Background
Home visiting programs promote child development, family health, and positive parenting, yet workforce stress, burnout, and turnover threaten service quality and continuity. This study examined how reflective supervision, tenure, stress, and burnout influence turnover intentions among home visitors and supervisors. It also explored work-related stressors, resilience strategies, and how the findings informed statewide policy and organizational changes to strengthen workforce well-being and retention.
Methods
Data were drawn from the 2024 MIECHV and IDHS Home Visiting Workforce Survey (n=208), including 117 home visitors and 51 supervisors. Participants completed measures of reflective supervision, stress, burnout, turnover intentions, and demographics, along with open-ended questions on workplace stressors and coping strategies. Two path models examined direct and indirect relationships among reflective supervision, tenure, stress, burnout, and turnover intentions. Qualitative responses were analyzed thematically using NVivo.
Results
Among home visitors, greater reflective supervision was associated with lower stress, which reduced burnout and turnover intentions through significant indirect pathways. Among supervisors, longer tenure was associated with higher stress, which increased burnout and turnover intentions.
Qualitative findings identified multilevel stressors, including secondary trauma, workload, documentation, staffing instability, administrative burden, limited leadership support, poverty, housing instability, and systemic inequities. Resilience strategies included self-care, social support, boundary setting, reflective supervision, leadership support, mental health consultation, flexible work environments, professional development, and community partnerships. Findings informed statewide workforce initiatives in Illinois, including expanded mental health consultation, Joy in Work continuous quality improvement efforts, establishment of a salary floor, reduced administrative burden, and simplified reporting requirements.
Conclusions
Reflective supervision is a key organizational strategy for reducing stress, preventing burnout, and supporting workforce retention. Findings highlight resilience as a multilevel process requiring coordinated support across individual, organizational, and systems levels. By translating research into policy and organizational action, this study contributes to strengthening workforce well-being, retention, and service continuity for families.
