From Burnout to Policy Change: How Social Work Research Informed Workforce Retention In Home Visiting Programs

Background and Purpose
Home visiting programs provide critical support to expectant parents and families with children up to five years old through regular visits by trained professionals. These programs promote child development, family health, and parenting capacity, particularly for families facing socioeconomic risk. However, high levels of stress, secondary traumatic stress, and burnout among home visiting staff contribute to workforce instability, threatening service continuity and equity in access to care. Turnover disrupts relationships with families and undermines program effectiveness, especially in underserved communities. This study examines how stress, burnout, and work environment influence turnover intention among home visiting staff and identifies multilevel drivers of workforce strain. Importantly, this study also demonstrates how research findings informed statewide policy and programmatic changes to strengthen workforce retention in a Midwestern state.

Methods
This mixed-methods study used data from the 2025 MIECHV and IDHS-DEC Home Visiting Workforce Survey (N = 138), administered by the Center for Prevention Research and Development at the University of Illinois Urbana-Champaign. The sample included 116 participants (73 home visitors and 43 supervisors). Participants reported levels of stress, burnout, satisfaction with work environment, and turnover intention, along with open-ended responses on sources of stress. Structural equation modeling was used to examine direct and indirect relationships among stress, burnout, work environment, and turnover intention. Qualitative data were analyzed using thematic analysis in NVivo to identify multilevel contributors to workforce stress.

Results
Findings identified burnout as the central mechanism linking stress and work environment to turnover intention. Stress was indirectly associated with turnover through burnout, while burnout was a significant predictor of turnover intention. Work environment had both direct and indirect effects, with more supportive environments associated with lower burnout and reduced turnover intention. Qualitative findings revealed that stress and burnout were shaped by interconnected factors across multiple levels. At the individual level, staff reported secondary trauma, challenges with client engagement, and work-life balance. At the organizational level, workload, administrative burden, and workplace climate were key contributors. At the community level, limited resources for families, referral system gaps, and language barriers further intensified stress. Critically, these findings were translated into actionable changes at the state level. The Illinois Department of Human Services implemented research-informed strategies, including mental health consultation for staff, “Joy in Work” continuous quality improvement initiatives, establishment of a salary floor, reduction of administrative burden, and simplification of reporting requirements.

Conclusions and Implications
This study advances social work research by demonstrating how rigorous, mixed-methods inquiry can directly inform policy and organizational change to promote workforce stability. Findings highlight burnout and work environment as predictors of turnover and key leverage points for intervention. By translating research into policy action, this work contributes to strengthening the home visiting workforce and improving service continuity for families, particularly those experiencing structural inequities. Future research should evaluate the impact of these policy changes on workforce well-being and retention. This study underscores the role of social work research in advancing equitable, community-centered systems and driving meaningful change at the practice and policy levels.