Effects of COVID-19 on Home Visiting Services for Vulnerable Families: A Cross-State Analysis of Enrollment, Engagement, and Attrition Patterns

Introduction: COVID-19 has resulted in massive health and economic consequences, with effects felt most acutely by populations that were disadvantaged prior to the pandemic. For families with young children, the effects have been compounded by service interruptions, though there is a lack of empirical evidence that demonstrates how COVID-19 has affected home visiting programs. This cross-state study is the first to examine the effects of the pandemic on home visiting enrollment, engagement, and retention patterns. Method: Program implementation records gathered from 2017-2020 in Arkansas and Wisconsin were analyzed. Both states operate a large network of home visiting programs that serve predominantly low-income families and that are supported by the federal Maternal, Infant, and Early Childhood Home Visiting program. Trends prior to COVID were compared to post-COVID trends (March 12 to December 31, 2020) in program enrollments, service capacity, visitation frequency, service modalities, attrition rates, and service duration. Results: Compared to average pre-pandemic enrollments from 2017-2019, post-COVID enrollments decreased by 33-36%. Total visits fell by 15-24%; the percentage of completed visits relative to expected visits declined more modestly. However, the average duration of services increased post-COVID while rates of early program dropout decreased. Discussion: The findings suggest that enrollment and engagement in home visiting decreased during the COVID-19 pandemic, which is unfortunate given the large number of vulnerable families served nationwide. Further research is needed to examine how COVID affected both consumer and program behaviors. Public Significance Statement The COVID-19 pandemic has produced disruptions across human service sectors in the United States, though no studies have documented how home visiting programs have been affected. This study showed that home visiting enrollment and engagement decreased post-COVID, potentially compounding the effects of the pandemic on vulnerable families. Further disparity research is needed to identify programs and populations most affected by the pandemic.