Poster #67 - Caregiver attrition in home-based parenting programs: A multi-program examination

• In Event: Poster Session 03

Abstract

Introduction: Early childhood serves as a period where risk for child abuse and neglect is amplified (Fortson et al. 2016; Zimmerman and Mercy 2010). Home-based services are often effective at reducing child maltreatment (Daro and McCurdy 2007; Petersen et al. 2014; Chaffin et al. 2012; Chaiyachati et al. 2018; Lee et al. 2018) and improving parenting skills (Filene et al. 2013; McKelvey et al. 2015). The efficacy of these services is in part related to their intensity, as advantageous outcomes increase with the number of home visits (see e.g., Nievar et al. 2010) and length of time in program (Raikes et al. 2006). As such, enhancing participant retention in services is important for program effectiveness and promoting the health and wellbeing of children (Beasley et al. 2018; McCurdy and Daro 2001; Beasley et al. 2014b).
Methods: Participants included caregivers and providers involved in one of three volunteer home-based parenting program models—Nurse Family Partnership (C1), Healthy Families America (HFA), and Parents as Teachers (PAT). A purposive sampling method was used with caregivers and program providers. Caregivers were classified as engaged (completion of five or more sessions) and unengaged (completion of less than five sessions and no longer involved in services). A total of 85 caregivers (68 engaged, 17 unengaged) were involved in focus groups/individual interviews and 54 providers were involved in individual interviews across home-based parenting programs. All study data collection and evaluation methods were approved by the University Institutional Review Boards (IRBs).
Results: Findings indicate that caregivers’ perception of providers can be ascribed to attrition. More specifically, caregiver perception of providers’ professionality (e.g., keeping appointments, showing up on time, returning phone calls) plays a large role in whether or not caregivers continually engage in home-based programs. Caregivers who reported their provider exhibiting the aforementioned unprofessional behaviors also described a lack of trust in the provider. Disengaged caregivers also reported feeling displeased with the amount of control they had over their learning process, and that some providers lacked cultural sensitivity, with multiple caregivers reporting perceived judgement by their provider. Providers stated that disengaged caregivers were often unorganized, distracted, disinterested, and unwilling to change; all of which may be attributed to the cognitive load associated with poverty and high-risk families.
Discussion: This study highlights the importance of healthy and strong relationships between caregivers and home-based service providers. Moreover, the study found that across multiple home-based services, one of the leading reasons for attrition were caregivers’ negative perceptions of providers, which led to distrust and disengagement in the home-based service programs. Due to the knowledge that caregiver engagement is paramount to program success, which is necessary for healthy family functioning, this study proves relevance to provider training and consideration for provider-client match selections by home-based service programs. Further, programs should focus on ensuring that caregiver-provider interactions instill trust in the provider through repetitively compassionate, trauma informed interactions that foster collaboration toward program goals and definitions of success.

Authors

• Salena King, Oklahoma State University - Stillwater
  Presenting Author

• Lana Beasley, Oklahoma State University - Stillwater

• Devin Rae Barlaan, Oklahoma State University - Tulsa

• Peter Mundey, Savannah State University

• Leigh Ridings, Medical University of South Carolina

• Jennfier Shields, University of Oklahoma Health Sciences

• Jane Silovsky, University of Oklahoma Health Sciences

• David Bard, University of Oklahoma Health Sciences