Engaging and retaining families in services is a common and widely-acknowledged challenge in the field of parent and early childhood programming. Rates of attrition ranging from 40% or higher are typical among home visitation programs, even in highly successful, evidence-based programs. Understanding and addressing reasons for attrition and barriers to engagement are essential. Even the best programming and service delivery systems will be ineffective if families do not access them or remain engaged long enough to reap the benefits.
Like many social service providers, the Children’s Services Council of Palm Beach County, Florida, has encountered challenges with engaging and retaining participants in its coordinated network of services for women, and children, known as the Healthy Beginnings System of Care. The Healthy Beginnings System of Care connects pregnant women and families with young children to a comprehensive set of programs and services with the goals of promoting healthy births, reducing child abuse and neglect, and increasing school readiness.
Getting to the Root of Client Attrition
Concerned about the pregnant women and families of young children who were declining or dropping out of services, the Children’s Services Council commissioned Metis Associates to conduct a survey of disengaged families. The study sought to understand their reasons for drop-off and identify recommendations for system improvement. Drawing from other studies in the field, Metis developed and administered a telephone survey to over 500 women, each of whom had dropped off at one of four key points. These were before contact (after being identified as at-risk), before an assessment, at enrollment, and during participation.
The survey addressed motivations for consenting to be contacted by the Healthy Beginnings staff, knowledge of Healthy Beginnings, and respondents’ experiences with the system. It also asked about reasons for drop-off, levels of satisfaction with and perceived value of Healthy Beginnings services, unmet needs, and suggestions for how to reach better and retain participants.
To ensure survey results were generalizable to the population of individuals who drop off from the Healthy Beginnings System, Metis developed a stratified sampling plan. The plan was based on clients discharged from the system in previous years during the same time of the study. The sample was stratified by race/ethnicity, primary service recipient (i.e., mother or child), and point of drop-off. A target sample of 600 was developed in proportion to each subgroup. The survey was administered in the respondent’s preferred language (English, Spanish, or Haitian Creole).
Findings and Recommendations for Improving Client Engagement
The conclusions of the Metis study corroborate earlier research showing that multiple factors are at play in client engagement and attrition from services. In general, the reasons for the drop-off in Palm Beach County were not related to a lack of satisfaction with the Healthy Beginnings System. Instead, the survey revealed the following three key reasons:
- Lack of awareness – pregnant women and mothers do not always understand the Healthy Beginnings System and its processes, which can result in early drop-off from the system
- Time constraints – lack of time is a significant barrier to engaging and remaining enrolled in services
- Obstacles to participation – barriers to participation can vary for families of different racial/ethnic backgrounds, such as lack of time
The complexity of families’ reasons for drop-off, both in the literature and in the Metis study, points to Metis presented the Children’s Services Council with the following recommendations that they adopted for enhancing the System’s effectiveness:
- Clearly communicate system processes and benefits to families
- Tailor outreach and engagement to family strengths, needs, and preferences
- Provide greater flexibility in programming, including light-touch options
- Promote increased cultural competence among all providers who encounter the family