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Introduction

Early childhood home visiting programs provide new and expecting parents with information, support, referrals, and connections to community resources and services. These programs build relationships to support families in reaching their goals. They aim to improve maternal and child health, prevent child abuse and neglect, encourage positive parenting, and promote child development and school readiness.

Until recently, however, little research has been available on the home visiting staff that deliver these services or on the professional development system that supports them. A strong workforce is a critical part of effective programs. As the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program continues to support home visiting services across the country, more information is needed to understand the home visiting workforce and how to recruit, train, and retain qualified staff.

In 2016, the Office of Planning, Research, and Evaluation in the Administration for Children and Families, in collaboration with the Health Resources and Services Administration, contracted with the Urban Institute to do a study of the home visiting workforce in MIECHV-funded local implementing agencies (LIAs) to gather needed information about home visitors’ backgrounds and career paths. A national survey of all MIECHV-funded LIAs and case studies across 26 of those LIAs explored why home visitors enter the home visiting field, why they stay in or leave the field, their backgrounds and job qualifications, their work environments and opportunities for growth and advancement, and staff training experiences and needs.

This report summarizes survey findings and key themes from the case studies. The study findings highlight the factors that support home visitors in their roles and ways in which home visiting staff feel challenged. Together, the survey and case study findings provide insights into the experiences of this diverse and understudied workforce and point to strategies that could further strengthen them.

Primary Research Questions

1. What are the characteristics of home visitors and their supervisors, including their demographics, qualifications, and employment history?
2. What are the characteristics of home visiting jobs, including schedules, compensation, and benefits?
3. What factors contribute to the recruitment and retention of home visitors?

Purpose

A stable and well-trained workforce is a critical part of effective home visiting program implementation. To support MIECHV awardees, local programs, and home visiting model developers recruit, train, and retain qualified staff, more information is needed on the career pathways and work experiences of home visitors and their supervisors.

This report presents findings from a national descriptive study of the home visiting workforce in local agencies receiving MIECHV funding. It provides information on the qualifications and career pathways of home visitors and home visiting supervisors, a description of home visitors’ job experiences, and details on programs’ experiences with staff recruitment, training, and retention.

Key Findings and Highlights

Analyses of survey and case study data point to the following key findings:

• Staff qualifications are strong and often exceed the minimum required by the home visiting model their agency uses. Seventy-three percent of home visitors and 90 percent of home visiting supervisors have a bachelor’s degree or higher. Most studied nursing, social work, or education, including early childhood and special education.
• Home visitors receive extensive on-the-job training but point to areas where they could use further in-depth training to better serve families’ needs. The most common topics include early childhood mental health, serving children or parents with disabilities, laws and public policy affecting families they serve, maternal mental health, and trauma-informed practices.
• Home visitors are highly satisfied with some aspects of their jobs, such as relationships with families, supervisors, and coworkers, but are generally dissatisfied with their pay and opportunities for promotion. They are motivated to work directly with families and build long-term relationships, which other employment settings cannot offer. The experience of a promotion, perceived work environment quality, schedule flexibility, and work-life balance are associated with home visitors’ intent to stay in their position over the next two years.
• One-third of program managers report currently having one or more vacancies for home visitor positions. Recruiting bilingual job candidates is a top challenge. Because training new staff is costly, investing up front to find candidates well fit for the job is worth the effort.

Methods

The project includes two major components: (1) a two-stage national survey of the home visiting workforce in local implementing agencies (LIAs) receiving funding from the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, and (2) case studies in eight states involving interviews with program leaders and supervisory staff, as well as focus groups with home visitors in 26 LIAs.

Program managers in all MIECHV-funded agencies were invited to participate in a 20-minute web-based survey that collected information on staffing, funding sources, staff recruitment and turnover, and program management. Program managers submitted email addresses for home visitors and home visiting supervisors in their programs, which comprised the sample for the second stage of the survey. These staff were invited to participate in a 23-minute web-based survey that collected information on educational attainment, work experience, compensation and benefits, job schedule, work environment, supervision, job satisfaction, training needs, and demographic characteristics.

Glossary

Early childhood home visiting: a service delivery strategy for achieving greater child and family health and well-being. Local home visiting programs connect new and expecting parents with a designated support person—a trained nurse, social worker, parent educator, or early childhood specialist—who provides services in the home. Services generally consist of screening, case management, family support or counseling, and caregiver skills training.

Local implementing agency (LIA): a local organization, such as a community action agency, community nonprofit, or public health or education department, that receives funding to implement home visiting services under MIECHV. States, territories, and tribes work with LIAs to train a high-quality home visiting workforce, establish data reporting and financial accountability systems, and develop recruitment and referral networks.

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program: administered by the Health Resources and Services Administration in partnership with the Administration for Children and Families, the MIECHV Program was established in 2010 to support voluntary, evidence-based home visiting for at-risk pregnant women and parents with children up to kindergarten entry. The program provides grants to states, US territories, and tribes, which conduct needs assessments to identify eligible at-risk communities and serve priority populations.