Cleveland Home Visit, Doula Programs Switch to Remote Care Due to COVID-19

Community health worker Jill Sands plays with a client's infant during a home visit in Elyria in January. In Cuyahoga County, home visit programs have switched to remote care due to the COVID-19 pandemic.
Community health worker Jill Sands plays with a client's infant during a home visit in Elyria in January. In Cuyahoga County, home visitors and birth workers are now meeting with clients remotely due to the COVID-19 pandemic. [Anna Huntsman / ideastream]
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Programs aimed at lowering infant mortality rates often rely on home visits and support personnel who form relationships with pregnant women. Research shows this kind of program has been successful for reducing infant deaths and in Cleveland, public health officials have been trying to ramp up these services to try to reduce the disproportionately high African American infant mortality rate.  

During the pandemic, these services have had to be altered.

ideastream’s Anna Huntsman checked in with local organizations and spoke with Morning Edition host Amy Eddings about how they're adapting.

How are community health workers who support pregnant women, such as doulas, conducting their services and communicating with clients right now?

Like many healthcare professionals, maternal health and birth workers have transitioned to telehealth services. So instead of meeting with a client at their home, the workers are communicating via Zoom or FaceTime, as well as calls and texts. I spoke with Christin Farmer, CEO of Birthing Beautiful Communities, which is a nonprofit that works with pregnant moms who are at high risk for infant mortality. She said one of the biggest changes in their program has been their labor and delivery coaching services.

“The hospitals are only allowing one support person to come into the room with them, and instead of making a family choose between a family member and us, we have just opted to do the labor and delivery over FaceTime," Farmer said. "It's not a perfect process. Sometimes the connection is lost and we have to get back on and find our way through. But it hasn't been as difficult, or even as awkward, as we thought it might be.”

But have there been hiccups when trying to provide care and support remotely, because of the so-called digital divide?

Yes, the organizations I spoke with said there have been some issues, particularly with clients not having access to smartphones or WiFi. Here’s Bernadette Kerrigan, Executive Director of First Year Cleveland, a public health consortium focused on reducing infant mortality in Cuyahoga County:

"Our families are asking for help with paying their phone bills so that they can do remote prenatal care, [and] help with making sure WiFi is in their home," she said. "Some plans do not have unlimited phone time so, you know [with] a prenatal care appointment, you could be on the phone with your OB or midwife for 30 or 40 minutes, so we want to make sure you have all your questions answered."

First Year Cleveland isn’t directly addressing these issues but they’re connecting families to community resources about phone plans and WiFi access to try to help.

And also as a way to address the digital divide, Birthing Beautiful Communities just received funding from the Cleveland Foundation’s coronavirus fund, which will help them with buying tablets or phones for their clients who don’t have access to video chatting capabilities. 

Are there concerns that the inability to connect with clients face-to-face will have a long-term impact on health or birth outcomes?

Research has shown that home visit programs are effective in reducing infant mortality rates. But Farmer said she isn’t too concerned because the workers have built strong relationships with their clients, and that’s what really makes the difference.

“It isn’t the in-person home physical visit that is actually helping to support the women, it is just the social and emotional connection that is helping to support the women," she said. "So being there, having someone there to talk to you, and talk you through things, doesn’t require you to be in-person.”

And Kerrigan said it’s too early to tell whether these virtual visits will have a measurable impact on health outcomes or infant mortality rates.

“Right now, it is too soon. It’s only been five weeks that we’ve been offering remote. So we are needing to look at the data to see how the outcomes look, and we won’t have that data probably for another two months," she said.

Kerrigan and Farmer both said that while remote care has brought some challenges, some insights for future care have come out of it. For example, some of the families have said they actually prefer connecting over the phone instead of in-person for scheduling or comfortability reasons.

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