"We're the Constant": Navigating Resource Scarcity and Relational Depth in Rural and Urban Home Visiting Programs

This qualitative focus group study examined how home visitors in Iowa navigate structural barriers and fragmented service systems across rural and urban contexts, and how these dynamics shape maltreatment prevention work. Four focus groups were conducted with 34 home visitors representing multiple evidence-based models. Using thematic analysis, we identified four interconnected themes: structural barriers (transportation, childcare, housing, healthcare access, eligibility constraints), service fragmentation (poor interagency coordination, inconsistent knowledge, waitlists, and service capacity limits), workarounds (informal networks, stopgap supports, and creative problem solving), and role expansion (advocacy, modeling, life skills instruction, resource navigation, and sustained emotional support). Across settings, home visitors described functioning as "the constant" for families amid unstable and under-resourced systems. Rural context intensified these dynamics through geographic distance and limited service availability. Findings suggest that relational constancy and frontline adaptations may function as practical mechanisms that sustain engagement and stability in maltreatment prevention.