Paraprofessional home visitation: Conceptual and pragmatic considerations

The adaptation for paraprofessional visitors of a home visitation model originally developed for nurses is described. There are several hypothesized benefits of using paraprofessional home visitors, including power as role models and increased empathy with clients. Challenges inherent in employing paraprofessionals include limited formal education and resulting lack of credibility among professional care providers, difficulties in acculturation to the workplace, and learning how to effectively focus their commitment to and identification with the community. These challenges result in the need for unique training and sensitive and consistent supervision. Implementation data from the randomized trial of home visitation in Denver indicate that paraprofessional visitors conducted the program according to the prescribed visitation schedule and covered the material appropriately. Differences that emerged between nurse and paraprofessional visitors regarding content covered are discussed and suggestions are made for future programmatic considerations.