Evaluation of a Community-Based Approach to Strengthen Retention in Early Childhood Home Visiting.

Home visiting (HV) is a strategy for delivering services designed to promote positive parenting and prevent exposure to toxic stress during a critical period of child development. Home visiting programs are voluntary and family engagement and retention in service can influence outcomes. Most participants receive less home visits and for a shorter time than prescribed by evidence-based models. The purpose of this study was to evaluate community-based enrichment of HV (CBE-HV), an approach that was developed and implemented to increase engagement and retention in HV. CBE-HV strategies included (1) community engagement, (2) ancillary supports for families in HV, and (3) enhancements to a HV program. A retrospective, quasi-experimental study was conducted to estimate the effect of CBE-HV on the retention of families in a HV program. Comparisons of study participants were made post-implementation of CBE-HV (n = 2191) and over time (n = 3786)-pre- versus post-CBE-HV implementation in the study communities. The CBE-HV effect was statistically significant and protective (hazards ratio [HR] 0.77, 95 % confidence interval [CI]: 0.67, 0.88), indicating that attrition from HV was 23 % less in the CBE-HV group relative to the post-implementation comparison group. In the temporal comparison of study communities, CBE-HV was also associated with a significantly lower risk of HV attrition (HR: 0.71, 95 % CI: 0.56, 0.89). The study demonstrated that CBE-HV is a promising approach to achieve stronger retention and engagement in HV. Further research is needed to identify the components of CBE-HV approaches that are most effective.

Development, implementation and evaluation of a unique African-American faith-based approach to increase automobile restraint use.

OBJECTIVE: Despite generalized intervention programs, restraint use among African Americans remains below national levels, especially among children. This study describes the development and implementation of a community participatory faith-based youth injury prevention program. METHODS: Through a partnership with the African-American faith-based community and our injury prevention group, a unique multigenerational intervention program was developed targeting motor vehicle restraint use. Once developed, the program was initially evaluated by comparing outcomes between control and intervention churches. The main objective was to observe adult and pediatric restraint use before and after program implementation. RESULTS: Overall, there was excellent recognition and participation in the program. Following program implementation, significant improvements were observed in restraint use compared to control churches. In particular, there was a 72% reduction in unrestrained children, a 25% increase in children being secured in the rear-seat position and a nearly 20% increase in driver restraint use. CONCLUSIONS: The development and implementation of a culturally sensitive intervention program can significantly improve restraint use in a minority population. Partnering with the community in all phases of the program is essential to its success.