Photo courtesy of Early Learning Institute
Nine-month-old Camilia in Sonoma County visits with her developmental therapist by video call.

The stay-at-home order has upended some of California’s most crucial educational and health services for infants and toddlers — home visits and early intervention services — at a time when families may need them the most.

Home visiting programs send nurses, social workers and other trained professionals to the homes of low-income parents to give health and early education advice. They also help children meet milestones, like crawling, picking up objects, speaking their first words and playing. Speech therapists and others also conduct home visits to do early intervention with children who have developmental delays.

These home visitors are now making video calls, recording stories, dropping off learning materials on doorsteps and parking outside families’ homes to provide mobile hotspots, all to keep connecting with their clients.

Parents are referred to home visiting programs by doctors or other health care workers when they are pregnant or just had a baby, or by social service agencies or community-based organizations. About 32,000 children were served by home visiting programs in California in 2017-18, according to the California Budget and Policy Center, a nonprofit research organization that works to improve social service programs for low- and middle-income residents. Parents are referred to early intervention programs when their children are diagnosed with a developmental delay. Early intervention programs serve about 40,000 infants and toddlers with special needs in the state.

Studies have found home-visiting programs, such as the Nurse-Family Partnership, have long-term benefits for children’s reading and math skills, in addition to improving their health and mental health, and help mothers get high school diplomas or GEDs and better jobs. After Gov. Gavin Newsom expanded funding for home visiting last year, some advocates expect programs to be able to serve three times as many families by 2021.

Early learning advocates say the services provided by home visits are now more important than ever. Studies have shown some home visiting programs help prevent child abuse. Many advocates are concerned that child abuse could increase during the stay-at-home orders, with children and parents or guardians all at home together, under stress because of the pandemic and with little contact with other people outside the home.

“Given the concern of increased stress levels and being within a home that might not be as stable and safe as would be ideal, the more we can get support to people to prevent harm to children, the better off we’ll be,” said Gina Daleiden, executive director of First 5 Yolo County, a county commission that operates several home visiting programs in the county. First 5 commissions in every county in California fund and support health and education services for children 0-5 years old.

One of the biggest barriers to video call home visits is that many of the families participating do not have internet access at home.

In Mono County, on the eastern side of the Sierra Nevada, some families ran out of internet data on their cellphones in the middle of their first virtual visits. So now, some home visitors bring mobile hotspots in their cars and park outside families’ homes so that parents and children can connect to the internet.

“We’ve had phone calls with some of those families, but it’s really much more rich when you can see how the parent and child are interacting,” said Molly DesBaillets, executive director of First 5 Mono County. “For example, if the activity the visit is centered around is Play-Doh and the child is making it into a ball, we would model narrating what the child is doing, in the hopes that the parent would continue to do that after the visit. So that’s one of the reasons we felt it is so important to do face-to-face, even if it’s on an internet platform, versus a phone call.”

Two-year-old Diego talks on a toy phone during a video call with a therapist in Sonoma County. Photo courtesy of Early Learning Institute.

Samantha Tooley, a parent who is trained to work with other parents, does home visits for the San Joaquin County Office of Education. She is recording videos of herself reading stories and posting them on YouTube and on private Facebook groups for the parents she works with. She’s also sending ideas for activities each child can do.

“We’re lucky that we’ve been able to utilize social media and that it’s there,” Tooley said. “It’s been easy to me because I am a millennial. I feel like if we didn’t have social media during this time, it would have been extremely difficult.”

Although video calls help home visitors connect with parents, they can be a challenge for small children.

“Our message to parents has been to limit screen time. Now we’re asking them to engage with us over a screen,” said Michele Rogers, executive director of the Early Learning Institute, a nonprofit organization in Sonoma County that conducts early intervention visits for children under 3 years old who have speech or other developmental delays.

Rogers said early intervention therapists are trying to make video visits more interactive, and they make sure parents know that children have permission to wander around the room.

“Sometimes they’ll be on the screen and sometimes not,” she said. “You cannot make a screaming 18-month-old sit in front of the phone so his therapist can play with him.”

In addition to those challenges, referrals for early intervention services have gone down in some cases because physicians are not seeing many children for regular check-ups. Rogers said it’s important for parents to know they do not need a doctor’s referral to get early intervention services. If they notice a delay, they can reach out directly to ask for an assessment.

In some cases, the visits from afar have been unexpectedly positive. One of the first times Andrea Jahns, a developmental specialist with the Early Learning Institute, connected via online video with one of her clients, a 2-year-old boy who has speech delays, she was nervous. Her own son, who is around the same age as her client, was at home with her and she knew he might interrupt. But it turned out that her son actually helped the other little boy.

“Once my son noticed there was a child on the screen, he started bringing balls to the screen to show him,” wrote Jahns in an email. “The boy repeatedly said ‘ball’ or ‘big ball’ each time my son brought a new one. Then he started saying, ‘Share?’ putting his hand towards the screen, indicating he wanted my son to hand him the ball. It was like a virtual play date with two toddlers who have never met. Almost made my job too easy!”

Speech therapists in Sonoma County have also told Rogers that the virtual visits have encouraged some mothers to be more involved, singing songs and doing activities directly with their children.

“We’re only there an hour a week, so this is what we want,” Rogers said.

Petaluma mom Patricia Vasquez’s 2-year-old daughter Genesis has cerebral palsy. They have been receiving weekly home visits for a little more than a year, and Vasquez said seeing the visitor in person before the stay-at-home order helped her and her daughter learn sign language to communicate. For two weeks now they have had video visits, but Genesis doesn’t like to sit still watching the camera. What has worked better for Vasquez is that the home visitor has sent her text messages with ideas for activities Vasquez can do with her daughter.

“We’ve learned different things to do at home,” Vasquez said. “She sent me recipes to make Play-Doh with no chemicals. We’ve learned a lot now that we are staying at home, too.”

Home visitors in several counties have been surprised at how many clients still wanted to participate in visits while they shelter in place, even if they are virtual.

In Yolo County, pediatricians or obstetricians used to literally walk new parents down the medical clinic hall to introduce them to their home visitor. Now, doctors have to introduce them by phone call. Even so, families seem to be even more eager to participate now than before, said Daleiden.

“It’s an anxious time for everybody and particularly for new mothers, or new mothers to be, especially as they’re sheltering in place at home,” Daleiden said. “They really do want connection, so they’re saying yes to that first phone call and then to the idea of working in a virtual way.”

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  1. Karen Berman 6 months ago6 months ago

    I really appreciate you posting this reflection on the use of teletherapy and televisits in California. We are having similar experiences here in Illinois and realize how much we are al learning about our ability to be flexible and responsive in how we reach families through EI right now. Some of these learnings will be helpful even as we emerge from COVID-19. Look forward to hearing more about your work over the next months.

  2. Lynn Shea 6 months ago6 months ago

    The guiding principle of early intervention services is the intervention takes place between visits. This is because babies and toddlers at this age especially, learn best by repetition and in the context of a loving relationship. Thus we work with the parents to work with the child and do very little working with the child directly and this can be accomplished quite nicely through tele-intervention. See the 15 minute YouTube video attached for an example.