Paraprofessional home visitors’ perspectives on addressing poor mental health, substance abuse, and domestic violence: A qualitative study

This research was conducted to understand paraprofessional home visitors’ perceptions of their training in addressing poor mental health, substance abuse, and domestic violence, and their actions in working with families in addressing these issues. Five focus groups were conducted with a total of 28 paraprofessional home visitors. Three main themes emerged from qualitative analysis. Home visitors experienced tension between addressing families’ more pressing needs such as housing or utilities and addressing poor mental health, substance abuse, and domestic violence. Home visitors felt that they received extensive training in these risk areas, but that this training focused heavily on knowledge acquisition rather than skill development. Home visitors also desired more guidance in addressing families’ poor mental health, substance abuse, and domestic violence concerns—namely, more clarity on the extent to which they should address these issues during visits and more and varied supervision. Home visitors need more training on how to initiate conversations about mental health, substance abuse, and domestic violence, including how to transition conversations from other client needs. Home visiting programs must clarify home visitors’ roles in addressing clients’ poor mental health, substance abuse, and domestic violence and provide additional and varied supervision to home visitors.