Home visitation programs: Critical Issues and Future Directions

High rates of program attrition in home-based family support and child maltreatment prevention services are common. Researchexamining factors related to family engagement (i.e., enrollment and completion rates) may help program developers increase theimpact of child abuse prevention services by reducing attrition. The present study examined the relative influence of provider,program, and individual factors from the Integrated Theory of Parent Involvement (ITPI) as well as maternal and family demo-graphic and risk variables in predicting service enrollment and completion in a home-based child maltreatment prevention service(SafeCareþ) and a standard community care program (Services as Usual [SAU]). Participants were 398 female caregivers ofchildren ages 5 and below. Support was found for the primary role of program and provider factors in client enrollment andcompletion of services. Specifically, participants in SafeCareþ were 4 times more likely to enroll in services and 8.5 times morelikely to complete services than those in SAU. Family risk variables including intimate partner psychological aggression, substanceabuse, and depression were also significant predictors. Recommended next steps include integration of risk-related factors in theITPI framework and disentangling specific provider and program factors related to service engagement.

Predictors of client engagement and attrition in home-based child maltreatment prevention services.

Research Findings: Early Head Start home-based programs provide services through weekly home visits to families with children up to age 3, but families vary in how long they remain enrolled. In this study of 564 families in home-based Early Head Start programs, “dropping out” was predicted by specific variations in home visits and certain family characteristics. It also was negatively related to several targeted program outcomes. Home visits to dropout families focused less on child development, were less successful at engaging parents, and had more distractions. Dropout families had more risks and changes of residence, were more likely to be headed by a single mother, and were less likely to have a mother with poor English skills or a child with a documented disability. Practice or Policy: Home visiting programs may be able to reduce dropout rates, and thereby increase the duration of services to each family, by keeping home visits engaging and focused on child development and also by individualizing to ...

Who Drops Out of Early Head Start Home Visiting Programs

Predictors of engagement in mothers receiving home visitation in the first year of service was examined. Early engagement was studied in three ways: (1) length of time active in the program during the first year of service (duration), (2) number of visits received (quantity), and (3) gaps in service between visits (consistency). Examined visits received in 515 first-time mothers in a Healthy Families America (HFA) program. Parameters of engagement were investigated, and predictors of engagement were identified using demographics and the Kempe Family Stress Inventory. Inclusive of the Assessment Visit, 31.8% of mothers disengaged prior to the first month of service. Remaining active in the program was associated with being Caucasian, and increased parenting risk (mental health/substance abuse history, low social support, increased stress). Most mothers had fewer home visits than prescribed. Gaps in prescribed service were common, with 89.4% of mothers experiencing gaps between visits of 1 month, and dropping to 16.4% having gaps of 2 months. In contrast to findings from clinic-based interventions, early engagement in home visitation is associated with lower levels of functioning and acute needs. These findings add to a growing body of literature suggesting that increased adversity promotes engagement in prevention programs in general, and home visitation programs in particular. To the extent that mothers who are actively engaged in home visitation are likely to have increased psychosocial needs, curricula may require modification and augmentation to address these needs and optimize program effectiveness.

Predictors of Early Engagement in Home Visitation

Strength-based practice and parental engagement in child welfare services: An empirical examination

The purpose of this study was to examine the relationship between nurse and client characteristics and the reason for client termination from public health nursing maternal and child home visits. The results indicate that clients who dropped out of services received more contacts from the nurses, missed more appointments with the nurses, and were given advice from the nurses on more topics. They also differed from clients who continued with services until the nursing care plan goals were met in reference to marital status, mental illness, source of payment for services, and use of WIC and food stamps. Nurses whose clients were more likely to continue until goals were met were higher in conscientiousness, learned more from experience, and learned less from coworkers or learning on their own. They also worked more hours per week. These findings have implications for practice and research.

Mary A. Schorn

Papers

Dropping out of maternal and child home visits.