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

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for your article. It was a very interesting read, and with that in mind, I hope you take my comments in the constructive manner in which they are given. It may well be that some of these comments can be justified by yourselves. 

Line 137-138, is there more recent literature than Miller and Bogatova (2009)? With a declaration such as 'nearly 50% of respondents indicating they did not plan to be in their jobs in five years', we would need more contemporary literature for it to be relevant.  

Line 223 - data is plural, so should be 'data were' not 'data was' - some publishers don't mind it being used as a singular term, so please check with this. 

Line 222 - I noted here that focus groups were recorded with permission - however, I could not find evidence of ethics approval or how consent was gained from participants. Please excuse me if I have missed this. 

Line 237 - should it be 'an' important context? 

I have also noted the paper does not have a theoretical framework or theoretical background. Once again, I will defer to the publishers on this, but a theoretical frame would have supported the discussion. 

On pages 5 and 6 you discuss materials and methods, yet a discussion on methodology is not clear. I see you have used evaluation research, but there is no explanation as to how you employed this approach. This explanation could accompany your use of grounded theory to identify emerging themes. 

The themes were well chosen and the discussion made sense. 

Figure 1 on Page 11 looks wobbly - is it supposed to be? If so, what is the relevance of this? in particular I am referring to the circle in which 'Home stress of crisis' is located. 

Line 421: should this commence 'The' findings? 

Lines 453-464: your use of literature echoing the stress experienced by HVs was prior to Covid. Is there anything during or post Covid? if not, explain this is a gap in the literature and your research will add to the literature. 

Just a general observation, the Home Visitor is a role not necessarily shared by other countries. To this end, a brief explanation to ground your reader may be helpful. Behrens et al. (2025) https://doi.org/10.1016/j.ecresq.2024.11.011 provide an explanation in theirs which may be useful. I did read how you have stated most are early childhood educators ... however, in my very limited experience, they not all are and some maybe therapists (as mentioned by Behrens et al). At times I felt early childhood educator and Home Visitor were used interchangeably - is this accurate?

Overall, I thought the paper would contribute to the literature, particularly in relation to recommending ways to move forward. 

I wish you all the best with your paper. Due to the theoretical frame, I have erred on major revisions. Otherwise it would have been minor. 

Author Response

Thank you for the opportunity to address reviewers’ thoughtful comments, which we are confident will make our paper “Anything would be easier than what we're doing right now.”: Early Head Start Home Visitors’ experiences working through an environmental crisis” stronger.   Please find reviewer comments italicized with their original line of reference below followed by how they were addressed (highlighted in the manuscript).

 

Reviewer 1:

Comment 1:  Line 137-138, is there more recent literature than Miller and Bogatova (2009)? With a declaration such as 'nearly 50% of respondents indicating they did not plan to be in their jobs in five years', we would need more contemporary literature for it to be relevant.

Response 1:  Thank you for pointing this out. We have replaced this sentence with the following and an updated citation:  “A wide range of stressors have 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 turnover.”

 

A few lines later we also updated the job turnover citation:  “…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).”

 

Comment 2:  Line 223 - data is plural, so should be 'data were' not 'data was' -some publishers don't mind it being used as a singular term, so please check with this.

Response 2:  Thank you for catching this - ‘was’ was changed to ‘were’

Comment 3:  Line 222 - I noted here that focus groups were recorded with permission - however, I could not find evidence of ethics approval or how consent was gained from participants. Please excuse me if I have missed this.

Response 3: Thank you for this concern.  Although our Institutional Review Board deemed this evaluation research ‘Exempt’ (reflected in our Institutional Review Board Statement) due to their perspective on program evaluation work executed for the purpose of program improvement, they did so after reviewing our consenting script and methods.  We have added “participants’ verbal” permission for additional clarity.

Comment 4: Line 237 - should it be 'an' important context?

            Response 4:  After review we think context here is broader than ‘an’ would imply.

Comment 5:  I have also noted the paper does not have a theoretical framework or theoretical background. Once again, I will defer to the publishers on this, but a theoretical frame would have supported the discussion.

Response 5:  Thank you for noting the benefits of including a theoretical framework supporting the work of EHS home visitors.  We have included the following language:    [line ~56 on]

“Early Head Start HV work embodies core constructs of Social Cognitive Theory including self-efficacy, modeling and learning in a social context (Bandura, 2986).  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  (Headstart.gov). 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. 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). “

 

Comment 6:  On pages 5 and 6 you discuss materials and methods, yet a discussion on methodology is not clear. I see you have used evaluation research, but there is no explanation as to how you employed this approach. This explanation could accompany your use of grounded theory to identify emerging themes.

Response 6:  Thank you for this observation.  While we do feel that the methods of the research have been detailed, we have added the following sentence (LINE 228-29) to clarify use of findings for evaluative purposes:  “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-families), that were collected and shared with XF EHS leadership for their ongoing program improvement efforts, and in keeping with their federal funding reporting requirements.”

 

Comment 7:  Figure 1 on Page 11 looks wobbly - is it supposed to be? If so, what is the relevance of this? in particular I am referring to the circle in which 'Home stress of crisis' is located.

Response 7:  Thank you for the opportunity to clarify this intentional effort.  We have added the language “Ovals and rectangles in this model are drawn deliberately shaky or off-balance, suggesting the stressful dynamics described.” which we hope clarifies our intent and findings.

Comment 8:  Line 421: should this commence 'The' findings?

            Response 8:  After review we think starting with ‘Findings’ reads as hoped and have left it.

Comment 9:  Lines 453-464: your use of literature echoing the stress experienced by HVs was prior to Covid. Is there anything during or post Covid? if not, explain this is a gap in the literature and your research will add to the literature.

Response 9:  Thank you for pointing out this gap.  While there is not yet much literature, we have updated some citations, lines 497-506 and 514-518.  

Thank you again to the reviewer for the thoughtful questions and comments.  We believe that our responses to these make this a stronger manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this important piece of research describing the experiences of Early Head Start Home Visitors during COVID.  This research demonstrates the impact of COVID not only on families but on the crucial workforce that supports families.

The introduction clearly describes challenges facing the ECE workforce.  For the benefit of readers outside the US it would be helpful to provide some extra context about HVs.  For example, do HVs only come from an education background? Do they have extra training? Are HVs only found in a Head Start context?

The challenges presented seem to be broadly applied to ECE professionals, which include HV.  Is there literature that specifically describes HV experiences rather than ECE more broadly? I expect home visitors to face slightly different challenges to centre-based educators.  Or, are home visits part of the job of an educator in head start? Are there differences between pay, conditions or experiences of educators outside the Head start system? Again, to a reader outside the system, it is not completely clear.

Paragraph 2-3, line 453. These paragraphs deal with HV stress.  Many suggestions on how to mitigate or manage stress are given, most of which encompass support or training.  Whilst these are undoubtably important, they are individual level supports requiring effort and upskilling from the HV.  I wonder about broader system or policy level changes that could actually remove some of the burdens?  This is especially important as the results indicate that HV sacrificed their own wellbeing to do their job.

Author Response

Thank you for the opportunity to address reviewers’ thoughtful comments, which we are confident will make our paper “Anything would be easier than what we're doing right now.”: Early Head Start Home Visitors’ experiences working through an environmental crisis” stronger.   Please find reviewer comments italicized with their original line of reference below followed by how they were addressed (highlighted in the manuscript).

Comment 1:  For the benefit of readers outside the US it would be helpful to provide some extra context about HVs. For example, do HVs only come from an education background? Do they have extra training? Are HVs only found in a Head Start context?

The challenges presented seem to be broadly applied to ECE professionals, which include HV. Is there literature that specifically describes HV experiences rather than ECE more broadly? I expect home visitors to face slightly different challenges to centre-based educators. Or, are home visits part of the job of an educator in head start? Are there differences between pay, conditions or experiences of educators outside the Headstart system? Again, to a reader outside the system, it is not completely clear.

Response 1:  Thank you for the opportunity to address the important (and sometimes vague) distinctions between (and overlap in) roles of home visitors.  While original lines 35-40 aimed to clarify language for the purposes of our study, we have added the following language to further demonstrate the roles of and backgrounds of home visitors, in particular with Early Head Start.  Please see lines ~40-54 for this language: 

“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 (National Conference of State Legislatures n.d.; U.S. Department of Health and Human Services n.d.).  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 associates or bachelor’s degree  (U.S. Department of Health and Human Services n.d.b).

Comment 2:  Paragraph 2-3, line 453.

These paragraphs deal with HV stress. Many suggestions on how to mitigate or manage stress are given, most of which encompass support or training. Whilst these are undoubtably important, they are individual level supports requiring effort and up-skilling from the HV. I wonder about broader system or policy level changes that could actually remove some of the burdens? This is especially important as the results indicate that HV sacrificed their own wellbeing to do their job.

Response 2: Thank you for this observation and consideration of levels above and beyond individual HVs.  We consider the EHS organizational-level policies and approaches to provide supports for HVs to be critical and feasible but agree about the opportunities that system-level changes would provide.  We have added the following two sentences in the discussion and the conclusion to better acknowledge some of these tensions:

“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.”

“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 and accessible health care, affordable housing, paid parental leave and affordable quality early childhood education.”

Thank you again to the reviewer for the thoughtful questions and comments.  We believe that our responses to these make this a stronger manuscript.

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors, 

Thank you for your amendments. 

Congratulations on your paper and good luck with publication.