Introduction
Research Questions
- Which factors (facilitators or barriers) influence family engagement at each stage in which programs and families interact: outreach, recruitment, retention, and active participation? What are the factors at the family, home visitor, program, community, and systems levels of influence, and how do these factors interact across levels? What is known about families that are not served by home visiting? Do eligible families that are less likely to enroll or remain in a home visiting program share common characteristics? Are there systemic barriers to access within the service system?
- What strategies are programs using to support family engagement at each stage? How effective are these strategies, and for whom are they effective?
Early childhood home visiting is a service delivery strategy that supports a range of positive outcomes, including improved child and maternal health, children’s development and school readiness, family economic self-sufficiency, and the reduction of child abuse and neglect. Evidence-based home visiting programs reached about 278,000 families in 2021, according to the National Home Visiting Resource Center, but many more families are eligible and could benefit from these programs. This literature synthesis aims to deepen understanding of the facilitators of and barriers to family engagement in home visiting, the strategies programs use to support engagement, and topics that would benefit from further research.
Purpose
This synthesis is one component of the Understanding and Expanding the Reach of Home Visiting (HV-REACH) project, funded by the Office of Planning, Research, and Evaluation in the Administration for Children and Families, in collaboration with the Health Resources and Services Administration. HV-REACH is identifying, developing, studying, and disseminating evidence-informed resources and strategies that early childhood home visiting programs can use to achieve more equitable access to and participation in home visiting services and, ultimately, better outcomes for children and families.
The literature synthesis seeks to inform program practitioners and policymakers about factors and strategies that facilitate family engagement in home visiting and barriers to engagement. The synthesis also informs the project’s conceptual framework of family engagement in home visiting, a toolkit of engagement resources, and research topics for further study.
Key Findings and Highlights
Key facilitators to family engagement across the stages (outreach, recruitment, retention, and active participation) include the following, and their absence can be barriers to engagement:
- Relevant program content and support. Families enroll and remain in home visiting when they perceive it as beneficial and believe it meets their expectations and ongoing needs for support or information.
- A positive dynamic between home visitors and families. A relationship with a home visitor that is trusting, supportive, and stable—that begins during outreach and persists over time—also supports family engagement.
- Flexibility. Scheduling flexibility supports families’ enrollment and retention.
Home visiting programs and home visitors can develop strategies to promote engagement:
- Strengthen outreach and recruitment. Programs can achieve this by (1) building relationships with varied community referral partners and having smooth referral processes; (2) disseminating clear, complete, and linguistically accessible information; (3) ensuring program staff conduct outreach in all eligible neighborhoods within the community and are persistent in building trusting relationships with families; (4) working with families to help spread the word; and (5) having clear and simple enrollment processes.
- Support a favorable match and a positive dynamic between home visitors and families. Home visitors with favorable interpersonal qualities and, potentially, similar personalities or life experiences as families can support a positive dynamic. For some families, being paired with a home visitor from their community can influence engagement.
- Offer flexible scheduling, content, and activities to prioritize families’ needs and goals. Flexible scheduling for the day, time, and meeting location can help accommodate families’ work or school schedules. Programs can also prioritize information, instruction, and activities that families most want and need.
Methods
The literature synthesis draws on 36 research manuscripts. The project team searched for peer-reviewed and gray literature on family engagement in home visiting published from 2011 to 2021. They also searched for and included applicable literature reviews on early care and education and parent training programs that support child mental health—fields that also engage families in voluntary services. The team prioritized articles with information on (1) outreach or recruitment or (2) factors or strategies at the program, community, or systems levels that influence engagement. They accepted all research designs and did not assess study quality.
Citation
Kleinman, Rebecca, Catherine Ayoub, Patricia Del Grosso, Jessica F. Harding, Ruth Hsu, McMillan Gaither, Christina Mondi-Rago, Mary Kalb, Joseph O’Brien, Joanne Roberts, Emily Rosen, and Mindy Rosengarten. (2023). Understanding Family Engagement in Home Visiting: Literature Synthesis.” OPRE Report #2023-004. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
Glossary
- Active participation:
- A family’s responsiveness during services. It encompasses a family’s responsiveness to the home visitor and program content, perceptions of or satisfaction with home visiting, and application of new skills learned through home visiting.
- Family engagement:
- Family engagement occurs when programs and families interact; interactions begin at outreach and recruitment and, for families that enroll, extend to retention and active participation.
- Outreach:
- Efforts to strengthen program awareness and referrals. It encompasses how programs or staff recognize and connect with eligible or potentially eligible families.
- Recruitment:
- Efforts to enroll families and a family’s enrollment decision. It encompasses a program’s marketing, messaging, and relationship-building efforts; and reasons families do or do not enroll.
- Retention:
- A family’s continued attendance in services. It encompasses ways programs or staff encourage families to continue attending services; and reasons families continue to participate (or do not continue).