By Linda Gilkerson and Kerry Cassidy Norton, Association of Maternal & Child Health Programs, March 2021
Within the past decade, home visiting programs for infants, young children, and families have greatly expanded. In 2018 alone, 286,108 families and 312,635 children received support through home visiting programs in the United States.1 This level of growth requires a skilled and supported workforce ready to address the complex challenges that families who are served experience. Home visiting is a relationship-based service where professionals work with families to support their health and well-being, and assist them in achieving family goals. Often, home visitors help families experiencing intimate partner violence, substance use disorders, and mental health challenges. Home visitors may also have a history of adverse child experiences (ACEs). For example, 81 percent of home visitors in Region X reported at least one ACE, and 33 percent reported having experienced four or more.2 Those with this history are at risk of secondary trauma and burnout, which requires systems to have additional capacity building as well as support for home visitors.
There are strategies that home visitors can use to build strong relationships with families and sustain their own well-being while doing the work. To address this need, the Oregon Maternal Infant and Early Childhood Home Visiting (MIECHV) program participated in the Region X Innovation Grant, which was funded by the Health Resources and Services Administration, along with MIECHV programs in Alaska, Idaho and Washington. This workforce development grant delivered a new home visiting approach to Oregon. This practice, called FAN (Facilitating Attuned Interactions), is a conceptual model and practical tool for relationship building and reflective practice, which can be used regardless of the model of home visiting used and has been demonstrated to reduce burnout and increase reflective capacity in home visitors.3 The theory of change underlying the FAN approach is attunement, defined as engaging with a person so they feel connected and understood which opens the space for change. FAN teaches providers to be as adept at reading adult cues as they are at reading baby cues. Providers learn to observe parents, match interactions to what the parents are most able to use in the moment and respond flexibly to meet them where they are.
To do this, the FAN identifies five processes for attuned communication: Calming, Feeling, Thinking, Doing, and Reflecting, as demonstrated in the graphic below. The model itself can be used in a range of settings across many disciplines, as will be discussed later in this article.
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