Saskatchewan KidsFirst Program Evaluation (2007-10): Staffing www.kidSKAN.ca/KidsFirst 1
Staff training and retention in a home visiting intervention: findings from our evaluation of Saskatchewans KidsFirst program
HOME VISITING AS AN INTERVENTION STRATEGY
Home visiting began as a community nursing strategy more than a century ago. With the government social spending cutbacks in the 1980s and 1990s in the U.S. and Canada, home visiting interventions have been used with increasing frequency to reach vulnerable children and families.
Home visitors work with families in many ways, including: developing trusting, nurturing relationships between parent and child informally teaching parenting skills being the link for parents when it comes programs, events and services in their community helping parents access basic needs such as child care, transportation and food advocating for parents when they need to approach community agencies helping parents develop their communication skills and confidence establishing social connections between families and their communities
WHAT IS KidsFirst?
KidsFirst is a federally-funded, provincially-run intervention program launched in 2002 that provides support and services to vulnerable families with young children (aged 0-5) in Saskatchewan. It is offered in nine areas of the province that were identified as having high levels of need when the program was established. There are KidsFirst programs in Meadow Lake, Moose Jaw, Nipawin, Northern Saskatchewan, North Battleford, Yorkton and selected neighbourhoods in Prince Albert, Regina and Saskatoon.
KidsFirst uses intensive home visiting to support children living in very vulnerable circumstances so that they can be nurtured and supported by healthy, well-functioning families. Home visitors work to build capacity in families, promote healthy child development and facilitate goal achievement for parents (such as returning to school or finding a job). KidsFirst also connects families with mental health and addiction services as well as early learning and childcare programs. Home visitors focus on the positive, building on each familys strengths to build parents self-esteem and confidence.
Saskatchewan KidsFirst Program Evaluation (2007-10): Staffing www.kidSKAN.ca/KidsFirst2
KidsFirst is an intersectoral and inter-agency partnership, and sites collaborate with multiple stakeholders, as well as contract with many agencies to perform services. At each site, there is a local accountable partner and a local management committee that provides guidance on program implementation.
KidsFirst home visitors provide support on a case-by-case basis, to meet each familys needs and build upon each familys strengths. They help families with day-to-day needs such as transportation, child care, housing, medical attention
and job readiness training. And they use the Growing Great Kids curriculum to teach families about effective parenting through child interaction and child-centered activities (see http://www.greatkidsinc.org).
KidsFirst was designed as a dyad model of home visitation, in which professionals, usually with a background in social work, and paraprofessionals, who do not have formal training, work together to meet the needs of families. In KidsFirst, program managers and home visiting supervisors (professionals) train and supervise home visitors (paraprofessionals).
In practice, however, home visitor supervisors are not always trained professionals. While the job requirements for home visiting supervisors typically involve a higher levels of education than that required for home visitors themselves, backgrounds of these staff members vary from site to site in the program. Some adhere strictly to the dyad model, while others diverge significantly in their hiring practices.
STAFF TRAINING AND AND RETENTION
Each site is responsible for staff training and development. Training varies from site to site, covering areas such as early speech development, family violence, safety, FASD, HIV/ AIDS/ hepatitis, autism spectrum disorder, breastfeeding, nutrition, family literacy, non-violent crisis intervention, shaken baby syndrome and postpartum depression. One site allows all home visitors five professional development days each year
This fact sheet is part of a series describing our three-year evaluation of KidsFirst, funded by the Canadian Population Health Initiative, and the Government of Saskatchewan, with some additional support from MITACS, and the College of Medicine at the University of Saskatchewan. The evaluation was led by Nazeem Muhajarine, lead of the Healthy Children Research Team at the Saskatchewan Population Health and Evaluation Research Unit (SPHERU), in partnership with staff from the Early Childhood Development Unit in the Saskatchewan Ministry of Education, and KidsFirst program staff. A full list of team members is found in the reports.
The following reports were produced as part of this evaluation: Evaluation Framework Community Profiles Focused Literature Review Using Theory to Plan and Evaluate KidsFirst Report of the Qualitative Study Report of the Quantitative Study Summary of Findings and Recommendations.
Reports and fact sheets can all be read online or downloaded from www.kidskan.ca, the Saskatchewan Knowledge to Action Network for Early Childhood Development; go to www.kidskan.ca/kidsfirst, or click on KidsFirst under the Projects menu on the front page. For more information, contact Fleur Macqueen Smith, firstname.lastname@example.org, 306-966-2957, Knowledge Transfer Manager of the Healthy Children Research Team in SPHERU.
They taught me how to stay calm when the kids get frustrating. And they taught me how to tone my temper down and taught me better ways to communicate. Now I can communicate with my son a lot more. parent
In the curriculum they lay out really easy, simple activities that we teach them. Lots of [these activities] dont even require supplies. [The curriculum] even just
goes back to traditional games like This Little Piggy. home visitor
Saskatchewan KidsFirst Program Evaluation (2007-10): Staffing www.kidSKAN.ca/KidsFirst 3
to increase their skills. Another site has put almost of its home visitors through a second tier of training in the Growing Great Kids curriculum, while a third has implemented a skill development and mentoring process for home visitors.
Most of the nine sites have reported challenges in retaining staff, citing a variety of reasons: burnout, having to work in high-risk environments, a lack of workplace support, low wages, and finding other avenues for career growth. (These challenges are described in detail in the Report of the Qualitative Study, available at www.kidskan.ca/node/279). High burnout: Some home visitors say that they did not clearly understand the nature of the work or their job descriptions when they were first employed. Because of the sensitive and demanding nature of these jobs, some home visitors have had problems establishing boundaries between their jobs and home lives.
High risk: Safety was a concern for many home visitors. In small town sites, KidsFirst families might know where staff live and visit them at home. Home visitors also had to deal with people facing addictions or substance abuse issues, or situations in which a parent posed a safety risk to the family. On top of this, many visitors had to deal with environmental hazards such as mould, mice, bed bugs and lice.
Lack of workplace support: While many sites are trying to find ways to reduce burnout or ensure they provide a workplace with open communication, the lack of support for staff remains a challenge. In some cases, tension between various levels of administration, or management and staff has led to high turnover.
Insufficient salary: Many said their income, which in some cases was capped, was not enough for them to live on, especially in light of the heavy work load and high risk nature of the job. The situation was especially tough for those trying to raise their own families. Many were unable to get by without some kind of supplement to their income. In some case, home visitors took second jobs or set up businesses on the side to bring in more income. In response, the pay scale has been upgraded to reflect qualifications and experience in some cases.
Growth opportunities: Some home visitors use home visiting jobs as a stepping stone, particularly in light of low pay rates or the fact many start with minimal qualifications and education. For some, the job of home visitor provides relevant training and experience, which ultimately allows them to find better-paying positions elsewhere, especially in larger communities.
Beyond the obvious logistical obstacles for the administration of KidsFirst, staffing issues also undermine the very nature of the work home visitors do. High case loads mean less time for home visitors to spend with each family, and high staff turnover means the relationships built between visitor and family are severed when a home visitors leaves the job and has to be replaced.
When it comes to the parent/child interactions, a lot of role modeling is what I do: getting on the floor and playing, talking, singing, laughing, interacting. Its just playing. And for me, the more I role model and the more I play, the
more I get the families off the couch [and] on the floor. home visitor
Were putting ourselves at risk all the time with the families we work with and with
the job that we do. home visitor
We also have a lot of paperwork for every phone call we make, for everything that we do, we have to jot it down on paper on three different computer systems. Sometimes its hard ... Theres not enough time in the day.
Kidsfirst staff member
Saskatchewan KidsFirst Program Evaluation (2007-10): Staffing www.kidSKAN.ca/KidsFirst4
DEALING WITH STAFFING CHALLENGES
KidsFirst program managers have taken many approaches to dealing with staffing issues, such as conducting salary reviews, providing more training opportunities, and holding staff retreats and conferences with sessions to support home visiting staff, such as self-care and safety.
Some KidsFirst program sites match potential home visitors with families that would best suit them. While in some sites, home visitors need formal qualifications in order to best support a family, at others, personal experience is valued over a formal set of skills. At one site, families are invited to attend the interview process with potential home visitors, and the familys comfort level with an applicant is a factor in determining whether the person is hired. Such steps are designed to best ensure a strong relationship between visitor and family.
However, one of the findings of the evaluation noted that improved staff retention is one area of the program that should be addressed (see the Summary of Findings and Recommendations at www.kidskan.ca/node/281). One
possible direction would be for KidsFirst to hire specialized home visitors for the high-needs families, known in the program as complex-needs families. The evaluation showed that these families are hard to reach and retain in the
program, and that lay home visitors are not able to deal with some of the specialized issues that arise with these families.
Specialized case workers with training in psychology, nursing, mental health, and social work could take a greater role in serving high-needs families. This would better address the needs of families experiencing exceptionally challenging circumstances, as well as ease the burden felt by home visitors. Further, this
would offer home visitors additional supervision and support, which may improve retention. Paraprofessional home visitors could then focus more time on other, lower-needs families.
This recommendation is supported by findings from the literature review conducted as part of this evaluation, which suggested that those with complex needs benefit more from intensive services provided by professionals than they do from less intensive services provided by paraprofessionals (available at www.kidskan.ca/node/197).
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I think a lot of people use KidsFirst as a stepping-stone sometimes just to see if this is their kind of field ... We have had a few [individuals] go on to [study] Social Work; weve had a couple that have [gone] on to get their degree and
stuff like that. home visitor