Academic journal article Family Relations

Multi-Level Determinants of Mothers' Engagement in Home Visitation Services*

Academic journal article Family Relations

Multi-Level Determinants of Mothers' Engagement in Home Visitation Services*

Article excerpt

A two-level hierarchical linear model was used to investigate the impact of poor community health and maternal isolation on mothers' active engagement in a home-visiting family support program. Data came from 4,057 mothers with firstborn infants who enrolled in the Oregon Healthy Start (OHS) home-visiting program from 1995 through 1998. At the time of this study OHS operated in 15 Oregon counties. Results showed that if the mother was living in a county that displayed poor community health, or if the mother was isolated from immediate family and friendship networks, the likelihood of actively engaging in home visits was significantly reduced. Implications for programming and study limitations are discussed.

Key Words: community, home, visitation, infants, mothers.

National surveys report parents generally approve of the idea of home-visiting family support programs (Taffee-Young, Davis, & Schoen, 1996). Visiting families at home allows families to receive support services in the convenience of their own home, eliminating potential barriers such as the need for child care and transportation costs. Still, many eligible parents do not participate in these voluntary services (Daro & Gelles, 1992). Reaching and enrolling target families in services is a common problem for programs designed to support children and families (McCurdy, Hurvis, & Clark, 1996), especially for those serving high-risk populations (Larner, Halpern, & Harkavy, 1992). A number of studies report that up to 25% of eligible parents decline to enroll in home-visiting family support programs (Gomby, Culross, & Behrman, 1999; National Committee to Prevent Child Abuse [NCPCA], 1996; Olds, Henderson, Tatelbaum, & Chamberlin, 1986).

Even when parents enroll in home visitation programs, there is no guarantee that they will engage in services (Daro & Harding, 1999). A survey by Healthy Families America (HFA) found that most home-visiting programs considered parents enrolled if they agreed to participate when services were initially offered (D. Daro, personal communication, September 1997). Agreeing to participate in a program is different from actively engaging in services (Herzog, Cherniss, & Menzel, 1986). For example, evaluation of Hawaii's Healthy Start program, a home-visiting program for at-risk parents with newborns, found that, beyond the 15% of "initial refusals," there was an additional 15% of "secondary refusals" (Hawaii Department of Health, 1992; NCPCA, 1996)-those who initially enrolled in services, but who dropped from the program after receiving few, if any, home visits during 3 months of intensive outreach efforts. Other studies confirm that a substantial portion of parents drop out of home-visiting programs within the first few weeks after enrollment (Marcenko & Spence, 1994; Myers-Walls, Elicker, & Bandyck, 1997). Conceptually, parents who never actively engage in home visitation services after initial enrollment are a unique group that requires further research. The purpose of this study is to examine the community- and maternal-level factors that contribute to the decision to actively engage in home visitation services.

Previous Research

We agree with Duggan and colleagues (2000) that "it is important to understand which at-risk families programs reach and engage" (p. 256). We propose that past research on participation in home-visiting programs has not sufficiently examined distinct degrees of participation. Studies have not differentiated degrees of participation by separating nonengaging families from engaging families. Instead, studies of program participation have combined families who enrolled but were dropped or withdrew after receiving few, if any, home visits (nonengaging families) with other families who received ongoing home visits but dropped out at some point before program completion (Clark & Winje, 1998; Halpern, 1992). In fact, most studies of attrition from therapeutic treatment programs struggled with defining who to include and how to differentiate degrees of participation (Harris, 1998). …

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