Staff training and retention in a home visiting intervention:
findings from our evaluation of Saskatchewan’s KidsFirst program
What is KidsFirst?
KidsFirst is a federally-funded, provincially-run intervention
program launched in 2002 that provides support and services
to vulnerable families with young children (aged 0-5) in
Saskatchewan. It is offered in nine areas of the province
that were identified as having high levels of need when
the program was established: Meadow Lake, Moose Jaw,
Nipawin, Northern Saskatchewan, North Battleford, Yorkton
and selected neighbourhoods in Prince Albert, Regina and
Saskatoon.
KidsFirst uses intensive home visiting to build capacity in
families, promote healthy child development and facilitate
goal achievement for parents (such as returning to school or
finding a job). It is a paraprofessional home visiting program,
where lay home visitors receive support from professionals.
KidsFirst is an intersectoral and inter-agency partnership,
and sites collaborate with multiple stakeholders, as well
as contract with many agencies to perform services. At
each site, there is a local accountable partner and a local
management committee that provides guidance on program
implementation.
Saskatchewan KidsFirst Program Evaluation (2007-10): Staffing
As part of a three-year evaluation of KidsFirst, researchers
interviewed participants, home visitors, program staff and
other key stakeholders at each site to learn about parents’
experiences and the program as a whole, and the impact
that it has had. This fact sheet is based on the Report of the
Qualitative Study, available at: www.kidskan.ca/node/279).
The Role of KidsFirst home visitors
KidsFirst home visitors provide support to families on a case-
by-case basis, to meet each family’s needs and build on each
family’s strengths. They work with families in many ways,
including:
• developing trusting, nurturing relationships between
parent and child
• informally teaching parenting skills using the Growing
Great Kids curriculum
• connecting parents with programs, events and services in
their community
• helping parents access basic needs such as child care,
transportation and food
• advocating for parents when they need to approach
community agencies
www.kidSKAN.ca/KidsFirst 1
 • helping parents develop their communication skills and
confidence
• establishing social connections between families and their “They taught me how to stay calm when
communities
KidsFirst home visitors use the Growing Great Kids curriculum,
which is intended to teach families about effective parenting
with a focus on child development needs (see http://www.
greatkidsinc.org). It provides home visitors with a way of
focusing on child interaction and child-centered activities,
which have been associated with positive child outcomes.
This fact sheet is part of a series describing our three-year
evaluation of KidsFirst, funded by the Canadian Population
Health Initiative, and the Government of Saskatchewan, with
some additional support from MITACS, and the College of
Medicine at the University of Saskatchewan. The evaluation
was led by Nazeem Muhajarine, lead of the Healthy Children
Research Team at the Saskatchewan Population Health and
Evaluation Research Unit (SPHERU), in partnership with
staff from the Early Childhood Development Unit in the
Saskatchewan Ministry of Education, and KidsFirst program
staff. A full list of team members is found in the reports.
The following reports were produced as part of this evaluation:
• Evaluation Framework
• Community Profiles
• Focused Literature Review
• Using Theory to Plan and Evaluate KidsFirst
• Report of the Qualitative Study
• Report of the Quantitative Study
• Summary of Findings and Recommendations.
Reports and fact sheets can all be read online or downloaded
from www.kidSKAN.ca, the Saskatchewan Knowledge to
Action Network for Early Childhood Development; go to www.
kidSKAN.ca/KidsFirst, or click on “KidsFirst” under the Projects
menu on the front page. For more information, contact Fleur
Macqueen Smith, fleur.macqueensmith@usask.ca, 306-966-
2957, Knowledge Transfer Manager of the Healthy Children
Research Team in SPHERU.
In the curriculum they lay out really easy, simple activities that we teach them.
Lots of [these activities] don’t even require supplies. [The curriculum] even just
goes back to traditional games like This Little Piggy. — home visitor
2 Saskatchewan KidsFirst Program Evaluation (2007-10): Staffing
the kids get frustrating. And they taught
me how to tone my temper down and
taught me better ways to communicate.
Now I can communicate with my son a
lot more.” — parent
Home visitors adapt the curriculum depending on families’
needs, based on their cultural background and family
context. Some home visitors prefer to make use of “teachable
moments” that arise during visits, while others prefer
teaching in a more structured manner by outlining what
parents will learn in a given day, and spending time during
visits looking through the curriculum book.
If, during any given visit, the parent is not interested in
focusing on the curriculum, the home visitor respects that.
Further, when families are dealing with a crisis, the home
visitor’s first priority is to help them get through it.
More often than not, families find the curriculum useful. One
family noted to their home visitor that the curriculum has
“completely changed how [we] parent.” Home visitors have
also maintained that it leads to family development.
I have a family with a mom and dad. I was sitting talking with
them, and the dad was teaching, or playing, with their daughter,
and feeding the daughter, and he was doing one of the brain
builders [from the curriculum]… she was only two years old
… and I noticed the bonding between the [family]. They were
working as a team.
— home visitor
www.kidSKAN.ca/KidsFirst
Staff training and and retention
KidsFirst was designed as a dyad model of home visitation, in
which professionals, usually with a background in social work,
and paraprofessionals, who do not have formal training, work
together to meet the needs of families. In KidsFirst, program
managers and home visiting supervisors (professionals) train
and supervise home visitors (paraprofessionals).
In practice, however, home visitor supervisors are not
always trained professionals. While the job requirements for
home visiting supervisors typically involve a higher levels
of education than that required for
home visitors themselves,
backgrounds of these staff
members vary from site to
site in the program. Some
adhere strictly to the dyad
model, while others diverge
significantly in their hiring
practices.
Each site is responsible for staff
training and development.
Training varies from site to site,
covering areas such as early
speech development, family
violence, safety, FASD, HIV/ AIDS/ hepatitis,
autism spectrum disorder, breastfeeding, nutrition, family
literacy, non-violent crisis intervention, shaken baby
syndrome and postpartum depression. One site allows all
home visitors five professional development days each year
to increase their skills. Another site has put almost of its
home visitors through a second tier of training in the Growing
Great Kids curriculum, while a third has implemented a skill
development and mentoring process for home visitors.
Most of the nine sites have reported challenges in retaining
staff, citing a variety of reasons: burnout, having to work
in high-risk environments, a lack of workplace support,
low wages, and finding other avenues for career growth.
(These challenges are described in detail in the Report of the
Qualitative Study, available at www.kidskan.ca/node/279).
High burnout: Some home visitors say that they did not
clearly understand the nature of the work or their job
descriptions when they were first employed. Because of the
sensitive and demanding nature of these jobs, some home
visitors have had problems establishing boundaries between
their jobs and home lives.
High risk: Safety was a concern for many home visitors. In
small town sites, KidsFirst families might know where staff
live and visit them at home. Home visitors also had to deal
Saskatchewan KidsFirst Program Evaluation (2007-10): Staffing
with people facing addictions or substance abuse issues, or
situations in which a parent posed a safety risk to the family.
On top of this, many visitors had to deal with environmental
hazards such as mould, mice, bed bugs and lice.
Lack of workplace support: While many sites are trying
to find ways to reduce burnout or ensure they provide a
workplace with open communication, the lack of support for
staff remains a challenge. In some cases, tension between
various levels of administration, or management and staff has
led to high turnover.
Insufficient salary: Many said their
income, which in some cases was
capped, was not enough for them
to live on, especially in light of the
heavy work load and high risk
nature of the job. The situation was
especially tough for those trying
to raise their own families. Many
were unable to get by without
some kind of supplement to their
income. In some case, home
visitors took second jobs or set
up businesses on the side to bring
in more income. In response, the pay
scale has been upgraded to reflect qualifications and
experience in some cases.
Growth opportunities: Some home visitors use home
visiting jobs as a stepping stone, particularly in light of low
pay rates or the fact many start with minimal qualifications
and education. For some, the job of home visitor provides
relevant training and experience, which ultimately allows
them to find better-paying positions elsewhere, especially in
larger communities.
Beyond the obvious logistical obstacles for the administration
of KidsFirst, staffing issues also undermine the very nature of
We also have a lot of paperwork
for every phone call we make, for
everything that we do… Sometimes
it’s hard ... There’s not enough time in
the day.
— KidsFirst staff member
www.kidSKAN.ca/KidsFirst 3
the work home visitors do. High case loads mean less time
for home visitors to spend with each family, and high staff
turnover means the relationships built between visitor and
family are severed when a home visitors leaves the job and
has to be replaced.
Dealing with staffing
challenges
KidsFirst program managers
have taken many approaches
to dealing with staffing issues,
such as conducting salary
reviews, providing more training
opportunities, and holding staff
retreats and conferences with
sessions to support home visiting
staff, such as self-care and safety.
Some KidsFirst program sites match potential home visitors
with families that would best suit them. While in some sites,
home visitors need formal qualifications in order to best
support a family, at others, personal experience is valued
over a formal set of skills. At one site, families are invited to
attend the interview process with potential home visitors,
and the family’s comfort level with an applicant is a factor
in determining whether the person is hired. Such steps are
designed to best ensure a strong relationship between visitor
and family.
However, one of the findings of the evaluation noted that
improved staff retention is one area of the program that
should be addressed (see the Summary of Findings and
Recommendations at www.kidskan.ca/node/281). One
possible direction would be for KidsFirst to hire specialized
home visitors for the high-needs families, known in the
program as complex-needs families. The evaluation showed
that these families are hard to reach and retain in the
4 Saskatchewan KidsFirst Program Evaluation (2007-10): Staffing
program, and that lay home visitors are not able to deal with
some of the specialized issues that arise with these families.
Specialized case workers with training in psychology,
nursing, mental health, and social work could take a greater
role in serving high-needs families. This
would better address the needs of families
experiencing exceptionally challenging
circumstances, as well as ease the burden
felt by home visitors. Further, this would
offer home visitors additional supervision
and support, which may improve
retention. Paraprofessional home visitors
could then focus more time on other,
lower-needs families.
This recommendation is supported by
findings from the literature review conducted as part of
this evaluation, which suggested that those with complex
needs benefit more from intensive services provided by
professionals than they do from less intensive services
provided by paraprofessionals (available at
www.kidskan.ca/node/197).
I think a lot of people use KidsFirst
as a stepping-stone sometimes just
to see if this is their kind of field ... We
have had a few [individuals] go on to
[study] Social Work; we’ve had a couple
that have [gone] on to get their degree
and stuff like that. — home visitor
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