Does Modality Matter? the Role of Virtual and In-Person Service Delivery In Addressing Maternal Mental Health and Child Developmental Risk In Home Visiting

Background and Purpose: Home visiting (HV) programs are a key public health strategy for low-income young children and families in the United States and can mitigate mental health and developmental risk through timely screening and care coordination. In the post-pandemic context, HV programs have expanded to include telehealth modalities, increasing flexibility in service delivery. However, it is unclear whether virtual HV can identify and address maternal and child risk as effectively as in-person HV services. This study examined whether modality during the early phase of HV services was associated with retention, completion of maternal mental health and child developmental screenings, identification of maternal and child risk, and referral to services.

Methods: Administrative data were gathered from 19,712 families who enrolled in the Parents as Teachers (PAT) HV program between 2023 and 2025. Modality during the intake phase was defined as receiving only virtual, only in-person, or hybrid (virtual and in-person) visits across the first four PAT visits. Separate multilevel linear and logistic regression models examined associations between modality and (1) participation in PAT, (2) receipt of maternal depression and child developmental screening, (3) meeting clinical cut-offs on screening tools, and (4) referral to services. Models adjusted for clustering by PAT site and applied corrections for multiple comparisons.

Results: Families who received virtual or hybrid services in the intake phase completed more total PAT visits (IRR=1.30, p<.001 and IRR=1.09, p<.001, respectively), and families receiving virtual visits were significantly more likely to receive a sufficient dosage of PAT visits (OR=1.45, p<.001). In terms of maternal depression screening, mothers participating in virtual visits were more likely to be screened within 90 days (OR=1.50, p<.001). However, mothers receiving virtual or hybrid visits were less likely to screen positive for depression than mothers receiving in-person services (OR=0.65, p<.001 and OR=0.86, p=.02, respectively), and yet were more likely to be referred to outside mental health services (OR=1.38, p<.001 and (OR=1.23, p<.01, respectively). In terms of child developmental screening, children receiving virtual or hybrid visits were less likely to be screened within 90 days (OR=0.67, p<.001 and OR=0.76, p<.001, respectively), and children receiving virtual visits were less likely to be flagged for developmental concerns (OR=0.66, p<.001). There were no modality differences for whether children were referred to services.

Conclusions and Implications: Findings suggest that virtual and hybrid service delivery in the intake phase is associated with increased participation in HV services over time. Virtual and hybrid service delivery also appears to be associated with timely maternal depression screening, but also lower rates of identified maternal mental health risk. Additionally, mothers receiving virtual and hybrid HV services were more likely to be referred out for mental health services, suggesting potential discrepancies between screening results and referral decision-making. In contrast, findings show potential barriers to both child developmental screening access and risk detection in virtual formats. Together, these findings raise important questions about how modality shapes screening processes and highlight the need to better understand how relational and observational components of HV influence risk identification.