Session: Engagement and Retention in Home Visitation Programs: Lessons Learned from Three RCT Intervention Studies with Families at Risk for Child Welfare Involvement (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Purpose:  This symposium highlights lessons learned about engagement and retention in home visitation service models across three intervention studies. Home visitation programs remain one of the preferred platforms to deliver services to families involved or at risk of involvement with the child welfare system.  Despite the prevalence of this service delivery platform, many home visitation programs experience high rates of attrition.  Contributing factors to attrition include burden, perceived benefit, and appropriateness of the service.    This symposium seeks to explore how client engagement and retention can combat attrition. 

Methods: These studies had various proximal outcomes but shared the distal outcome of decreasing child maltreatment reports within populations of vulnerable families.  The goal of this symposium is to better understand the process of engagement and retention in the context of efficacy and effectiveness intervention research studies of home visitation programs.The three studies employ different methodologies to explore different aspects of client engagement and retention. All three of these studies were conducted with families that were referred by child welfare or at an increased risk of child welfare involvement in a Midwestern metropolitan region.  Two of the studies are efficacy studies. Early Childhood Connections (ECC) and NuMoms consist of a randomized control trial (RCT) built upon existing services provided by established community agencies (Parents as Teachers and Nurses for Newborns respectively).  Quantitative analyses of participants in the ECC study were conducted to identify participant characteristics related to engagement and retention in the intervention delivered by parent educators.  The NuMoms study tested the provision of an adapted form of Problem Solving Therapy for post partum women with symptoms of depression and/or stress delivered by nurse home visitors.  Triple P was an effectiveness study of a behavioral parent training intervention with services provided only by the research team.  Qualitative interviews with study participants are used from both the Triple P and the NuMoms studies.  The Triple P paper explores the impact of provider characteristics and the provider-client relationship on client engagement while the NuMoms presentation explores barriers to intervention completion. 

Implications: Comparing findings from intervention studies that use existing agency service platforms compared to a research team delivery model provides a unique opportunity to explore subject engagement and retention in home visitation.  If home visitation is to be used as a platform for further innovation with vulnerable families it is important to understand factors impacting attrition.  Exploring participant engagement also provides important context for understanding how to conceptualize dosage. For example, in one of these studies it was found that most participants did not complete the intervention but retained and utilized the information provided in the sessions they completed.