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The Team for Infants Exposed to Substance use (TIES) Program is a home-based family support program in the Social Work Department that provides a holistic, multi-disciplinary, community-based model to address the unique needs of families affected by maternal substance use. The TIES model, now in its 30th year, is delivered by masters-prepared social workers along with endorsed infant family specialists to provide intensive, home-based services to promote child development and healthy family functioning. The design of the two-role model addresses gaps and challenges identified in other home visiting programs, including poor participant engagement and retention. The model design has allowed program participants to achieve statistically significant positive outcomes in the domains of maternal substance use, parenting skills, child and maternal health, and income and housing stability. This study posits that these positive outcomes are attributed in part to the therapeutic relationship between the mothers and their specialists which fosters family engagement and retention through the duration of an intensive, long-term program.

Data were collected from 2012 to September 2022 from 235 participants, among which, 67% of the participants successfully completed the TIES Program, and 33% were discharged early. The average length of participation was 19.8 months in a program ranging from 18-33 months depending on the age of the focus child at enrollment. The Working Alliance Inventory (WAI), a validated scale measuring therapeutic alliance, was adapted to assess the relationship between staff and participants. The scale was administered to staff and participants once six months after enrollment, and once at discharge. Logistic regression was conducted to examine the impact of relationship on program completion, and linear regression was conducted to examine the impact of relationship on length of program participation.

Preliminary results indicated that a 1 unit increase in relationship leads to 2.2 times greater odds of program completion. In addition, each 1-point increase in relationship leads to 1.63-1.65 more months of program participation. The upcoming full analysis will examine the moderating effects of participants’ demographics and virtual visits. These initial results showed that the therapeutic relationship has a significant impact on program engagement and retention. The stronger the relationship is, the longer a participant will stay in the program. The results speak to the importance of building relationship and bonding with participants early on for better program outcomes.

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Strong Therapeutic Relationships Boost Engagement and Retention in Home Visiting Model for Families Affected by Maternal Substance Use