Sarah Rabot, MBA and Rachel Yard

July 23, 2020

While young children do not seem to become as sick as adults from COVID-19, children and their families — particularly those with low incomes — are experiencing significant impacts from the pandemic. Shelter-in-place orders, closed childcare centers, and parental employment losses have created a critical crisis for many families with young children. In some states, agencies serving young children and their families are partnering in new ways to address this heightened need.

The Center for Health Care Strategies (CHCS) recently spoke with Mary Alice Cohen, director of the Division of Community and Family Support in the Colorado Office of Early Childhood, and Gina Robinson, program administrator in the Health Programs Office within the Colorado Department of Health Care Policy and Financing, about how their agencies partnered to support families with young children during the COVID-19 pandemic, as well as the challenges they faced. Colorado is a participant in Aligning Early Childhood and Medicaid, a national initiative led by CHCS with support from the Robert Wood Johnson Foundation, through which the state is working to create greater alignment between Medicaid and early childhood services to better meet the needs of young children and their families.

Q: How have your agencies responded to the critical needs of young children and their families during COVID-19?

Families were in crisis — parents were panicked about lack of formula and food for their families. We worked with regional food banks to ensure they were able to deliver, free of charge, food that families needed.

A: M.A. Cohen: We responded to the immediate needs of families by looking through a few different lenses: basic needs; child development and mental health; childcare; and telehealth. To address basic needs we secured a $3 million dollar FEMA grant for formula, wipes, and diapers, which were distributed through our Early Childhood Councils, Family Resource Centers, and early childcare providers. Families were in crisis — parents were panicked about lack of formula and food for their families. We worked with regional food banks to ensure they were able to deliver, free of charge, food that families needed. Child development and the mental health of families was another concern because parents were feeling isolated, unsure how to talk to their children about the pandemic, and how to access the mental health support they needed.  In response, we created the family resource roundup which provides resources on parenting during COVID-19, including the early childhood development guidelines so that parents can support their children age-appropriately. To address childcare needs, we worked in close partnership with the governor’s office and used CARES Act funding to ensure access to childcare, free of charge, for all essential workers. We were able to provide childcare to over 5,200 children through 515 providers.

G. Robinson: To address the immediate closure of many provider offices, Medicaid removed the need for a provider signature on all benefits related to early intervention as a requirement to prescribe the services. This ensures that families have access to services without the need to track down their provider for a physical signature. Telehealth was already an option for early intervention so it didn’t require any changes on the Medicaid side, but already having it in place made it more easily transferable to other things like occupational, physical, and speech language therapy. Additionally, we added phones to our acceptable telehealth equipment list because we are very aware of internet access issues in Colorado, especially in rural areas. We want to make sure families have the tools they need to connect with providers during COVID-19.

Q: What successes have you seen since moving services for young children to telehealth?

Since March 1 we have certified almost 900 additional telehealth providers around the state, bringing our total number of certified telehealth providers in Colorado to almost 1,500. This dramatic increase in access has been vital during this time.

A: M.A. Cohen: We have been able to advance telehealth quickly during COVID-19 since Medicaid already had approved its use for programs like early intervention. Since March 1 we have certified almost 900 additional telehealth providers around the state, bringing our total number of certified telehealth providers in Colorado to almost 1,500. This dramatic increase in access has been vital during this time.

We have also seen a leap in home visiting since transitioning to telehealth. Between January 1 and March 20, there were 650 in-person home visits. In April alone there were almost 400 virtual visits. There are a couple of factors that led to this increase. Families were in crisis and really needed the additional support. The other factor is that home visiting programs are seeing a very low no-show rate since switching to telehealth.

Q: What are the challenges since implementing telehealth more broadly?

A: G. Robinson: A success and challenge is that right now parents are completely and totally involved in their children’s services, which has led to great parent engagement. Parents are more available for telehealth because they don’t have to get their child to appointments, since transportation and transition time can eat up time spent interacting with providers. Without the provider in-house, the parent has to be a more active participant in service delivery. The challenge is parents giving that up when we resume in-home visits, as we’ve heard how many parents love this shift in role. It’s something we’ll need to approach thoughtfully when we transition back to in-home visits and consider how to balance the parent’s active engagement versus the previous role of being an observer.

M.A. Cohen: Families are missing in-person contact. The early intervention and home visiting team has created a statewide task force to determine how to transition back to in-person when appropriate. Another challenge is that many telehealth providers who are working from home also have children at home with them. Trying to balance their workload against their own lack of childcare is a challenge. That was really tough for a lot of our frontline workers. We have also had to be thoughtful about privacy concerns that arise over telehealth that aren’t normally an issue in-person, such as who else might be in the room that we can’t see. We’ve held trainings for providers to address this challenge.

Q: How has the relationship between Medicaid and the Office of Early Childhood strengthened the response to families with young children during COVID-19?

These honest conversations have strengthened our relationship and allowed us to collaborate on goals that benefit from both agencies’ buy-in.

A: G. Robinson: We’ve created common goals and a mutual understanding of how to meet them. We’re willing to have hard conversations — what is possible to accomplish together and what isn’t. These honest conversations have strengthened our relationship and allowed us to collaborate on goals that benefit from both agencies’ buy-in. Concerning COVID-19, we’ll continue to partner to address the many challenges faced by families with young children in Colorado. Specifically, that includes evaluating our efforts to-date, analyzing data when it is ready, and deciding what we can do long term to support this population.

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