a young woman holds her baby and talks to a nurse

Considerations for Supporting the Home Visiting Workforce Under MIECHV Reauthorization

Home visiting is a voluntary resource provided to pregnant people and new parents, through which families receive regular visits from a practitioner who gives them information about prenatal and early childhood care and offers socioemotional support. The largest single source of funding for home visiting in the United States is the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. Congress’ 2022 reauthorization of MIECHV has the potential to double federal investment in the program over five years, enabling awardees to better serve children and families by strengthening the home visiting workforce, in part through dedicated funding for workforce support.

The MIECHV Program

The Maternal Infant, and Early Childhood Home Visiting (MIECHV) Program is administered by the Health Resources and Services Administration (HRSA) in partnership with the Administration for Children and Families (ACF). MIECHV funds are administered to states and jurisdictions, which contract with local implementing agencies (LIAs) to implement evidence-based home visiting programs. Funds are also administered to Tribal organizations to implement programs in American Indian and Alaska Native communities.

Home visiting leaders, including representatives from the Association of State and Tribal Home Visiting Initiatives (ASTHVI), have identified maintaining a robust and well-trained workforce as both a key challenge and a top priority for the field. Prior to the COVID-19 pandemic, local and national studies indicated that 12 to 18 percent of home visitors planned to leave their positions in one to two years, and that average 12-month turnover rates ranged from 15 to 40 percent. ASTHVI indicates that these rates have likely increased since the start of the pandemic, jeopardizing programs’ investments in home visitor training and disrupting participating families. For example, changing home visitors has been shown to negatively impact families’ length of enrollment and visit frequency, while alignment on goals between families and home visitors has been shown to extend enrollment length. Inadequate pay and benefits are often cited as a key driver of home visitor turnover.

Even prior to reauthorization, MIECHV awardees had begun implementing innovative strategies to address workforce challenges using a range of funding sources. We spoke with home visiting leaders in three states to learn more about their efforts to strengthen the workforce, including efforts to increase home visitors’ compensation and provide additional supports for their professional and personal well-being. In this brief, we present an overview of these efforts—in the form of “snapshots” highlighting efforts from the three states—and offer considerations for MIECHV awardees as they plan for the future of their home visiting programs.


State Snapshots

Alabama

alabama state outline

In Alabama, MIECHV administrators have worked to deliver better support to their home visiting workforce by increasing the amount of funds allocated to LIAs per enrolled family. This increase has allowed LIAs to provide additional supports to home visitors, including:

  • Higher compensation, including better pay and benefits
  • Higher mileage reimbursement
  • Additional opportunities for professional development (e.g., attending conferences and trainings)

These changes were intended to address discrepancies in compensation across the state and increase retention of home visitors. A MIECHV leader identified the state’s investments in professional development—which have been informed by a statewide survey of home visitors—as particularly important, given the large number of new home visitors in Alabama (following heightened staff turnover during the COVID-19 pandemic).

While generally well-received, the state has faced some tradeoffs and challenges in implementing these supports. First, in some cases, increasing the funds allocated per family reduced the total number of families LIAs could serve (given a flat overall budget). With ongoing staffing challenges, the state determined that it was necessary to decrease capacity and increase support for home visitors. Second, because LIAs often house multiple programs and have multiple funding streams, offering increases only to MIECHV-funded home visitors created new inequities within some agencies. State MIECHV staff provided additional support and potential solutions to LIAs navigating this issue.

Colorado

Colorado state outline

In Colorado, MIECHV administrators have used multiple approaches to better support the home visiting workforce, including:

  • Flexible funding to assist LIAs with emerging needs (e.g., costs associated with training, operational items like cell phones and tablets, additional compensation)
  • Recruitment and retention bonuses
  • A federally registered home visitor apprenticeship program
  • A loan forgiveness program for home visitors
  • Mental health consultation for home visitors

The state also implemented a pilot program to offer increased mileage reimbursement to home visitors but elected to discontinue it due to limited uptake, as many LIAs were reluctant to offer increased reimbursement to their home visitors but not to other program staff who incur travel expenses.

These strategies have been developed and funded through state funds, federal stimulus funds, and the Preschool Development Grant, and implemented through the state’s Home Visiting Investment Taskforce. MIECHV leaders in Colorado cited additional funding available through reauthorization as an opportunity to further support the workforce, as it allows the program to increase funding to LIAs, which in turn allocate funds to staffing. One MIECHV leader explained, “Whenever there is an increase that allows you to support the workforce by increasing the funding you’re providing, that’s a win. When the wins come through, and hopefully it does mean more sustainable funding in the future, that’s huge.”

Iowa

Iowa state outline

MIECHV administrators in Iowa have focused their home visiting workforce efforts on increasing home visitor compensation through two mechanisms:

While not contractually required, the recommended starting wage is intended to exert pressure on LIAs to offer more competitive wages, and LIAs must submit a plan for increasing staff compensation to this recommended rate. To facilitate this shift, the state increased funding per family by $500 in 2023. State leaders are currently discussing increasing the recommended wage and adopting a tiered compensation system that offers additional compensation based on prior experience, competencies, and/or location.

These changes were intended to reduce turnover and advance equity by making it economically feasible for potential home visitors from racially, ethnically, linguistically, culturally, and socioeconomically diverse backgrounds to join the field. Iowa’s efforts have been informed by findings from an evaluation of workforce well-being and input from key stakeholder groups, including the state’s Family Support Leadership Group, Home Visitor Expert Panel, and Learned Experience Leader groups. Additional state-level efforts to grow and diversify the home visiting workforce include expanding recruitment efforts, developing a career pathway for home visitors, and providing mental health consultation services.

Looking ahead, MIECHV leaders in Iowa foresee using funding available through MIECHV reauthorization to both “[keep] the lights on” for existing efforts and expand services. They hope to sustain or increase funding for projects and initiatives currently funded through other sources (e.g., the American Rescue Plan Act and MIECHV Innovation Awards), including increases to PAEYS incentives and continued retention incentives.


Considerations for MIECHV Awardees

MIECHV reauthorization presents an exciting opportunity for awardees to better support children and families by both expanding access to home visiting services for families and investing in the well-being of their home visiting workforce. As awardees continue to determine how to best support the home visiting workforce with these funds, we offer the following considerations based on the experiences of Alabama, Colorado, and Iowa:

MIECHV awardees should consult with interested parties when planning and implementing new policies and programs to ensure that solutions are responsive to their needs and interests. Interested parties might include LIA leaders and staff, home visitors, families, other stakeholders in the early childhood field. Strategies for data collection and consultation include advisory groups, task forces, and surveys to gain insight from the workforce.

MIECHV awardees should increase home visitor compensation to advance home visitors’ well-being, improve retention, and advance equity. However, while a necessary strategy, increasing compensation may cause disruption and inequities at the LIA level, given that LIAs often also employ staff who are not home visitors. Awardees should think about how to mitigate these potential negative outcomes when designing programs and policies and provide clear guidance to LIAs on navigating these challenges. For example, MIECHV program directors could provide outreach to LIA leadership to engage in conversations on how to best address potential inequities.

MIECHV awardees should consider providing workforce supports that promote professional development and well-being in addition to compensation. Such supports might include access to trainings and conferences, which build home visitors’ skills and foster a sense of camaraderie; mental health supports, including mental health consultation; career pathways; and opportunities for greater workplace flexibility and autonomy. States may face fewer barriers to providing these supports relative to increasing compensation.


Acknowledgments

The authors would like to thank Maggie Enlow, Joyce Johnson, Angela Ben-Zerky, Aaron Miller, Kelly Schulte, and Claire Carlson for sharing information on their states’ approaches to supporting the home visiting workforce. The authors would also like to thank ASTHVI for their partnership and support in identifying MIECHV awardees to feature. Lastly, the authors would like to thank our Child Trends colleagues, Kristen Harper, Jessica Conway, and Silvana Esposito Hackett for their review of this work.


Suggested citation

Falletta, K., Rosinsky, K., & Crowne, S. (2024). Considerations for supporting the home visiting workforce under MIECHV reauthorization. Child Trends. DOI: 10.56417/3403q5030n

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