Folger AT, Brentley AL, Goyal NK, Hall ES, Sa T, Peugh JL, Teeters AR, Van Ginkel JB, Ammerman RT. Evaluation of a community-based approach to strengthen retention in early childhood home visiting. Prev Sci. 2016 Jan;17(1):52-61.
The purpose of this study was to evaluate community-based enrichment of HV (CBE-HV), an approach developed and implemented to increase engagement and retention in Every Child Succeeds. CBE-HV strategies included: (1) community engagement, (2) ancillary supports for families in HV, and (3) enhancements to the home visiting program. Researchers used a retrospective, quasi-experimental design. It revealed that mothers were more likely to join earlier in their pregnancy, and that attrition from Every Child Succeeds was 23 % less in the CBE-HV group relative to standard home visiting. This study provides important guidance for how to increase retention in home visited mothers.
Goyal NK, Ammerman RT, Massie JA, Clark M, Van Ginkel JB. Using quality improvement to promote implementation and increase well child visits in home visiting. Child Abuse Negl. 2016 Mar;53:108-17.
The objective of this study was to increase the percentage of infants enrolled in home visiting who completed at least three recommended well-child pediatric visits in the first six months of life. A series of 33 quality improvement cycles conducted at three sites involving 18 home visitors and 139 families with infants in the target age range. Over the project timeline, the percentage of infants receiving at least three well-child visits in the first six months increased from 58% to 86%. This study provides an example of how quality improvement methods enhance outcomes in home visiting.
Ammerman RT, Chen J, Mallow PJ, Rizzo JA, Folger AT, Van Ginkel JB. Annual direct health care costs, out of pocket expenditures and employee absenteeism costs in high-risk, low income mothers with major depression. J Affect Disord. 2016 Jan 15;190:386-94. 
The purpose of the study was to determine the health care and labor productivity costs associated with major depressive disorder in high-risk, low-income mothers. The 1996–2011 Medical Expenditure Panel Survey (MEPS) used to determine insurer expenditures, out-of-pocket (OOP) expenses, and lost wage earnings in depressed and non-depressed mothers. Depression increased overall direct health care expenditures by $1.89 billion (range: $1.28–$2.60 billion) and indirect costs by $523 million annually, with a range of $353–$719 million. This study is the first to document the elevated costs of depression in high-risk mothers.
Goyal NK, Folger AT, Hall ES, Teeters AR, Van Ginkel JB, Ammerman RT. Multilevel assessment of factors associated with prenatal engagement in home visiting. J Epidemiol Community Health. 2016 Sep;70(9):888-94.
This retrospective cohort study of first-time mothers enrolled in home visiting sought to identify variables associated with prenatal engagement and retention. Results found that 25.3% enrolled ≤20 weeks and 7.4% enrolled early and received ≥75% of expected visits. There was significant variation in early enrollment based on clustering by agency (p<0.001). Increasing community violence disproportionately affected early enrollment among white women (AOR 0.80, p=0.005) compared with black women (AOR 0.95, p=0.30). Teenagers demonstrated a decreased likelihood of enrolling early. This study demonstrates that program, individual, and community variables influence timing of enrollment and early engagement in home visiting.