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Background: The Team for Infants Exposed to Substance use (TIES) Program is a home-based family support program providing a multi-disciplinary, community-based approach to address the complex needs of families with young children affected by maternal substance use. The TIES Program focuses on six goal areas: maternal drug use, parenting skills, child health, parent health, income stability, and housing stability. This study examines the effectiveness of this home-based program during the peak COVID-19 period of April 1, 2020 – March 31, 2021.

Study Question: How did the COVID-19 pandemic affect parenting practices and child health in the TIES Program compared to those in a matched comparison group?

Methods: Data was collected from 2016 to September 2023. Given the nested structure of the data, we used multi-level models (MLM) and generalized estimating equations (GEE) to estimate the impact of the COVID-19 period on parenting practices and child health goal attainment after controlling for other covariates. Bootstrap procedure was also employed.

Results: We found little impact of the COVID-19 period on TIES participants, but a pervasive and statistically significant negative impact on parenting practices and child health goal attainment from the comparison group. Specifically, results indicated that for the comparison group, the COVID-19 period tended to decrease parenting goal scores by 0.54 to 0.59 units (p<0.001), and child health goal scores by 0.8 units (p<0.001) on scales of 1-5 yet had no statistically significant impact on these two goal areas for the TIES participants. Additionally, of 14 outcome variables analyzed using MLM and GEE, 13 (93%) were negatively impacted during the COVID-19 period in the comparison group, with scores from the comparison group being 5% to 20% lower than those from the TIES Program. Bootstrap results showed similar findings.

Conclusions: The TIES program and its dedicated staff pivoted to provide virtual home visits and employed creative problem-solving to support families during the COVID-19 pandemic. Participation in TIES provided a protective effect for families when compared to those who did not have intensive home-based family support. Home-based family support programs provide vital supportive services in the best of times. Disruption of normal home visiting activities during the pandemic forced programs to think creatively to continue to provide critical services to families that may have otherwise lost access to resources, delayed physical and behavioral healthcare, and experienced severe isolation. The TIES Program demonstrated that virtual modifications in times of emergency can keep families engaged and supported.

Document Type


The Impact of COVID-19 on the Effectiveness of a Home-based Family Support Program