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Direct Service Providers for Children and Families: Information for Home Visitors

How home visitors can protect themselves and their clients from COVID-19 and other diseases that can be spread from person to person.

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Home-visiting professionals, or home visitors, provide many needed services directly to children and families in their home. These direct service providers can include maternal, infant, early childhood, and early intervention home visitors. They also may be teachers and therapists who provide needed services for infants, children, and teens, including those with disabilities. When in-person services are delivered, they are often done in close and consistent contact with the clients. This means that it is important to use prevention strategies to protect the home visitor and the family from diseases that can be spread from person to person, such as COVID-19, but also flu, colds, and other respiratory or gastrointestinal illnesses. In addition, home visitors are trusted sources of information and support for families, particularly those who experience health inequity. This page provides an overview of how home visitors can protect themselves and their clients during home visits.

Occupational therapist sitting with a child

Strategies to prevent the spread of COVID-19

With current high uptake of COVID-19 vaccination and high levels of population immunity from both vaccination and infections, the risk of medically significant disease, hospitalization, and death from COVID-19 is greatly reduced for most people. At the same time, we know that some people and communities, such as our oldest citizens, people who are immunocompromised, and people with disabilities, are more likely to get severely ill and face challenging decisions navigating a world with COVID-19.

People who are up to date on COVID-19 vaccines have much lower risk of severe illness and death from COVID-19 than unvaccinated people. However, many home visitors work with children who are not yet eligible for vaccination. When making decisions about preventive behaviors in addition to vaccination, people should consider the COVID-19 Community Level in the county. These levels show the degree of risk (low, medium, high) and describe the prevention strategies that are recommended for each level. Prevention strategies — like staying up to date on vaccines, screening testing, ventilation, and wearing masks — can help limit severe disease and reduce the potential for strain on the healthcare system. For home visitors who work with children, it may not be feasible to use all recommended prevention strategies. Therefore, particularly in communities with medium or high COVID-19 levels, home visitors should use multiple layers of recommended COVID-19 strategies to the extent possible while also following any applicable guidance from regulatory agencies and state and local public health departments.

The following information is a brief overview of strategies that home visitors can use when working with children and families. Detailed information about ways home visitors can protect themselves is in the COVID-19 Guidance for Direct Service Providers (cdc.gov) and in the COVID-19 Guidance for Operating Early Care and Education/Child Care (ECE) Programs (cdc.gov)

Ways home visitors can protect themselves and the families they serve:

1. Vaccination

Vaccination is the leading public health prevention strategy to end the COVID-19 pandemic. COVID-19 vaccines available in the United States are effective at protecting people from getting seriously ill, being hospitalized, and dying from COVID-19. As with vaccines for other diseases, people who are up to date with their COVID-19 vaccines are best protected.

Home visitors can protect themselves, their own families, and the families they care for by staying up to date with all vaccinations, including COVID-19 vaccines. As trusted professionals who know their families well, home visitors can play a role in helping families learn about the importance of vaccines and about supporting children’s healthy development by keeping up to date on all well visits and preventive screenings, such as screening for developmental delays and lead poisoning. They can help connect the family to a regular primary healthcare provider who provides consistent and supportive health care and serves as the family’s medical home. They can remind families that children should get all routine vaccinations to help protect themselves and others from vaccine-preventable diseases, and that family members who are up to date on all vaccines protect children who are not yet old enough to get all vaccines.

Families who are not up to date with all vaccinations may have questions and concerns about the vaccines. Home visitors can promote vaccines by:

2. Ventilation

Improving ventilation is an important COVID-19 prevention strategy that can reduce the number of virus particles in the air. Along with other preventive strategies, bringing fresh outdoor air into a building helps keep virus particles from concentrating inside. Home visitors can improve ventilation or ask families to improve ventilation during the visit by

  • Opening multiple doors and windows, if feasible.
  • Using child-safe fans to increase the effectiveness of open windows.
  • Using the exhaust fan in the kitchen or bathroom to increase air flow, particularly if opening windows is not possible.
  • Using portable HEPA air cleaners.
  • Visiting with the child outdoors when possible.

Learn more about encouraging families to improve the ventilation in their home.

3. Hygiene: Respiratory Etiquette, Handwashing, Cleaning, Sanitizing, and Disinfecting

Home visitors can limit the spread of illnesses by following all guidance on cleaning, sanitizing, and disinfecting. During home visits, many activities may involve touching children, and infants and toddlers often need to be held.  For COVID-19 in general, cleaning once a day is usually enough to sufficiently remove potential virus that may be on surfaces. However, in addition to cleaning for COVID-19, home visitors should practice and encourage families to practice respiratory etiquette and recommended procedures for cleaning, sanitizing, and disinfection, such as after diapering, feeding, and exposure to bodily fluids. See more information about cleaning and sanitizing toys.

Home visitors can use the following strategies:

  • Use respiratory etiquette, including covering coughs and sneezes and washing hands immediately after blowing the nose, coughing, or sneezing.
  • Wash hands frequently using soap and water for at least 20 seconds.
    • If handwashing is not possible, use hand sanitizer containing at least 60% alcohol. Hand sanitizers should be stored up, away, and out of sight of young children and should be used only with adult supervision for children under 6 years of age or for children with certain disabilities that make it hard for the child to use hand sanitizer safely on their own.
  • Avoid touching the eyes while holding, washing, or feeding a child.
  • Wear disposable gloves during activities such as dressing, bathing/showering, toileting, feeding. Safely dispose of gloves after use. Wash hands before and after taking off disposable gloves. If gloves are unavailable, wash hands immediately after.
  • Change clothes right away if body fluids get on them, whenever possible, and then rewash hands. Launder work uniforms or clothes after each use with the warmest appropriate water setting for the items and dry items completely.
  • Wash anywhere that was in contact with a child’s body fluids and follow recommendations on cleaning and sanitizing toys, other learning tools, and assistive devices, particularly if they were in contact with body fluids.
  • Follow recommendations for cleaning and disinfecting the home if someone is sick, or tests positive for COVID-19.

4. Masks

When people ages 2 and older wear a well-fitting mask correctly and consistently, they protect others as well as themselves from infections that are spread through the air or through respiratory droplets. Consistent and correct mask use is recommended in public settings in communities with high COVID-19 Community Levels, and around people at high risk for severe disease in communities with medium COVID-19 Community Levels. At all COVID-19 Community Levels, people can wear a mask based on personal preference, informed by personal level of risk. People with symptoms of COVID-19, people with a positive COVID-19 test results who are around other people, and people who are quarantining because of a close contact, should wear a mask.

Masks should not be worn by children under age 2. Some older children or adults cannot wear a mask, or cannot safely wear a mask, because of a disability as defined by the Americans with Disabilities Act (ADA) (42 U.S.C. 12101 et seq.).

When choosing a mask, home visitors can consider fit, comfort, and the special needs of the people around them. To facilitate learning and social and emotional development, consider wearing a clear mask or cloth mask with a clear panel when interacting with young children, children learning to speak or read, children learning another language, or when interacting with people who rely on reading lips. Generally, vinyl and non-breathable materials are not recommended for masks. However, for ease of lip-reading, this is an exception to that general guidance.

5. Physical Distancing

It is generally recommended that people maintain a distance of at least 6 feet from persons who are sick with COVID-19. However, maintaining physical distance between a home visitor and their clients is often not feasible during home visiting, especially during certain activities such as physical therapy, feeding, holding/comforting, and among younger children in general. When it is not possible to maintain physical distance in home visiting settings, it is especially important to layer multiple prevention strategies, such as masking indoors, improved ventilation, handwashing, covering coughs and sneezes, and regular cleaning to help reduce COVID-19 transmission risk.

6. Isolation and Quarantine

People who are confirmed to have COVID-19 or are showing symptoms of COVID-19 need to stay home (known as isolation) regardless of their vaccination status. This includes

  • People who have a positive viral test for COVID-19, whether or not they have symptoms.
  • People with symptoms of COVID-19, including people who are awaiting test results or have not been tested. People with symptoms should isolate even if they do not know if they have been in close contact with someone with COVID-19.

People who come into close contact with someone with COVID-19 should quarantine if they have not had confirmed COVID-19 within the last 90 days and are in one of the following groups:

Home visitors can encourage families to monitor children at home for fever (a temperature of 100.4 ºF (38.0 ºC)  or other signs of illnesses that could be spread to others [PDF – 1 page], including COVID-19, and adjust visit schedules if needed. Services may be provided virtually during quarantine or isolation if feasible.

Learn more about CDC guidance on COVID-19 Quarantine and Isolation and about making decisions about the length of quarantine and isolation for young children:  Isolation and Quarantine in Early Care and Education (ECE) Programs.

7. Mental Health Support

Taking care of children requires a lot of effort and includes many challenges. CDC provides resources to support the mental health of home visitors and the families they serve, for example:

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