Real-World Sustainability of Early Head Start + Parenting: Home Visitors' Strengths, Needs, and Perceptions

Recent federal and state initiatives on home visiting have increased attention on the characteristics of the workforce providing home-based services to low-income families (DiLauro & Schrieiber, 2012). The extant literature suggests considerable variability in capacities and needs, in terms of both home visitors and the structure and mission of the agencies in which they work (Whitaker, Becker, Herman, & Gooze, 2013). This paper summarizes a mixed-methods study of Early Head Start (EHS) home visitors conducted within a larger project on buffering “toxic stress” among EHS children. This larger randomized trial is evaluating home-based EHS plus Dozier’s Attachment and Biobehavioral Catch-up (ABC) parenting intervention provided by supplemental parent coaches. Our in-depth examination of EHS home visitors will inform ongoing considerations of the long-term sustainability of supplemental parenting services within the federally-funded EHS program.

The quantitative component included 23 home visitors from four EHS programs  (92% response rate). All completed an anonymous survey assessing demographics, psychological wellbeing, and perceptions of the work and work environment. There was wide variability in home visitors’ education, years of home visiting experience, and English language proficiency. Most home visitors reported positive alliances with families. Home visitors who reported greater decision-making authority, higher “skill discretion” (interesting, skills-based work), and more positive working alliances with their families also indicated that they were more likely to stay in their position (t’s = 2.17 - 3.58, all p’s < .05). 57% agreed that their job was “the perfect job for [them].” A second wave of surveys will be administered in December, 2014. Ongoing analyses are examining associations between home visitors’ individual and occupational characteristics and (a) job turnover and (b) family engagement. 

The qualitative component included semi-structured interviews with a subset of 11 home visitors whose families received both EHS and ABC. Home visitors responded to questions about their work with families, their experience within their EHS programs, and their perceptions about supplementing EHS with ABC. Home visitors reported that they were generally gratified in their work. They also cited unavailability of mental health services for their families as hindering the home visitors’ ability to promote family development. EHS home visitors lauded the addition of ABC, particularly because it was delivered in English or Spanish and because there was strong coordination with the supplemental parenting coaches.

Quantitative and qualitative findings will be integrated and discussed in terms of scale-up, sustainability, and the role of prevention science in federally-funded programs.