As the count of confirmed cases of COVID-19 in Chicago rises—reaching over 2,000 by press time on March 30—home-visiting services for families and expectant parents are joining the ranks of healthcare providers and others who are using telemedicine to see their patients.
For Diana McClarien, the director of grantee support services at the Ounce of Prevention Fund, the switch from in-person to virtual visits has been relatively smooth. “We have a lot of younger parents, so they’re pretty tech savvy,” she says.
The Ounce, as it’s called, is a local nonprofit that runs a nationwide education program along with two home-visit services: one for low-income, at-risk families with kids up to age three, and one for young moms. It’s one of several Chicago services that uses home visitors to provide additional care for families who could benefit from parenting advice, educational support, or guidance navigating the healthcare system and community resources.
Like many other providers and community organizations that rely on in-person interactions, the Ounce was in “panic mode” after Mayor Lori Lightfoot and Governor J.B. Pritzker announced a “stay-at-home” order to limit the transmission of COVID-19, McClarien said. They had already closed their Bronzeville early childhood center, Educare Chicago at the Charles A. Hayes Early Childhood Investment Center, but had to figure out how to keep their home-visit services running from a safe distance.
“[But] besides not being able to be present, it’s been fine,” McClarien said. They’re keeping to the same schedule of weekly “visits,” though they’ve reduced the session time from ninety to sixty minutes, and are sending extra educational videos and resources from their staff educators over the phone. They’re also working on getting families on a group videochat to get back on schedule with biweekly parenting groups.
If anything, they’re hearing more from their parents now about where they’re at. Many families have been needing diapers, McClarien says. More recently, she’s been hearing from the Ounce’s four home visitors that parents are stressed about being laid off and about needing to get on unemployment. In response to that, they’ve been providing guidance, as well as care packages with diapers, wipes, formula, and developmentally appropriate books, and are about to send small-amount gift cards to help the families get by—though they’re still figuring out how to get them to their families safely.
Across the city, home visitors are helping to maintain a crucial line of information and resources between providers and families with young children.
Nurses at Rush Hospital who are providing virtual “home visits” to parents that have welcomed an infant in the last three weeks say that they’re getting “very specific” questions from parents, as not a lot of the information about COVID-19 coming from providers or from Rush itself is geared toward addressing infant or family safety, pediatric physician Gina Lowell said.
“We’re starting calls with a lot of anxiety [from the parents],” said nurse and home visitor Kathryn Kaintz. “We can stay on the line for a long time [up to three hours], so we’ve been able to talk families down a little bit.”
Kaintz is one of two nurses at Rush conducting home visits through Family Connects, which is in the beginning of a two-year-long, four-hospital pilot aimed to provide supplemental assistance for new parents. The pilot is in its infancy: they were gearing up to launch the service when the “stay-at-home” order came.
Rush is unique in that it’s the only of the four hospitals that’s able to go forward providing services in the midst of the crisis. The other three hospitals in the pilot—Mount Sinai in North Lawndale, St. Bernard in Englewood, and Norwegian American in Humboldt Park—were relying on the Chicago Department of Public Health’s (CDPH) public health nurses, who have been deployed elsewhere to help with efforts to treat patients with coronavirus. Rush, however, staffs the service with nurses from the Rush College of Nursing; Kaintz and Hepburn are faculty clinicians at the college.
When asked about the paused services at the other hospitals—and about other home-visit services staffed by CDPH’s nurses, including one that serves postpartum women with high blood pressure and one that serves high-risk infants—CDPH spokesperson Elena Ivanova wrote, “CDPH’s home visits are a supplement to, not a replacement for, care by mothers’ medical providers. As always, but especially during this time, it is crucial that new moms and parents stay in close communication with their medical providers.”
When the Weekly spoke with their team on Thursday, March 26, nurses Kaintz and Darlene Hepburn had conducted seven total visits and were preparing for another later that day. That’s twice a day, but they were preparing to scale up to four visits a day to be able to accommodate the roughly thirty babies born every week at Rush.
Initially, both Kaintz and Hepburn were disappointed to hear that they wouldn’t be able to conduct visits in person. “I’m always in the home or in person in the community, so I was like, ‘I don’t know how I do on the phone,’” said Kaintz, whose background is in providing community- and mental health–centered home visits. “I rely so much on body language and active listening.”
But they’ve found the visits have been helpful for parents, even over the phone. “I was really pleasantly surprised about how helpful it seemed to the mom to have the opportunity to speak [to a nurse],” Hepburn said.
On top of providing basic resources and information—about newborn health, breastfeeding, and more—Family Connects, which was originally designed by Duke University for the city of Durham, North Carolina, has been shown to reduce infant visits to the ER by fifty-nine percent. That’s especially important right now, said Lowell. “We want to keep healthy babies out of the ER setting, where there can be a lot of exposure to [virus-carrying] individuals right now.”
The Ounce’s McClarien said that one of the most important things that home visitors can teach their families is how to advocate for themselves and for their children. Until the stay-at-home order is over—which may not be until late April, according to a recent announcement from the mayor—they’re trying to help families keep on the same page as their primary care providers.
“We’re asking our families to call their pediatricians and see if there’s a protocol they use to minimize risk,” McClarien says. “And we’re giving them some language to use. So, [if a parent says], ‘I’m calling to reschedule a well-child visit [from] over two years ago, and there are some immunizations this baby needs’—they’ll prioritize this child.”
Even so, there are some parts of home-visit sessions that can’t be replicated over the phone or videochat.
These are things like newborn weight checks—and, for moms, blood-pressure checks, which are essential for women with hypertension, a condition that puts them at higher risk of developing blood clots or having strokes or heart attacks after birth. Women of color, but especially Black women, are at higher risk of developing complications and of dying during and in the period after birth, as recent reporting on the Black maternal health crisis has shown. Increased care for moms in the postpartum period—as well as training on implicit bias—has been shown to reduce those rates.
And, though neither home-visit service is supposed to replace primary care for mothers or babies, fear of COVID-19 may prevent families—especially those sharing a home with older parents or grandparents—from keeping their postpartum checkups.
Lowell, the pediatric physician at Rush, said her team has had to reach out to families scheduled for checkups, and to reassure them that they have implemented new workflows to separate healthy and sick families in different units. But even so, one family couldn’t be convinced to show up to a newborn checkup. “They were not having it,” she said.
But it’s not all bad news. Increasingly parents with blood pressure conditions are able to get prescriptions for blood pressure cuffs to keep at home. Family Connects nurse Kaintz said that a patient she talked to last week had been keeping her own blood pressure log.
For McClarien, one of the concerns is that the work they’ve put in to convince families of the importance of going to the doctor and keeping up with health checks and dental exams—which are two things that they can’t keep up for as long as their home visits are remote—will backslide. Once the crisis has passed, “we’re going to start over, all over again,” she said.
But in the meantime, the Ounce’s family support specialists and home visitors are helping families stay on top of appointments as best as they can. “Things are evolving,” McClarien said.
And families have jumped on board with the new normal. Before the COVID-19 crisis, families would send home visitors pictures of their kids on occasion, she said. “Now it’s like every day. That’s really nice.”
Correction, April 1, 2020: The Family Connects service run from Rush relies on nurses from the Rush College of Nursing, not from Rush Hospital.
Correction, April 3, 2020: CDPH spokesperson Elena Ivanova’s last name was incorrectly spelled Ivanovich.
Emeline Posner is a senior editor. She last wrote about COVID-19 unemployment benefits and who qualifies.