Policy Recommendations for Moving Toward a Coordinated Home Visiting Infrastructure in California | Findings from the First 5 California Home Visiting Workforce Study

Home Visiting Workforce Policy Recommendations

Our recommendations are organized into three policy areas: workforce pipeline and preparation, program-level practices that support retention, and coordination with the early childhood system. These areas represent progress in workforce development, moving the California home visiting workforce from its current state of affairs—i.e., lacking cohesive workforce development supports—toward a well-defined and well-supported profession. The figure below displays the three policy areas along a continuum and describes how a statewide home visiting workforce infrastructure would facilitate progress along this continuum toward a coordinated home visiting profession.

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Continuum of Home Visiting Workforce Development Recommendations in California

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Policy Area 1: Workforce Pipeline and Preparation: Growing Home Visiting in California

These recommendations can advance the state’s efforts in moving toward a coordinated home visiting workforce by first establishing a statewide definition of what constitutes home visiting, and then addressing current gaps in the field’s foundational areas of workforce development: core competencies in education and training, hiring supports, and documented pathways for advancement.

• Clearly define the necessary skills and related activities in which home visitors engage and define the skills needed to supervise and support home visitors, regardless of model. These skills should be supported by hiring managers and used in hiring decisions.
• Create a core set of cross-model home visitor competencies and parallel competencies for supervisors. Example competencies could include knowledge of child health and development, skills in supporting parent-child attachment, and attitudes that value the parent’s role.

3. Increase awareness of home visiting as a profession among institutes of higher education. The vast majority of home visitors do not learn about the profession while enrolled in college, and higher education institutions offer very few courses specifically focused on home visiting.

• Create avenues for individuals to learn about home visiting as a career path. Provide information to department leads, practicum/internship courses, and instructors in relevant areas.
• Embed home visitor competencies that are related to child development, early literacy, and family stress and mental health in higher education courses, including community college programs; and in fields related to home visiting (e.g., early childhood, human development and family studies, social work, public health).

4. Develop a pipeline for recruitment and career advancement. California’s home visiting workforce is diverse in terms of educational background and lived experiences, and families and home visitors alike value both aspects of diversity. Building a pipeline will require incorporating education and lived experiences throughout all processes, including staff recruitment, and ensuring that career advancement accounts for lived experiences as well as education and certification.

• Engage in community-based outreach/recruitment to ensure that home visitors are from the same communities as participating families and are diverse in socioeconomic backgrounds, education, work experiences, and racial or cultural identity.
• Develop pathways for career advancement based on competencies. The pathways should recognize work and life experiences in addition to education and training, provide multiple opportunities for career advancement, and be connected to adequate increases in compensation and benefits.

5. Increase access to high-quality trainings across the state to strengthen, coordinate, and expand available opportunities. Home visiting staff participate in model-specific trainings and other trainings across a wide range of topics. However, most home visiting staff want additional training in many topics, and access to trainings is inequitable across regions of the state.

• Develop a repository of existing trainings (virtual and in-person) that will facilitate cross-model trainings. This repository can address the range of needs that all programs across the state can access and should include information to allow programs to make informed decisions about the selection of trainings for their staff.
• While trainings must be available to meet the range of home visitor needs, trainings should be available that specifically include diversity, equity, and inclusion topics and are appropriate for various program and community contexts.

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Policy Area 2: Program-level Practices That Support the Workforce and Enhance Staff Retention

The following recommendations support California’s goal of a coordinated workforce infrastructure by addressing gaps in program-level practices applicable across home visiting models. The home visiting workforce study found that about 20 percent of home visitors expected to leave the field within one year. Likewise, supervisors reported difficulties finding and retaining staff. Supporting home visitor competencies and well-being and improving programs’ work climate will not only help retain trained home visitors but also optimize their role in supporting positive outcomes for children and families. These practices should ensure that all home visiting programs, regardless of model, have the competencies to meet home visitor needs. They should be culturally responsive, strengths-based, and trauma-informed, and should support staff members’ long-term retention.

1. Build the capabilities of home visiting supervisors. To develop home visitors’ skills, supervisors must be able to facilitate home visitors’ application of training content to practice.

• Ensure that supervision is supportive and reflective across programs through the use of cross-model trainings, materials, and/or communities of practice based on supervisor core competencies.
• Encourage models and programs to require supervisors to routinely observe home visitors during visits or review video-recorded visits to provide feedback and build home visitors’ skills in working with families.

2. Strengthen home visitors’ ongoing supports. In addition to trainings, home visitors need support to build skills and integrate trainings into ongoing practice with families.

• Provide coaching/support via supervision on applying training content and home visitor competencies in work with families.
• Provide home visitors with access to mental health consultation to support their work with families who face challenges such as mental health concerns, substance use, and involvement with the child welfare system.
• Expand reimbursement for education and professional development opportunities to address the content areas in which staff would like more training.
• Provide peer learning communities for home visitors and supervisors to support development and build on the knowledge and skills learned in training.

3. Prioritize the mental health and well-being of the workforce. The study revealed a high prevalence of depressive symptoms, stress, and adverse life experiences among the home visiting workforce. Given that the COVID pandemic is ongoing, home visitors in California have emergent mental health and well-being needs that must be addressed to cultivate a stable and supported workforce.

• Provide resources to support home visitors who have experienced depressive symptoms, stress, and/or traumatic life events.
• Encourage agencies to develop employee assistance programs and ensure that staff have the information and resources needed to access mental health supports.
• Provide opportunities for home visitors to develop and increase mindfulness and relaxation skills. Opportunities could include dedicated time during the day for mindfulness activities or stipends to allow staff to participate in mindfulness activities outside of work.

4. Address working conditions and program climate. Strengthen working conditions and program climate to support equity, staff empowerment, connectedness, and financial health.

• Expand program-level trainings on structural racism, social justice, and equity to reduce experiences of discrimination in the workplace.
• Create opportunities for home visitors to feel empowered in programmatic decisions by developing ways for staff to contribute to decisions. These opportunities might include the ability to provide anonymous feedback, attend listening sessions, choose trainings to attend, have direct communication with decision makers, and join staff councils or committees.
• Create opportunities for home visitors to engage with each other in team-building activities.
• Provide salaries that reflect a local wage rate that allows staff to meet their own and their families’ needs.

5. Center family voice in home visiting service delivery, goals, and other program activities. Centering families’ goals and supporting their cultural needs is the foundation of supporting equitable service delivery.

• Provide strategies and tools for home visitors to work with families in achieving family-driven goals and to allow for family voice in decision making.
• Create family advisory boards or steering committees where parents can weigh in on decisions and provide feedback on services.
• Ensure that home visiting programs have supports in place for families’ cultural and language needs. This includes collecting and providing data about the communities in which programs operate and developing recruitment strategies to hire staff who are fluent in languages spoken by families.

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Policy Area 3: Coordination with the Early Childhood System

The following recommendations support California’s goal of developing a coordinated home visiting workforce by leveraging the resources and infrastructure of the wider early childhood system to increase efficiency and cohesion. As part of this, it is essential to integrate the home visiting workforce within the broader early childhood system. The early childhood system in California includes child welfare, early care and education, early intervention, public health, and other early care and family-serving programs. Together, these programs represent a whole-child and family-centered approach to working with families and often utilize similar strategies—including home visiting, specifically—as part of their service delivery or prevention models.

In addition, the workforce study found that almost half of home visitors had experience as early childhood educators. This highlights the overlap between the home visiting and education workforces, as well as the need to comprehensively recognize the education, trainings, and life experiences of staff across the early childhood field. Likewise, other researchers have noted that the competencies for early childhood educators, home visitors, early interventionists, and child protective services workers also overlap. Creating shared data systems and training opportunities would be both efficient and effective for strengthening coordination between service systems.

1. Increase opportunities for professionals from across the early childhood landscape to come together. Over the course of this study, stakeholders shared how home visiting programs and other early childhood programs often serve the same families. In addition, the workforce is fluid; stakeholders shared how home visitors often come from the early care and education field and leave for opportunities in education or preschool settings.

• Bring together child welfare, early intervention, early care and education, and home visiting staff in county-level groups or statewide conferences to reduce siloed work experiences. Shared trainings and complementary pathways for career advancement can help build awareness of systems of supports for families and of career opportunities across service types.
• Create communities of practice across home visiting models and other early childhood system staff/programs.

2. Create integrated data systems. Accessing and integrating home visiting data—such as the characteristics of families served or the number of funded slots by program—is a top challenge for home visiting programs and administrators and, in many ways, limits the workforce’s effectiveness at meeting families’ needs. Right now, California does not have a system to compile data across its home visiting programs.

• Continue to build on the home visiting mapping tool to inform state and local efforts. To understand the full spectrum of services available to families, integrate home visiting service information with data systems for other services, including child care and early intervention.
• Leveraging the home visiting mapping tool data as a starting point, design and implement a workforce registry so individuals can cross between different early childhood careers and move their education and professional development activities with them.

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Considerations for Successful Implementation of the Workforce Policy Recommendations

While California has invested in expanding home visiting across the state, several strategies have not been enacted at the state level, including consistent use of braided or blended funding, data sharing among state agencies, and policies that ensure long-term workforce stability. California’s recent expansion in home visiting funds and home visiting coordination grants acknowledge this lack of coordination and represents an initial step toward an integrated home visiting infrastructure; however, collaboration is needed across the state’s home visiting and broader early childhood systems to achieve the goal of a coordinated home visiting profession.

The following considerations for policy recommendation implementation were developed with input from policy leaders in California; staff from CDPH and CDSS; local advocacy groups representing child welfare, early education, and health; and home visiting staff from programs representing the Bay Area, Central Valley and Sierra, Central Coast, and Los Angeles County regions.

Coordinate Home Visiting Funding Sources and Data Systems Across the State.

Current funding streams and data collection requirements for home visiting programs are not coordinated across the state, and not all counties in California have equal access to funding sources for home visiting. Addressing this lack of coordination and regional equity will be critical to successfully develop a coordinated home visiting infrastructure that can support staff across counties. Implementation of these efforts should include:

• Coordination between home visiting funders in California—Increased coordination or consolidation of state funds would support counties that want to provide or expand home visiting services by extending funding timelines and broadening requirements, which some counties report as barriers to applying for home visiting funding. Current barriers to stronger coordination also include a lack of alignment between local First 5 county commissions and the county-level offices that administer state and federally funded home visiting, and a lack of infrastructure in the county to apply for funding. Efforts to coordinate will require addressing these and any additional barriers reported by counties.
• Coordinated data governance—State agencies like CDSS and CDPH want more statewide home visiting data and an easier way to visualize those data. There is currently a lack of data integration across different home visiting models or across the types of databases that programs use. However, an integrated data system will need strong oversight to ensure that all programs can consistently provide data that are usable at the state level and, to the extent feasible, are inclusive of data from home-grown models.

Build on Momentum from Other Complementary State Early Childhood Policy Priorities.

All of our policy recommendations not only reflect the goals and experiences of the home visiting workforce in California, but also reflect many of the goals laid out in the state’s Master Plan for Early Learning and Care. Specifically, there is clear alignment around the use of workforce competencies, the need for integrated data systems, the need to center family voices, and the need to create career pathways that account for diverse backgrounds and lived experiences. Home visiting and early care and education are two significant parts of the broader early childhood system in California, and represent a continuum of care from prenatal to age 8 that is particularly focused on engaging families. Building on momentum from the Master Plan for Early Learning will provide some justification for these policy recommendations and will allow some foundational strategies to be implemented that will not only support the success of these recommendations, but also support wider early childhood system integration.

Determine Clear Roles for Key State-level Stakeholders.

While all stakeholders—First 5 California, home visiting program staff and families, home visiting model developers (representing models on the HHS list and those local to California), state agencies funding and implementing home visiting, First 5 county commissions, and other local implementers—should be present for planning and discussion, the work of building the coordinated infrastructure will be done by a subset of key stakeholders who must be identified early in the process. This subset must have decision-making power and buy-in from the field. Funding is a critical aspect of this coordination work, so local groups that make decisions about funding at the local level must also be included along with state-level funders. Examples of groups that collaborate on local funding decisions include the California Conference of Local Health Officers, the County Health Executives Association of California, and the County Welfare Directors Association of California.

Leverage Existing Workforce Development Efforts and Lessons Learned from Other Fields.

California has rich examples of existing workforce development strategies taking place on the local level that have produced promising outcomes. These outcomes include coordinated training efforts across different programs and models specifically for supporting underserved populations, as well as the establishment of pathways for career development that include a range of leadership roles and embed life experience in the workforce preparation process. Leveraging this work when implementing program-level recommendations in particular will ensure that efforts are not unnecessarily duplicated and lessons learned from past workforce development strategies can be applied when relevant. Examples of these workforce development and training efforts include the following:

• California’s rapid response virtual home visiting webinars—cross-model training supports deployed during the pandemic
• Local community advisory boards to support home visiting programs—advisory bodies that support program implementation activities at the local level
• ZERO TO THREE’s communities of practice—virtual communities to share strategies for workforce well-being and other supports for home visitors
• Antelope Valley and South East LA Home Visitor Apprenticeship Program—apprenticeship program representing partnerships with Early Care & Education Pathways to Success (ECEPTS), the local health agency, a local community college, and a child care resource center that has created a training process that integrates college coursework, work-based learning, and coaching
• LA Best Babies Network training and technical assistance program—cross-model network to coordinate training efforts for home visiting staff in Los Angeles
• Home visiting program supports for workforce well-being, including self-care webinars, the provision of mental health experts to home visitors, and copay coverage for home visitors’ visits with a mental health clinician

Utilize Learnings from the COVID-19 Pandemic and Other Emergencies

This includes the ways in which home visiting remained flexible and responsive during the pandemic, and continued to support families’ needs during the shift from home visiting goals to acute, basic needs. At the onset of COVID-19, the home visiting workforce had to rapidly shift to virtual home visits, a move supported by statewide training efforts across home visiting models. This huge change in service delivery was largely successful for both home visitors and families, as home visitors were able to continue meeting with families and families felt supported via virtual services.

Coordination and collaboration are required across all levels of home visiting stakeholders in California for successful implementation of these recommendations. Two policy areas—workforce pipeline and preparation and coordination with the early childhood system—represent system-level recommendations intended to support building the foundation of a statewide infrastructure to meet a range of workforce needs. The program-level practices policy area is also vital for workforce development but is amenable to more incremental change, and particular strategies can be implemented by and adapted to fit local community and home visiting model contexts. Together, all three policy areas represent critical components of a coordinated workforce infrastructure that first defines home visiting in California and develops a home visiting workforce pipeline, then creates ongoing supports for staff development and retention, and then embeds home visiting in the early childhood system—all of which contribute to improved service delivery and outcomes for families and children.

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Footnotes

[1] First 5 California distributes funds to local communities through the state’s 58 individual counties, all of which have created their own local First 5 county commissions.

[2] Home visiting programs included in the F5CA Home Visiting Workforce Study are administered through the California Departments of Public Health, Social Services, and Education, along with local First 5 county commissions. Data were gathered from a range of programs that provide home visiting services, many of which were developed locally to meet their communities’ unique needs. Home visiting programs that self-identified as meeting the study’s definition of home visiting (see Appendix A for more information) were invited to take part in the study.

[3] Harrington, M., Angel, S., Newkirk, C., Fenton, J., & Scott, C. (2019). Improving Recruitment and Retention in Home Visiting Program. Home Visitation Programs-Los Angeles County Compensation and Turnover Study. Los Angeles, CA: First 5 LA

[4] These programs voluntarily participated in the study; as a result, total slots reported in the tool are likely an underrepresentation of the total slots available in California.