Elsevier

Women's Health Issues

Volume 18, Issue 2, March–April 2008, Pages 118-129
Women's Health Issues

Article
Engagement in Paraprofessional Home Visitation: Families’ Reasons for Enrollment and Program Response to Identified Reasons

https://doi.org/10.1016/j.whi.2007.10.005Get rights and content

Home visitation programs have exhibited modest impact in promoting maternal and child health outcomes; therefore, formative research is necessary to examine whether home visiting program models or actual implementation need to be modified. In particular, client engagement and retention have been identified as areas in which program implementation can be enhanced. This study assessed home visiting clients’ reasons for entering home visiting programs and their perception of programs’ response to these identified needs. We asked newly enrolled home visiting clients (n = 123) to identify reasons for entering their home visiting program, including their first and second most important reasons. The most frequently cited reasons for enrolling were wanting information about job training, completing one’s education, keeping in good health during pregnancy, and learning about infant growth and development. Home visiting programs’ response to clients’ identified needs varied. Needs more closely related to home visiting program goals of providing parenting education and promoting prenatal health were most often met, whereas needs less closely related to program goals (e.g., life course needs such as information about job training or education) were less often met. Our findings suggest that home visiting programs in urban contexts should consider modifying their program protocols to better respond to employment- and education-related issues facing their clients.

Section snippets

The Context for the Present Study: Baltimore’s Comprehensive Family Support Strategy

The Safe and Sound Campaign, created in 1997, is a comprehensive initiative to improve the degree to which children grow up safe, nurtured, and healthy in Baltimore City. One of the Campaign’s 5 strategies—Baltimore’s Comprehensive Family Support Strategy (BCFSS)—aims to improve the health, functioning, and self-reliance of families with children birth to 6. An ad hoc Strategy Team on Family Support selected 6 health and well-being indicators to impact: a) low birth weight, b) preterm birth, c)

Home Visiting Program Models

Two home visiting program models were implemented across the 5 BCFSS neighborhoods implementing home visiting at the time of this study. Three neighborhoods used a Healthy Start home visiting model (Devaney, Howell, McCormick, & Moreno, 2000); Healthy Start is an initiative funded by the Maternal and Child Health Bureau to promote community-based maternal and child health programs, with a particular emphasis on reducing infant mortality. At the onset of BCFSS implementation, the 3 neighborhoods

Baseline Maternal Characteristics

Nearly all study participants were African American, with a mean age just under 23 years (Table 1). About three quarters (77%) enrolled prenatally; for 39% of enrollees, this was their first pregnancy. Although only 40% had graduated from high school or had a GED, 59% had worked either part or full time, in the past year. More than 60% exhibited signs of poor mental health and 13% were experiencing intimate partner violence. In the past year, 44% of enrollees reported drug use and 9% reported

Discussion

Three main findings emerged from this study. First, we found that mothers identified multiple reasons for entering home visitation programs and that their reasons spanned domains. Among all identified reasons for entering, the 2 life course reasons—wanting referrals to job training and/or available jobs and wanting information on how to complete one’s education—were most often given as the first or second most important reason for joining a home visiting program.

Second, we found that maternal

Conclusions

Our findings indicating a high prevalence of employment- and education-related reasons for entering home visiting, juxtaposed with the great need for employment and education services in urban settings, leads us to recommend that home visiting programs in urban settings adopt approaches to maximize their ability to respond to client life course needs. If home visiting programs can provide services and resources that respond to employment- and education-related needs, they might improve their

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    Supported by the Safe and Sound Campaign of Baltimore, Maryland.

    1

    S. Darius Tandon, PhD, is an Assistant Professor in the Department of Pediatrics at the Johns Hopkins University School of Medicine with a joint appointment in the Bloomberg School of Public Health’s Department of Population, Family, & Reproductive Health. He is a community psychologist who conducts research on perinatal health as well as adolescent and young adult mental health.

    2

    Kathleen Parillo, MA, is a graduate of Towson University’s Masters of Arts program in Experimental Psychology. She is currently employed by NOVA Research Company in Bethesda, Maryland.

    3

    Constance Mercer, BA, has a degree in Early Childhood Education and has worked as a home visitor in Baltimore City and Howard County, Maryland. She is currently a Senior Research Assistant in the Department of Pediatrics at the Johns Hopkins University School of Medicine.

    4

    Maureen Keefer, BA, has a degree in English and Psychology from the University of Virginia. She is currently a Data Analyst in the Department of Pediatrics at the Johns Hopkins University School of Medicine.

    5

    Anne K. Duggan, ScD, is a Professor in the Department of Pediatrics at the Johns Hopkins University School of Medicine with a joint appointment in the Bloomberg School of Public Health’s Department of Health Policy and Management. She has conducted extensive research on the effectiveness of home visiting programs for pregnant women and women with young children in preventing child abuse and neglect.

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