Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Increasing Retention in Home Visitation

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Project Number: R40 MC 06632-04
Grantee: Cincinnati Children's Hospital Medical Center
Department/Center: Behavioral Medicine & Clinical Psychology
Project Date: 01/01/2006

Final Report

Increasing Retention in Home Visitation Final Report (PDF) Exit Disclaimer

Principal Investigator

Robert T. Ammerman, M.S., Ph.D.
Division of Psychology, MLC-3015, 3333 Burnet Avenue
Cincinnati, OH  45229-3039
Phone: (513) 636-8209


  • Women/Maternal
  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)


Virtually all child abuse prevention programs lose a sizable proportion of otherwise eligible participants to disengagement and attrition. Among those who are retained, many do not adhere to program protocols. Although a number of factors have been implicated in attrition and decreased program adherence, diminished motivation and commitment to sustained participation in long-term prevention programs has emerged as a prominent contributor. We propose to conduct a randomized controlled clinical trial of Motivational Interviewing (MI) to enhance retention and promote program adherence in 284 first time mothers receiving home visitation, a widely used approach to child abuse prevention. MI is a client-centered strategy that focuses specifically on increasing motivation and commitment to change. MI will be evaluated in two models of home visitation: Nurse Home Visitation and Healthy Families America. Mothers in four agencies (two each of NHV and HFA) will be randomly assigned to MI or Home Visitation As Usual (HVAU) conditions. Half of the home visitors will be extensively trained in MI procedures, and intervention fidelity will be monitored. The other half (HVAU) will receive an attention control training. It is hypothesized that (1) the MI condition will be superior to HVAU in terms of retention and program adherence, (2) MI will result in benefits in both the HFA and NHV models, (3) mothers with higher levels of depression and trauma history will be more likely to be retained relative to their counterparts with lower levels of depression and trauma history, and (4) retained mothers in the MI condition will have better outcomes than retained mothers in the HVAU condition. This proposal addresses MCHB Strategic Research Issues 3 (assure quality of care for MCH populations) and 4 (promoting the healthy development of MCH populations) by seeking to improve delivery and impact of home visitation, and providing young children and their families with a higher quality of care by helping them sustain commitment to an early prevention program.


Listed is descending order by year published.

Ammerman RT, Shenk CE, Teeters AR, Noll JG, Putnam FW, Van Ginkel JB. Impact of depression and childhood trauma in mothers receiving home visitation. Journal of Child and Family Studies. 2011. Advance online publication. doi: 10.1007/s10826-011-9513-9.

Ammerman RT, Putnam FW, Bosse NB, Teeters AR, Van Ginkel JB. Maternal depression in home visitation: a systematic review. Aggress Violent Behav. 2010 May;15(3):191-200.

Ammerman RT, Putnam FW, Bosse NR, Teeters AR, Van Ginkel JB. Maternal depression in home visitation: a systematic review. Aggress Violent Behav. 2010 May;15(3):191-200.

Donovan EF, Ammerman RT, Besl J, Atherton H, Khoury JC, Altaye M, et al. Intensive home visiting is associated with decreased risk of infant death. Pediatrics. 2007 Jun;119(6):1145-51.


Violence & Abuse, Home Visiting, Depression, Health Care Quality, Mental Health & Wellbeing

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