Program Adherence and Retention

A major challenge for long-term prevention programs such as home visitation is retention of families over the full course of service. Several studies document premature dropout in home visitation programs, with up to 50 percent of clients leaving programs after one year. There are numerous reasons why families drop out of services, including relocation, difficulty scheduling home visits and dissatisfaction with services. Understanding the reasons why families stay or leave home visitation programs, and designing strategies to help them remain engaged in the services, is an important focal point of our research.

Recently Funded Research

Increasing Retention in Home Visitation

R40 funded by the Maternal and Child Health Bureau: This study is a randomized controlled clinical trial of motivational interviewing (MI) to enhance retention and promote program adherence for 232 first-time mothers receiving home visitation. MI is a client-centered strategy that focuses specifically on increasing motivation and commitment to change. Mothers in four agencies (two each in HFA and NFP models were randomly assigned to MI or “home visitation as usual” (HVAU) conditions. Half of the home visitors were trained in MI procedures. Mothers and children were assessed at enrollment, and again at nine and 18 months later. In addition to measuring retention, we collected data on maternal and child psychosocial functioning. The other half of test subjects (HVAU) received an attention-control condition.

We hypothesized that (1) the MI condition would be superior to HVAU in terms of retention and program adherence, (2) MI would result in benefits in both the HFA and NFP models, (3) mothers with higher levels of depression and trauma history would be more likely to be retained relative to their counterparts, and (4) retained mothers in the MI condition would still have better outcomes than retained mothers in the HVAU condition.

Data analyses are currently being conducted.