The Benefits and Costs of Caring: A Mixed Methods Study of Early Head Start Home Visitors

Abstract

Early Head Start (EHS) home visitors are the lynchpin connecting program goals with service outcomes, yet scant attention has been paid to issues concerning the home visiting workforce. In particular, the ways in which EHS home visitors are affected by prolonged relationships with low-income, high risk families are not well understood. Guided by a strengths-based, developmental-ecological framework, this mixed methods study examined the influence of individual, occupational, and organizational factors on compassion satisfaction, secondary traumatic stress, and burnout. Home visitor compassion satisfaction, secondary traumatic stress, and burnout were also examined as predictors of (a) home visitor turnover and (b) family engagement. In the quantitative phase of this study, 77 home visitors from Maryland and the District of Columbia completed pencil and paper surveys that assessed individual, occupational, and organizational characteristics that prior research and theory have shown are associated with compassion satisfaction, secondary traumatic stress, and burnout. Survey data from a subsample of 27 home visitors were linked with family-level data from the Partners for Parenting study in order to examine associations between home visitor compassion satisfaction, secondary traumatic stress, burnout, and EHS family demographic and psychological risk. Home visitor survey data were also linked to home visitor turnover at 6 months post-survey and with indicators of EHS family engagement. In the qualitative phase, seven home visitors from the larger sample completed semi-structured interviews addressing occupational stress. EHS home visitors in this sample evidenced moderate to high compassion satisfaction and low to moderate secondary traumatic stress. The quantitative and qualitative results supported an ecological approach to understanding compassion satisfaction, secondary traumatic stress, and burnout. Results from bivariate correlation analyses suggested that lower attachment avoidance and perceptions of low supervisor support were associated with six month turnover. Higher levels of compassion satisfaction, greater material hardship, greater perspective taking ability, larger caseloads, and higher levels of EHS family cumulative risk were associated with more positive home visitor ratings of working alliance. Results are discussed in terms of their implications for practice, policy, and research.