Standardizing Wages, Boosting Funding, and Streamlining Reporting Will Strengthen the Home Visiting Profession

February 14, 2023
Policy Brief

Executive Summary

Home visiting is an evidence-based strategy that connects families with a trained professional to support the healthy development and well-being of children, expectant parents, and families. These services are carried out by dedicated home visitors who build trusting relationships with families to reach positive family outcomes.  Home visitors work to increase school readiness, reduce preterm births, improve parent-child relationships,  support family economic security, and more. In 2021, around 56 home visitors provided evidence-based services to over 500 families and over 600 individual children within the District of Columbia. Home visitors cite the trusting relationships they build with families and the support they are able to provide as highly rewarding and the primary motivator of their work.

At the same time, analysis of home visitor experience shows home visitors face low compensation and heavy administrative workload, contributing to high turnover rates in the profession, and disrupting relationships and the support home visitors provide. The DC Home Visiting Council identified paths for policymakers to increase worker satisfaction and decrease turnover, including:

  1. Standardize and increase home visitor wages through a salary scale calculation
  2. Increase home visiting grant funding to enable programs to raise wages, hire more staff, and adapt how the investments will best fit their workforce
  3. Work with local agencies administering home visiting funds to streamline data reporting requirements

Background

Who are home visitors? 

A home visitor is a trained professional who provides services to parents and children in a safe, comfortable location of the parent’s choosing–often a home, library, or during the COVID-19 pandemic–a virtual setting. DC home visitors primarily use one of five evidence-based home visiting models: Parents as Teachers (PAT), Healthy Families America (HFA), Nurse-Family Partnership (NFP), Home Instruction for Parents of Preschool Youngsters (HIPPY), and Early Head Start (EHS). Each model includes or is paired with an evidence-based curriculum for home visiting targeted at a specific stage of family and child development.1 Some programs have developed local adaptations of these models to meet the needs of the specific populations they serve.

The home visitor builds a trusting relationship with parents and children through consistent visits over months or years to support families’ individual goals and challenges. All families need support to reach their goals through periods of pregnancy, infancy, and early childhood, and home visitors support families navigating through systems that perpetuate poverty, racism, and inequality. Home visiting–through the meaningful relationships home visitors develop with families–improves maternal health outcomes, early childhood outcomes, and family economic security. Home visiting also decreases instances of abuse and neglect, strengthening communities by providing information, services, and referrals to further community support systems. Furthermore, the cumulative effects of positive outcomes from this intervention provide significant cost savings for states.2  

The Home Visiting Council and Home visiting workforce conditions 

The DC Home Visiting Council (HV Council) is a coalition of home visiting providers, local government representatives, early childhood advocates, and community-based programs. The HV Council works to ensure programs are available and accessible to expectant parents and the families of young children, secure local funding to maintain these services, and advocate for home visitors’ needs. In 2021, the Home Visiting Council surveyed home visitors in the District of Columbia  to understand the landscape of  home visiting, and documented findings in the Voices from the Field Report. The report’s findings confirmed what programs have shared anecdotally for years: too many home visitors leave the field due to low compensation and high administrative workload, disrupting the care and relationship between the home visitor and the families they support, diminishing the positive effects of home visiting on family, child, and community outcomes.3 These findings for DC reflect national trends in home visitor satisfaction, turnover, and compensation, highlighting the need for innovative thinking, policy-making, and program design to increase the appeal and longevity of the career of home visitor.4

The Voices from the Field report describes highly rewarding relationships between home visitors and families. However, home visitors spend 23 hours a week documenting home visits and family information for funding agencies and internal reporting that is often duplicative. This results in home visitors who want to prioritize connecting with and supporting families but feel overburdened and stressed over the redundant and heavy administrative workloads.5

In addition, low pay contributes to job dissatisfaction, as is the case for many low wage workers.6 The Home Visiting Council survey data show the average salary for DC Home Visitors was $43,997 in 2021. The District has a higher cost of living than the national average, costing $46,308 per year for a single adult to $134,547 per year for a family of four to secure a modest, adequate standard of living.7 As 81% of Home Visitors in DC have a Bachelor’s degree or higher, many seek career advancement and higher wages in adjacent professions such as social work, early childhood education, or nursing.8 Currently, home visitors are leaving the field due to low pay, limited opportunities for growth, and other concerns including safety and administrative burden. About 36% say they are unlikely to stay in their current home visiting role in the next five years and 42% say they would not remain a home visitor if they left their current role.

The costs of home visitor turnover is high. Recruiting, interviewing, and training a new home visitor costs roughly $5,000. Repeating this process yearly siphons program resources that would better support current home visitors and families.

Recommendations

The Home Visiting Council has identified multiple opportunities for policymakers to improve workforce conditions for home visitors, keeping them in the profession and building the capacity to spend more time dedicated to the families they serve.

Recommendation One: Standardize and increase home visitor wages through a salary scale calculation 

Home visitor salaries often vary by program funding source, organizational structure, program model, and the experience and education levels of the home visitor. Understanding the value home visitors add to their community and referencing best practices from the field and related professions, the Home Visiting Council recommends increased public funding to local home visiting programs that can be allocated to increasing home visitor salaries. The Home Visiting Council is an ideal venue for programs and funding agencies – including DC Health and CFSA – to work together to identify the best approach to implement wage increases across programs. Several suggestions include:

  • Building a detailed salary scale based on education levels, credentials, and years of experience.
    • A home visitor salary scale could be modeled after the District’s successful early childhood educator salary scale. This consistency across DC’s early childhood field would create a more robust early childhood workforce, allowing a stronger pipeline of workers for the many programs that families of young children rely upon, including home visiting, and reducing interruptions to valuable services for families.
  • Recommending a minimum salary requirement for all home visitors.
    • Due to the variety of models and organizational structures, home visiting programs may have different approaches to educational requirements for their staff, which impact their decisions behind compensation. Establishing a required minimum salary for all home visitors, based on best practices from the field and data from the DC workforce, may help programs boost salaries of their entire staff and level the playing field across programs.
  • Incorporating a requirement for home visiting grants to increase salaries
    • Local agencies could add a requirement or policy in their grants that a portion of the funding is allocated towards home visitor salaries. This would ensure accountability from employers of home visitors, so that policymakers are assured that funding increases are directed at providing better salaries for home visitors and increasing the impact of home visiting programs on families.

All approaches recommended above must be accompanied by public funding that is sufficient to support salary increases and the resulting costs to home visiting organizations of raising salaries, such as payroll taxes, social security, and others.

Increasing home visitor compensation may also have unintended consequences on public benefits that some home visitors currently rely on. An estimated 57% of DC home visitors utilize Medicaid. The Home Visiting Council will continue to research state examples and consult with policy experts to ensure that positive improvements in wages does not have significant negative impacts on home visitors and their families who are currently enrolled in public assistance programs.

Recommendation Two: Increase home visiting grant funding to enable programs to raise wages, hire more staff, and adapt how the investments will best fit their workforce

Although the COVID-19 pandemic added intense pressure on home visiting programs, these programs have been operating with the same resources since before the pandemic. As of FY23, DC home visiting program grants had not increased since 2019 and even then, not all locally funded programs were granted any enhancements from policymakers.

Throughout the pandemic, home visiting program participants experienced significant increases in the depth and breadth of their needs, on top of previously existing every day challenges. As a result, home visitors found their role shift from a primary emphasis on growth and development for families to chiefly crisis intervention. Programs noted an increase in this demand for home visitors’ time in supporting families, as well as resources and supplies requested from families, including diapers, food, and other basic needs. Combined with the rising rates of inflation, the costs for these programs have grown while grant amounts have remained stagnant.

We recommend increased grant amounts to local home visiting programs to ensure programs have the capacity and resources to better support their staff and their family participants. This investment will allow programs the flexibility to spend the way each program can best operate, whether it involves purchasing more supplies like diapers and food for families or upgrading the benefits that home visitors receive. Programs can also address burnout and attrition with this funding by hiring an additional home visitor to re-distribute workloads, creating openings for professional growth in the organization, or offering more staff training on reflective supervision9 and secondary trauma.10

Recommendation Three: Work with local agencies to streamline data reporting requirements

Home visitors prioritize building trusting and long-term relationships with families to achieve success in their work and outcomes. However, the inordinate amount of time spent responding to heavy reporting requirements cuts into the valuable time spent on relationship building for home visitors, leading to increased workloads, higher stress and frustration. These challenges can ultimately impact the time needed for meaningful and high quality visits with families in some cases.

Depending on the type of grant funding and the specific model’s requirements, home visiting programs may have up to two or three databases into which a home visitor must report similar data. The various systems don’t necessarily speak to each other, creating an excessive and duplicative workload for the home visitor.

To address this challenge, we recommend that funding agencies collaborate with the Home Visiting Council’s programs to streamline data reporting requirements. A crosswalk that identifies overlap between multiple data systems may help agencies better understand where data requirements can be streamlined. Further research exploring how other states or models have attempted to resolve this challenge may be helpful.

Additional Considerations

We hope that this brief serves as a uniting starting point for long-needed home system changes that strengthen the field of home visiting and ultimately support families to be healthy, financially secure, and ready for the highs and lows that they will face. As policymakers consider the implementation of these recommendations, collaboration with stakeholders, including home visiting administrators, funders, home visitors, and other stakeholders, will be crucial for fleshing out and identifying the best approaches for each of these solutions.

  • Create a salary scale based on education level and years of experience  —>  suggest a scale comparable to early educators in this brief
  • Recommend building a salary scale collaboratively with programs and agencies → highlight the importance of it in the brief to strengthen overall EC field ; work with programs and agencies in the next couple months on what would be best to implement based on model or organization.
  • Recommend a minimum salary requirement for all home visitors (to boost everyone else’s) → calculate minimum based on survey results and input from programs ($48,000 min)
  • Increase program grants and add a requirement or policy in the grant that a portion of the money goes towards home visitor salaries  —> recommend a % increase to grants (based on inflation rates and an estimate of what would get home visitors to a $2000 increase etc) in policy brief; look into how it would work to add a requirement to grants
  1. National Home Visiting Resource Center. (2021). 2021 Home Visiting Yearbook. James Bell Associates and the Urban Institute.

  2. ZERO TO THREE. (2014, 16 Feb). The Research Case for Home Visiting. National Center for Infants Toddlers and Families. Accessed at: https://www.zerotothree.org/resources/144-the-research-case-for-home-visiting

  3. District of Columbia Home Visiting Council. (2021). Voices from the Field: The Experiences of the District’s Home Visitors. Accessed at: http://www.dchomevisiting.org/uploads/1/1/9/0/119003017/home_visitors_experience_report-final_english.pdf

  4. Sandstrom, H. Benatar, S. Peters, R. Genua, D. Coffey, A. Lou, C. Adelstein, S. Greenberg, E. (2020, January).  Home Visiting Career Trajectories. Urban Institute. Accessed at:  https://www.urban.org/research/publication/home-visiting-career-trajectories

  5. District of Columbia Home Visiting Council. (2021). Voices from the Field: The Experiences of the District’s Home Visitors. Accessed at: http://www.dchomevisiting.org/uploads/1/1/9/0/119003017/home_visitors_experience_report-final_english.pdf

  6. The Economic Policy Institute. (2022, March). Family Budgets in Washington, DC. Accessed at https://www.epi.org/resources/budget-factsheets/

  7. District of Columbia Home Visiting Council. (2021). Voices from the Field: The Experiences of the District’s Home Visitors. Accessed at: http://www.dchomevisiting.org/uploads/1/1/9/0/119003017/home_visitors_experience_report-final_english.pdf