Recruiting and Retaining High-Risk Families in Evidence-Based Home Visiting Programs Implemented By Community-Based Organizations

Introduction:

The national Maternal Infant and Early Childhood Home Visiting (MIECHV) program funds evidence based home visiting (EBHV) to support at-risk parents to raise children who are physically, socially and emotionally healthy and ready to learn (HRSA, 2015).  The RE-AIM framework for implementation evaluation asserts that, to achieve public health impact, programs must have appropriate R=reach into the target population.  Current home visiting research suggests that higher risk families are more likely to engage in programs (Damashek et al., 2011), but may also be more likely to drop out of programs (O’Brien et al., 2012; Roggman et al., 2008).  This paper examines the reach and retention of three different MIECHV funded programs in Washington, DC: HFA, HIPPY, and PAT. 

Methods:

Data were obtained from the mixed-methods DC-MIECHV evaluation.

Quantitative: Secondary analysis of the statewide Data Collection and Reporting System (DCRS) provided data about 469 families enrolled from 2012 to 2015, including demographic characteristics and seven standardized assessments of risk.

Qualitative: 30 semi-structured interviews were conducted with families who dropped out and remained in the programs, as well as staff and supervisors with each of the programs. 

Results:

DC-MIECHV programs were effective at enrolling the intended high-risk target populations: 88% live in poverty, 79% were at risk of substance abuse during pregnancy (4Ps), 60% reported high-risk attitudes about parenting (AAPI), 44% reported clinical-level depressive symptoms (CES-D), and 33% reported clinical level abusive inter-partner behavior (ABI). Interviews with program staff revealed “creative outreach” strategies for recruiting and engaging families.

Retention of families was a challenge.  56% of families withdrew from HIPPY, 53% from PAT, and 39% from HFA (X2=9.226, p=.010).  Program withdrawal was associated with risks like at least weekly use of tobacco, drugs or alcohol, and protective factors like working full-time (X2=7.864, p=.020). 

Differences were found by program: 63% of depressed parents withdrew from HIPPY (X2=4.017, p=.045); 40% of depressed parents withdrew from PAT (X2=9.638, p=.002). Interviews with parents offered families’ perspectives about the programs, and barriers to participating in the programs. 

Conclusions:

A better understanding of program’s recruitment and retention of families in EBHV is a vital first step toward achieving the intended impact of any preventive program.  A better understanding of barriers to participation and risk factors for dropping out of services positions community-based agencies to anticipate and respond to the needs of families.