استرس شغلی و رفاه در میان مراجعه کنندگان اولیه: مطالعه روش های ترکیبی Occupational stress and well-being among Early Head Start home visitors: A mixed methods study

1. Introduction Home visiting is apromising service strategy forpromoting child health and development among vulnerable expectant families and families with young children (Gomby, 2007). Passage of the Maternal, Infant, and Early Childhood HomeVisiting (MIECHV)legislation under the 2010 Affordable Care Act introduced an unprecedented era of dissemination of “evidence-based” home-visiting programs that had previously demonstrated positive effects, such as Early Head Start, Healthy Families America, and the Nurse–Family Partnership (Harding, Galano, Martin, Huntington, & Schellenbach, 2007; Love et al., 2005; Olds, 2006). With this new era came growing recognition of the need to elucidate the factors and processes that promote successful replication and scale-up of evidence-based home-visiting strategies (Goldberg, Bumgarner, & Jacobs, 2016; Paulsell, Del Grosso, & Supplee, 2014). One key factor known to support implementation fidelity is the competence and confidence of the workforce (Bertram, Blase, & Fixsen, 2015). Home visitors must be selected, trained, and supported to promote intended outcomes while working with families with a wide range of strengths and needs. The extent to which home visitor capacities fit with target population characteristics and specific program goals warrants further investigation (Duggan et al., 2007). Home-visiting programs typically target families with high levels of risk including poor infant health, poverty, domestic violence, parental substance abuse, and child maltreatment (Adirim & Supplee, 2013; Paulsell, Avellar, Sama Martin, & Del Grosso, 2010). Programs also intend to improve a broad range of outcomes (e.g., maternal and child health, school readiness, andeconomic self-sufficiency; U.S. Department ofHealth and Human Services Administration for Children and Families, 2015). When working with families with multiple, complex risks, home visitors must have the requisite capacities and supports to achieve intended outcomes. One question that has received little empirical attention concerns how the nature of the work both positively and negatively affects home visitors’ capacity and motivation to carry out their roles. Work with vulnerable families might be experienced as stimulating and rewarding, resulting in compassion satisfaction or, conversely, as stressful and overwhelming, leading to burnout, secondary traumatic stress, or job withdrawal (Stamm, 2002). To fill the gap in the literature on home visitor perceptions of their work, this mixed methods study examined the associations between home visitor, client, and work characteristics and compassion satisfaction, secondary traumatic stress, burnout, and job withdrawal among Early Head Start home visitors.