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Introduction: The Adverse Early Childhood Experiences (ACE) study illustrates the disproportionate effects of childhood trauma on long-term health equity. Interventionists, including evidence-based home visiting services are providing screenings and prevention initiatives to low-income families to ameliorate the effects of ACEs. However, what is not known is the impact the number of ACEs may have on family engagement and retention in home visiting services. The purpose of this study is to examine the possible associations between ACEs and engagement and retention of low-income families enrolled in home visiting services.
Methods: This study looks at a community sample of families in one state in the U.S. enrolled in home visiting programs. Parent (N=1282) age averaged 29 years (SD=8) with a majority of White enrollees (60%). Family Map Inventories were used as a semi-structured interview to assess key characteristics of each family and home environment to predict healthy development and highlight any ACEs. Characteristics of all home visits were reported and an average was taken.
Results: Study results showed that of the sample children were exposed to one (27%), two (18%), three (11%) or four or more ACEs (12%). Findings, controlling for demographics, from a logistic regression show ACEs were negatively associated with program retention at 3 (Wald=9.28, p=.06) and 6 (Wald=11.72, p=.02) months. Families scoring with 4 or more ACEs were almost twice as likely to leave the program (OR=2, p=.006; OR=1.8, p=.006). ANCOVA results revealed home visitors rated families as less engaged (F(4, 1429)=4.27; p=.002) and more distracted (F(4, 1405)=4.27; p=.002). Home visits were also rated lowers in overall quality (F(4, 1429)=5.77; p<.001). However, families who stayed in services showed a significant decrease in ACEs (McNemar; p=.001) with 20.1% of the sample scoring above 3 at enrollment compared to 14.4% at follow-up.
Conclusions: Results suggest that the greater the number of ACEs decreases the quality of engagement and retention in evidence-based home visiting services. Engagement and retention in home visiting services can help to mitigate the effects of ACEs thus improving the quality of life for children under the age of five.