Examining the Range of Barriers and Facilitators of Parent Engagement in Home Visiting Programs for High Risk Families

Identifying determinants of parent engagement is critical for meeting the needs of high-risk, vulnerable populations.  Often, parent characteristics are the focus of investigation, and engagement strategies typically involve efforts to motivate parents (e.g., offer incentives) or reduce pragmatic barriers. These efforts have  limited success, and significant engagement challenges remain. This is likely because they fail to address the range of contributing factors, including service context and provider characteristics.

We examined engagement in home visiting programs for mothers and infants at risk. These programs are Healthy Families America, Parents as Teachers, and Nurse Family Partnership.  Each has demonstrated efficacy for improving behavior and health outcomes among families served. However, enrollment and retention challenges limit their reach and effectiveness.

Our sample consists of 75 providers from 11 agencies. Data available on 48 providers reveals 90% have a Bachelor’s degree and 61% had prior relevant work experience. Providers completed the Staff Beliefs Questionnaire (Shepard & Silver, 2008) to assess program-specific beliefs (1-5 scale; high scores more positive) and the Evidence-Based Practice Attitudes Scale (Aarons, 2004) to assess openness to evidence-based curricula (0-4 scale; high scores indicating more open). Providers completed the Survey of Organizational Functioning to assess job attitudes (burnout, job satisfaction) and perceptions of the adequacy of workplace resources and supervision quality (1-5 scale). We also collected agency turnover rates, provider compensation, and per family expenditures.

Completed visits ranged from 6.3 to 15.4 per family, and average length of participation was 20.4 to 28.7 weeks. Premature drop-out rates ranged from 23% to 100% by agency. We also will have ratings of client participation and openness to content during visits.

We found considerable variability in provider beliefs and job attitudes. Providers had positive model expectations (m=4.68; range 1.71-5.00) and were generally neutral about time burden (m=3.19, range 1.00-4.50). Openness to evidence-based curricula ranged from 2.13 to 4.00 (m=3.05). Moderate burnout (m=2.21, range 1.00-4.00) and job satisfaction (m = 3.86, range 2.83-4.6) were reported. Providers generally agreed to having positive supervision experiences (m=4.07), but varied in feeling respected by supervisors (range 1.00-5.00, m=3.61). Turnover rates varied considerably but were high overall. Finally, per family expenditures also varied considerably ($2457-$8768 per family).

We will examine these characteristics as determinants of engagement and will discuss implications for building agency and intra-agency capacity in order to effectively address engagement challenges.