Multi‐Level Determinants of Mothers' Engagement in Home Visitation Services^*

Abstract

A two-level hierarchical linear model was used to investigate the impact of poor community health and maternal isolation on mothers' active engagement in a home-visiting family support program. Data came from 4,057 mothers with firstborn infants who enrolled in the Oregon Healthy Start (OHS) home-visiting program from 1995 through 1998. At the time of this study OHS operated in 15 Oregon counties. Results showed that if the mother was living in a county that displayed poor community health, or if the mother was isolated from immediate family and friendship networks, the likelihood of actively engaging in home visits was significantly reduced. Implications for programming and study limitations are discussed.

Principles of Precision Prevention Science for Improving Recruitment and Retention of Participants

“…Crime, social disorganization, and other related factors may present barriers to participation. For example, mothers who lived in communities with poorer overall community health in combination with mother isolation inhibited participation in a home visiting program in Oregon (McGuigan et al 2003). Other programs describe evidence of higher social cohesion as related to stronger recruitment through word of mouth (Miller Gaubert et al 2012), strong referral networks among community providers (Miller Gaubert et al 2012;Zaveri et al 2015), or building social cohesion to keep participants engaged (Perou et al 2012).…”

Provider Cultural Competency, Client Satisfaction, and Engagement in Home-Based Programs to Treat Child Abuse and Neglect

“…In an effort to reduce such negative outcomes, programs to treat or prevent child abuse and neglect have been disseminated throughout the United States. Many of these programs are delivered in the home to reduce barriers to treatment engagement (e.g., lack of transportation or child care); however, home-based programs still suffer from high rates of attrition (up to 67%; Duggan et al, 2000; Gomby, Culross, & Behrman, 1999; McGuigan, Katzev, & Pratt, 2003; Navaie-Waliser et al, 2000). Such high rates of attrition may limit the impact of home-based child maltreatment programs; thus, it is important for researchers to identify factors that are related to client engagement in home-based programs to increase their effectiveness.…”

Early Findings From a Community-Based Title IV-E Waiver Demonstration Program to Increase Family Engagement

“…Our findings reveal typical rates of engagement at P2S case closure compared to home-visiting (e.g., see Katz et al, 2001;McGuigan, Katzev, & Pratt, 2003) and center-based, parenting-focused programs (e.g., see Chaffin et al, 2009;Marcynyszyn, Maher, & Corwin, 2011b) for child welfareinvolved families. At the same time, the results around program adherence (e.g., time to first contact) and family engagement were somewhat mixed and certainly program refinements are needed or the program guidelines need to be adjusted based on what was learned about the intensity of the work around family engagement.…”

“…Of the caregivers, 22% were engaged in less than one-third of case plan services, 10% were engaged in between one-third and two-thirds, and 68% were engaged in two-thirds or more of case plan services at case closure. Given the literature on engagement with home visiting child services among child welfare-involved families, a figure that approaches 70% appears to be a notable level of engagement (see Katz et al, 2001;McGuigan, Katzev, & Pratt, 2003). …”