Telehealth in home visiting for new mothers: Are outcomes different if the first visits are in person?

总结 针对新妈妈的家访计划有着广泛的目标，包括改善产妇和新生儿的健康状况。 儿童健康，减少虐待儿童，改善儿童发展。超过286，000个家庭 面对逆境，每年都有19个以证据为基础的模型在美国， 提供支持、教育和与其他服务的联系。在2020年之前，只有一小部分访问是 通过远程家访（teleHV;电话或视频会面）提供。冠状病毒疾病-2019 2019冠状病毒病（COVID-19）大流行需要快速采用远程HV;截至2020年4月初，99%的家访是通过 远程HV。在2020年之前，仅建议将teleHV作为亲自访问的部分替代品， 在家访者和家庭之间建立了关系之后，由于 治疗关系。这种关系是整个家访计划的关键因素，因为它服务于 作为教学、指导和与家庭合作的基础。只有有限的证据表明 teleHV，尽管我们预计在COVID-19之后，许多家庭将使用亲自访问和teleHV的组合 由于更大的灵活性和其他优点，取消了限制。我们建议进行二次数据分析， 利用这一自然实验，并确定是否在建立家园期间亲自访问 在建立这种关系的过程中，来访者-家庭关系与比电视更好的结果相关。 关系我们还将探讨与更好的结果相关的家庭特征是否在不同的年龄段之间存在差异。 人家访和teleHV，这将有助于我们理解接受和 家庭特征的teleHV的有效性。我们将考虑两种健康结果（母亲抑郁症）， 症状，母乳喂养，亲密伴侣暴力[IPV]）和过程结果（保留，访问出席率， 筛选完成）。我们将从一个大型的、以证据为基础的家庭访问项目“护士家庭”中获得数据。 伙伴关系。NFP在美国大约有260个站点; 1000到1600名孕妇首先- 母亲每月登记的时间，在妊娠晚期之前，并接受定期访问（频率因 从怀孕到孩子的第二个生日，护士每周到每月提供一次咨询。 NFP国家服务办公室在接收时和规定的时间点收集所有登记家庭的数据 关于访问，筛查和结果（包括孕产妇和儿童健康）。我们以前工作过 这些数据，并有能力访问和分析它们。我们估计的主要样本量 目标是每组3 000个家庭。这将允许足够的功率进行回归分析，控制 家庭、项目地点和社区特征。该项目将提供有关 亲自与通过远程HV建立家访关系的重要性。这些知识将帮助 家庭访问计划在未来更好地利用远程HV，为家庭服务带来更好的结果， 这些情况，包括减少卫生不公平现象。

Summary Home visiting programs for new mothers have a broad range of goals, including improvements in maternal and child health, reductions in child maltreatment, and improvements in child development. Over 286,000 families facing adversity are served annually by 19 evidence-based models throughout the United States, which provide support, education, and connections to other services. Before 2020, only a small portion of visits were delivered through tele home visiting (teleHV; phone or video encounters). The Coronavirus Disease-2019 (COVID-19) pandemic required rapid adoption of teleHV; by early April 2020, 99% of home visits were by teleHV. Prior to 2020, teleHV was recommended only as a partial replacement for in-person visits and only after a relationship between the home visitor and family was established, because of the importance of the therapeutic relationship. This relationship is a key element across home visiting programs, because it serves as the foundation for teaching, mentoring, and collaborating with the family. There is limited evidence regarding teleHV, although we anticipate many families will use a mix of in-person visits and teleHV after COVID-19 restrictions are lifted due to greater flexibility and other advantages. We propose a secondary data analysis to make use of this natural experiment and determine if in-person visits during the establishment of the home visitor-family relationship is associated with better outcomes than teleHV during the establishment of this relationship. We will also explore if family characteristics associated with better outcomes vary between in- person home visiting and teleHV, which will contribute to our understanding of both acceptance and effectiveness of teleHV by family characteristics. We will consider both health outcomes (maternal depressive symptoms, breastfeeding, intimate partner violence [IPV]) and process outcomes (retention, visit attendance, screening completion). We will obtain data from a large, evidence-based home visiting program, Nurse-Family Partnership (NFP). NFP has approximately 260 sites across the United States; 1000 to 1600 pregnant first- time mothers enroll per month, before their third trimester and receive regular visits (frequency varies by developmental stage: weekly to monthly) from nurses during pregnancy through the child’s second birthday. The NFP National Service Office collects data on all enrolled families both at intake and at defined time points regarding visits, screenings, and outcomes (including maternal and child health). We have previously worked with these data and are well-positioned to access and analyze them. Our estimated sample size for the primary aim is 3000 families per group. This will allow sufficient power to conduct regression analyses, controlling for family, program site, and community characteristics. This project will provide critical new knowledge about the importance of starting the home visiting relationship in person vs. through teleHV. This knowledge will help home visiting programs better utilize teleHV in the future, resulting in better outcomes for the families served in these circumstances, including reductions in health inequities.