Using Quality Improvement (QI)-Focused Evaluation to Redesign Direct Home- and Community-based Services during the COVID-19 Public Health Emergency:

Like many UCEDDs in the Developmental Disabilities (DD) network, the Center for Development and Disability at the University of New Mexico offers direct service programs in home and community settings. Before the start of the COVID-19 pandemic, services were delivered in-person to about 1,000 families across the state including clients with intellectual or developmental disabilities and/or from at-risk communities. In March 2020, due to the spread of COVID-19, a public health emergency was declared in New Mexico and home and community services were stopped throughout the state. This meant direct service programs at the Center had to turn to telehealth – the use of telecommunications and virtual technology – to deliver services. Center faculty and staff then developed a hybrid quality improvement – evaluation process to assess how this change affected services. The results of this process are reported in this article. The purpose of our evaluation was to both understand “what it takes” to deliver effective services using telehealth, and to assess the how clients and providers experiences services delivered by telehealth. This paper describes findings based on a combination of interviews, focus groups, surveys and program data, focused on four questions: How did clients rate the quality and efficacy of telehealth-based services? How did clients/families compare virtual to in-person services? What were the experiences of service providers as the switch to telehealth-based services took place? What barriers did they face related to technology and a new service delivery processes? What changes did program leaders make to support staff and service delivery? How did programs use technology to deliver services? How well equipped were Center programs to use telehealth to provide services and how were obstacles overcome? The article ends by discussing four issues that all UCEDD’s and other agencies delivering telehealth/distance-based direct services might consider moving forward