Characterizing Family Engagement in Rhode Island’s Home Visiting Programs

Abstract

A child’s first few years are a critical developmental period that has enduring health effects, and children living in poverty are particularly at risk. The Rhode Island Department of Health (RIDOH) implements three evidence-based home visiting programs to ensure children have opportunities to thrive. These programs have demonstrated positive outcomes for children and families. However, RIDOH has been experiencing challenges in engaging families to enroll and participate in these programs. This DELTA project aims to: (1) identify factors that influence enrollment and participation across three home visiting programs for birth cohorts 2014-2016 in the four core cities where most disadvantaged families reside; (2) understand barriers in delivering and accessing home visiting programs. A mixed methods approach was taken. To assess factors thought to be associated with family enrollment and participation, bivariate and multivariate analyses of data were performed. Potential engagement factors included characteristics of child (disabling condition, low birth weight), family (maternal age, marital status, health insurance, language, and prenatal visits; and parental education, race/ethnicity, and social-behavioral factors) and other (participation in short-term home visiting program). To provide more context for these results, focus groups and interviews were conducted with 45 home visitors and other staff as well as 40 families with young children to understand barriers in delivering or accessing home visiting services. Though RIDOH was successful in targeting high-risk population, there was low enrollment—28% to 64% of eligible children across the four core cities. However, once enrolled participation was high with over 90% having more than 4 visits. Lack of awareness or understanding of home visiting programs and indicators of greater vulnerability appeared to contribute to low enrollment rates. Young maternal age, public insurance, <12th grade maternal education, minority race/ethnicity, social-behavioral factors (e.g., substance use, involvement with foster care), and prior contact with short-term home visiting program were significantly associated with lower enrollment. Only language (non-English) was correlated with higher participation. Recommendations for RIDOH to increase family enrollment and sustain participation in home visiting programs are: (1) conduct outreach to increase awareness of programs; (2) support home visitors; (3) use an integrated home visiting – mental health model approach; and (4) involve families to identify needed community resources.