Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment

Abstract

Objective As nurse home visiting to prevent child maltreatment grows in popularity with both program administrators and legislators, it is important to understand engagement in such programs in order to improve their community-wide effects. This report examines family demographic and infant health risk factors that predict engagement and follow-through in a universal home-based maltreatment prevention program for new mothers in Durham County, North Carolina. Method Trained staff members attempted to schedule home visits for all new mothers during the birthing hospital stay, and then nurses completed scheduled visits three to five weeks later. Medical record data was used to identify family demographic and infant health risk factors for maltreatment. These variables were used to predict program engagement (scheduling a visit) and follow-through (completing a scheduled visit). Results Program staff members were successful in scheduling 78% of eligible families for a visit and completing 85% of scheduled visits. Overall, 66% of eligible families completed at least one visit. Structural equation modeling (SEM) analyses indicated that high demographic risk and low infant health risk were predictive of scheduling a visit. Both low demographic and infant health risk were predictive of visit completion. Conclusions Findings suggest that while higher demographic risk increases families’ initial engagement, it might also inhibit their follow-through. Additionally, parents of medically at-risk infants may be particularly difficult to engage in universal home visiting interventions. Implications for recruitment strategies of home visiting programs are discussed.

Community contextual effects on at‐risk mothers' engagement in Georgia's Maternal, Infant, and Early Childhood Home Visiting programme

“…In addition, we observed that family‐level risk factors were associated with lower levels of home visiting programme engagement. This finding is consistent with previous research that demonstrated home visiting engagement tended to be diminished among mothers at greater socioe‐conomic risk due to a lack of both material and relational resources (Alonso‐Marsden et al, ; Daro, McCurdy, Falconnier, & Stojanovic, ; Raikes et al, ). Considering that families with lower socio‐economic status tend to live in more disadvantaged communities, a double burden may be placed on engaging families who could benefit from home visiting services the most.…”

“…Home visiting has been associated with improvement in various outcomes related to child development, including parental stress and risk of mental health problems (Ferguson & Vanderpool, ; Sweet & Appelbaum, ), risk of child abuse and neglect (Avellar & Supplee, ; Bilukha et al, ; Peacock, Konrad, Watson, Nickel, & Muhajarine, ), childhood psychological and behavioural problems (Lowell, Carter, Godoy, Paulicin, & Briggs‐Gowan, ; Moss et al, ), and mother–child interactions (de la Rosa, Perry, Dalton, & Johnson, ; Horowitz et al, ). Home visiting programmes are designed to actively address risk at the family level, and accordingly, research on home visiting has extensively investigated family risk factors (Alonso‐Marsden et al, ; Ammerman et al, ). Less is known about the families' community environment and contextual influences on family engagement in home visiting programmes (Goyal et al, ; Ingoldsby, ).…”

Evaluation of a Community-Based Approach to Strengthen Retention in Early Childhood Home Visiting

“…The findings supported CBE-HV as influential to individual participation in HV and suggested this approach elicited community-level support and acceptance of HV. The positive effect in a high risk community was encouraging, because previous research has shown this risk can inhibit maternal follow-through with service (Alonso-Marsden et al, 2013). This effect was above and beyond other positive influences on retention that accrued over time including program maturity, initiation of quality improvement, and collaborations with obstetricians.…”

The Welcome Baby Program: An Implementation and Outcomes Evaluation

“…For the independent variables, we selected variables that might predict continuing in the program or dropping out based on characteristics associated with attrition in the home visiting literature (Alonso-Marsden et al, 2013;Daro, Boller, and Hart, 2014;Daro et al, 2012;Daro et al, 2003;Holland et al, 2014;Ingoldsby et al, 2013;Lanier, Maguire-Jack, and Welch, 2015;McCurdy and Daro, 2001;McFarlane et al, 2010;McGuigan, Katzev, and Pratt, 2003) and research on access and retention in ongoing health treatment services (Andersen and Newman, 1973;Andersen, 1995;Gelberg, Andersen, and Leake, 2000;Ober et al, 2018). The variables fell into three categories:…”