“Anything Would Be Easier than What We’re Doing Right Now”: Early Head Start Home Visitors’ Experiences Working Through an Environmental Crisis

Abstract

Home Visitors and early childhood educators play a critical role in supporting the development of young children from low-income families in the United States. During the COVID-19 pandemic, restrictions on service delivery dramatically impacted the professional experience of Home Visitors, presenting significant new challenges for this dedicated, often under-compensated workforce. An external evaluation team explored the experiences of Early Head Start Home Visitors serving six regions of a county in the mid-Atlantic region. Researchers engaged Early Head Start program partners in identifying issues and methods of investigation to help inform organizational efforts to support their staff and the families they serve. Findings include that Home Visitors experienced significant stress and mental health challenges due to the frequently shifting environment, loss of peer interactions and loss of personal boundaries due primarily to their efforts to sufficiently support families in a time of crisis. These experiences contribute to burnout and increase the chances of early care and education workers leaving the field despite a deep commitment to the work. Considerations for how to retain high-quality early childhood education workers, in particular through potential significant environmental disruptions, include the need for strong peer support networks and transparent, responsive leadership.

1. Introduction

Through a recent environmental crisis, the COVID-19 pandemic, Early Head Start (EHS) services had to shift significantly and repeatedly, managing challenges experienced by the families served as well as those by the Home Visitors (HV). These services provide critical, high-quality HV support to low-income families with children from birth to three years old. A contracted external evaluation team explored both family and HVs’ experiences during this time as part of one EHS provider’s annual quality improvement efforts. This component of the evaluation study aims to amplify the voices of HVs, exploring their work as critical resources in meeting families’ needs as well as recognizing their own needs in a time of national and community crisis.

Studies of Early Care and Education (ECE) professionals use various terms to reflect the diversity of roles within the field, including early childhood educators (sometimes also abbreviated as ECE), Home Visitors (HVs), many of whom are also early childhood educators, and childcare workers, typically employed in center-based settings. In this paper, we use the terminology adopted by individual studies when referencing their findings. More broadly, we use ECE workers as an umbrella term encompassing all of these roles, and HVs specifically to denote professionals who engage directly with families, primarily in their homes, to promote children’s developmental progress and provide parenting support (The National Conference of State Legislatures n.d.; U.S. Department of Health and Human Services n.d.a). Unlike center-based workers, Home Visitors work with a two-generation framework in recipients’ homes, providing services that simultaneously support children and their caregivers, through developmental screenings, service referrals for economic or health needs, and education and modeling for caregiver-child interactions (McKelvey et al. 2024). Developing responsive and trusting relationships with families within their natural environment is key to Home Visitors’ ability to strategize approaches with caregivers that will lead to positive outcomes for their children (McKelvey et al. 2024). While HV qualifications can vary by program (Milojevich et al. 2025; Lewis et al. 2020), Home Visitors with Early Head Start are required to have a minimum of a home-based Child Development Associate credential, a comparable credential or equivalent coursework as part of an associate’s or bachelor’s degree (U.S. Department of Health and Human Services n.d.b).

Early Head Start HV work embodies core constructs of Social Cognitive Theory including self-efficacy, modeling and learning in a social context (Bandura 1986). HVs provide critical social support, fostering caregivers’ self-efficacy by modeling positive parent–child interactions, encouraging caregivers, building on family strengths and equipping caregivers with strategies to promote their children’s learning and development (U.S. Department of Health and Human Services n.d.c). Self-efficacy, the belief in one’s ability to successfully perform a task or manage a challenge, is key to caregivers initiating new behaviors and their persistence in the face of obstacles (Bandura 1977). Caregivers with a higher sense of self-efficacy engage in more positive parenting practices, experience lower stress, and support better child outcomes (McKelvey et al. 2024). Self-efficacy is also key for the HV workforce, including confidence in their ability to effectively engage families and meet program expectations. High professional self-efficacy is associated with persistence, resilience and job satisfaction, while low professional self-efficacy has been linked with burnout and attrition among Early Head Start HVs (West et al. 2018).

1.1. Impact of the COVID-19 Pandemic on Parents in Poverty

The COVID-19 pandemic impacted early childhood educators and the families they serve in unprecedented ways (Atiles et al. 2021; Bromer et al. 2021; Manning and Jeon 2020), worsening existing burdens on parents and presenting new challenges regarding childcare and financial stability, physical and mental health (Araújo et al. 2021; Gromada et al. 2020; Spiteri 2021; UNESCO 2022).

In many cases, the pandemic exacerbated caregiver stress, impacting parents’ ability to buffer children from unpredictable environmental changes, and potentially impacting children’s developmental outcomes (Karpman et al. 2020; Yoshikawa et al. 2020). Parents were forced to cut back spending on basic necessities (Karpman et al. 2020), and single-parent households especially struggled economically, managing rising unemployment rates and the constraints of single-parent income (Parolin and Lee 2022). Economic strain, coupled with social isolation as a result of national lockdown orders, may have contributed to poorer mental and physical health, especially for low-income parents (Williams et al. 2021). Families living in poverty experienced worsened inequities such as food insecurity, housing instability, and family disruptions (Kalluri et al. 2021; Williams et al. 2021). The long-term impact of the COVID-19 pandemic on young children remains to be seen, but research on environmental disasters suggests the potential for long-term adverse consequences for young children, most sensitive to environmental stressors including parents who may struggle to provide consistent, supportive care in times of crisis (Barrero-Castillero et al. 2019; Lundberg and Wuermli 2012; Yoshikawa et al. 2020). Nationally, research on population-level consequences of the pandemic revealed that its adverse effects were both more common and more severe for the very families that home visiting aims to support (Simmons et al. 2021; Tai et al. 2021).

Pennsylvania (PA), between pandemic onset and summer 2023, experienced the loss of nearly 600 childcare centers (2189 closed, while approximately 1500 new facilities opened). X County, in Southwestern PA, had over 180 childcare programs permanently close from 2019 through November 2023 (Tuncer et al. 2023). Although new facilities opened during this time, the closures and associated disruptions to childcare options, in particular through the height of the pandemic period, increased parental stress and limited their options to manage work (Tuncer et al. 2023). In addition, parents with school-age children managed unprecedented school closures, disrupting home dynamics and parents’ work options. Across the country, in the first pandemic year (school year 2020–2021), over 1500 districts experienced district-wide school closures and over 1900 shifted to fully remote learning; the following school year, over 1900 districts did the same (Zviedrite et al. 2024). Over 96% of these closures impacted public schools (Zviedrite et al. 2024). Low-income families were significantly affected, as an average of 57% of students experiencing closures for school years 2020–2022 were children who qualified for free or reduced lunch (Zviedrite et al. 2024). Single-parent households overall had higher exposure to school closures and childcare center closures (Parolin and Lee 2022), presenting significant challenges for more vulnerable families.

1.2. Early Care and Education Staff Challenges

Outside of times of crisis, ECE workers contend with multiple challenges in the profession, including low wages and high levels of financial and general stress.

1.2.1. Near the Poverty Line: Early Childhood Education

ECE professionals’ low pay has been a topic of debate for years (Bridges et al. 2011; McLean et al. 2021) often cited as a reason for their stress (Al-Adwan and Al-Khayat 2016; Cumming and Wong 2018; Hall-Kenyon et al. 2014). The median wage for ECE workers falls below 97% of all other occupations in the United States. Around 13.1% of early childhood educators earn below the federal poverty line (McLean et al. 2024), and childcare workers’ families are more than twice as likely to live in poverty as other workers’ families (Economic Policy Institute 2025). The median early childhood educator wage in every state fall below a living wage for a single adult with no children (McLean et al. 2024), and, at $24,000–$31,000 a year in 2020, falls near the federal poverty level of a family of four ($26,200) (McLean et al. 2021; U.S. Department of Health and Human Services 2020). In one study, at least half of ECE workers had concerns about their ability to pay for their families’ healthcare, monthly bills and inability to take sick leave for fear of lost wages (McLean et al. 2021; Whitebook et al. 2017). In addition, given their relatively low wages, infant care for one child costs an average of 55% of median childcare worker’s monthly earnings (Landiver 2023).

In addition to low wages, there are wage disparities by race/ethnicity for ECE professionals. Even with equivalent educational background, Black and Latina childcare center-based teaching staff (who make up a disproportionate number of center-based and home-based providers) are paid lower wages than their Asian and White colleagues (Liu et al. 2023; McLean et al. 2024). The wage gap between Black and White early childhood educators is estimated to be from $3000 (Roberts et al. 2019) to more than $8000 per year (McLean et al. 2024).

Access to benefits like health insurance are not always available from ECE employers, and family childcare providers do not receive benefits at all, unless they purchase them out of their earnings, as such an estimated 43% of early educators participate in at least one public safety net programs such as Medicaid, the Earned Income Tax Credit, Supplemental Nutrition Assistance Program, and the Temporary Assistance for Needy Families (McLean et al. 2024). Recognizing some of the financial stressors for ECE workers, several states and the District of Columbia have improved supports by covering health insurance premiums (DC Health Link 2022), funding retirement programs (Child Care Providers United n.d.), loan forgiveness programs (U.S. Department of Health and Human Services 1994), and subsidizing childcare costs for some ECE workers (Powell and Dade 2023). Little progress has been made in increasing wages even as federal and state mandates are requiring higher levels of education for ECE professionals (Hall-Kenyon et al. 2014; McLean et al. 2024; Wasmuth and Nitecki 2020).

1.2.2. Pre-Pandemic Stressors for Early Care and Education Professionals

Educators tend to have high daily stress (Gallup, Inc. 2014; Markow et al. 2013), even outside of environmental catastrophes such as wildfires, floods and pandemics. One study showed ECE professionals serving children aged birth to five struggle with physical and mental health more than the broader population of similar demographics, and that nearly a quarter of Head Start teachers showed clinically significant depressive symptoms (Whitaker et al. 2013). Another study in one California county (Whitebook et al. 2017) found 50% or higher ECE workers expressed concerns about not having enough income to pay for their families’ monthly bills, food and healthcare, and not being able to afford to take sick leave due to the fear of losing pay. Only 43% of the ECE workers were able to complete their required paperwork during paid work hours. A wide range of stressors has been shown to negatively impact Home Visitors specifically, including low pay, isolation, workload (duplicative paperwork and heavy caseloads), dangerous environments, inadequate training and secondary trauma (Lewis et al. 2020). High levels of stress have been found to lead to HV burnout, compassion fatigue and high turnover.

1.2.3. Mental Health Challenges During Catastrophe

The COVID-19 pandemic created conditions that exacerbate the numerous existing challenges faced by ECE professionals (Allen et al. 2020; Blum and Dobrotić 2021; Dayal and Tiko 2020; Eadie et al. 2021), and during the COVID-19 pandemic, Early Head Start HV turnover rate increased significantly from about 19% in 2019 to nearly 29% in 2022 (Sandstrom et al. 2024). Initially home visiting programs had to quickly adapt from providing in-person home visits with families to a new remote model in response to COVID-19, including relying on teleconferencing (Williams et al. 2021). ECE professionals manage family/work balance, health challenges, and economic challenges under normal circumstances, but may lack sufficient coping skills to navigate additional crisis conditions (Atiles et al. 2021), including fear of losing their jobs, and worries related to their professional duties (Dayal and Tiko 2020). Importantly, although the pandemic caused many ECE professionals to experience poorer well-being, there is evidence that many were able to prevent this from impacting the quality of their work with families. For example, in one study, ECE professionals were more than twice as likely to indicate that the pandemic negatively impacted their personal well-being (86%) as having a negative impact on their relationship with children (37%) (Eadie et al. 2021).

1.3. Early Head Start—What It Does and Who It Serves

Early Head Start (EHS) is a national initiative that began in 1995 as an expansion of the Head Start Program (Office of Head Start n.d.). EHS provides high-quality support services to families in poverty with children aged 0 to 3 years, designed to help children meet developmental milestones. These services are delivered either as home-based services via HVs, center-based services or through Family childcare services (Office of Head Start n.d.).

Family Foundations (FF) EHS is a non-profit organization in the mid-Atlantic region of the United States, which provides EHS home visiting and additional services across six regions of one county, three within a mid-sized city and three outside of the city. FF EHS implements principles from the theory of family support using “strengths-based practice, relationship-focused work, collaborative partnerships between families and staff, and program services rooted in and responsive to local communities (McAllister and Thomas 2007). Through weekly home visiting, staff support families in the development of positive parent–child relationships, providing parenting education, children’s developmental assessments, and developmentally appropriate, engaging activities. HVs additionally support parents in meeting family goals relating to family relationships, employment, mental health, and housing. Parents have opportunities to take on leadership positions through parent committees and policy council, and to participate in bimonthly group socializations for families to engage in activities facilitated by FF EHS staff.

The three city regions served by FF EHS are made up of dozens of neighborhoods in which up to 26% of families are living below federal poverty levels, as well as some neighborhoods that have been gentrified in the past decade (

Table 1. Family and child demographics by region, served by FF EHS.

Region	Population	Poverty Rates: % Families Below Poverty *	# of Children < 5 YOA in Female-Headed Households Below Poverty-Level **	# of Children 0–3 Receiving Early Intervention Services ***
				Cognitive Development Concerns	Physical Development Concerns	Social–Emotional Concerns	Speech/Language Delays
City regions, each inclusive of multiple neighborhoods
EE	77,856	9.5–21.1%	815	3	147	44	162
NS	41,088	5.8–12.2%	731	3	106	21	99
HL	54,826	4–26.2%	815	1	73	18	62
County regions, each inclusive of small adjacent communities
CL	19,589	2.6–14.9%	711	13	417	95	442
MR	24,024	5–21.1%	346	8	258	49	248
TR	35,747	7.4–28.4%	301	1	46	16	77
Total	253,130		3719	29	1047	243	1090

Source: 2020 U.S. Census. https://www.census.gov/quickfacts/ (accessed on 31 March 2023) * S1702: Poverty Status in the Past 12 Months of Families, 2021 ACS 5-year estimates. Range represents poverty status across multiple communities included in each service area. ** B17006: Poverty Status in the Past 12 Months of Related Children Under 18 Years by Family Type…, 2021 ACS 5-Year Estimates. *** The Alliance for Infants and Toddlers; Children Receiving Services 2022, Ages Birth to 3 years old.

). Across these regions over 2300 children under 5 years of age live in single female-headed households below poverty level, and a sizable number of children under 3 years old are receiving early intervention services for a range of developmental concerns. Three additional regions outside of the city are former industrial towns and small suburbs with family poverty rates up to 28%. These communities are generally at a significant distance from city services and lack sufficient community resources, including limited or no public transportation, few or no full-service grocery stores and limited quality childcare options. In these communities, over 1300 children under 5 years old live in single female headed households below poverty level, and a significantly higher proportion of children under 3 (compared to the city neighborhoods served) receive early intervention services for concerns including cognitive and physical development concerns, social–emotional concerns and speech and language delays.

Families living in poverty experience a range of inherent challenges, including financial instability, unreliable or unaffordable childcare, psychological distress and physical health issues (Karpman et al. 2020; Sandstrom et al. 2019; Spiteri 2021). Instability in employment and associated economic hardship and stressors can negatively impact young children’s physical and mental health (Golberstein et al. 2019; Kalil 2013). HVs work with families in the context of these many challenges, aiming to help families navigate circumstances and connect to resources as effectively as possible for the benefit of their young children.

2. Materials and Methods

As an external evaluation team contributing to ongoing quality improvement efforts of FF EHS, evaluators conducted focus groups with twenty-five HVs to learn: (1) their perspectives on the impact of the COVID-19 pandemic on EHS families, in particular given shifts to remote home visiting and (2) the work experiences and changing needs of HVs during the pandemic. Trained facilitators led three focus groups on a remote platform, due to pandemic restrictions, between December 2020 and January 2021, each with HVs representing two FF EHS locations within the county. The six FF EHS sites include three within the city, and three in economically distressed communities outside of the city (Table 1). All HVs were women, representing a variety of races, predominantly Black and White, and ranged in their years of experience with EHS, some having been employed in the field for a decade or more, including with other home visiting or EHS programs.

As part of a community-engaged and participatory approach to this evaluation research (Cousins and Earl 1992; Wallerstein and Duran 2010; Wiggins et al. 2017), evaluators engaged with a leadership team of FF EHS staff, including coordinators from the six sites, to construct and revise focus group questions, and shared findings with and responded to questions from a joint staff and parent leadership group. FF EHS site coordinators indicated that focus groups including HVs from across sites would be ideal, in that they could be conducted remotely and give HVs the opportunity to share space and ideas with peers from other locations. Focus groups were recorded with HV’s verbal permission to ensure accuracy, and data were transcribed by a third-party service. Three researchers parallel-coded line-by-line in various pairs, reaching consensus on each assigned code, and using grounded theory to identify emerging themes and conceptual relationships, including representative quotes to demonstrate findings, and documented the analysis process to ensure confirmability and credibility of findings (Tolley et al. 2016). Findings from this qualitative evaluation research on process and outcomes supplement quantitative neighborhood-level community assessment data (across topics such as household income, households with young children, home rental costs and other topics impacting low-income families), which were collected and shared with FF EHS leadership for their ongoing program improvement efforts, and in keeping with their federal funding reporting requirements.

HVs reflected on experiences over the prior year, which included the early stages of the pandemic in March 2020, when home visits had to rapidly shift to remote, an extended period with no available vaccines, and the anticipatory period of soon-to-be-available vaccines in January 2021. Lockdowns, school shutdowns and shifting public health messaging regarding risk, masking and vaccination all impacted HVs as well as the families they serve within the County.

3. Results

This paper spotlights the voices of Home Visitors, including their perspectives on how families were faring, both with expected and unexpected dynamics. These are shared here as important context for understanding HV experiences of work inextricably tied to families. Parent voices on their own experiences are critical and explored separately. HVs discussed the impact of pandemic changes on their work, including challenges engaging families remotely, shifting work expectations and adaptations, increased work and work-related stress, isolation and loss of peer support, and dissolution of boundaries between their work life and private life.

3.1. Increased Challenges and Unexpected Benefits for Families

Home visitors supported many EHS parents facing significant challenges managing family dynamics, caring for young children while working from home or assisting their siblings with remote schooling, as well as managing isolation and mental health challenges brought on by the pandemic. HVs described families managing “constant change and disruption to everything” and parents who were exhausted, overwhelmed, anxious and depressed. They saw the disruptions caused by the pandemic as exacerbating the challenges low-income families already had before the pandemic due to being low-income and often in under-resourced communities. Families managed new logistical challenges around closing childcare centers, reduced transportation options, due to both families’ lack of private vehicles and their fear of using public transportation, as well as varying levels of comfort with and access to the technology newly required for communication, schooling, work, and home visits. As one HV shared:

“It’s the same challenges that I’ve always seen with the same families, but it’s times ten. It’s the housing. It’s the transportation. It’s ‘I can’t get to appointments. I can’t pay utilities. I can’t get enough food,’ but it’s just amplified.”

HVs also described a range of concerns that parents had about their children’s welfare. Many parents were confused by emerging negative behaviors of their small children who were newly surrounded by siblings or having to play solo while parents worked from home. Parents expressed concerns about their children’s social skill development and concerns about the unknown, what life would be like when they were no longer in isolation.

HVs also reported on positives they saw for their families in the shift to “remote everything” (schooling, services, some parents’ work), including their observations that many parents seemed to be more actively engaged in parenting during the tele-home visits than in the past, participating in activities with their children and increasing their knowledge of child development through the process of documenting activities. According to one HV, “So I think the parents are strengthening their relationship with their child through more hands-on with their children, as opposed to us being in the home.” HVs indicated a growing sense of technological savviness among parents for accessing mental health services and pediatric appointments, finding resources and social support groups. “…they’re figuring out how to use the tool [technology], not just as a social tool which you’ve always used, but really as a productive tool.” Some parents learned how to use technology in new ways to benefit their lives, including using FaceTime for their child’s physical therapy, finding the resources they need, and using apps that connect them with other parents, such as mom’s groups and support groups. Some parents gained better access to mental health counseling or were better able to attend doctors’ appointments. HVs described parents participating in activities with their children and increasing their knowledge of child development through documenting activities.

3.2. Impact on Home Visitors’ Experience of Work

Even though HVs saw a myriad of positives for parents when visits happened remotely or outside of the home, they did not see positives for their own work. Significant challenges that HVs managed included remotely assessing and engaging young children and supporting families, especially those who are non-native English speakers.

3.2.1. Challenges Working Remotely with Small Children and Parents

As the pandemic restricted HVs’ in-person weekly visits and required a shift to remote visits, this impacted HVs’ ability to engage directly with children in hands-on activities and modeling for parents, as well as relationship building with both. The experiences of HVs during remote visits presented innumerable challenges and frustrations, including the difficulty of assessing children’s development and making necessary recommendations in a virtual environment. There were fewer opportunities to view interactions between parents and children virtually, leading HVs to worry about what might be missed in assessments, potentially missed opportunities to identify children in need of early intervention. HVs were challenged to coax young children to engage in ‘home visits’ conducted on a screen. Expressing this difficulty, an HV explained, “They may walk away or just say they’re done, and I’m really big right now on not forcing the kids because they’re stressed, and they can’t verbalize it.”

HVs encountered challenges engaging remotely with parents, but especially with families who were not native English speakers—using technology was difficult for many, and children and parents began losing the English they had gained, thus making communication and relationship building for HVs more difficult.

When I’m in person I understand them perfectly fine. Over the phone, I have no clue what they’re saying. I don’t think we understand how much, when we talk about communication, it’s body language, and it’s something about that in-person interaction that allows you to understand what they’re saying.

HVs were challenged to get past surface-level engagement with many parents via tele-home visits, and tired from the additional effort. “Trying to get enthusiasm and empathy across a camera or a telephone all the time for work is really, really difficult and exhausting.”

3.2.2. Shifting Expectations and Adaptations

Expectations for contact with families and documentation requirements shifted multiple times as the pandemic unfolded. HVs were unclear on how to meet their usual work objectives, as they did not translate easily to the pandemic world.

We’re all doing so much that we don’t know how to do.

This is a different world. This is a completely different world. You can’t hold me to the standards of when things had some sense of normalcy. It doesn’t work like that. It has to change.

‘Adapt to this. Adapt to that. Adapt to all of these things.’ right? And it’s tough. It’s tough.

3.2.3. Work and Stress Increased

HVs’ workload significantly increased as they needed to remind parents of appointments more frequently, deliver supplies to families, research new home visiting strategies, and manage increased documentation. HVs experienced an increase in clerical work and required documentation, causing additional stress for many.

I feel like it’s like I’m never not working.

I used to love-- I was never late on paperwork. I was always done … I kept all my visits. I enjoyed my job. [Now] I hate it. I literally hate it now and just looking at the paperwork—if you all could see my desk back here [gestures to background] Do you see this? Do you see all of this stuff?.. …it’s just so overwhelming, and it just gives me so much anxiety. It’s just like where do I begin? Something as simple as paperwork has to be put off until bedtime. But then at that point, you’re exhausted. So, it’s like, how do you manage that?

And it’s not even that we’re complaining. We’re really trying to let you guys know how our life has changed since we’ve been working from home. And how frustrating it is. And how hard it is.

As always, HVs needed to recruit new families and build rapport, but now they needed to find innovative ways to engage children remotely or in outside venues like porches and parks. “Early childhood [education], it’s our craft. So, everybody is throwing all kinds of different strategies around to pull these kids and their parents in virtually.” This also led to HVs experiencing significant shift in their roles, moving from focusing on interactive child development to engaging with the family in a more services-related role, which they described as “more social work, parent support and less child-centered stuff”, in which they felt they were “more of a therapist”, and “not working in my strength.”

3.2.4. Shifting and Missing Boundaries

HVs recognized that families had extra needs during this time and responded with increased flexibility. However, the shifts in their boundaries with families resulted in a significant lack of work–life balance. HVs shared that before the pandemic they had strict boundaries as a form of professionalism and self-care, such as not answering phone calls after the workday, but this shifted with the pandemic.

Before, I had a very strict, ‘When my workday is done, I’ll answer you tomorrow,’ But with the stress that’s going [on], I just feel I want to be there with them. So… even if it’s during the day, if I have five different families texting me during the day, I’m answering this text versus, like you said, just going into their home once a week.

They just don’t look at the time that they’re calling you. Your phone could ring at 9:00 p.m. because there’s something that they just have to discuss... you don’t want to make them feel that they’re not important to us.

HVs faced the challenge of enforcing boundaries after work hours and wanted to be responsive and supportive of their family’s needs.

[Even after hours] I will peek at my phone. It’s right there. So, there is that sense that work is just always there. Not to mention the emotional part because you care about these families—they’re people. And so, you are invested. It’s not just a job that you leave. So, there is those thoughts about them and what they’re going through.

HVs working from home had no transition time or space between intensive family visits, unplanned, and sometimes emotional, family support calls, paperwork, and their own home life, impacting their ability to manage life demands in addition to work.

3.3. Impact on Home Visitors as Humans

3.3.1. Isolation and Loss of Peer Support

HVs described that the first many months of remote work were isolating, without the frequent and informal peer interactions that typically provided opportunities to share resources, intervention ideas and morale boosts.

It’s really been very isolating, personally, professionally, to feel like I’m doing this job alone.

[I want to ask other HVs] how did you get to that intervention? Did it actually work? What was the response from the family? What was the response from the other staff? That’s the kind of thing, that back-and-forth conversation, is what we’re missing.

HVs described the need for safe spaces to talk openly about their struggles, fears, and frustrations, a space without management and where home visitors are free to set the agenda, process what they are feeling and receive the support they need, without judgment, so they can continue to do the work they deem important.

A more informal environment where we don’t have to be so professional, so I can say, ‘I hated doing home visits yesterday. Did anybody else?’ [laughter]… because we really need to get that off our chests.

3.3.2. Home Life Stress

HVs shared that the combination of work stress along with the rest of life stressors, exacerbated by the pandemic, was very challenging to manage.

Right now, I’m a home visitor, I’m a teacher. I’m a mom, I’m the lunch lady. I’m making sure people are getting naps. So that I can plan around my other visits. And I’m trying to hurry up and eat so that I can do this visit and do this assessment. And I just feel really strained and stressed and I’m pulling in every other direction.

These personal and household situations often mirrored those of the families they helped. Managing both personal life stress and work stress was not a simple task to accomplish, often resulting in emotional drain, mental fatigue and frequent burnout as highlighted in the HV quotes below:

Anything would be easier than what we’re doing right now.

It’s just you kind of pick your poison, your happiness, your mental health, or kind of your paperwork and your job and your income.

COVID has burnt me out. I’m burnt out. I’m done. [laughter] I feel like I don’t have much to give right now. I’m tired. Because you’re trying to talk to someone else and be supportive, help them out. But you’re dealing with some of the same stresses too.

Taken together, these findings highlight the dual impact of the pandemic on families and HVs, exacerbating existing inequities while also revealing new opportunities and challenges. While HVs witnessed increased strain on families and adapted in innovative ways, they simultaneously experienced deep professional and personal tolls. Their reflections emphasize the need for responsive systems of support that center both the well-being of families and the workforce that serves them.

3.4. Limitations

Although this research makes contributions towards understanding the impact of the COVID-19 pandemic on HVs, there are some limitations. First, as a community-engaged qualitative study, context is critical, and caution should be taken to avoid generalizing findings to communities with significantly different demographics or community resources. Second, the dynamics of virtual focus groups are different than in-person groups, and this may have affected the level of participation by HVs while sharing information. However, through many years of continuous quality improvement projects, the evaluation team/facilitators remained the same, and many HVs were familiar with the team members and expressed comfort with sharing their perspectives. Additionally, the facilitators were experienced in qualitative data collection and conducting remote research activities to probe and encourage participation during the virtual focus groups.

4. Discussion

Findings highlight multiple ways in which the pandemic affected EHS HVs’ experiences of trying to support families while managing new and additional burdens brought on by the crisis (Figure 1). The evaluation team noted how markedly stressed and fatigued HVs were, in stark contrast to over a dozen prior years of data collection. Ovals and rectangles in this model are drawn deliberately shaky or off-balance, suggesting the stressful dynamics described by HVs.

HVs managed multiple challenges through the pandemic, trying to adapt their practice to remote platforms and becoming familiar with new technology quickly. HVs’ reflections on the difficulties of shifting their focus from providing services, their strengths, to engaging families online mirrors national experiences. During the initial months of school closures due to the pandemic, 25.27% of ECEs nationally had not received any training on remote learning (Steed et al. 2022). Among those who had received training, it was on using teleconferencing tools rather than on how to engage with and provide lessons to children online (Steed et al. 2022). An earlier study examining the efforts of ECEs during the pandemic found these staff needed increased support to learn virtual platforms and engage children online, and efforts to engage ECEs in redesigning training content to prioritize the immediate needs of the ECEs proved successful (Crawford et al. 2021). One survey of over 1300 ECE programs with HVs found 40% cited knowledge on how to adapt visits as a challenge, and over half cited privacy concerns and HV comfort as challenges (Tai et al. 2021). Utilized out of necessity in crisis, teleconferencing has remained an option to connect with families when they cannot host a home visit (Al-Taiar et al. 2023; Korfmacher et al. 2021). However, HVs must also contend with families’ technology limitations, including major challenges in access to stable internet (50%) and hardware to support video conferencing (52%), as well as their comfort with using the technology for home visits (62%), describing this as a challenge, and another 20% as a major challenge (Tai et al. 2021). Sharing the resources and strategies that ECEs developed through the pandemic (Crawford et al. 2021) to guide HVs on successful remote engagement could prove invaluable in any variety of circumstances, including environmental crises like hurricanes and wildfires or the next health crisis. Arguably, professional development opportunities such as training, continuing education and resource development should incorporate HVs’ perspectives and needs, aiming to build ECEs’ resilience in anticipation of the unexpected.

HVs were struggling with numerous stressors including worrying about and being responsive to families, challenges engaging them online, shifting expectations, increased documentation, blurring boundaries and their own life stressors. They spoke to the need for peer support and opportunities to vent without judgment, and shared resources and ideas with their colleagues. These findings are echoed in the literature, suggesting positive relationships with peers as an effort to reduce burnout. HVs with limited opportunities to collaborate with colleagues have been shown to be more likely to be stressed and to develop symptoms of burnout (Jovanovic 2013; Lewis et al. 2020), while having positive relationships and collaborations with colleagues supports HV well-being (Nislin et al. 2016), including through a pandemic (Kuhns et al. 2024). Nationally, while many HVs have found their work with families and children to be rewarding, they have also experienced varying levels of secondary trauma and burnout even before pandemic times, exacerbated by a perceived lack of supervisor consideration (West et al. 2018). Studies since the COVID-19 pandemic reveal correlations between HV anxiety, compassion fatigue and burnout and suggest these can be mitigated with operational procedures that prioritize and emphasize work with families over strict fidelity to program models (Ross et al. 2023).

HVs discussed the importance of communication and transparency regarding process and decisions in a time of crisis, and the need for additional curriculum support and new strategies to help translate how to accomplish the goals and activities in the shift to virtual programming. HVs were also interested in outside mental health supports. There is evidence that ECE workers can benefit from professional supports to bolster their well-being (Cumming and Wong 2018; Eadie et al. 2021, Korfmacher et al. 2021), and that buffer against work stressors, including additional training and coaching, informal peer support and formal networking and support through networks and associations (Bromer et al. 2021). Research since the pandemic reinforces that HV stress (except that associated with safety concerns on home visits) can be mitigated with supportive supervision, workplace cohesion and open communication (Kuhns et al. 2024).

The National Home Visiting Resource Center (2020) provides key recommendations that this work supports. Recommendations include:

Provide ongoing training and coaching for home visitors to address sensitive topics like the many that families are managing can help to build HV skills and confidence, and help them to avoid burnout; provide training for supervisors to provide ‘reflective supervision’ to allow HVs to explore feelings arising from interactions with families and detect any signs of mental distress; incorporate well-being practices through trainings on detecting signs of distress can raise HVs awareness of secondary traumatic stress and help them develop strategies of self-care. Training on stress reduction, to develop skills and knowledge around positivity and communication, empathy and emotional self-regulation has had a marked impact on home visitor retention rates and promotes positive workplace cultures via modelling and practicing self-care through exercise breaks, retreats with experts and paid time off. Workplace culture can further be enhanced by promoting staff empowerment, encouraging staff to seek support from leadership, maintaining manageable caseloads and ensuring adequate wages and benefits.

Largely, concerns about wages did not come up in these focus groups; HVs were most focused on how to manage doing their work well given the circumstances. Some HVs did indicate that receiving some help to cover the cost of increased internet or phone use would be helpful, but this was not common. However, given that the turnover rate in childcare work is about 65% percent higher than in other jobs (Fee 2024), and that turnover and attrition in the field directly negatively impact staff and families, consideration of wages and opportunities to reduce financial stressors are warranted. Financial insecurity is a significant concern for ECEs (McLean et al. 2024); unless there are multiple earners in a family, childcare workers may be unable to afford to stay in the field. In addition, since caseload management during a crisis may unavoidably demand high mental resilience, it would be helpful to relieve other sources of stress to support ECE well-being in times of crisis. Nonetheless, since improving wages is largely dependent on the shifting political will of federal funders, EHS programs can meanwhile bolster organizational policies and resources that support HVs while advocating for financially competitive wages.

Importantly, as part of a participatory evaluation approach, findings were shared in several ways with participants. After all data collection and in the early analysis process, when initial findings suggested a level of HV distress that the long-time evaluation team had not witnessed before, anonymized aggregated feedback was shared with FF EHS leadership to inform their approaches in this difficult time. At the study conclusion, in addition to a formal written report to meet federal funding requirements for evidence of ongoing quality improvement, the evaluation team presented a detailed overview with evidence and key findings to a shared leadership team meeting of parents, staff and leadership. We answered questions and received confirmation of the accuracy and importance of our findings from multiple perspectives. FF EHS then used findings in the development of multiple initiatives to meet HV needs, many of them in keeping with the National Home Visiting Resource Center recommendations, including a well-received Partner with Peers program to be explored elsewhere.

5. Conclusions

Early Care and Educators, and Home Visitors in particular, play an invaluable role in the development and health of children and their low-income families. Their roles and deep commitment are especially critical in the absence of policy-level changes that could more broadly support low-income families, such as ensuring living wages, affordable health care, affordable housing, paid parental leave and affordable quality early childhood education. HVs’ ability to adapt through the COVID-19 pandemic to provide ongoing services was marked, and their insights offer opportunities for providers and policymakers to consider how to better support their work, especially in the likely event of environmental crises. More frequent wildfires, hurricanes, floods and potential pandemics are among the number of significant disruptors to this critical and effective intervention model for families. HV reflections underscore the emotional cost of the work and the urgent need for systems that recognize and support the humanity of HVs, especially in times of crisis. Efforts to provide continuing education and training, responsive supervision, transparent and open communication, opportunities for peer support and improved wages could dramatically impact retention of this dedicated workforce and the proven benefits to children from low-income families.