McKelvey Lorraine M, Fitzgerald Shalese, Conners Edge Nicola A, Whiteside-Mansell Leanne
Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA.
Matern Child Health J. 2018 Oct;22(Suppl 1):33-42. doi: 10.1007/s10995-018-2533-y.
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.
目标 提高家庭留存率和参与度对于家访项目的成功至关重要。对于让抑郁的父母持续接受服务并参与其中，我们了解得很少。本研究的目的是探讨家访内容如何调节抑郁与留存率和参与度之间的关联。方法 样本（N = 1322）来自2012年4月1日至2016年6月30日期间接受“美国健康家庭”（n = 618）和“家长即教师”（n = 704）服务的家庭。父母的平均年龄为23岁（标准差 = 6）。近一半的父母是白人（48%），大多数是单身（71%）。使用患者健康问卷-2对抑郁进行筛查。家访人员报告每次家访时专注于特定内容的时间百分比以及家长的参与度。结果 多层次回归分析表明，家访人员用于支持亲子互动的时间量调节了抑郁与6个月（B = 0.08，标准误 = 0.03，p = 0.003）和12个月（B = 0.1，标准误 = 0.03，p < 0.001）留存率之间的关联，即对于抑郁的父母存在更强的正相关。关注儿童发展内容与6个月（B = 0.07，标准误 = 0.01，p < 0.001）和12个月（B = 0.08，标准误 = 0.01，p < 0.001）留存率的主要效应为正向，而关注个案管理内容与6个月（B = -0.06，标准误 = 0.01，p < 0.001）和12个月（B = -0.07，标准误 = 0.01，p < 0.001）留存率的效应为负向。结论 当家访人员专注于儿童发展和亲子互动时，家庭更有可能被留存，但更多关注个案管理时则可能性较小。抑郁筛查呈阳性的父母在更多时间用于支持亲子互动时更有可能继续接受服务。
