Management Practices to Promote Home Visitor Retention: What Does a National Study of the Home Visiting Workforce Tell Us?

Publication Date: October 28, 2021
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  • Published: 2021


Research Questions

  1. How often do programs use different management practices, and how does that vary across program settings?
  2. How influential is employee input in different areas of program decision-making?
  3. How do program management practices relate to home visitors’ turnover intentions?

Home visiting programs in agencies funded by the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program use various management practices to onboard, train, and evaluate their staff. However, which practices are used varies between different programs and by program setting. This brief summarizes findings from the Home Visiting Career Trajectories project on management practices used by home visiting programs receiving MIECHV Program funding.   


This brief examines management practices used by home visiting programs receiving MIECHV Program funding based on national surveys of program managers and staff conducted in 2018. Analyses explore how frequently program managers report using various management practices, the influence of employee input in different areas of program policy decision-making, and associations between these factors and home visitors’ turnover intentions.

Key Findings and Highlights

Key findings include the following:

  • Nearly all program managers reported using some practices that aim to support staff development, including providing informal opportunities for feedback and practicing reflective supervision, regardless of program setting. Additionally, more than 90 percent reported scheduling formal sessions to provide feedback on performance reviews, supporting staff to set and track professional development goals throughout the year, and using performance reviews as a professional development tool.
  • Between a half and two-thirds of programs reported assigning peer mentors, providing training on how to evaluate employee performance, and using annual performance reviews for salary and promotion decisions. Compared with other programs, programs in community nonprofits less frequently reported assigning peer mentors to new home visitors and training supervisors on assessing employee performance. 
  • Around 70 percent of program managers reported that employee input is influential in setting policies on staff safety, the physical work environment, and service improvement, but less than half reported staff input is influential in hiring decisions (43 percent) and implementing technical changes affecting the agency (e.g., relocation; restructuring programs) or staff layoffs (23 percent).
  • Several program management practices reported by managers are related to home visitors’ intentions to stay in their job or the field. These practices include assigning peer mentors (56 percent of programs), using performance reviews for salary and promotion decisions (64 percent of programs), and continuous employee goal setting and goal-tracking (90 percent of programs).
  • Overall, 54 percent of home visitors reported they were very likely to remain in their current position in the next two years and 28 percent reported they were very or somewhat likely to find a job not in home visiting. In programs where managers reported greater employee influence on the physical work environment, staff hiring, and service improvements for families, home visitors were more likely to have said they intend to stay in their jobs or in the home visiting field for the next two years.


The Home Visiting Career Trajectories project includes two major components: (1) a two-stage national survey of the home visiting workforce in local implementing agencies (LIAs) receiving MIECHV Program funding and (2) case studies in eight states involving interviews with program leaders and supervisory staff, as well as focus groups with home visitors in 26 LIAs. Data on program management practices for this brief are drawn from the Program Manager Survey. The correlational analysis examining the relationship between home visitors’ career intentions and different program management practices link the Program Manager Survey data to data from the Home Visitor and Supervisor Survey. Survey data reflect a point in time in late 2018.


Lou, Cary, Heather Sandstrom, and Sarah Benatar. 2021. “Management Practices to Promote Home Visitor Retention: What Does a National Study of the Home Visiting Workforce Tell Us?” OPRE Report #2021-193. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.


Early Childhood Home Visiting:
A service delivery strategy for achieving greater child and family health and well-being. Local home visiting programs connect new and expecting parents with a designated support person—a trained nurse, social worker, parent educator, or early childhood specialist—who provides services in the home. Services generally consist of screening, case management, family support or counseling, and caregiver skills training.
Local implementing agency (LIA):
A local organization, such as a community action agency, community nonprofit, or public health or education department, that receives funding to implement home visiting services under MIECHV. States, territories, and tribes work with LIAs to train a high-quality home visiting workforce, establish data reporting and financial accountability systems, and develop recruitment and referral networks.
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program:
administered by the Health Resources and Services Administration in partnership with the Administration for Children and Families, the MIECHV Program was established in 2010 to support voluntary, evidence-based home visiting for at-risk pregnant women and parents with children up to kindergarten entry. The program provides grants to states, US territories, and tribes, which conduct needs assessments to identify eligible at-risk communities and serve priority populations.
OPRE Research Topics: