom visits,” she said. “Our clients are on board and eager to participate. They also appreciate seeing us face-to-face, but, of course, it’s a little different over the computer.” 

Coronavirus has made it impossible for Welcome Baby and L.A. County’s other home visiting programs to proceed as usual. Dating back to 1998’s Proposition 10, which directed revenue from tobacco sales to county-level efforts to improve children’s development and school readiness, California’s voluntary home visiting programs have been linked to improved parenting, treatment of children, birth outcomes, and academic preparedness. Anyone can enroll in a home visiting program, but families with socioeconomic, mental health or other challenges, such as prior contact with child protective services, typically take part. 

“We know that the children in families who enroll in these programs are better prepared for kindergarten and have higher immunization rates and lower rates of hospitalizations and mood and anxiety disorders,” said Jana Wright, director of policy for LA Best Babies Network and coordinator of the L.A. County Perinatal and Early Childhood Home Visitation Consortium. “Families have fewer calls to child protective services, and kids have fewer adverse childhood experiences.”

Remote drop-ins have given the organizations that provide home visits a window into clients’ homes during the pandemic. But staying connected has meant overcoming the digital divide in low-income communities, where many families lack internet access, laptops and smartphones. 

And that’s hardly the only challenge home visiting programs are addressing. Gov. Gavin Newsom’s May revisions to the 2020-21 state budget could see funding to California’s home visiting programs reduced by $34.5 million. Unable to serve families in person and with steep budget cuts looming, home visiting providers face unprecedented uncertainty amid the coronavirus crisis.

home visitors
A girl works on an art project from home with the help of her Early Head Start teacher. Photo courtesy of The Children’s Institute

According to Ronald E. Brown, CEO of the Children’s Bureau of Southern California, which supports 40,000 children and parents with services such as home visits, parenting classes, counseling, foster care and adoption, the shift to virtual home visits makes it harder to get a complete picture of a family’s circumstances.

“It’s about context,” he said. “We don’t treat a person, we treat an environment. We look at things collectively because people don’t live in isolation.”

As soon as home visitors drive up to a residence, they start to take note of the neighborhood in which a family lives. Inside of a home, they search for signs of everything — from whether a new mother has the baby blues to whether a child has bruises or cringes during interactions with certain household members. They also observe whether new people have moved into the home, former family members have returned, or if some family members, such as a suddenly unemployed parent, is spending much more time in the residence.

With videoconferencing alone, these sorts of details may get lost, Brown fears, and could lead to fewer formal reports of abuse and neglect.

“Observational qualities are critical and important, particularly as mandated reporters,” he said.

Virtual check-ins with families may not be ideal, but Brown said the Children’s Bureau is making them work. Clients are keeping their videoconferencing appointments, and many of them enjoy the flexibility these online visits afford them. Representatives from the Children’s Institute and Richstone Family Center, both of which provide home visits in L.A. County, also say that they’ve successfully conducted online meetings with families, but not without challenges. 

“For the duration of the stay-at-home order, we’ve been pretty successful for virtual visits via telephone or Zoom, but we prefer Zoom because at least there’s a semblance of what a physical visit is like,” said Carrie Honn, manager of Richstone’s home visitation program. “The virtual visits have been far more successful for a lot of families. Before all of this, there was constant rescheduling — if we’re serving a family that has four kids under the age of 5, you can imagine how swamped mom must be.”

Richstone offers comprehensive prevention, early intervention, and treatment programs for families through home visits, individual and family therapy, early childhood education programs, trauma-focused treatment, and more. In April, the nonprofit managed to conduct visits with 80 of the 85 families enrolled in its home visiting program. 

“We’re proud of those numbers,” Honn said. “We really tackled this despite the stay-at-home order, but even then, we didn’t just stop there.”

During these visits, Richstone workers question parents about children’s developmental milestones, inquiring, for example, whether an 18-month old can say 10 words. But they also check in about the physical needs of families, such as whether they have enough food or diapers. They have also referred children and parents to mental health services.

Fundraising nearly $250,000 has enabled the Children’s Institute to cover rent and utilities for families as well as to deliver meals, diapers, soap, lunches and snacks to them. Workers have also dropped off learning packets, complete with crayons and construction paper, to keep children engaged. During videoconferences, they make sure children have up-to-date immunizations and health screenings.

The Children’s Institute provides early education, behavioral health and family strengthening services to 26,000 children and families in the Los Angeles area. It also offers training in clinical treatment, parenting and trauma-informed care to professionals and caregivers. 

The pandemic has led to the Children’s Institute holding abbreviated meetings — 15 to 30 minutes rather than an hour — with families. During these visits, they might provide lessons from their socioemotional curriculum or teach children and families relaxation and emotional regulation techniques, according to Ana Palacios, vice president of the institute’s early childhood services program. 

“We’ve also been utilizing YouTube,” she said. “They’ll do a children’s activity using videos that parents can access at any time.”

Children tear into snacks provided from The Children’s Institute’s Thrive Market. Photo courtesy of The Children’s Institute

Above all, they are prioritizing the fundamental needs of families. Before teaching children lessons, the institute is making sure families haven’t been evicted or forced to live in their cars during the pandemic, according to CEO Martine Singer.

“We’re just helping people on the brink of destitution,” she said. 

Through it all, the Children’s Institute has helped their clients, most of whom are low-income, stay connected. Other than a cell phone, many families have no means of remaining in touch, so the institute’s home visitors have helped them obtain free Wi-Fi and distributed 700 tablets parents can use to engage in virtual visits. 

These providers may have worked against the digital divide, but officials are less certain about the impact that imminent state budget cuts will have on their services longer-term. They receive funding from multiple sources, including California Work Opportunities and Responsibility to Kids. But the governor’s May budget revision cuts the CalWorks home visiting budget by $30 million, which Wright said could “cause ramifications for years.”

If the cuts are finalized, they would cause the reach of home visiting programs to decrease when providers hoped to expand them, Wright said. As it is, Los Angeles serves about 4% of the population of families with pregnant women or children ages 0 to 5.

“If we don’t have that influx of money, it’s just going to crumble,” Wright said of L.A. County’s network of home visiting programs. “We won’t have the resources.”

Nadra Nittle is a freelance reporter and can be reached at nnittle@chronicleofsocialchange.org.

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