Virtual Site Reviews: Supporting Subrecipients through a Global Health Crisis

Every Body Texas, the statewide Title X grantee for Texas, supports a network of 36 health care agencies that operated 174 sites during fiscal year 2020 and served more than 180,000 clients. COVID-19 posed many challenges to Every Body Texas, including forcing the agency to figure out how to adapt its in-person subrecipient site review process so it could continue providing high-quality oversight of its subrecipient network.

Together, the Every Body Texas Title X team built a virtual site review process that combined all key elements of the agency’s in-person reviews. The team developed a template for each virtual visit, designating timelines and touchpoints for connecting with subrecipients. They also created a user-friendly online portal where a variety of subrecipient clinic staff—including those who were uninvolved in the traditional in-person review process—could upload documents and medical charts for review.

It was particularly challenging to make the financial and clinical observation portions of the review virtual. Ultimately, Every Body Texas developed a model for mock observations that allowed them to follow a hypothetical client through the subrecipient’s processes of eligibility, intake, and a clinical encounter. With this model, the team could monitor compliance with Title X regulations and provide coaching to ensure clinicians and clinic staff were centering the needs of the client.

Many subrecipients appreciated the switch to virtual site reviews. Martha Zuniga, Executive Director of South Texas Family Planning, said, “The virtual site review allowed us to return calls [to Every Body Texas] to clarify or explain things at a convenient time for us and it was overall less disruptive of our regular work schedules.”

Over the last year, Every Body Texas conducted virtual site reviews with a third of its Title X subrecipient network. Even though the agency looks forward to safely returning to an in-person review process, it intends to continue implementing some strategies from its virtual site reviews. Title X grantees can refer to the RHNTC’s Planning and Conducting Title X Site Visits Toolkit for guidance, steps, and resources about conducting site visits.