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.

Home visitors in the Florida MIECHV program served as trusted confidants that helped families navigate social services. Future research should focus on the impact that home visiting has on immigrant health and whether this impact is maintained over time.

The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is designed to support pregnant women and families in developing skills and utilizing resources necessary to promote their children's physical, social, and emotional development. Little evaluation attention has focused on large-scale, public policy driven home-visiting programs. Social support provision is a critical component of a successful home-visiting program; therefore, there is a need to better understand participants' perceptions of social support provided to them in this context. Forty-five home-visiting participants from five Florida MIECHV programs completed semistructured telephone interviews. Participants discussed their experiences with the MIECHV program, including descriptions of their interactions with home visitors. Content analysis revealed that participants experienced multilayered social support from home-visiting staff. Families needed and received substantial emotional, instrumental, informational, and appraisal support at the individual level. This support was embedded within and strengthened by the strategies and activities of the home-visiting model of service provision. Results highlight the powerful opportunity home visiting offers as a method of service delivery within the larger system of care to increase social support in families experiencing high risk for negative maternal and child health outcomes. Implications for policy and practice are discussed.

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To improve intimate partner violence (IPV) service delivery, the Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Initiative's continuous quality improvement (CQI) team implemented a Breakthrough Series model Learning Collaborative with eight program sites. Using mixed-methods, we: examined post-Collaborative changes in Florida MIECHV home visitors' knowledge, system awareness, and confidence; identified strategies to address challenges in supporting families with IPV; and assessed post-Collaborative program improvements. The Collaborative included three interactive two-day sessions, six webinars, and testing strategies using the Model for Improvement (Plan-Do-Study-Act). Three online surveys assessed changes influencing IPV screening, referrals, and safety planning. Thematic content analysis of qualitative data revealed existing barriers and strategies to address challenges. Home visitors reported accurate knowledge (change: 2.3%-34.8%), confidence (change: 31.8%-37.9%), and system awareness (change: 22.7%-53.5%) for all items from baseline to final survey. There was also an increase in rates of IPV screening (change: 88.0%-91.0%) and referrals (change: 43.0%-100.0%). Strategies for addressing challenges in supporting families experiencing IPV were identified at the individual (self-care, continuous education); interpersonal (reflective supervision, trauma-informed approach); organizational (defining success, supportive agency/program, policies); and community (collaboration with IPV service providers) levels.Lessons learned from the MIECHV IPV Learning Collaborative informed future CQI projects.