Home Visiting Recruitment and Uptake Evidence Review

Home visiting is a voluntary service delivery strategy that aims to support the health and well-being of parents or caregivers and their young children (birth through age 5). The potential positive impacts of home visiting on outcomes such as child health and development, maltreatment prevention, and family economic self-sufficiency are limited by low enrollment among eligible families and high attrition.

This report describes the findings from an evidence review that examined strategies to enhance recruitment and uptake of families into home visiting services. The Conrad N. Hilton Foundation (referred to as “the Foundation” throughout this report) requested this evidence review to inform and guide its grantmaking strategies, specifically where investments can be targeted for evidence-building work in New Mexico and Los Angeles County.

Through this evidence review, we initially identified 344 resources. After evaluating each resource individually, we included 71 of them in our analysis. As a result of resource identification, data extraction, and content analysis, the Child Trends team arrived at a set of 21 strategies for enhancing recruitment and uptake that were summarized into the following four themes:

• Messaging & Outreach: Increase public awareness of and interest in home visiting. This theme includes efforts to improve and expand public awareness and understanding of home visiting, universal outreach, and incentives for participation.
• Responsiveness & Flexibility: Tailor program practices to meet family needs and preferences and reduce barriers. This theme includes selecting home visiting models that reflect the local culture, ensuring flexibility in timing and location of visits and prioritizing families’ preferences and goals.
• Referral Partnerships: Foster a referral network and establish efficient referral processes. This theme includes efforts to increase referrals to home visiting among individuals or agencies that interact with expectant parents or new caregivers—especially individuals and/or agencies who are already trusted by families and serving families affected by negative social determinants of health.
• Programmatic Efforts: Increase home visiting program capacity pertaining to effective, strategic recruitment and uptake. This theme includes the hiring, training, and engagement work that home visiting programs can do to invest in more robust recruitment and uptake.

In reviewing the literature, the Child Trends team made the following observations:

• The evidence base for effective strategies related to recruitment and uptake is sparse. Many of the strategies described below are recommended or are currently being implemented, but do not yet have evidence that they directly affect recruitment or uptake. In particular, quantitative findings are scarce and often rely on administrative data. More rigorous quantitative evidence would strengthen our understanding of the best, most effective strategies.
• There is no consistent definition or operationalization of uptake, complicating our efforts to better understand this construct. In the resources identified in this review, uptake is often vaguely described, if mentioned at all. Other times, it is described as participation in the first 1-3 sessions.  Although recruitment can be measured more easily, programs rarely track who does not enroll, limiting potential study designs that could compare families’ enrollment decisions based on strategies used for recruitment.
• Many of the strategies we identified to promote recruitment and uptake align with those known to promote family engagement and retention (i.e., longer-term outcomes) and correspond with principles of high-quality home visiting services.

Based on our review, we have identified four particularly promising strategies for increasing recruitment and uptake of home visiting services:

Most promising strategies

• Intentionally foster ongoing relationships with referral agencies.
• Promote universal access to “light-touch” home visiting models.
• Demonstrate flexibility and responsiveness to families regarding the timing, location, and content of home visiting services.
• Integrate community members into home visiting recruitment and uptake efforts.