title: Exploring Multilevel Factors for Family Engagement in Home Visiting Across Two National Models.
abstract: The associations of family, home visitor and site characteristics with family engagement within the first 6 months were examined. The variation in family engagement was also explored. Home visiting program participants were drawn from 21 Healthy Families America sites (1707 families) and 9 Nurse-Family Partnership sites (650 families) in New Jersey. Three-level nested generalized linear mixed models assessed the associations of family, home visitor and site characteristics with family receipt of a high dose of services in the first 6 months of enrollment. A family was considered to have received a high dose of service in the first 6 months of enrollment if they were active at 6 months and had received at least 50% of their expected visits in the first 6 months. In general, both home visiting programs engaged, at a relatively high level (Healthy Families America (HFA) 59%, Nurse-Family Partnership (NFP) 64%), with families demonstrating high-risk characteristics such as lower maternal education, maternal smoking, and maternal mental health need. Home visitor characteristics explained more of the variation (87%) in the receipt of services for HFA, while family characteristics explained more of the variation (75%) in the receipt of services for NFP. At the family level, NFP may improve the consistency with which they engage families by increasing retention efforts among mothers with lower education and smoking mothers. HFA sites seeking to improve engagement consistency should consider increasing the flexible in home visitor job responsibilities and examining the current expected-visit policies followed by home visitors on difficult-to-engage families.
authors.affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. alatimore@jhu.edu.
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Latimore
authors.affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Burrell
authors.affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Crowne
authors.affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Ojo
authors.affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Fallon
authors.initials: F
authors.lastname: Cluxton-Keller
authors.affiliation: Division of Family and Community Partnerships, New Jersey Department of Children and Families, Trenton, NJ, USA.
authors.forename: Sunday
authors.initials: S
authors.lastname: Gustin
authors.affiliation: Division of Family Health Service, New Jersey Department of Health, Trenton, NJ, USA.
authors.forename: Lakota
authors.initials: L
authors.lastname: Kruse
authors.affiliation: Division of Family and Community Partnerships, New Jersey Department of Children and Families, Trenton, NJ, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Hellman
authors.affiliation: Division of Family and Community Partnerships, New Jersey Department of Children and Families, Trenton, NJ, USA.
authors.forename: Lenore
authors.initials: L
authors.lastname: Scott
authors.affiliation: Division of Family Development, New Jersey Department of Human Services, Trenton, NJ, USA.
authors.forename: Annette
authors.initials: A
authors.lastname: Riordan
authors.affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Duggan
mesh_terms: D005190:Family; D006792:House Calls; D006801:Humans; D008962:Models, Theoretical
keywords: Context; Engagement; Home visiting; Multilevel; Retention