Clinician Racial Biases: Preliminary Investigation on Predictors of Poor Therapeutic Alliance and Retention in Home Visiting Intervention Program

Improving Infant Mental Health Home Visiting Training to Strengthen Cultural Responsiveness and Increase Equity

Infant Mental Health Home Visiting (IMH-HV) is a needs-driven, relationship-based home visiting intervention with demonstrated positive outcomes for parents and young children. Prior research found that higher therapeutic alliance (TA) was associated with improved program retention and provider race affected TA and retention for clients. The objective of this quality improvement project was to inform improvements to IMH-HV provider trainings to better prepare providers to effectively engage and support diverse families. Focus groups or individual interviews were completed with 18 providers and 7 clients (parents/caregivers). Participants self-selected into one of three groups offered separately to providers and clients: White identifying, Black identifying and Non-Specified identity groups. A racially diverse, interdisciplinary team facilitated focus groups and interviews and conducted thematic analysis of the data. Analysis identified barriers and opportunities for effective engagement of clients: when providers and clients are of different racial/ethnic backgrounds, provider attempts to forge a connection may make families feel 'othered'; providers may not see their racial identity as salient, yet it influences their practice and the establishment of rapport with families; patience, tolerating discomfort, and allowing a family to determine whether the provider can be trusted are key. Effective IMH-HV practice with clients of diverse backgrounds requires a high level of self-understanding on the part of providers. Enhancing training to promote deeper consideration of both the perspectives of diverse clients and the salience of one's own identity has potential to reduce barriers to TA, improve program retention, and address health disparities.

Maintaining Family Engagement During Home Visitor Turnover: a Mixed Methods Study of Best Practices

Evidence-based home visiting services (EBHV) are available in states and localities nationwide through the federally-funded Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Nevertheless, the anticipated benefits of EBHV, such as improved child developmental outcomes and increased positive parenting practices, may be undermined by the fact that most families withdraw from services earlier than the model developers planned. Prior studies have linked family attrition with staff turnover. The current study used a mixed methods design to investigate the conditions under which families remained active in the home visiting program after their assigned home visitor resigned. Coincidence Analysis revealed that giving families advance notice (at least 1 month) prior to the home visitors' upcoming resignation or developing a strong positive working alliance with the inheriting home visitor appears to independently make a difference for ongoing family engagement at 3 and 6 months following a staff transition. These findings suggest that emphasizing how staff turnover is managed may mitigate the risk of family withdrawal during these transitions.