Addressing Barriers to Recruitment and Retention in the Implementation of Parenting Programs: Lessons Learned for Effective Program Delivery in Rural and Urban Areas
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.
KeywordsRecruitment 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.
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.
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, parental permission, and youth assent was obtained from all participants in the studies from which these lessons learned were drawn.
- American Community Survey. (2008). 2008 American community survey 1-year estimates. Selected economic characteristics. http://factfinder.census.gov/servlet/ADPTable?_bm=y&-geo_id=40000US74746&-qr_name=ACS_2008_1YR_G00_DP3&-context=adp&-ds_name=&-tree_id=308&-_lang=en&-redoLog=false&-format.
- 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. https://doi.org/10.1017/S0954579409000121.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1037/fam0000036.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1007/s10826-011-9472-1.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1007/s11121-006-0032-7.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1093/her/cyq006.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1037/0012-16220.127.116.112.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1037/0022-006X.75.4.568.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1007/s10900-008-9140-6.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1177/1049731513490811.CrossRefGoogle Scholar
- 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. https://www.familyworksinc.com/uploads/2/0/5/2/20527778/parenting_wisely_6_months_later.pdf.
- 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
- Dishion, T. J., & Kavanagh, K. (2003). Intervening in adolescent problem behavior: A family centered approach. New York: The Guilford Press.Google Scholar
- 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. https://doi.org/10.1001/archpedi.161.12.1123.CrossRefGoogle Scholar
- 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
- Gordon, D. A. (2011). Parenting Wisely evaluation tools. http://www.familyworksinc.com/research-articles.html.
- 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. https://doi.org/10.1037/0893-164X.16.4S.S55.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1037/0893-164X.14.2.174.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1111/j.1744-6171.2011.00288.x.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1111/j.1469-7610.1997.tb01621.x.CrossRefPubMedGoogle Scholar
- Kellerman, P. F. (1992). Focus on psychodrama. London: Jessica Kingsley.Google Scholar
- 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
- Loeber, R., & Stouthamer-Loeber, M. (1987). Prediction. In H. C. Quay (Ed.), Handbook of juvenile delinquency (pp. 325–382). New York: Wiley.Google Scholar
- 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
- 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
- National Institute of Justice. (2012). All Programs & Practices. https://www.crimesolutions.gov/Programs.aspx#Programs.
- North Carolina State Bureau of Investigations. (2015). Crime in North Carolina-2014: Annual summary report of 2014 uniform crime reporting data. http://crimereporting.ncsbi.gov/public/2014/ASR/2014%20Annual%20Summary.pdf.
- Office of Juvenile Justice and Delinquency Prevention (OJJDP). (2012). Model program guide. https://www.ojjdp.gov/mpg.
- 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
- 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
- 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. https://doi.org/10.1023/A:1024601906942.CrossRefPubMedGoogle Scholar
- Patterson, G. R. (1982). Coercive family process. Eugene, OR: Castalia.Google Scholar
- Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). A social learning approach. IV. Antisocial boys. Eugene, OR: Castalia.Google Scholar
- 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. https://doi.org/10.1093/jpepsy/jsj046.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.jrp.2007.06.003.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1146/annurev.psych.121208.131619.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1007/s11121-012-0337-7.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1037/a0033950.CrossRefPubMedGoogle Scholar
- Smokowski, P. R., & Bacallao, M. (2010). Becoming bicultural: Risk, resilience, and Latino youth.. New York, NY: New York University Press.Google Scholar
- 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. https://doi.org/10.1037/0022-006x.67.1.157.CrossRefPubMedGoogle Scholar
- Statistical Atlas (2017). Race and ethnicity in Richmond, Virginia. http://statisticalatlas.com/place/Virginia/Richmond/Race-and-Ethnicity.
- 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. https://doi.org/10.1007/s11121-009-0131-3.CrossRefPubMedPubMedCentralGoogle Scholar
- Substance Abuse and Mental Health Administration (SAMHSA). (2016). National Registry of Evidence-based Programs and Practices (NREPP). https://www.samhsa.gov/nrepp.
- United States Census Bureau. (2016a). QuickFacts: North Carolina. https://www.census.gov/quickfacts/fact/table/NC/PST045216.
- United States Census Bureau. (2016b). QuickFacts, Robeson County, North Carolina: Population estimates, July 1, 2016, (V2016). https://www.census.gov/quickfacts/fact/chart/robesoncountynorthcarolina/PST045216.
- United States Census Bureau. (2016c). Small area income and poverty estimates, under age 18 in poverty: Robeson County, North Carolina. https://www.census.gov/did/www/saipe/data/interactive/saipe.html?s_appName=saipe&map_yearSelector=2015&map_geoSelector=u18_c&s_state=37&s_county=37155&s_measures=u18_snc&menu=grid_proxy.
- WISQARS. (2010). Leading causes of death reports, 1999-2007. https://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html.
- World Health Organization. (2016). INSPIRE: Seven strategies for ending violence against children. Geneva, Switzerland: Author [Alexander Butchart and Susan Hillis].Google Scholar
- 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. https://doi.org/10.1111/1467-8624.00446.CrossRefPubMedGoogle Scholar