Abstract
Home visiting programs are an evidence-based approach to reducing adversity exposure and promoting well-being in children experiencing high-risk factors. Despite decades of research demonstrating the benefits of these programs, barriers continue to impact enrollment, engagement, and retention over time. The present qualitative study explored home visiting providers’ perceptions of the behaviors they use to promote enrollment and engagement and reduced attrition for families. Twenty-one providers of three home visiting models (Nurse-Family Partnership, Parents as Teachers, and SafeCare) completed in-depth, semi-structured interviews to probe into provider behaviors that might improve program outcomes. Qualitative data analysis of interviews was conducted using NVivo software with a template approach used to identify broad themes. Findings indicated differences in provider behaviors across enrollment (provider approach and outreach), engagement (provider support and communication), and retention (provider sharing resources and setting goals). Across all three, providers emphasized the importance of building rapport. Implications suggest that workforce structure and training include behavioral strategies to improve enrollment, engagement, and retention in programs to promote program and familial success.
Highlights
-
Provider approach and outreach are related to the promotion of enrollment in home visiting programs focused on families experiencing high-risk factors.
-
Provider support and communication promote the engagement of families in home visiting programs.
-
Sharing resources and setting goals with families were strategies reported by providers to promote the retention of families in home visiting programs.
Similar content being viewed by others
References
Abrahamse, M. E., Niec, L. N., Junger, M., Boer, F., & Lindauer, R. J. L. (2016). Risk factors for attrition from an evidence-based parenting program: Findings from the Netherlands. Children and Youth Services Review, 64, 42–50. https://doi.org/10.1016/j.childyouth.2016.02.025.
Ammerman, R. T., Stevens, J., Putnam, F. W., Altaye, M., Hulsmann, J. E., Lehmkuhl, H. D., Monroe, J. C., Gannon, T. A., & Van Ginkel, J. B. (2006). Predictors of early engagement in home visitation. Journal of Family Violence, 21(2), 105–115. https://doi.org/10.1007/s10896-005-9009-8.
Anthony, E. R., Cho, Y., Fischer, R. L., & Matthews, L. (2021). Examining the causal impact of prenatal home visiting on birth outcomes: A propensity score analysis. Maternal and Child Health Journal, 25, 947–955. https://doi.org/10.1007/s10995-020-03054-7.
Barlow, J., Kirkpatrick, S., Stewart‐Brown, S., & Davis, H. (2005). Hard‐to‐reach or out‐of‐reach? Reasons why women refuse to take part in early interventions. Children & Society, 19(3), 199–210. https://doi.org/10.1002/chi.835.
Baziyants, G. A., Dodge, K. A., Bai, Y., Goodman, W. B., O’Donnell, K., & Murphy, R. A. (2023). The effects of a universal short-term home visiting program: Two-year impact on parenting behavior and parent mental health. Child Abuse & Neglect, 140, 106140. https://doi.org/10.1016/j.chiabu.2023.106140.
Beasley, L. O., Ridings, L. E., Smith, T. J., Shields, J. D., Silovsky, J. F., Beasley, W., & Bard, D. (2017). A qualitative evaluation of engagement and attrition in a nurse home visiting program: From the participant and provider perspective. Prevention Science, 19(4), 528–537. https://doi.org/10.1007/s11121-017-0846-5.
Beasley, L. O., Silovsky, J. F., Ridings, L. E., Smith, T. J., & Owora, A. (2014). Understanding program engagement and attrition in child abuse prevention: A mixed-methods approach. Journal of Family Strengths, 14(1), 20.
Chen, M., & Chan, K. L. (2015). Effects of parenting programs on child maltreatment prevention. Trauma, Violence, & Abuse, 17(1), 88–104. https://doi.org/10.1177/1524838014566718.
Conti, G., Smith, J., Anson, E., Groth, S., Knudtson, M., Salvati, A., & Olds, D. (2024). Early home visits and health outcomes in low-income mothers and offspring: 18-Year follow-up of a randomized clinical trial. JAMA Network Open, 7(1), e2351752–e2351752. https://doi.org/10.1001/jamanetworkopen.2023.51752.
Damashek, A., Doughty, D., Ware, L., & Silovsky, J. (2010). Predictors of client engagement and attrition in home-based child maltreatment prevention services. Child Maltreatment, 16(1), 9–20. https://doi.org/10.1177/1077559510388507.
Duffee, J. H., Mendelsohn, A. L., Kuo, A. A., Legano, L. A., Earls, M. F., Chilton, L. A., & Committee on Child Abuse and Neglect. (2017). Early childhood home visiting. Pediatrics, 140(3), e20172150 https://doi.org/10.1542/peds.2017-2150.
Duggan, A., Portilla, X. A., Filene, J. H., Crowne, S. S., Hill, C. J., Lee, H., & Knox, V. (2018). Implementation of evidence-based early childhood home visiting: Results from the Mother and Infant Home Visiting Program Evaluation. OPRE Report 2018-76A. Office of Planning, Research and Evaluation
Eckenrode, J., Campa, M. I., Morris, P. A., Henderson, Jr., C. R., Bolger, K. E., Kitzman, H., & Olds, D. L. (2017). The prevention of child maltreatment through the nurse family partnership program: Mediating effects in a long-term follow-up study. Child Maltreatment, 22(2), 92–99. https://doi.org/10.1177/1077559516685185.
Edwards, A., & Lutzker, J. R. (2008). Iterations of the SafeCare model: An evidence-based child maltreatment prevention program. Behavior Modification, 32(5), 736–756. https://doi.org/10.1177/0145445508317137.
Fauth, R. C., Sturmfels, N., Lehmann, H., Filene, J., Taylor, M., Kane, M. C., Peplinski, K., & Duggan, A. (2024). Conceptualizing family engagement in home visiting: Exploring the use of existing data to promote collaborative research. HARC (hvresearch.org).
Gershater-Molko, R. M., Lutzker, J. R., & Wesch, D. (2003). Project SafeCare: Improving health, safety, and parenting skills in families reported for, and at-risk for child maltreatment. Journal of Family Violence, 18, 377–386. https://doi.org/10.1023/A:1026219920902.
Goodman, W. B., Dodge, K. A., Bai, Y., Murphy, R. A., & O’Donnell, K. (2021). Effect of a universal postpartum nurse home visiting program on child maltreatment and emergency medical care at 5 years of age: A randomized clinical trial. JAMA Network Open, 4(7), e2116024–e2116024. https://doi.org/10.1001/jamanetworkopen.2021.16024.
Goyal, N. K., Hall, E. S., Jones, D. E., Meinzen-Derr, J. K., Short, J. A., Ammerman, R. T., & Van Ginkel, J. B. (2014). Association of maternal and community factors with enrollment in home visiting among at-risk, first-time mothers. American Journal of Public Health, 104, S144–S151. https://doi.org/10.2105/ajph.2013.301488.
Gubbels, J., van der Put, C. E., Stams, G. J. J., Prinzie, P. J., & Assink, M. (2021). Components associated with the effect of home visiting programs on child maltreatment: A meta-analytic review. Child Abuse & Neglect, 114, 104981. https://doi.org/10.1016/j.chiabu.2021.104981.
Hackworth, N. J., Matthews, J., Westrupp, E. M., Nguyen, C., Phan, T., Scicluna, A., Cann, W., Bethelsen, D., Bennetts, S. K., & Nicholson, J. M. (2018). What influences parental engagement in early intervention? Parent, program and community predictors of enrolment, retention and involvement. Prevention Science, 19(7), 880–893. https://doi.org/10.1007/s11121-018-0897-2.
Han, K., & Oh, S. (2022). The effectiveness of home visiting programs for the prevention of child maltreatment recurrence at home: A systematic review and meta-analysis. Child Health Nursing Research, 28(1), 41–50. https://doi.org/10.4094/chnr.2022.28.1.41.
Heinrichs, N., Bertram, H., Kuschel, A., & Hahlweg, K. (2005). Parent recruitment and retention in a universal prevention program for child behavior and emotional problems: Barriers to research and program participation. Prevention Science, 6(4), 275–286. https://doi.org/10.1007/s11121-005-0006-1.
Holland, M. L., Christensen, J. J., Shone, L. P., Kearney, M. H., & Kitzman, H. J. (2014). Women’s reasons for attrition from a nurse home visiting program. Journal of Obstetric, Gynecologic & Neonatal Nursing, 43(1), 61–70. https://doi.org/10.1111/1552-6909.12263.
Leijten, P., Gardner, F., Melendez-Torres, G. J., van Aar, J., Hutchings, J., Schulz, S., Knerr, W., & Overbeek, G. (2019). Meta-analyses: Key parenting program components for disruptive child behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 58(2), 180–190. https://doi.org/10.1016/j.jaac.2018.07.900.
Lowe, K., Cartagena, D., & Gudger, K. (2021). Evaluation of a home visiting program: Perspectives of mothers. Home Healthcare Now, 39(2), 91–98. https://doi.org/10.1097/NHH.0000000000000948.
McCurdy, K., & Daro, D. (2001). Parent involvement in family support programs: An integrated theory. Family Relations, 50(2), 113–121. https://doi.org/10.1111/j.1741-3729.2001.00113.x.
McCurdy, K., Daro, D., Anisfeld, E., Katzev, A., Keim, A., LeCroy, C., McAfee, C., Nelson, C., Falconnier, L., McGuigan, W. M., Park, J. K., Sandy, J., & Winje, C. (2006). Understanding maternal intentions to engage in home visiting programs. Children and Youth Services Review, 28(10), 1195–1212. https://doi.org/10.1016/j.childyouth.2005.11.010.
McGuigan, W. M., & Gassner, B. (2015). Engagement and retention in home visiting child abuse prevention programs. Home Visitation Programs, 101–117. https://doi.org/10.1007/978-3-319-17984-1_7.
Molloy, C., Beatson, R., Harrop, C., Perini, N., & Goldfeld, S. (2021). Systematic review: Effects of sustained nurse home visiting programs for disadvantaged mothers and children. Journal of Advanced Nursing, 77(1), 147–161. https://doi.org/10.1111/jan.14576.
Mytton, J., Ingram, J., Manns, S., & Thomas, J. (2014). Facilitators and barriers to engagement in parenting programs: a qualitative systematic review. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 41(2), 127–137. https://doi.org/10.1177/1090198113485755.
National Home Visiting Resource Center (2018). Home Visiting Yearbook. https://www.nhvrc.org/wp-content/uploads/NHVRC_Yearbook_2018_FINAL.pdf.
Nievar, M. A., Van Egeren, L. A., & Pollard, S. (2010). A meta-analysis of home visiting programs: Moderators of improvements in maternal behavior. Infant Mental Health Journal, 31(5), 499–520. https://doi.org/10.1002/imhj.20269.
O’Brien, R. A., Moritz, P., Luckey, D. W., McClatchey, M. W., Ingoldsby, E. M., & Olds, D. L. (2012). Mixed methods analysis of participant attrition in the Nurse-Family Partnership. Prevention Science, 13(3), 219–228. https://doi.org/10.1007/s11121-012-0287-0.
Olds, D. L. (2006). The nurse–family partnership: An evidence-based preventive intervention. Infant Mental Health Journal, 27, 5–25. https://doi.org/10.1002/imhj.20077.
Olds, D. L., Henderson, Jr, C. R., Tatelbaum, R., & Chamberlin, R. (1988). Improving the life-course development of socially disadvantaged mothers: A randomized trial of nurse home visitation. American Journal of Public Health, 78(11), 1436–1445. https://doi.org/10.2105/ajph.78.11.1436.
Pais, J., & Sexer, L. P. (2023). The effectiveness of a parents as teachers home visitation program on school readiness: An application of complier average causal effect analysis. Journal of Evidence-Based Social Work, 20(5), 637–652. https://doi.org/10.1080/26408066.2023.2201233.
Patton, M. Q. (2002). Two decades of developments in qualitative inquiry: A personal, experiential perspective. Qualitative Social Work, 1(3), 261–283. https://doi.org/10.1177/1473325002001003636.
Perrin, E. C., Leslie, L. K., & Boat, T. (2016). Parenting as primary prevention. JAMA Pediatrics, 170(7), 637. https://doi.org/10.1001/jamapediatrics.2016.0225.
Ramakrishnan, R., Holland, V., Agu, N., Brady, C., & Marshall, J. (2022). Characteristics associated with participant attrition and retention in a perinatal home visiting program. Prevention Science, 23(6), 1007–1017. https://doi.org/10.1007/s11121-022-01338-8.
Riley, S., Brady, A. E., Goldberg, J., Jacobs, F., & Easterbrooks, M. A. (2008). Once the door closes: Understanding the parent–provider relationship. Children and Youth Services Review, 30(5), 597–612. https://doi.org/10.1016/j.childyouth.2007.11.011.
Sidebotham, P., & Heron, J. (2006). Child maltreatment in the “Children of the Nineties”: A cohort study of risk factors. Child Abuse & Neglect, 30(5), 497–522. https://doi.org/10.1016/j.chiabu.2005.11.005.
Slack, K. S., Berger, L. M., DuMont, K., Yang, M.-Y., Kim, B., Ehrhard-Dietzel, S., & Holl, J. L. (2011). Risk and protective factors for child neglect during early childhood: A cross-study comparison. Children and Youth Services Review, 33(8), 1354–1363. https://doi.org/10.1016/j.childyouth.2011.04.024.
Spoth, R., & Redmond, C. (2000). Research on family engagement in preventive interventions: Toward improved use of scientific findings in primary prevention practice. The Journal of Primary Prevention, 21(2), 267–284. https://doi.org/10.1023/a:1007039421026.
Stevens, J., Ammerman, R. T., Putnam, F. W., Gannon, T., & van Ginkel, J. B. (2005). Facilitators and barriers to engagement in home visitation: A qualitative analysis of maternal, provider, and supervisor data. Journal of Aggression, Maltreatment & Trauma, 11(4), 75–93. https://doi.org/10.1300/J146v11n04_04.
Supplee, L. H., & Duggan, A. (2019). Innovative research methods to advance precision in home visiting for more efficient and effective programs. Child Development Perspectives, 13(3), 173–179. https://doi.org/10.1111/cdep.12334.
Wagner, M. M., & Clayton, S. L. (1999). The parents as teachers program: Results from two demonstrations. The Future of Children, 9(1), 91–115. https://doi.org/10.2307/1602723.
Wagner, M., Spiker, D., Linn, M. I., & Hernandez, F. (2003). Dimensions of parental engagement in home visiting programs: Exploratory study. Topics in Early Childhood Special Education, 23(4), 171–187. https://doi.org/10.1177/02711214030230040101.
Whitaker, D. J., Self-Brown, S., Hayat, M. J., Osborne, M. C., Weeks, E. A., Reidy, D. E., & Lyons, M. (2020). Effect of the SafeCare© intervention on parenting outcomes among parents in child welfare systems: A cluster randomized trial. Preventive Medicine, 138, 106167. https://doi.org/10.1016/j.ypmed.2020.106167.
Whittaker, K. A., & Cowley, S. (2010). An effective programme is not enough: A review of factors associated with poor attendance and engagement with Parenting Support Programmes. Children & Society, 26(2), 138–149. https://doi.org/10.1111/j.1099-0860.2010.00333.
Funding
This work was funded in part by the Maternal, Infant, and Early Childhood Home Visiting program of the Health Resources and Services Administration via the following grants: D89MC23154, D89MC28275, X10MC29496.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Ethical Approval
The current study engaged with human participants with all recruitment and data collection methods approved by University IRBs.
Informed Consent
The current study engaged with human participants and utilized informed consent that was approved by University IRBs.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Beasley, L.O., Milojevich, H., Fuller, S. et al. A Qualitative Approach to Understanding Provider Behaviors that Promote Enrollment, Engagement, and Retention in Home Visiting Services. J Child Fam Stud (2024). https://doi.org/10.1007/s10826-024-02907-x
Accepted:
Published:
DOI: https://doi.org/10.1007/s10826-024-02907-x