Engagement and Retention in Florida MIECHV Programs

• In Event: 3-149 - Taking Evidence-Based Home Visiting to Scale: Lessons Learned From MIECHV-Funded Evaluations

Integrative Statement

Successful participation and engagement in home visiting programs is important for increasing participant retention and program effectiveness. However, achieving and sustaining participant engagement remains one of the greatest challenges faced by home visiting programs. Because positive program outcomes are tied to engagement and retention, this evaluation utilized a mixed-methods, multi-level approach to understanding facilitators and barriers from multiple perspectives.

Evaluation research questions were 1) What factors influence participants’ engagement and retention in the home visiting program? 2) What strategies can be used to increase participants’ engagement and retention in the home visiting program?

Methods used to answer the evaluation questions including a quantitative analysis of MIECHV participant data; focus groups with home visiting staff; focus groups with former program participants (alumni); a Photovoice project with current program participants; and journey mapping, which involved observation of home visiting processes followed by interviews with the home visitors and families.

Survival analyses was conducted on participation data in order to identify organizational and family factors predictive of retention or attrition. Focus groups with home visiting staff elicited staffs’ definitions of engagement and retention as well as facilitators and barriers. Journey mapping involved evaluators shadowing home visitors throughout their typical work days to reveal positive and negative aspects of visits, including factors impacting engagement and retention. The Photovoice project was conducted remotely, and involved participants taking and describing pictures that captured their parenting experiences, social support systems and the significance of their home visitors impacting engagement. Triangulation of findings were done to validate results and to identify new information that was unique to methods used.

Home visiting staff defined engagement from the perspective of participant and home visitor engagement. Retention was defined as remaining in the program for the duration of two years. Survival analyses (N=2,348) found that protective factors for protective from dropping out of the program early (retention) were: higher maternal education; increased maternal age (25-29 years [HR=0.63; 95%CI: 0.45,0.87], 30-34 years [HR=0.47; 95%CI: 0.24,0.42], 35+ years [HR=0.49; 95%CI: 0.36,0.68] more likely to remain in the program than teenagers).; enrollment during pregnancy (HR=0.74; 95%CI: 0.56,0.98); and receipt of more than one home visit per month. The primary reason for attrition was loss to follow up occurring in 57.6% of study sample, which was confirmed by staff who attributed this disconnected participants’ telephones and housing instability. Substance abuse was also associated with attrition (HR=1.84; 95%CI: 1.34, 2.52) and identified as a challenge to engaging and retaining participants along with other issues such as mental health difficulties and intimate partner violence. A key theme that emerged across all qualitative methods was the importance of home visitor-participant relationship dynamics and quality. Home visitors were described as providing all forms of social support, and a trusting relationship with clear communication about goals and expectations increased participant engagement and retention.

Authors

• Jennifer Marshall, University of South Florida
  Presenting Author

• Ngozichukwuka Agu, University of South Florida
  Non-Presenting Author

• Dogeli Rojas, University of South Florida
  Non-Presenting Author

• Rema Ramakrishnan, University of South Florida
  Non-Presenting Author

• Vanessa Sharon, University of South Florida
  Non-Presenting Author