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The associations of family, home visitor and site characteristics with family engagement within the first 6 months were examined. The variation in family engagement was also explored. Home visiting program participants were drawn from 21 Healthy Families America sites (1707 families) and 9 Nurse-Family Partnership sites (650 families) in New Jersey. Three-level nested generalized linear mixed models assessed the associations of family, home visitor and site characteristics with family receipt of a high dose of services in the first 6 months of enrollment. A family was considered to have received a high dose of service in the first 6 months of enrollment if they were active at 6 months and had received at least 50% of their expected visits in the first 6 months. In general, both home visiting programs engaged, at a relatively high level (Healthy Families America (HFA) 59%, Nurse-Family Partnership (NFP) 64%), with families demonstrating high-risk characteristics such as lower maternal education, maternal smoking, and maternal mental health need. Home visitor characteristics explained more of the variation (87%) in the receipt of services for HFA, while family characteristics explained more of the variation (75%) in the receipt of services for NFP. At the family level, NFP may improve the consistency with which they engage families by increasing retention efforts among mothers with lower education and smoking mothers. HFA sites seeking to improve engagement consistency should consider increasing the flexible in home visitor job responsibilities and examining the current expected-visit policies followed by home visitors on difficult-to-engage families.

The general goal of this study consists of analyzing the influence of different types of human services in the quality of life of their nested users. Several multilevel models were proposed to test for significant differences not only in the overall quality of life score, but also in each of the eight core domains. Participants included 11,624 users of social and human services and the assessment quality of life instrument was the GENCAT Scale. Variables that were studied in the different models were gender, age, and diagnostic group (elderly, intellectual disability, physical disability, mental health problems, and chemical dependency) at the individual user level (level 1: individual), while type of services—in terms of the main population addressed by their supports (i. e. the aforementioned groups)—was studied at service level (level 2: organizational). In order to explain differences, individual characteristics were introduced first, types of services were introduced next, and finally joint individual and service variables were introduced in a single model. The main results of this study were that personal and organizational variables exhibited a different level of influence on users’quality of life; and also that the type of services significantly influenced the quality of life of its users. The results of this study lead to practical implications for services providing support to these diagnostic groups, especially for those interested in managing, assessing, and improving quality of life related personal outcomes at the user level as well as quality enhancement at the organizational level.

Therapeutic alliance may influence treatment outcomes for individuals with autism spectrum disorder (ASD). The present study examined the trajectory of alliance, observationally-measured at four timepoints during a 16-week mindfulness-based treatment targeting emotion regulation problems in adolescents and young adults with ASD ( n  = 37, mean age = 15.28, 78.40% male). Variability in alliance as a function of client characteristics and the degree to which alliance predicted emotion regulation outcomes were assessed using parent-report forms. Results demonstrate that alliance fluctuates throughout treatment. Moreover, stronger alliance predicts decreased dysphoria at posttreatment. Results also suggest that increased ASD symptom severity and depression predict weaker alliance early and throughout treatment. Findings highlight a need for clinicians to consider the importance of developing strong alliance for clients with ASD.

The objective of this paper is to report on the effectiveness of a mental health addition to a national nurse-delivered home visiting program. The methods are as follows: analysis of pre/post-launch of the standard Mental Health Intervention and comparison of 356 teams randomized to standard versus enhanced implementation. Stepwise regression controlled for significant client characteristics that were related to relevant outcomes. These characteristics were used in generalized mixed effect models comparing pre/post implementation and intervention and control groups. Pre/post analysis showed that only clients with no elevated mental health screening scores or mental health diagnoses at enrollment showed a significant decrease in depressive symptoms. Clients enrolled with and without mental health needs at enrollment significantly decreased on anxiety scores while referrals to mental health care increased. Teams receiving enhanced implementation enrolled more clients with mental health needs and clients completed more well-child visits and use of safe sleep practices. By integrating mental health care into maternal, infant, and early childhood home visiting programs, a new equitable model of primary mental health care can reach populations in need. This example provides a new paradigm of accessible and equitable mental health care for the future that can be implemented in a variety of home visiting programs.

In social work and other community-based human services settings, clients often present with complex financial problems. As a need for more formal training is beginning to be addressed, evaluation of existing training is important, and this study evaluates outcomes from the Financial Stability Pathway (FSP) project. Designed to prepare professionals with the knowledge, attitudes, and skills to effectively assess and respond to clients' financial problems, we evaluated the FSP using a one-group pre-, post-, and follow-up design. Results suggest that with training and ongoing booster sessions including peer support, professionals' preparedness and confidence increased, which strongly predicted the use of practice behaviors learned during training. Implications for professional education and training are discussed.

Welfare sanctions are financial penalties applied to individuals who fail to comply with welfare program rules. Their widespread use reflects a turn toward disciplinary approaches to poverty management. In this article, we investigate how implicit racial biases and discrediting social markers interact to shape officials' decisions to impose sanctions. We present experimental evidence based on hypothetical vignettes that case managers are more likely to recommend sanctions for Latina and black clients—but not white clients—when discrediting markers are present. We triangulate these findings with analyses of state administrative data. Our results for Latinas are mixed, but we find consistent evidence that the probability of a sanction rises significantly when a discrediting marker (i.e., a prior sanction for noncompliance) is attached to a black rather than a white welfare client. Overall, our study clarifies how racial minorities, especially African Americans, are more likely to be punished for deviant behavior in the new world of disciplinary welfare provision.

Delayed access to mental health services for children and adolescents has been linked to an increased risk of harm and nonattendance to scheduled appointments. While studies suggest that the lack of standardized assessments for prioritizing individuals has contributed to long wait times, the inconsistent use of assessments across service sectors in Ontario continues to persist. This has contributed to a paucity of information surrounding which children and adolescents may require urgent mental health services. Using a large secondary data set, this study examined whether service sector (e.g., school), and other individual client characteristics (e.g., age, sex, legal guardianship, interpersonal and school conflict) predicted greater mental health service urgency in 61,448 children and adolescents assessed using the interRAI Child and Youth Mental Health Screener. Binary logistic regression revealed that all predictors, except for sector, showed a significant effect on service urgency. Findings are instrumental in prioritization, reducing the likelihood that children with acute needs remain on waitlists.

The study aimed to examine the association between cross-sector collaboration in Nurse-Family Partnership (NFP), a model home visiting program, and participant retention. We used the 2018 NFP Collaboration Survey that measured agency-level collaboration, operationalized as relational coordination and structural integration, among nine community provider types (including obstetrics care, substance use treatment, child welfare). This dataset was linked to 2014–2018 NFP program implementation data (n = 36,900). We used random-intercept models with nurse-level random effects to examine the associations between provider-specific collaborations and participant retention adjusting for client, nurse, and agency characteristics. The adjusted models suggest that stronger relational coordination between nurses and substance use treatment providers (OR:1.177, 95% CI: 1.09–1.26) and greater structural integration with child welfare (OR: 1.062, CI: 1.04–1.09) were positively associated with participant retention at birth. Stronger structural integration between other home visiting programs and supplemental nutrition for women, infants, and children was negatively associated with participant retention at birth (OR: 0.985, CI: 0.97–0.99). Structural integration with child welfare remained significantly associated with participant retention at 12-month postpartum (OR: 1.032, CI: 1.01–1.05). In terms of client-level characteristics, clients who were unmarried, African-American, or visited by nurses who ceased NFP employment prior to their infant’s birth were more likely to drop out of the NFP program. Older clients and high school graduates were more likely to remain in NFP. Visits by a nurse with a master’s degree, agency rurality, and healthcare systems that implement the program were associated with participant retention. Cross-sector collaboration in a home visiting setting that bridges healthcare and addresses social determinants of health has potential to improve participant retention. This study sets the groundwork for future research to explore the implications of collaborative activities between preventive services and community providers.

Objective This research delved into the experiences of couples and therapists in online couples therapy with an emphasis on therapeutic boundaries. Background Although the popularity of online therapy has surged, limited understanding exists about the meanings and experiences tied to therapeutic boundaries in this context, underscoring the need for its examination to enhance online therapy's effectiveness. Method A purposive sample of 51 participants, including 36 individuals (comprising 18 couples who underwent separate interviews), and 15 couple and family therapists were interviewed in four online focus groups. Constructivist grounded theory guided the data analysis to discern therapeutic boundary dimensions. Results The analysis identified three dimensions of therapeutic boundaries: (a) boundaries between the therapist and couple, (b) boundaries between the couple and their family, and (c) boundaries between the therapists and their own families. Conclusion The study offers insights into the nuanced concept of liminality within therapists' and couples' transition to online couples therapy, particularly emphasizing disruptions in conventional therapeutic paradigms. Implications To uphold the integrity and bolster the therapeutic alliance in online couples therapy, there is a compelling need for therapists to transition toward novel means of establishing boundaries, moving away from traditional constructs.

Most evidence-based home visiting models are designed to support families from pregnancy through a child’s second birthday, though programs often struggle to retain families for this long. Previous research on client and program factors that predict attrition has produced mixed results, which may be partly because attrition is typically conceptualized as a homogeneous phenomenon. The current study sampled 991 women who received home visiting services from one of 26 agencies in a statewide network of evidence-based programs. Participants who remained in services were compared to three types of early leavers: those who communicated their intent to leave (active attrition), those whose cases closed due to non-participation (passive attrition), and those who moved from the service area. Within a year of enrollment, 42% of women exited services. Cox regression results suggested no differences in the timing of service exit among the three attrition types. Multinomial analyses revealed that, when compared to participants who remained in services, active leavers were more likely to be married or cohabitating, while passive leavers were more likely to be younger, African American, unemployed, and to have a home visitor with low job satisfaction. Participants who moved were less likely to be Latina and employed. An early pattern of inconsistent attendance was the strongest predictor of active and passive withdrawal. Rates of attrition varied by home visiting model, though inconsistent attendance was a robust predictor of passive attrition across models. This study underscores the need to scrutinize service duration as a metric of success in home visiting.