Abstract
Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors’ engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.
Highlights
Maternal and child home visitors provide a specialized set of supports and resources to families using various program models and curricula (Gomby 2005; Sweet and Appelbaum 2004)
This study identifies sources of staff stress within the Florida MIECHV program and home visitors’ perceptions around how that stress directly impacts engagement with participants
In Fall 2015, ten focus groups were held with Florida MIECHV home visitors on-site at each of the ten MIECHV local implementing agencies throughout the state
Summary
Maternal and child home visitors provide a specialized set of supports and resources to families using various program models and curricula (Gomby 2005; Sweet and Appelbaum 2004). While research shows that home care workers experience stress due to heavy caseloads, difficult clients, and safety hazards in client homes, there is scant literature on work-related stressors among home visiting staff in an evidence-based program (Denton et al 2002). The multifaceted responsibilities of home visitors in evidencebased programs contribute to work-related stress: delivering a specific curriculum; addressing multiple social determinants of health; documenting their efforts; and continuous professional development (Barak et al 2014; Gill et al 2007; Williams et al 2008). Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention
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