Stress As a Central Node: Reflective Supervision and Tenure in Burnout and Turnover Models

Background and Purpose

Home visiting programs provide voluntary support to expectant parents and caregivers of children up to five years old through regular visits by trained professionals. These programs aim to enhance child development, family health, parenting skills, and family bonding, particularly for low-income and at-risk families. Literature showed that home visiting staff were more likely to experience significant secondary traumatic stress and burnout, low job satisfaction, leading to high turnover rates, which can negatively affect service delivery and program outcomes. In addition, research also showed that turnover intention is a strong indicator for turnover. Thus, this study explores how reflective supervision, tenure, stress, and burnout influence turnover intentions among home visitors and their supervisors. We examine whether stress mediates the relationship between support systems (reflective supervision or tenure) and burnout, and whether both stress and burnout contribute to turnover. The proposed study is to inform policy and workforce strategies that promote retention in home visiting programs.

Methods

The study sample included 168 home visitors and home visitor supervisors selected from the 2024 MIECHV and IDHS-DEC Home Visiting Workforce Survey. The survey administered by the Center for Prevention Research and Development at the University of Illinois Champaign – Urbana, reaching 208 home visiting professionals in Illinois with a 74% response rate. Participants were asked to self-rate their stress levels, burnout, reflective supervision, and turnover intentions including demographics. Structuring Equation Modeling was used to explore direct and indirect relationships among the hypothesized variables.

Results

The study identified two distinct models explaining turnover intentions for home visitors and their supervisors. Among home visitors (n=117), reflective supervision and stress influenced turnover intentions indirectly through burnout. Specifically, lower levels of reflective supervision were associated with higher stress, which contributed to greater burnout and subsequently, increased turnover intentions. Additionally, elevated stress independently led to higher burnout and a greater likelihood of turnover intentions. In contrast, the model for home visitor supervisors (n=51) indicated that tenure had a direct effect on stress and an indirect effect on burnout. Higher stress levels, associated with longer tenure, contributed to increased burnout, ultimately heightening turnover intentions.

Conclusions and implications

Consistent with previous studies, our findings showed that reflective supervision indirectly affects turnover via stress and burnout for home visitors. While tenure indirectly affects turnover for supervisors, possibly because supervisors see tenure as career progression, unlike home visitors. A limitation of this study is the inclusion of only a few key variables, excluding several individual, environmental, and organizational factors. To mitigate turnover intentions, agencies should prioritize raising awareness about stress and burnout, as these issues significantly impact the well-being and performance of home visitors and supervisors. Programs could adopt strategies to alleviate stress, such as creating supportive work environments, strengthening and training supervisor on reflective supervision, increasing trust and organizational commitment, and providing additional training to help home visitors handle the emotional demands of their roles. More exploration on differences in stressors for home visitors versus supervisors might shed light into creative strategies to reduce stressors respective to each position.