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. 2013 Aug;37(8):555-65.
doi: 10.1016/j.chiabu.2013.03.012. Epub 2013 May 6.

Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment

Shelley Alonso-Marsden  1 , Kenneth A Dodge, Karen J O'Donnell, Robert A Murphy, Jeannine M Sato, Christina Christopoulos
Affiliations

Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment

Shelley Alonso-Marsden et al. Child Abuse Negl. 2013 Aug.

Abstract

Objective: As nurse home visiting to prevent child maltreatment grows in popularity with both program administrators and legislators, it is important to understand engagement in such programs in order to improve their community-wide effects. This report examines family demographic and infant health risk factors that predict engagement and follow-through in a universal home-based maltreatment prevention program for new mothers in Durham County, North Carolina.

Methods: Trained staff members attempted to schedule home visits for all new mothers during the birthing hospital stay, and then nurses completed scheduled visits three to five weeks later. Medical record data was used to identify family demographic and infant health risk factors for maltreatment. These variables were used to predict program engagement (scheduling a visit) and follow-through (completing a scheduled visit).

Results: Program staff members were successful in scheduling 78% of eligible families for a visit and completing 85% of scheduled visits. Overall, 66% of eligible families completed at least one visit. Structural equation modeling (SEM) analyses indicated that high demographic risk and low infant health risk were predictive of scheduling a visit. Both low demographic and infant health risk were predictive of visit completion.

Conclusions: Findings suggest that while higher demographic risk increases families' initial engagement, it might also inhibit their follow-through. Additionally, parents of medically at-risk infants may be particularly difficult to engage in universal home visiting interventions. Implications for recruitment strategies of home visiting programs are discussed.

Keywords: Engagement; Follow-through; Home visiting; Maltreatment; Prevention; Risk.

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Figures

Figure 1
Figure 1
Theoretical model for directionality of effects of infant health and family demographic risk on engagement outcomes.
Figure 2
Figure 2
Final “pruned” structural model for initial family engagement in Durham Connects (n = 2279). Notes: Circles represent latent variables. Squares represent observed variables. Standardized path coefficients are presented. † p < .10, * p < .05, ** p < .01, *** p < .001.
Figure 3
Figure 3
Final “pruned” structural model for family follow-through in Durham Connects (n = 1765). Notes: Circles represent latent variables. Squares represent observed variables. Standardized path coefficients are presented. † p < .10, * p < .05, ** p < .01, *** p < .001.
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