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Enrollment and Retention in Voluntary Home Visiting Programs. Deborah Daro. Challenges in attracting and retaining families in voluntary prevention programs is long standing.
As policy interests shift to achieving measurable population level change in critical outcome areas, greater emphasis is being placed on successfully engaging a broader segment of the at-risk population.
Research on the issue has identified a number of participant, provider and contextual characteristics that impact enrollment and retention.
Programs need intentional strategies to improve performance in this area.Main Points
Engagement and Enrollment
Poor retention rates limit a program’s overall impacts and compromise their ability to “go to scale”.
Research often does not adequately consider the multiple decision points in determining a participant’s service levels.
Research does not fully examine the unique impacts of related factors operating at different conceptual levels.The Enrollment/Engagement Problem
Tested this theory against a retrospective sample to confirm factors associated with duration and dosage.
Tested the theory against a prospective sample to confirm factors associated with intent, actual enrollment and retention.
Applied statistical methods (HLM) to detect unique impacts of individual, provider, program and community characteristics on enrollment and retention decisions.Daro McCurdy Research Approach
Intent is the strongest predictor of enrollment.
Retention is influenced by many factors and multiple levels:
Participant objective experiences
Participant subjective experiences
Community characteristicsDaro McCurdy Assumptions
I want it.
I’ll try it.
I’ll stick with it.
Demographic characteristics; initial concerns; service attitudes and prior experiences; community context.
Demographics; job credentials; service delivery style; work environment.
Connection to community; staff-participant matching.Model Predictors
Readiness to change
acceptance and first contact
Informal social control
Service delivery style
Maternal perception of infant risk – those worried about their baby or who had given birth to a low weight baby are more likely to seek out services.
In some cases, interest in services is higher during pregnancy than at birth.
Parents can articulate possible program benefits.
Parents see a need to focus on parental capacity – they are open to learning.What draws parents to these programs?
Perception that program changed them.
Involvement with other service programs.
Residing in high risk communities.
More personal service delivery style which balancing responsiveness with mission.What factors contribute to retention?
Several studies suggest Hispanics are most open to program.
Infant risk – higher the risk the more visits accepted.
Support for program among informal network.
Strong relationship with home visitor.
Residing in a high risk community.
Not working and/or not in school.
Prior work experience/not simply educational qualifications
Relationship with familyWhat factors account for more visits?
New parents enroll to help their infant but remain to help themselves.
High risk families living in distressed communities can be successfully enrolled and retained.
Service delivery style and work experience are strong predictors of retention and dosage success.
Service duration and dosage, while correlated, represent different aspects of “engagement”.General Findings
Present the program as serving child and parent.
Stress “good care” is more than meeting an infant’s physical needs.
Broaden the benefits to parents
Establish linkages to other providers as child develops and parent matures.
Embed program in trusted community organizations
“Normalize” the service as something of benefit to all parents.Targets of Opportunity
Train staff on cultural sensitivity and humility.
Evaluate race-matching participants and providers.
Ensure outreach message demonstrates respects for diversity.
Focus on the “fit”
Hire for openness and empathy; train and supervisor to insure competence and quality.
Seek a balance between respect for participant and delivering the program message.Targets of Opportunity