The state is moving steadily toward longer-term home visiting models in public health that demand careful attention to the relationship between the family and the nurse home visitor in order to positively influence the parent-child relationship. A 2008 statewide needs assessment conducted by the Minnesota Department of Health found that reflective practice was ranked as the most important training need for practitioners. With support of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, that pilot is now being implemented statewide.

At the state level, program staff meet regularly with reflective practice consultants to create a state system supporting local reflective practices. With local leadership support, supervisors provide reflective supervision to the home visitors; the home visitors in turn use reflective practice approaches to more effectively engage parents.

The state created a reflective practice mentor model offering a menu of options, including one-on-one reflective supervision, case conferences, and group reflection opportunities. Supervisors who participated in one-on-one mentoring had the quickest uptake on the reflective practice concepts and approach. All MIECHV local implementing agencies have been required by the state to contract with an infant mental health consultant to help facilitate integration of reflective practices, build a common language, increase the skills of managers and supervisors to engage in reflective practice, and to provide case support.

The University of Minnesota Center for Early Education and Development is evaluating the MIECHV effort, looking at mindfulness, self-regulation, and burnout to see if staff who receive reflective practice support stay in their jobs longer. There has been a shift in the culture to embracing reflective practice as an essential component of home visiting and a recognition that reflective practice empowers parents.