Virtual Services in Early Childhood: A Model Worth Continuing?

The pandemic has brought about a dramatic increase in the use of virtual early childhood services, such as telehealth, teleconsultation, virtual coaching, and remote home visiting and early intervention. Virtual visits existed before the pandemic (The Hechinger Report; Cole et al., 2019), but are likely to continue as a way of providing services to more families and early childhood professionals.

What do we mean by virtual service delivery?

Virtual service delivery goes by many different names, all essentially referring to providing services to families and early childhood professionals remotely with the assistance of technology.

What is virtual service delivery?

Virtual service delivery is a broad umbrella term for “… an alternative to providing services and supports to young children and families in person”, and “can include low-tech options, such as delivering instruction via a packet dropped off at the child’s home” (Early Childhood Technical Assistance Center). It is commonly used within education, coaching, and home visiting programs. Closely related terms you might see include virtual home visits, remote service delivery, distance learning, virtual coaching, and remote learning.

What is telehealth?

Telehealth is another term frequently used within the early childhood virtual service delivery discussion and is particularly common in medicine, behavioral health, early intervention, and early childhood mental health consultation. Telehealth is defined as “…the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration” ( Closely related terms you might see include teleconsultation, teletherapy, telepractice, tele-intervention, and remote early intervention.

How has virtual service delivery been used in the field?

Over the past two years we have seen some exciting examples of virtual service delivery in the field. Health, mental health, and instructional providers have adapted traditional services to a virtual delivery format, expanding opportunities to reach new clients. Check out just a few examples below.

Pediatric Primary Care

In response to COVID-19, pediatric primary care providers began offering hybrid well child visits. Aspects of these appointments, such as collecting medical history, can be completed remotely and followed by an in-person visit to complete components that need a physical presence (Wenderlich & Herendeen, 2021). The added convenience for families and the availability of high-quality care for patients have led advocates to push for the continued use of this hybrid model even as risk of exposure is mitigated through other strategies.

Parent-Child Interaction Therapy

Parent-Child Interaction Therapy (PCIT), a treatment designed for families with young children experiencing behavioral and/or emotional difficulties, was quickly adapted for virtual use in response to the COVID-19 health crisis. Typically, PCIT is delivered in a clinical setting where the clinician provides coaching behind a one-way mirror to teach caregivers how to appropriately manage their child’s challenging behaviors. This model is “particularly amendable to the telehealth format” (Gurwitch et al., 2020) and, recognizing this, the PCIT International Board of Directors and PCIT Master Trainers supported providers making the pivot to a virtual format. They encouraged the implementation of psychological first aid and developed guidance on how to perform virtual PCIT by offering handouts, how-to-guides, videos, and webinars.

Early Childhood Instructional Coaching

In response to COVID-19, the Detroit Early Learning Coaching Initiative (DELCI) adapted their coaching model to a virtual format (Lloyd et al., 2021). Recruitment went from in-person drop ins at prospective sites to leveraging social media and other online groups to share resources that spark interest among ECE programs and staff. The program also adopted a virtual coaching platform and made further adaptations to it so it would be more suited to ECE coaching. Coaches then relied on videos for observations and virtual one-on-one meetings with staff to provide feedback and set goals.

Is virtual service delivery worth further investment?

There are several reasons to suggest that virtual service delivery is not only worth continuing but also worth further developing.

Increased access to important services

In their evaluation of telehealth use by early interventionists, Cole and colleagues (2019) found that telehealth increases the number of visits to families and the number of families seen. It also added flexibility for providers and families, which enabled visits during non-traditional hours. Providers found that having sessions during daily routines provided families with tools in real time to address challenges in a meaningful manner.

Potential to deepen engagement with clients

Home visitors, instructional coaches, and behavioral health providers have all reported or seen ways in which virtual service delivery has the surprising potential to deepen their engagement with parents, caregivers, and teachers stemming from the constraints of not being in the same room.

For example, in their proposed guidelines for adapting directed family play therapy to a virtual setting, Smith, Norton, and Marroquin (2021) write, “Therapists can intentionally make their virtual presence smaller to give parents greater power and responsibility for their family’s change process” (p. 9). If therapists are in the same room, then there is the possibility that parents would defer to them and allow them to handle situations. However, since that is not available with telehealth, parents have the chance to be more actively involved.

This is something instructional coaches have seen with teachers as well. Coaches from DELCI saw that they were not able to “take over” interactions between children and teachers or providers when coaching virtually. As a result, coaches say there is “more active utilization and implementation of instructional strategies” (Lloyd et al., 2021, p. 8). Coaches think this was also further supported by teacher openness to changes in their teaching practice stemming from the use of video recordings in virtual coaching, which coaches believe teachers perceive as more objective accounts of their teaching.

Supporting Virtual Service Delivery in the Future

Providers and researchers have learned a lot from these experiences about how to support the continued use of virtual service delivery. A recommendation that is relevant to all providers and stakeholders is to plan for what Child Trends has called the ABCDs of virtual service delivery: Assistance navigating software, Broadband access, Connectivity, and Devices to access the internet. There are, however, other things that specific stakeholders can do:

  • Programs and practitioners: When deciding between virtual or face to face delivery, consider the number of children in the home, whether there is more than one caregiver available to help with the children during meetings, and the availability of a private space for use during virtual sessions (Child First).
  • Researchers: Partner with practitioners to develop and test methods for adapting services to a virtual format (Smith et al., 2021). “Before researchers can test new methods, those methods must first be developed and proposed” (Smith et al., 2021, p. 2).
  • Policymakers: Make emergency telehealth coverage options permanent (Gurwitch et al., 2020).
  • Credentialing and degree programs: Equip future virtual service delivery providers with robust training, highly operationalized curriculum where appropriate, immediate access to supervisors and peer support (Traube et al., 2020).

Where can I go to learn more?

Check out these resources to learn more and share this post with others who may need support with virtual service delivery.

COVID-19 and the Head Start Community: Operating Remote or Virtual Services: Here you can find what Head Start recommends to support virtual service delivery. This page compiles resources on virtual learning strategies and supporting families to access virtual services while also providing specific resources for educators, home visitors, family service staff, and early interventionists.

COVID-19 and Infant and Early Childhood Mental Health Consultation (IECMHC): How to Provide Services When Everything is Different: The Center of Excellence for Infant & Early Childhood Mental Health Consultation offers support to the field via affinity conversations, technical assistance, and interviews with providers who discuss their experience operating virtually.  

Telehealth Service in Infant Mental Health Home Visiting: This resource offers ways of tailoring strategies that can help infant mental health services be effective in the context of telehealth.

Telehealth, Teleconsultation and Virtual Coaching Resources from the Colorado Office of Early Childhood: Colorado’s Office of Early Childhood provides program specific guidance, technology supports, and privacy and security tips.

Early Childhood Technical Assistance Center: Remote Service Delivery and Distance Learning: ECTA has compiled resources from professional associations with guidance on the provision of virtual service delivery.

Lyndsay Shields

Lindsay Shields

Lindsay is the Research and Operations Coordinator at ECE Insights and a second-year Ph.D. student in CU Denver’s Child, Youth, and Family Studies program concentrating on Early Childhood Policy. She has years of experience working at a Head Start program in Tulsa, Oklahoma where she began as a preschool teacher and then worked in the program’s Research and Innovation department.

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