Demographic and psychological factors that predict retention in infant mental health home visiting

Home visiting programs are prominent prevention and intervention models that improve the well-being of infants, young children and their families who are at risk for negative outcomes. However, many home visiting programs struggle to retain families for the length of the intervention. We used survival analysis to examine the impact of demographic (e.g., education, socioeconomic status) and mental health concerns (e.g., maternal stress, therapist-rated mental health status) factors on the retention of 70 mothers in Infant Mental Health-Home Visiting (IMH-HV), a multi-faceted, needs-driven, relationship-focused psychotherapeutic home visiting model. The impact of both individual and cumulative factors on retention was examined. Results revealed that shorter retention in treatment was predicted by younger maternal age at the time of childbirth, lower levels of education, and an accumulation of demographic characteristics often reflecting structural inequalities. In contrast, mental health concerns, depression in particular, predicted longer retention. For each additional structural inequity, the risk of leaving treatment increased by 60%. For each additional mental health concern, the risk of leaving treatment decreased by 25%. The findings regarding structurally-driven inequities are consistent with much of the previous research. In contrast, the finding that those with a higher composite mental health score were more likely to remain in treatment longer than those with lower levels is counter to many studies. These results may be partially explained by the mental health and relational focus of the Michigan model of IMH-HV.