Fear and Stigma with Home Visiting: Barriers to Participation

Background: Many home visiting programs are identified as primary or secondary child maltreatment prevention programs (among other positive outcomes). Yet families who are most at-risk of adverse outcomes are often difficult to reach and engage in home visiting. While in-home service delivery removes many logistical barriers to engagement, a small body of literature identifies other barriers to home visiting which range from the stigma of needing help with parenting to fear of a referral to child protective services (CPS).

Using data from 16 focus groups of parents and other caretakers (hereafter parents) collected as part of a comprehensive state-wide needs assessment of home visiting, we analyzed these data to explore the perceived barriers to engaging in home visiting services.

Methods: The focus group data was collected in 2019 in a northeastern state. Focus groups were held in rural, suburban, and urban areas with 117 parents and were conducted in monolingual English (n=11), monolingual Spanish (n=3), and Spanish and English (n=2). Fathers participated in most groups and one fathers-only group was recruited. Focus groups were advertised by local service agencies in geographic areas selected to represent the whole state. They included both parents who had and had not received home visiting. This allowed for richer discussion of why families did not participate in home visiting. The questions for this study emerged during inductive coding for the needs assessment. Specifically for this analysis, we used constant comparison analysis to perform opening coding, axial coding, and theme development for the groups and individuals. Using multiple focus groups allowed us compare themes across groups and helped us reach data saturation.

Results: Most parents who were receiving or had received home visiting were very satisfied with their program. However, some parents recalled concerns and fears they had when they began home visiting and some parents who had not received services described fears related to the program. Parents described feeling stigmatized by being offered home visiting because they felt judged as a bad parent who needed help and some saw home visiting as an extension of CPS services. They were also concerned about being judged by the home visitor for their parenting style and the state of their home. They also expressed fear of having someone come into their home and many were afraid that the home visitor would report them to CPS for a minor problem, like a broken floorboard, which could eventually lead to the removal of their child(ren).

Conclusions and Implications: Even when home visiting addresses concrete logistical barriers such as transportation and cost, there are still barriers to participation. Many of the concerns described could be interpreted as parents feeling held to the standard of living and parenting of middle-class white families. The fears parents had of being reported to CPS, while uncommon, are not unfounded. Home visitors are mandated reporters who are often instructed to err on the side of over- rather than under-reporting. More understanding is needed of these issues and possible solutions to address stigma, judgment, and fear.