ABSTRACT
The article "Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study", written by Paige J. Alitz, Shana Geary, Pamela C. Birriel, Takudzwa Sayi, Rema Ramakrishnan, Omotola Balogun, Alison Salloum and Jennifer T. Marshall, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 31 May 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 25 July 2018 to
ABSTRACT
Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors' engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.
Subject(s)
Adaptation, Psychological , Burnout, Professional , House Calls , Occupational Stress/psychology , Aluminum Compounds , Child , Child, Preschool , Female , Focus Groups , Humans , Infant , Magnesium Compounds , Pregnancy , Qualitative Research , Silicates , Social SupportABSTRACT
OBJECTIVE: The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program aims to minimize the occurrence of adverse maternal and child health outcomes for mothers deemed at-risk during pregnancy or shortly after childbirth. This study sought to understand the needs of and challenges faced by immigrant families in accessing health care through the perspective of Florida MIECHV home visitors, supervisors, and administrators. DESIGN AND SAMPLE: In this exploratory qualitative study, focus groups were held at each of the Florida MIECHV-funded program sites with a total of 81 MIECHV staff to discuss how the program addresses a range of participant needs. MEASURES: Data were collected through 32 semi-structured focus groups. Transcripts were analyzed using a hybrid approach entailing the development of an a priori codebook and thematic analysis. RESULTS: Staff from eight of the 11 programs described social and physical isolation and economic hardship faced by immigrant families enrolled in their programs, resulting in barriers to needed health care and social services. CONCLUSIONS: Home visitors in the Florida MIECHV program served as trusted confidants that helped families navigate social services. Future research should focus on the impact that home visiting has on immigrant health and whether this impact is maintained over time.
Subject(s)
Administrative Personnel/psychology , Emigrants and Immigrants , Health Status , House Calls , Maternal-Child Health Services/organization & administration , Administrative Personnel/statistics & numerical data , Adult , Child, Preschool , Female , Florida , Focus Groups , Health Services Accessibility/economics , Health Services Needs and Demand , Humans , Infant , Infant, Newborn , Poverty , Pregnancy , Program Evaluation , Qualitative Research , Social Isolation , Young AdultABSTRACT
OBJECTIVES: To examine contributing factors and potential reasons for hospital differences in unexpected newborn complication rates in Florida. METHODS: We conducted a population-based retrospective cohort study of linked birth certificate and hospital discharge records from 2004 to 2013. The study population included 1 604 774 term, singleton live births in 124 hospitals. Severe and moderate complications were identified via a published algorithm. Logistic mixed-effects models were used to examine risk factors for complications and to estimate the percentage of hospital variation explained by factors. Descriptive analyses were performed to explore reasons for the differences. RESULTS: Hospital total complication rates varied from 6.7 to 98.6 per 1000 births. No correlation between severe and moderate complication rates by hospital was identified. Leading risk factors for complications included medically indicated early-term delivery, no prenatal care, nulliparity, prepregnancy obesity, tobacco use, and delivery in southern Florida hospitals. Hospital factors such as geographic location, level of care or birth volume, and Medicaid births percentage explained 35% and 27.8% of variation in severe and moderate complication rates, respectively. Individual factors explained an additional 6% of variation in severe complication rates. Different complication subcategories (eg, infections, hospital transfers) drove the hospital factors that contributed to severe and moderate complications. CONCLUSIONS: Variation in unexpected complication rates is more likely to be related to hospital rather than patient characteristics in Florida. The high proportion of variation explained by hospital factors suggests potential opportunities for improvement, and identifying specific complication categories may provide focus areas. Some of the opportunities may be related to differences in hospital coding practice.
