Date of Completion


Embargo Period



home visiting, engagement, risk, dropout, person-centered approach

Major Advisor

Preston Britner, Ph.D.

Associate Advisor

JoAnn Robinson, PhD

Associate Advisor

Anne Farrell, PhD

Associate Advisor

Monica Oxforn, PhD

Field of Study

Human Development and Family Studies


Doctor of Philosophy

Open Access

Open Access


Home visiting programs are a common early intervention for families with young children who are experiencing multiple stressors in the developmental environment. Evaluations of the effectiveness of these programs produce mixed findings; high dropout rates, influenced by both family and program characteristics, are a major challenge for home visiting programs. To understand better for whom these programs are effective under what circumstances, evaluations need to capture the complexity of program experience. This study explored the relation between patterns of risk at intake, engagement quality, and program completion, using a case survey design. Patterns across three domains of family stress were examined: parent-child relationship stress, parent depression, and environmental stress. In addition, three features of engagement were coded: client disposition, insight, connecting to services. The sample consisted of 152 mostly multiple need families in Child First. Results showed that sixty percent of the sample did not complete the program. The patterns of stressors at intake reflecting low levels of stress in all three domains and elevated levels of stress in all three domains occurred more often than expected by chance, suggesting a significant interaction between the three domains within individuals. The most frequently observed pattern was that of high reported environmental stress only. Over half of those who reported elevated environmental stress and high stress in all three domains did not complete the program, and for most of these clients their case notes in their initial visits did not include a discussion of connecting to other community services. In addition, parents who were noted to demonstrate a disposition reflecting greater resistance towards the home visitor during their final visits were more likely to not complete the program than those who were cooperative; a significant effect of site was also demonstrated. The results of this exploratory study provide initial insight around the influence of psychosocial stress and environmental stress at intake on client’s program experience and the utility of measuring the quality of engagement in services. Directions for future studies that would further disentangle the complexity of program experience and inform clinical practice are discussed.