Social work in early childhood home visitation: State administrator perspectives on the growing roles of social workers

Background: Health care reform has expanded home visiting programs in public health departments, which increasingly employ social workers as home visitors and program supervisors. Little is known about how stakeholders understand the role and potential contribution of social workers or how social work roles develop within established home visiting programs. Methods: Interviews 90-120 minutes in length were conducted with 15 administrators of a statewide home visiting training network in a large Midwestern state. Interviews and field notes were transcribed by the author and analyzed with NVivo 10. Analytic strategies used included open, intuitive, sequenced coding, assertions analysis (content analysis of transcripts and field notes), and pragmatic compression to focus analysis on the research question at hand and give thick description explanatory power. Results: Four primary themes emerged: 1) Social workers from traditional child welfare social work domains have skills easily transferrable to home visitation. 2) Home visiting models emphasize intensive, reflective supervision and master's-level social workers are sought after as home visiting supervisors. 3) Specific social work approaches (e.g., beginning where the client is, using an ecological systems perspective) complement the nonjudgmental, accepting emphasis of home visitation. 4) Social workers' skills in assessment and linkage complement nurses' skills in health education and early childhood specialists' skills in curriculum development. Conclusions: Social workers with master's degrees and skills in reflective supervision, social group work, and strengths-based family assessment are increasingly valued in home visitation programs. Research and education in public health social work will benefit from focusing on these core skills.