Modeling Barriers to Participation and Retention in a Longitudinal Parenting Intervention Susanna Visser, MS*, Marc N. Elliott, PhD^, Ruth Perou, PhD*, Angelika H. Claussen, PhD* * Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities ^ RAND Corporation The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention. They do not represent and should not be construed to represent any agency determination or policy.

Introduction Legacy for Children TM –Multi-site, randomized controlled trial of a parenting intervention for low-income mothers –Annual assessments and supplemental contact for retention prenatally to age five  Non-response at recruitment and attrition threatens the integrity of evaluations  Parenting intervention research in high-risk maternal-child populations may be subject to unique threats  Custodial issues  Persistent illness of the child or mother  High mobility

Evaluation Retention in Large-Scale Early Intervention Programs Abecedarian –81.1% at age 8 –93.7% at age 21 Project CARE –91% at 54 months Brookline Early Education Program –71% at age 25 Infant Health and Development Project –100% at age 5 (985) –88.7% at age 8 (874) High Scope/Perry Preschool –95% retention rate at age 27

Purpose Identify site-specific factors associated with: –Consent to Legacy Maternal baseline assessment among consenting mothers –2-year maternal-child assessment among those assessed at baseline

Main Study Recruitment MiamiUCLA 418 Eligible: 76% 96 Ineligible 315 Consented 75% 103 Refused 525 Screened514 Screened 471 Eligible: 84% 54 Ineligible 300 Consented 64% 171 Refused

Assessment Completion

Assessment Completion Rates Baseline 1-Year 2-year

Method Bivariate logistic regression modeled factors associated with: –Consent among screened mothers –Baseline assessment completion among consenting mothers –2-year assessment completion among mothers who completed the baseline assessment Demographic factors with p <.2 were entered into endpoint-specific multivariate logistic models Non-significant factors were pruned from the full model in a backward step-wise fashion.

Method (continued) Maternal Demographic Factors –Maternal racial/ethnic identity –English spoken in the home –Maternal age –Household income –Maternal educational attainment –Employment status –In School –Marital status Other Maternal Measures –Physical and mental health (SF-12) –Depression (CIDI) –Social support (Duke Functional SS) Receive love and affection (Affective SS) Opportunity for connection (Confidante SS) Availability of resources (Instrumental SS) –Knowledge of child development (KIDI)

Results Factors Predicting Consent among Eligible Mothers In Miami, those in English-speaking homes were more than twice as likely to consent –(X 2 = 9.01, p =.003; OR = 2.0: 1.3, 3.2) In LA, a trend was noted with mothers from English-speaking homes consenting more frequently –(X 2 = 3.07, p =.08; OR = 1.6:.95, 2.6)

Results Factors Predicting Baseline Completion among Consenting Mothers Unmarried mothers were more likely to complete baseline in Miami –(X 2 = 4.7, p =.03; OR = 4.1: 1.2, 13.4) Mothers from English-speaking homes were more likely to complete baseline in LA –(X 2 = 4.1, p =.04; OR = 2.3: 1.1, 5.2)

Results Factors Predicting 2-Year Completion among Baseline Completers Indices of social support predicted 2-year completion in Miami (X 2 = 8.56, p =.01) –Greater affective social support (OR = 1.2: 1.1, 1.4) –Lower confidante social support (OR =.87:.79,.99) Indices of social support and a trend on depression predicted 2-year completion in Miami predicted 2-year completion in LA (X 2 = 14.64, p =.002) –Greater affective social support (OR = 1.3: 1.1, 1.5) –Lower instrumental social support (OR =.78:.66,.93) –Depression (OR = 3.9:.86, 18.1)

UCLA 2-Year Completion Rates CIDI Depression at Baseline p =.078

Summary of Results Factors Associated with Endpoint Consent to Legacy Baseline Completion 2-Year Completion MiamiEnglishUnmarriedGreater Affective SS Lower Confidante SS UCLAEnglish (trend)EnglishGreater Affective SS Lower Instrumental SS Depression (trend) Measures of SES (employment, household income, education), racial/ethnic identity, and physical health were unrelated to retention.

Small Sample Size in LA

Conclusions Generally, English speakers with greater affective social support were more successfully retained by Legacy Several unique factors were associated with assessment retention by site –Mothers with fewer functional resources and less social connection were more likely to be retained by Legacy Additional emphasis on understanding and addressing the barriers to participation (including language barriers) may improve the effectiveness and generalizability of the Legacy intervention

Thank You More information is available at Susanna Visser, MS