Digging Deeper: An Exploratory Analysis of Telehealth Barriers and Facilitators Among Child Welfare Involved Families

Background/Purpose: Identified as a current grand challenge –and further accelerated and exasperated by the COVID-19 pandemic—is the need for harnessing technology and integrating telehealth into social work practice. Telehealth, or virtual service delivery, holds immense potential for promoting equity and empowering vulnerable populations, including child welfare (CW) involved families, by reducing geographical barriers and other accessibility concerns. While telehealth has the potential to improve service access, many questions persist regarding the associated benefits and challenges for vulnerable families receiving telehealth adaptations of established, in-person evidence-based (EB) interventions. This study contributes to the expanding body of literature on social work’s shift to telehealth delivery of interventions by investigating barriers and facilitators to virtual implementation of an EB early childhood intervention - originally intended for in-person delivery- among CW-involved families participating in a Regional Partnership Grant (RPG, funded by Children’s Bureau, ACF) initiative.

Methods: The study sample included 68 CW-involved families. All families received Attachment and Biobehavioral Catch-up (ABC); at program exit, clinicians completed a family-specific exit survey including 17 barriers and 23 facilitators (informed by Almathami et al., 2020) to examine telehealth implementation of the ABC intervention. Variables were examined individually and cumulatively (summed barriers and facilitators scores), and the bivariate relationship with ABC completion status was analyzed.

Results: Case and sample descriptives revealed: 59 (87%) ABC cases participated via telehealth; 33 (49%) ABC cases successfully completed; children were primarily White (51%), non-Hispanic/Latino (81%), males (63%) in foster care (64%) with a mean age of 1.1 (SD=1.2) years old; and ABC caregivers were primarily White (74%), non-Hispanic/Latino (95%), females (95%) with an average age of 36 (SD=11.1) years old. The most common clinician-identified barriers to telehealth implementation were: poor video/audio quality (24%); internet access issues (19%); scheduling conflicts (19%); and slow internet speed (10%). The most prevalent telehealth facilitators included: reduced travel time (59%); schedule flexibility (59%); convenience (58%); increased participant motivation and engagement (32%); and improved accessibility (27%). When examined cumulatively, cases averaged 1.4 (SD=1.5) barriers and 4.5 (SD=3.3) facilitators, as reported by the clinician. Bivariate results revealed a significant relationship between the number of barriers and facilitators reported and ABC completion status. Specifically, cases with more barriers were significantly more likely to drop out of ABC services (χ2(df) =11.4(5), p=.043) whereas cases with more facilitators were significantly more likely to successfully complete ABC services (χ2(df) =21.8(12), p=.040).

Conclusion: Though the profession has long acknowledged the significance of methods like telehealth, these exploratory findings highlight that merely offering telehealth as a service option may not be meeting the unique needs of vulnerable, CW-involved populations. Technological barriers may hinder families' ability to successfully complete virtual interventions. Further, findings warrant the need for research to examine the congruence of EB interventions and telehealth service delivery by examining rates of attrition in addition to program impacts. An integration of technology into clinical practice and practice settings necessitates not only providing effective services but also minimizing technological barriers, enhancing facilitators, and ensuring selected interventions (i.e., curriculum components) are congruent with families’ needs.