These two studies investigated maternal engagement and retention in a voluntary, home-visiting program. The program screened families at the birth of their first child for risk characteristics associated with poor child and family outcomes. Higher risk families were offered regular home visits and support for up to 5 years. In the first study, a two-level hierarchical general linear model (HGLM) was used to examine the impact of poor community health and maternal isolation on mother's active engagement in the program, following initial enrollment. Data came from 4,057 mothers with firstborn infants, who enrolled in the Oregon Healthy Start (OHS) home-visiting program from 1995 through 1998. At the time of this study OHS was operating in 15 Oregon counties. Results showed that living in a county characterized by poor community health, or maternal isolation from supportive family and friendship networks, significantly reduced the likelihood of mothers actively engaging in home visits after enrollment. Hispanic mothers were significantly more likely to engage in services than mothers of other ethnicities. In the second study, a three-level hierarchical general linear model (HGLM) was used to investigate the impact of community violence, home visitor attributes, and maternal attributes on maternal retention in the OHS home-visiting program. Data came from 1,093 mothers with firstborn infants, served by 71 home visitors, residing in 12 communities being served by the OHS program prior to February 2000. Results showed that mothers who lived in communities that displayed higher levels of community violence were less likely to remain in the OHS program. Mothers were more likely to remain in the program when served by home visitors who received more active supervision. Mothers who were older were more likely to remain in the OHS program than were younger mothers. Hispanic mothers were more likely to remain in the OHS program than were mothers of other ethnic groups. Each study presents the implications for programmatic application. / Graduation date: 2002

This study utilized a qualitative approach to explore how Healthy Start home visiting services affect participants' parenting and lives in general. The purpose of this study was to explore both the intended and unintended outcomes of Healthy Start, using the theory of transformative learning. This theory postulates that through education individuals examine their thoughts, beliefs, and behaviors. This self-examination results in changes in self-perception that can impact lives in many unexpected ways. Through interviews with 20 families, who had participated in Healthy Start for at least 6 months, families reported both anticipated and unanticipated changes in their lives. It was found that Healthy Start influences a variety of positive outcomes for families. Previous quantitative findings were supported. According to the parents interviewed, Healthy Start is achieving its intended outcomes and goals. Parents reported greater ability to access health care services, improvements in their home learning environment, and improved interactions with their child. Parents also indicated increased knowledge of child development and community resources. Findings also provided support for the occurrence of transformative learning. Interviewed parents indicated that their involvement with Healthy Start impacted more than just their parenting. Through a supportive relationship and goal setting, the participants were able to reach beyond basic parent education. The interviews suggest that the mechanism for transformative learning lies in the supportive, non-threatening relationship that develops between parent and home visitor. This supportive relationship, in addition to guided goals setting, enhances a parent's feelings of self-efficacy and increases their ability to make life changes and persist in the face of challenges. Parents reported improved relationships with others, increased feelings of confidence, and the ability to accomplish otherwise unattainable things. / Graduation date: 2002

Two studies investigated the characteristics of high-risk Hispanic parents with young children who were enrolled in a primary prevention home visitation program targeting first birth families. In the first study, more and less acculturated high-risk Hispanic families were compared to high-risk non-Hispanic White families on differences in demographic characteristics, risk factors associated with poor child outcomes, and parent behaviors related to infant health. Using the General Linear Model Univariate procedure, these characteristics were then related to level of parenting skills, measured after approximately one year of service. A total of 1005 families were included in the study. There were important differences in parent psychosocial characteristics, health risks, and outcomes among Hispanic families. Hispanic mothers who were more acculturated, as measured by use of English in the home, were more likely to be at risk for substance abuse, mental illness, and family conflict. They were more likely to smoke and less likely to breastfeed. Less acculturated Hispanic mothers were less educated and more likely to be isolated. Controlling for pretest scores and education level, there were significant between group differences on parenting skills after one year of service, however the effect was small and overshadowed by the significant interaction effect between partner status and household category. Scores for single Spanish-speaking Hispanic mothers were significantly lower than scores of Spanish-speaking Hispanics in partner households. Risk factors that were positively associated with program progress included breastfeeding and mother's education level. Smoking, mental illness, and unrealistic expectations for the child were negatively associated with program progress. The second paper addressed the efficacy of an age-paced parenting newsletter as part of a home-visiting program for Spanish-speaking Hispanic parents. Family Service Workers serving these families delivered the newsletter and used it as a curriculum guide and teaching tool for families. Parents reported reading the newsletter, learning from it, and changing their behavior in response to newsletter content. Home visitors reported that it was a useful tool to reach high-risk parents with important parenting information. They found that it was particularly useful to combat inappropriate or unhealthful parenting advice from well-meaning family members and friends. / Graduation date: 2004