Abstract
Objectives Improving family retention and engagement is crucial to the success of home visiting programs. Little is known about retaining and engaging depressed parents in services. The purpose of the study is to examine how home visit content moderates the association between depression and retention and engagement. Methods The sample (N = 1322) was served by Healthy Families America (n = 618) and Parents as Teachers (n = 704) between April 1, 2012 and June 30, 2016. Parents averaged 23 years (SD = 6). Nearly half of the parents were White (48%) and the majority was single (71%). Depression was screened with the Patient Health Questionnaire-2. Home visitors reported the percent of time focused on particular content and parent engagement at every home visit. Results Multilevel regression analyses showed the amount of time that home visitors spent supporting parent–child interaction moderated the association between depression and retention at 6 (B = .08, SE = .03, p = .003) and 12 (B = .1, SE = .03, p < .001) months, such that there was a stronger positive association for depressed parents. The main effects of child development focused content and retention at 6 (B = .07, SE = .01, p < .001) and 12 (B = .08, SE = .01, p < .001) months were positive, while effects of case management focused content at 6 (B = − .06, SE = .01, p < .001) and 12 (B = − .07, SE = .01, p < .001) months were negative. Conclusions Families were more likely to be retained when home visitors focused on child development and parent–child interaction, but less likely with more case management focus. Parents with positive depression screens were more likely to remain in services with more time spent focused on supporting parent–child interactions.
Highlights
Depressive symptoms are common among parents receiving home visiting services and may impede the effectiveness of the intervention
The purpose of the current study is to investigate how program process variables— the percent of time home visitors focus the content of home visits on parent–child interactions, child development, and parent/family case management—influence the association between caregiver depression at enrollment and engagement and retention in services
The two-way interaction with the moderator parent–child interaction was significant for predicting retention at 6 (B = .08, SE = .03, p = .003) and 12 (B = .1, SE = .03, p = .000) months
Summary
Depressive symptoms are common among parents receiving home visiting services and may impede the effectiveness of the intervention. Our findings provide guidance to home visitors, indicating that they may increase the likelihood that parents will remain in the intervention if they stay focused on supporting the parent–child relationship. This is especially true for parents with depressive symptoms. Maternal depression significantly increased the likelihood of interactions where maternal behaviors with children were negative in affect (i.e., irritable, hostile or coercive) and were less emotionally available, reciprocal, and positive in interactions with their children. The effects of depression in infancy are evident even when depressive symptoms do not meet the criteria for a major depressive disorder (Conners-Burrow et al 2014, 2015, 2016)
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