Understanding Enrollment and Retention of High-Risk Families in Home Visiting Programs

• In Event: Poster Session 07
  In Poster Session: PS 07 Topic - Prevention and Interventions

Abstract

Home visiting programs are designed to provide parenting supports and resource connections for families with the goal of preventing child maltreatment. Recent attention to the evidence of their effectiveness (REFS) calls attention to the value of earlier enrollment to maximize potential benefits. Prenatal enrollment in home visiting programs has shown positive effects on some child and family outcomes (Goyal et al, 2013. Brown et al., 2017), but some research suggests that attrition (i.e., dropping out of the program before completing the curriculum) remains a challenge that may be exacerbated for families who enroll prenatally (Ammerman, 2016; Daro et al., 2003; Foulon et al., 2013). While programs are designed to address the complex needs of families with significant risk factors, it is not known whether the accumulation of risks prior to program enrollment may impact retention or outcomes related to home visiting participation.
The purpose of this study was to examine home visiting enrollment patterns, family characteristics, and program outcomes for families who access home visiting services in one rural state. It was designed to address the question of if the effects of prenatal enrollment are influenced by cumulative risk.
We used a statewide integrated administrative data system to combine program enrollment records with vital statistics birth records to support a comprehensive, population-based analysis. Variables from home visiting records included timing of enrollment, enrollment duration, and program type. Birth record variables were combined to create a cumulative risk indicator at the time of the child’s birth comprising a sum of dichotomous variables including poverty, inadequate prenatal care, preterm/low birth weight, teen mother, single mother, mother without a high school degree, and exposure to prenatal smoking.
Preliminary analyses are presented here and additional work will be completed prior to the final presentation in April 2020. A three-way moderation analysis examined whether relationships between prenatal enrollment, program type, and program retention were different (i.e., moderated) by cumulative risk. Findings suggest that children with more cumulative risk who enroll in MIECHV programs prenatally evidence better retention outcomes compared to children with similar cumulative risks who enroll in the state-funded home visiting program prenatally (see Table 1 for three way interaction results). Additional analyses will include other variables available from the home visiting records such as the number of assessments completed within the first three months of enrollment and relationship quality between the home visitor and family. These analyses will be completed using latent variable analysis and multiple regression analyses.
Connecting high-risk mothers with home visiting resources before the birth of their baby puts programs in a unique position to assess family needs and provide families more resources to support successful transitions into parenthood. However, to maximize utility we need clearer understanding of which families and which services are best suited for a prenatal enrollment approach. Findings from this study will be useful to inform this work.

Authors

• Jessica S Bruning, Iowa State University
  Presenting Author

• Heather L. Rouse, Iowa State University
  Non-Presenting Author

• Cassandra Dorius, Iowa State University
  Non-Presenting Author

• Todd Abraham, Iowa State University
  Non-Presenting Author

• Janet Horras, Iowa Department of Public Health
  Non-Presenting Author