The challenge of relationships and fidelity: Home visitors' perspectives

This qualitative study examines home visitors' perspectives on their practical attempts to establish and maintain relationships with clients while also maintaining fidelity to their evidence-based program model. Drawing from a sample of 85 home visitors from three types of evidence-based home visitation programs in Illinois, our results demonstrate that home visitors often feel compelled to adjust the program curriculum to clients' perceived needs. Home visitors also feel that in order to establish and maintain relationships with clients they need to be flexible in working days and working hours, accept alternative meeting places, use cell phones and text messaging, and address crisis situations before presenting the curriculum. Although they acknowledged paperwork as being important to support fidelity, they also perceived it as harming the natural course of relationships or devaluing the importance of relationships in successful programs. State budget cuts, which led to local program instability, also emerged as a barrier to relationships. The cuts discouraged home visitors from using flexible practices within the context of model fidelity. This paper offers a framework for understanding the tensions between relationships and fidelity and discusses implications for policy.