CalWORKs Home Visiting Program: A lifeline for families during the pandemic

California has the nation’s highest rate of poverty, with a third of Californians living in or near the poverty line. The situation would be even worse without services provided by the state’s social safety net program, CalWORKs (California Work Opportunity and Responsibility to Kids). But how were CalWORKs services affected by the pandemic? An evaluation of CalWORKs Home Visiting Program (HVP) conducted by UC San Francisco’s Family Health Outcomes Project and School of Nursing provides a glimpse into its impact.

Taking a two-generation approach to tackling poverty

In 2019, CalWORKs kept 12.1% of children out of poverty, according to the Public Policy Institute of California. That year, CalWORKs rolled out its HVP across 44 of the 58 counties in the state to further help lift families out of poverty. The program works by pairing families with a trained professional who provides at-home parenting guidance and coaching and facilitates access to health, educational, and social services. By using a two-generation approach, focusing on low-income children and parents from the same household, CalWORKs HVP combines parent and child interventions to interrupt the cycle of poverty.

Then COVID hit in 2020, followed by other natural and human-caused disasters in California that seemed not to let up over the following two years. The program built on in-person relationships had to adapt quickly to connect with clients virtually and find new ways to meet the basic needs of young families.

Linda Franck, RN, PhD, FAAN (left)
Jennifer Rienks, PhD (right)

"A remarkable achievement"

Despite these obstacles, CalWORKs HVP was universally considered a “lifeline” for families struggling to provide a safe and healthy home in the midst of economic, social, and emotional challenges. according to the evaluation conducted by UCSF for the California Department of Social Services.  

To identify the program’s successes and opportunities for growth, the researchers studied data from January 2019 to June 2021. They collected 1,617 surveys from clients and staff and conducted interviews and focus groups. A secondary analysis was conducted using case data from nearly 5,000 clients across 19 counties.

The researchers found that CalWORKs HVP, through a large network of collaborative agencies, enabled parents to better provide for their child’s health and developmental needs. The program achieved very high rates of child developmental screenings that are essential to identifying potential developmental delays and did so at a time when screening rates were declining nationwide due to the pandemic. In addition, home visitors provided assistance with their clients’ essential needs, making many referrals for food and housing support, health care, and mental health.

“This is a remarkable achievement when viewed in the context of not only a pandemic but also concurrent multiple natural disasters and civil unrest,” wrote the authors.

“CalWORKs HVP helped me be a better mom.” 

Central to the success of the CalWORKs HVP program was the relationship between home visitors and their clients. Clients said that home visitors provided a consistent, wise, supportive presence during pregnancy and early parenting that enabled parents to better provide for their child’s health and developmental needs.

Challenges and lessons learned

The program saw several successes despite a variety of challenges in effectively implementing this complex web of support, including workforce challenges, availability of referral services, and administrative burdens. This was particularly the case for smaller counties. The pandemic also created significant hardships for families and for CalWORKs HVP staff, including a dearth of referral resources, isolation, and technology challenges.

Overall, the COVID-19 pandemic led to significant innovation in CalWORKs HVP delivery that may benefit the program going forward, such as flexibility in the visit format and a broadening of the home visitor role in assisting clients with meeting basic needs, according to the authors; “Future programming will need to be attentive to rebuilding staff capacity, providing additional support where needed, and to the ongoing struggle of clients and families in meeting basic nutrition and housing needs so that clients and home visitors can again focus more of their attention on child health development and client educational, economic, and financial capability opportunities, and improve the likelihood that they will exit poverty."

Learn more about HVP and read the full report

Citation: Rienks J, Franck LS, Remy LL, Shiau R, Clay M, Kaseff L, Mehra R, Cervetto J, de Veer D, Broder L, Das A, Lang J, Schifsky E. (2021) CalWORKs Home Visiting Program Evaluation: Legislative Report. University of California, San Francisco and Resource Development Associates.