Four types of staff implemented the program: (1) assessors evaluated potential clients’ eligibility for services, (2) program coordinators oversaw the program and supervised staff, (3) home visitors met regularly with families, and (4) clerical or administrative staff supported the program (two studies). HANDS
also employed regional technical assistants to support sites (one study). To consolidate resources, staff in many counties served more than one role. Coordinators, for example, may have also functioned as assessors or home visitors, and some coordinators oversaw more than one county. Staff, particularly assessors, may have had other job duties in the health department besides HANDS
. In some sites, interagency council members (such as obstetricians) referred clients to HANDS
or helped train staff (pilot study).
Coordinators and assessors were mainly registered nurses (RN), licensed practical nurses, or licensed social workers. In one study, an RN or social work license was required to conduct the assessment. Home visitors were typically paraprofessionals with some public health background or had a bachelor’s degree in a related field (pilot study). Another study reported that both professionals and paraprofessionals served as home visitors. Professional staff included licensed public health nurses, social workers, college graduates with case management experience, and individuals with advanced training in early childhood education. Paraprofessionals were required to be at least age 18. Experience levels varied across sites, but most HANDS staff had prior experience in home health (typically as aides). Many home visitors, for example, had been involved in another statewide program that followed young pregnant women through their child’s first birthday (two studies).
All HANDS staff in the state participated in a pre-service training held at a central location (two studies). In the early implementation phase, the training lasted four days for coordinators and five days for home visitors and assessors. Program coordinators often attended more than one training. Pre-service training was described as interactive—with lecture, discussion, and role-playing—and trainees were assigned homework at the end of each day. Some implementing agencies and collaborating agencies provided additional training for home visitors. In some cases, additional training was offered to those staff who lacked prior experience in home health. Hospital staff in one county presented information on relevant topics, such as breastfeeding and infant nutrition (pilot study). Home visitors in at least a few sites shadowed another home visitor as part of their training (two studies). Another study reported that both professional and paraprofessional home visitors received pre-service training and that paraprofessionals received intensive ongoing training, particularly during the first two years of employment.
Coordinators supervised staff and were sometimes responsible for staff in partner counties (pilot study). Another study reported that paraprofessional home visitors were supervised by a licensed public health nurse or social worker. The format for supervision was not standardized, resulting in varied quality across sites (two studies). However, as part of later implementation, the frequency and length of supervision was standardized, and supervisors typically reviewed charts, caseloads, and case-specific issues, and documented their discussions with staff on a standard form. Some supervisors viewed this time as an opportunity to mentor home visitors. Technical assistants were available to support supervisors in their role (one study).
Caseloads varied considerably across sites. In one site, for example, staff had an average caseload of 15 to 18 families. In another, staff had a caseload of 30 families, including some who persistently missed appointments. Sites attempted to distribute caseloads evenly across staff, and some overbooked staff to account for likely program dropouts. Staff were expected to complete more than three visits per day, though two visits was more realistic (one study).