Journal of Child and Family Studies

, Volume 27, Issue 9, pp 2925–2942 | Cite as

Addressing Barriers to Recruitment and Retention in the Implementation of Parenting Programs: Lessons Learned for Effective Program Delivery in Rural and Urban Areas

  • Paul SmokowskiEmail author
  • Rosalie Corona
  • Martica Bacallao
  • Beverly L. Fortson
  • Khiya J. Marshall
  • Anna Yaros
Original Paper


Research has demonstrated the effectiveness of family-based programs for reducing adolescent risk behaviors and promoting adolescent health; however, parent engagement, specifically in terms of recruitment and retention, remains a consistent challenge. Recruitment rates for family-based prevention programs range from 3 to 35%, while, on average, 28% of caregivers drop out before program completion. Thus, engagement of parents in prevention programming is of utmost concern to ensure families and youth benefit from implementation of family-based programs. In this manuscript, two Centers for Disease Control and Prevention-funded projects share their experiences with engagement of parents in violence prevention programs. Problems related to parent engagement are reviewed, as are structural, attitudinal, and interpersonal barriers specific to recruitment and retention. Examples of successful implementation strategies identified across urban and rural sites are also analyzed and lessons learned are provided.


Recruitment Retention Parenting wisely Staying connected with your teen Family check-up 



Funding for this research was provided through cooperative agreements with the U.S. Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control (Dr. Paul Smokowski, University of North Carolina at Chapel Hill [CE001948] and Dr. Albert D. Farrell, Virginia Commonwealth University [CE001956]). Intergovernmental personnel acts (Dr. Paul Smokowski, University of Kansas [16IPA1605209] and Dr. Rosalie Corona, Virginia Commonwealth University [16IPA1605208]) for the first two authors were utilized to summarize research across projects.

Author Contributions

P.S. collaborated on the design and execution of the study conducted in the rural site and collaborated in the writing of the paper. R.C. collaborated on the design and execution of the study conducted in the urban site and collaborated in the writing of the paper. M.B. collaborated on the design and execution of the study conducted in the rural site and collaborated in the writing of the paper. B.L.F. collaborated in the writing of the paper. K.J.M. collaborated in the writing of the paper. A.Y. collaborated on the design and execution of the study conducted in the urban site and collaborated in the writing of the paper.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

Approval for the two projects was obtained from the Virginia Commonwealth University (urban sample) and the University of North Carolina at Chapel Hill (rural sample). All study procedures were in accordance with the ethical standards of the institutional and/or research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent, parental permission, and youth assent was obtained from all participants in the studies from which these lessons learned were drawn.


  1. American Community Survey. (2008). 2008 American community survey 1-year estimates. Selected economic characteristics.
  2. Andreas, J. B., & Watson, M. W. (2009). Moderating effects of family environment on the association between children’s aggressive beliefs and their aggression trajectories from childhood to adolescence. Development and Psychopathology, 21, 189–205. Scholar
  3. Bamberger, K. T., Coatsworth, J. D., Fosco, G. M., & Ram, N. (2014). Change in participant engagement during a family-based preventive intervention: Ups and downs with time and tension. Journal of Family Psychology, 28, 811–820. Scholar
  4. Baydar, N., Reid, M. J., & Webster‐Stratton, C. (2003). The role of mental health factors and program engagement in the effectiveness of a preventive parenting program for Head Start mothers. Child Development, 74, 1433–1453. Scholar
  5. Becker, K. D., Brandt, N. E., & Buckingham, S. L. (2015). Engaging youth and families in school mental health services. Child and Adolescent Psychiatric Clinics, 24, 385–398. Scholar
  6. Breland-Noble, A. M., Bell, C. C., Burriss, A., & Poole, H. K., AAKOMA Project Adult Advisory Board. (2012). The significance of strategic community engagement in recruiting African American youth & families for clinical research. Journal of Child and family Studies, 21, 273–280. Scholar
  7. Brody, G. H., Murry, V. M., Chen, Y., Kogan, S. M., & Brown, A. C. (2006). Effects of family risk factors on dosage and efficacy of a family-centered preventive intervention for rural African Americans. Prevention Science, 7, 281–291. Scholar
  8. Byrnes, H. F., Miller, B. A., Aalborg, A. E., Plasencia, A. V., & Keagy, C. D. (2010). Implementation fidelity in adolescent family-based prevention programs: Relationship to family engagement. Health Education Research, 25, 531–541. Scholar
  9. Cannon, E., & Levy, M. (2008). Substance-using Hispanic youth and their families: Review of engagement and treatment strategies. The Family Journal, 16, 199–203. Scholar
  10. Chacko, A., Jensen, S. A., Lowry, L. S., et al. (2016). Engagement in behavioral parent training: Review of the literature and implications for practice. Clinical Child and Family Psychology Review, 19, 204–215. Scholar
  11. Chen, X., Li, D., Li, Z. Y., Li, B. S., & Liu, M. (2000). Sociable and prosocial dimensions of social competence in Chinese children: Common and unique contributions to social, academic, and psychological adjustment. Developmental Psychology, 36, 302–314. Scholar
  12. Coatsworth, J. D., Duncan, L. G., Pantin, H., & Szapocznik, J. (2006). Patterns of retention in a preventive intervention with ethnic minority families. Journal of Primary Prevention, 27, 171–193. Scholar
  13. Coatsworth, J. D., Hemady, K. T., & George, M. W. (2017). Predictors of group leaders’ perceptions of parents’ initial and dynamic engagement in a family preventive intervention. Prevention Science, 27, 171–193. Scholar
  14. Connell, A. M., Dishion, T. J., Yasui, M., & Kavanagh, K. (2007). An adaptive approach to family intervention: Linking engagement in family-centered intervention to reductions in adolescent problem behavior. Journal of Consulting and Clinical Psychology, 75, 568–579. Scholar
  15. Corona, R., Gonzalez, T., Cohen, R., Edwards, C., & Edmonds, T. (2009). Richmond Latino needs assessment: A community-university partnership to identify health concerns and service needs for Latino youth. Journal of Community Health, 34, 195–201. Scholar
  16. Cotter, K. L., Bacallao, M., Smokowski, P. R., & Robertson, C. I. B. (2013). Parenting interventions implementation science: How delivery format impacts the Parenting Wisely program. Journal of Research on Social Work Practice, 23, 639–650. Scholar
  17. Cotter, K. L., Rose, R. A., Bacallao, M., & Smokowski, P. R. (2018). Parenting Wisely six months later: How delivery format impacts program effects at follow-up. Journal of Primary Prevention.
  18. David-Ferdon, C., Vivolo-Kantor, A. M., Dahlberg, L. L., Marshall, K. J., Rainford, N., & Hall, J. E. (2016). A comprehensive technical package for the prevention of youth violence and associated risk behaviors. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.CrossRefGoogle Scholar
  19. Deater-Deckhard, K., Dodge, K. A., Bates, J. E., & Pettit, G. S. (1996). Physical discipline among African American and European American mothers: Links to children’s externalizing behaviors. Developmental Psychology, 32, 1065–1072. Scholar
  20. Dishion, T. J., & Kavanagh, K. (2003). Intervening in adolescent problem behavior: A family centered approach. New York: The Guilford Press.Google Scholar
  21. Dishion, T. J., McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54, 755–764. Scholar
  22. Dishion, T. J., Patterson, G. R., Stoolmiller, M., & Skinner, M. L. (1991). Family, school, and behavioral antecedents to early adolescent involvement with antisocial peers. Developmental Psychology, 27, 172–180. Scholar
  23. Dodge, K. A., Pettit, G. S., & Bates, J. E. (1994). Socialization mediators of the relation between socioeconomic status and child conduct problems. Child Development, 65, 649–665. Scholar
  24. Dumas, J. E., Begle, A. M., French, B., & Pearl, A. (2010). Effects of monetary incentives on engagement in the PACE parenting program. Journal of Clinical Child & Adolescent Psychology, 39, 302–313. Scholar
  25. Dumas, J. E., Nissley-Tsiopinis, J., & Moreland, A. D. (2007). From intent to enrollment, attendance, and participation in preventive parenting groups. Journal of Child and family Studies, 16, 1–26. Scholar
  26. Fagan, A. A., & Catalano, R. F. (2013). What works in youth violence prevention: A review of the literature. Research on Social Work Practice, 23, 141–156. Scholar
  27. Finigan-Carr, N. M., Copeland-Linder, N., Haynie, D. L., & Cheng, T. L. (2014). Engaging urban parents of early adolescents in parenting interventions: Home visits vs. group sessions. School Community Journal, 24, 63–82.PubMedPubMedCentralGoogle Scholar
  28. Forehand, R., Armistead, L., Long, N., Wyckoff, S. C., Kotchick, B. A., & Whitaker, D., et al. (2007). Efficacy of a parent-based sexual-risk prevention program for African American preadolescents: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 161, 1123–1129. Scholar
  29. Forehand, R., Lafko, N., Parent, J., & Burt, K. B. (2014). Is parenting the mediator of change in behavioral parent training for externalizing problems of youth? Clinical Psychology Review, 34, 608–619. Scholar
  30. Fortson, B. L., Klevens, J., Merrick, M. T., Gilbert, L. K., & Alexander, S. P. (2016). Preventing child abuse and neglect: A technical package for policy, norm, and programmatic activities. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.Google Scholar
  31. Frankel, F., & Simmons, III, J. Q. (1992). Parent behavioral training: Why and when some parents drop out. Journal of Clinical Child Psychology, 21, 322–330. Scholar
  32. Gordon, D. A. (2000). Parent training via CD-ROM: Using technology to disseminate effective prevention practices. The Journal of Primary Prevention, 21, 227–251. Scholar
  33. Gordon, D. A. (2011). Parenting Wisely evaluation tools.
  34. Gordon, D. A.., & Stanar, C. R.. (2003). Lessons learned from the dissemination of Parenting Wisely, a parent training CD-ROM. Cognitive and Behavioral Practice, 10, 312–323. Scholar
  35. Gorman-Smith, D., Tolan, P. H., & Henry, D. B. (2000). A developmental-ecological model of the relation of family functioning to patterns of delinquency. Journal of Quantitative Criminology, 16, 169–198.CrossRefGoogle Scholar
  36. Gorman-Smith, D., Tolan, P. H., Henry, D. B., Leventhal, A., Schoeny, M., Lutovsky, K., & Quintana, E. (2002). Predictors of participation in a family-focused preventive intervention for substance use. Psychology of Addictive Behaviors, 16, S55–S64. Scholar
  37. Griffin, K. W., Botvin, G. J., Scheier, L. M., Diaz, T., & Miller, N. L. (2000). Parenting practices as predictors of substance use, delinquency, and aggression among urban minority youth: Moderating effects of family structure and gender. Psychology of Addictive Behaviors, 14, 174–184. Scholar
  38. Haggerty, K. P., Skinner, M. L., MacKenzie, E. P., & Catalano, R. F. (2007). A randomized trial of Parents Who Care: Effects on key outcomes at 24-month follow-up. Prevention Science, 8, 249–260. Scholar
  39. Hooven, C., Walsh, E., Willgerodt, M., & Salazar, A. (2011). Increasing participation in prevention research: Strategies for youth, parents and schools. Journal of Child and Adolescent Psychiatric Nursing, 24, 137–149. Scholar
  40. Ingoldsby, E. M. (2010). Review of interventions to improve family engagement and retention in parent and child mental health programs. Journal of Child and family Studies, 19, 629–645. Scholar
  41. Kacir, C., & Gordon, D. (1999). Parenting adolescents wisely: The effectiveness of an interactive videodisk parent training program in Appalachia. Child & Family Behavior Therapy, 21, 1–22. Scholar
  42. Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36, 567–589. Scholar
  43. Kazdin, A. E. (1996). Dropping out of child psychotherapy: Issues for research and implications for practice. Clinical Child Psychology and Psychiatry, 1, 133–156. Scholar
  44. Kazdin, A. E., Holland, L., Crowley, M., & Breton, S. (1997). Barriers to Participation in Treatment Scale: Evaluation and validation in the context of child outpatient treatment. Journal of Child Psychology and Psychiatry, 38, 1051–1062. Scholar
  45. Kazdin, A. E., & Wassell, G. (2000). Predictors of barriers to treatment and therapeutic change in outpatient therapy for antisocial children and their families. Mental Health Services Research, 2, 27–40. Scholar
  46. Kellerman, P. F. (1992). Focus on psychodrama. London: Jessica Kingsley.Google Scholar
  47. Kipper, D. A., & Ritchie, T. D. (2003). The effectiveness of psychodramatic techniques: A meta-analysis. Group Dynamics: Theory, Research, and Practice, 7, 13–25. Scholar
  48. Kumpfer, K. L., & Alvarado, R. (2003). Family-strengthening approaches for the prevention of youth problem behaviors. American Psychologist, 58, 457–465. Scholar
  49. Lefever, J. B., Bigelow, K. M., Carta, J. J., & Borkowski, J. G. (2013). Prediction of early engagement and completion of a home visitation parenting intervention for preventing child maltreatment. NHSA Dialog, 16(1), 1–19.Google Scholar
  50. Lochman, J. E. (2000). Parent and family skills training in targeted prevention programs for at-risk youth. The Journal of Primary Prevention, 21, 253–265. Scholar
  51. Loeber, R., & Stouthamer-Loeber, M. (1987). Prediction. In H. C. Quay (Ed.), Handbook of juvenile delinquency (pp. 325–382). New York: Wiley.Google Scholar
  52. Lundahl, B., Risser, H. J., & Lovejoy, M. C. (2006). A meta-analysis of parent training: Moderators and follow-up effects. Clinical Psychology Review, 26, 86–104. Scholar
  53. MacNaughton, K. L., & Rodrigue, J. R. (2001). Predicting adherence to recommendations by parents of clinic-referred children. Journal of Consulting and Clinical Psychology, 69, 262–270. Scholar
  54. McKay, M. M., & Bannon, Jr, W. M. (2004). Engaging families in child mental health services. Child and Adolescent Psychiatric Clinics of North America, 13, 905–921. Scholar
  55. Meek, J., Lillehoj, C. J., Welsh, J., & Spoth, R. (2004). Rural community partnership recruitment for an evidence-based family-focused prevention program: The PROSPER Project. Rural Mental Health, 29, 23–28.Google Scholar
  56. Mendez, J. L., Carpenter, J. L., LaForett, D. R., & Cohen, J. S. (2009). Parental engagement and barriers to participation in a community‐based preventive intervention. American Journal of Community Psychology, 44, 1–14. Scholar
  57. Moran, P., Ghate, D., & van der Merwe, A. (2004). What works in parenting support? A review of the international evidence. London: Policy Research Bureau.Google Scholar
  58. Murry, V. M., Berkel, C., Brody, G. H., Gibbons, M., & Gibbons, F. X. (2007). The Strong African American Families program: Longitudinal pathways to sexual risk reduction. Journal of Adolescent Health, 41, 333–342. Scholar
  59. National Institute of Justice. (2012). All Programs & Practices.
  60. North Carolina State Bureau of Investigations. (2015). Crime in North Carolina-2014: Annual summary report of 2014 uniform crime reporting data.
  61. Office of Juvenile Justice and Delinquency Prevention (OJJDP). (2012). Model program guide.
  62. O’Neill, H., & Woodward, R. (2002). Evaluation of the Parenting Wisely CD-ROM parent training programme: An Irish replication. Irish Journal of Psychology, 23, 62–72.Google Scholar
  63. Oxford, L., & Wiener, D. (2003). Action therapy with families and groups using creative arts improvisation in clinical practice. In L. Oxford & D. J. Weiner (Eds.), Action therapy with families and groups: Using creative arts improvisation in clinical practice (pp. 45–74). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  64. Pantin, H., Coatsworth, J. D., Feaster, D. J., Newman, F. L., Briones, E., Prado, G., et al. (2003). Familias Unidas: The efficacy of an intervention to promote parental investment in Hispanic immigrant families. Prevention Science, 4, 189–201. Scholar
  65. Patterson, G. R. (1982). Coercive family process. Eugene, OR: Castalia.Google Scholar
  66. Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). A social learning approach. IV. Antisocial boys. Eugene, OR: Castalia.Google Scholar
  67. Perrino, T., Coatsworth, J. D., Briones, E., Pantin, H., & Szapocznik, J. (2001). Initial engagement in parent-centered preventive interventions: A family systems perspective. The Journal of Primary Prevention, 22, 21–44. Scholar
  68. Prado, G., Pantin, H., Schwartz, S., Lupei, N. S., & Szapocznik, J. (2006). Predictors of engagement and retention into a parent-centered, ecodevelopmental HIV preventive intervention for Hispanic adolescents and their families. Journal of Pediatric Psychology, 31, 874–890. Scholar
  69. Prinz, R. J., & Miller, G. E. (1994). Family-based treatment for childhood antisocial behavior: Experimental influences on dropout and engagement. Journal of Consulting and Clinical Psychology, 62, 645–650. Scholar
  70. Pursell, G. R., Laursen, B., Rubin, K. H., Booth-LaForce, C., & Rose-Krasnor, L. (2008). Gender differences in patterns of association between prosocial behavior, personality, and externalizing problems. Journal of Research in Personality, 42, 472–481. Scholar
  71. Quinn, W. H., Hall, D. B., Smith, E. P., & Rabiner, D. (2010). Predictors of family participation in a multiple family group intervention for aggressive middle school students. Journal of Community Psychology, 38, 227–244. Scholar
  72. Sandler, I. N., Schoenfelder, E. N., Wolchik, S. A., & MacKinnon, D. P. (2011). Long-term impact of prevention programs to promote effective parenting: Lasting effects but uncertain processes. Annual Review of Psychology, 62, 299–329. Scholar
  73. Schoenfelder, E. N., Sandler, I. N., Millsap, R. E., Wolchik, S. A., Berkel, C., & Ayers, T. S. (2013). Caregiver responsiveness to the family bereavement program: What predicts responsiveness? What does responsiveness predict? Prevention Science, 14, 545–556. Scholar
  74. Small, L. A., Jackson, J., Gopalan, G., & McKay, M. M. (2015). Meeting the complex needs of urban youth and their families through the 4Rs 2Ss Family Strengthening Program: The “real world” meets evidence-informed care. Research on Social Work Practice, 25, 433–445.CrossRefPubMedGoogle Scholar
  75. Smith, J. D., Dishion, T. J., Shaw, D. S., & Wilson, M. N. (2013). Indirect effects of fidelity to the Family Check-Up on changes in parenting and early childhood problem behaviors. Journal of Consulting and Clinical Psychology, 81, 962–974. Scholar
  76. Smokowski, P. R., & Bacallao, M. (2010). Becoming bicultural: Risk, resilience, and Latino youth.. New York, NY: New York University Press.Google Scholar
  77. Spoth, R., & Redmond, C. (2000). Research on family engagement in preventive interventions: Toward improved use of scientific findings in primary prevention practice. The Journal of Primary Prevention, 21, 267–284. Scholar
  78. Spoth, R., Goldberg, C., & Redmond, C. (1999). Engaging families in longitudinal preventive intervention research: Discrete-time survival analysis of socioeconomic and social-emotional risk factors. Journal of Consulting and Clinical Psychology, 67, 157–163. Scholar
  79. Spoth, R., Guyll, M., Chao, W., & Molgaard, V. (2003). Exploratory study of a preventive intervention with general population African American families. The Journal of Early Adolescence, 23, 435–468. Scholar
  80. Statistical Atlas (2017). Race and ethnicity in Richmond, Virginia.
  81. Sterrett, E., Jones, D. J., Zalot, A., & Shook, S. (2010). A pilot study of a brief motivational intervention to enhance parental engagement: A brief report. Journal of Child and family Studies, 19, 697–701. Scholar
  82. Stormshak, E. A., Fosco, G. M., & Dishion, T. J. (2010). Implementing interventions with families in schools to increase youth school engagement: The Family Check-Up model. School Mental Health, 2, 82–92. Scholar
  83. Stormshak, E. A., Connell, A., & Dishion, T. J. (2009). An adaptive approach to family-centered intervention in schools: Linking intervention engagement to academic outcomes in middle and high school. Prevention Science, 10, 221–235. Scholar
  84. Substance Abuse and Mental Health Administration (SAMHSA). (2016). National Registry of Evidence-based Programs and Practices (NREPP).
  85. United States Census Bureau. (2016a). QuickFacts: North Carolina.
  86. United States Census Bureau. (2016b). QuickFacts, Robeson County, North Carolina: Population estimates, July 1, 2016, (V2016).
  87. United States Census Bureau. (2016c). Small area income and poverty estimates, under age 18 in poverty: Robeson County, North Carolina.
  88. WISQARS. (2010). Leading causes of death reports, 1999-2007.
  89. World Health Organization. (2016). INSPIRE: Seven strategies for ending violence against children. Geneva, Switzerland: Author [Alexander Butchart and Susan Hillis].Google Scholar
  90. Zhou, Q., Eisenberg, N., Losoya, S. H., Fabes, R. A., Reiser, M., & Guthrie, I. K., et al. (2002). The relations of parental warmth and positive expressiveness to children’s empathy-related responding and social functioning: A longitudinal study. Child Development, 73, 893–915. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Paul Smokowski
    • 1
    Email author
  • Rosalie Corona
    • 2
  • Martica Bacallao
    • 3
  • Beverly L. Fortson
    • 4
  • Khiya J. Marshall
    • 4
  • Anna Yaros
    • 2
    • 5
  1. 1.School of Social WelfareUniversity of KansasLawrenceUSA
  2. 2.Virginia Commonwealth UniversityRichmondUSA
  3. 3.University of AlabamaTuscaloosaUSA
  4. 4.Division of Violence Prevention, National Center forInjury Prevention and ControlCenters for Disease Control and PreventionAtlantaUSA
  5. 5.RTI InternationalDurhamUSA

Personalised recommendations