Healthy Child Development Begins at Home: Increasing Engagement in Home-Based Parent Support Programs

Current evidence suggests that social work is well positioned to implement, at scale, effective universal health promotion and prevention strategies designed to benefit all young people. Home-based parent support services, also known as home visitation, are an important evidence based practice in the area of parenting and health care education, child maltreatment prevention, and early intervention and education services for young children and their families. However, home-based parent support services often serve small numbers of eligible families and have substantial drop-out rates despite the fact that locating services in the home inherently addresses several logistical barriers (e.g., transportation or child care) common to clinic or center-based services. Reasons for the limited reach of these services are varied and include factors such as logistical or concrete barriers (e.g., dose or scheduling expectations), personal or psychological barriers (e.g., reluctance to have a provider in the home), social or political values and attitudes.

Low engagement may limit the impact of home-based services on expected child and family outcomes. Because home-based parent support services can be expensive to deliver, improving engagement is an important target for maximizing the efficiency of investment in such programs. Furthermore, research on engagement in home-based parent support services has been identified as a national research priority. To build strong science around this priority area and ultimately improve outcomes for healthy child development, innovative research approaches are needed.

In this roundtable, discussants will conceptualize current national efforts to develop a cross-model science of engagement in home-based parent support models. For the purpose of this discussion we define engagement as the depth and strength of connections between the service consumer and the service itself, as opposed to proxy indicators of completed sessions, retention, and attrition. Specifically, discussants will facilitate a conversation about the key facets of the Parent Engagement Continuum that are the scientific base for research on programmatic engagement: (1) acceptability/social norms, (2) recruitment, (3) enrollment, (4) participation, and (5) maintenance. Several tangible examples of the aforementioned national effort to develop a science of engagement will be highlighted. Examples will address aspects of the Parent Engagement Continuum and include: (1)The Annie E. Casey funded Coalition for Research on Engagement and Well-Being efforts to develop a collaboration among evidence-based parent support practices to create a scientific base for engagement research (2) Research on the feasibility of delivering home-based parent support models through telehealth platforms to increase engagement in enrollment and participation; (2) A multi-method examination of factors related to maternal participation in services during the transition from pregnancy to postpartum among three nationally disseminated home visitation models; (3) The adaptation of an evidence-based parent participation toolkit, developed in child mental health, to increase active engagement in home visitation programs, specifically focused here on child-welfare involved families, emphasizing enrollment, participation, and maintenance.

Our ultimate goal in this roundtable is to catalyze a dynamic conversation about strategies for incorporating research on engagement into home-based parent support models to effectively address a critical window of opportunity for healthy child development.