FAMILIES Management Practices to Promote Home Visitor Retention What Does a National Study of the Home Visiting Workforce Tell Us? OPRE Report #2021-193 Cary Lou, Heather Sandstrom, and Sarah Benatar September 2021 Home visiting aids new and expectant parents by providing information, support, and connections to community resources. Home visiting programs in agencies funded by the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program use various management practices to onboard, train, and evaluate their staff. But how do these practices relate to home visitors’ retention? Preventing staff turnover is a key goal to help maintain a qualified and well-trained workforce (ACF 2015; Franko et al. 2019; Office of Head Start 2015). This brief summarizes findings on program management practices 1 from the Home Visiting Career Trajectories project—a national descriptive study of home visiting staff experiences and perceptions of the field from 2018 (box 1). Key findings include the following:  Nearly all program managers reported using some practices that aim to support staff development, including providing informal opportunities for feedback and practicing reflective supervision, 2 regardless of program setting. Additionally, more than 90 percent reported scheduling formal sessions to provide feedback on performance reviews, supporting staff to set and track professional development goals throughout the year, and using performance reviews as a professional development tool.  Between a half and two-thirds of programs reported assigning peer mentors, providing training on how to evaluate employee performance, and using annual performance reviews for salary and promotion decisions. Compared with other programs, programs in community nonprofits less frequently reported assigning peer mentors to new home visitors and training supervisors on assessing employee performance.  Around 70 percent of program managers reported employee input is influential in setting policies on staff safety, the physical work environment, and service improvement, but less than MANAGEMENT PRACTICES TO PROMOTE HOME VISITOR RETENTION 1 half reported staff input is influential in hiring decisions (43 percent) and implementing technical changes affecting the agency (e.g., relocation; restructuring programs) or staff layoffs (23 percent). 3  Several program management practices reported by managers are related to home visitors’ intentions to stay in their job or the field. These practices include assigning peer mentors (56 percent of programs), using performance reviews for salary and promotion decisions (64 percent of programs), and continuous employee goal-setting and goal-tracking (90 percent of programs).  Overall, 54 percent of home visitors reported they were very likely to remain in their current position in the next two years and 28 percent reported they were very or somewhat likely to find a job not in home visiting. In programs where managers reported greater employee influence on the physical work environment, staff hiring, and service improvements for families, home visitors were more likely to have said they intend to stay in their jobs or in the home visiting field for the next two years. BOX 1 Overview of Study Methods and Data Sources The Home Visiting Career Trajectories project surveyed home visitors, home visiting supervisors, and program managers employed in local agencies nationwide receiving funding from the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program in fiscal year 2017. With data collected in 2018, this descriptive study captured a snapshot of staff qualifications, job experiences, career pathways, and characteristics and practices of MIECHV-funded agencies before the COVID-19 pandemic. Interviews with program managers and supervisors and focus groups with home visitors in eight states conducted in fall 2018 provided qualitative information to supplement survey data. For more information, see the final study report: Heather Sandstrom, Sarah Benatar, Rebecca Peters, Devon Genua, Amelia Coffey, Cary Lou, Shirley Adelstein, and Erica Greenberg, Home Visiting Career Trajectories: Final Report (Washington, DC: Urban Institute, 2020), https://www.urban.org/research/publication/home-visiting- career-trajectories. Data on program management practices for this brief are drawn from the Program Manager Survey. The correlational analysis examining the relationship between home visitors’ career intentions and different program management practices link the Program Manager Survey data to data from the Home Visitor and Supervisor Survey. Survey data reflect a point in time in late 2018. How Do Management Practices Vary across Program Settings? According to program managers, some management practices are more commonly used than others (figures 1 and 2). Nearly all program managers reported using reflective supervision and providing feedback on performance through informal opportunities. More than 90 percent also reported using annual performance reviews as a professional development tool compared with around two-thirds who reported using them as a factor in salary and promotion decisions. 2 MANAGEMENT PRACTICES TO PROMOTE HOME VISITOR RETENTION However, only about half of managers reported that their programs assign peer mentors to new home visitors or provide training on how to complete an accurate assessment of employee performance for staff responsible for such reviews (figure 2). The share of program managers reporting that their programs employ these management practices varied by agency setting. Managers in community nonprofit agencies were slightly less likely than those in other types of agencies to report that their programs provide training on how to complete staff performance evaluations or assign new home visitors peer mentors (figure 2). FIGURE 1 Managers Reported Nearly Universal Use of Reflective Supervision and Informal Opportunities for Feedback Program management practices Use of reflective supervision 99% Informal opportunities to provide feedback on 99% performance A performance review process used as a professional 93% development tool Formal sessions to provide feedback on performance 91% review Employee goal-setting and goal-tracking throughout 90% the year An appeals process if an employee disagrees with 78% performance review results Programs using practice Source: Program Manager Survey. Notes: For each item, sample sizes range from 341 to 343 program managers. Percentages are calculated from valid responses and exclude missing cases. Only totals are shown for these practices because of little variation by agency type. MANAGEMENT PRACTICES TO PROMOTE HOME VISITOR RETENTION 3 FIGURE 2 About Half of Programs Assign Peer Mentors and Train Supervisory Staff on Evaluating Employees, and Two-Thirds Use Annual Performance Reviews for Salary and Promotion Decisions Government health agency Community nonprofit Other type of agency Total Program management practices 63% Annual performance reviews used for salary and 66% promotion decisions 59% 64% 58% 51% New home visitors are assigned a peer mentor 67% 56% 61% Training on how to make an accurate evaluation of 50% employee performance for persons evaluating employees 64% 56% Programs using practice Source: Program Manager Survey. Notes: Other agencies include health care provider, faith-based, university, tribal, and nonhealth government agencies. For each item, sample sizes range from 341 to 343 program managers. Percentages are calculated from valid responses and exclude missing cases. How Influential Is Employee Input in Different Areas of Program Decisionmaking? On the Program Manager Survey, respondents rated on a 5-point scale how influential employee input is for program policy and decisionmaking, where 1 was not at all influential and 5 was extremely influential. We found that employee input was generally less influential in staffing decisions and more influential in other areas. Managers most often reported that employee input was influential (rating of 4 or 5) in setting policies on staff safety, how to improve the physical work environment, and how to improve services to families (figure 3). Employee input was less frequently reported as influential in setting policies for and making decisions about hiring new staff, employee layoffs, and in implementing technical changes affecting the larger agency and its staff, such as organizational restructuring or relocation. There was little variation by agency type in program managers’ reports of the influence of employee input, with a few exceptions. For instance, program managers in government health (36 percent) and community nonprofit (44 percent) agencies were significantly less likely than those in other types of agencies (49 percent) to report employee input was influential in making program decisions around hiring. 4 MANAGEMENT PRACTICES TO PROMOTE HOME VISITOR RETENTION FIGURE 3 Managers Reported Employee Input Was Most Influential in Making Program Policies and Decisions on Staff Safety, the Physical Work Environment, and How to Improve Services Influence of employee input on aspect of program Policies regarding staff safety 77% How to improve the physical work environment 70% How to improve services to families 69% Work schedule (e.g., overtime, flextime) 62% Policies addressing employee health and mental health 58% Hiring of new employees 43% Implementation of technical changes that impact the 23% agency and employees; staff layoffs Programs reporting employee input was influential (4 or 5 on a 5-point scale) Source: Program Manager Survey. Notes: For each item, the sample size is 343 program managers. Percentages are calculated from valid responses and exclude missing cases. Only totals are shown for these practices because of little variation by agency type. How Do Program Management Practices Relate to Home Visitors’ Turnover Intentions? We examined the associations between program practices and home visitors’ self-reported job and career plans including their likelihood in the next two years of (a) staying in the same position and (b) finding a job not in home visiting. Program management practices were reported by managers in the 2018 Program Manager Survey and home visitors’ career intentions were drawn from the 2018 Home Visitor/Supervisor Survey. We found that the use of select management practices and considering staff input in certain program decisions, as reported by program managers, were significantly associated with home visitors’ job and career turnover intentions. In our analysis, we accounted for the influence of personal and program characteristics, such as home visitors’ education level and agency type. 4 The probability of home visitors saying they were very likely to stay in their job was significantly higher in programs where managers reported:  assigning peer mentors (used by 56 percent of programs),  using employee goal-setting and goal-tracking throughout the year (used by 90 percent of programs), MANAGEMENT PRACTICES TO PROMOTE HOME VISITOR RETENTION 5  using annual performance reviews for salary and promotion decisions (used by 64 percent of programs), and  relying heavily on staff input when setting program decisions on improving the physical work environment (reported by 70 percent of programs). Moreover, program managers’ reports of staff influence in setting certain program policies was related to home visitors’ career turnover intentions. Home visitors were more likely to report being somewhat or very likely to find a job not in home visiting in the next two years when their program managers reported that staff input has little influence in program decisions on hiring new staff and how to improve services for families. Conclusions Program managers in MIECHV-funded local implementing agencies reported using various management practices to support staff. Nearly all program managers reported using some practices such as reflective supervision and providing informal opportunities for feedback. However, a smaller share of managers reported their programs used practices like assigning peer mentors and training staff on assessing employee performance. With an annual turnover rate of more than 10 percent for home visitors, retaining staff is key to ensuring programs have the workforce they need to deliver services to families (ACF 2015; Franko et al. 2019; Office of Head Start 2015). Home visitors’ turnover intentions are significantly related to whether their programs use certain practices, including several less frequently used practices such as assigning peer mentors and considering annual performance reviews when making salary and promotion decisions. Home visitors’ plans to stay in the broader home visiting field were also related to whether their program managers said home visitor input was influential in the programs’ decisionmaking around service improvements for families and staff hiring. Future work could test the effectiveness of these less common practices, examining whether programs that adopt these practices can improve home visitors’ retention. Further research can also assess if the positive associations we observe in the HVCT survey data remain consistent over time and as the pandemic recedes. Results from further research may help clarify why staff input in particular policy areas but not others is associated with home visitors’ turnover intentions. Given these findings, programs should consider assessing their current management practices. Using positive management practices and listening to employee voices in matters affecting their work are related to program efforts to support and retain home visitors. 6 MANAGEMENT PRACTICES TO PROMOTE HOME VISITOR RETENTION Notes 1 Questions on program management practices were included in the Program Manager Survey. Specifically, program managers were asked if their programs use practices related to evaluating and reviewing employee performance, goal-setting and goal-tracking, and reflective supervision. They were also asked if they assigned peer mentors to new home visitors as well as other practices not shown in this brief, including other onboarding and training practices for new home visitors and supervisors and if programs shift caseloads to existing staff when a home visitor departs. 2 Reflective supervision is a relationship-based practice in which home visitors and supervisors reflect on home visitors’ experiences with families within the context fo their feelings and reflections. 3 When describing the level of employee input in program policy areas, we use the term “influential” when program managers reported that the influence of employee input in the area was a 4 or 5 on a 5-point scale, where 1 is not at all influential and 5 is extremely influential. 4 We used multivariate analyses to examine the use of different management practices and the influence of employee input on various aspects of policy and decisionmaking, as reported on the Program Manager Survey, and their associations with two outcomes reported in the Home Visitor and Supervisor Survey: (1) home visitors’ intent to stay in current position over the next two years (a rating of “very likely”) and (2) intent to find a job not in home visiting over the next two years (a rating of “somewhat likely” or “very likely”). These analyses focused on nonsupervisor home visitors and included 406 respondents who provided information on all outcome, explanatory, and control variables included in the analyses. Associations reported in the findings are statistically significant at a 90 percent confidence level or above after controlling for home visitors’ demographics, family characteristics, education, professional experience and background, job characteristics and requirements, and work environment from the Home Visitor and Supervisor Survey, as well as characteristics of their program, program manager, and agency, pulled from the Program Manager Survey. The analyses used multivariate logistic regression models to examine the two binary outcomes, and standard errors are clustered at the program level. References ACF (Administration for Children and Families). 2015. The Faces of Early Head Start: A National Picture of Early Head Start Programs and the Children and Families They Serve. OPRE Report #2015-29. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, US Department of Health and Human Services. Franko, Meg, Anthony Molieri, Diana Schaack, Ann Wacker, Miriam Estrada, and Heather Gann. 2019. “The Region X Home Visiting Workforce Study: Brief 2.” Denver, CO: Butler Institute for Families, Graduate School of Social Work, University of Denver. Office of Head Start. 2015. Head Start Fact Sheets. Washington, DC: HHS, ACF. About the Authors Cary Lou is a research associate in the Center on Labor, Human Services, and Population. His research focuses on quantitative analysis and policies impacting children. Heather Sandstrom is a principal research associate in the Center on Labor, Human Services, and Population. Her research examines early childhood programs that support the development and well- being of children and families, including home visiting and high-quality early care and education. MANAGEMENT PRACTICES TO PROMOTE HOME VISITOR RETENTION 7 Sarah Benatar is a principal research associate in the Health Policy Center. Her research focuses on maternal and child health, including perinatal health and access to care as well as early childhood support and development. Acknowledgments This brief was funded by the Administration for Children and Families Office of Planning, Research, and Evaluation, in collaboration with the Health Resources and Services Administration. We are grateful to them and to all our funders, who make it possible for Urban to advance its mission. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Funders do not determine research findings or the insights and recommendations of Urban experts. Further information on the Urban Institute’s funding principles is available at urban.org/fundingprinciples. Suggested citation: Lou, Cary, Heather Sandstrom, and Sarah Benatar. 2021. “Management Practices to Promote Home Visitor Retention: What Does a National Study of the Home Visiting Workforce Tell Us?” OPRE Report #2021-193. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Sign-up for the OPRE Newsletter Follow OPRE on Twitter Like OPRE on Facebook @OPRE_ACF facebook.com/OPRE.ACF Follow OPRE on Connect on LinkedIn Instagram @opre_acf company/opreacf ABOUT THE URBAN INSTITUTE The nonprofit Urban Institute is a leading research organization dedicated to developing evidence-based insights that improve people’s lives and strengthen communities. For 50 years, Urban has been the trusted source for rigorous analysis of complex social and economic issues; strategic advice to policymakers, philanthropists, and practitioners; and new, promising ideas that expand opportunities for all. Our work inspires effective decisions that advance fairness and 500 L’Enfant Plaza SW enhance the well-being of people and places. Washington, DC 20024 Copyright © September 2021. Urban Institute. Permission is granted for www.urban.org reproduction of this file, with attribution to the Urban Institute. 8 MANAGEMENT PRACTICES TO PROMOTE HOME VISITOR RETENTION