Collaboration between nurse home visitors and child welfare predicts participant attrition in home visiting programs

Evidence-based home visiting programs like Nurse-Family Partnership (NFP) improve the health of families experiencing social and economic adversities. Cross-sector collaboration is thought to influence the ability of these programs to improve maternal-child health and prevent child maltreatment.

To assess the association between NFP and Child Protective Services (CPS) collaboration and participant attrition in NFP.

We included NFP participants (n = 95,397) in the United States with their first visit between January 1, 2015 and December 31, 2021.

We used Cox Proportional Hazards models to estimate adjusted hazard (dropout) ratios associated with NFP-CPS collaboration. We operationalized collaboration as two domains: relational coordination measured by the 7-item Relational Coordination Scale and structural integration measured by 4 adapted items from the Interagency Collaboration Activities Scale on shared resources.

We found no statistically significant association between participant attrition and relational coordination, while structural integration was negatively associated with attrition (HR:0.986 [0.981-0.992]. Among NFP families referred to CPS by their NFP nurse (n = 2968), integration was also negatively associated with attrition (HR:0.955 [0.921-0.992]). In stratified models, integration was negatively associated with attrition for participants receiving NFP through government agencies (HR:0.969 [0.962-0.0.976]) and health care entities (HR:0.980, [0.965-0.995]), but not for community-based organizations. Coordination was positively associated with attrition for participants receiving NFP out of health care entities (HR:1.067 [1.029-1.111]).

Our results highlight associations between provider collaboration and participant attrition in NFP. What structures should be enacted to facilitate collaboration for families with multiple adversities needs continued research and innovation.