Abstract of Distinction: Predicting Retention in Infant Mental Health Home Visiting Services

Home visiting by trained counselors for at-risk infants has been proposed as a means to promote positive child development. The State of Michigan is requiring further evaluation of outcome of home visiting, including child and maternal health and reductions in child maltreatment. The current study recruited 80 families, with a child aged 0-24 months, who were newly enrolling in infant mental health home visiting services, at 12 agencies throughout the state of Michigan. Assessments will be completed at start of services, 3 months, 6 months, 9 months and 1 year. Among instruments completed by the caregiver at baseline are the Patient Health Questionnaire (PHQ-9), a PTSD checklist (PCL-5) and the Adverse Childhood Experiences (ACE).

At the current time, 9 months following beginning of recruitment, home visiting is under way with the 80 recruited families having had an average of 18 home visits (ranging from 1 to 56) and an average duration of treatment of 4.7 months (ranging from 0 to 9.2 months). At this time, 22 families have terminated services. One family terminated due to moving and one terminated due to reaching the goals of treatment. This study examines the predictors of termination for other 20 families.

Survival analysis was used, since the families remaining in treatment have been censored at this point. Survival analysis takes into account the length of time before “failure” (in this case, terminating treatment) and also uses data from all the families up to the last time seen in treatment.

We predicted survival to termination with mental health of caregiver. Although nearly 40% of the sample met probably diagnosis of PTSD, total number of PTSD symptoms did not predict termination (parameter = -.03, p = .35) . 46.9 % of the sample of caregivers reported mild to moderate depression and 30% reported severe depression. However, total number of depression symptoms did not predict termination (parameter = -.00, p = .94). In addition, nearly 60% of the caregivers were at risk due to Adverse Childhood Experiences (ACE); however, the total ACE score did not predict termination (parameter = -.012, p = .87). For depression and Adverse Childhood Experiences, visual inspection of survival functions showed that those with higher levels of adversity were LESS likely to terminate services.

These preliminary data suggest that families who are experiencing mental health issues and are at risk due to childhood experiences are equally able to remain engaged in infant mental health home visiting services as those who have less adversity. If this trend continues throughout the duration of home visiting, these families are likely to benefit greatly from the services.