Form 1 Community Interview Protocol

Attachment A. Community Interview Protocol

Key Informant Interview

This protocol will be used to guide discussions with:

• Representatives from MIECHV awardee agencies

• State and local representatives from home visiting, public health, health care, and other human service agencies in the early childhood system, community organizers, Tribal elders, religious leaders, and members of activist coalitions

Introduction

Hello, thank you for taking the time to speak with me today. My name is [NAME OF INTERVIEWER] and I’m with Child Trends. We were contracted by the Health Resources and Services Administration, or HRSA, to examine how home visiting can address challenges from COVID-19. Specifically, we are exploring the policy and health systems context in your community, as well as home visiting’s role in addressing health inequities arising from COVID-19. This may include how home visiting programs have supported families and communities through collaboration and adaptation.

We plan to record this interview, but the information you share today will not be identified in any recordings, notes, or transcriptions. The transcript from this interview will only be seen by the study team. Your individual answers will not be shared with anyone at your program or any local or state agencies. We will also plan to remove any language that could possibly identify you in some way. Some questions in the interview ask about your experiences during the COVID-19 pandemic and may be upsetting for some people. It is up to you to share as you feel comfortable. You do not have to answer any questions you don’t want to, and we can stop the interview at any time.

Do you have any questions before we get started?

Are you willing to complete the interview? By agreeing, you are providing consent for us to record this call.

Policy and health systems context in the community

Before we get started, since so much time has passed since the start of pandemic, we want to set the scene by reviewing some of the major milestones over the last 2 and a half years.

FACILITATOR’S NOTE: Share the following events on a paper timeline or via slides.

Key pandemic milestones:

• March 2020: COVID-19 pandemic began in the US, shutdowns and “social distancing” begin; many schools and child care facilities close

• April 2020: The CDC recommends wearing a mask in public spaces

• November 2020: President Biden is elected into office

• Early 2021: Vaccines became widely available for adults (all adults eligible in April)

• Summer/fall 2021: Delta variant peaks

• November 2021: Vaccines become widely available for kids ages 5-11

• Winter 2021/2022: Omicron variant peaks

• Spring 2022: Restrictions begin lifting

1. Based on your experiences and your memories of the pandemic so far, what is missing from this list of milestones? What other events were important in your community?

For participants familiar with state and community-level policies:

2. We know that there were many policies put in place during the course of the COVID-19 pandemic. For instance, [PLACEHOLDERS for Health related policies] and [PLACEHOLDERS for policies that enacted closures].

• Please describe these policies and their impact on families in your community.

• What are some of the other important state and community level policies put in place during the course of the COVID-19 pandemic? Please describe these policies and their impact on families in your community.

Home visiting response to COVID-19

For participants familiar with home visiting implementation (either delivering home visiting or collaborating with agencies delivering home visiting):

Now we’d like to ask some questions about home visiting implementation during the COVID-19 pandemic.

3. In general, in what ways has home visiting in your program/community changed since before the pandemic began in March 2020? (using timeline approach)

4. How was the recruitment of families into home visiting impacted based on pandemic milestones?

• How did you recruit families at the onset of the pandemic in March 2020?

• How did you recruit families in early 2021, when vaccines became widely available for adults?

• How are you currently recruiting families?

• Do you foresee recruitment continuing to function in this way even after the pandemic is over?

5. Did outreach differ by racial and ethnic community during the pandemic?

• Before the pandemic were there communities that did not have access to home visiting? Have there been communities prior to the pandemic that you struggled to reach for the provision of services?

  • What factors limited their access to home visiting?

• Have there been communities that have not had access to home visiting during the pandemic?

  • What factors have limited their access to home visiting?

6. How has families’ interest in participating in home visiting changed over the course of the pandemic, if at all?

• What factors have caused them to be more or less interested in participating?

• How has the involvement of other family members in visits changed over the course of the pandemic, if at all? For example, the involvement of fathers, grandparents, and siblings.

  • What factors have prompted this change in involvement?

7. How has service delivery been customized over the course of the pandemic?

For all participants:

8. How have turnover rates among frontline staff changed since the start of the pandemic, if at all?

• What are the main factors behind these changes?

• Have staff been deployed or reassigned to other work in your agency?

• How have new staff been oriented to their position and supported in their work, if applicable?

• How has your program been affected by staffing shortages, if at all?

• How have the families you serve been affected by staffing shortages at your organization, if at all?

Community strengths and challenges

9. For all participants: Please tell us about the needs of families and children in your community during the COVID-19 pandemic.

10. Are you aware of historical disparities within your community? (e.g., race, gender, ethnicity)

• How has your organization acknowledged these historical disparities within the community, if at all?

• How have historical disparities impacted how families in your community have experienced the COVID-19 pandemic?

11. How have communities and community groups worked to fill gaps to address the health, nutritional, and educational needs of families during the pandemic?

• Which groups/organizations have been active in this work in your community?

12. What needs of families remain unmet and/or have been especially difficult to meet?

• For which groups of people?

• What are the primary barriers to meeting these needs?

Home visiting’s role in the community system

For participants familiar with home visiting (either delivering home visiting or collaborating with agencies delivering home visiting):

The next set of questions are about home visiting’s role in the community, including collaborating with other organizations in the community to meet families’ needs.

13. What role has home visiting played in connecting families to services to meet their needs, if any?

• How has that role shifted during the pandemic?

14. Throughout the pandemic, in what ways has home visiting improved the way systems operated or filled the void when systems broke down? By “systems” we mean the coordinated structures, supports, and services available to meet families’ needs.

• How have home visiting programs collaborated with partners to provide cross-sector help, if at all?

• What innovative partnerships between home visiting and other sectors (e.g., housing, etc.) have emerged, if any?

• How have any collaborations or partnerships formed early on in the pandemic evolved over time? Have any collaborations ended?

• Do you foresee home visiting continuing to function in this way even after the pandemic is over?

Program’s Role in Equity

For all participants:

15. How is your agency addressing equity in its work, if at all?

• Does it have a mission statement committed to racial equity?

  • If yes, how does this manifest in its work, if at all?

    • What have been some successes of the agency’s efforts to advance racial equity, if any?

    • What have been some challenges, if any?

  • If no, in what other ways does the agency address racial equity, if any?

• Does it have a mission statement committed to other types of equity, such as geographic equity, gender and sexual orientation, ableism, etc.?

  • If yes, how does this manifest in its work, if at all?

    • What have been some successes of the agency’s efforts to advance other types of equity, if any?

    • What have been some challenges, if any?

  • If no, in what other ways does the agency address other types of equity, if any?

• Does your agency have an equity task force or Diversity, Equity, Inclusion, and Accessibility (DEIA) lead?

  • If yes, what is the role of that person/body?

    • What impact have they had, if any, on organization operations?

For participants from home visiting agencies:

16. To what extent does your home visiting program prioritize health equity in its work, if at all?

• How does your program seek to meet the needs of families experiencing inequities in health and well-being outcomes, if at all?

• How does your program prioritize equity more broadly, for example, incorporating family voice into decision making about services?

• How does your program identify and address institutional racism and its impact on health equity, if at all?

  • Does the organizational culture and communications address these topics?

    • If yes, in what ways?

    • If no, why not?

Conclusion

17. Do you have recommendations for local organization, agencies, or community members who may be interested in joining our community research team or participating in other data collection activities, including focus groups and surveys?

18. Is there anything else you’d like to share with us that we haven’t talked about already?

Thank you for your time today! In appreciation of your time, we will be sending you a $50 e-gift card to Amazon.

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