The Impact of the Working Alliance on Home Visit Quality in Early Head Start

Background and Purpose

The goals of Early Head Start (EHS) are to “promote the development of the children, and to enable their parents to fulfill their roles as parents and to move towards self-sufficiency.” In working towards these goals, the relationship between parents and staff within the program are vital for furthering parent engagement, increasing collaboration, and ultimately increasing the benefits families receive from the intervention.

The working alliance consists of three key components needed for progress within a therapeutic environment: the agreement on goals between the therapist and patient, the agreement on tasks needed to complete these goals between the therapist and patient, and the bond between the therapist and patient. Over the last forty-four years, the working alliance has been applied to many relationships outside of a therapeutic setting. This includes workplace coaching, teacher-student relationships, and youth psychotherapy.

Although some research examines parents and children as dyads, no research to my knowledge examines the relationship between parents and staff of early childhood interventions as a distinguishable dyadic partnership. Given that the relationship between parents and staff is reciprocal, understanding the influence of this dyadic partnership is key to improving the quality of early childhood interventions. Use of the working alliance to understand home visiting programs provides relevant context needed within early childhood interventions. Understanding the role of the working alliance within EHS will help strengthen the program’s policies and processes by identifying potential areas of training and will expand the research literature.

Methods

Data from the cross-sectional Baby FACES Spring 2022 dataset (ICPSR 38660), provides a nationally representative sample of programs, centers, home visitors, teachers/classrooms, and enrolled families within EHS. Data analysis consists of Structural Equation Modeling (SEM) that treats the parent and staff working alliance as a dyad. The data consists of matched pairs of parents and staff with a one-with-many approach to account for each staff member completing surveys on multiple parents and families. The working alliance between parents and staff is a mixed independent variable with differences both within and across dyads. The model is nonrecursive, with a feedback loop between parent and staff perceptions of the working alliance. Exogenous variables focus on both staff and parent mental health, including staff depressive symptoms, parental depressive symptoms, and parenting stress.

Results

The mental health of parents and staff in EHS is an important factor in both parent and staff perceptions of the working alliance. In addition, the working alliance is reciprocal; staff perceptions of the working alliance influence parent perceptions of the working alliance and vice versa.

Conclusions and Implications

Understanding parent and staff perceptions of the working alliance in EHS provides valuable context for improving outcomes for families. By considering parents and staff as a dyad, influences from both perspectives can impact the relationship. However, additional research is needed with consideration of this dyadic relationship. Policy and practice implications, as well as future research, will be discussed.