Asking the Right Questions: Screening as a Tool for Family Engagement in Early Home Visiting

Jared Barton, Pegah Naemi Jimenez, Jacklyn Biggs,

Teri Garstka, Melinda Lewis, Tom Ball

What We Know

Evidence-based home visiting is an intervention that improves family outcomes

The early childhood years matter a lot; it’s a critical period for building resilience, nurturing healthy development, and preventing adverse childhood experiences.ⁱ As every parent knows, however, raising young children can be stressful. Especially for families with extra challenges, getting some help can make a significant difference. Here, there’s important evidence that early childhood evidence-based home visiting (EBHV) interventions help promote child development, build parenting skills, support positive parent-child interactions, and improve maternal health; home visiting can also help prevent infant mortality, premature birth, low birth weight, and child maltreatment.ⁱⁱ Connecting families to EBHV helps families thrive, then, but of course that success hinges on delivering services to those who could benefit. Unfortunately, because EBHV is usually voluntary, not every family can or will engage—or stay in services for as long as recommended. Increasing family retention is therefore a priority for many EBHV programs and early childhood advocate.

What explains family engagement?

While many factors may affect retention in EBHV programs, trusting and meaningful relationships between a trained, professional, home visitor and a family serve as the channel for delivering the education, support, and connections that home visiting promises.ⁱⁱⁱ Unfortunately, early worker/family interactions may be dominated by screening obligations that can interfere with the establishment of rapport. Even worse, perceived invasiveness of required assessments might discourage family participation entirely.^iv

This study sought to understand how screening practices (re: maternal depression, substance use, intimate partner violence, child development) affect families’ connections to their home visitor and then influence duration in EBHV. We considered whether families’ participation was impacted by standardized screening practices during early engagement and/or by perceived relationship skills of the home visitor administering the screenings. 

We analyzed data from 1,032 families and 48 home visitors between 2011 and 2016. We considered the number of screenings administered and tested interactions between home visitors’ relationship-building skills and screenings completed.

What We Found

• The number of screenings administered by three months was significantly and positively associated with program duration; a one-unit increase in screenings by three months resulted in a 36% increase in a family’s duration in home visiting.

• Home visitor tenure was also statistically associated with longer duration; each one unit increase in home visitor tenure meant a 10% increase in duration.

• When home visitors were skilled at cultivating relationships, the number of screenings received by three months did not significantly influence retention. However, when home visitors’ relationship building skills were rated low, more screening during the first three months had greater effect on families remaining in services.

How do screenings keep families engaged?

If a family’s relationship with their home visitor is strong, and/or the home visitor can quickly and accurately identify family needs through screenings, families receive the services they need—when and how they need them. These positive engagements make families more likely to remain in EBHV, which then helps them reap successful outcomes.

What It Means For Practice And Policy

In contrast to worries about the burden of data collection, this evidence suggests that administering screening tools early facilitates prompt identification of family needs. Screenings may also present home visitors with opportunities for building relationships with families, which in turn may keep them engaged. This effect on duration could be attributed to encouraging disclosures of personal information, which can develop social bonds and build perceived trust,^vi and/or by facilitating individualized services and targeted referrals.

There may be multiple pathways to enhance retention in EBHV programs:

• While conducting screenings may not be as influential on retention when home visitors are skilled at building strong relationships, if relationships are weaker, conducting more screenings may help home visitors provide effective services. EBHV programs may therefore utilize assessment practices to catalyze sustained engagement among families working with home visitors of varying skill levels.
• Because families served by more experienced home visitors were retained longer, EBHV programs should see retention of home visitors as a key component of family engagement.
• EBHV programs might reconsider screenings as opportunities for relationship building rather than an administrative burden. These early experiences are opportunities to connect, engage, and empower families. The act of asking for support as a new parent is an invitation to connect. Assessments can be framed as the foundation for strong alliances, in pursuit of the positive outcomes everyone wants for families: health, growth, and well-being. 

References

i Bethell, C. D., Newacheck, P., Hawes, E., & Halfon, N. (2014). Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health Affairs, 33(12), 2106–2115.

ii Guttentag, C. L., et al. (2014). “My Baby & Me”: Effects of an early, comprehensive parenting intervention on at-risk mothers and their children. Developmental Psychology, 50(5), 1482.

iii Korfmacher, J., et al. (2008). Parent involvement in early childhood home visiting. Child & Youth Care Forum, 37(4), 171–196.

iv Stevens, J., et al. (2005). Facilitators and barriers to engagement in home visitation: A qualitative analysis of maternal, provider, and supervisor data. Journal of Aggression, Maltreatment and Trauma, 11(4), 75–93.

v Barton, J., Jimenez, P.N., Biggs, J., Garstka, T.A., Ball, T.C. (2020). Strengthening family retention and relationships in home visiting programs through early screening and assessment practices. Children and Youth Services Review, 118, 105495. https://doi.org/10.1016/j.childyouth.2020.105495.

vi Jack, S. M., DiCenso, A., & Lohfeld, L. (2002). Opening doors: Factors influencing the establishment of a working relationship between paraprofessional home visitors and at-risk families. Canadian Journal Nursing Research, 34(4), 59–69. 

Citations

Barton, J., Jimenez, P.N., Biggs, J., Garstka, T.A., Lewis, M., & Ball, T.C. (2023). Asking the Right Questions: Screening as a Tool for Family Engagement in Early Home Visiting. Lawrence, KS: Center for Research to Transform Systems for Families, Communities & Social Justice; Center for Community Engagement & Collaboration; School of Social Welfare, University of Kansas.