title: Evaluation of a Community-Based Approach to Strengthen Retention in Early Childhood Home Visiting.
abstract: Home visiting (HV) is a strategy for delivering services designed to promote positive parenting and prevent exposure to toxic stress during a critical period of child development. Home visiting programs are voluntary and family engagement and retention in service can influence outcomes. Most participants receive less home visits and for a shorter time than prescribed by evidence-based models. The purpose of this study was to evaluate community-based enrichment of HV (CBE-HV), an approach that was developed and implemented to increase engagement and retention in HV. CBE-HV strategies included (1) community engagement, (2) ancillary supports for families in HV, and (3) enhancements to a HV program. A retrospective, quasi-experimental study was conducted to estimate the effect of CBE-HV on the retention of families in a HV program. Comparisons of study participants were made post-implementation of CBE-HV (n = 2191) and over time (n = 3786)-pre- versus post-CBE-HV implementation in the study communities. The CBE-HV effect was statistically significant and protective (hazards ratio [HR] 0.77, 95 % confidence interval [CI]: 0.67, 0.88), indicating that attrition from HV was 23 % less in the CBE-HV group relative to the post-implementation comparison group. In the temporal comparison of study communities, CBE-HV was also associated with a significantly lower risk of HV attrition (HR: 0.71, 95 % CI: 0.56, 0.89). The study demonstrated that CBE-HV is a promising approach to achieve stronger retention and engagement in HV. Further research is needed to identify the components of CBE-HV approaches that are most effective.
authors: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 5041, Cincinnati, OH, 45529, USA. alonzo.folger@cchmc.org.
authors: Alonzo T
authors: AT
authors: Folger
authors: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 5041, Cincinnati, OH, 45529, USA.
authors: Anita L
authors: AL
authors: Brentley
authors: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 5041, Cincinnati, OH, 45529, USA.
authors: Neera K
authors: NK
authors: Goyal
authors: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 5041, Cincinnati, OH, 45529, USA.
authors: Eric S
authors: ES
authors: Hall
authors: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 5041, Cincinnati, OH, 45529, USA.
authors: Ting
authors: T
authors: Sa
authors: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 5041, Cincinnati, OH, 45529, USA.
authors: James L
authors: JL
authors: Peugh
authors: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 5041, Cincinnati, OH, 45529, USA.
authors: Angelique R
authors: AR
authors: Teeters
authors: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 5041, Cincinnati, OH, 45529, USA.
authors: Judith B
authors: JB
authors: Van Ginkel
authors: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 5041, Cincinnati, OH, 45529, USA.
authors: Robert T
authors: RT
authors: Ammerman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006792:House Calls; D006801:Humans; D016487:Parenting; D014481:United States; D055815:Young Adult
keywords: Child maltreatment; Community engagement; Home visiting; Retention