The following recommendations for policy and practice strategies are intended to inform policymakers and other home visiting stakeholders about home visiting’s role in the field of early care and family-serving programs in California—and to provide evidence for why a coordinated infrastructure is needed to support the workforce. Because the landscape of California’s home visiting programs and workforce is so diverse, data collection was designed to capture the breadth of programs, staff experiences, and family needs to provide a comprehensive description of the workforce from which these policy recommendations were developed.
The policy recommendations are intended to support broad development of a statewide infrastructure that can meet this range of strengths and needs, while the implementation of particular strategies can be adapted to fit local community and home visiting model contexts.
In this video, home visiting stakeholders in California—including families participating in a home visiting program—describe why home visiting matters and why strengthening the workforce is a key step in ensuring that families across the state can access and benefit from home visiting.
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.
Continuum of Home Visiting Workforce Development Recommendations 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.
The F5CA Home Visiting Workforce study documented a wide variety of program models and home visitor credentials across the state of California. For instance, while most home visiting staff hold a bachelor’s degree or higher, staff also represent a wide range of educational backgrounds, including child development, early childhood education, psychology, social work/social welfare, and nursing. Staff who participated in the study represent 54 home visiting models across 171 programs. A focus on the workforce pipeline and workforce preparation can professionalize the field by explaining, elevating, and valuing the work of home visitors.
1. Define home visiting in California. Develop a shared definition of home visiting for the state that captures the range of services and program types that currently identify as home visiting.
2. Define home visiting as a profession for the state of California. The considerable variability in home visitors’ educational backgrounds creates a lack of cohesion in the types of knowledge and skills that home visiting staff bring to their work, and creates hiring challenges for programs and providers because the skills needed to be a home visitor are not uniformly defined.
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.
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.
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.
I have my bachelor’s degree in child development. I think that has really helped set the foundation for this role because I have a good, solid background in the field that I work in, and it has really helped pave that understanding and how to work with different types of families and really share how important the first years of life are and really put it in a sense of parents getting to understand that and how it will benefit their children.
State-level home visiting funders could:
Home visiting model developers could:
Faculty at institutes of higher education and community colleges could ensure that home visitor competencies are embedded in relevant courses.
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.
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.
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.
4. Address working conditions and program climate. Strengthen working conditions and program climate to support equity, staff empowerment, connectedness, and financial health.
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.
When I really do look at the difference in agencies with a degree, there’s a huge difference in pay. I know sometimes I feel like because I don’t have that paper, I don’t get that money, but I still do the same amount of work.
Home visiting program leaders could:
Home visiting model developers could:
Home visiting program funders could:
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.
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.
State-level leaders could:
Home visiting program leaders could:
Home visiting program funders could:
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.
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:
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.
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.
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:
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.
The policies are spot on and represent a diverse, passionate and skilled population of individuals providing hard work, heart work, and compassion. The commitment in every aspect of home visitation, every position, and vision is ultimately about partnering with families and a community that support and inspire others to prosper, be healthy, resilient, and successful.
These policy recommendations were informed by the First 5 California Home Visiting Workforce Study, which was funded by First 5 California and conducted in collaboration with Harder+Company Community Research, Advent Consulting, and Allen, Shea & Associates. The project team would like to acknowledge the individuals who made this work possible, including the home visiting families, program managers, and staff who participated in data collection, as well as Deborah Stark, members of the study’s Core Advisory Group, and home visiting policy and advocacy stakeholders who all provided input and additional context to ensure the study’s policy recommendations would be relevant for California.
In addition, we would like to extend special thanks to our Child Trends colleagues who provided insights and expertise during the development of the policy recommendations, and those who contributed to data collection and analysis. They include April Wilson, Beth Jordan, Audrey Franchett, Sarah Kelley, Catherine Schaefer, Emilia Sotolongo, and Alison Sapp. Also, we would like to thank our Child Trends Communications team, who offered expertise in user experience design, including Stephen Russ, Jody Franklin, and Catherine Nichols. Finally, we want to thank the staff at Harder+Company, who managed home visitor and family data collection: Courtney Huff, Haley Mousseau, Veronica Awan, Allison Smith, and Nia Gordon; as well as the staff at Allen, Shea & Associates who led interviews with families: Mechele Small Haggard, Mony Flores-Bauer, and William Allen.
 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.
 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.
 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
 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.
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