Positive Deviance As a Social Innovation for the Prevention Program Workforce

Background and Purpose

Positive deviance as an approach investigates how some deviant behaviors produce valuable/desired social and behavioral change. Within social work and prevention science, positive deviance can inform program implementation by uncovering strategies used by client outliers to achieve desired outcomes. One study (Rotheram-Fuller et al., 2017) used a positive deviance approach in recruiting paraprofessional home visitors, inviting mothers from a local school who were particularly engaging role models to be trained as home visitors, then monitoring how their engagement and performance held up over time. However, as home visitation has been increasingly mandated to use specific, evidence-based program models with a strong emphasis on implementation fidelity, little is known about how positive deviance may inform existing home visiting programs. This study contributes to filling this gap by investigating how positive deviance approaches are present in a sample of non-nurse home visitation programs.

Methods

In-depth, semi-structured, qualitative interviews approximately 90-120 minutes in length were conducted with 34 program administrators in a Midwestern, statewide network of home visiting programs using Healthy Families America/HFA and Parents as Teachers/PAT program models. Interviews were transcribed, coded thematically, and subjected to content analysis. A total of 71 references discussing potential positive deviance were analyzed for themes.

Results

This analysis found four primary thematic topics where positive deviance was present in this sample: 1) Home visitors were framed as de facto role models in small communities anyway and therefore should be positive ones, as one supervisor noted, “We try to discourage spanking, but that’s really hard to do as a home visitor if they saw you spank your child in Walmart a couple days ago.” 2) Positive-deviant supervisors developed reflective relationships with home visitors that moved the work from supervision to coaching, e.g., “eventually you allow staff to get to self-discovery which is far more powerful than anyone telling us what to do.” 3) In the HFA model, positive-deviant participants in home visiting also sometimes became positive-deviant home visitors, who “understand without judgment why a mother sells her food stamps for gas money to get to work.” 4) Positive deviance sometimes competed against other assigned duties and program changes, such as when desire to work primarily with a Spanish-speaking caseload, older children, or pregnant women no longer served by a changing program meant that positive-deviant home visitors quit their jobs.

Conclusions and Implications

These findings point to the potential of positive-deviant supervisors to enhance supervision-as-usual using relationship-based coaching. They also point to how positive-deviant clients can become uniquely attuned home visitors. Future research should investigate in larger samples how home visitors/supervisors are positive outliers within mandated program models, as well as where and why positive-deviant workers leave their jobs. Positive deviance is a promising approach for dissemination and implementation of new engagement strategies in the prevention program workforce.

Reference

Rotheram-Fuller, E., Swendeman, D., Becker, K., Daleiden, E., Chorpita, B., Youssef, M. K., & Rotheram-Borus, M. J. (2017). Adapting current strategies to implement evidence-based prevention programs for paraprofessional home visiting. Prevention Science, 18(5), 590-599. doi:10.1007/s11121-017-0787-z