An Exploratory Study of Therapeutic Relationships and Participant Retention in a Specialized Home Visiting Program

Previous studies have shown the positive impacts that home-visiting programs have on children, parents, and families. Despite the record of success from home-visiting programs, there can be high rates of attrition in such programs, and researchers have explored the impact of a variety of socio-demographic factors to understand attrition in home-visiting programs and to drive improvements in the delivery of service. This exploratory study examines how various factors impact participant completion and retention in the TIES program, a home-visiting program based at Children’s Mercy Hospital in Kansas City, Missouri, that serves families impacted by substance use. Three hundred nineteen (N = 319) TIES participants from 2012 through 2022 are included in this study. We used statistical analysis to explore how demographic factors impact program completion and retention, as well as how the relationship between the TIES participant and their home visitor, measured by the Working Alliance Inventory Short Form (WAI-S), impacts program completion and retention. This study also examines the impact of participant engagement—measured using an internally developed and validated scale—on program completion and retention within the TIES initiative. Analyses found that demographic variables had no impact on program completion or retention, but, consistent with prior research, a stronger relationship with the home visitor was associated with greater odds of program completion and retention. Stronger participant engagement was also found to be associated with greater odds of program completion and retention.